Report the charge amount for this claim line. 0 dollar charges allowed only when the procedure code indicates a Category II procedure All code vs. a service code. When reporting Total Charges for facilities must Amount of for the entire claim use 001 (the Charge be greater MC 63 11/8/12 Integer Currency provider charges generally accepted Total Charge 99% A0 Amount than zero for the claim line Revenue Code) in MC054 (Revenue when Code). Do not code decimal or MC0130 is round up / down to whole dollars, not 6. code zero cents (00) when applicable. EXAMPLE: 150.00 is reported as 15000; 150.70 is reported as 15070 Report the amount paid for the claim line. Report 0 if line is paid as part of another procedure / claim line. Do not report any value if the line is Amount paid by Paid denied. Do not code decimal or MC 64 10/3/10 Integer Currency the carrier for the All 99% A0 Amount round up / down to whole dollars, claim line code zero cents (00) when applicable. EXAMPLE: 150.00 is reported as 15000; 150.70 is reported as 15070 Report the prepaid amount for this claim line. Report the Fee for Service equivalent amount for Amount carrier Capitated services. Report 0 when Prepaid has prepaid there is no Prepaid amount. Do not MC 65 11/8/12 Integer Currency All 100% A2 Amount towards the claim code decimal or round up / down to line whole dollars, code zero cents (00) when applicable. EXAMPLE: 150.00 is reported as 15000; 150.70 is reported as 15070
MC 63 Charge Amount 11/8/12 Integer Currency Amount of provider charges for the claim line Report the charge amount for this claim line. 0 dollar charges allowed only when the procedure code indicates a Category II procedure code vs. a service code. When reporting Total Charges for facilities for the entire claim use 001 (the generally accepted Total Charge Revenue Code) in MC054 (Revenue Code). Do not code decimal or round up / down to whole dollars, code zero cents (00) when applicable. EXAMPLE: 150.00 is reported as 15000; 150.70 is reported as 15070 All must be greater than zero when MC0130 is not 6. 99% A0 MC 64 Paid Amount 10/3/10 Integer Currency Amount paid by the carrier for the claim line Report the amount paid for the claim line. Report 0 if line is paid as part of another procedure / claim line. Do not report any value if the line is denied. Do not code decimal or round up / down to whole dollars, code zero cents (00) when applicable. EXAMPLE: 150.00 is reported as 15000; 150.70 is reported as 15070 All 99% A0 MC 65 Prepaid Amount 11/8/12 Integer Currency Amount carrier has prepaid towards the claim line Report the prepaid amount for this claim line. Report the Fee for Service equivalent amount for Capitated services. Report 0 when there is no Prepaid amount. Do not code decimal or round up / down to whole dollars, code zero cents (00) when applicable. EXAMPLE: 150.00 is reported as 15000; 150.70 is reported as 15070 All 100% A2
v3-1-apcd-medical-claim-file-submission-guide-2013-06.docx