Service Report the individual's first name Required Provider Name First First name of here. If provider is a facility or MC 29 10/30/14 Text when 92% C First Provider Service Provider organization , do not report any value MC027 = 1 Name here Service Report the individual's middle initial Required Provider Name Middle Middle initial of here. If provider is a facility or MC 30 10/30/14 Text when 2% C Middle Provider Service Provider organization , do not report any MC027 = 1 Initial here Servicing Report the name of the organization Provider Last name or or last name of the individual Last Name Last / Organization MC 31 6/24/10 Text provider. determines if this is an All 94% A2 Name or Org Provider Name of Service Organization or Individual Name Provider reported here. Name Report the individuals name-suffix when applicable here. Used to Service Lookup capture the generation of the Required Provider Name MC 32 Provider 10/30/14 - int[1] individual clinician (e.g., Jr. Sr., III). when 2% Z Suffix Suffix Integer Do not report degree acronyms here. MC027 = 1 EXAMPLE: 0 = Unknown / Not Applicable Description 1 I. 2 II. 3 III. 4 Jr. 5 Sr. 0 Unknown / Not Applicable Report the standard code that defines this provider for this line of External Service External Code service. Taxonomy values for Code MC 33 Provider 11/8/12 Source 5 - Taxonomy Code the reporting of nurses, assistants All 98% A2 Source 5 Taxonomy Taxonomy and laboratory technicians, where - Text applicable, as well as Physicians, Medical Groups, Facilities, etc.
MC 29 Service Provider First Name 10/30/14 Text Name First Provider First name of Service Provider Report the individual's first name here. If provider is a facility or organization , do not report any value here Required when MC027 = 1 92% C MC 30 Service Provider Middle Initial 10/30/14 Text Name Middle Provider Middle initial of Service Provider Report the individual's middle initial here. If provider is a facility or organization , do not report any here Required when MC027 = 1 2% C MC 31 Servicing Provider Last Name or Name 6/24/10 Text Name Last / Org Provider Last name or Organization Name of Service Provider Report the name of the organization or last name of the individual provider. determines if this is an Organization or Individual Name reported here. All 94% A2 MC 32 Service Provider Suffix 10/30/14 Lookup - Integer int[1] Provider Name Suffix Report the individuals name-suffix when applicable here. Used to capture the generation of the individual clinician (e.g., Jr. Sr., III). Do not report degree acronyms here. EXAMPLE: 0 = Unknown / Not Applicable Required when MC027 = 1 2% Z Description 1 I. 2 II. 3 III. 4 Jr. 5 Sr. 0 Unknown / Not Applicable MC 33 Service Provider Taxonomy 11/8/12 External Code Source 5 - Text External Code Source 5 - Taxonomy Taxonomy Code Report the standard code that defines this provider for this line of service. Taxonomy values for the reporting of nurses, assistants and laboratory technicians, where applicable, as well as Physicians, Medical Groups, Facilities, etc. All 98% A2
apcd-medical-claim-file-submission-guide.docx