Report the unique code which identifies for the carrier / submitter who or which individual provider Plan cared for the patient for the claim line Rendering Plan Rendering MC 11/8/12 Text ID Link to in question. This code must be able All 100% A0 Provider Number to link to the Provider File. Any value Identifier in this field must also show up as a value in field PV002 (Provider ID) on the Provider File. Report the unique code identifies the location / site of the service provided by the plan rendering provider identified in MC134. The code should link to a provider record in field PV002 (Provider ID) and indicate that the service was performed at a specific location; e.g.: Provider Location of Dr. Jones Pediatrics, 123 Main St, MC 11/8/12 Text ID Link to All 98% A2 Location Provider Boston, MA, or Pediatric Associates, or Mass General Hospital, etc. Only the code is needed in this field, and the link to the Provider ID in the field PV002 (Provider ID) will allow the physical address and other identifying information about the service location to be captured. Type of location is an incorrect value. External Codes Report the ICD diagnosis code as External Required Source 8 - applied to the patient upon Discharge Code ICD Discharge when MC 11/8/12 International varchar[7] discharge. This may or may not be 80% B Diagnosis Source 8 Diagnosis Code is Classification of the same as the primary diagnosis or - Text populated Diseases admitting diagnosis. Carrier Report the identifier the carrier / Specific submitter uses internally to uniquely ID Link to Member's Unique MC Unique 11/8/12 Text identify the member. Used to validate All 100% A0 ME107 ID Member Unique Member ID and link back to ID Member Eligibility
MC Plan Rendering Provider Identifier 11/8/12 Text ID Link to Plan Rendering Number Report the unique code which identifies for the carrier / submitter who or which individual provider cared for the patient for the claim line in question. This code must be able to link to the Provider File. Any value in this field must also show up as a value in field PV002 (Provider ID) on the Provider File. All 100% A0 MC Provider Location 11/8/12 Text ID Link to Location of Provider Report the unique code identifies the location / site of the service provided by the plan rendering provider identified in MC134. The code should link to a provider record in field PV002 (Provider ID) and indicate that the service was performed at a specific location; e.g.: Dr. Jones Pediatrics, 123 Main St, Boston, MA, or Pediatric Associates, or Mass General Hospital, etc. Only the code is needed in this field, and the link to the Provider ID in the field PV002 (Provider ID) will allow the physical address and other identifying information about the service location to be captured. Type of location is an incorrect value. All 98% A2 MC Discharge Diagnosis 11/8/12 External Code Source 8 - Text External Codes Source 8 - International Classification of Diseases varchar[7] ICD Discharge Diagnosis Code Report the ICD diagnosis code as applied to the patient upon discharge. This may or may not be the same as the primary diagnosis or admitting diagnosis. Required when is populated 80% B MC Carrier Specific Unique Member ID 11/8/12 Text ID Link to ME107 Member's Unique ID Report the identifier the carrier / submitter uses internally to uniquely identify the member. Used to validate Unique Member ID and link back to Member Eligibility All 100% A0
apcd-medical-claim-file-submission-guide.docx