| FileMan FileNo | FileMan Filename | Package |
|---|---|---|
| 161.4 | FEE BASIS SITE PARAMETERS | Fee Basis |
| Package | Total | FileMan Files |
|---|---|---|
| Kernel | 2 | INSTITUTION(#4)[27] STATE(#5)[4] |
| Field # | Name | Loc | Type | Details |
|---|---|---|---|---|
| .001 | NUMBER | NUMBER |
|
|
| .01 | STATION OF JURISDICTION NAME | 0;1 | FREE TEXT | ************************REQUIRED FIELD************************
|
| 1 | STATION ADDRESS LINE 1 | 0;2 | FREE TEXT | ************************REQUIRED FIELD************************
|
| 2 | STATION ADDRESS LINE 2 | 0;3 | FREE TEXT |
|
| 3 | CITY | 0;4 | FREE TEXT | ************************REQUIRED FIELD************************
|
| 4 | STATE | 0;5 | POINTER TO STATE FILE (#5) | ************************REQUIRED FIELD************************ STATE(#5)
|
| 5 | ZIP | 0;6 | FREE TEXT | ************************REQUIRED FIELD************************
|
| 5.5 | MAIL CODE | 1;11 | FREE TEXT |
|
| 6 | STATION TELEPHONE NUMBER | 0;7 | FREE TEXT | ************************REQUIRED FIELD************************
|
| 7 | APPROVING OFFICIAL FOR 7079 | 0;8 | FREE TEXT | ************************REQUIRED FIELD************************
|
| 8 | TITLE OF APPROVING OFFICIAL | 0;9 | FREE TEXT | ************************REQUIRED FIELD************************
|
| 9 | MEDICAID DISPENSING FEE | 0;10 | NUMBER | ************************REQUIRED FIELD************************
|
| 10 | NEXT BATCH NUMBER | FBNUM;1 | NUMBER | ************************REQUIRED FIELD************************
|
| 11 | NEXT INVOICE NUMBER | FBNUM;2 | NUMBER | ************************REQUIRED FIELD************************
|
| 12 | MEDICAL PAYMENT VENDOR DISPLAY | 0;11 | FREE TEXT |
|
| 13 | PHARMACY PAYMNT VENDOR DISPLAY | 0;12 | FREE TEXT |
|
| 14 | DEFAULT AUTH. TIME RANGE | 0;13 | NUMBER |
|
| 15 | ASK VENDOR DURING AUTH. | 1;1 | SET |
|
| 16 | STATION ADDRESS LINE 3 | 1;2 | FREE TEXT |
|
| 17 | MAX # PAYMENT LINE ITEMS | FBNUM;3 | NUMBER | ************************REQUIRED FIELD************************
|
| 17.1 | MAX # CH PAYMENT LINES | FBNUM;4 | NUMBER | ************************REQUIRED FIELD************************
|
| 17.2 | MAX # CNH PAYMENT LINES | FBNUM;5 | NUMBER | ************************REQUIRED FIELD************************
|
| 19 | *EDIT AUTH. DURING PAYMENT | 1;4 | FREE TEXT |
|
| 21 | *ASK PROGRAM SPECIFIC AUTH. | 1;6 | SET |
|
| 22 | APPROVING OFFICIAL FOR 7078 | 1;7 | FREE TEXT |
|
| 23 | TITLE 7078 APPROVING OFFICIAL | 1;8 | FREE TEXT |
|
| 25 | COPIES OF 7078 TO BE PRINTED | 1;5 | NUMBER | ************************REQUIRED FIELD************************
|
| 27 | PSA DEFAULT INSTITUTION | 1;3 | POINTER TO INSTITUTION FILE (#4) | ************************REQUIRED FIELD************************ INSTITUTION(#4)
|
| 28 | 7078 DEFAULT AUTH SERVICE TEXT | S;0 | WORD-PROCESSING #161.428 |
|
| 29 | DATE BATCH PURGE LAST RUN | PURGE;1 | DATE |
|
| 30 | OUTPATIENT MONTHLY LIMITATION | 1;9 | NUMBER | ************************REQUIRED FIELD************************
|
| 31 | TRANSMISSION HEADER | 1;10 | FREE TEXT | ************************REQUIRED FIELD************************
|
| 32 | TRACK INCOMPLETE UNAUTH CLAIM? | UC;1 | SET |
|
| 32.5 | 'INITIAL ENTRY' STATUS FOR U/C | UC;7 | SET |
|
| 33 | UNAUTHORIZED CLAIM PRINTER | UC;2 | FREE TEXT |
|
| 34 | UNAUTHORIZED CLAIM LETTER | UC;3 | SET |
|
| 35 | NUMBER OF COPIES | UC;4 | NUMBER |
|
| 35.5 | PRINT U/C ON LETTERHEAD? | UC;8 | SET |
|
| 35.6 | STATION NAME (EDITABLE) | UC;9 | FREE TEXT | ************************REQUIRED FIELD************************
|
| 35.7 | UC LETTER LINES AFTER CC | UC;10 | NUMBER |
|
| 36 | FPPS TRANSMIT START | 2;1 | DATE |
|
| 37 | FPPS TRANSMIT END | 2;2 | DATE |
|
| 38 | PROJECT ARCH REMINDER DELAY | ARCH;1 | NUMBER |
|
| 39 | UNIQUE CLAIM IDENTIFIER SEQ | 2;3 | FREE TEXT |
|
| 40 | ALLOW FB PAID TO IB | 2;4 | SET |
|
| 80 | LAST IPAC NUMBER | IPAC;1 | NUMBER |
|
| Name | Line Occurrences (* Changed, ! Killed) |
|---|---|
| ^FBAA(161.4 - [#161.4] | .01(XREF 1S), .01(XREF 1K) |
| >> | Not killed explicitly |
| * | Changed |
| ! | Killed |
| ~ | Newed |
| Name | Field # of Occurrence |
|---|---|
| >> %DT | 29+1*, 36+1*, 37+1* |
| >> DA | .01(XREF 1S), .01(XREF 1K) |
| >> DIC("S" | 33SCR+1* |
| X | .001+1!, .01+1!, .01(XREF 1S), .01(XREF 1K), 1+1!, 2+1!, 3+1!, 5+1!, 5.5+1!, 6+1! , 7+1!, 8+1!, 9+1*!, 10+1!, 11+1!, 12+1, 13+1, 14+1!, 16+1!, 17+1! , 17.1+1!, 17.2+1!, 19+1, 22+1!, 23+1!, 25+1!, 29+1*!, 30+1!, 31+1!, 33+1! , 35+1!, 35.6+1!, 35.7+1!, 36+1*!, 37+1*!, 38+1!, 39+1!, 80+1! |
| >> Y | 12OT+1, 13OT+1, 19OT+1, 29+1, 36+1, 37+1 |
| >> Y(0 | 12OT+1*, 13OT+1*, 19OT+1* |