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Medical Claims File Submission

Massachusetts

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


Name:Medical Claims File Submission
State:Massachusetts
Definition:A MA APCD File Type for reporting all Paid Medical Claim Lines of a given time period. File accommodates Facility, Professional, Reimbursement Forms and Replacement and Void lines.
VersionOctober 1, 2014 - v4.0

File Specification for Medical Claims File Submission

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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Data Element ID Data Element Code Value
HD001 Record Type HD Header Elements
HD004 Type of File MC MEDICAL CLAIM
HD009 APCD Version Number 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
MC003 Insurance Type Code/Product 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
MC011 Individual Relationship Code 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
MC012 Member Gender F Female
M Male
O Other
U Unknown
MC027 Service Provider Entity Type Qualifier 1 Person
2 Non-person entity
MC031 Service Provider Suffix 0 Unknown / Not Applicable
1 I.
2 II.
3 III.
4 Jr.
5 Sr.
MC038 Claim Status 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
MC081 Capitated Encounter Flag 1 Yes
2 No
3 Unknown
4 Other
5 Not Applicable
MC094 Type of Claim 001 Professional
002 Facility
003 Reimbursement Form
MC107 ICD Indicator 0 ICD-10
9 ICD-9
MC113 Payment Arrangement Type 01 Capitation
02 Fee for Service
03 Percent of Charges
04 DRG
05 Pay for Performance
06 Global Payment
07 Other
08 Bundled Payment
09 Payment Amount Per Episode (PAPE) (MassHealth)
MC115 Medicare Indicator 1 Yes
2 No
3 Unknown
4 Other
5 Not Applicable
MC118 Referral Indicator 1 Yes
2 No
3 Unknown
4 Other
5 Not Applicable
MC119 PCP Indicator 1 Yes
2 No
3 Unknown
4 Other
5 Not Applicable
MC122 Global Payment Flag 1 Yes
2 No
3 Unknown
4 Other
5 Not Applicable
MC123 Denied Flag 1 Yes
2 No
3 Unknown
4 Other
5 Not Applicable
MC126 Accident Indicator 1 Yes
2 No
3 Unknown
4 Other
5 Not Applicable
MC127 Family Planning Indicator 0 Unknown / Not Applicable / Not Avail
1 Family planning services provided
2 Abortion services provided
3 Sterilization services provided
4 No family planning services provided
MC128 Employment Related Indicator 1 Yes
2 No
3 Unknown
4 Other
5 Not Applicable
MC129 EPSDT Indicator 0 Unknown / Not Applicable / Not Available
1 EPSDT Screen
2 EPSDT Treatment
3 EPSDT Referral
MC130 Procedure Code Type 1 CPT or HCPCS Level 1 Code
2 HCPCS Level II Code
3 HCPCS Level III Code (State Medicare code).
4 American Dental Association (ADA) Procedure Code (Also referred to as CDT code.)
5 State defined Procedure Code
6 CPT Category II
7 CPTCategory III Code
MC131 InNetwork Indicator 1 Yes
2 No
3 Unknown
4 Other
5 Not Applicable
MC138 Claim Line Type A Amendment
B Back Out
O Original
R Replacement
V Void
MC241 APCD ID Code 0 Unknown / Not Applicable
1 FIG - Fully-Insured Commercial Group Enrollee
2 SIG - Self-Insured Group Enrollee
3 GIC - Group Insurance Commission Enrollee
4 MCO - MassHealth Managed Care Organization Enrollee
5 Supplemental Policy Enrollee
6 ICO - Integrated Care Organization or SCO - Senior Care Option
MC244 Claim Line Paid Flag 1 Yes
2 No
3 Unknown
4 Other
5 Not Applicable
MC245 Type of Facility 1 General Acute Care Facility
2 Skilled Nursing Facility/Long Term Care Facility
3 Intermediate Care Facility
4 Hospice Facility
5 Designated Cancer Center
6 Designated Inpatient Children's Hospital
7 Inpatient Rehabilitation Facility
8 Inpatient Pyschiatric Hospital
9 Critical Access Hospital
70 Other Type of Facility
MC246 MassHealth Claim Type A INPATIENT PART A CROSSOVER UB92
B PROFESSIONAL PART B CROSSOVER
C OUTPATIENT PART B CROSSOVER UB-04
D DENTAL
H HOME HEALTH AND COMMUNITY HEALTH
I HOSPITAL INPATIENT
L LONG TERM CARE
M PHYSICIAN CLAIM
O HOSPITAL OUTPATIENT
P PHARMACY
Q COMPOUND DRUG CLAIMS
MC899 Record Type MC
TR001 Record Type TR
TR004 Type of File MC
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