CHANGED. All Provider ID Address Location Code fields: Length of the field = 5; Data Type = C • Narrations In segment “3.1 Provider Data Set with Record Layout” Xxxx Xxxxxxxxxx Date Revision Name 09/20/2017 Add to the list of changes: • Field#37: NDC Number – now will be required on Hospital and Professional claims in addition to the Pharmacy ones. • Field#38: Metric Quantity - now will be required on Hospital and Professional claims in addition to the Pharmacy ones. Removed ACO PIDSL field from: • Internal Provider Type Data Set table • Provider Specialty Data Set Elements table • Member File Layout Xxxx Xxxxxxxxxx 08/14/2017 • Secure FTP Server - changes to the server related information in the section • Data Requirements section – mentioning of ACO program implementation • Data Set Elements tables are enhanced with Record Layout information. Obsolete: • Encounter Record Layout section • Provider Record Layout section Encounter Data Set Changes to the existing fields: • Field#1: MCE PIDSL (former Claim Payer) • Field#3: ACO PIDSL (Former “Plan Identifier”) • Field#7: o Pricing Indicator (former “Filler”) o the length changed from 9 to 20 • Field#13: Submission Clarification Code” (former “Filler”) • Field#32: Gender Code, added value of “O” for “Other” • Field #33: Type of Bill (former “Place of Service Type”) • Field#71: Added values of “7 = ACO-A”, “8 = ACO-B” and “9= ACO-C” • Field#195: ACO Categories, added value ‘ACO’ for ACO Service Category Type Introducing new fields • Field #204: Value Code • Field #205: Value Amount • Field # 206 - 221: Surgical Procedure Codes 10-25 • Field#222: Attending Prov. ID Address Location Code • Field#223: Billing Provider ID Address Location Code • Field#224: Prescribing Prov. ID Address Location Code • Field#225: PCP Provider ID Address Location Code • Field#226: Referring Provider ID Address Location Code • Field#227: Servicing Provider ID Address Location Code • Field#228: PCC Provider ID • Field#229: PCC Provider ID Type • Field#230: PCC Provider ID Address Location Code Provider Data Set Elements related tables and Additional Reference Data Set Elements: Changed and added fields • Field #1 “Claim Payer” is replaced with “MCE PIDSL” • Added field “ACO PIDSL” at the end of the files Provider Data Set file Xxxx Xxxxxxxxxx Field # Field Name Former Field Name 1 MCE PIDSL Claim Payer 22 PCC Provider ID IPA/PMG ID 31 PCC Provider ID Type IPA/PMG ID_Type Date Revision Name 35 ACO PIDSL 36 Provider ID Address Location Code 37 PCC ID Address Location Code 38 Provider Network ID TYPE 39 Provider Network ID Address Location Code Internal Provider Type Data Set Provider Specialty Data Set Elements Member Enrollment File Field # Field Name Former Field Name 1 MCE PIDSL Claim Payer 12 PCC Provider ID Address Location Code 13 PCC Practice ID Address Location Code 14 ACO PIDSL 06/06/2017 III. Error HandlingDenial Code not in Denied Claims file - New error codes added 72* Claim Number/Suffix in Denied Claims Reason Code file not in Denied Claims file 73* Claim Number/Suffix in Denied Claims file not in Denied Claims Reason Code file 74 Correction to a claim that is not in MH DW * Specific for denied claims only Xxxx Xxxxxxxxxx
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