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Accident Indicator

MC126, Massachusetts

Versions: December 1, 2010 - v2.1 • June 7, 2013 - v3.1• October 1, 2014 - v4.0Compare Versions


Name:Accident Indicator
Data Element ID:MC126
Description:Indicator - Accident Related
State:Massachusetts
Data Type:Lookup Table - Integer
Data Type Description:tlkpFlagIndicators
Format:int[1]
Length:1
Column:127
Threshold:1
File:MC
Element Submission Guideline:Report the value that defines the element. EXAMPLE: 1 = Yes, Claim Line is Accident related.
Condition:All
Cat:A2
Permissible Values: Accident Indicator uses the following permissible values:
Code / Value Meaning
1 Yes
2 No
3 Unknown
4 Other
5 Not Applicable
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File Specification for Multiple versionsMedical Claims File Submission - October 1, 2014 - v4.0

Data Element ID Data Element Description Type Format Length
Multiple versionsHD001 Record Type Header Record Identifier Text char[2] 2
Multiple versionsHD002 Submitter Header Submitter / Carrier ID defined by CHIA Integer varchar[6] 6
Multiple versionsHD003 National Plan ID Header CMS National Plan Identification Number (PlanID) Integer int[10] 10
Multiple versionsHD004 Type of File Defines the file type and data expected. Text char[2] 2
Multiple versionsHD005 Period Beginning Date Header Period Start Date Date Period - Integer int[6] CCYYMM 6
Multiple versionsHD006 Period Ending Date Header Period Ending Date Date Period - Integer int[6] CCYYMM 6
Multiple versionsHD007 Record Count Header Record Count Integer varchar[10] 10
Multiple versionsHD008 Comments Header Carrier Comments Text varchar[80] 80
Multiple versionsHD009 APCD Version Number Submission Guide Version Decimal - Numeric char[3] 3
Multiple versionsMC001 Submitter CHIA defined and maintained unique identifier Integer varchar[6] 6
Multiple versionsMC002 National Plan ID CMS National Plan Identification Number (PlanID) Integer int[10] 10
Multiple versionsMC003 Insurance Type Code/Product Type / Product Identification Code Lookup Table - Text char[2] 2
Multiple versionsMC004 Payer Claim Control Number Payer Claim Control Identification Text varchar[35] 35
Multiple versionsMC005 Line Counter Incremental Line Counter Integer varchar[4] 4
Multiple versionsMC005A Version Number Claim Service Line Version Number Integer varchar[4] 4
Multiple versionsMC006 Insured Group or Policy Number Group / Policy Number Text varchar[30] 30
Multiple versionsMC007 Subscriber SSN Subscriber's Social Security Number Numeric char[9] 9
Multiple versionsMC008 Plan Specific Contract Number Contract Number Text varchar[30] 30
Multiple versionsMC009 Member Suffix or Sequence Number Member/Patient's Contract Sequence Number Text varchar[20] 20
Multiple versionsMC010 Member SSN Member/Patient's Social Security Number Numeric char[9] 9
Multiple versionsMC011 Individual Relationship Code Patient to Subscriber Relationship Code Lookup Table - Text char[2] 2
Multiple versionsMC012 Member Gender Patient's Gender Lookup Table - Text char[1] 1
Multiple versionsMC013 Member Date of Birth Member/Patient's date of birth Full Date - Integer int[8] CCYYMMDD 8
Multiple versionsMC014 Member City Name City name of the Member/Patient Text varchar[30] 30
Multiple versionsMC015 Member State State / Province of the Patient External Code Source 2 - Text char[2] 2
Multiple versionsMC016 Member ZIP Code Zip Code of the Member / Patient External Code Source 2 - Text varchar[9] 9
Multiple versionsMC017 Date Service Approved (AP Date) Date Service Approved by Payer Full Date - Integer int[8] CCYYMMDD 8
Multiple versionsMC018 Admission Date Inpatient Admit Date Full Date - Integer int[8] CCYYMMDD 8
