C.M.R. 90, 590, ch. 243, app 590-243-D-1
Data Element # | Data Element Name | Date Effective | Type | Maximum Length | Description/Codes/Sources |
MC001 | Submitter | 1/1/2003 | Text | 8 | MHDO-assigned identifier of payor submitting claims data. Do not leave blank. |
MC002 | Payor | 7/1/2012 | Text | 8 | MHDO-assigned code of the insurer/underwriter in the case of premiums-based coverage, or of the administrator in the case of self-funded coverage. Do not leave blank. |
MC003 | Insurance Type/Product Code | 1/1/2003 | Text | 2 | Code identifying the type of insurance policy within a specific insurance program. Refer to Appendix A 16 Medicare Part C MD Medicare Part D SP Supplemental Policy |
MC004 | Payor Claim Control Number | 1/1/2003 | Text | 35 | Must apply to the entire claim and be unique within the payor's system. Shall be left blank when the payor indicates the record contains 42 CFR Part 2 SUD-related data by setting the value of MC333 = 'Y'. |
MC005 | Line Counter | 4/1/2004 | Number | 4 | Line number for this service The line counter begins with 1 and is incremented by 1 for each additional service line of a claim. Shall be left blank when the payor indicates the record contains 42 CFR Part 2 SUD-related data by setting the value of MC333 = 'Y'. |
MC005A | Version Number | 1/1/2010 | Number | 4 | The version number of this claim service line. The original claim will have a version number of 0, with the next version being assigned a 1, and each subsequent version being incremented by 1 for that service line. Shall be left blank when the payor indicates the record contains 42 CFR Part 2 SUD-related data by setting the value of MC333 = 'Y'. |
MC006 | Insured Group or Policy Number | 1/1/2003 | Text | 30 | Group or policy number - not the number that uniquely identifies the subscriber. Shall be left blank when the payor indicates the record contains 42 CFR Part 2 SUD-related data by setting the value of MC333 = 'Y'. |
MC007 | Subscriber Social Security Number | 1/1/2003 | Text | 9 | Subscriber's social security number Leave blank if unavailable. Shall be left blank when the payor indicates the record contains 42 CFR Part 2 SUD-related data by setting the value of MC333 = 'Y'. |
MC008 | Plan Specific Contract Number | 1/1/2003 | Text | 80 | Plan-assigned contract number Leave blank if contract number = subscriber's social security number. Shall be left blank when the payor indicates the record contains 42 CFR Part 2 SUD-related data by setting the value of MC333 = 'Y'. |
MC009 | Member Suffix or Sequence Number | 1/1/2003 | Text | 20 | Uniquely numbers the member within the contract. Shall be left blank when the payor indicates the record contains 42 CFR Part 2 SUD-related data by setting the value of MC333 = 'Y'. |
MC010 | Member Identification Code | 1/1/2003 | Text | 50 | Member's social security number Leave blank if unavailable. Shall be left blank when the payor indicates the record contains 42 CFR Part 2 SUD-related data by setting the value of MC333 = 'Y'. |
MC011 | Individual Relationship Code | 1/1/2003 | Text | 2 | Member's relationship to insured Refer to Appendix A Shall be left blank when the payor indicates the record contains 42 CFR Part 2 SUD-related data by setting the value of MC333 = 'Y'. |
MC012 | Member Gender | 1/1/2003 | Text | 1 | Refer to Appendix A Shall be left blank when the payor indicates the record contains 42 CFR Part 2 SUD-related data by setting the value of MC333 = 'Y'. |
MC013 | Member Date of Birth | 1/1/2003 | Text | 8 | CCYYMMDD Shall be left blank when the payor indicates the record contains 42 CFR Part 2 SUD-related data by setting the value of MC333 = 'Y'. |
MC014 | Member City Name | 4/1/2004 | Text | 30 | City name of member Refer to Appendix A Shall be left blank when the payor indicates the record contains 42 CFR Part 2 SUD-related data by setting the value of MC333 = 'Y'. |
MC015 | Member State or Province | 4/1/2004 | Text | 2 | As defined by the US Postal Service and Canada Post Refer to Appendix A Shall be left blank when the payor indicates the record contains 42 CFR Part 2 SUD-related data by setting the value of MC333 = 'Y'. |
MC016 | Member ZIP Code | 1/1/2003 | Text | 11 | ZIP Code of member - may include non-US codes Refer to Appendix A Shall be left blank when the payor indicates the record contains 42 CFR Part 2 SUD-related data by setting the value of MC333 = 'Y'. |
MC017 | Date Service Approved (AP Date) | 1/1/2003 | Text | 8 | CCYYMMDD The value 'CCYY0101', where CCYY is the year in which the service was approved, shall be used when the payor indicates the record contains 42 CFR Part 2 SUD-related data by setting the value of MC333 = 'Y'. |
MC018 | Admission Date | 1/1/2003 | Text | 8 | Required for all inpatient claims CCYYMMDD The value 'CCYY0101', where CCYY is the year in which the admission occurred, shall be used when the payor indicates the record contains 42 CFR Part 2 SUD-related data by setting the value of MC333 = 'Y'. |
MC019 | Admission Hour | 4/1/2004 | Text | 2 | Required for all inpatient claims Time is expressed in military time - HH |
MC020 | Priority (Type) of Admission or Visit | 4/1/2004 | Number | 1 | Required for all inpatient claims Refer to Appendix A |
MC021 | Point of Origin for Admission or Visit | 4/1/2004 | Text | 1 | Required for all inpatient claims Refer to Appendix A |
MC022 | Discharge Hour | 4/1/2004 | Text | 2 | Time expressed in military time - HH |
MC023 | Patient Discharge Status | 1/1/2003 | Text | 2 | Required for all inpatient claims Refer to Appendix A |
MC024 | Rendering Provider Number | 1/1/2003 | Text | 30 | Payor-assigned rendering provider number |
MC025 | Rendering Provider Tax ID Number | 1/1/2003 | Text | 10 | Federal taxpayer's identification number |
