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Global: ^IBA(364.5

Package: Integrated Billing

Global: ^IBA(364.5


Information

FileMan FileNo FileMan Filename Package
364.5 IB DATA ELEMENT DEFINITION Integrated Billing

Description

Accessed By FileMan Db Calls, Total: 5

Package Total Routines
Integrated Billing 5 IBCEFG41    IBCEFG6    IBCEFG61    IBYOPRE    IBYPPCC    

Pointed To By FileMan Files, Total: 1

Package Total FileMan Files
Integrated Billing 1 IB FORM FIELD CONTENT(#364.7)[.03]    

Pointer To FileMan Files, Total: 1

Package Total FileMan Files
VA FileMan 1 FILE(#1)[.05]    

Fields, Total: 11

Field # Name Loc Type Details
.01 NAME 0;1 FREE TEXT
************************REQUIRED FIELD************************

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<3)!'(X'?1P.E) X
  • LAST EDITED:  DEC 19, 1995
  • HELP-PROMPT:  Answer must be 3-30 characters in length.
  • DESCRIPTION:  
    The name to be used to uniquely identify this data element.
  • CROSS-REFERENCE:  364.5^B
    1)= S ^IBA(364.5,"B",$E(X,1,30),DA)=""
    2)= K ^IBA(364.5,"B",$E(X,1,30),DA)
.02 SECURITY LEVEL 0;2 SET
************************REQUIRED FIELD************************
  • 'N' FOR NATIONAL,NO EDIT;
  • 'L' FOR LOCAL;

  • LAST EDITED:  FEB 15, 1996
  • DESCRIPTION:  
    If this field is set to N (NATIONAL,NO EDIT), this is a secured data element and will not be allowed to be edited or deleted.
.03 TYPE OF ELEMENT 0;3 SET
************************REQUIRED FIELD************************
  • 'F' FOR NON-MULTIPLE FILEMAN FIELD;
  • 'E' FOR EXTRACTED VIA CODE;
  • 'C' FOR CONSTANT VALUE;

  • LAST EDITED:  FEB 15, 1996
  • DESCRIPTION:  
    The type of data element being defined as needed by one or more forms. This field determines the type of retrieval needed to get the actual data element's value for a given bill.
  • CROSS-REFERENCE:  ^^TRIGGER^364.5^.04
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X="FC",Y(1)=X S X=Y(0),X=X S Y=X,X=Y(1),X=X S X=X[Y I X S X=DIV S Y(1)=$S($D(^IBA(364.5,D0,0)):^(0),1:"") S X=$P(Y(1),U,4),X=X S DIU=X K Y S X=DIV S X="I" X ^DD(364.5,.03,1,1,1.
    4)
    1.4)= S DIH=$S($D(^IBA(364.5,DIV(0),0)):^(0),1:""),DIV=X S $P(^(0),U,4)=DIV,DIH=364.5,DIG=.04 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    2)= Q
    3)= DO NOT DELETE
    CREATE CONDITION)= "FC"[INTERNAL(TYPE OF ELEMENT)
    CREATE VALUE)= S X="I"
    DELETE VALUE)= NO EFFECT
    FIELD)= ELEMENT CATEGORY
    If TYPE OF ELEMENT is 'F' or 'C' then ELEMENT CATEGORY must be 'I'.
  • CROSS-REFERENCE:  ^^TRIGGER^364.5^.06
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=Y(0),X=X S X=X'="F" I X S X=DIV S Y(1)=$S($D(^IBA(364.5,D0,0)):^(0),1:"") S X=$P(Y(1),U,6),X=X S DIU=X K Y S X="" X ^DD(364.5,.03,1,2,1.4)
    1.4)= S DIH=$S($D(^IBA(364.5,DIV(0),0)):^(0),1:""),DIV=X S $P(^(0),U,6)=DIV,DIH=364.5,DIG=.06 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    2)= Q
    3)= DO NOT DELETE
    CREATE CONDITION)= INTERNAL(TYPE OF ELEMENT)'="F"
    CREATE VALUE)= @
    DELETE VALUE)= NO EFFECT
    FIELD)= FILEMAN FIELD REFERENCE
    This triggers the FILEMAN FIELD REFERENCE field to null if the element type is not FILEMAN field type of element.
  • CROSS-REFERENCE:  ^^TRIGGER^364.5^.08
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=Y(0),X=X S X=X'="C" I X S X=DIV S Y(1)=$S($D(^IBA(364.5,D0,0)):^(0),1:"") S X=$P(Y(1),U,8),X=X S DIU=X K Y S X="" X ^DD(364.5,.03,1,3,1.4)
    1.4)= S DIH=$S($D(^IBA(364.5,DIV(0),0)):^(0),1:""),DIV=X S $P(^(0),U,8)=DIV,DIH=364.5,DIG=.08 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    2)= Q
    3)= DO NOT DELETE
    CREATE CONDITION)= INTERNAL(TYPE OF ELEMENT)'="C"
    CREATE VALUE)= @
    DELETE VALUE)= NO EFFECT
    FIELD)= CONSTANT VALUE
    This triggers the CONSTANT VALUE field to null if the element type is not CONSTANT type of element.
  • CROSS-REFERENCE:  ^^TRIGGER^364.5^1
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=Y(0),X=X S X=X'="E" I X S X=DIV S Y(1)=$S($D(^IBA(364.5,D0,1)):^(1),1:"") S X=$E(Y(1),1,245),X=X S DIU=X K Y S X="" X ^DD(364.5,.03,1,4,1.4)
    1.4)= S DIH=$S($D(^IBA(364.5,DIV(0),1)):^(1),1:""),DIV=X S DE=0-$L(DIH),DIU=$E(DIH,1,245),Y=$E(DIH,246,999),^(1)=$J("",$S(DE>0:DE,1:0))_DIV_$S(Y?." ":"",1:$J("",245-$L(DIV))_Y),DIH=364.5,DIG=1 D ^DICR:$O(^DD(DIH,DIG,1,0))>
    0
    2)= Q
    3)= DO NOT DELETE
    CREATE CONDITION)= INTERNAL(TYPE OF ELEMENT)'="E"
    CREATE VALUE)= @
    DELETE VALUE)= NO EFFECT
    FIELD)= EXTRACT CODE
    This triggers the EXTRACT CODE field to null if the element type is not an EXTRACTED VIA CODE type of element.
.04 ELEMENT CATEGORY 0;4 SET
************************REQUIRED FIELD************************
  • 'I' FOR INDIVIDUAL ELEMENT;
  • 'G' FOR GROUP ELEMENT;

