36 Emancipated Minor 39 Organ Donor 40 Cadaver Donor 41 Injured Plaintiff Child Where Insured Has No Financial 43 Responsibility 53 Life Partner 76 Dependent Report patient gender as found on the claim Lookup Member Patient's in alpha format. Used to validate clinical DC 13 6/24/10 Table tlkpGender char[1] All 100% B Gender Gender services when applicable and Unique Text Member ID. EXAMPLE: F = Female Code Description F Female M Male O Other U Unknown Member Full Century Year Report the date the member / patient was DC 14 Date of 6/24/10 Date - Month Day int[8] born in CCYYMMDD Format. Used to All 99% B – date of birth Birth Integer CCYYMMDD validate Unique Member ID. City name of Member Report the city name of the member / Address City the DC 15 City 6/24/10 Text varchar[50] patient. Used to validate Unique Member All 99% B Member Name ID External Address State State / Report the state of the patient as defined by Member Code External Code DC 16 11/8/12 char[2] Province of the the US Postal Service. Report Province All 99% B State Source Source 2 – Patient when Country Code does not = USA 2 - Text States External Address Zip Report the 5 or 9 digit Zip Code as defined Zip Code of Member Code External Code by the United States Postal Service. When DC 17 11/8/12 varchar[9] the Member / All 99% B ZIP Code Source Source 2 - Zip submitting the 9-digit Zip Code do not Patient 2 - Text Codes include hyphen.
36 Emancipated Minor 39 Organ Donor 40 Cadaver Donor 41 Injured Plaintiff 43 Child Where Insured Has No Financial Responsibility 53 Life Partner 76 Dependent DC 13 Member Gender 6/24/10 Lookup Table Text tlkpGender char[1] Patient's Gender Report patient gender as found on the claim in alpha format. Used to validate clinical services when applicable and Unique Member ID. EXAMPLE: F = Female All 100% B Code Description F Female M Male O Other U Unknown DC 14 Member Date of Birth 6/24/10 Full Date - Integer Century Year Month Day – CCYYMMDD int[8] date of birth Report the date the member / patient was born in CCYYMMDD Format. Used to validate Unique Member ID. All 99% B DC 15 Member City Name 6/24/10 Text Address City Member varchar[50] City name of the Report the city name of the member / patient. Used to validate Unique Member ID All 99% B DC 16 Member State 11/8/12 External Code Source 2 - Text Address State External Code Source 2 – States char[2] State / Province of the Patient Report the state of the patient as defined by the US Postal Service. Report Province when Country Code does not = USA All 99% B DC 17 Member ZIP Code 11/8/12 External Code Source 2 - Text Address Zip External Code Source 2 - Zip Codes varchar[9] Zip Code of the Member / Patient Report the 5 or 9 digit Zip Code as defined by the United States Postal Service. When submitting the 9-digit Zip Code do not include hyphen. All 99% B
v3-1-apcd-dental-claim-file-submission-guide-2013-06.docx