Report the unique code which identifies the location / site of the service provided by the plan rendering provider identified in MC134. The code should link to a provider record in field PV002 (Provider ID) and indicate that the service was performed at a specific location; e.g.: Dr. Jones Pediatrics, Provider ID Link to Location of MC 11/8/12 Text 123 Main St, Boston, MA, or All 98% A2 Location PV002 Provider Pediatric Associates, or Mass General Hospital, etc. Only the code is needed in this field, and the link to the Provider ID in the field PV002 (Provider ID) will allow the physical address and other identifying information about the service location to be captured. Type of location is an incorrect value. External Codes Report the ICD diagnosis code as External Required Source 8 - applied to the patient upon Discharge Code ICD Discharge when MC 11/8/12 International varchar[7] discharge. This may or may not be 80% B Diagnosis Source 8 Diagnosis Code MC069 is Classification of the same as the primary diagnosis or - Text populated Diseases admitting diagnosis. Carrier Report the identifier the carrier / Specific submitter uses internally to uniquely ID Link to Member's Unique MC Unique 11/8/12 Text identify the member. Used to validate All 100% A0 ME107 ID Member Unique Member ID and link back to ID Member Eligibility (ME107). Lookup Report the code that defines the Claim Line Claim Line Activity MC 11/8/12 - char[1] line status in terms of adjudication. All 98% A2 Type Type Code Text EXAMPLE: O = Original Code Description O Original V Void R Replacement
MC Provider Location 11/8/12 Text ID Link to PV002 Location of Provider Report the unique code which identifies the location / site of the service provided by the plan rendering provider identified in MC134. The code should link to a provider record in field PV002 (Provider ID) and indicate that the service was performed at a specific location; e.g.: Dr. Jones Pediatrics, 123 Main St, Boston, MA, or Pediatric Associates, or Mass General Hospital, etc. Only the code is needed in this field, and the link to the Provider ID in the field PV002 (Provider ID) will allow the physical address and other identifying information about the service location to be captured. Type of location is an incorrect value. All 98% A2 MC Discharge Diagnosis 11/8/12 External Code Source 8 - Text External Codes Source 8 - International Classification of Diseases varchar[7] ICD Discharge Diagnosis Code Report the ICD diagnosis code as applied to the patient upon discharge. This may or may not be the same as the primary diagnosis or admitting diagnosis. Required when MC069 is populated 80% B MC Carrier Specific Unique Member ID 11/8/12 Text ID Link to ME107 Member's Unique ID Report the identifier the carrier / submitter uses internally to uniquely identify the member. Used to validate Unique Member ID and link back to Member Eligibility (ME107). All 100% A0 MC Claim Line Type 11/8/12 Lookup - Text char[1] Claim Line Activity Type Code Report the code that defines the line status in terms of adjudication. EXAMPLE: O = Original All 98% A2 Code Description O Original V Void R Replacement
v3-1-apcd-medical-claim-file-submission-guide-2013-06.docx