The MA APCD reserves this field for MC Filler 10/30/14 Filler Filler int[1] Filler All 0% Z future use. Do not populate. Lookup Report the value that defines the Referral Indicator - Referral MC 11/8/12 Table - int[1] element. EXAMPLE: 1 = Yes All 100% A0 18 Indicator Needed Integer service was preceded by a referral. Value Description 1 Yes 2 No 3 Unknown 4 Other 5 Not Applicable Report the value that defines the Lookup PCP Indicator - PCP element. EXAMPLE: 1 = Yes MC 11/8/12 Table - int[1] All 100% A2 Indicator Rendered Service service was performed by members Integer PCP. Value Description 1 Yes 2 No 3 Unknown 4 Other 5 Not Applicable External Diagnostic Required Code External Code DRG Related Group Report the level used for severity when MC 11/8/12 Source Source 15 - int[1] 80% B Level Code Severity adjustment when applicable. MC071 is 15 - DRG Level populated Integer
MC Filler 10/30/14 Filler Filler int[1] Filler The MA APCD reserves this field for future use. Do not populate. All 0% Z MC Referral Indicator 11/8/12 Lookup Table - Integer int[1] Indicator - Referral Needed Report the value that defines the element. EXAMPLE: 1 = Yes service was preceded by a referral. All 100% A0 Value Description 1 Yes 2 No 3 Unknown 4 Other 5 Not Applicable MC PCP Indicator 11/8/12 Lookup Table - Integer int[1] Indicator - PCP Rendered Service Report the value that defines the element. EXAMPLE: 1 = Yes service was performed by members PCP. All 100% A2 Value Description 1 Yes 2 No 3 Unknown 4 Other 5 Not Applicable MC DRG Level 11/8/12 External Code Source 15 - Integer External Code Source 15 - DRG int[1] Diagnostic Related Group Code Severity Level Report the level used for severity adjustment when applicable. Required when MC071 is populated 80% B 18
apcd-medical-claim-file-submission-guide.docx