Data Element Date Maximum # Data Element Name Effective Type Length Description/Codes/Sources DC001 Submitter 1/1/2003 Text 8 MHDO-assigned identifier of payer submitting claims data. Do not blank. DC002 Payer 7/1/2012 Text 8 MHDO-assigned code of the insurer/ underwriter in the case of coverage, or of the administrator in the case of self-funded coverage. Do not leave blank. DC003 Insurance Type/Product Code 1/1/2003 Text 2 Code identifying the type of insurance policy within a specific insurance program. to Appendix A 1/1/2003 Text 35 Must apply to entire claim and be unique within the payer's DC004 Payer Claim Control Number system Line Counter 4/1/2004 Number 4 Line number for this service The line counter begins with 1 and is incremented by 1 for each additional service line of a claim. DC006 Insured Group or Policy Number 1/1/2003 Text 30 Group or policy number - not the number that uniquely identifies the subscriber DC007 Subscriber Social Security Number 1/1/2003 Text 9 Subscriber’s social security number Leave blank if unavailable. DC008 Plan Specific Contract Number 1/1/2003 Text 80 Plan assigned contract number Leave blank if contract number = subscriber’s social security number. DC009 Member Suffix or Sequence Number 1/1/2003 Text 20 Uniquely numbers the member within the contract DC010 Member Identification Code 1/1/2003 Text 50 Member’s social security number Leave blank if unavailable. Individual Relationship Code 1/1/2003 Text 2 Member's relationship to insured
Data Element Date Maximum # Data Element Name Effective Type Length Description/Codes/Sources DC001 Submitter 1/1/2003 Text 8 MHDO-assigned identifier of payer submitting claims data. Do not blank. DC002 Payer 7/1/2012 Text 8 MHDO-assigned code of the insurer/ underwriter in the case of coverage, or of the administrator in the case of self-funded coverage. Do not leave blank. DC003 Insurance Type/Product Code 1/1/2003 Text 2 Code identifying the type of insurance policy within a specific insurance program. to Appendix A DC004 Payer Claim Control Number 1/1/2003 Text 35 Must apply to entire claim and be unique within the payer's system Line Counter 4/1/2004 Number 4 Line number for this service The line counter begins with 1 and is incremented by 1 for each additional service line of a claim. DC006 Insured Group or Policy Number 1/1/2003 Text 30 Group or policy number - not the number that uniquely identifies the subscriber DC007 Subscriber Social Security Number 1/1/2003 Text 9 Subscriber’s social security number Leave blank if unavailable. DC008 Plan Specific Contract Number 1/1/2003 Text 80 Plan assigned contract number Leave blank if contract number = subscriber’s social security number. DC009 Member Suffix or Sequence Number 1/1/2003 Text 20 Uniquely numbers the member within the contract DC010 Member Identification Code 1/1/2003 Text 50 Member’s social security number Leave blank if unavailable. Individual Relationship Code 1/1/2003 Text 2 Member's relationship to insured
Chapter%20243_Proposed%20Rule_V3_110116.docx