The MA APCD reserves this for MC 23 Filler 10/30/14 Filler Filler char[4] Filler future use. Do not populate with any All 0% Z data. Required External External Code when Code Inpatient Report the appropriate Discharge Discharge Source 14 - MC094 = MC 24 11/8/12 Source char[2] Discharge Status Status Code of the patient as defined 98% A1 Status Discharge 002 and 14 - Code by External Code Source Status MC069 is Numeric populated Report the carrier / submitter assigned service provider number. This number should be the identifier Service Service Provider ID Link to used for internal identification MC 25 Provider 6/24/10 Text Identification All 99% A1 24 PV002 purposes, and does not routinely Number Number change. The value in this field must match a record in the provider file in PV002. Service Report the Federal Tax ID of the Provider Service Provider's MC 26 11/8/12 Numeric ID Tax char[9] Service Provider here. Do not use All 97% C Tax ID Tax ID number hyphen or alpha prefix. Number Report the Primary National Provider National External External Code National Provider ID (NPI) of the Service Provider in Provider Code Source 3 - Identification (NPI) MC 27 10/30/14 int[10] MC024. This ID should be found on All 98% A2 ID - Source 3 National of the Service the Provider File in the NPI Field Service - Integer Provider ID Provider (PV039) Report the value that defines the Service Service Provider entity type. Only Provider Lookup Service Provider individuals should be identified with a MC 28 Entity 11/8/12 Table - int[1] Entity Identifier All 98% A0 1. Facilities, professional groups and Type integer Code clinic sites should all be identified Qualifier with a 2. EXAMPLE: 1 = Person Value Description 1 Person 2 Non-person entity
MC 23 Filler 10/30/14 Filler Filler char[4] Filler The MA APCD reserves this for future use. Do not populate with any data. All 0% Z MC 24 Discharge Status 11/8/12 External Code Source 14 - Numeric External Code Source 14 - Discharge Status char[2] Inpatient Discharge Status Code Report the appropriate Discharge Status Code of the patient as defined by External Code Source Required when MC094 = 002 and MC069 is populated 98% A1 MC 25 Service Provider Number 6/24/10 Text ID Link to PV002 Service Provider Identification Number Report the carrier / submitter assigned service provider number. This number should be the identifier used for internal identification purposes, and does not routinely change. The value in this field must match a record in the provider file in PV002. All 99% A1 MC 26 Service Provider Tax ID Number 11/8/12 Numeric ID Tax char[9] Service Provider's Tax ID number Report the Federal Tax ID of the Service Provider here. Do not use hyphen or alpha prefix. All 97% C MC 27 National Provider ID - Service 10/30/14 External Code Source 3 - Integer External Code Source 3 - National Provider ID int[10] National Provider Identification (NPI) of the Service Provider Report the Primary National Provider ID (NPI) of the Service Provider in MC024. This ID should be found on the Provider File in the NPI Field (PV039) All 98% A2 MC 28 Service Provider Entity Type Qualifier 11/8/12 Lookup Table - integer int[1] Service Provider Entity Identifier Code Report the value that defines the Service Provider entity type. Only individuals should be identified with a 1. Facilities, professional groups and clinic sites should all be identified with a 2. EXAMPLE: 1 = Person All 98% A0 Value Description 1 Person 2 Non-person entity 24
apcd-medical-claim-file-submission-guide.docx