0 Unknown / Not Applicable National Provider Report the Primary National Provider National External External Code Indentification ID (NPI) of the Plan Rendering Provider Code Source 3 – MC 10/30/14 Int[10] (NPI) of the Plan Provider in MC134. This ID should All 98% A2 ID Plan Source 3 National – Rendering be found on the Provider File in the Rendering Integer Provider ID – Provider NPI Field (PV039) The Benefit Plan Contract ID is the issuer-generated unique ID number for the benefit plan provides Required coverage for this claim. when Identifier for the Report the carrier/submitter-assigned Carrier is Benefit benefit plan the identifier as it appears in BP001 in BP Plan MC 10/30/14 Text member is the Benefit Plan File. This element is submitter 100% A2 Contract Benefit Plan ID enrolled in that used to understand Benefit Plan, and claim ID covers this claim Eligibility and Claim attributes of the is subject member / subscriber as applied to to Risk this record for the Massachusetts Adjustment Alternative Risk Adjustment Methodology. Lookup Report the that defines the Claim Line Claim Line Paid MC 10/30/14 Table - int[1] element. EXAMPLE: 1 = Yes, Claim Required 100% B Paid Flag Indicator Integer Line was paid. Value Description 1 Yes 2 No 3 Unknown 4 Other 5 Not Applicable Lookup Type of Type of Facility Report the value that defines the type MC 10/30/14 Table - int[2] Required 98% B Facility Indicator of facility setting for this claim. Integer
0 Unknown / Not Applicable MC National Provider ID – Plan Rendering 10/30/14 External Code Source 3 – Integer External Code Source 3 – National Provider ID Int[10] National Provider Indentification (NPI) of the Plan Rendering Provider Report the Primary National Provider ID (NPI) of the Plan Rendering Provider in MC134. This ID should be found on the Provider File in the NPI Field (PV039) All 98% A2 MC Benefit Plan Contract ID 10/30/14 Text Benefit Plan ID Identifier for the benefit plan the member is enrolled in that covers this claim The Benefit Plan Contract ID is the issuer-generated unique ID number for the benefit plan provides coverage for this claim. Report the carrier/submitter-assigned identifier as it appears in BP001 in the Benefit Plan File. This element is used to understand Benefit Plan, Eligibility and Claim attributes of the member / subscriber as applied to this record for the Massachusetts Alternative Risk Adjustment Methodology. Required when Carrier is BP submitter and claim is subject to Risk Adjustment 100% A2 MC Claim Line Paid Flag 10/30/14 Lookup Table - Integer int[1] Claim Line Paid Indicator Report the that defines the element. EXAMPLE: 1 = Yes, Claim Line was paid. Required 100% B Value Description 1 Yes 2 No 3 Unknown 4 Other 5 Not Applicable MC Type of Facility 10/30/14 Lookup Table - Integer int[2] Type of Facility Indicator Report the value that defines the type of facility setting for this claim. Required 98% B
apcd-medical-claim-file-submission-guide.docx