Multiple versionsMC019 Filler Filler Filler char[4] 4
Multiple versionsMC020 Admission Type Admission Type Code External Code Source 14 - Integer int[1] 1
Multiple versionsMC021 Admission Source Admission Source Code External Code Source 14 - Text char[1] 1
Multiple versionsMC022 Filler Filler Filler char[4] 4
Multiple versionsMC023 Discharge Status Inpatient Discharge Status Code External Code Source 14 - Numeric char[2] 2
Multiple versionsMC024 Service Provider Number Service Provider Identification Number Text varchar[30] 30
Multiple versionsMC025 Service Provider Tax ID Number Service Provider's Tax ID number Numeric char[9] 9
Multiple versionsMC026 National Provider ID - Service National Provider Identification (NPI) of the Service Provider External Code Source 3 - Integer int[10] 10
Multiple versionsMC027 Service Provider Entity Type Qualifier Service Provider Entity Identifier Code Lookup Table - integer int[1] 1
Multiple versionsMC028 Service Provider First Name First name of Service Provider Text varchar[25] 25
Multiple versionsMC029 Service Provider Middle Initial Middle initial of Service Provider Text varchar[25] 25
Multiple versionsMC030 Servicing Provider Last Name or Organization Name Last name or Organization Name of Service Provider Text varchar[60] 60
Multiple versionsMC031 Service Provider Suffix Provider Name Suffix Lookup Table - Integer int[1] 1
Multiple versionsMC032 Service Provider Taxonomy Taxonomy Code External Code Source 5 - Text varchar[10] 10
Multiple versionsMC033 Service Provider City Name City Name of the Provider Text varchar[30] 30
Multiple versionsMC034 Service Provider State State of the Service Provider External Code Source 2 - Text char[2] 2
Multiple versionsMC035 Service Provider ZIP Code Zip Code of the Service Provider External Code Source 2 - Text varchar[9] 9
Multiple versionsMC036 Type of Bill - on Facility Claims Type of Bill External Code Source 14 - Integer int[2] 2
Multiple versionsMC037 Site of Service - on NSF/CMS 1500 Claims Place of Service Code External Code Source 13 - Numeric char[2] 2
Multiple versionsMC038 Claim Status Claim Line Status Lookup Table - Numeric varchar[2] 2
Multiple versionsMC039 Admitting Diagnosis Admitting Diagnosis Code External Code Source 8 - Text varchar[7] 7
Multiple versionsMC040 E-Code ICD Diagnostic External Injury Code External Code Source 8 - Text varchar[7] 7
Multiple versionsMC041 Principal Diagnosis ICD Primary Diagnosis Code External Code Source 8 - Text varchar[7] 7
Multiple versionsMC042 Other Diagnosis - 1 ICD Secondary Diagnosis Code External Code Source 8 - Text varchar[7] 7
Multiple versionsMC043 Other Diagnosis - 2 ICD Other Diagnosis Code External Code Source 8 - Text varchar[7] 7
Multiple versionsMC044 Other Diagnosis - 3 ICD Other Diagnosis Code External Code Source 8 - Text varchar[7] 7
Multiple versionsMC045 Other Diagnosis - 4 ICD Other Diagnosis Code External Code Source 8 - Text varchar[7] 7
Multiple versionsMC046 Other Diagnosis - 5 ICD Other Diagnosis Code External Code Source 8 - Text varchar[7] 7
Multiple versionsMC047 Other Diagnosis - 6 ICD Other Diagnosis Code External Code Source 8 - Text varchar[7] 7
Multiple versionsMC048 Other Diagnosis - 7 ICD Other Diagnosis Code External Code Source 8 - Text varchar[7] 7
Multiple versionsMC049 Other Diagnosis - 8 ICD Other Diagnosis Code External Code Source 8 - Text varchar[7] 7
Multiple versionsMC050 Other Diagnosis - 9 ICD Other Diagnosis Code External Code Source 8 - Text varchar[7] 7
Multiple versionsMC051 Other Diagnosis - 10 ICD Other Diagnosis Code External Code Source 8 - Text varchar[7] 7
Multiple versionsMC052 Other Diagnosis - 11 ICD Other Diagnosis Code External Code Source 8 - Text varchar[7] 7
