Report the Primary National Provider National External External Code National Provider ID (NPI) of the Service Provider in Provider Code Source 3 - Identification (NPI) MC 27 10/30/14 int[10] MC024. This ID should be found on All 98% A2 ID - Source 3 National of the Service the Provider File in the NPI Field Service - Integer Provider ID Provider (PV039). Report the value that defines the Service Service Provider entity type. Only Provider Lookup Service Provider individuals should be identified with a MC 28 Entity 11/8/12 Table - int[1] Entity Identifier All 98% A0 1. Facilities, professional groups and Type integer Code clinic sites should all be identified Qualifier with a 2. EXAMPLE: 1 = Person Description 1 Person 2 Non-person entity Service Report the individual's first name Required Provider Name First name of here. If provider is a facility or MC 29 10/30/14 Text when 92% C First Provider Service Provider organization , do not report any value MC027 = 1 Name here. Service Report the individual's middle initial Required Provider Name Middle Middle initial of here. If provider is a facility or MC 30 10/30/14 Text when 2% C Middle Provider Service Provider organization , do not report any value MC027 = 1 Initial here. Servicing Report the name of the organization Provider Last name or or last name of the individual Last Name Last / Organization MC 31 6/24/10 Text provider. MC027 determines if this is All 94% A2 Name or Org Provider Name of Service an Organization or Individual Name Provider reported here. Name Report the individuals name-suffix when applicable here. Used to Service Lookup capture the generation of the Required Provider Name MC 32 Provider 10/30/14 - int[1] individual clinician (e.g., Jr. Sr., III). when 2% Z Suffix Suffix Integer Do not report degree acronyms here. MC027 = 1 EXAMPLE: 0 = Unknown / Not Applicable Value Description 1 I.
MC 27 National Provider ID - Service 10/30/14 External Code Source 3 - Integer External Code Source 3 - National Provider ID int[10] National Provider Identification (NPI) of the Service Provider Report the Primary National Provider ID (NPI) of the Service Provider in MC024. This ID should be found on the Provider File in the NPI Field (PV039). All 98% A2 MC 28 Service Provider Entity Type Qualifier 11/8/12 Lookup Table - integer int[1] Service Provider Entity Identifier Code Report the value that defines the Service Provider entity type. Only individuals should be identified with a 1. Facilities, professional groups and clinic sites should all be identified with a 2. EXAMPLE: 1 = Person All 98% A0 Description 1 Person 2 Non-person entity MC 29 Service Provider First Name 10/30/14 Text Name First Provider name of Service Provider Report the individual's first name here. If provider is a facility or organization , do not report any value here. Required when MC027 = 1 92% C MC 30 Service Provider Middle Initial 10/30/14 Text Name Middle Provider Middle initial of Service Provider Report the individual's middle initial here. If provider is a facility or organization , do not report any value here. Required when MC027 = 1 2% C MC 31 Servicing Provider Last Name or Name 6/24/10 Text Name Last / Org Provider Last name or Organization Name of Service Provider Report the name of the organization or last name of the individual provider. MC027 determines if this is an Organization or Individual Name reported here. All 94% A2 MC 32 Service Provider Suffix 10/30/14 Lookup - Integer int[1] Provider Name Suffix Report the individuals name-suffix when applicable here. Used to capture the generation of the individual clinician (e.g., Jr. Sr., III). Do not report degree acronyms here. EXAMPLE: 0 = Unknown / Not Applicable Required when MC027 = 1 2% Z Value Description 1 I.
v6-apcd-medical-claim-file-submission-guide-FINAL.docx