External Address Service State of the Code External Code Report the state of the service providers as DC 29 Provider 11/8/12 char[2] Service All 98% B Source Source 2 defined by the US Postal Service – State Provider 2 - Text States External Address Zip Service Zip Code of Report the 5 or 9 digit Zip Code as defined Code External Code DC 30 Provider 11/8/12 varchar[9] the Service by the US Postal Service. When submitting All 98% B Source Source 2 - Zip ZIP Code Provider the 9-digit Zip Code do not include hyphen. 2 - Text Codes External Facility Code External Code Report the code the defines the location Type - Place of DC 31 11/8/12 Source Source 13 - char[2] code where services were performed by the All 80% B Service Code 13 - Place of Service provider referenced on the claim Numeric Lookup Claim Claim Line Report the value that defines the payment DC 32 11/8/12 Table - tlkpClaimStatus varchar[2] All 98% A0 Status Status status of this claim line Numeric Value Description 1 Processed as primary 2 Processed as secondary 3 Processed as tertiary 4 Denied Processed as primary, forwarded to 19 additional payer(s) Processed as secondary, forwarded to 20 additional payer(s) Processed as tertiary, forwarded to 21 additional payer(s) 22 Reversal of previous payment Not our claim, forwarded to additional 23 payer(s) 25 Predetermination Pricing Only - no payment
DC 29 Service Provider State 11/8/12 External Code Source 2 - Text Address External Code Source 2 – States char[2] State of the Service Provider Report the state of the service providers as defined by the US Postal Service All 98% B DC 30 Service Provider ZIP Code 11/8/12 External Code Source 2 - Text Address Zip External Code Source 2 - Zip Codes varchar[9] Zip Code of the Service Provider Report the 5 or 9 digit Zip Code as defined by the US Postal Service. When submitting the 9-digit Zip Code do not include hyphen. All 98% B DC 31 Facility Type - 11/8/12 External Code Source 13 - Numeric External Code Source 13 - Place of Service char[2] Place of Service Code Report the code the defines the location code where services were performed by the provider referenced on the claim All 80% B DC 32 Claim Status 11/8/12 Lookup Table - Numeric tlkpClaimStatus varchar[2] Claim Line Status Report the value that defines the payment status of this claim line All 98% A0 Value Description 1 Processed as primary 2 Processed as secondary 3 Processed as tertiary 4 Denied 19 Processed as primary, forwarded to additional payer(s) 20 Processed as secondary, forwarded to additional payer(s) 21 Processed as tertiary, forwarded to additional payer(s) 22 Reversal of previous payment 23 Not our claim, forwarded to additional payer(s) 25 Predetermination Pricing Only - no payment
v6-apcd-dental-claim-file-submission-guide-Redline-.docx