Carrier See mapping notes for primary Defined External Code specialty code in PV030. Known Table - Source 4 Required – Other additional specialty code for a OR - Specialties when PV 43 Specialty 11/8/12 Specialty Code provider should be populated in this 0% B External - OR = 0, 1, 2, 3, – Code 2 element. Value can come from Code Carrier Defined 4, or 5 either a Carrier Defined Table or the Source 4 Table External Code Source. - Integer Carrier See mapping notes for primary Defined External Code specialty code in PV030. Known Table - Source 4 - Required Other additional specialty code for a OR - Specialties when PV 44 Specialty 11/8/12 Specialty Code provider should be populated in this 0% B External - OR = 0, 1, 2, 3, – Code 3 element. Value can come from Code Carrier Defined 4, or 5 either a Carrier Defined Table or the Source 4 External Code Source. - Integer Report the value that defines the element. Pay-for-performance bonuses or year-end withhold Required Pay for Lookup Indicator - Provider returns based on performance for at when PV 45 11/8/12 Table - int[1] 100% A2 Contract Payment least one service performed by this PV034 = 1, Flag Integer provider within the month. 2, or 3 EXAMPLE: 1 = Yes, provider has a contract incentive. Value Description 1 Yes 2 No 3 Unknown 4 Other 5 Not Applicable Report the value that defines the element. NonClaims payments that Lookup occur at least once within the month NonClaims Indicator - Provider PV 46 11/8/12 Table - int[1] must be reported. EXAMPLE: 1 = All 100% A2 Flag Contract Payment Integer Yes, provider may be eligible to receive other payments not flowing through the claims system.
PV 43 Other Specialty Code 2 11/8/12 Carrier Defined Table - OR - External Code Source 4 - Integer External Code Source 4 – Specialties - OR – Carrier Defined Table Specialty Code See mapping notes for primary specialty code in PV030. Known additional specialty code for a provider should be populated in this element. Value can come from either a Carrier Defined Table or the External Code Source. Required when = 0, 1, 2, 3, 4, or 5 0% B PV 44 Other Specialty Code 3 11/8/12 Carrier Defined Table - OR - External Code Source 4 - Integer External Code Source 4 - Specialties - OR – Carrier Defined Specialty Code See mapping notes for primary specialty code in PV030. Known additional specialty code for a provider should be populated in this element. Value can come from either a Carrier Defined Table or the External Code Source. Required when = 0, 1, 2, 3, 4, or 5 0% B PV 45 Pay for Flag 11/8/12 Lookup Table - Integer int[1] Indicator - Provider Contract Payment Report the value that defines the element. Pay-for-performance bonuses or year-end withhold returns based on performance for at least one service performed by this provider within the month. EXAMPLE: 1 = Yes, provider has a contract incentive. Required when PV034 = 1, 2, or 3 100% A2 Value Description 1 Yes 2 No 3 Unknown 4 Other 5 Not Applicable PV 46 NonClaims Flag 11/8/12 Lookup Table - Integer int[1] Indicator - Provider Contract Payment Report the value that defines the element. NonClaims payments that occur at least once within the month must be reported. EXAMPLE: 1 = Yes, provider may be eligible to receive other payments not flowing through the claims system. All 100% A2
v3-1-apcd-provider-file-submission-guide-2013-06.docx