Report the Plan assigned contract number. Plan Do not include values in this element that Specific Contract will distinguish one member of the family DC 9 6/24/10 Text ID Contract varchar[30] All 70% C Contract Number from another. This should be the contract Number or certificate number for the subscriber and all of the dependents. Member Suffix or Contract Report the unique number / identifier of the DC 10 6/24/10 Text ID Sequence varchar[20] All 98% B Sequence member / patient within the contract Number Number Report the patient's social security number here; used to validate Unique Member ID; Member Social DC 11 11/8/12 Numeric ID Tax char[9] will not be passed into analytic file. Do not All 70% B SSN Security use hyphen. If not available do not report Number any value here Patient to Individual Lookup Report the value that defines the Patient's Subscriber DC 12 6/24/10 varchar[2] relationship to the Subscriber. EXAMPLE: All 98% B Relationship Code Numeric 20 = Self / Employee Code Description 1 Spouse 4 Grandfather or Grandmother 5 Grandson or Granddaughter 7 Nephew or Niece 10 Foster Child 15 Ward 17 Stepson or Stepdaughter 19 Child 20 Self/Employee 21 Unknown 22 Handicapped Dependent 23 Sponsored Dependent
DC 9 Plan Specific Contract Number 6/24/10 Text ID Contract varchar[30] Contract Number Report the Plan assigned contract number. Do not include values in this element that will distinguish one member of the family from another. This should be the contract or certificate number for the subscriber and all of the dependents. All 70% C DC 10 Member Suffix or Number 6/24/10 Text ID Sequence varchar[20] Contract Sequence Number Report the unique number / identifier of the member / patient within the contract All 98% B DC 11 Member SSN 11/8/12 Numeric ID Tax char[9] Social Security Number Report the patient's social security number here; used to validate Unique Member ID; will not be passed into analytic file. Do not use hyphen. If not available do not report any value here All 70% B DC 12 Individual Code 6/24/10 Lookup Numeric varchar[2] Patient to Subscriber Relationship Code Report the value that defines the Patient's relationship to the Subscriber. EXAMPLE: 20 = Self / Employee All 98% B Description 1 Spouse 4 Grandfather or Grandmother 5 Grandson or Granddaughter 7 Nephew or Niece 10 Foster Child 15 Ward 17 Stepson or Stepdaughter 19 Child 20 Self/Employee 21 Unknown 22 Handicapped Dependent 23 Sponsored Dependent
v5-apcd-dental-claim-file-submission-guide-REDLINE.docx