Report the amount paid to the provider for this claim line if the provider qualified / met performance guarantees. Report 0 if the provider Amount to be paid has the agreement but did not satisfy Withhold to the provider the measure, else do not report any MC 11/8/12 Integer Currency All 98% A2 Amount upon guarantee of value here. Do not code decimal or performance 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 The MA APCD reserves this field for MC Filler 10/30/14 Filler Filler int[1] Filler All 0% Z future use. Do not populate. Lookup Report the value that defines the Referral Indicator - Referral MC 11/8/12 Table - int[1] element. EXAMPLE: 1 = Yes All 100% A0 18 Indicator Needed Integer service was preceded by a referral. Value Description 1 Yes 2 No 3 Unknown 4 Other 5 Not Applicable Report the value that defines the Lookup PCP Indicator - PCP element. EXAMPLE: 1 = Yes MC 11/8/12 - int[1] All 100% A2 Indicator Rendered Service service was performed by members Integer PCP. Value Description 1 Yes 2 No 3 Unknown 4 Other 5 Not Applicable
MC Withhold Amount 11/8/12 Integer Currency Amount to be paid to the provider upon guarantee of performance Report the amount paid to the provider for this claim line if the provider qualified / met performance guarantees. Report 0 if the provider has the agreement but did not satisfy the measure, else do not report any value here. 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 98% A2 MC Filler 10/30/14 Filler Filler int[1] Filler The MA APCD reserves this field for future use. Do not populate. All 0% Z MC Referral Indicator 11/8/12 Lookup Table - Integer int[1] Indicator - Referral Needed Report the value that defines the element. EXAMPLE: 1 = Yes service was preceded by a referral. All 100% A0 Value Description 1 Yes 2 No 3 Unknown 4 Other 5 Not Applicable MC PCP Indicator 11/8/12 Lookup - Integer int[1] Indicator - PCP Rendered Service Report the value that defines the element. EXAMPLE: 1 = Yes service was performed by members PCP. All 100% A2 Value Description 1 Yes 2 No 3 Unknown 4 Other 5 Not Applicable 18
v5-apcd-medical-claim-file-submission-guide-FINAL.docx