MC026 | National Provider ID - Rendering Provider | 4/1/2004 | Text | 20 | National Provider ID for Rendering Provider This data element pertains to the entity or individual directly providing the service. Refer to Appendix A |
MC027 | Rendering Provider Entity Type Qualifier | 4/1/2004 | Number | 1 | HIPAA provider taxonomy classifies provider groups (clinicians who bill as a group practice or under a corporate name, even if that group is composed of one provider) as a "person", and these shall be coded as a person. Refer to Appendix A |
MC028 | Rendering Provider First Name | 1/1/2003 | Text | 40 | Individual first name Leave blank if provider is a facility or organization. |
MC029 | Rendering Provider Middle Name | 1/1/2003 | Text | 25 | Individual middle name or initial Leave blank if provider is a facility or organization. |
MC030 | Rendering Provider Last Name or Organization Name | 1/1/2003 | Text | 60 | Full name of provider organization or last name of individual provider |
MC031 | Rendering Provider Suffix | 1/1/2003 | Text | 10 | Suffix to individual name Leave blank if provider is a facility or organization. The service provider suffix shall be used to capture the generation of the individual clinician (e.g., Jr., Sr., III), if applicable, rather than the clinician's degree (e.g., MD, LCSW). |
MC032 | Rendering Provider Specialty | 1/1/2003 | Text | 10 | Refer to Appendix A If defined by payor, then dictionary for specialty code values must be supplied during testing. |
MC033 | Placeholder | 10/1/2014 | N/A | 0 | Leave blank Service Provider City Name retired; refer to MC089 - Service Facility Location City Name |
MC034 | Placeholder | 10/1/2014 | N/A | 0 | Leave blank Service Provider State or Province retired; refer to MC090 - Service Facility Location Address State or Province |
MC035 | Placeholder | 10/1/2014 | N/A | 0 | Leave blank Service Provider ZIP Code retired; refer to MC091 - Service Facility Location Address State or Province |
MC036 | Type of Bill - Institutional | 4/1/2004 | Text | 3 | Required for institutional claims Not to be used for professional claims Exclude leading zero, but include frequency indicator, if present Refer to Appendix A |
MC037 | Place of Service - Professional | 4/1/2004 | Text | 2 | Required for professional claims Not to be used for institutional claims Refer to Appendix A |
MC038 | Claim Status | 1/1/2003 | Text | 2 | Refer to Appendix A |
MC039 | Placeholder | 2/1/2025 | N/A | 0 | Leave blank. ICD-9 Admitting Diagnosis retired. See MC202 for ICD-10 Admitting Diagnosis. |
MC040 | Placeholder | 2/1/2025 | N/A | 0 | Leave blank. ICD-9 E-Code retired. See MC206 and following fields for ICD-10 External Cause of Injury codes. |
MC041 | Placeholder | 2/1/2025 | N/A | 0 | Leave blank. ICD-9 Principal Diagnosis retired. See MC200 for ICD-10 Principal Diagnosis. |
MC042 | Placeholder | 2/1/2025 | N/A | 0 | Leave blank. Other ICD-9 Diagnosis - 1 retired. See MC254 and following fields for ICD-10 secondary, etc. diagnoses. |
MC043 | Placeholder | 2/1/2025 | N/A | 0 | Leave blank. Other Diagnosis - 2 retired |
MC044 | Placeholder | 2/1/2025 | N/A | 0 | Leave blank. Other Diagnosis - 3 retired |
MC045 | Placeholder | 2/1/2025 | N/A | 0 | Leave blank. Other Diagnosis - 4 retired |
MC046 | Placeholder | 2/1/2025 | N/A | 0 | Leave blank. Other Diagnosis - 5 retired |
MC047 | Placeholder | 2/1/2025 | N/A | 0 | Leave blank. Other Diagnosis - 6 retired |
MC048 | Placeholder | 2/1/2025 | N/A | 0 | Leave blank. Other Diagnosis - 7 retired |
MC049 | Placeholder | 2/1/2025 | N/A | 0 | Leave blank. Other Diagnosis - 8 retired |
MC050 | Placeholder | 2/1/2025 | N/A | 0 | Leave blank. Other Diagnosis - 9 retired |
MC051 | Placeholder | 2/1/2025 | N/A | 0 | Leave blank. Other Diagnosis - 10 retired |
MC052 | Placeholder | 2/1/2025 | N/A | 0 | Leave blank. Other Diagnosis - 11 retired |
MC053 | Placeholder | 2/1/2025 | N/A | 0 | Leave blank. Other Diagnosis - 12 retired |
MC054 | Revenue Code | 1/1/2003 | Text | 4 | National Uniform Billing Committee Codes Code using leading zeroes, left justified, and four digits. Refer to Appendix A |
MC055 | Procedure Code | 1/1/2003 | Text | 10 | Health Care Common Procedural Coding System (HCPCS), the CPT codes of the American Medical Association, the CDT from the American Dental Association, and the HIPPS codes from the Health Insurance Prospective Payment System. Specify the procedure or service on a capitated service record and set the Payment Arrangement Type Indicator (MC331) = '09'. Refer to Appendix A |
MC056 | Procedure Modifier - 1 | 1/1/2003 | Text | 2 | Procedure modifier required when a modifier clarifies/improves the reporting accuracy of the associated procedure code. |
MC057 | Procedure Modifier - 2 | 1/1/2003 | Text | 2 | Procedure modifier required when a modifier clarifies/improves the reporting accuracy of the associated procedure code. |
MC057A | Procedure Modifier - 3 | 10/1/2014 | Text | 2 | Procedure modifier required when a modifier clarifies/improves the reporting accuracy of the associated procedure code. |
MC057B | Procedure Modifier - 4 | 10/1/2014, | Text | 2 | Procedure modifier required when a modifier clarifies/improves the reporting accuracy of the associated procedure code. |
MC058 | Placeholder | 2/1/2025 | N/A | 0 | Leave blank. ICD-9-CM Procedure Code retired See MC302 and following fields for ICD-10 procedure codes. |
MC059 | Claim Date - From | 1/1/2003 | Text | 8 | First date of service for this claim. See mapping to form locators and the 005010 in Appendix D-2. See MC334 for line-level service from date. CCYYMMDD The Payment Arrangement Type Indicator (MC331) = '09' for all capitated service records. The value 'CCYY0101', where CCYY is year of the first date of service for the claim, shall be used when the payor indicates the record contains 42 CFR Part 2 SUD-related data by setting the value of MC333 = 'Y'. |
