Version 4.0; required for reporting 4.0 periods October 2013 onward; No longer valid as of August 2016 Version 5.0; required for reporting periods October 2013 onward as of 5.0 August 2016;No longer valid as of August 2017 Version 6.0; required for reporting 6.0 periods October 2013 onward as of August 2017 CHIA defined and Report the Unique Submitter ID as 1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 01 identifier the Submitter ID reported in HD002. Do not report any value 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 which this patient's 3 10/30/14 Table char[2] All 98% A2 Identification Code claim line was processed. Text EXAMPLE: HM = HMO Code Description 09 Self-pay 10 Central Certification 11 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
4.0 Version 4.0; required for reporting periods October 2013 onward; No longer valid as of August 2016 5.0 Version 5.0; required for reporting periods October 2013 onward as of August 2016;No longer valid as of August 2017 6.0 Version 6.0; required for reporting periods October 2013 onward as of August 2017 1 Submitter 11/8/12 Integer ID Submitter varchar[6]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 value 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 3 Insurance Type 10/30/14 Lookup Table Text char[2] Type / Product Identification Code Report the code that defines the type of insurance which this patient's claim line was processed. EXAMPLE: HM = HMO All 98% A2 Code Description 09 Self-pay 10 Central Certification 11 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 01 02
v6-apcd-medical-claim-file-submission-guide-FINAL.docx