Report the placement number of the diagnosis(es) a procedure is related to for a professional Can report up to four diagnostic positions within Required Diagnostic Diagnostic Pointer the first nine diagnoses that can be when MC 10/30/14 Integer ID Diagnosis varchar[4] 98% B Pointer Number reported. Do not separate multiple MC094 = mappings with spaces, zeros or 001 special characters. Do not zero fill. EXAMPLE: Procedure related to diagnoses 1, 4 and 5 = 145 or ADE Report the identifier of the provider that submitted the referral for the Referring service or ordered the test that is on Required ID Link to Referring Provider MC Provider 11/8/12 Text the claim (if applicable). The value when 98% A2 PV002 ID ID in this field must have a = 1 corresponding Provider ID (PV002) on the provider file. Report the that defines the Payment Lookup Payment contracted payment methodology for MC 11/8/12 Table - char[2] Arrangement Type All 98% A0 this claim line. EXAMPLE: 02 = Fee Type Numeric Value for Service Description 01 Capitation 02 Fee for Service Percent of Charges 04 DRG 05 Pay for Performance Global Payment Other Bundled Payment ( 09 Valid for HD002 = Payment Amount Per Episode 09 MassHealth (PAPE) (MassHealth) orgid ONLY )
MC Diagnostic Pointer 10/30/14 Integer ID Diagnosis varchar[4] Diagnostic Pointer Number Report the placement number of the diagnosis(es) a procedure is related to for a professional Can report up to four diagnostic positions within the first nine diagnoses that can be reported. Do not separate multiple mappings with spaces, zeros or special characters. Do not zero fill. EXAMPLE: Procedure related to diagnoses 1, 4 and 5 = 145 or ADE Required when MC094 = 001 98% B MC Referring Provider ID 11/8/12 Text ID Link to PV002 Referring Provider ID Report the identifier of the provider that submitted the referral for the service or ordered the test that is on the claim (if applicable). The value in this field must have a corresponding Provider ID (PV002) on the provider file. Required when = 1 98% A2 MC Payment Type 11/8/12 Lookup Table - Numeric char[2] Payment Arrangement Type Value Report the that defines the contracted payment methodology for this claim line. EXAMPLE: 02 = Fee for Service All 98% A0 Description 01 Capitation 02 Fee for Service Percent of Charges 04 DRG 05 Pay for Performance Global Payment Other Bundled Payment 09 Payment Amount Per Episode (PAPE) (MassHealth) ( 09 Valid for HD002 = MassHealth orgid ONLY )
apcd-medical-claim-file-submission-guide.docx