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 1 Yes 2 No 3 Unknown 4 5 Not Applicable Carrier Defined External Code Table - Source 16 - Report the code that defines the reason for Required Denial OR - Reason Codes Denial Reason denial of the claim line. Carrier must submit DC 65 11/8/12 varchar[20] when 98% A2 Reason External OR Code denial reason codes in separate table to the – DC063 = 1 Code Carrier Defined APCD. Source Table - 16 Payment Lookup Payment Report the value that defines the contracted DC 66 11/8/12 Table - char[2] Arrangement payment methodology for this claim line. All 98% A0 Numeric Type Value EXAMPLE: 02 = Fee for Service Type Value Description 01 Capitation 02 Fee for Service 03 Percent of Charges
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 1 Yes 2 No 3 Unknown 4 5 Not Applicable DC 65 Denial Reason 11/8/12 Carrier Defined Table - OR - External Code Source 16 External Code Source 16 - Reason Codes OR – Carrier Defined Table - varchar[20] 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 DC063 = 1 98% A2 DC 66 Payment Type 11/8/12 Lookup Table - Numeric char[2] Payment Arrangement Type Value Report the value that defines the contracted payment methodology for this claim line. EXAMPLE: 02 = Fee for Service All 98% A0 Value Description 01 Capitation 02 Fee for Service 03 Percent of Charges
v6-apcd-dental-claim-file-submission-guide-Redline-.docx