Multiple versionsMC053 Other Diagnosis - 12 ICD Other Diagnosis Code External Code Source 8 - Text varchar[7] 7
Multiple versionsMC054 Revenue Code Revenue Code External Code Source 14 - Numeric char[4] 4
Multiple versionsMC055 Procedure Code HCPCS / CPT Code External Code Source 9 - Text varchar[10] 10
Multiple versionsMC056 Procedure Modifier - 1 HCPCS / CPT Code Modifier External Code Source 9 - Text char[2] 2
Multiple versionsMC057 Procedure Modifier - 2 HCPCS / CPT Code Modifier External Code Source 9 - Text char[2] 2
Multiple versionsMC058 ICD-CM Primary Procedure Code ICD Primary Procedure Code External Codes Source 8 - Text varchar[7] 7
Multiple versionsMC059 Date of Service - From Date of Service Full Date - Integer int[8] CCYYMMDD 8
Multiple versionsMC060 Date of Service - To Date of Service Full Date - Integer int[8] CCYYMMDD 8
Multiple versionsMC061 Quantity Claim line units of service Quantity - Integer ±varchar[15] 15
Multiple versionsMC062 Charge Amount Amount of provider charges for the claim line Integer ±varchar[10] 10
Multiple versionsMC063 Paid Amount Amount paid by the carrier for the claim line Integer ±varchar[10] 10
Multiple versionsMC064 Prepaid Amount Amount carrier has prepaid towards the claim line Integer ±varchar[10] 10
Multiple versionsMC065 Copay Amount Amount of Copay member/patient is responsible to pay Integer ±varchar[10] 10
Multiple versionsMC066 Coinsurance Amount Amount of coinsurance member/patient is responsible to pay Integer ±varchar[10] 10
Multiple versionsMC067 Deductible Amount Amount of deductible member/patient is responsible to pay on the claim line Integer ±varchar[10] 10
Multiple versionsMC068 Patient Control Number Patient Control Number Text varchar[20] 20
Multiple versionsMC069 Discharge Date Discharge Date Full Date - Integer int[8] CCYYMMDD 8
Multiple versionsMC070 Service Provider Country Code Country name of the Service Provider External Code Source 1 - Text char[3] 3
Multiple versionsMC071 DRG Diagnostic Related Group Code External Code Source 15 - Text varchar[7] 7
Multiple versionsMC072 DRG Version Diagnostic Related Group Version Number External Code Source 15 - Text char[2] 2
Multiple versionsMC073 Filler Filler Filler char[4] 4
Multiple versionsMC074 Filler Filler Filler char[2] 2
Multiple versionsMC075 Drug Code National Drug Code (NDC) External Code Source 12 - Text char[11] 11
Multiple versionsMC076 Billing Provider Number Billing Provider Number Text varchar[30] 30
Multiple versionsMC077 National Provider ID - Billing National Provider Identification (NPI) of the Billing Provider External Code Source 3 - Integer int[10] 10
Multiple versionsMC078 Billing Provider Last Name or Organization Name Last name or Organization Name of Billing Provider Text varchar[60] 60
Multiple versionsMC079 Product ID Number Product Identification Text varchar[30] 30
Multiple versionsMC080 Payment Reason Payment Reason Code Carrier Defined Table - OR - External Code Source 16 - Text varchar[30] 30
Multiple versionsMC081 Capitated Encounter Flag Indicator - Capitation Payment Lookup Table - Integer int[1] 1
Multiple versionsMC082 Member Street Address Street address of the Member/Patient Text varchar[50] 50
Multiple versionsMC083 Other ICD-CM Procedure Code - 1 ICD Secondary Procedure Code External Codes Source 8 - Text varchar[7] 7
Multiple versionsMC084 Other ICD-CM Procedure Code - 2 ICD Other Procedure Code External Codes Source 8 - Text varchar[7] 7
Multiple versionsMC085 Other ICD-CM Procedure Code - 3 ICD Other Procedure Code External Codes Source 8 - Text varchar[7] 7
Multiple versionsMC086 Other ICD-CM Procedure Code - 4 ICD Other Procedure Code External Codes Source 8 - Text varchar[7] 7
Multiple versionsMC087 Other ICD-CM Procedure Code - 5 ICD Other Procedure Code External Codes Source 8 - Text varchar[7] 7