MC060 | Claim Date - Thru | 1/1/2003 | Text | 8 | Last date of service for this claim. See mapping to form locators and the 005010 in Appendix D-2. See MC335 for line-level service through date. CCYYMMDD The Payment Arrangement Type Indicator (MC331) = '09' for all capitated service records. The value 'CCYY0101', where CCYY is year of the last date of service for the claim, shall be used when the payor indicates the record contains 42 CFR Part 2 SUD-related data by setting the value of MC333 = 'Y'. |
MC061 | Quantity | 1/1/2003 | Number | 10 | Count of services performed, which shall be set equal to one on all observation bed service lines and should be set equal to zero on all other room and board service lines, regardless of the length of stay. Code decimal point. On a capitated service record, the value of this field is greater than or equal to 1. The Payment Arrangement Type Indicator (MC331) = '09' for all capitated service records. |
MC062 | Charge Amount | 1/1/2003 | Number | 10 | Do not code decimal point. Two decimal places implied. |
MC063 | Paid Amount | 1/1/2003 | Number | 10 | Includes any withhold amounts. On a capitated service record, set the value of this field = '0'. The Payment Arrangement Type Indicator (MC331) = '09' for all capitated service records. Do not code decimal point. Two decimal places implied. |
MC064 | Placeholder | 2/1/2025 | N/A | 0 | Prepaid amount retired. |
MC065 | Co-pay Amount | 1/1/2003 | Number | 10 | The preset, fixed dollar amount for which the individual is responsible. Do not code decimal point. Two decimal places implied. |
MC066 | Coinsurance Amount | 1/1/2003 | Number | 10 | The dollar amount an individual is responsible for - not the percentage. Do not code decimal point. Two decimal places implied. |
MC067 | Deductible Amount | 1/1/2003 | Number | 10 | Do not code decimal point. Two decimal places implied. |
MC068 | Patient Account/Control Number | 7/1/2006 | Text | 20 | Identifier assigned by hospital |
MC069 | Discharge Date | 7/1/2006 | Text | 8 | Date patient discharged. Required for all inpatient claims. CCYYMMDD The value 'CCYY0101', where CCYY is the year in which discharge occurred, shall be used when the payor indicates the record contains 42 CFR Part 2 SUD-related data by setting the value of MC333 = 'Y'. |
MC070 | Placeholder | 2/1/2016 | N/A | 0 | Leave blank. Service Provider Country Name retired |
MC071 | Placeholder | 2/1/2025 | N/A | 0 | Leave blank. DRG retired |
MC072 | Placeholder | 2/1/2025 | N/A | 0 | Leave blank. DRG Version retired |
MC073 | Placeholder | 2/1/2025 | N/A | 0 | Leave blank. APC retired |
MC074 | Placeholder | 2/1/2025 | N/A | 0 | Leave blank. APC Version retired |
MC075 | Drug Code | 1/1/2010 | Text | 11 | An NDC code used only when a medication is paid for as part of a medical claim. Refer to Appendix A |
MC076 | Billing Provider Number | 1/1/2010 | Text | 30 | Payor-assigned billing provider number. This number should be the identifier used by the payor for internal identification purposes, and does not routinely change. |
MC077 | National Provider ID - Billing Provider | 1/1/2010 | Text | 20 | National Provider ID for billing provider Refer to Appendix A |
MC078 | Billing Provider Last Name or Organization Name | 1/1/2010 | Text | 60 | Full name of provider billing organization or last name of individual billing provider. |
MC079 | Billing Provider Tax ID | 10/1/2014 | Text | 10 | Federal taxpayer's identification number |
MC080 | Billing Provider Address Line 1 | 10/1/2014 | Text | 55 | Address information for billing provider |
MC081 | Billing Provider Address Line 2 | 10/1/2014 | Text | 55 | Address information for billing provider |
MC082 | Billing Provider City Name | 10/1/2014 | Text | 30 | City name of billing provider Refer to Appendix A |
MC083 | Billing Provider State or Province | 10/1/2014 | Text | 2 | As defined by the US Postal Service and Canada Post Refer to Appendix A |
MC084 | Billing Provider Zip Code | 10/1/2014 | Text | 11 | ZIP Code of billing provider - may include non-US codes Do not include dash Refer to Appendix A |
MC085 | Service Facility Location Name | 10/1/2014 | Text | 60 | Laboratory or service facility name If not available or not specified, do not populate. |
MC086 | National Provider ID - Service Facility | 10/1/2014 | Text | 20 | National Provider ID for laboratory or service facility If not available or not specified, do not populate. Refer to Appendix A |
MC087 | Service Facility Location Address Line 1 | 10/1/2014 | Text | 55 | Address information for laboratory or service facility If not available or not specified, do not populate. Address Line 1. |
MC088 | Service Facility Location Address Line 2 | 10/1/2014 | Text | 55 | Address information for laboratory or service facility If not available or not specified, do not populate. Address Line 2. |
MC089 | Service Facility Location City Name | 10/1/2014 | Text | 30 | City name of laboratory or service facility If not available or not specified, do not populate. City Name. Refer to Appendix A |
MC090 | Service Facility Location State or Province | 10/1/2014 | Text | 2 | As defined by the US Postal Service and Canada Post If not available or not specified, do not populate. Refer to Appendix A |
MC091 | Service Facility Location Zip Code | 10/1/2014 | Text | 11 | ZIP Code of service facility - may include non-US codes Do not include dash If not available or not specified, do not populate. Refer to Appendix A |
MC092 | Service Facility Number | 2/1/2016 | Text | 30 | Payor-assigned service facility number. This number should be the identifier used by the payor for internal identification purposes and does not routinely change. If not available or not specified, do not populate. |
MC093 | Service Facility Location Country Code | 2/1/2016 | Text | 2 | Use ISO 3166-1 alpha-2 country codes. Refer to Appendix A. If not available or not specified, do not populate. |
