Carrier Defined External Code Report the code that defines the Table - Source 16 - reason for denial of the claim line. Required Denial OR - Denial Reason Denial Reason MC 11/8/12 Carrier must submit denial reason when 98% A2 Reason External OR Code codes in separate table to the MA = 1 Code Carrier-Defined APCD. Source lookup 16 - Text Required when MC094 = Report the ID that reflects the 002 and provider that provided general MC036 = oversight of the patient's care. This 11, 18, 21, individual may or may not be the Attending Attending Provider 28, 41, 65, MC 10/30/14 Text ID Link to Servicing or Rendering provider. 98% A1 Provider ID 66, 84, 86 This needs to be found in field or 89 (type PV002 on the Provider File. This of bill field may or may not be NPI based indicates on the carrier’s identifier system. an inpatient visit) Lookup Report the value that defines the Accident Indicator - MC 11/8/12 - int[1] element. EXAMPLE: 1 = Yes, Claim All 100% A2 Indicator Accident Related Integer Line is Accident related. Description 1 Yes 2 No 3 Unknown 4 Other 5 Not Applicable Report the value that defines if family Family Lookup Service is related planning services were provided. MC Planning 11/8/12 - int[1] All 98% A2 to Family Planning EXAMPLE: 0 = Unknown / Not Indicator Integer Applicable Description
MC Denial Reason 11/8/12 Carrier Defined Table - OR - External Code Source 16 - Text External Code Source 16 - Denial Reason OR Carrier-Defined lookup Denial Reason Code Report the code that defines the reason for denial of the claim line. Carrier must submit denial reason codes in separate table to the MA APCD. Required when = 1 98% A2 MC Attending Provider 10/30/14 Text ID Link to Attending Provider ID Report the ID that reflects the provider that provided general oversight of the patient's care. This individual may or may not be the Servicing or Rendering provider. This needs to be found in field PV002 on the Provider File. This field may or may not be NPI based on the carrier’s identifier system. Required when MC094 = 002 and MC036 = 11, 18, 21, 28, 41, 65, 66, 84, 86 or 89 (type of bill indicates an inpatient visit) 98% A1 MC Accident Indicator 11/8/12 Lookup - Integer int[1] Indicator - Accident Related Report the value that defines the element. EXAMPLE: 1 = Yes, Claim Line is Accident related. All 100% A2 Description 1 Yes 2 No 3 Unknown 4 Other 5 Not Applicable MC Family Planning Indicator 11/8/12 Lookup - Integer int[1] Service is related to Family Planning Report the value that defines if family planning services were provided. EXAMPLE: 0 = Unknown / Not Applicable All 98% A2 Description
apcd-medical-claim-file-submission-guide.docx