Report the date that appears on the check and/or remit and/or explanation of benefits Full Century Year and corresponds to any and all types of Paid Paid date of DC 46 6/24/10 Date - Day - int[8] payment in CCYYMMDD Format. This can All 98% A0 Date the claim line Integer CCYYMMDD be the same date as Processed Date. EXAMPLE: Claims paid in full, partial or zero paid. Report the maximum amount contractually allowed, and that a carrier will pay to a provider for a particular procedure or service. This will vary by provider contract Required and most often it is less than or equal to the when Allowed Allowed DC 47 11/8/12 Integer Currency fee charged by the provider. Report 0 when DC031 99% A2 Amount Amount the claim line is denied. Do not code does not = decimal or round up / down to whole dollars, 4, 22, or 23 code zero cents (00) when applicable. EXAMPLE: 150.00 is reported as 15000; 150.70 is reported as 15070 External Required External Code Tooth Code Tooth Number when Source 10 - Report the tooth identifier(s) when DC032 is DC 48 10/30/14 Source varchar[2] or DC032 = 100% A2 Tooth within the given range Letter 10 - Identification D2000 thru Numbering Text D2999 Required External when External Code Code Report the standard quadrant identifier from reports Dental Source 10 - Dental DC 49 10/30/14 Source char[2] the External Code Source here. Provides 100% B Quadrant Dental Quadrant 10 - further detail on procedure(s). Quadrants Numeric Dental Code External Required Code External Code Report the tooth surface(s) that this service Tooth Tooth Service when DC 50 10/30/14 Source Source 10 - varchar[5] relates to. Provides further detail on 100% A2 Surface Identification 10 - Tooth Surfaces procedure. Text
DC 46 Paid Date 6/24/10 Full Date - Integer Century Year Day - CCYYMMDD int[8] Paid date of the claim line Report the date that appears on the check and/or remit and/or explanation of benefits and corresponds to any and all types of payment in CCYYMMDD Format. This can be the same date as Processed Date. EXAMPLE: Claims paid in full, partial or zero paid. All 98% A0 DC 47 Allowed Amount 11/8/12 Integer Currency Allowed Amount Report the maximum amount contractually allowed, and that a carrier will pay to a provider for a particular procedure or service. This will vary by provider contract and most often it is less than or equal to the fee charged by the provider. Report 0 when the claim line is denied. Do not code decimal or round up / down to whole dollars, code zero cents (00) when applicable. EXAMPLE: 150.00 is reported as 15000; 150.70 is reported as 15070 Required when DC031 does not = 4, 22, or 23 99% A2 DC 48 Tooth 10/30/14 External Code Source 10 - Text External Code Source 10 - Tooth Numbering varchar[2] Tooth Number or Letter Identification Report the tooth identifier(s) when DC032 is within the given range Required when DC032 = D2000 thru D2999 100% A2 DC 49 Dental Quadrant 10/30/14 External Code Source 10 - Numeric External Code Source 10 - Dental Quadrants char[2] Dental Quadrant Report the standard quadrant identifier from the External Code Source here. Provides further detail on procedure(s). Required when reports Dental Code 100% B DC 50 Tooth Surface 10/30/14 External Code Source 10 - Text External Code Source 10 - Tooth Surfaces varchar[5] Tooth Service Identification Report the tooth surface(s) that this service relates to. Provides further detail on procedure. Required when 100% A2
v5-apcd-dental-claim-file-submission-guide-REDLINE.docx