MC094 | Billing Provider Country Code | 2/1/2016 | Text | 2 | Use ISO 3166-1 alpha-2 country codes. Refer to Appendix A. |
MC101 | Subscriber Last Name | 1/1/2010 | Text | 60 | The subscriber last name Shall be left blank when the payor indicates the record contains 42 CFR Part 2 SUD-related data by setting the value of MC333 = 'Y'. |
MC102 | Subscriber First Name | 1/1/2010 | Text | 35 | The subscriber first name Shall be left blank when the payor indicates the record contains 42 CFR Part 2 SUD-related data by setting the value of MC333 = 'Y'. |
MC103 | Subscriber Middle Name | 1/1/2010 | Text | 25 | The subscriber middle name or initial Shall be left blank when the payor indicates the record contains 42 CFR Part 2 SUD-related data by setting the value of MC333 = 'Y'. |
MC104 | Member Last Name | 1/1/2010 | Text | 60 | The member last name Shall be left blank when the payor indicates the record contains 42 CFR Part 2 SUD-related data by setting the value of MC333 = 'Y'. |
MC105 | Member First Name | 1/1/2010 | Text | 35 | The member first name Shall be left blank when the payor indicates the record contains 42 CFR Part 2 SUD-related data by setting the value of MC333 = 'Y'. |
MC106 | Member Middle Name | 1/1/2010 | Text | 25 | The member middle name or initial Shall be left blank when the payor indicates the record contains 42 CFR Part 2 SUD-related data by setting the value of MC333 = 'Y'. |
MC107 | Attending Provider Number | 2/1/2016 | Text | 30 | Payor-assigned attending provider number. This number should be the identifier used by the payor for internal identification purposes and does not routinely change. |
MC108 | National Provider ID - Attending Provider | 2/1/2016 | Text | 20 | National Provider ID for attending provider Refer to Appendix A |
MC109 | Attending Provider First Name | 2/1/2016 | Text | 40 | Individual first name |
MC110 | Attending Provider Middle Name | 2/1/2016 | Text | 25 | Individual middle name or initial |
MC111 | Attending Provider Last Name | 2/1/2016 | Text | 60 | Individual last name |
MC112 | Attending Provider Suffix | 2/1/2016 | Text | 10 | Individual name suffix The attending provider suffix shall be used to capture the generation of the individual clinician (e.g., Jr., Sr., III), if applicable, rather than the clinician's degree (e.g., MD, LCSW). |
MC113 | Attending Provider Specialty | 2/1/2016 | Text | 10 | Refer to Appendix A If defined by payor, then dictionary for specialty code values must be supplied during testing. |
MC114 | Operating Provider Number | 2/1/2016 | Text | 30 | Payor-assigned operating provider number. This number should be the identifier used by the payor for internal identification purposes and does not routinely change. |
MC115 | National Provider ID - Operating Provider | 2/1/2016 | Text | 20 | National Provider ID for operating provider Refer to Appendix A |
MC116 | Operating Provider First Name | 2/1/2016 | Text | 40 | Individual first name |
MC117 | Operating Provider Middle Name | 2/1/2016 | Text | 25 | Individual middle name or initial |
MC118 | Operating Provider Last Name | 2/1/2016 | Text | 60 | Individual last name |
MC119 | Operating Provider Suffix | 2/1/2016 | Text | 10 | Individual name suffix The operating provider suffix shall be used to capture the generation of the individual clinician (e.g., Jr., Sr., III), if applicable, rather than the clinician's degree (e.g., MD, LCSW). |
MC120 | Referring Provider Number | 2/1/2016 | Text | 30 | Payor-assigned referring provider number. This number should be the identifier used by the payor for internal identification purposes and does not routinely change. |
MC121 | National Provider ID - Referring Provider | 2/1/2016 | Text | 20 | National Provider ID for referring provider Refer to Appendix A |
MC122 | Referring Provider First Name | 2/1/2016 | Text | 40 | Individual first name |
MC123 | Referring Provider Middle Name | 2/1/2016 | Text | 25 | Individual middle name or initial |
MC124 | Referring Provider Last Name | 2/1/2016 | Text | 60 | Individual last name |
MC125 | Referring Provider Suffix | 2/1/2016 | Text | 10 | Individual name suffix The referring provider suffix shall be used to capture the generation of the individual clinician (e.g., Jr., Sr., III), if applicable, rather than the clinician's degree (e.g., MD, LCSW). |
MC200 | Principal Diagnosis | 10/1/2014 | Text | 7 | ICD-10-CM Do not code decimal point. Refer to Appendix A |
MC201 | Present On Admission Indicator | 10/1/2014 | Text | 1 | Standard POA code set Refer to Appendix A |
MC202 | Admitting Diagnosis | 10/1/2004 | Text | 7 | Required on all inpatient admission claims and encounters ICD-10-CM Do not code decimal point. Refer to Appendix A |
MC203 | Reason for Visit Diagnosis - 1 | 10/1/2014 | Text | 7 | ICD-10 CM Do not code decimal point. Refer to Appendix A |
MC204 | Reason for Visit Diagnosis - 2 | 10/1/2014 | Text | 7 | ICD-10 CM Do not code decimal point. Refer to Appendix A |
MC205 | Reason for Visit Diagnosis - 3 | 10/1/2014 | Text | 7 | ICD-10 CM Do not code decimal point. Refer to Appendix A |
MC206 | External Cause of Injury - 1 | 10/1/2014 | Text | 7 | ICD-10-CM Do not code decimal point. Refer to Appendix A Shall be left blank when the payor indicates the record contains 42 CFR Part 2 SUD-related data by setting the value of MC333 = 'Y'. |
MC207 | Present On Admission Indicator - 1 | 10/1/2014 | Text | 1 | Standard POA code set Refer to Appendix A Shall be left blank when the payor indicates the record contains 42 CFR Part 2 SUD-related data by setting the value of MC333 = 'Y'. |
MC208 | External Cause of Injury - 2 | 10/1/2014 | Text | 7 | ICD-10-CM Do not code decimal point. Refer to Appendix A Shall be left blank when the payor indicates the record contains 42 CFR Part 2 SUD-related data by setting the value of MC333 = 'Y'. |
