Report the submitter-assigned identifier as it appears in PR001 in Product ID ID Link to Product the Product File. This element is MC 80 11/8/12 Text All 100% A0 Number PR001 Identification used to understand Product and Eligibility attributes of the member / subscriber as applied to this record. Carrier External Code Defined Source 16 - Required Table - Report the value that describes how Claim when Payment Payment Reason the claim line was paid, either using a OR - MC 81 11/8/12 Adjustment MC038 = 100% A0 Reason External Code standard code set or a proprietary list Reasons- OR 1, 2, 3, 19, – Code pre-sent by submitter. Carrier Defined 20, or 21 Source 16 - Text Report the value that defines the Capitated Lookup Indicator - element. EXAMPLE: 1 = Yes MC 82 Encounter 11/8/12 Table - int[1] Capitation All 100% A0 payment for this service is covered Flag Integer Payment under a capitated arrangement. Value Description 1 Yes 2 No 3 Unknown 4 Other 5 Not Applicable Do not populate with any data. MC 83 Filler 2/2017 text Filler char[0] Filler All 100% A0 Required to be NULL.
MC 80 Product ID Number 11/8/12 Text ID Link to PR001 Product Identification Report the submitter-assigned identifier as it appears in PR001 in the Product File. This element is used to understand Product and Eligibility attributes of the member / subscriber as applied to this record. All 100% A0 MC 81 Payment Reason 11/8/12 Carrier Defined Table - OR - External Code Source 16 - Text External Code Source 16 - Claim Adjustment Reasons- OR – Carrier Defined Payment Reason Code Report the value that describes how the claim line was paid, either using a standard code set or a proprietary list pre-sent by submitter. Required when MC038 = 1, 2, 3, 19, 20, or 21 100% A0 MC 82 Capitated Encounter Flag 11/8/12 Lookup Table - Integer int[1] Indicator - Capitation Payment Report the value that defines the element. EXAMPLE: 1 = Yes payment for this service is covered under a capitated arrangement. All 100% A0 Value Description 1 Yes 2 No 3 Unknown 4 Other 5 Not Applicable MC 83 Filler 2/2017 text Filler char[0] Filler Do not populate with any data. Required to be NULL. All 100% A0
v6-apcd-medical-claim-file-submission-guide-FINAL.docx