Multiple versionsMC088 Other ICD-CM Procedure Code - 6 ICD Other Procedure Code External Codes Source 8 - Text varchar[7] 7
Multiple versionsMC089 Paid Date Paid date of the claim line Full Date - Integer int[8] CCYYMMDD 8
Multiple versionsMC090 LOINC Code Logical Observation Identifiers, Names and Codes (LOINC) External Code Source 11 - Text varchar[7] 7
Multiple versionsMC091 Coinsurance Days Covered Coinsurance Days Quantity - Integer ±varchar[4] 4
Multiple versionsMC092 Covered Days Covered Inpatient Days Quantity - Integer ±varchar[4] 4
Multiple versionsMC093 Non Covered Days Noncovered Inpatient Days Quantity - Integer ±varchar[4] 4
Multiple versionsMC094 Type of Claim Type of Claim Indicator Lookup Table - Text char[3] 3
Multiple versionsMC095 Coordination of Benefits/TPL Liability Amount Amount due from a Secondary Carrier when known Integer ±varchar[10] 10
Multiple versionsMC096 Other Insurance Paid Amount Amount paid by a Primary Carrier Integer ±varchar[10] 10
Multiple versionsMC097 Medicare Paid Amount Amount Medicare paid on claim Integer ±varchar[10] 10
Multiple versionsMC098 Allowed amount Allowed Amount Integer ±varchar[10] 10
Multiple versionsMC099 Non-Covered Amount Amount of claim line charge not covered Integer ±varchar[10] 10
Multiple versionsMC100 Delegated Benefit Administrator Organization ID CHIA defined and maintained Org ID for linking across submitters Integer varchar[6] 6
Multiple versionsMC101 Subscriber Last Name Last name of Subscriber Text varchar[60] 60
Multiple versionsMC102 Subscriber First Name First name of Subscriber Text varchar[25] 25
Multiple versionsMC103 Subscriber Middle Initial Middle initial of Subscriber Text char[1] 1
Multiple versionsMC104 Member Last Name Last name of Member/Patient Text varchar[60] 60
Multiple versionsMC105 Member First Name First name of Member/Patient Text varchar[25] 25
Multiple versionsMC106 Member Middle Initial Middle initial of Member/Patient Text char[1] 1
Multiple versionsMC107 ICD Indicator International Classification of Diseases version Lookup Table - Integer int[1] 1
Multiple versionsMC108 Procedure Modifier - 3 HCPCS / CPT Code Modifier External Code Source 9 - Text char[2] 2
Multiple versionsMC109 Procedure Modifier - 4 HCPCS / CPT Code Modifier External Code Source 9 - Text char[2] 2
Multiple versionsMC110 Claim Processed Date Claim Processed Date Full Date - Integer int[8] CCYYMMDD 8
Multiple versionsMC111 Diagnostic Pointer Diagnostic Pointer Number Integer varchar[4] 4
Multiple versionsMC112 Referring Provider ID Referring Provider ID Text varchar[30] 30
Multiple versionsMC113 Payment Arrangement Type Payment Arrangement Type Value Lookup Table - Numeric char[2] 2
Multiple versionsMC114 Excluded Expenses Amount not covered at the claim line due to benefit/plan limitation Integer ±varchar[10] 10
Multiple versionsMC115 Medicare Indicator Indicator - Medicare Payment Applied Lookup Table - Integer int[1] 1
Multiple versionsMC116 Withhold Amount Amount to be paid to the provider upon guarantee of performance Integer ±varchar[10] 10
Multiple versionsMC117 Filler Filler Filler int[1] 1
Multiple versionsMC118 Referral Indicator Indicator - Referral Needed Lookup Table - Integer int[1] 1
Multiple versionsMC119 PCP Indicator Indicator - PCP Rendered Service Lookup Table - Integer int[1] 1
Multiple versionsMC120 DRG Level Diagnostic Related Group Code Severity Level External Code Source 15 - Integer int[1] 1
Multiple versionsMC121 Patient Total Out of Pocket Amount Total amount patient/member must pay Integer ±varchar[10] 10
Multiple versionsMC122 Global Payment Flag Indicator - Global Payment Lookup Table - Integer int[1] 1
