USHIK: APCD File Submission Comparison

File Submission Comparison

Selected Items

Item Name	Version	State	Type	Organization
Pharmacy Claims File Submission	December 1, 2010 - v2.1	Massachusetts	File Specification	Massachusetts Center for Health Information and Analysis (MCHIA)
Pharmacy Claims File Submission	June 7, 2013 - v3.1	Massachusetts	File Specification	Massachusetts Center for Health Information and Analysis (MCHIA)
Pharmacy Claims File Submission	October 1, 2014 - v4.0	Massachusetts	File Specification	Massachusetts Center for Health Information and Analysis (MCHIA)

Identifying Attributes

File Specification:	Pharmacy Claims File Submission - December 1, 2010 - v2.1 (Massachusetts)	Pharmacy Claims File Submission - June 7, 2013 - v3.1 (Massachusetts)	Pharmacy Claims File Submission - October 1, 2014 - v4.0 (Massachusetts)
Responsible Organization:	Massachusetts Center for Health Information and Analysis	Massachusetts Center for Health Information and Analysis	Massachusetts Center for Health Information and Analysis
Definition:	A MA APCD File Type for reporting all Paid Pharmacy Claim Lines of a given time period. File accommodates Replacement and Void lines.	A MA APCD File Type for reporting all Paid Pharmacy Claim Lines of a given time period. File accommodates Replacement and Void lines.	A MA APCD File Type for reporting all Paid Pharmacy Claim Lines of a given time period. File accommodates Replacement and Void lines.

Data Elements & Codes

File Specification:

Pharmacy Claims File Submission - December 1, 2010 - v2.1 (Massachusetts)

Pharmacy Claims File Submission - June 7, 2013 - v3.1 (Massachusetts)

Pharmacy Claims File Submission - October 1, 2014 - v4.0 (Massachusetts)

HD001

Name:	Record Type
Type:	Text
Length:	2
Codes:
HD

Name:	Record Type
Type:	Text
Length:	2
Codes:
HD	Header Elements

Name:	Record Type
Type:	Text
Length:	2
Codes:
HD	Header Elements

HD002

Name:	Payer
Type:	Text
Length:	8

Name:	Submitter
Type:	Integer
Length:	6

Name:	Submitter
Type:	Integer
Length:	6

HD003

Name:	National Plan ID
Type:	Text
Length:	30

Name:	National Plan ID
Type:	Integer
Length:	10

Name:	National Plan ID
Type:	Integer
Length:	10

HD004

Name:	Type of File
Type:	Text
Length:	2
Codes:
PC

Name:	Type of File
Type:	Text
Length:	2
Codes:
PC	PHARMACY CLAIM

Name:	Type of File
Type:	Text
Length:	2
Codes:
PC	PHARMACY CLAIM

HD005

Name:	Period Beginning Date
Type:	Date Period
Length:	6

Name:	Period Beginning Date
Type:	Date Period - Integer
Length:	6

Name:	Period Beginning Date
Type:	Date Period - Integer
Length:	6

HD006

Name:	Period Ending Date
Type:	Date Period
Length:	6

Name:	Period Ending Date
Type:	Date Period - Integer
Length:	6

Name:	Period Ending Date
Type:	Date Period - Integer
Length:	6

HD007

Name:	Record Count
Type:	Integer
Length:	10

Name:	Record Count
Type:	Integer
Length:	10

Name:	Record Count
Type:	Integer
Length:	10

HD008

Name:	Comments
Type:	Text
Length:	80

Name:	Comments
Type:	Text
Length:	80

Name:	Comments
Type:	Text
Length:	80

HD009

Data Element: HD009
not present in this file submission.

