identify a provider and that provider’s affiliation, when applicable as well as the provider's practice location within this provider file. The following are the elements that are required to link to PV002: Provider File Link: Provider Affiliation; – Member Eligibility Links: ME036 Health Care Home ID; ME046 Member PCP – – ID; Medical Claim Links: MC024 Service Provider Number; MC076 Billing Provider – – Number; MC112 Referring Provider ID; MC125 Attending Provider; MC134 Plan – – – Rendering Provider Identifier; MC135 Provider Location; – Pharmacy Claim Links: PC043 Prescribing Provider ID; PC059 Recipient PCP ID; – – Dental Claim Link: DC018 Service Provider Number – Loading a record where PV002 = PV056 establishes a base record for a provider. All other instances of that PV002 value represent affiliations or additional locations for a provider. See the File Examples.xls” document for sample data. (Available at: “Provider ) New Data Elements Administrative Simplification, CHIA has worked with Division of Insurance, The Connector, Group Insurance Commission and our own internal departments to identify new elements to be added to the MA APCD Dataset to satisfy that goal. Below is a list of those elements, the submitter type expected to report them, the reason and the data expected within the element. PV065 Disbursement Code; – MassHealth only; to aid in payment methodology analysis
identify a provider and that provider’s affiliation, when applicable as well as the provider's practice location within this provider file. The following are the elements that are required to link to PV002: Provider File Link: – Provider Affiliation; Member Eligibility Links: ME036 – Health Care Home ID; ME046 – Member PCP ID; Medical Claim Links: MC024 – Service Provider Number; MC076 – Billing Provider Number; MC112 – Referring Provider ID; MC125 – Attending Provider; MC134 – Plan Rendering Provider Identifier; MC135 – Provider Location; Pharmacy Claim Links: PC043 – Prescribing Provider ID; PC059 – Recipient PCP ID; Dental Claim Link: DC018 – Service Provider Number Loading a record where PV002 = PV056 establishes a base record for a provider. All other instances of that PV002 value represent affiliations or additional locations for a provider. See the “Provider File Examples.xls” document for sample data. (Available at: ) New Data Elements Administrative Simplification, CHIA has worked with Division of Insurance, The Connector, Group Insurance Commission and our own internal departments to identify new elements to be added to the MA APCD Dataset to satisfy that goal. Below is a list of those elements, the submitter type expected to report them, the reason and the data expected within the element. PV065 – Disbursement Code; MassHealth only; to aid in payment methodology analysis
apcd-provider-file-submission-guide.docx