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Payer

PCSP901, Maine

Versions: 2010-03-16• v1.1Compare Versions


Name:Payer
Data Element ID:PCSP901
Description:This field contains the MHDO submitter code for the payer submitting payments. The first character of the submitter code indicates the type of submitter. This field is primarily used for tracking compliance by payer. It is derived from PC001 in the pharmacy claims data.
State:Maine
Data Type:CHAR
Length:6
Database Fieldname:PAYER
Warnings :A single payer may have multiple submitter codes because the payer is submitting from more than one system or from more than one location. All submitter codes associated with a single payer will have the same first 5 characters. A suffix will be used to distinguish the location and/or system variations. For a variety of reasons, the Data Bank may include submissions from unlicensed entities. The unlicensed entities will have a payer code beginning with the letter U. If the submitter does become licensed in Maine, the first letter of the payer code will be changed to the appropriate value of C or T and the trailing four characters will remain unchanged. Therefore, a payer code of U0756 may become T0756 in the future. Note that due to administrative relationships between payers, it is possible that one or more payers are responsible for submitting eligibility data that applies to a single claims submission and vice versa. The use of payer code alone may not be sufficient to identify all claims and eligibility data associated with that payer.
Date Required :2003-01-31
Permissible Values: Payer uses the following permissible values:
Code / Value Meaning
C Commercial carrier
T Third Party Administrator
U Unlicensed entity
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File Specification for Multiple versionsPharmacy Service Providers File Submission - v1.1

Data Element ID Data Element Description Type Format Length
Multiple versionsPCSP901 Payer This field contains the MHDO submitter code for the payer submitting payments. The first character of the submitter code indicates the type of submitter. This field is primarily used for tracking compliance by payer. It is derived from PC001 in the pharmacy claims data. CHAR 6
Multiple versionsPCSP902 Data Processing Center Code This field contains the unique pharmacy identifier that crosses all payers. This field is the link to the Pharmacy Master file (PM901). NUMBER 12
Multiple versionsPCSP903 Pharmacy Number This is the pharmacy number assigned by the payer. This field is derived from PC018 in the pharmacy claims data. CHAR 30
Multiple versionsPCSP904 Pharmacy Tax ID Number This field should contain the pharmacy''s tax identification number. This field is derived from PC019 in the pharmacy claims data. CHAR 10
Multiple versionsPCSP905 Pharmacy Name This field contains the name of the pharmacy filling the prescription. This field is derived from PC020 in the pharmacy claims data. CHAR 100
Multiple versionsPCSP906 National Pharmacy ID Number This field is derived from PC021 in the pharmacy claims data. CHAR 20
Multiple versionsPCSP907 Pharmacy City Name This field contains the city name of the pharmacy. This field is derived from PC022 in the pharmacy claims data. CHAR 30
Multiple versionsPCSP908 Pharmacy State or Province This is the two character abbreviation for city as defined by the US Postal Service. This field is derived from PC023 in the pharmacy claims data. CHAR 2
Multiple versionsPCSP909 Pharmacy Zip Code This field contains the zip code of the pharmacy location. It may contain non US codes. This field is derived from PC024 in the pharmacy claims data. VARCHAR 11
Multiple versionsPCSP910 Pharmacy ID # This field is used to link to the pharmacy claims data (PC913). It is the primary identification number for each Pharmacy Detail record. Number 12

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