Payer Claim Report the Unique identifier within the Claim PC 4 6/24/10 Text ID Claim Number Control payer's system that applies to the entire All 100% A0 Control Identification claim Number Report the line number for this service within the Start with 1 and increment Line Incremental PC 5 11/8/12 Integer ID Count varchar[4] by 1 for each additional line. Do not start All 100% A0 Counter Line Counter with 0, include alphas or special characters. Report the version number of this claim Claim Service service line. The version number begins Version PC 6 7/6/10 Integer Counter varchar[4] Line Version with 0 and is incremented by 1 for each All 100% A0 Number Number subsequent version of that service line. No alpha or special characters. Insured Report the number that defines the or Group / Policy insured group or policy. Do not report the PC 7 6/24/10 Text ID Group All 98% C Policy Number number that uniquely identifies the Number subscriber or member Report the Subscriber's SSN here; used Subscriber's to validate Unique Member ID; will not be Subscriber PC 8 11/8/12 Numeric ID Tax char[9] Social Security passed into analytic file. Do not use All 85% B SSN Number hyphen. If not available do not report any value here Report the Plan assigned contract Plan number. Do not include values in this Specific Contract element that will distinguish one member PC 9 6/24/10 Text ID Contract All 98% C Contract Number of the family from another. This should Number be the contract or certificate number for the subscriber and all of the dependents. Member Suffix or Contract Report the unique number / identifier of PC 10 6/24/10 Text ID Sequence All 98% B Sequence Sequence the member within the contract Number Number Report the patient's social security number here; used to validate Unique Member Social PC 11 11/8/12 Numeric ID Tax char[9] Member ID; will not be passed into All 98% B SSN Security analytic file. Do not use hyphen. If not Number available do not report any value here
PC 4 Payer Claim Control Number 6/24/10 Text ID Claim Number Claim Control Identification Report the Unique identifier within the payer's system that applies to the entire claim All 100% A0 PC 5 Line Counter 11/8/12 Integer ID Count varchar[4] Incremental Line Counter Report the line number for this service within the Start with 1 and increment by 1 for each additional line. Do not start with 0, include alphas or special characters. All 100% A0 PC 6 Version Number 7/6/10 Integer Counter varchar[4] Claim Service Line Version Number Report the version number of this claim service line. The version number begins with 0 and is incremented by 1 for each subsequent version of that service line. No alpha or special characters. All 100% A0 PC 7 Insured or Policy Number 6/24/10 Text ID Group Group / Policy Number Report the number that defines the insured group or policy. Do not report the number that uniquely identifies the subscriber or member All 98% C PC 8 Subscriber SSN 11/8/12 Numeric ID Tax char[9] Subscriber's Social Security Number Report the Subscriber's SSN here; used to validate Unique Member ID; will not be passed into analytic file. Do not use hyphen. If not available do not report any value here All 85% B PC 9 Plan Specific Contract Number 6/24/10 Text ID Contract Contract Number Report the Plan assigned contract number. Do not include values in this element that will distinguish one member of the family from another. This should be the contract or certificate number for the subscriber and all of the dependents. All 98% C PC 10 Member Suffix or Sequence Number 6/24/10 Text ID Sequence Contract Sequence Number Report the unique number / identifier of the member within the contract All 98% B PC 11 Member SSN 11/8/12 Numeric ID Tax char[9] Social Security Number Report the patient's social security number here; used to validate Unique Member ID; will not be passed into analytic file. Do not use hyphen. If not available do not report any value here All 98% B
v5-apcd-pharmacy-claim-file-submission-guide-FINAL.docx