Name:	APCD Version Number
Type:	Decimal - Numeric
Length:	3
Codes:
2.1	Prior Version; valid only for reporting periods prior to October 2013
3.0	Current Version; required for reporting periods as of October 2013

Name:	APCD Version Number
Type:	Decimal - Numeric
Length:	3
Codes:
2.1	Prior Version; valid only for reporting periods prior to October 2013
3.0	Version 3.0; required for reporting periods as of October 2013 No longer valid as of May 2015
4.0	Version 4.0; required for reporting periods October 2013 onward as of May 2015

PC001

Name:	Payer
Type:	Text
Length:	8

Name:	Submitter
Type:	Integer
Length:	6

Name:	Submitter
Type:	Integer
Length:	6

PC002

Name:	Plan ID
Type:	Text
Length:	30

Name:	National Plan ID
Type:	Integer
Length:	10

Name:	National Plan ID
Type:	Integer
Length:	10

PC003

Name:	Insurance Type Code/Product
Type:	Text
Length:	2
Codes:
09	Self-pay
10	Central Certification
11	Other Non-Federal Programs
12	Preferred Provider Organization (PPO)
13	Point of Service (POS)
14	Exclusive Provider Organization (EPO)
15	Indemnity Insurance
16	Health Maintenance Organization (HMO) Medicare Risk
17	Dental Maintenance Organization (DMO)
AM	Automobile Medical
BL	Blue Cross / Blue Shield
CC	Commonwealth Care
CE	Commonwealth Choice
CH	Champus
CI	Commercial Insurance Co.
DS	Disability
HM	Health Maintenance Organization
LI	Liability
LM	Liability Medical
MA	Medicare Part A
MB	Medicare Part B
MC	Medicaid
OF	Other Federal Program

TV	Title V
VA	Veterans Administration Plan
WC	Workers' Compensation

Name:	Insurance Type Code/Product
Type:	Lookup Table - Text
Length:	2
Codes:
09	Self-pay
10	Central Certification
11	Other Non-Federal Programs
12	Preferred Provider Organization (PPO)
13	Point of Service (POS)
14	Exclusive Provider Organization (EPO)
15	Indemnity Insurance
16	Health Maintenance Organization (HMO) Medicare Risk
17	Dental Maintenance Organization (DMO)
AM	Automobile Medical
BL	Blue Cross / Blue Shield
CC	Commonwealth Care
CE	Commonwealth Choice
CH	Champus
CI	Commercial Insurance Co.
DS	Disability
HM	Health Maintenance Organization
LI	Liability
LM	Liability Medical
MA	Medicare Part A
MB	Medicare Part B
MC	Medicaid
OF	Other Federal Program
TF	HSN Trust Fund
TV	Title V
VA	Veterans Administration Plan
WC	Workers' Compensation
ZZ	Other

Name:	Insurance Type Code/Product
Type:	Lookup Table - Text
Length:	2
Codes:
09	Self-pay
10	Central Certification
11	Other Non-Federal Programs
12	Preferred Provider Organization (PPO)
13	Point of Service (POS)
14	Exclusive Provider Organization (EPO)
15	Indemnity Insurance
16	Health Maintenance Organization (HMO) Medicare Risk
17	Dental Maintenance Organization (DMO)
AM	Automobile Medical
BL	Blue Cross / Blue Shield
CC	Commonwealth Care
CE	Commonwealth Choice
CH	Champus
CI	Commercial Insurance Co.
DS	Disability
HM	Health Maintenance Organization
LI	Liability
LM	Liability Medical
MA	Medicare Part A
MB	Medicare Part B
MC	Medicaid
OF	Other Federal Program
TF	HSN Trust Fund
TV	Title V
VA	Veterans Administration Plan
WC	Workers' Compensation
ZZ	Other