MC209 | Present On Admission Indicator - 2 | 10/1/2014 | Text | 1 | Standard POA code set Refer to Appendix A Shall be left blank when the payor indicates the record contains 42 CFR Part 2 SUD-related data by setting the value of MC333 = 'Y'. |
MC210 | External Cause of Injury - 3 | 10/1/2014 | Text | 7 | ICD-10-CM Do not code decimal point. Refer to Appendix A Shall be left blank when the payor indicates the record contains 42 CFR Part 2 SUD-related data by setting the value of MC333 = 'Y'. |
MC211 | Present On Admission Indicator - 3 | 10/1/2014 | Text | 1 | Standard POA code set Refer to Appendix A Shall be left blank when the payor indicates the record contains 42 CFR Part 2 SUD-related data by setting the value of MC333 = 'Y'. |
MC212 | External Cause of Injury - 4 | 10/1/2014 | Text | 7 | ICD-10-CM Do not code decimal point. Refer to Appendix A Shall be left blank when the payor indicates the record contains 42 CFR Part 2 SUD-related data by setting the value of MC333 = 'Y'. |
MC213 | Present On Admission Indicator - 4 | 10/1/2014 | Text | 1 | Standard POA code set Refer to Appendix A Shall be left blank when the payor indicates the record contains 42 CFR Part 2 SUD-related data by setting the value of MC333 = 'Y'. |
MC214 | External Cause of Injury - 5 | 10/1/2014 | Text | 7 | ICD-10-CM Do not code decimal point. Refer to Appendix A Shall be left blank when the payor indicates the record contains 42 CFR Part 2 SUD-related data by setting the value of MC333 = 'Y'. |
MC215 | Present On Admission Indicator - 5 | 10/1/2014 | Text | 1 | Standard POA code set Refer to Appendix A Shall be left blank when the payor indicates the record contains 42 CFR Part 2 SUD-related data by setting the value of MC333 = 'Y'. |
MC216 | External Cause of Injury - 6 | 10/1/2014 | Text | 7 | ICD-10-CM Do not code decimal point. Refer to Appendix A Shall be left blank when the payor indicates the record contains 42 CFR Part 2 SUD-related data by setting the value of MC333 = 'Y'. |
MC217 | Present On Admission Indicator - 6 | 10/1/2014 | Text | 1 | Standard POA code set Refer to Appendix A Shall be left blank when the payor indicates the record contains 42 CFR Part 2 SUD-related data by setting the value of MC333 = 'Y'. |
MC218 | External Cause of Injury - 7 | 10/1/2014 | Text | 7 | ICD-10-CM Do not code decimal point. Refer to Appendix A Shall be left blank when the payor indicates the record contains 42 CFR Part 2 SUD-related data by setting the value of MC333 = 'Y'. |
MC219 | Present On Admission Indicator - 7 | 10/1/2014 | Text | 1 | Standard POA code set Refer to Appendix A Shall be left blank when the payor indicates the record contains 42 CFR Part 2 SUD-related data by setting the value of MC333 = 'Y'. |
MC220 | External Cause of Injury - 8 | 10/1/2014 | Text | 7 | ICD-10-CM Do not code decimal point. Refer to Appendix A Shall be left blank when the payor indicates the record contains 42 CFR Part 2 SUD-related data by setting the value of MC333 = 'Y'. |
MC221 | Present On Admission Indicator - 8 | 10/1/2014 | Text | 1 | Standard POA code set Refer to Appendix A Shall be left blank when the payor indicates the record contains 42 CFR Part 2 SUD-related data by setting the value of MC333 = 'Y'. |
MC222 | External Cause of Injury - 9 | 10/1/2014 | Text | 7 | ICD-10-CM Do not code decimal point. Refer to Appendix A Shall be left blank when the payor indicates the record contains 42 CFR Part 2 SUD-related data by setting the value of MC333 = 'Y'. |
MC223 | Present On Admission Indicator - 9 | 10/1/2014 | Text | 1 | Standard POA code set Refer to Appendix A Shall be left blank when the payor indicates the record contains 42 CFR Part 2 SUD-related data by setting the value of MC333 = 'Y'. |
MC224 | External Cause of Injury - 10 | 10/1/2014 | Text | 7 | ICD-10-CM Do not code decimal point. Refer to Appendix A Shall be left blank when the payor indicates the record contains 42 CFR Part 2 SUD-related data by setting the value of MC333 = 'Y'. |
MC225 | Present On Admission Indicator - 10 | 10/1/2014 | Text | 1 | Standard POA code set Refer to Appendix A Shall be left blank when the payor indicates the record contains 42 CFR Part 2 SUD-related data by setting the value of MC333 = 'Y'. |
MC226 | External Cause of Injury - 11 | 10/1/2014 | Text | 7 | ICD-10-CM Do not code decimal point. Refer to Appendix A Shall be left blank when the payor indicates the record contains 42 CFR Part 2 SUD-related data by setting the value of MC333 = 'Y'. |
MC227 | Present On Admission Indicator - 11 | 10/1/2014 | Text | 1 | Standard POA code set Refer to Appendix A Shall be left blank when the payor indicates the record contains 42 CFR Part 2 SUD-related data by setting the value of MC333 = 'Y'. |
MC228 | External Cause of Injury - 12 | 10/1/2014 | Text | 7 | ICD-10-CM Do not code decimal point. Refer to Appendix A Shall be left blank when the payor indicates the record contains 42 CFR Part 2 SUD-related data by setting the value of MC333 = 'Y'. |
MC229 | Present On Admission Indicator - 12 | 10/1/2014 | Text | 1 | Standard POA code set Refer to Appendix A Shall be left blank when the payor indicates the record contains 42 CFR Part 2 SUD-related data by setting the value of MC333 = 'Y'. |
MC230 | External Cause of Injury - 13 | 10/1/2014 | Text | 7 | ICD-10-CM Do not code decimal point. Refer to Appendix A Shall be left blank when the payor indicates the record contains 42 CFR Part 2 SUD-related data by setting the value of MC333 = 'Y'. |
MC231 | Present On Admission Indicator - 13 | 10/1/2014 | Text | 1 | Standard POA code set Refer to Appendix A Shall be left blank when the payor indicates the record contains 42 CFR Part 2 SUD-related data by setting the value of MC333 = 'Y'. |
MC232 | External Cause of Injury - 14 | 10/1/2014 | Text | 7 | ICD-10-CM Do not code decimal point. Refer to Appendix A Shall be left blank when the payor indicates the record contains 42 CFR Part 2 SUD-related data by setting the value of MC333 = 'Y'. |
