Address Service External Country Country name of Report the three-character country Provider Code MC 71 12/1/10 External Code char[3] the Service code as defined by ISO 3166-1, All 98% C Country Source 1 Source 1 - Provider Alpha 3 Code - Text Countries Report the DRG number applied to this claim on every line to which it’s applicable. Insurers and health care claims processors shall code using the CMS methodology when Required External available. When the CMS when External Code Diagnostic Code methodology for DRGs is not MC094 = MC 72 DRG 11/8/12 Source 15 - varchar[7] Related Group 98% B Source available, but the All Payer DRG 002 and DRG Code 15 - Text system is used, the insurer shall MC069 is format the DRG and the complexity populated level within the same element with the prefix of "A" and with a hyphen separating the AP DRG from the complexity level (e.g. AXXX-XX) External Required External Code Diagnostic DRG Code Report the version of the grouper when MC 73 11/8/12 Source 15 - char[2] Related Group 20% B Version Source used. MC071 is DRG Version Number 15 - Text populated Required External Ambulatory Report the APC number applied to when External Code Code Payment this claim line, with the leading MC094 = MC 74 APC 11/8/12 Source 15 - char[4] 20% C Source Classification zero(s) when applicable. Code using 002 and DRG 15 - Text Number the CMS methodology. MC039 is null External Ambulatory Required External Code APC Code Payment Report the version of the grouper when MC 75 11/8/12 Source 15 - char[2] 20% C Version Source Classification used. MC073 is DRG 15 - Text Version populated
MC 71 Service Provider Country Code 12/1/10 External Code Source 1 - Text Address Country External Code Source 1 - Countries char[3] Country name of the Service Provider Report the three-character country code as defined by ISO 3166-1, Alpha 3 All 98% C MC 72 DRG 11/8/12 External Code Source 15 - Text External Code Source 15 - DRG varchar[7] Diagnostic Related Group Code Report the DRG number applied to this claim on every line to which it’s applicable. Insurers and health care claims processors shall code using the CMS methodology when available. When the CMS methodology for DRGs is not available, but the All Payer DRG system is used, the insurer shall format the DRG and the complexity level within the same element with the prefix of "A" and with a hyphen separating the AP DRG from the complexity level (e.g. AXXX-XX) Required when MC094 = 002 and MC069 is populated 98% B MC 73 DRG Version 11/8/12 External Code Source 15 - Text External Code Source 15 - DRG char[2] Diagnostic Related Group Version Number Report the version of the grouper used. Required when MC071 is populated 20% B MC 74 APC 11/8/12 External Code Source 15 - Text External Code Source 15 - DRG char[4] Ambulatory Payment Classification Number Report the APC number applied to this claim line, with the leading zero(s) when applicable. Code using the CMS methodology. Required when MC094 = 002 and MC039 is null 20% C MC 75 APC Version 11/8/12 External Code Source 15 - Text External Code Source 15 - DRG char[2] Ambulatory Payment Classification Version Report the version of the grouper used. Required when MC073 is populated 20% C
v3-1-apcd-medical-claim-file-submission-guide-2013-06.docx