PC004

Name:	Payer Claim Control Number
Type:	Text
Length:	35

Name:	Payer Claim Control Number
Type:	Text
Length:	35

Name:	Payer Claim Control Number
Type:	Text
Length:	35

PC005

Name:	Line Counter
Type:	Integer
Length:	4

Name:	Line Counter
Type:	Integer
Length:	4

Name:	Line Counter
Type:	Integer
Length:	4

PC005A

Name:	Version Number
Type:	Integer
Length:	4

Name:	Version Number
Type:	Integer
Length:	4

Name:	Version Number
Type:	Integer
Length:	4

PC006

Name:	Insured Group or Policy Number
Type:	Text
Length:	30

Name:	Insured Group or Policy Number
Type:	Text
Length:	30

Name:	Insured Group or Policy Number
Type:	Text
Length:	30

PC007

Name:	Subscriber SSN
Type:	Text
Length:	9

Name:	Subscriber SSN
Type:	Numeric
Length:	9

Name:	Subscriber SSN
Type:	Numeric
Length:	9

PC008

Name:	Plan Specific Contract Number
Type:	Text
Length:	30

Name:	Plan Specific Contract Number
Type:	Text
Length:	30

Name:	Plan Specific Contract Number
Type:	Text
Length:	30

PC009

Name:	Member Suffix or Sequence Number
Type:	Text
Length:	20

Name:	Member Suffix or Sequence Number
Type:	Text
Length:	20

Name:	Member Suffix or Sequence Number
Type:	Text
Length:	20

PC010

Name:	Member SSN
Type:	Text
Length:	9

Name:	Member SSN
Type:	Numeric
Length:	9

Name:	Member SSN
Type:	Numeric
Length:	9

PC011

Name:	Individual Relationship Code
Type:	Integer
Length:	2
Codes:
1	Spouse
4	Grandfather or Grandmother
5	Grandson or Granddaughter
7	Nephew or Niece




10	Foster Child
15	Ward
17	Stepson or Stepdaughter
19	Child
20	Self/Employee
21	Unknown
22	Handicapped Dependent
23	Sponsored Dependent
24	Dependent of a Minor Dependent
29	Significant Other
32	Mother
33	Father
36	Emancipated Minor
39	Organ Donor
40	Cadaver Donor
41	Injured Plaintiff
43	Child Where Insured Has No Financial Responsibility
53	Life Partner
76	Dependent

Name:	Individual Relationship Code
Type:	Lookup Table - Text
Length:	2
Codes:




01	Spouse
04	Grandfather or Grandmother
05	Grandson or Granddaughter
07	Nephew or Niece
10	Foster Child
15	Ward
17	Stepson or Stepdaughter
19	Child
20	Self/Employee
21	Unknown
22	Handicapped Dependent
23	Sponsored Dependent
24	Dependent of a Minor Dependent
29	Significant Other
32	Mother
33	Father
36	Emancipated Minor
39	Organ Donor
40	Cadaver Donor
41	Injured Plaintiff
43	Child Where Insured Has No Financial Responsibility
53	Life Partner
76	Dependent

Name:	Individual Relationship Code
Type:	Lookup Table - Text
Length:	2
Codes:




01	Spouse
04	Grandfather or Grandmother
05	Grandson or Granddaughter
07	Nephew or Niece
10	Foster Child
15	Ward
17	Stepson or Stepdaughter
19	Child
20	Self/Employee
21	Unknown
22	Handicapped Dependent
23	Sponsored Dependent
24	Dependent of a Minor Dependent
29	Significant Other
32	Mother
33	Father
36	Emancipated Minor
39	Organ Donor
40	Cadaver Donor
41	Injured Plaintiff
43	Child Where Insured Has No Financial Responsibility
53	Life Partner
76	Dependent

PC012

Name:	Member Gender
Type:	Text
Length:	1
Codes:
F	Female
M	Male
O	Other
U	Unknown

Name:	Member Gender
Type:	Lookup Table - Text
Length:	1
Codes:
F	Female
M	Male
O	Other
U	Unknown

Name:	Member Gender
Type:	Lookup Table - Text
Length:	1
Codes:
F	Female
M	Male
O	Other
U	Unknown