  • INPUT TRANSFORM:  I $P($G(^IBA(364.5,DA,0)),U,3)="F",$G(X)="G" K X
  • LAST EDITED:  FEB 15, 1996
  • HELP-PROMPT:  This indicates an INDIVIDUAL or GROUP of elements will be returned. Group is not valid for Fileman type elements.
  • DESCRIPTION:  
    This defines whether the data element to be extracted is a single piece of data or is a string of related data. Fileman field references must be designated as individual elements.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
    TRIGGERED by the TYPE OF ELEMENT field of the IB DATA ELEMENT DEFINITION File
  • CROSS-REFERENCE:  ^^TRIGGER^364.5^.06
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=Y(0),X=X S X=X="G" I X S X=DIV S Y(1)=$S($D(^IBA(364.5,D0,0)):^(0),1:"") S X=$P(Y(1),U,6),X=X S DIU=X K Y S X="" X ^DD(364.5,.04,1,1,1.4)
    1.4)= S DIH=$S($D(^IBA(364.5,DIV(0),0)):^(0),1:""),DIV=X S $P(^(0),U,6)=DIV,DIH=364.5,DIG=.06 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    2)= Q
    CREATE CONDITION)= INTERNAL(ELEMENT CATEGORY)="G"
    CREATE VALUE)= ""
    DELETE VALUE)= NO EFFECT
    FIELD)= FILEMAN FIELD REFERENCE
.05 BASE FILE 0;5 POINTER TO FILE FILE (#1) FILE(#1)

