Value Description 1 Processed as primary 2 Processed as secondary 3 Processed as tertiary 4 Denied Processed as primary, forwarded to 19 additional Processed as secondary, forwarded 20 to additional payer(s) Processed as tertiary, forwarded to 21 additional 22 Reversal of previous payment Not our claim, forwarded to additional 23 payer(s) Predetermination Pricing Only - no 25 payment Required when External Codes MC094 = External Source 8 - Report the diagnostic code assigned 002 and Admitting Code Admitting MC 40 11/8/12 International varchar[7] by provider that supported admission MC036 = 98% A1 Diagnosis Source 8 Diagnosis Code Classification of into the inpatient setting. 11, 18, 21, - Text Diseases 28, 41, 65, 66, 84, 86, or 89 External External Cause External Codes Source 8 ICD Diagnostic Report the external cause code for MC 41 11/8/12 Code - International varchar[7] External Injury patient when appropriate to the All 3% C Source 8 Classification of Code claim. - Text Diseases External Codes External Source 8 - Report the Primary ICD Diagnosis Principal Code ICD Primary MC 42 2/2016 International varchar[7] Code here. All 99% A0 Diagnosis Source 8 Diagnosis Code Classification of Do not code decimal point. - Text Diseases
Value Description 1 Processed as primary 2 Processed as secondary 3 Processed as tertiary 4 Denied 19 Processed as primary, forwarded to additional 20 Processed as secondary, forwarded to additional payer(s) 21 Processed as tertiary, forwarded to additional 22 Reversal of previous payment 23 Not our claim, forwarded to additional payer(s) 25 Predetermination Pricing Only - no payment MC 40 Admitting Diagnosis 11/8/12 External Code Source 8 - Text External Codes Source 8 - International Classification of Diseases varchar[7] Admitting Diagnosis Code Report the diagnostic code assigned by provider that supported admission into the inpatient setting. Required when MC094 = 002 and MC036 = 11, 18, 21, 28, 41, 65, 66, 84, 86, or 89 98% A1 MC 41 External 11/8/12 External Code Source 8 - Text External Cause Codes Source 8 - International Classification of Diseases varchar[7] ICD Diagnostic External Injury Code Report the external cause code for patient when appropriate to the claim. All 3% C MC 42 Principal Diagnosis 2/2016 External Code Source 8 - Text External Codes Source 8 - International Classification of Diseases varchar[7] ICD Primary Diagnosis Code Report the Primary ICD Diagnosis Code here. Do not code decimal point. All 99% A0
v6-apcd-medical-claim-file-submission-guide-FINAL.docx