Multiple versionsMC123 Denied Flag Denied Claim Line Indicator Lookup Table - Integer int[1] 1
Multiple versionsMC124 Denial Reason Denial Reason Code Carrier Defined Table - OR - External Code Source 16 - Text varchar[15] 15
Multiple versionsMC125 Attending Provider Attending Provider ID Text varchar[30] 30
Multiple versionsMC126 Accident Indicator Indicator - Accident Related Lookup Table - Integer int[1] 1
Multiple versionsMC127 Family Planning Indicator Service is related to Family Planning Lookup Table - Integer int[1] 1
Multiple versionsMC128 Employment Related Indicator Indicator - Accident Related Lookup Table - Integer int[1] 1
Multiple versionsMC129 EPSDT Indicator Service related to Early Periodic Screening, Diagnosis and Treatment (EPSDT) Lookup Table - Integer int[1] 1
Multiple versionsMC130 Procedure Code Type Claim line Procedure Code Type Identifier Lookup Table - Integer int[1] 1
Multiple versionsMC131 InNetwork Indicator Indicator - Network Rate Applied Lookup Table - Integer int[1] 1
Multiple versionsMC132 Service Class Service Class Code Carrier Defined Table - Text char[2] 2
Multiple versionsMC133 Bill Frequency Code Bill Frequency External Code Source 14 - Text char[1] 1
Multiple versionsMC134 Plan Rendering Provider Identifier Plan Rendering Number Text varchar[30] 30
Multiple versionsMC135 Provider Location Location of Provider Text varchar[30] 30
Multiple versionsMC136 Discharge Diagnosis ICD Discharge Diagnosis Code External Code Source 8 - Text varchar[7] 7
Multiple versionsMC137 Carrier Specific Unique Member ID Member's Unique ID Text varchar[50] 50
Multiple versionsMC138 Claim Line Type Claim Line Activity Type Code Lookup Table - Text char[1] 1
Multiple versionsMC139 Former Claim Number Previous Claim Number Text varchar[35] 35
Multiple versionsMC140 Member Street Address 2 Secondary Street Address of the Member/Patient Text varchar[50] 50
Multiple versionsMC141 Carrier Specific Unique Subscriber ID Subscriber's Unique ID Text varchar[50] 50
Multiple versionsMC142 Other Diagnosis - 13 ICD Other Diagnosis Code External Code Source 8 - Text varchar[7] 7
Multiple versionsMC143 Other Diagnosis - 14 ICD Other Diagnosis Code External Code Source 8 - Text varchar[7] 7
Multiple versionsMC144 Other Diagnosis - 15 ICD Other Diagnosis Code External Code Source 8 - Text varchar[7] 7
Multiple versionsMC145 Other Diagnosis - 16 ICD Other Diagnosis Code External Code Source 8 - Text varchar[7] 7
Multiple versionsMC146 Other Diagnosis - 17 ICD Other Diagnosis Code External Code Source 8 - Text varchar[7] 7
Multiple versionsMC147 Other Diagnosis - 18 ICD Other Diagnosis Code External Code Source 8 - Text varchar[7] 7
Multiple versionsMC148 Other Diagnosis - 19 ICD Other Diagnosis Code External Code Source 8 - Text varchar[7] 7
Multiple versionsMC149 Other Diagnosis - 20 ICD Other Diagnosis Code External Code Source 8 - Text varchar[7] 7
Multiple versionsMC150 Other Diagnosis - 21 ICD Other Diagnosis Code External Code Source 8 - Text varchar[7] 7
Multiple versionsMC151 Other Diagnosis - 22 ICD Other Diagnosis Code External Code Source 8 - Text varchar[7] 7
Multiple versionsMC152 Other Diagnosis - 23 ICD Other Diagnosis Code External Code Source 8 - Text varchar[7] 7
Multiple versionsMC153 Other Diagnosis - 24 ICD Other Diagnosis Code External Code Source 8 - Text varchar[7] 7
Multiple versionsMC154 Present on Admission Code (POA) - 01 POA code for Principal Diagnosis External Code Source 15 - Text char[1] 1
Multiple versionsMC155 Present on Admission Code (POA) - 02 POA code for Other Diagnosis - 1 External Code Source 15 - Text char[1] 1
Multiple versionsMC156 Present on Admission Code (POA) - 03 POA code for Other Diagnosis - 2 External Code Source 15 - Text char[1] 1
