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Medical Service Providers File Submission

Maine

Versions: 2010-03-16• v1.2Compare Versions


Name:Medical Service Providers File Submission
State:Maine
Definition:Not Provided
Versionv1.2

File Specification for Medical Service Providers File Submission

Data Element ID Data Element Description Type Format Length
Multiple versionsMCSP001 Provider ID # This field is used to link to the Medical Claims data (MC912). It is the primary identification number for each Medical Service Provider record. CHAR 12
Multiple versionsMCSP002 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. CHAR 6
Multiple versionsMCSP003 Service Provider Number This is the provider number assigned by the payer. This Field is derived from MC024 in the medical claims data. CHAR 30
Multiple versionsMCSP004 Service Provider Tax ID Number This field should contain the provider's tax identification Number. For an individual this code is often the social security number. This field is derived from MC025 in the medical claims data. CHAR 10
Multiple versionsMCSP005 Service Provider Entity Type Qualifier This field is used to distinguish an individual Practitioner from a business entity. This field is derived from MC027 in the medical claims data. CHAR 1
Multiple versionsMCSP006 Service Provider First Name This field contains the first name of the practitioner. If the provider is a facility, this field will be blank. This field is derived from MC028 in the medical claims data or from PC044 in the pharmacy claims data. CHAR 25
Multiple versionsMCSP007 Service Provider Middle Name This field contains the practitioner's middle name or initial. This field is derived from MC029 in the medical claims data or from PC045 in the pharmacy claims data. CHAR 25
Multiple versionsMCSP008 Service Provider Last Name or Organization Name This field contains the full name of provider organization or last name of individual provider. This field is derived from MC030 in the medical claims data or from PC046 in the pharmacy claims data. CHAR 60
Multiple versionsMCSP009 Service Provider Suffix This field contains the generational suffix for the individual. This field is derived from MC031 in the medical claims data. CHAR 10
Multiple versionsMCSP010 Service Provider Specialty This field contains the specialty code assigned by the payer. Use this field to link to the provider specialty table (SP901). Since specialty codes are not unique across payers, you must also link on Payer. This field is derived from MC032 in the medical claims data. CHAR 10
Multiple versionsMCSP011 Service Provider City Name This field contains the city name of provider - preferably practice location. This field is derived from MC033 in the medical claims data. CHAR 30
Multiple versionsMCSP012 Service Provider State or Province This is the two character abbreviation for city as defined by the US Postal Service. This field is derived from MC034 in the medical claims data. CHAR 2
Multiple versionsMCSP013 Service Provider ZIP Code This field contains the zip code of provider practice location. It may contain non-US codes. This field is derived from MC035 in the medical claims data. CHAR 11
Multiple versionsMCSP014 Data Processing Center Provider Code This field contains the unique provider identifier that crosses all payers. This field is the link to the Medical Provider Master file (MPM901). NUMBER 12
Multiple versionsMCSP015 Taxonomy Code This field is used to standardize the specialty coding of the provider records. It is based upon the service provider specialty code (MC032) and the linkage activity. A DPCID will have only one national TAXONOMY code. CHAR 10
Multiple versionsMCSP016 Individual Practitioner Flag This field is used to determine if the provider name may be released. Eliminated 04/01/2007 upon the release of practitioner identifiable data elements. NUMBER 1
Multiple versionsMCSP017 Prescribing Physician This field contains the prescribing physician's DEA (Drug Enforcement Authority) registration number. This field is derived from PC047. CHAR 9
Multiple versionsMCSP018 National Provider Identifier This field is reserved for future use. CHAR 20
Multiple versionsMCSP019 File Individual Indicates the source of information as coming from the Medical or Pharmacy files. CHAR 1

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Data Element ID Data Element Code Value
MCSP002 Payer C Commercial carrier
T Third Party Administrator
U Unlicensed entity
MCSP005 Service Provider Entity Type Qualifier 1 Person
2 Non-Person Entity
MCSP016 Individual Practitioner Flag 0 Release
1 Withhold
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