Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 590 - MAINE HEALTH DATA ORGANIZATION › Chapter 243 - UNIFORM REPORTING SYSTEM FOR HEALTH CARE CLAIMS DATA SETS › Appendix 590-243-D-1 - Maine Health Data Organization Medical Claims File Specifications

Current through 2024-29, July 17, 2024
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