PC013

Name:	Member Date of Birth
Type:	Date
Length:	8

Name:	Member Date of Birth
Type:	Full Date - Integer
Length:	8

Name:	Member Date of Birth
Type:	Full Date - Integer
Length:	8

PC014

Name:	Member City Name of Residence
Type:	Text
Length:	50

Name:	Member City Name of Residence
Type:	Text
Length:	50

Name:	Member City Name of Residence
Type:	Text
Length:	50

PC015

Name:	Member State
Type:	Text
Length:	2

Name:	Member State
Type:	External Code Source 2 - Text
Length:	2

Name:	Member State
Type:	External Code Source 2 - Text
Length:	2

PC016

Name:	Member ZIP Code
Type:	Text
Length:	11

Name:	Member ZIP Code
Type:	External Code Source 2 - Text
Length:	9

Name:	Member ZIP Code
Type:	External Code Source 2 - Text
Length:	9

PC017

Name:	Date Service Approved (AP Date)
Type:	Date
Length:	8

Name:	Date Service Approved (AP Date)
Type:	Full Date - Integer
Length:	8

Name:	Date Service Approved (AP Date)
Type:	Full Date - Integer
Length:	8

PC018

Name:	Pharmacy Number
Type:	Text
Length:	30

Name:	Pharmacy Number
Type:	Text
Length:	30

Name:	Pharmacy Number
Type:	Text
Length:	30

PC019

Name:	Pharmacy Tax ID Number
Type:	Text
Length:	10

Name:	Pharmacy Tax ID Number
Type:	Numeric
Length:	9

Name:	Pharmacy Tax ID Number
Type:	Numeric
Length:	9

PC020

Name:	Pharmacy Name
Type:	Text
Length:	100

Name:	Pharmacy Name
Type:	Text
Length:	100

Name:	Pharmacy Name
Type:	Text
Length:	100

PC021

Name:	National Pharmacy ID Number
Type:	Text
Length:	20

Name:	National Provider ID - Pharmacy
Type:	External Code Source 3 - Integer
Length:	10

Name:	National Provider ID - Pharmacy
Type:	External Code Source 3 - Integer
Length:	10

PC022

Name:	Pharmacy Location City
Type:	Text
Length:	30

Name:	Pharmacy Location City
Type:	Text
Length:	30

Name:	Pharmacy Location City
Type:	Text
Length:	30

PC023

Name:	Pharmacy Location State
Type:	Text
Length:	2

Name:	Pharmacy Location State
Type:	External Code Source 2 - Text
Length:	2

Name:	Pharmacy Location State
Type:	External Code Source 2 - Text
Length:	2

PC024

Name:	Pharmacy ZIP Code
Type:	Text
Length:	11

Name:	Pharmacy ZIP Code
Type:	External Code Source 2 - Text
Length:	9

Name:	Pharmacy ZIP Code
Type:	External Code Source 2 - Text
Length:	9

PC024A

Name:	Pharmacy Country Code
Type:	Text
Length:	3

Name:	Pharmacy Country Code
Type:	External Code Source 1 - Text
Length:	3

Name:	Pharmacy Country Code
Type:	External Code Source 1 - Text
Length:	3

PC025

Name:	Claim Status
Type:	Integer
Length:	2
Codes:




01	Processed as primary
02	Processed as secondary
03	Processed as tertiary
04	Denied
19	Processed as primary, forwarded to additional payer(s)
20	Processed as secondary, forwarded to additional payer(s)
21	Processed as tertiary, forwarded to additional payer(s)
22	Reversal of previous payment

Name:	Claim Status
Type:	Lookup Table - Numeric
Length:	2
Codes:
1	Processed as primary
2	Processed as secondary
3	Processed as tertiary
4	Denied




19	Processed as primary, forwarded to additional payer(s)
20	Processed as secondary, forwarded to additional payer(s)
21	Processed as tertiary, forwarded to additional payer(s)
22	Reversal of previous payment
23	Not our claim, forwarded to additional payer(s)
25	Predetermination Pricing Only - no payment

Name:	Claim Status
Type:	Lookup Table - Numeric
Length:	2
Codes:
1	Processed as primary
2	Processed as secondary
3	Processed as tertiary
4	Denied




19	Processed as primary, forwarded to additional payer(s)
20	Processed as secondary, forwarded to additional payer(s)
21	Processed as tertiary, forwarded to additional payer(s)
22	Reversal of previous payment
23	Not our claim, forwarded to additional payer(s)
25	Predetermination Pricing Only - no payment

