Carrier Report the identifier the carrier / Specific submitter uses internally to uniquely ID Link to Member's Unique MC Unique 11/8/12 Text identify the member. Used to validate All 100% A0 ME107 ID Member Unique Member ID and link back to ID Member Eligibility (ME107). Report the code that defines the Lookup Claim Line Claim Line Activity claim line status in terms of MC 11/8/12 Table - char[1] All 98% A2 Type Type Code adjudication. EXAMPLE: O = Text Original Code Description O Original V Void R Replacement B Back Out A Amendment Report the Claim Control Number (MC004) that was originally sent in a prior filing that this line corresponds Former to. When reported, this data cannot Previous Claim MC Claim 12/1/10 Text ID Number equal its own MC004. Use of All 0% B Number Number Claim Number” to version “Former claims can only be used if approved by the MA APCD. Contact the MA APCD for conditions of use. Do not populate with any data. MC Filler 2/2017 text Filler char[0] Filler All 100% A0 Required to be NULL. Carrier Report the identifier the carrier / Specific submitter uses internally to uniquely Subscriber's MC Unique 11/8/12 Text ID Link to identify the subscriber. Used to All 100% A0 Unique ID Subscriber validate Unique Member ID and link ID back to Member Eligibility (ME117).
MC Carrier Specific Unique Member ID 11/8/12 Text ID Link to ME107 Member's Unique ID Report the identifier the carrier / submitter uses internally to uniquely identify the member. Used to validate Unique Member ID and link back to Member Eligibility (ME107). All 100% A0 MC Claim Line Type 11/8/12 Lookup Table - Text char[1] Claim Line Activity Type Code Report the code that defines the claim line status in terms of adjudication. EXAMPLE: O = Original All 98% A2 Code Description O Original V Void R Replacement B Back Out A Amendment MC Former Claim Number 12/1/10 Text ID Number Previous Claim Number Report the Claim Control Number (MC004) that was originally sent in a prior filing that this line corresponds to. When reported, this data cannot equal its own MC004. Use of “Former Claim Number” to version claims can only be used if approved by the MA APCD. Contact the MA APCD for conditions of use. All 0% B MC Filler 2/2017 text Filler char[0] Filler Do not populate with any data. Required to be NULL. All 100% A0 MC Carrier Specific Unique Subscriber ID 11/8/12 Text ID Link to Subscriber's Unique ID Report the identifier the carrier / submitter uses internally to uniquely identify the subscriber. Used to validate Unique Member ID and link back to Member Eligibility (ME117). All 100% A0
v6-apcd-medical-claim-file-submission-guide-FINAL.docx