Report the Year and Month of the reported submission period in CCYYMM format. Period Date Century Year Header Period This date period must be repeated in - 5 11/8/12 Period Month int[6] Mandatory 100% HM Start Date HD006, TR005 and TR006. This same date DC Date Integer CCYYMM must be selected in the upload application for successful transfer. Report the Year and Month of the reporting Period Date Century Year submission period in CCYYMM format. Header Period - 6 Ending 11/8/12 Period Month int[6] This date period must match the date period Mandatory 100% HM Ending Date DC Date Integer CCYYMM reported in HD005 and be repeated in TR005 and TR006 Report the total number of records Record Header Record submitted within this file. Do not report - 7 11/8/12 Integer Counter varchar[10] Mandatory 100% HM Count leading zeros, space fill, decimals, or any DC special characters. May be used to document the submission Header Carrier - 8 11/8/12 Text Free Text Field varchar[80] by assigning a filename, system source, Optional 0% HO Comments DC compile identifier, etc. Report the version number as presented on the APCD Dental File Submission APCD Decimal Submission Guide in 0.0 Format. Sets the intake control - 9 Version ID Version char[3] Mandatory 100% HM Guide Version for editing elements. Version must be DC Number Numeric accurate else file will drop. EXAMPLE: 3.0 = Version 3.0 Code Description Prior Version; valid only for reporting 2.1 periods prior to October 2013 Version 3.0; required for reporting periods 3.0 as of October 2013 No longer valid as of – May 2015 4.0 CHIA defined and Report the Unique Submitter ID as defined 1 Submitter 11/8/12 Integer ID OrgID varchar[6] maintained by CHIA here. This must match the All 100% A0 unique Submitter ID reported in HD002. identifier
5 Period Date 11/8/12 Date Period Integer Century Year Month CCYYMM int[6] Header Period Start Date Report the Year and Month of the reported submission period in CCYYMM format. This date period must be repeated in HD006, TR005 and TR006. This same date must be selected in the upload application for successful transfer. Mandatory 100% HM 6 Period Ending Date 11/8/12 Date Period Integer Century Year Month - CCYYMM int[6] Header Period Ending Date Report the Year and Month of the reporting submission period in CCYYMM format. This date period must match the date period reported in HD005 and be repeated in TR005 and TR006 Mandatory 100% HM 7 Record 11/8/12 Integer Counter varchar[10] Header Record Count Report the total number of records submitted within this file. Do not report leading zeros, space fill, decimals, or any special characters. Mandatory 100% HM 8 11/8/12 Text Free Text Field varchar[80] Header Carrier Comments May be used to document the submission by assigning a filename, system source, compile identifier, etc. Optional 0% HO 9 APCD Version Number Decimal - Numeric ID Version char[3] Submission Guide Version Report the version number as presented on the APCD Dental File Submission Guide in 0.0 Format. Sets the intake control for editing elements. Version must be accurate else file will drop. EXAMPLE: 3.0 = Version 3.0 Mandatory 100% HM Code Description 2.1 Prior Version; valid only for reporting periods prior to October 2013 3.0 Version 3.0; required for reporting periods as of October 2013 – No longer valid as of May 2015 4.0 1 Submitter 11/8/12 Integer ID OrgID varchar[6] CHIA defined and maintained unique identifier Report the Unique Submitter ID as defined by CHIA here. This must match the Submitter ID reported in HD002. All 100% A0 DC - DC DC DC DC - -
v5-apcd-dental-claim-file-submission-guide-REDLINE.docx