DS Disability HM Health Maintenance Organization LI Liability LM Liability Medical MA Medicare Part A MB Medicare Part B MC Medicaid OF Federal Program TF HSN Trust Fund TV Title V VA Veterans Administration Plan WC Workers' Compensation ZZ Other Claim Report the Unique identifier within the Claim ID Claim 4 6/24/10 Text varchar[35] Control payer's system that applies to the entire All 100% A0 Control Number Identification claim. Number Report the line number for this service Line Incremental within the Start with 1 and increment 5 11/8/12 Integer ID varchar[4] All 100% A0 Counter Line Counter by 1 for each additional line. Do not start with 0, include alphas or special characters. Report the version number of this claim Claim Service service line. The version number begins Version 6 7/6/10 Integer Counter varchar[4] Line Version with 0 and is incremented by 1 for each All 100% A0 Number Number subsequent version of that service line. No alpha or special characters. Insured Report the number that defines the insured Group or Group / Policy group or policy. Do not report the number 7 11/8/12 Text ID Group varchar[30] All 98% Policy Number that uniquely identifies the subscriber or Number member.
DS Disability HM Health Maintenance Organization LI Liability LM Liability Medical MA Medicare Part A MB Medicare Part B MC Medicaid OF Federal Program TF HSN Trust Fund TV Title V VA Veterans Administration Plan WC Workers' Compensation ZZ Other 4 Claim Control Number 6/24/10 Text ID Claim Number varchar[35] Claim Control Identification Report the Unique identifier within the payer's system that applies to the entire claim. All 100% A0 5 Line Counter 11/8/12 Integer ID varchar[4] Incremental Line Counter Report the line number for this service within the Start with 1 and increment by 1 for each additional line. Do not start with 0, include alphas or special characters. All 100% A0 6 Version Number 7/6/10 Integer Counter varchar[4] Claim Service Line Version Number Report the version number of this claim service line. The version number begins with 0 and is incremented by 1 for each subsequent version of that service line. No alpha or special characters. All 100% A0 7 Insured Group or Policy Number 11/8/12 Text ID Group varchar[30] Group / Policy Number Report the number that defines the insured group or policy. Do not report the number that uniquely identifies the subscriber or member. All 98%
v6-apcd-dental-claim-file-submission-guide-Redline-.docx