External Report a Procedure modifier Procedure External Code Code / CPT Code when a modifier clarifies / improves MC Modifier - 11/8/12 Source 9 - char[2] All 0% C Source 9 Modifier the reporting accuracy of the 3 Modifiers - Text associated procedure code (MC055). External Report a valid Procedure modifier Procedure External Code Code / CPT Code when a modifier clarifies / improves MC Modifier - 11/8/12 Source 9 - char[2] All 0% C Source 9 Modifier the reporting accuracy of the 4 Modifiers - Text associated procedure code (MC055). Report the date the was Claim Century Year processed by the carrier / submitter Full Date Claim Processed MC Processed 11/8/12 Month Day - int[8] in CCYYMMDD Format. This date All 98% A2 - Integer Date Date CCYYMMDD can be equal to Paid Date, but cannot be after Paid Date. Report the placement number of the diagnosis(es) a procedure is related to for a professional Can report up to four diagnostic positions within Required Diagnostic Diagnostic Pointer the first nine diagnoses that can be when MC 10/30/14 Integer ID Diagnosis varchar[4] 98% B Pointer Number reported. Do not separate multiple MC094 = mappings with spaces, zeros or 001 special characters. Do not zero fill. EXAMPLE: Procedure related to diagnoses 1, 4 and 5 = 145 or ADE Report the identifier of the provider that submitted the referral for the Referring service or ordered the test that is on Required ID Link to Referring Provider MC Provider 11/8/12 Text the claim (if applicable). The value when 98% A2 PV002 ID ID in this field must have a MC118 = 1 corresponding Provider ID (PV002) on the provider file. Report the value that defines the Payment Lookup Payment contracted payment methodology for MC 11/8/12 Table - char[2] Arrangement Type All 98% A0 this claim line. EXAMPLE: = Fee Type Numeric Value for Service Value Description 01 Capitation 02 Fee for Service Percent of Charges
MC Procedure Modifier - 3 11/8/12 External Code Source 9 - Text External Code Source 9 - Modifiers char[2] / CPT Code Modifier Report a Procedure modifier when a modifier clarifies / improves the reporting accuracy of the associated procedure code (MC055). All 0% C MC Procedure Modifier - 4 11/8/12 External Code Source 9 - Text External Code Source 9 - Modifiers char[2] / CPT Code Modifier Report a valid Procedure modifier when a modifier clarifies / improves the reporting accuracy of the associated procedure code (MC055). All 0% C MC Claim Processed Date 11/8/12 Full Date - Integer Century Year Month Day - CCYYMMDD int[8] Claim Processed Date Report the date the was processed by the carrier / submitter in CCYYMMDD Format. This date can be equal to Paid Date, but cannot be after Paid Date. All 98% A2 MC Diagnostic Pointer 10/30/14 Integer ID Diagnosis varchar[4] Diagnostic Pointer Number Report the placement number of the diagnosis(es) a procedure is related to for a professional Can report up to four diagnostic positions within the first nine diagnoses that can be reported. Do not separate multiple mappings with spaces, zeros or special characters. Do not zero fill. EXAMPLE: Procedure related to diagnoses 1, 4 and 5 = 145 or ADE Required when MC094 = 001 98% B MC Referring Provider ID 11/8/12 Text ID Link to PV002 Referring Provider ID Report the identifier of the provider that submitted the referral for the service or ordered the test that is on the claim (if applicable). The value in this field must have a corresponding Provider ID (PV002) on the provider file. Required when MC118 = 1 98% A2 MC Payment Type 11/8/12 Lookup Table - Numeric char[2] Payment Arrangement Type Value Report the value that defines the contracted payment methodology for this claim line. EXAMPLE: = Fee for Service All 98% A0 Value Description 01 Capitation 02 Fee for Service Percent of Charges
v6-apcd-medical-claim-file-submission-guide-Redline-.docx