Multiple versionsMC157 Present on Admission Code (POA) - 04 POA code for Other Diagnosis - 3 External Code Source 15 - Text char[1] 1
Multiple versionsMC158 Present on Admission Code (POA) - 05 POA code for Other Diagnosis - 4 External Code Source 15 - Text char[1] 1
Multiple versionsMC159 Present on Admission Code (POA) - 06 POA code for Other Diagnosis - 5 External Code Source 15 - Text char[1] 1
Multiple versionsMC160 Present on Admission Code (POA) - 07 POA code for Other Diagnosis - 6 External Code Source 15 - Text char[1] 1
Multiple versionsMC161 Present on Admission Code (POA) - 08 POA code for Other Diagnosis - 7 External Code Source 15 - Text char[1] 1
Multiple versionsMC162 Present on Admission Code (POA) - 09 POA code for Other Diagnosis - 8 External Code Source 15 - Text char[1] 1
Multiple versionsMC163 Present on Admission Code (POA) - 10 POA code for Other Diagnosis - 9 External Code Source 15 - Text char[1] 1
Multiple versionsMC164 Present on Admission Code (POA) - 11 POA code for Other Diagnosis - 10 External Code Source 15 - Text char[1] 1
Multiple versionsMC165 Present on Admission Code (POA) - 12 POA code for Other Diagnosis - 11 External Code Source 15 - Text char[1] 1
Multiple versionsMC166 Present on Admission Code (POA) - 13 POA code for Other Diagnosis - 12 External Code Source 15 - Text char[1] 1
Multiple versionsMC167 Present on Admission Code (POA) - 14 POA code for Other Diagnosis - 13 External Code Source 15 - Text char[1] 1
Multiple versionsMC168 Present on Admission Code (POA) - 15 POA code for Other Diagnosis - 14 External Code Source 15 - Text char[1] 1
Multiple versionsMC169 Present on Admission Code (POA) - 16 POA code for Other Diagnosis - 15 External Code Source 15 - Text char[1] 1
Multiple versionsMC170 Present on Admission Code (POA) - 17 POA code for Other Diagnosis - 16 External Code Source 15 - Text char[1] 1
Multiple versionsMC171 Present on Admission Code (POA) - 18 POA code for Other Diagnosis - 17 External Code Source 15 - Text char[1] 1
Multiple versionsMC172 Present on Admission Code (POA) - 19 POA code for Other Diagnosis - 18 External Code Source 15 - Text char[1] 1
Multiple versionsMC173 Present on Admission Code (POA) - 20 POA code for Other Diagnosis - 19 External Code Source 15 - Text char[1] 1
Multiple versionsMC174 Present on Admission Code (POA) - 21 POA code for Other Diagnosis - 20 External Code Source 15 - Text char[1] 1
Multiple versionsMC175 Present on Admission Code (POA) - 22 POA code for Other Diagnosis - 21 External Code Source 15 - Text char[1] 1
Multiple versionsMC176 Present on Admission Code (POA) - 23 POA code for Other Diagnosis - 22 External Code Source 15 - Text char[1] 1
Multiple versionsMC177 Present on Admission Code (POA) - 24 POA code for Other Diagnosis - 23 External Code Source 15 - Text char[1] 1
Multiple versionsMC178 Present on Admission Code (POA) - 25 POA code for Other Diagnosis - 24 External Code Source 15 - Text char[1] 1
Multiple versionsMC179 Condition Code - 1 Condition Code External Code Source 14 - Text char[2] 2
Multiple versionsMC180 Condition Code - 2 Condition Code External Code Source 14 - Text char[2] 2
Multiple versionsMC181 Condition Code - 3 Condition Code External Code Source 14 - Text char[2] 2
Multiple versionsMC182 Condition Code - 4 Condition Code External Code Source 14 - Text char[2] 2
Multiple versionsMC183 Condition Code - 5 Condition Code External Code Source 14 - Text char[2] 2
Multiple versionsMC184 Condition Code - 6 Condition Code External Code Source 14 - Text char[2] 2
Multiple versionsMC185 Condition Code - 7 Condition Code External Code Source 14 - Text char[2] 2
Multiple versionsMC186 Condition Code - 8 Condition Code External Code Source 14 - Text char[2] 2