PC026

Name:	Drug Code
Type:	Text
Length:	11

Name:	Drug Code
Type:	External Code Source 12 - Text
Length:	11

Name:	Drug Code
Type:	External Code Source 12 - Text
Length:	11

PC027

Name:	Drug Name
Type:	Text
Length:	80

Name:	Drug Name
Type:	External Code Source 12 - Text
Length:	80

Name:	Drug Name
Type:	External Code Source 12 - Text
Length:	80

PC028

Name:	New Prescription or Refill
Type:	Integer
Length:	2

Name:	New Prescription or Refill
Type:	Numeric
Length:	2

Name:	New Prescription or Refill
Type:	Numeric
Length:	2

PC029

Name:	Generic Drug Indicator
Type:	Text
Length:	1
Codes:
1	Yes
2	No
3	Unknown
4	Other
5	Not Applicable

Name:	Generic Drug Indicator
Type:	Lookup Table - Integer
Length:	1
Codes:
1	Yes
2	No
3	Unknown
4	Other
5	Not Applicable

Name:	Generic Drug Indicator
Type:	Lookup Table - Integer
Length:	1
Codes:
1	Yes
2	No
3	Unknown
4	Other
5	Not Applicable

PC030

Name:	Dispense as Written Code
Type:	Integer
Length:	1
Codes:
0	Not dispensed as written
1	Physician dispense as written
2	Member dispense as written
3	Pharmacy dispense as written
4	No generic available
5	Brand dispensed as generic
6	Override
7	Substitution not allowed, brand drug mandated by law
8	Substitution allowed, generic drug not available in marketplace
9	Other

Name:	Dispense as Written Code
Type:	Lookup Table - Integer
Length:	1
Codes:
0	Not dispensed as written
1	Physician dispense as written
2	Member dispense as written
3	Pharmacy dispense as written
4	No generic available
5	Brand dispensed as generic
6	Override
7	Substitution not allowed, brand drug mandated by law
8	Substitution allowed, generic drug not available in marketplace
9	Other

Name:	Dispense as Written Code
Type:	Lookup Table - Integer
Length:	1
Codes:
0	Not dispensed as written
1	Physician dispense as written
2	Member dispense as written
3	Pharmacy dispense as written
4	No generic available
5	Brand dispensed as generic
6	Override
7	Substitution not allowed, brand drug mandated by law
8	Substitution allowed, generic drug not available in marketplace
9	Other

PC031

Name:	Compound Drug Indicator
Type:	Text
Length:	1
Codes:
1	Yes
2	No
3	Unknown
4	Other
5	Not Applicable

Name:	Compound Drug Indicator
Type:	Lookup Table - Integer
Length:	1
Codes:
1	Yes
2	No
3	Unknown
4	Other
5	Not Applicable

Name:	Compound Drug Indicator
Type:	Lookup Table - Integer
Length:	1
Codes:
1	Yes
2	No
3	Unknown
4	Other
5	Not Applicable

