File Guideline and Layout Legend File: Identifies the file per element as well as the Header and Trailer Records that repeat on all MA APCD File Types. Headers and Trailers are Mandatory as a whole, with just a few elements allowing situational reporting. Col: Identifies the column the data resides in when reported Elmt: This is the number of the element in regards to the file type Data Element Name: Provides identification of basic data required Date Modified: Identifies the last date that an element was adjusted Type: Defines the data as Decimal, Integer, Numeric or Text. Additional information provided for identification, e.g., Date Period Integer – Type Description: Used to group like-items together for quick identification Format / Length: Defines both the reporting length and element min/max requirements. See below: char[n] this is a length element of [n] characters, cannot report below or above [n]. This can be any type of data, but is – governed by the type listed for the element, Text vs. Numeric. varchar[n] this is a variable length field of max [n] characters, cannot report above [n]. This can be any type of data, but is governed – by the type listed for the element, Text vs. Numeric. int[n] this is a fixed type and length element of [n] for numeric reporting only. This cannot be anything but numeric with no decimal – points or leading zeros. The plus/minus symbol (±) in front on any of the Formats above indicate that a negative can be submitted in the element under specific conditions. Example: When the Claim Line Type (MC138) = V (void) or B (backout) then certain claim values can be negative. Description: Short description that defines the data expected in the element Element Submission Guideline: Provides detailed information regarding the data required as well as constraints, exceptions and examples. Condition: Provides the condition for reporting the data %: Provides the base percentage that the MA APCD is expecting in volume of data in regards to condition requirements.
File Guideline and Layout Legend File: Identifies the file per element as well as the Header and Trailer Records that repeat on all MA APCD File Types. Headers and Trailers are Mandatory as a whole, with just a few elements allowing situational reporting. Col: Identifies the column the data resides in when reported Elmt: This is the number of the element in regards to the file type Data Element Name: Provides identification of basic data required Date Modified: Identifies the last date that an element was adjusted Type: Defines the data as Decimal, Integer, Numeric or Text. Additional information provided for identification, e.g., Date Period – Integer Type Description: Used to group like-items together for quick identification Format / Length: Defines both the reporting length and element min/max requirements. See below: char[n] – this is a length element of [n] characters, cannot report below or above [n]. This can be any type of data, but is governed by the type listed for the element, Text vs. Numeric. varchar[n] – this is a variable length field of max [n] characters, cannot report above [n]. This can be any type of data, but is governed by the type listed for the element, Text vs. Numeric. int[n] – this is a fixed type and length element of [n] for numeric reporting only. This cannot be anything but numeric with no decimal points or leading zeros. The plus/minus symbol (±) in front on any of the Formats above indicate that a negative can be submitted in the element under specific conditions. Example: When the Claim Line Type (MC138) = V (void) or B (backout) then certain claim values can be negative. Description: Short description that defines the data expected in the element Element Submission Guideline: Provides detailed information regarding the data required as well as constraints, exceptions and examples. Condition: Provides the condition for reporting the data %: Provides the base percentage that the MA APCD is expecting in volume of data in regards to condition requirements.
v5-apcd-pharmacy-claim-file-submission-guide-FINAL.docx