Multiple versionsMC187 Condition Code - 9 Condition Code External Code Source 14 - Text char[2] 2
Multiple versionsMC188 Condition Code - 10 Condition Code External Code Source 14 - Text char[2] 2
Multiple versionsMC189 Condition Code - 11 Condition Code External Code Source 14 - Text char[2] 2
Multiple versionsMC190 Condition Code - 12 Condition Code External Code Source 14 - Text char[2] 2
Multiple versionsMC191 Value Code - 1 Value Code External Code Source 14 - Text char[2] 2
Multiple versionsMC192 Value Amount - 1 Amount that corresponds to Value Code - 1 Integer ±varchar[10] 10
Multiple versionsMC193 Value Code - 2 Value Code External Code Source 14 - Text char[2] 2
Multiple versionsMC194 Value Amount - 2 Amount that corresponds to Value Code - 2 Integer ±varchar[10] 10
Multiple versionsMC195 Value Code - 3 Value Code External Code Source 14 - Text char[2] 2
Multiple versionsMC196 Value Amount - 3 Amount that corresponds to Value Code - 3 Integer ±varchar[10] 10
Multiple versionsMC197 Value Code - 4 Value Code External Code Source 14 - Text char[2] 2
Multiple versionsMC198 Value Amount - 4 Amount that corresponds to Value Code - 4 Integer ±varchar[10] 10
Multiple versionsMC199 Value Code - 5 Value Code External Code Source 14 - Text char[2] 2
Multiple versionsMC200 Value Amount - 5 Amount that corresponds to Value Code - 5 Integer ±varchar[10] 10
Multiple versionsMC201 Value Code - 6 Value Code External Code Source 14 - Text char[2] 2
Multiple versionsMC202 Value Amount - 6 Amount that corresponds to Value Code - 6 Integer ±varchar[10] 10
Multiple versionsMC203 Value Code - 7 Value Code External Code Source 14 - Text char[2] 2
Multiple versionsMC204 Value Amount - 7 Amount that corresponds to Value Code - 7 Integer ±varchar[10] 10
Multiple versionsMC205 Value Code - 8 Value Code External Code Source 14 - Text char[2] 2
Multiple versionsMC206 Value Amount - 8 Amount that corresponds to Value Code - 8 Integer ±varchar[10] 10
Multiple versionsMC207 Value Code - 9 Value Code External Code Source 14 - Text char[2] 2
Multiple versionsMC208 Value Amount - 9 Amount that corresponds to Value Code - 9 Integer ±varchar[10] 10
Multiple versionsMC209 Value Code - 10 Value Code External Code Source 14 - Text char[2] 2
Multiple versionsMC210 Value Amount - 10 Amount that corresponds to Value Code - 10 Integer ±varchar[10] 10
Multiple versionsMC211 Value Code - 11 Value Code External Code Source 14 - Text char[2] 2
Multiple versionsMC212 Value Amount - 11 Amount that corresponds to Value Code - 11 Integer ±varchar[10] 10
Multiple versionsMC213 Value Code - 12 Value Code External Code Source 14 - Text char[2] 2
Multiple versionsMC214 Value Amount - 12 Amount that corresponds to Value Code - 12 Integer ±varchar[10] 10
Multiple versionsMC215 Occurrence Code - 1 Occurrence Code External Code Source 14 - Text char[2] 2
Multiple versionsMC216 Occurrence Date - 1 Date that corresponds to Occurrence Code - 1 Full Date - Integer int[8] CCYYMMDD 8
Multiple versionsMC217 Occurrence Code - 2 Occurrence Code External Code Source 14 - Text char[2] 2
Multiple versionsMC218 Occurrence Date - 2 Date that corresponds to Occurrence Code - 2 Full Date - Integer int[8] CCYYMMDD 8
Multiple versionsMC219 Occurrence Code - 3 Occurrence Code External Code Source 14 - Text char[2] 2
Multiple versionsMC220 Occurrence Date - 3 Date that corresponds to Occurrence Code - 3 Full Date - Integer int[8] CCYYMMDD 8
Multiple versionsMC221 Occurrence Code - 4 Occurrence Code External Code Source 14 - Text char[2] 2
Multiple versionsMC222 Occurrence Date - 4 Date that corresponds to Occurrence Code - 4 Full Date - Integer int[8] CCYYMMDD 8
Multiple versionsMC223 Occurrence Code - 5 Occurrence Code External Code Source 14 - Text char[2] 2
