External Required External Code Diagnostic DRG Code Report the version of the grouper when MC 73 11/8/12 Source 15 - char[2] Related Group 20% B Version Source used. is DRG Version Number 15 - Text populated The MA APCD reserves this field for MC 74 Filler 10/30/14 Filler Filler char[4] Filler future use. Do not populate with any All 0% Z data. The MA APCD reserves this field for MC 75 Filler 10/30/14 Filler Filler char[2] Filler future use. Do not populate with any All 0% Z data. Report the NDC code used only when a medication is paid for as part of a medical claim or when a DME External External Code device has an NDC code. J codes Drug Code Source 12 - National Drug MC 76 6/24/10 char[11] should be submitted under procedure All 1% B Code Source National Drug Code (NDC) code (MC055), and have a procedure 12 - Text Codes code type of 'HCPCS'. Drug Code as defined by the FDA in 11 digit format (5-4-2) without hyphenation. Report the carrier / submitter assigned billing provider number. This number should be the identifier Billing ID Link to Billing Provider used for internal identification MC 77 Provider 6/24/10 Text All 99% B PV002 Number purposes, and does not routinely Number change. The value in this field must match a record in the provider file in PV002. External External Code National Provider Report the Primary National Provider National Code Source 3 - Identification (NPI) ID (NPI) here. This ID should be MC 78 Provider 10/30/14 int[10] All 99% A2 Source 3 National of the Billing found on the Provider File in the NPI ID - Billing - Integer Provider ID Provider field (PV039). Billing Provider Last name or Report the name of the organization Last Name Last / Organization MC 79 6/24/10 Text or last name of the individual All 99% B Name or Org Provider Name of Billing provider. Provider Name
MC 73 DRG Version 11/8/12 External Code Source 15 - Text External Code Source 15 - DRG char[2] Diagnostic Related Group Version Number Report the version of the grouper used. Required when is populated 20% B MC 74 Filler 10/30/14 Filler Filler char[4] Filler The MA APCD reserves this field for future use. Do not populate with any data. All 0% Z MC 75 Filler 10/30/14 Filler Filler char[2] Filler The MA APCD reserves this field for future use. Do not populate with any data. All 0% Z MC 76 Drug Code 6/24/10 External Code Source 12 - Text External Code Source 12 - National Drug Codes char[11] National Drug Code (NDC) Report the NDC code used only when a medication is paid for as part of a medical claim or when a DME device has an NDC code. J codes should be submitted under procedure code (MC055), and have a procedure code type of 'HCPCS'. Drug Code as defined by the FDA in 11 digit format (5-4-2) without hyphenation. All 1% B MC 77 Billing Provider Number 6/24/10 Text ID Link to PV002 Billing Provider Number Report the carrier / submitter assigned billing 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% B MC 78 National Provider ID - Billing 10/30/14 External Code Source 3 - Integer External Code Source 3 - National Provider ID int[10] National Provider Identification (NPI) of the Billing Provider Report the Primary National Provider ID (NPI) here. This ID should be found on the Provider File in the NPI field (PV039). All 99% A2 MC 79 Billing Provider Last Name or Name 6/24/10 Text Name Last / Org Provider Last name or Organization Name of Billing Provider Report the name of the organization or last name of the individual provider. All 99% B
apcd-medical-claim-file-submission-guide.docx