Report the total amount patient / member is responsible to pay to the provider as part of their costs for Patient services. Report 0 if there are no Total amount Total Out Out of Pocket expenses. Do not code MC 11/8/12 Integer Currency patient/member All 100% A2 of Pocket decimal or round up / down to whole must pay Amount dollars, code zero cents (00) when applicable. EXAMPLE: 150.00 is reported as 15000; 150.70 is reported as 15070 Report the value that defines the Global Lookup Indicator - Global element. EXAMPLE: 1 = Yes the MC Payment 11/8/12 - int[1] All 100% A0 Payment claim line was paid under a global Flag Integer payment arrangement. Value Description 1 Yes 2 No 3 Unknown 4 5 Not Applicable Lookup Report the value that defines the Required Denied Denied Line MC 11/8/12 Table - int[1] element. EXAMPLE: 1 = Yes, Claim when 100% A0 Flag Indicator Integer Line was denied. MC038 = 4 Value Description 1 Yes 2 No 3 Unknown 4 5 Not Applicable
MC Patient Total Out of Pocket Amount 11/8/12 Integer Currency Total amount patient/member must pay Report the total amount patient / member is responsible to pay to the provider as part of their costs for services. Report 0 if there are no Out of Pocket expenses. Do not code decimal or round up / down to whole dollars, code zero cents (00) when applicable. EXAMPLE: 150.00 is reported as 15000; 150.70 is reported as 15070 All 100% A2 MC Global Payment Flag 11/8/12 Lookup - Integer int[1] Indicator - Global Payment Report the value that defines the element. EXAMPLE: 1 = Yes the claim line was paid under a global payment arrangement. All 100% A0 Value Description 1 Yes 2 No 3 Unknown 4 5 Not Applicable MC Denied Flag 11/8/12 Lookup Table - Integer int[1] Denied Line Indicator Report the value that defines the element. EXAMPLE: 1 = Yes, Claim Line was denied. Required when MC038 = 4 100% A0 Value Description 1 Yes 2 No 3 Unknown 4 5 Not Applicable
v5-apcd-medical-claim-file-submission-guide-REDLINE.docx