MC233 | Present On Admission Indicator - 14 | 10/1/2014 | Text | 1 | Standard POA code set Refer to Appendix A Shall be left blank when the payor indicates the record contains 42 CFR Part 2 SUD-related data by setting the value of MC333 = 'Y'. |
MC234 | External Cause of Injury - 15 | 10/1/2014 | Text | 7 | ICD-10-CM Do not code decimal point. Refer to Appendix A Shall be left blank when the payor indicates the record contains 42 CFR Part 2 SUD-related data by setting the value of MC333 = 'Y'. |
MC235 | Present On Admission Indicator - 15 | 10/1/2014 | Text | 1 | Standard POA code set Refer to Appendix A Shall be left blank when the payor indicates the record contains 42 CFR Part 2 SUD-related data by setting the value of MC333 = 'Y'. |
MC236 | External Cause of Injury - 16 | 10/1/2014 | Text | 7 | ICD-10-CM Do not code decimal point. Refer to Appendix A Shall be left blank when the payor indicates the record contains 42 CFR Part 2 SUD-related data by setting the value of MC333 = 'Y'. |
MC237 | Present On Admission Indicator - 16 | 10/1/2014 | Text | 1 | Standard POA code set Refer to Appendix A Shall be left blank when the payor indicates the record contains 42 CFR Part 2 SUD-related data by setting the value of MC333 = 'Y'. |
MC238 | External Cause of Injury - 17 | 10/1/2014 | Text | 7 | ICD-10-CM Do not code decimal point. Refer to Appendix A Shall be left blank when the payor indicates the record contains 42 CFR Part 2 SUD-related data by setting the value of MC333 = 'Y'. |
MC239 | Present On Admission Indicator - 17 | 10/1/2014 | Text | 1 | Standard POA code set Refer to Appendix A Shall be left blank when the payor indicates the record contains 42 CFR Part 2 SUD-related data by setting the value of MC333 = 'Y'. |
MC240 | External Cause of Injury - 18 | 10/1/2014 | Text | 7 | ICD-10-CM Do not code decimal point. Refer to Appendix A Shall be left blank when the payor indicates the record contains 42 CFR Part 2 SUD-related data by setting the value of MC333 = 'Y'. |
MC241 | Present On Admission Indicator - 18 | 10/1/2014 | Text | 1 | Standard POA code set Refer to Appendix A Shall be left blank when the payor indicates the record contains 42 CFR Part 2 SUD-related data by setting the value of MC333 = 'Y'. |
MC242 | External Cause of Injury - 19 | 10/1/2014 | Text | 7 | ICD-10-CM Do not code decimal point. Refer to Appendix A Shall be left blank when the payor indicates the record contains 42 CFR Part 2 SUD-related data by setting the value of MC333 = 'Y'. |
MC243 | Present On Admission Indicator - 19 | 10/1/2014 | Text | 1 | Standard POA code set Refer to Appendix A Shall be left blank when the payor indicates the record contains 42 CFR Part 2 SUD-related data by setting the value of MC333 = 'Y'. |
MC244 | External Cause of Injury - 20 | 10/1/2014 | Text | 7 | ICD-10-CM Do not code decimal point. Refer to Appendix A Shall be left blank when the payor indicates the record contains 42 CFR Part 2 SUD-related data by setting the value of MC333 = 'Y'. |
MC245 | Present On Admission Indicator - 20 | 10/1/2014 | Text | 1 | Standard POA code set Refer to Appendix A Shall be left blank when the payor indicates the record contains 42 CFR Part 2 SUD-related data by setting the value of MC333 = 'Y'. |
MC246 | External Cause of Injury - 21 | 10/1/2014 | Text | 7 | ICD-10-CM Do not code decimal point. Refer to Appendix A Shall be left blank when the payor indicates the record contains 42 CFR Part 2 SUD-related data by setting the value of MC333 = 'Y'. |
MC247 | Present On Admission Indicator - 21 | 10/1/2014 | Text | 1 | Standard POA code set Refer to Appendix A Shall be left blank when the payor indicates the record contains 42 CFR Part 2 SUD-related data by setting the value of MC333 = 'Y'. |
MC248 | External Cause of Injury - 22 | 10/1/2014 | Text | 7 | ICD-10-CM Do not code decimal point. Refer to Appendix A Shall be left blank when the payor indicates the record contains 42 CFR Part 2 SUD-related data by setting the value of MC333 = 'Y'. |
MC249 | Present On Admission Indicator - 22 | 10/1/2014 | Text | 1 | Standard POA code set Refer to Appendix A Shall be left blank when the payor indicates the record contains 42 CFR Part 2 SUD-related data by setting the value of MC333 = 'Y'. |
MC250 | External Cause of Injury - 23 | 10/1/2014 | Text | 7 | ICD-10-CM Do not code decimal point. Refer to Appendix A Shall be left blank when the payor indicates the record contains 42 CFR Part 2 SUD-related data by setting the value of MC333 = 'Y'. |
MC251 | Present On Admission Indicator - 23 | 10/1/2014 | Text | 1 | Standard POA code set Refer to Appendix A Shall be left blank when the payor indicates the record contains 42 CFR Part 2 SUD-related data by setting the value of MC333 = 'Y'. |
MC252 | External Cause of Injury - 24 | 10/1/2014 | Text | 7 | ICD-10-CM Do not code decimal point. Refer to Appendix A Shall be left blank when the payor indicates the record contains 42 CFR Part 2 SUD-related data by setting the value of MC333 = 'Y'. |
MC253 | Present On Admission Indicator - 24 | 10/1/2014 | Text | 1 | Standard POA code set Refer to Appendix A Shall be left blank when the payor indicates the record contains 42 CFR Part 2 SUD-related data by setting the value of MC333 = 'Y'. |
MC254 | Other Diagnosis - 1 | 10/1/2014 | Text | 7 | ICD-10-CM Do not code decimal point. Refer to Appendix A |
MC255 | Present On Admission Indicator - 1 | 10/1/2014 | Text | 1 | Standard POA code set Refer to Appendix A |
MC256 | Other Diagnosis - 2 | 10/1/2014 | Text | 7 | ICD-10-CM Do not code decimal point. Refer to Appendix A |
MC257 | Present On Admission Indicator - 2 | 10/1/2014 | Text | 1 | Standard POA code set Refer to Appendix A |
MC258 | Other Diagnosis - 3 | 10/1/2004 | Text | 7 | ICD-10-CM Do not code decimal point. Refer to Appendix A |
MC259 | Present On Admission Indicator - 3 | 10/1/2014 | Text | 1 | Standard POA code set Refer to Appendix A |
