1 Family planning services provided 2 Abortion services provided 3 Sterilization services provided 4 No family planning services provided 0 Unknown / Not Applicable / Not Avail Report the value that defines the Lookup Indicator - element. EXAMPLE: 1 = Yes, Claim MC Related 11/8/12 - int[1] All 100% A2 Accident Related Line was related to employment Indicator Integer accident. Value Description 1 Yes 2 No 3 Unknown 4 Other 5 Not Applicable Service related to Report the that defines if service Early Periodic was related to EPSDT and the type Lookup EPSDT Screening, of EPSDT service, such as MC 11/8/12 - int[1] All 98% B Indicator Diagnosis and 'screening', 'treatment' or ‘referral’. Integer Treatment EXAMPLE: 0 = Unknown / Not (EPSDT) Applicable Value Description 1 EPSDT Screen 2 EPSDT Treatment 3 EPSDT Referral Unknown / Not Applicable / Not 0 Available Procedure Lookup line Report the value that defines the type MC Code 10/30/14 Table - int[1] Procedure Code of Procedure Code expected in All 98% A1 Type Integer Type Identifier MC055. Value Description
1 Family planning services provided 2 Abortion services provided 3 Sterilization services provided 4 No family planning services provided 0 Unknown / Not Applicable / Not Avail MC Related Indicator 11/8/12 Lookup - Integer int[1] Indicator - Accident Related Report the value that defines the element. EXAMPLE: 1 = Yes, Claim Line was related to employment accident. All 100% A2 Value Description 1 Yes 2 No 3 Unknown 4 Other 5 Not Applicable MC EPSDT Indicator 11/8/12 Lookup - Integer int[1] Service related to Early Periodic Screening, Diagnosis and Treatment (EPSDT) Report the that defines if service was related to EPSDT and the type of EPSDT service, such as 'screening', 'treatment' or ‘referral’. EXAMPLE: 0 = Unknown / Not Applicable All 98% B Value Description 1 EPSDT Screen 2 EPSDT Treatment 3 EPSDT Referral 0 Unknown / Not Applicable / Not Available MC Procedure Code Type 10/30/14 Lookup Table - Integer int[1] line Procedure Code Type Identifier Report the value that defines the type of Procedure Code expected in MC055. All 98% A1 Value Description
apcd-medical-claim-file-submission-guide.docx