Provider provider number. This number Number should be the identifier used by the payer for internal identification purposes, and does not routinely change. 2/1/2016 Text 20 National Provider ID for MC121 National Provider ID referring provider – Referring Refer to Appendix A Provider Referring 2/1/2016 Text 40 Individual first name Provider Name MC123 Referring 2/1/2016 Text 25 Individual middle name or initial Provider Middle Name MC124 Referring 2/1/2016 Text 60 Individual last name Provider Last Name 2/1/2016 Text 10 Individual name suffix Referring Provider Suffix The referring provider suffix be used to capture the generation of the individual clinician (e.g., Jr., Sr., III), if applicable, rather than the clinician’s degree (e.g., MD, LCSW). MC200 Principal 10/1/2014 Text 7 ICD-10-CM Do not code Diagnosis decimal point. to Appendix A
Provider Number provider number. This number should be the identifier used by the payer for internal identification purposes, and does not routinely change. MC121 National Provider ID – Referring Provider 2/1/2016 Text 20 National Provider ID for referring provider Refer to Appendix A Referring Provider Name 2/1/2016 Text 40 Individual first name MC123 Referring Provider Middle Name 2/1/2016 Text 25 Individual middle name or initial MC124 Referring Provider Last Name 2/1/2016 Text 60 Individual last name Referring Provider Suffix 2/1/2016 Text 10 Individual name suffix The referring provider suffix be used to capture the generation of the individual clinician (e.g., Jr., Sr., III), if applicable, rather than the clinician’s degree (e.g., MD, LCSW). MC200 Principal Diagnosis 10/1/2014 Text 7 ICD-10-CM Do not code decimal point. to Appendix A
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