MC260 | Other Diagnosis - 4 | 10/1/2014 | Text | 7 | ICD-10-CM Do not code decimal point. Refer to Appendix A |
MC261 | Present On Admission Indicator - 4 | 10/1/2014 | Text | 1 | Standard POA code set Refer to Appendix A |
MC262 | Other Diagnosis - 5 | 10/1/2004 | Text | 7 | ICD-10-CM Do not code decimal point. Refer to Appendix A |
MC263 | Present On Admission Indicator - 5 | 10/1/2014 | Text | 1 | Standard POA code set Refer to Appendix A |
MC264 | Other Diagnosis - 6 | 10/1/2014 | Text | 7 | ICD-10-CM Do not code decimal point. Refer to Appendix A |
MC265 | Present On Admission Indicator - 6 | 10/1/2014 | Text | 1 | Standard POA code set Refer to Appendix A |
MC266 | Other Diagnosis - 7 | 10/1/2004 | Text | 7 | ICD-10-CM Do not code decimal point. Refer to Appendix A |
MC267 | Present On Admission Indicator - 7 | 10/1/2014 | Text | 1 | Standard POA code set Refer to Appendix A |
MC268 | Other Diagnosis - 8 | 10/1/2014 | Text | 7 | ICD-10-CM Do not code decimal point. Refer to Appendix A |
MC269 | Present On Admission Indicator - 8 | 10/1/2014 | Text | 1 | Standard POA code set Refer to Appendix A |
MC270 | Other Diagnosis - 9 | 10/1/2004 | Text | 7 | ICD-10-CM Do not code decimal point. Refer to Appendix A |
MC271 | Present On Admission Indicator - 9 | 10/1/2014 | Text | 1 | Standard POA code set Refer to Appendix A |
MC272 | Other Diagnosis - 10 | 10/1/2014 | Text | 7 | ICD-10-CM Do not code decimal point. Refer to Appendix A |
MC273 | Present On Admission Indicator - 10 | 10/1/2014 | Text | 1 | Standard POA code set Refer to Appendix A |
MC274 | Other Diagnosis - 11 | 10/1/2004 | Text | 7 | ICD-10-CM Do not code decimal point. Refer to Appendix A |
MC275 | Present On Admission Indicator - 11 | 10/1/2014 | Text | 1 | Standard POA code set Refer to Appendix A |
MC276 | Other Diagnosis - 12 | 10/1/2014 | Text | 7 | ICD-10-CM Do not code decimal point. Refer to Appendix A |
MC277 | Present On Admission Indicator - 12 | 10/1/2014 | Text | 1 | Standard POA code set Refer to Appendix A |
MC278 | Other Diagnosis - 13 | 10/1/2004 | Text | 7 | ICD-10-CM Do not code decimal point. Refer to Appendix A |
MC279 | Present On Admission Indicator - 13 | 10/1/2014 | Text | 1 | Standard POA code set Refer to Appendix A |
MC280 | Other Diagnosis - 14 | 10/1/2014 | Text | 7 | ICD-10-CM Do not code decimal point. Refer to Appendix A |
MC281 | Present On Admission Indicator - 14 | 10/1/2014 | Text | 1 | Standard POA code set Refer to Appendix A |
MC282 | Other Diagnosis - 15 | 10/1/2014 | Text | 7 | ICD-10-CM Do not code decimal point. Refer to Appendix A |
MC283 | Present On Admission Indicator - 15 | 10/1/2014 | Text | 1 | Standard POA code set Refer to Appendix A |
MC284 | Other Diagnosis - 16 | 10/1/2014 | Text | 7 | ICD-10-CM Do not code decimal point. Refer to Appendix A |
MC285 | Present On Admission Indicator - 16 | 10/1/2014 | Text | 1 | Standard POA code set Refer to Appendix A |
MC286 | Other Diagnosis - 17 | 10/1/2014 | Text | 7 | ICD-10-CM Do not code decimal point. Refer to Appendix A |
MC287 | Present On Admission Indicator - 17 | 10/1/2014 | Text | 1 | Standard POA code set Refer to Appendix A |
MC288 | Other Diagnosis - 18 | 10/1/2014 | Text | 7 | ICD-10-CM Do not code decimal point. Refer to Appendix A |
MC289 | Present On Admission Indicator - 18 | 10/1/2014 | Text | 1 | Standard POA code set Refer to Appendix A |
MC290 | Other Diagnosis - 19 | 10/1/2014 | Text | 7 | ICD-10-CM Do not code decimal point. Refer to Appendix A |
MC291 | Present On Admission Indicator - 19 | 10/1/2014 | Text | 1 | Standard POA code set Refer to Appendix A |
MC292 | Other Diagnosis - 20 | 10/1/2014 | Text | 7 | ICD-10-CM Do not code decimal point. Refer to Appendix A |
MC293 | Present On Admission Indicator - 20 | 10/1/2014 | Text | 1 | Standard POA code set Refer to Appendix A |
MC294 | Other Diagnosis - 21 | 10/1/2004 | Text | 7 | ICD-10-CM Do not code decimal point. Refer to Appendix A |
MC295 | Present On Admission Indicator - 21 | 10/1/2014 | Text | 1 | Standard POA code set Refer to Appendix A |
MC296 | Other Diagnosis - 22 | 10/1/2014 | Text | 7 | ICD-10-CM Do not code decimal point. Refer to Appendix A |
MC297 | Present On Admission Indicator - 22 | 10/1/2014 | Text | 1 | Standard POA code set Refer to Appendix A |
MC298 | Other Diagnosis - 23 | 10/1/2014 | Text | 7 | ICD-10-CM Do not code decimal point. Refer to Appendix A |
MC299 | Present On Admission Indicator - 23 | 10/1/2014 | Text | 1 | Standard POA code set Refer to Appendix A |
MC300 | Other Diagnosis - 24 | 10/1/2014 | Text | 7 | ICD-10-CM Do not code decimal point. Refer to Appendix A |
MC301 | Present On Admission Indicator - 24 | 10/1/2014 | Text | 1 | Standard POA code set Refer to Appendix A |
MC302 | Principal Procedure Code | 10/1/2014 | Text | 7 | IDC-10-PCS Primary procedure code for this line of service Do not code decimal point. Refer to Appendix A |
MC303 | Other Procedure Code - 1 | 10/1/2014 | Text | 7 | ICD-10 PCS Do not code decimal point. Refer to Appendix A |
MC304 | Other Procedure Code - 2 | 10/1/2014 | Text | 7 | ICD-10 PCS Do not code decimal point. Refer to Appendix A |
MC305 | Other Procedure Code - 3 | 10/1/2014 | Text | 7 | ICD-10 PCS Do not code decimal point. Refer to Appendix A |
MC306 | Other Procedure Code - 4 | 10/1/2014 | Text | 7 | ICD-10 PCS Do not code decimal point. Refer to Appendix A |
MC307 | Other Procedure Code - 5 | 10/1/2014 | Text | 7 | ICD-10 PCS Do not code decimal point. Refer to Appendix A |
MC308 | Other Procedure Code- 6 | 10/1/2014 | Text | 7 | ICD-10 PCS Do not code decimal point. Refer to Appendix A |
MC309 | Other Procedure Code - 7 | 10/1/2014 | Text | 7 | ICD-10 PCS Do not code decimal point. Refer to Appendix A |
MC310 | Other Procedure Code - 8 | 10/1/2014 | Text | 7 | ICD-10 PCS Do not code decimal point. Refer to Appendix A |
