CHIA defined and Report the Unique Submitter ID as 1 Submitter 11/8/12 Integer ID Submitter varchar[6] maintained unique defined by CHIA here. This must All 100% A0 identifier the Submitter ID reported in HD002. Do not report any here until National PlanID is fully implemented. CMS National National This is a unique identifier as outlined 2 11/8/12 Integer ID Nat'l PlanID int[10] Plan Identification All 0% Z 02 Plan ID by Centers for Medicare and Number (PlanID) Medicaid Services (CMS) for Plans or Sub plans. Insurance Report the code that defines the type Lookup Type Type / Product of insurance under which this MC 3 11/8/12 char[2] All 92% C 03 Identification Code patient's claim line was processed. Text EXAMPLE: HM = HMO Code Description 09 Self-pay 10 Central Certification 11 Other Non-Federal Programs Preferred Provider Organization 12 (PPO) 13 Point of Service (POS) Exclusive Provider Organization 14 (EPO) 15 Indemnity Insurance Health Maintenance Organization 16 (HMO) Medicare Risk Dental Maintenance Organization 17 (DMO) AM Automobile Medical BL Blue Cross / Blue Shield CC Commonwealth Care CE Commonwealth Choice CH Champus CI Commercial Insurance Co.
1 Submitter 11/8/12 Integer ID Submitter varchar[6] CHIA defined and maintained unique identifier Report the Unique Submitter ID as defined by CHIA here. This must the Submitter ID reported in HD002. All 100% A0 2 National Plan ID 11/8/12 Integer ID Nat'l PlanID int[10] CMS National Plan Identification Number (PlanID) Do not report any here until National PlanID is fully implemented. This is a unique identifier as outlined by Centers for Medicare and Medicaid Services (CMS) for Plans or Sub plans. All 0% Z MC 3 Insurance Type 11/8/12 Lookup Text char[2] Type / Product Identification Code Report the code that defines the type of insurance under which this patient's claim line was processed. EXAMPLE: HM = HMO All 92% C Code Description 09 Self-pay 10 Central Certification 11 Other Non-Federal Programs 12 Preferred Provider Organization (PPO) 13 Point of Service (POS) 14 Exclusive Provider Organization (EPO) 15 Indemnity Insurance 16 Health Maintenance Organization (HMO) Medicare Risk 17 Dental Maintenance Organization (DMO) AM Automobile Medical BL Blue Cross / Blue Shield CC Commonwealth Care CE Commonwealth Choice CH Champus CI Commercial Insurance Co. 02 03
v3-1-apcd-medical-claim-file-submission-guide-2013-06.docx