PCIP DDE Claims Entry Screen to Report Rendering NPI

MAP171E has been added to the Direct Data Entry (DDE) Claims Entry screens to allow entry of line level National Provider Identifier (NPI) information for the rendering physician. This information is used to identify the services provided by primary care physicians for payment of the Primary Care Incentive Program (PCIP).

The screen is accessed by pressing the F11 key while on the DDE claims entry charge screen, claim page 2.

This is an image of the DDE MAP171E screen which contains various fields: the beneficiary Health Insurance Claim (HIC) number, Type of Bill (TOB), Status location (S/LOC), provider number and five rows for each claim indicating the provider's NPI, last name, first name, middle initial and specialty. The field titles and descriptions are indicated in the tables below.



Field Field Description
NDC CD PAGE There are 33 total pages to account for 450 revenue lines.
HIC Health Insurance Claim Number: 12- position alphanumeric field identifies Health Insurance Claim Number assigned to beneficiary by CMS.
TOB Type of Bill: Three-position alphanumeric field that identifies type of facility, bill classification, and frequency of claim in a particular period of care.
S/LOC Status and Location: Combination of status and location. First-alphanumeric position represents status of claim. Next five-alphanumeric positions represent location of claim.
PROVIDER Provider Number (Assigned by CMS): 13-position alphanumeric field displays identification number of institution that rendered services to beneficiary/patient
Based on DDE NPI/Legacy (OSCAR) indicator in Provider file, this field can display NPI number (if spaces or zero), or provider number (OSCAR/Legacy).
CL Three-position alphanumeric field that identifies claim line number
NDC FIELD 11-position alphanumeric field identifies National Drug Code (NDC)
NDC QUANTITY 11-digit field, in 99999999.999 format, that identifies NDC quantity
QUALIFIER Two-position alphanumeric field that identifies NDC quantity qualifier
LLR NPI Ten-position alphanumeric field that identifies line level rendering physician's NPI (National Provider Identifier) number
L Last Name:17-position alphanumeric field that identifies last name of physician
F First Name: Eight-position alphanumeric field that identifies first name of physician
M Middle Name: One-position alphanumeric field that identifies middle initial of physician
SC Specialty Code: Two-position alphanumeric field that identifies specialty code. See Specialty Codes table below.

SC = Specialty Codes

Code Physician Specialty
'02' General Surgery
'03' Allergy/Immunology
'04' Otolaryngology
'05' Anesthesiology
'06' Cardiology
'07' Dermatology
'08' Family Practice
'09' Interventional Pain Management
'10' Gastroenterology
'11' Internal Medicine
'12' Osteopathic Manipulative Therapy
'13' Neurology
'14' Neurosurgery
'16' Obstetrics/Gynecology
'17' Hospice And Palliative Care
'20' Orthopedic Surgery
'22' Pathology
'24' Plastic And Reconstructive Surgery
'25' Physical Medicine And Rehabilitation
'26' Psychiatry
'27' Geriatric Psychiatry
'28' Colorectal Surgery (Formerly Proctology)
'29' Pulmonary Disease
'30' Diagnostic Radiology
'33' Thoracic Surgery
'34' Urology
'36' Nuclear Medicine
'37' Pediatric Medicine
'38' Geriatric Medicine
'39' Nephrology
'40' Hand Surgery
'44' Infectious Disease
'46' Endocrinology
'48' Podiatry
'66' Rheumatology
'72' Pain Management
'76' Peripheral Vascular Disease
'77' Vascular Surgery
'78' Cardiac Surgery
'79' Addiction Medicine
'81' Critical Care (Intensivists)
'82' Hematology
'83' Hematology/Oncology
'84' Preventive Medicine
'86' Neuropsychiatry
'90' Medical Oncology
'91' Surgical Oncology
'92' Radiation Oncology
'93' Emergency Medicine
'94' Interventional Radiology
'98' Gynecological/Oncology
Last Updated Dec 18 , 2023