MCO - MassHealth Managed Care 4 Organization Enrollee 5 Supplemental Policy Enrollee ICO Integrated Care Organization or – 6 SCO Senior Care Option – 0 Unknown / Not Applicable Lookup Report the value that defines the element. Claim Line Line Paid PC 98 Table - tlkpFlagIndicators int[1] EXAMPLE: 1 = Yes, Claim Line was Required 100% B Paid Flag Indicator Integer paid. Description 1 Yes 2 No 3 Unknown 4 Other 5 Not Applicable Report PC here. This validates the type Record File Type PC 99 6/24/10 Text ID File char[2] of file and the data contained within the All 100% A0 Type Identifier file. This must match HD004 TR Record Trailer Record Report here. Indicates the end of the 1 6/24/10 Text ID Record char[2] Mandatory 100% TM Type Identifier data file Trailer Report the Unique Submitter ID as Submitter / 2 Submitter 11/8/12 Integer ID Submitter varchar[6] defined by CHIA here. This must match Mandatory 100% TM Carrier ID the Submitter ID reported in HD002 defined by CHIA CMS National Do not report any here until National Plan PlanID is fully implemented. This is a National 3 11/8/12 Integer ID Nat'l PlanID int[10] Identification unique identifier as outlined by Centers Situational 0% TS Plan ID Number for Medicare and Medicaid Services (PlanID) (CMS) for Plans or Sub plans Validates the Type of Report PC here. This must match the File 4 6/24/10 Text ID File char[2] file type defined Mandatory 100% TM File Type reported in HD004 in HD004. Report the Year and Month of the Period Date reported submission period in CCYYMM Century Year Trailer Period 5 Beginning 6/24/10 Period - int[6] format. This date period must match the Mandatory 100% TM Month - CCYYMM Start Date Date Integer date period reported in HD005 and HD006
4 MCO - MassHealth Managed Care Organization Enrollee 5 Supplemental Policy Enrollee 6 ICO – Integrated Care Organization or SCO – Senior Care Option 0 Unknown / Not Applicable PC 98 Claim Line Paid Flag Lookup Table - Integer tlkpFlagIndicators int[1] Line Paid Indicator Report the value that defines the element. EXAMPLE: 1 = Yes, Claim Line was paid. Required 100% B Description 1 Yes 2 No 3 Unknown 4 Other 5 Not Applicable PC 99 Record Type 6/24/10 Text ID File char[2] File Type Identifier Report PC here. This validates the type of file and the data contained within the file. This must match HD004 All 100% A0 1 Record Type 6/24/10 Text ID Record char[2] Trailer Record Identifier Report TR here. Indicates the end of the data file Mandatory 100% TM 2 Submitter 11/8/12 Integer ID Submitter varchar[6] Trailer Submitter / Carrier ID defined by CHIA Report the Unique Submitter ID as defined by CHIA here. This must match the Submitter ID reported in HD002 Mandatory 100% TM 3 National Plan ID 11/8/12 Integer ID Nat'l PlanID int[10] CMS National Plan Identification Number (PlanID) Do not report any 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 Situational 0% TS 4 Type of File 6/24/10 Text ID File char[2] Validates the file type defined in HD004. Report PC here. This must match the File Type reported in HD004 Mandatory 100% TM 5 Period Beginning Date 6/24/10 Date Period - Integer Century Year Month - CCYYMM int[6] Trailer Period Start Date Report the Year and Month of the reported submission period in CCYYMM format. This date period must match the date period reported in HD005 and HD006 Mandatory 100% TM
v6-apcd-pharmacy-claim-file-submission-guide-Redline-.docx