  • LAST EDITED:  MAR 11, 1996
  • HELP-PROMPT:  Enter the Fileman file to be used as a 'base' to extract the data from.
  • DESCRIPTION:  
    This is the number of the Fileman file to be used as a 'base' to extract data for this field.
.06 FILEMAN FIELD REFERENCE 0;6 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>65!($L(X)<1) X I $D(X),$P($G(^IBA(364.5,DA,0)),U,4)="G" K X
  • LAST EDITED:  DEC 21, 1995
  • HELP-PROMPT:  Must be a valid Fileman reference and ELEMENT CATEGORY must not be GROUP.
  • DESCRIPTION:  The valid Fileman field reference or simple Fileman navigation to be used to extract using the $$GET^DIQ utility. Note this will not return true multiple entries. Word-processing type fields are able to be retrieved,
    however. No syntax check is made on this field so the user must be careful to type a valid Fileman expression. This must be designated as an INDIVIDUAL element, not a group element.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
    TRIGGERED by the TYPE OF ELEMENT field of the IB DATA ELEMENT DEFINITION File
    TRIGGERED by the ELEMENT CATEGORY field of the IB DATA ELEMENT DEFINITION File
  • CROSS-REFERENCE:  ^^TRIGGER^364.5^.07
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=Y(0)="" I X S X=DIV S Y(1)=$S($D(^IBA(364.5,D0,0)):^(0),1:"") S X=$P(Y(1),U,7),X=X S DIU=X K Y S X="" X ^DD(364.5,.06,1,1,1.4)
    1.4)= S DIH=$S($D(^IBA(364.5,DIV(0),0)):^(0),1:""),DIV=X S $P(^(0),U,7)=DIV,DIH=364.5,DIG=.07 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^IBA(364.5,D0,0)):^(0),1:"") S X=$P(Y(1),U,7),X=X S DIU=X K Y S X="" X ^DD(364.5,.06,1,1,2.4)
    2.4)= S DIH=$S($D(^IBA(364.5,DIV(0),0)):^(0),1:""),DIV=X S $P(^(0),U,7)=DIV,DIH=364.5,DIG=.07 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    CREATE CONDITION)= FILEMAN FIELD REFERENCE=""
    CREATE VALUE)= @
    DELETE VALUE)= @
    FIELD)= #.07
.07 FILEMAN RETURN FORMAT 0;7 SET
  • 'I' FOR INTERNAL;
  • 'E' FOR EXTERNAL;

  • LAST EDITED:  DEC 05, 1995
  • DESCRIPTION:  This is the format for the retrieved data for Fileman-type data elements. It is recommended to use Internal format whenever possible to keep the data element definitions in this file as generic as possible to avoid
    duplication. The format capabilities of the forms generator should be used to interpret and reformat the data element when needed.
  • NOTES:  TRIGGERED by the FILEMAN FIELD REFERENCE field of the IB DATA ELEMENT DEFINITION File
.08 CONSTANT VALUE 0;8 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>80!($L(X)<1) X
  • LAST EDITED:  DEC 05, 1995
  • HELP-PROMPT:  Answer must be 1-80 characters in length.
  • DESCRIPTION:  
    The specific value that this data element should return for this data element.
  • NOTES:  TRIGGERED by the TYPE OF ELEMENT field of the IB DATA ELEMENT DEFINITION File
1 EXTRACT CODE 1;E1,245 MUMPS

  • INPUT TRANSFORM:  K:$L(X)>245 X D:$D(X) ^DIM
  • LAST EDITED:  DEC 05, 1995
  • HELP-PROMPT:  This is Standard MUMPS code.
  • DESCRIPTION:  The code to be executed by the forms generator to return the value(s) of the data element. If no ARRAY ROOT field is completed for this data element, the code should set the variable IBXDATA or the array IBXDATA(1)
    through IBXDATA(n) where n=the total # of iterations of the data element retrieved. If the ARRAY ROOT field has been completed for this data element, this code should set the variable referenced there. IBXIEN is assumed
    to be the internal entry number of the file (referenced by the variable IBXFILE) entry.
    WRITE AUTHORITY: @
  • NOTES:  TRIGGERED by the TYPE OF ELEMENT field of the IB DATA ELEMENT DEFINITION File
2 ARRAY ROOT 2;E1,50 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>50!($L(X)<1) X
  • LAST EDITED:  JAN 17, 1996
  • HELP-PROMPT:  Answer must be a valid array root name.
  • DESCRIPTION:  
    The local or global base root where multiple-valued output or word processing data is to be stored for this data element. IBXDATA is the default if there is no data in this field. Example of a global array: ^TMP($J)
3 DESCRIPTION 3;0 WORD-PROCESSING #364.53

  • LAST EDITED:  DEC 05, 1995
  • HELP-PROMPT:  Enter a description of the data element being defined.
  • DESCRIPTION:  
    This is a free text description of the data that this data element represents.

