Code Description O Original V Void R Replacement B Back Out A Amendment Report the Control Number (DC004) that was originally sent in a prior filing that Former this line corresponds to. When reported, ID Claim Previous Claim DC 61 12/1/10 Text varchar[35] this data cannot equal its own DC004. Use All 0% B Number Number Number of Claim Number” to version claims “Former can only be used if approved by the APCD. Contact the APCD for conditions of use. Required when External Codes DC032 is External Source 8 - within the Code ICD Diagnosis Report the ICD Diagnosis Code when DC 62 11/8/12 International varchar[7] ranges of 1% B Code Source Code applicable Classification of 8 - Text Diseases or D9220 or D9221 International Required Lookup Report the value that defines whether the ICD Classification when DC 63 11/8/12 - tlkpICDIndicator int[1] diagnoses on claim are ICD9 or ICD10. 100% B Indicator of Diseases DC061 is Integer EXAMPLE: 9 = ICD9 version populated Value Description 9 ICD-9 0 ICD-10 Required Lookup Report the value that defines the element. Denied Denied Claim when DC 64 11/8/12 Table - int[1] 1 = Yes, Claim Line was 100% A0 EXAMPLE: Flag Line Indicator DC031 = Integer denied. 04 Value Description
Code Description O Original V Void R Replacement B Back Out A Amendment DC 61 Former Number 12/1/10 Text ID Claim Number varchar[35] Previous Claim Number Report the Control Number (DC004) that was originally sent in a prior filing that this line corresponds to. When reported, this data cannot equal its own DC004. Use of “Former Claim Number” to version claims can only be used if approved by the APCD. Contact the APCD for conditions of use. All 0% B DC 62 Code 11/8/12 External Code Source 8 - Text External Codes Source 8 - International Classification of Diseases varchar[7] ICD Diagnosis Code Report the ICD Diagnosis Code when applicable Required when DC032 is within the ranges of or D9220 or D9221 1% B DC 63 ICD Indicator 11/8/12 Lookup - Integer tlkpICDIndicator int[1] International Classification of Diseases version Report the value that defines whether the diagnoses on claim are ICD9 or ICD10. EXAMPLE: 9 = ICD9 Required when DC061 is populated 100% B Value Description 9 ICD-9 0 ICD-10 DC 64 Denied Flag 11/8/12 Lookup Table - Integer int[1] Denied Claim Line Indicator Report the value that defines the element. EXAMPLE: 1 = Yes, Claim Line was denied. Required when DC031 = 04 100% A0 Value Description
v3-1-apcd-dental-claim-file-submission-guide-2013-06.docx