Data Date Type Maximum Element Data Element Effective Length Description/Codes/Sources # Name MC001 Submitter 1/1/2003 Text 8 MHDO-assigned identifier of payer submitting claims data. Do not leave blank. 7/1/2012 Text 8 MHDO-assigned code of the MC002 Payer insurer/underwriter in the case of coverage, or of the administrator in the case of self-funded coverage. Do not leave blank. MC003 Insurance 1/1/2003 Text 2 Code identifying the type of Type/Product insurance policy within a Code specific insurance program. to Appendix A 16 Medicare Part C MD Medicare Part D SP Supplemental Policy MC004 Payer Claim 1/1/2003 Text 35 Must apply to the entire claim Control Number and be unique within the payer’s system MC005 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. MC005A Version Number 1/1/2010 Number 4 The version number of this claim service line.
Data Element # Data Element Name Date Effective Type Maximum Length Description/Codes/Sources MC001 Submitter 1/1/2003 Text 8 MHDO-assigned identifier of payer submitting claims data. Do not leave blank. MC002 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. MC003 Insurance Type/Product Code 1/1/2003 Text 2 Code identifying the type of insurance policy within a specific insurance program. to Appendix A 16 Medicare Part C MD Medicare Part D SP Supplemental Policy MC004 Payer Claim Control Number 1/1/2003 Text 35 Must apply to the entire claim and be unique within the payer’s system MC005 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. MC005A Version Number 1/1/2010 Number 4 The version number of this claim service line.
Chapter%20243_Proposed%20Rule_V4_12_15_16%20AAG%20edits.docx