Carrier Defined External Code Table - Source 16 - Report the code that defines the Required Denial OR - Denial Reason Denial Reason reason for denial of the claim line. MC 11/8/12 when 98% A2 Reason External OR Code Carrier must submit denial reason = 1 Code Carrier-Defined codes in separate table to the APCD. Source lookup 16 - Text Report the ID that reflects the provider that provided general oversight of the patient's care. This Required individual may or may not be the when Attending Attending Provider MC 11/8/12 Text ID Link to Servicing or Rendering provider. = 002 and 98% A1 Provider ID This value needs to be found in field MC039 is PV002 on the Provider File. This populated field may or may not be NPI based on the carrier’s identifier system. Lookup Report the value that defines the Accident Indicator - MC 11/8/12 Table - int[1] element. EXAMPLE: 1 = Yes, Claim All 100% A2 Indicator Accident Related Integer Line is Accident related. Description 1 Yes 2 No 3 Unknown 4 5 Not Applicable Report the value that defines if family Family Lookup Service is related planning services were provided. MC Planning 11/8/12 Table - int[1] All 98% A2 to Family Planning EXAMPLE: 0 = Unknown / Not Indicator Integer Applicable Value Description 1 Family planning services provided 2 Abortion services provided 3 Sterilization services provided
MC Denial Reason 11/8/12 Carrier Defined Table - OR - External Code Source 16 - Text External Code Source 16 - Denial Reason OR Carrier-Defined lookup Denial Reason Code Report the code that defines the reason for denial of the claim line. Carrier must submit denial reason codes in separate table to the APCD. Required when = 1 98% A2 MC Attending Provider 11/8/12 Text ID Link to Attending Provider ID Report the ID that reflects the provider that provided general oversight of the patient's care. This individual may or may not be the Servicing or Rendering provider. This value needs to be found in field PV002 on the Provider File. This field may or may not be NPI based on the carrier’s identifier system. Required when = 002 and MC039 is populated 98% A1 MC Accident Indicator 11/8/12 Lookup Table - Integer int[1] Indicator - Accident Related Report the value that defines the element. EXAMPLE: 1 = Yes, Claim Line is Accident related. All 100% A2 Description 1 Yes 2 No 3 Unknown 4 5 Not Applicable MC Family Planning Indicator 11/8/12 Lookup Table - Integer int[1] Service is related to Family Planning Report the value that defines if family planning services were provided. EXAMPLE: 0 = Unknown / Not Applicable All 98% A2 Value Description 1 Family planning services provided 2 Abortion services provided 3 Sterilization services provided
v3-1-apcd-medical-claim-file-submission-guide-2013-06.docx