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APCD Council



Name:APCD Council
Abbreviation:APCD
Title of SystemAll-Payer Claims Database Council
Websitehttp://www.apcdcouncil.org/ Exit Disclaimer [www.apcdcouncil.org]
Who Maintains the SystemAll-Payer Claims Database Council
Versions:

File Specification for Medical Claims File Submission

Data Element ID Data Element
MC001 Payer
MC002 National Plan ID
MC003 Insurance Type/Product Code
MC004 Payer Claim Control Number
MC005 Line Counter
MC005A Version Number
MC006 Insured Group or Policy Number
MC007 Subscriber Social Security Number
MC008 Plan Specific Contract Number
MC009 Member Suffix or Sequence Number
MC010 Member Identification Code (Patient)
MC011 Individual Relationship Code
MC012 Member Gender (Patient)
MC013 Member Date of Birth (Patient)
MC014 Member City Name (Patient)
MC015 Member State or Province (Patient)
MC016 Member ZIP Code (Patient)
MC017 Date Service Approved/Accounts Payable Date/Actual
MC018 Admission Date
MC019 Admission Hour
MC020 Admission Type
MC021 Point of Origin
MC022 Discharge Hour
MC023 Discharge Status
MC024 Service Provider Number
MC025 Service Provider Tax ID Number
MC026 National Service Provider ID
MC027 Service Provider Entity Type Qualifier
MC028 Service Provider First Name
MC029 Service Provider Middle Name
MC030 Service Provider Last Name or Organization Name
MC031 Service Provider Suffix
MC032 Service Provider Specialty
MC033 Service Provider City Name
MC034 Service Provider State or Province
MC035 Service Provider ZIP Code
MC036 Type of Bill - Institutional
MC037 Facility Type - Professional
MC038 Claim Status
MC039 Admitting Diagnosis
MC040 E-Code
MC041 Principal Diagnosis
MC042 Other Diagnosis - 1
MC043 Other Diagnosis - 2
MC044 Other Diagnosis - 3
MC045 Other Diagnosis - 4
MC046 Other Diagnosis - 5
MC047 Other Diagnosis - 6
MC048 Other Diagnosis - 7
MC049 Other Diagnosis - 8
MC050 Other Diagnosis - 9
MC051 Other Diagnosis - 10
MC052 Other Diagnosis - 11
MC053 Other Diagnosis - 12
MC054 Revenue Code
MC055 Procedure Code
MC056 Procedure Modifier - 1
MC057 Procedure Modifier - 2
MC058 ICD-9-CM Procedure Code
MC059 Date of Service - From
MC060 Date of Service - Thru
MC061 Quantity
MC062 Charge Amount
MC063 Paid Amount
MC064 Prepaid Amount
MC065 Co-pay Amount
MC066 Coinsurance Amount
MC067 Deductible Amount
MC068 Patient Account/Control Number
MC069 Discharge Date
MC070 Service Provider Country Name
MC071 DRG
MC072 DRG Version
MC073 APC
MC074 APC Version
MC075 Drug Code
MC076 Billing Provider Number
MC077 National Billing Provider ID - "Biller"
MC078 Billing Provider Last Name or Organization Name
MC101 Encrypted Subscriber Last Name
MC102 Encrypted Subscriber First Name
MC103 Encrypted Subscriber Middle Initial
MC104 Encrypted Member Last Name
MC105 Encrypted Member First Name
MC106 Encrypted Member Middle Initial
MC899 Record Type

File Specification for Medical Eligibility File Submission

Data Element ID Data Element
ME001 Payer
ME002 National Plan ID
ME003 Insurance Type Code/Product
ME004 Year
ME005 Month
ME006 Insured Group or Policy Number
ME007 Coverage Level Code
ME008 Encrypted Subscriber Social Security Number
ME009 Encrypted Plan Specific Contract Number
ME010 Member Suffix or Sequence Number
ME011 Encrypted Member Identification Code
ME012 Individual Relationship Code
ME013 Member Gender
ME014 Member Date of Birth
ME015 Member City Name
ME016 Member State or Province
ME017 Member ZIP Code
ME018 Medical Coverage
ME019 Prescription Drug Coverage
ME020 Dental Coverage
ME021 Race 1
ME022 Race 2
ME023 Other Race
ME024 Hispanic Indicator
ME025 Ethnicity 1
ME026 Ethnicity 2
ME027 Other Ethnicity
ME028 Primary Insurance Indicator
ME029 Coverage Type
ME030 Market Category Code
ME031 Special Coverage
ME032 Insured Group Name
ME101 Encrypted Subscriber Last Name
ME102 Encrypted Subscriber First Name
ME103 Encrypted Subscriber Middle Initial
ME104 Encrypted Member Last Name
ME105 Encrypted Member First Name
ME106 Encrypted Member Middle Initial
ME899 Record Type

File Specification for Pharmacy Claims File Submission

Data Element ID Data Element
PC001 Payer
PC002 Plan ID
PC003 Insurance Type/Product Code
PC004 Payer Claim Control Number
PC005 Line Counter
PC006 Insured Group Number
PC007 Encrypted Subscriber Social Security Number
PC008 Plan Specific Contract Number
PC009 Member Suffix or Sequence Number
PC010 Member Identification Code
PC011 Individual Relationship Code
PC012 Member Gender
PC013 Member Date of Birth
PC014 Member City Name of Residence
PC015 Member State or Province
PC016 Member ZIP Code
PC017 Date Service Approved (AP Date)
PC018 Pharmacy Number
PC019 Pharmacy Tax ID Number
PC020 Pharmacy Name
PC021 National Pharmacy ID Number
PC022 Pharmacy Location City
PC023 Pharmacy Location State
PC024 Pharmacy ZIP Code
PC024A Pharmacy Country Name
PC025 Claim Status
PC026 Drug Code
PC027 Drug Name
PC028 New Prescription or Refill
PC029 Generic Drug Indicator
PC030 Dispense as Written Code
PC031 Compound Drug Indicator
PC032 Date Prescription Filled
PC033 Quantity Dispensed
PC034 Days Supply
PC035 Charge Amount
PC036 Paid Amount
PC036A Other Amount Paid
PC036B Other Payer Amount Recognized
PC037 Ingredient Cost/List Price
PC038 Postage Amount Claimed
PC039 Dispensing Fee
PC040 Co-pay Amount
PC041 Coinsurance Amount
PC042 Deductible Amount
PC043 Unassigned
PC044 Prescribing Physician First Name
PC045 Prescribing Physician Middle Name
PC046 Prescribing Physician Last Name
PC047 Prescribing Physician Number
PC048 Prescribing Physician Number
PC049 Prescribing Physician Plan Number
PC050 Prescribing Physician License Number
PC051 Prescribing Physician Street Address
PC052 Prescribing Physician Street Address 2
PC053 Prescribing Physician City
PC054 Prescribing Physician State
PC055 Prescribing Physician Zip
PC056 Product ID Number
PC057 Mail Order pharmacy
PC058 Script number
PC059 Recipient PCP ID
PC060 Single/Multiple Source Indicator
PC061 Member Street Address
PC062 Billing Provider Tax ID Number
PC063 Date of Payment
PC101 Encrypted Subscriber Last Name
PC102 Encrypted Subscriber First Name
PC103 Encrypted Subscriber Middle Initial
PC104 Encrypted Member Last Name
PC105 Encrypted Member First Name
PC106 Encrypted Member Middle Initial
PC899 Record Type

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