Required when GIC Report the GIC Assigned Provider GIC Provider Link ID Submitter PV 41 Provider 11/8/12 Text ID GIC Link ID. If not applicable, do not 0% B for GIC Carriers only is identified Link ID report any value here. as a GIC Submitter Report the submitter's proprietary Required specialty code for the provider here. Carrier when Proprietary additional specialty code for a Defined Carrier Defined = 0, 1, 2, 3, PV 42 Specialty Specialty Code provider should be populated in 90% A Table - Table - Specialty 4, or 5 and Code elements PV043 and PV044. Value Text PV030 is comes from a Carrier Defined Table blank only. Carrier See mapping notes for primary Defined External Code specialty code in PV030. Known Required Table - Source 4 – Other additional specialty code for a when OR - Specialties PV 43 Specialty 11/8/12 Specialty Code provider should be populated in this PV034 = 0, 0% B External - OR – Code 2 element. Value can come from 1, 2, 3, 4, Code Carrier Defined either a Carrier Defined Table or the or 5 Source 4 External Code Source. - Integer Carrier See mapping notes for primary Defined External Code specialty code in PV030. Known Required Table - Source 4 - Other additional specialty code for a when OR - Specialties PV 44 Specialty 11/8/12 Specialty Code provider should be populated in this PV034 = 0, 0% B External - OR – Code 3 element. Value can come from 1, 2, 3, 4, Code Carrier Defined either a Carrier Defined Table or the or 5 Source 4 External Code Source. - Integer Report the that defines the element. Pay-for-performance bonuses or year-end withhold Required Pay for Lookup Indicator - Provider returns based on performance for at when PV 45 11/8/12 Table - int[1] 100% A2 Contract Payment least one service performed by this PV034 = 1, Flag Integer provider within the month. 2, or 3 EXAMPLE: 1 = Yes, provider has a contract incentive. Value Description 1 Yes
PV 41 GIC Provider Link ID 11/8/12 Text ID GIC GIC Provider Link ID for GIC Carriers only Report the GIC Assigned Provider Link ID. If not applicable, do not report any value here. Required when Submitter is identified as a GIC Submitter 0% B PV 42 Proprietary Specialty Code Carrier Defined Table - Text Carrier Defined Table - Specialty Specialty Code Report the submitter's proprietary specialty code for the provider here. additional specialty code for a provider should be populated in elements PV043 and PV044. Value comes from a Carrier Defined Table only. Required when = 0, 1, 2, 3, 4, or 5 and PV030 is blank 90% A PV 43 Other Specialty Code 2 11/8/12 Carrier Defined Table - OR - External Code Source 4 - Integer External Code Source 4 – Specialties - OR – Carrier Defined Specialty Code See mapping notes for primary specialty code in PV030. Known additional specialty code for a provider should be populated in this element. Value can come from either a Carrier Defined Table or the External Code Source. Required when PV034 = 0, 1, 2, 3, 4, or 5 0% B PV 44 Other Specialty Code 3 11/8/12 Carrier Defined Table - OR - External Code Source 4 - Integer External Code Source 4 - Specialties - OR – Carrier Defined Specialty Code See mapping notes for primary specialty code in PV030. Known additional specialty code for a provider should be populated in this element. Value can come from either a Carrier Defined Table or the External Code Source. Required when PV034 = 0, 1, 2, 3, 4, or 5 0% B PV 45 Pay for Flag 11/8/12 Lookup Table - Integer int[1] Indicator - Provider Contract Payment Report the that defines the element. Pay-for-performance bonuses or year-end withhold returns based on performance for at least one service performed by this provider within the month. EXAMPLE: 1 = Yes, provider has a contract incentive. Required when PV034 = 1, 2, or 3 100% A2 Value Description 1 Yes
apcd-provider-file-submission-guide.docx