Multiple versionsMC224 Occurrence Date - 5 Date that corresponds to Occurrence Code - 5 Full Date - Integer int[8] CCYYMMDD 8
Multiple versionsMC225 Occurrence Span Code - 1 Occurrence Span Code External Code Source 14 - Text char[2] 2
Multiple versionsMC226 Occurrence Span Start Date - 1 Start Date that corresponds to Occurrence Span Code - 1 Full Date - Integer int[8] CCYYMMDD 8
Multiple versionsMC227 Occurrence Span End Date - 1 End Date that corresponds to Occurrence Span Code - 1 Full Date - Integer int[8] CCYYMMDD 8
Multiple versionsMC228 Occurrence Span Code - 2 Occurrence Span Code External Code Source 14 - Text char[2] 2
Multiple versionsMC229 Occurrence Span Start Date - 2 Start Date that corresponds to Occurrence Span Code - 2 Full Date - Integer int[8] CCYYMMDD 8
Multiple versionsMC230 Occurrence Span End Date - 2 End Date that corresponds to Occurrence Span Code - 2 Full Date - Integer int[8] CCYYMMDD 8
Multiple versionsMC231 Occurrence Span Code - 3 Occurrence Span Code External Code Source 14 - Text char[2] 2
Multiple versionsMC232 Occurrence Span Start Date - 3 Start Date that corresponds to Occurrence Span Code - 3 Full Date - Integer int[8] CCYYMMDD 8
Multiple versionsMC233 Occurrence Span End Date - 3 End Date that corresponds to Occurrence Span Code - 3 Full Date - Integer int[8] CCYYMMDD 8
Multiple versionsMC234 Occurrence Span Code - 4 Occurrence Span Code External Code Source 14 - Text char[2] 2
Multiple versionsMC235 Occurrence Span Start Date - 4 Start Date that corresponds to Occurrence Span Code - 4 Full Date - Integer int[8] CCYYMMDD 8
Multiple versionsMC236 Occurrence Span End Date - 4 End Date that corresponds to Occurrence Span Code - 4 Full Date - Integer int[8] CCYYMMDD 8
Multiple versionsMC237 Occurrence Span Code - 5 Occurrence Span Code External Code Source 14 - Text char[2] 2
Multiple versionsMC238 Occurrence Span Start Date - 5 Start Date that corresponds to Occurrence Span Code - 5 Full Date - Integer int[8] CCYYMMDD 8
Multiple versionsMC239 Occurrence Span End Date - 5 End Date that corresponds to Occurrence Span Code - 5 Full Date - Integer int[8] CCYYMMDD 8
Multiple versionsMC240 GIC ID GIC Member ID Text varchar[9] 9
Multiple versionsMC241 APCD ID Code Member Enrollment Type Lookup Table - Integer int[1] 1
MC242 National Provider ID - Plan Rendering National Provider Indentification (NPI) of the Plan Rendering Provider External Code Source 3 - Integer Int[10] 10
MC243 Benefit Plan Contract ID Identifier for the benefit plan the member is enrolled in that covers this claim Text Varchar[30] 30
MC244 Claim Line Paid Flag Claim Line Paid Indicator Lookup Table - Integer int[1] 1
MC245 Type of Facility Type of Facility Indicator Lookup Table - Integer int[2] 2
MC246 MassHealth Claim Type MassHealth Claim Type Indicator MassHealth specific claim type code Char[1] 1
MC247 MassHealth Rate Code MassHealth Rate Code Indicator MassHealth Rate code varchar[3] 3
Multiple versionsMC899 Record Type File Type Identifier Text char[2] 2
Multiple versionsTR001 Record Type Trailer Record Identifier Text char[2] 2
Multiple versionsTR002 Submitter Trailer Submitter / Carrier ID defined by CHIA Integer varchar[6] 6
Multiple versionsTR003 National Plan ID CMS National Plan Identification Number (PlanID) Integer int[10] 10
Multiple versionsTR004 Type of File Validates the file type defined in HD004. Text char[2] 2
Multiple versionsTR005 Period Beginning Date Trailer Period Start Date Date Period - Integer int[6] CCYYMM 6
Multiple versionsTR006 Period Ending Date Trailer Period Ending Date Date Period - Integer int[6] CCYYMM 6
Multiple versionsTR007 Date Processed Trailer Processed Date Full Date - Integer int[8] CCYYMMDD 8

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