Value Description 01 Capitation 02 Fee for Service 03 Percent of Charges 04 DRG 05 Pay for Performance 06 Global Payment 07 08 Bundled Payment (09 for HD002 = Payment Amount Per Episode (PAPE) 09 MassHealth (MassHealth) orgid ONLY ) Report the GIC Member Identification Required number as provided to GIC Plan PC 96 GIC ID 11/8/12 Text ID GIC varchar[9] GIC Member ID when 100% A0 Submitters. If not applicable do not report = 3 any value here Report the value that describes the member's / subscriber's enrollment into Lookup APCD ID Member one of the predefined categories; aligns PC 97 Table - tlkpADCDIdentifier int[1] All 100% A2 Code Enrollment Type enrollment to appropriate editing and Integer thresholds. EXAMPLE: 1 = FIG - Fully Insured Commercial Group Enrollee. Value Description FIG - Fully-Insured Commercial Group 1 Enrollee 2 SIG - Self-Insured Group Enrollee GIC - Group Insurance Commission 3 Enrollee MCO - MassHealth Managed Care 4 Organization Enrollee 5 Supplemental Policy Enrollee ICO Integrated Care Organization – 6 or SCO Senior Care Option – 0 Unknown / Not Applicable
Value Description 01 Capitation 02 Fee for Service 03 Percent of Charges 04 DRG 05 Pay for Performance 06 Global Payment 07 08 Bundled Payment 09 Payment Amount Per Episode (PAPE) (MassHealth) (09 for HD002 = MassHealth orgid ONLY ) PC 96 GIC ID 11/8/12 Text ID GIC varchar[9] GIC Member ID Report the GIC Member Identification number as provided to GIC Plan Submitters. If not applicable do not report any value here Required when = 3 100% A0 PC 97 APCD ID Code Lookup Table - Integer tlkpADCDIdentifier int[1] Member Enrollment Type Report the value that describes the member's / subscriber's enrollment into one of the predefined categories; aligns enrollment to appropriate editing and thresholds. EXAMPLE: 1 = FIG - Fully Insured Commercial Group Enrollee. All 100% A2 Value Description 1 FIG - Fully-Insured Commercial Group Enrollee 2 SIG - Self-Insured Group Enrollee 3 GIC - Group Insurance Commission Enrollee 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
v5-apcd-pharmacy-claim-file-submission-guide-FINAL.docx