Report the last name of the patient / member here. Used to validate Unique Member ID. Last name should exclude all punctuation, including hyphens and Member Last name of Name Last apostrophes, and be reported in upper DC 54 Last 6/24/10 Text varchar[60] All 100% B Member case. Name should be contracted where Name punctuation is removed, do not report spaces. EXAMPLE: O'Brien becomes OBRIEN; Carlton-Smythe becomes CARLTONSMYTHE Report the first name of the patient / member here. Used to validate Unique Member First name of Member ID. Exclude all punctuation, Name First DC 55 First 6/24/10 Text varchar[25] including hyphens and apostrophes. Name All 100% B Member Name should be contracted where punctuation is removed, do not report spaces. EXAMPLE: Anne-Marie becomes ANNEMARIE Middle initial of Member Report the middle initial of the patient / Name Middle the DC 56 Middle 6/24/10 Text char[1] member when available. Used to validate All 2% C Member Initial Unique Member ID. Carrier Report the identifier the carrier / submitter Specific uses internally to uniquely identify the ID Link to Member's DC 57 Unique 11/8/12 Text varchar[50] member. Used to validate Unique Member All 100% A0 ME107 Unique ID Member ID and link back to Member Eligibility ID (ME107) Carrier Report the identifier the carrier / submitter Specific uses internally to uniquely identify the ID Link to Subscriber's DC 58 Unique 11/8/12 Text varchar[50] subscriber. Used to validate Unique All 100% A0 ME117 Unique ID Member ID and link back to Member ID Eligibility (ME117) Secondary Member Report the address of member which may Street Address Street Address 2 include apartment number or suite, or other DC 59 11/8/12 Text varchar[50] of the All 2% B Address Member secondary information besides the street. 2 Used to validate Unique Member ID. Lookup Claim Line Report the code that defines the claim line Line DC 60 11/8/12 Table - char[1] Activity Type status in terms of adjudication. EXAMPLE: All 98% A2 Type Text Code O = Original
DC 54 Member Last Name 6/24/10 Text Name Last Member varchar[60] Last name of Report the last name of the patient / member here. Used to validate Unique Member ID. Last name should exclude all punctuation, including hyphens and apostrophes, and be reported in upper case. Name should be contracted where punctuation is removed, do not report spaces. EXAMPLE: O'Brien becomes OBRIEN; Carlton-Smythe becomes CARLTONSMYTHE All 100% B DC 55 Member First Name 6/24/10 Text Name First Member varchar[25] First name of Report the first name of the patient / member here. Used to validate Unique Member ID. Exclude all punctuation, including hyphens and apostrophes. Name should be contracted where punctuation is removed, do not report spaces. EXAMPLE: Anne-Marie becomes ANNEMARIE All 100% B DC 56 Member Middle Initial 6/24/10 Text Name Middle Member char[1] Middle initial of the Report the middle initial of the patient / member when available. Used to validate Unique Member ID. All 2% C DC 57 Carrier Specific Unique Member ID 11/8/12 Text ID Link to ME107 varchar[50] Member's Unique ID Report the identifier the carrier / submitter uses internally to uniquely identify the member. Used to validate Unique Member ID and link back to Member Eligibility (ME107) All 100% A0 DC 58 Carrier Specific Unique ID 11/8/12 Text ID Link to ME117 varchar[50] Subscriber's Unique ID Report the identifier the carrier / submitter uses internally to uniquely identify the subscriber. Used to validate Unique Member ID and link back to Member Eligibility (ME117) All 100% A0 DC 59 Member Street Address 2 11/8/12 Text Address 2 Member varchar[50] Secondary Street Address of the Report the address of member which may include apartment number or suite, or other secondary information besides the street. Used to validate Unique Member ID. All 2% B DC 60 Line Type 11/8/12 Lookup Table - Text char[1] Claim Line Activity Type Code Report the code that defines the claim line status in terms of adjudication. EXAMPLE: O = Original All 98% A2
v3-1-apcd-dental-claim-file-submission-guide-2013-06.docx