MC311 | Other Procedure Code - 9 | 10/1/2014 | Text | 7 | ICD-10 PCS Do not code decimal point. Refer to Appendix A |
MC312 | Other Procedure Code - 10 | 10/1/2014 | Text | 7 | ICD-10 PCS Do not code decimal point. Refer to Appendix A |
MC313 | Other Procedure Code - 11 | 10/1/2014 | Text | 7 | ICD-10 PCS Do not code decimal point. Refer to Appendix A |
MC314 | Other Procedure Code - 12 | 10/1/2014 | Text | 7 | ICD-10 PCS Do not code decimal point. Refer to Appendix A |
MC315 | Other Procedure Code - 13 | 10/1/2014 | Text | 7 | ICD-10 PCS Do not code decimal point. Refer to Appendix A |
MC316 | Other Procedure Code - 14 | 10/1/2014 | Text | 7 | ICD-10 PCS Do not code decimal point. Refer to Appendix A |
MC317 | Other Procedure Code - 15 | 10/1/2014 | Text | 7 | ICD-10 PCS Do not code decimal point. Refer to Appendix A |
MC318 | Other Procedure Code - 16 | 10/1/2014 | Text | 7 | ICD-10 PCS Do not code decimal point. Refer to Appendix A |
MC319 | Other Procedure Code - 17 | 10/1/2014 | Text | 7 | ICD-10 PCS Do not code decimal point. Refer to Appendix A |
MC320 | Other Procedure Code - 18 | 10/1/2014 | Text | 7 | ICD-10 PCS Do not code decimal point. Refer to Appendix A |
MC321 | Other Procedure Code - 19 | 10/1/2014 | Text | 7 | ICD-10 PCS Do not code decimal point. Refer to Appendix A |
MC322 | Other Procedure Code - 20 | 10/1/2014 | Text | 7 | ICD-10 PCS Do not code decimal point. Refer to Appendix A |
MC323 | Other Procedure Code - 21 | 10/1/2014 | Text | 7 | ICD-10 PCS Do not code decimal point. Refer to Appendix A |
MC324 | Other Procedure Code - 22 | 10/1/2014 | Text | 7 | ICD-10 PCS Do not code decimal point. Refer to Appendix A |
MC325 | Other Procedure Code - 23 | 10/1/2014 | Text | 7 | ICD-10 PCS Do not code decimal point. Refer to Appendix A |
MC326 | Other Procedure Code - 24 | 10/1/2014 | Text | 7 | ICD-10 PCS Do not code decimal point. Refer to Appendix A |
MC327 | Member Address Line 1 | 2/1/2019 | Text | 55 | Shall be left blank when the payor indicates the record contains 42 CFR Part 2 SUD-related data by setting the value of MC333 = 'Y'. |
MC328 | Member Address Line 2 | 2/1/2019 | Text | 55 | Shall be left blank when the payor indicates the record contains 42 CFR Part 2 SUD-related data by setting the value of MC333 = 'Y'. |
MC329 | Member Country Code | 2/1/2019 | Text | 2 | Use ISO 3166-1 alpha-2 country codes. Refer to Appendix A. Shall be left blank when the payor indicates the record contains 42 CFR Part 2 SUD-related data by setting the value of MC333 = 'Y'. |
MC330 | In-Plan Network Indicator | 2/1/2021 | Text | 1 | A yes/no indicator that specifies if the Billing Provider (not the benefit) is within the health plan network. Valid codes are: N=No; Y=Yes. |
MC331 | Payment Arrangement Type Indicator | 2/1/2022 | Text | 2 | Indicates the payment methodology. Valid codes are: 01=Unused/Retired 02=Fee for Service 03=Percent of Charges 04=DRG 05=Pay for Performance 06=Global Payment 07=APC 08=Other Claims-based Payment 09= Capitation contract per member per month (PMPM) |
MC332 | Member Age | 2/1/2025 | Text | 2 | Member's calculated age as of the service date. Round to the nearest integer. For ages GREATER THAN 90, indicate '90'. |
MC333 | Substance Use Disorder (SUD) Indicator | 2/1/2025 | Text | 1 | Indicates whether a record contains 42 CFR Part 2 SUD-related data or not. Valid values are: N = Record does not contain 42 CFR Part 2 SUD-related data. Send all available values of all requested fields. Y = Record contains 42 CFR Part 2 SUD-related data. The following fields shall be left blank: MC004-MC016; MC101-MC106; MC206 - MC253; and MC327-MC329. Fields MC017, MC018, MC059, MC060, MC069, MC334 and MC335 may be recoded to CCYY0101, where CCYY is the year of the date. NOTE: only 42 CFR Part 2 SUD-related claim lines shall be marked with 'Y'; other claim lines in the claim that are not 42 CFR Part 2 SUD-related shall be marked with 'N'. |
MC334 | Service Line Date - From | 2/1/2025 | Text | 8 | First date of service for this service line. Indicate the date of service at the line level, not the claim level. See mapping to form locators and the 005010 in Appendix D-2. CCYYMMDD On a capitated service record, this is the first day of service. The Payment Arrangement Type Indicator (MC331) = '09' for all capitated service records. Shall be left blank when the payor indicates the record contains 42 CFR Part 2 SUD-related data by setting the value of MC333 = 'Y'. |
MC335 | Service Line Date - Thru | 2/1/2025 | Text | 8 | Last date of service for this service line. Indicate the date of service at the line level, not the claim level. See mapping to form locators and the 005010 in Appendix D-2. CCYYMMDD On a capitated service record, this is the last day of service. The Payment Arrangement Type Indicator (MC331) = '09' for all capitated service records. Shall be left blank when the payor indicates the record contains 42 CFR Part 2 SUD-related data by setting the value of MC333 = 'Y'. |
MC336 | Carrier Specific Unique Member (CSUM) ID | 2/1/2025 | Text | 50 | This ID should uniquely and consistently identify a member in both the medical claims and the capitated payments files. It shall be used when the payor indicates that related records in the medical and capitation files contain 42 CFR Part 2 SUD-related data (MC333 = 'Y' and CF035 = 'Y'), and other inter-file identifiers shall be left blank. For fully identified data records that do not contain 42 CFR Part 2-related data (MC333 = 'N' and CF035 = 'N'), the CSUM ID shall be left blank, and all other inter-file identifiers shall be populated, when available. This ID must differ from any of the other identifiers on the record and may not be derived from any of these in a manner that the original values could be determined. |
MC899 | Record Type | 1/1/2003 | Text | 2 | Value = MC |
C.M.R. 90, 590, ch. 243, app 590-243-D-1