PC032

Name:	Date Prescription Filled
Type:	Date
Length:	8

Name:	Date Prescription Filled
Type:	Full Date - Integer
Length:	8

Name:	Date Prescription Filled
Type:	Full Date - Integer
Length:	8

PC033

Name:	Quantity Dispensed
Type:	Integer
Length:	10

Name:	Quantity Dispensed
Type:	Quantity - Integer
Length:	10

Name:	Quantity Dispensed
Type:	Quantity - Integer
Length:	10

PC034

Name:	Days Supply
Type:	Integer
Length:	3

Name:	Day's Supply
Type:	Quantity - Integer
Length:	4

Name:	Day's Supply
Type:	Quantity - Integer
Length:	4

PC035

Name:	Charge Amount
Type:	Integer
Length:	10

Name:	Charge Amount
Type:	Integer
Length:	10

Name:	Charge Amount
Type:	Integer
Length:	10

PC036

Name:	Paid Amount
Type:	Integer
Length:	10

Name:	Paid Amount
Type:	Integer
Length:	10

Name:	Paid Amount
Type:	Integer
Length:	10

PC037

Name:	Ingredient Cost/List Price
Type:	Integer
Length:	10

Name:	Ingredient Cost/List Price
Type:	Integer
Length:	10

Name:	Ingredient Cost/List Price
Type:	Integer
Length:	10

PC038

Name:	Postage Amount Claimed
Type:	Integer
Length:	10

Name:	Postage Amount Claimed
Type:	Integer
Length:	10

Name:	Postage Amount Claimed
Type:	Integer
Length:	10

PC039

Name:	Dispensing Fee
Type:	Integer
Length:	10

Name:	Dispensing Fee
Type:	Integer
Length:	10

Name:	Dispensing Fee
Type:	Integer
Length:	10

PC040

Name:	Copay Amount
Type:	Integer
Length:	10

Name:	Copay Amount
Type:	Integer
Length:	10

Name:	Copay Amount
Type:	Integer
Length:	10

PC041

Name:	Coinsurance Amount
Type:	Integer
Length:	10

Name:	Coinsurance Amount
Type:	Integer
Length:	10

Name:	Coinsurance Amount
Type:	Integer
Length:	10

PC042

Name:	Deductible Amount
Type:	Integer
Length:	10

Name:	Deductible Amount
Type:	Integer
Length:	10

Name:	Deductible Amount
Type:	Integer
Length:	10

PC043

Name:	Prescribing ProviderID
Type:	Text
Length:	28

Name:	Prescribing ProviderID
Type:	Text
Length:	30

Name:	Prescribing ProviderID
Type:	Text
Length:	30

PC044

Name:	Prescribing Physician First Name
Type:	Text
Length:	25

Name:	Prescribing Physician First Name
Type:	Text
Length:	25

Name:	Prescribing Physician First Name
Type:	Text
Length:	25

PC045

Name:	Prescribing Physician Middle Name
Type:	Text
Length:	25

Name:	Prescribing Physician Middle Name
Type:	Text
Length:	25

Name:	Prescribing Physician Middle Name
Type:	Text
Length:	25

PC046

Name:	Prescribing Physician Last Name
Type:	Text
Length:	60

Name:	Prescribing Physician Last Name
Type:	Text
Length:	60

Name:	Prescribing Physician Last Name
Type:	Text
Length:	60

PC047

Name:	Prescribing Physician DEA Number
Type:	Text
Length:	20

Name:	Prescribing Physician DEA Number
Type:	Text
Length:	9

Name:	Prescribing Physician DEA Number
Type:	Text
Length:	9

PC048

Name:	Prescribing Physician NPI
Type:	Text
Length:	20

Name:	National Provider ID - Prescribing
Type:	External Code Source 3 - Integer
Length:	10

Name:	National Provider ID - Prescribing
Type:	External Code Source 3 - Integer
Length:	10

