04 DRG 05 Pay for Performance 06 Global Payment 07 Other 08 Bundled Payment (Valid for Payment Amount Per Episode (PAPE) 09 MassHealth (MassHealth) ONLY) DC 67 Report the that describes the member's / subscriber's enrollment into one of the Lookup Member APCD ID predefined categories; aligns enrollment to DC 68 10/30/14 Table - int[1] Enrollment All 100% A2 Code appropriate editing and thresholds. Integer Type 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 or SCO 6 Senior Care Option – 0 Unknown / Not Applicable Claim Lookup Claim Line Report the value that defines the element. DC 69 Line Paid 10/30/14 - int[1] Required 100% B Paid Indicator EXAMPLE: 1 = Yes, Claim Line was paid. Flag Integer Value Description
04 DRG 05 Pay for Performance 06 Global Payment 07 Other 08 Bundled Payment 09 Payment Amount Per Episode (PAPE) (MassHealth) (Valid for MassHealth ONLY) DC 67 DC 68 APCD ID Code 10/30/14 Lookup Table - Integer int[1] Member Enrollment Type Report the 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 DC 69 Claim Line Paid Flag 10/30/14 Lookup - Integer int[1] Claim Line Paid Indicator Report the value that defines the element. EXAMPLE: 1 = Yes, Claim Line was paid. Required 100% B Value Description
v6-apcd-dental-claim-file-submission-guide-Redline-.docx