| FileMan FileNo | FileMan Filename | Package |
|---|---|---|
| 364 | EDI TRANSMIT BILL | Integrated Billing |
| Package | Total | FileMan Files |
|---|---|---|
| Integrated Billing | 3 | EDI MESSAGES(#364.2)[.05] BILL STATUS MESSAGE(#361)[.11] EXPLANATION OF BENEFITS(#361.1)[.19] |
| Package | Total | FileMan Files |
|---|---|---|
| Integrated Billing | 2 | BILL/CLAIMS(#399)[.01] EDI TRANSMISSION BATCH(#364.1)[.02, .06] |
| Field # | Name | Loc | Type | Details |
|---|---|---|---|---|
| .01 | BILL NUMBER | 0;1 | POINTER TO BILL/CLAIMS FILE (#399) | ************************REQUIRED FIELD************************ BILL/CLAIMS(#399)
|
| .02 | BATCH NUMBER | 0;2 | POINTER TO EDI TRANSMISSION BATCH FILE (#364.1) | EDI TRANSMISSION BATCH(#364.1)
|
| .03 | TRANSMISSION STATUS | 0;3 | SET | ************************REQUIRED FIELD************************
|
| .04 | STATUS DATE | 0;4 | DATE |
|
| .06 | RESUBMIT BATCH NUMBER | 0;6 | POINTER TO EDI TRANSMISSION BATCH FILE (#364.1) | EDI TRANSMISSION BATCH(#364.1)
|
| .07 | TEST BILL | 0;7 | SET |
|
| .08 | COB SEQUENCE | 0;8 | SET |
|
| .09 | 837 FHIR TRANS REQUEST | 0;9 | SET |
|
| .1 | RESUBMISSION | 0;10 | SET |
|
| .11 | FHIR BUNDLE VALIDATION | 0;11 | SET |
|
| .12 | OLD STATUS | 0;12 | FREE TEXT |
|
| ICR LINK | Subscribing Package(s) | Fields Referenced | Description |
|---|---|---|---|
| ICR #6208 | BILL NUMBER (.01). Access: Read w/Fileman BATCH NUMBER (.02). Access: Read w/Fileman |
| Name | Line Occurrences (* Changed, ! Killed) |
|---|---|
| ^DD(364.1 | ID.02+1 |
| ^IBA(364 - [#364] | IXABABISL+1*, IXABABIKL+1!, IXABABIKEIC+1!, IXABASTSL+1*, IXABASTKL+1!, IXABASTKEIC+1!, IXABDTSL+1*, IXABDTKL+1!, IXABDTKEIC+1!, IXACSL+1* , IXACKL+1!, IXACOBSL+1*, IXACOBKL+1!, IXACOBKEIC+1!, .01(XREF 1S), .01(XREF 1K), .02(XREF 3S), .02(XREF 3K), .03(XREF 1S), .03(XREF 1K) |
| ^IBA(364.1 - [#364.1] | ID.02+1 |
| Name | Field # of Occurrence |
|---|---|
| ^(0 | ID.02+1, ID.04+1 |
| >> | Not killed explicitly |
| * | Changed |
| ! | Killed |
| ~ | Newed |
| Name | Field # of Occurrence |
|---|---|
| >> %DT | .04+1* |
| %I | ID.02+1*! |
| >> C | ID.02+1* |
| >> DA | IXABABISL+1, IXABABIKL+1, IXABASTSL+1, IXABASTKL+1, IXABDTSL+1, IXABDTKL+1, IXACSL+1, IXACKL+1, IXACOBSL+1, IXACOBKL+1 , IXACOBP4CC+1, .01(XREF 1S), .01(XREF 1K), .02(XREF 3S), .02(XREF 3K), .03(XREF 1S), .03(XREF 1K) |
| >> DIC | ID.02+1, ID.03+1 |
| U | ID.02+1, ID.04+1 |
| X | IXABABISCC+1*, IXABABIKCC+1*, IXABASTSCC+1*, IXABASTKCC+1*, IXABDTSCC+1*, IXABDTKCC+1*, IXACSCC+1!, IXACOBSCC+1*, IXACOBKCC+1*, IXACOBP4CC+1* , .01(XREF 1S), .01(XREF 1K), .02(XREF 3S), .02(XREF 3K), .03(XREF 1S), .03(XREF 1K), .04+1*!, .12+1! |
| >> X1(1 | IXABASTKL+1, IXABASTKCC+1, IXABDTKL+1, IXABDTKCC+1, IXACKL+1, IXACOBKL+1, IXACOBKCC+1 |
| >> X1(2 | IXABABIKL+1, IXABABIKCC+1, IXABASTKL+1, IXABASTKCC+1, IXABDTKL+1, IXABDTKCC+1 |
| >> X1(3 | IXABABIKL+1, IXABABIKCC+1 |
| >> X2(1 | IXABASTSL+1, IXABASTSCC+1, IXABDTSL+1, IXABDTSCC+1, IXACSL+1, IXACOBSL+1, IXACOBSCC+1 |
| >> X2(2 | IXABABISL+1, IXABABISCC+1, IXABASTSL+1, IXABASTSCC+1, IXABDTSL+1, IXABDTSCC+1 |
| >> X2(3 | IXABABISL+1, IXABABISCC+1 |
| >> X2(4 | IXACOBSCC+1 |
| >> Y | ID.02+1*, .04+1 |