PC049

Name:	Prescribing Physician Plan Number
Type:	Text
Length:	30

Name:	Prescribing Physician Plan Number
Type:	Text
Length:	30

Name:	Prescribing Physician Plan Number
Type:	Text
Length:	30

PC050

Name:	Prescribing Physician License Number
Type:	Text
Length:	30

Name:	Prescribing Physician License Number
Type:	Text
Length:	30

Name:	Prescribing Physician License Number
Type:	Text
Length:	30

PC051

Name:	Prescribing Physician Street Address
Type:	Text
Length:	50

Name:	Prescribing Physician Street Address
Type:	Text
Length:	50

Name:	Prescribing Physician Street Address
Type:	Text
Length:	50

PC052

Name:	Prescribing Physician Street Address 2
Type:	Text
Length:	50

Name:	Prescribing Physician Street Address 2
Type:	Text
Length:	50

Name:	Prescribing Physician Street Address 2
Type:	Text
Length:	50

PC053

Name:	Prescribing Physician City
Type:	Text
Length:	30

Name:	Prescribing Physician City
Type:	Text
Length:	30

Name:	Prescribing Physician City
Type:	Text
Length:	30

PC054

Name:	Prescribing Physician State
Type:	Text
Length:	2

Name:	Prescribing Physician State
Type:	External Code Source 2 - Text
Length:	2

Name:	Prescribing Physician State
Type:	External Code Source 2 - Text
Length:	2

PC055

Name:	Prescribing Physician Zip
Type:	Text
Length:	10

Name:	Prescribing Physician Zip
Type:	External Code Source 2 - Text
Length:	9

Name:	Prescribing Physician Zip
Type:	External Code Source 2 - Text
Length:	9

PC056

Name:	Product ID Number
Type:	Text
Length:	20

Name:	Product ID Number
Type:	Text
Length:	30

Name:	Product ID Number
Type:	Text
Length:	30

PC057

Name:	Mail Order pharmacy
Type:	Text
Length:	1
Codes:
1	Yes
2	No
3	Unknown
4	Other
5	Not Applicable

Name:	Mail Order pharmacy
Type:	Lookup Table - Integer
Length:	1
Codes:
1	Yes
2	No
3	Unknown
4	Other
5	Not Applicable

Name:	Mail Order pharmacy
Type:	Lookup Table - Integer
Length:	1
Codes:
1	Yes
2	No
3	Unknown
4	Other
5	Not Applicable

PC058

Name:	Script number
Type:	Text
Length:	20

Name:	Script number
Type:	Text
Length:	20

Name:	Script number
Type:	Text
Length:	20

PC059

Name:	Recipient PCP ID
Type:	Text
Length:	30

Name:	Recipient PCP ID
Type:	Text
Length:	30

Name:	Recipient PCP ID
Type:	Text
Length:	30

PC060

Name:	Single/Multiple Source Indicator
Type:	Text
Length:	1
Codes:
1	Multi-source brand
2	Multi-source brand with generic equivalent
3	Single source brand
4	Single source brand with generic equivalent
5	Unknown

Name:	Single/Multiple Source Indicator
Type:	Lookup Table - Integer
Length:	1
Codes:
1	Multi-source brand
2	Multi-source brand with generic equivalent
3	Single source brand
4	Single source brand with generic equivalent
5	Unknown

Name:	Single/Multiple Source Indicator
Type:	Lookup Table - Integer
Length:	1
Codes:
1	Multi-source brand
2	Multi-source brand with generic equivalent
3	Single source brand
4	Single source brand with generic equivalent
5	Unknown

PC061

Name:	Member Street Address
Type:	Text
Length:	50

Name:	Member Street Address
Type:	Text
Length:	50

Name:	Member Street Address
Type:	Text
Length:	50

PC062

Name:	Billing Provider Tax ID Number
Type:	Text
Length:	10

Name:	Billing Provider Tax ID Number
Type:	Numeric
Length:	9

Name:	Billing Provider Tax ID Number
Type:	Numeric
Length:	9

PC063

Name:	Paid Date
Type:	Date
Length:	8

Name:	Paid Date
Type:	Full Date - Integer
Length:	8

Name:	Paid Date
Type:	Full Date - Integer
Length:	8

PC064

Name:	Date Prescription Written
Type:	Date
Length:	8

Name:	Date Prescription Written
Type:	Full Date - Integer
Length:	8

Name:	Date Prescription Written
Type:	Full Date - Integer
Length:	8

PC065

Name:	Coordination of Benefits/TPL Liability Amount
Type:	Integer
Length:	10

Name:	Coordination of Benefits/TPL Liability Amount
Type:	Integer
Length:	10

Name:	Coordination of Benefits/TPL Liability Amount
Type:	Integer
Length:	10

PC066

Name:	Other Insurance Paid Amount
Type:	Integer
Length:	10

Name:	Other Insurance Paid Amount
Type:	Integer
Length:	10

Name:	Other Insurance Paid Amount
Type:	Integer
Length:	10

PC067

Name:	Medicare Paid Amount
Type:	Integer
Length:	10

Name:	Medicare Paid Amount
Type:	Integer
Length:	10

Name:	Medicare Paid Amount

United States Health Information Knowledgebase

File Submission Comparison

Identifying Attributes

Data Elements & Codes