Medicare Code definition
Medicare Code added value “Part D Only” • Table O “Unit of Measure” • Field 11 “Medicare Code” description • Table I – B1 “Service Category (Using the SCO reporting groups) “– added value “309 B – Pharmacy/Drug (Non-Part D)” ▇▇▇▇ ▇▇▇▇▇▇▇▇▇▇ 12/15/2018 REMOVED: • Table N “Submission Clarification Code” • Section 1.1 – Removed requirements for Monthly Financial Reports ADDED: ▇▇▇▇ ▇▇▇▇▇▇▇▇▇▇ Date Revision Name • TABLE O - Unit Of Measure values • Field # 11 “Medicare Code” – added values (4 = Part A and D, 5 = Part B and D, 6 = Part A, B, and D) • Field #229 “Submission Clarification Code 2” • Field #230 “Submission Clarification Code 3” • Field #231 “Unit of Measure” • Submission Clarification Code description - Segment 2.0 “Data Elements Clarification” UPDATED: • TABLE C - Place of Service (HCFA 1500) Place of Service Codes for Professional Claims • TABLE M - POA Indicator Options and Definitions 3/14/2018 • The length of all Address Location Code fields has been increased to 15 C • The length of MMIS Plan type (MBH only) has been increased to 5 C Additions and corrected typos: • SEGMENT “Data Requirements” ADDED: • “MCO claims where “From Service Date” is prior to 03/01/2018, the value of MCO PIDSL should be entered in “Entity PIDSL” field (#3)” ENCOUNTER • Field # 3: Entity PIDSL – added to the description “an ACO with which a PCC is contracted with” • Field # 13: Submission Clarification Code – is required on Pharmacy claim lines only • Field # 33: Type Of Bill – should be submitted on Hospital (H) and LTS (L) claims only • Field # 36: Quantity - the values should be submitted on claims of all types, but Pharmacy (R – Prescription Drug) • Field # 49: PCC Provider ID – should be submitted on claims of all types • Field # 92: PCC Provider ID Type - should be submitted on claims of all types PROVIDER To the list “The following fields are 100% required on all records” Added: • 19. Entity PIDSL • Field# 35: Entity PIDSL - description changed to: MCO/ACO providers: if the provider is enrolled with MCO only (not with ACO) - MCO PIDSL in ENTITY_PIDSL if the provider is enrolled with ACO only - ACO PIDSL if the provider is enrolled with both, ACO and MCO - ACO PIDSL if provider is enrolled with multiple ACOs (e.g., a specialist), and a plan is an active MCO - MCO PIDSL if provider is enrolled with multiple ACOs (e.g., a specialist) and a plan is not an active MCO - old MCO PIDSL • SCO PIDSL for SCO providers One Care PIDSL for One Care providers” Authorization Type Data Set E...