Found Entries, Total: 372

NAME: N-CURR INSURED FULL NAME    NAME: N-CURR INSURED ID    NAME: N-CURR INSURED FULL ADDRESS    NAME: N-GET FROM PREVIOUS EXTRACT    NAME: N-CURR INSURED DEMOGRAPHICS    NAME: N-CURR INSURED EMPLOYER INFO    NAME: N-UB-04 SERVICE LINE (EDI)    NAME: N-PATIENT STATUS    
NAME: N-MEDICAL RECORD NUMBER    NAME: N-CONDITION CODES    NAME: N-VALUE CODES    NAME: N-UB92 FORM LOCATOR 56    NAME: N-UB92 FORM LOCATOR 57    NAME: N-UB92 FORM LOCATOR 31    NAME: N-UB-04 PROCEDURES    NAME: N-CMS-1500 PURCH SVC TOTAL    
NAME: N-INITIAL TREATMENT    NAME: N-ACUTE MANIFESTATION    NAME: N-ROI INDICATOR    NAME: N-ASSIGN OF BENEFITS INDICATOR    NAME: N-CURR INSURED PT RELATION    NAME: N-CURR INSURED GROUP NAME    NAME: N-CURR INSURED GROUP NUMBER    NAME: N-OTH INSURED DEMOGRAPHICS    
NAME: N-LAST XRAY    NAME: N-OTH INSURED EMPLOYR INFO    NAME: N-OTH INSURED GRP NAME    NAME: N-OTH INSURED FULL NAME    NAME: N-OTH INSURED GRP NUMBER    NAME: N-OTH INSURED ID    NAME: N-OTH INSURED PT RELATION    NAME: N-PATIENT CONDITION CODE    
NAME: N-PRIMARY AUTH CODE    NAME: N-CURR INSURANCE COMPANY NAME    NAME: N-OTH INSURANCE CO. NAME    NAME: N-CURR INS EMPLOYMENT STAT    NAME: N-OTHER INSURED EMPLOY STATUS    NAME: N-UB92 FORM LOCATOR 78    NAME: N-BILL DESIGNATION    NAME: N-CURR INS FORM LOC 64    
NAME: N-OTH INS FORM LOC 64    NAME: N-PROVIDER SIGNATURE ON FILE    NAME: N-PATIENT STREET ADDRESS LN 1    NAME: N-PATIENT STREET ADDRESS LN 2    NAME: N-PATIENT CITY    NAME: N-PATIENT STATE    NAME: N-PATIENT ZIP CODE    NAME: N-PATIENT PHONE    
NAME: N-PATIENT NAME    NAME: N-PATIENT BIRTHDATE    NAME: N-PATIENT SEX    NAME: N-PATIENT MARITAL STATUS    NAME: N-BILL NUMBER    NAME: N-PATIENT EMPLOYER NAME    NAME: N-STATEMENT COVERS FROM DATE    NAME: N-UB92 FORM LOCATOR 2    
NAME: N-TYPE OF BILL    NAME: N-BILL FREQUENCY    NAME: N-COVERED DAYS    NAME: N-NON-COVERED DAYS    NAME: N-ADMISSION DATE    NAME: N-TYPE OF ADMISSION    NAME: N-SOURCE OF ADMISSION    NAME: N-DISCHARGE DATE    
NAME: N-BILL REMARKS    NAME: N-ATT/REND PHYSICIAN NAME    NAME: N-OTHER PHYSICIAN    NAME: N-ADMITTING DIAGNOSIS    NAME: N-DIAGNOSES    NAME: N-CONDITION RELATED TO EMPLOY    NAME: N-CONDITION RELATED TO AUTO    NAME: N-CONDITION RELATED TO OTH ACC    
NAME: N-SIMILAR ILLNESS DATE    NAME: N-OTH CLAIM QUAL (HCFA 1500)    NAME: N-DATE OF CURRENT ILLNESS    NAME: N-DATE UNABLE TO WORK FROM    NAME: N-DATE UNABLE TO WORK TO    NAME: N-TOTAL CHARGES    NAME: N-BILLING PROVIDER    NAME: N-NON-INSTITUTIONAL CLAIM TYPE    
NAME: N-BILL SUBMISSION STATUS    NAME: N-PATIENT EMPLOYMENT STATUS    NAME: N-KILL IBXSAVE    NAME: N-OTH INSURANCE SEQUENCE    NAME: N-PRESCRIPTIONS    NAME: N-AGENT CASHIER MAIL SYMBOL    NAME: N-AGENT CASHIER STREET ADDRESS    NAME: N-AGENT CASHIER CITY    
NAME: N-AGENT CASHIER STATE    NAME: N-AGENT CASHIER ZIP CODE    NAME: N-AGENT CASHIER PHONE    NAME: N-FEDERAL TAX ID    NAME: N-OTHER CLAIM ID (HCFA 1500)    NAME: N-MAMMOGRAPHY CERT#    NAME: N-LAB CLIA NUMBER    NAME: N-LAB OR FACILITY PRIMARY ID    
NAME: N-FACILITY NAME    NAME: N-SET 837 HEADER NODE    NAME: N-FACILITY STREET ADDRESS 1    NAME: N-FACILITY CITY    NAME: N-FACILITY STATE    NAME: N-FACILITY ZIP CODE    NAME: N-BATCH NUMBER    NAME: N-BATCH DATE    
NAME: N-CLAIM CODES (HCFA 1500)    NAME: N-CURR INSURANCE CO ID NUM    NAME: N-RECEIVER ID NUMBER    NAME: N-OTH INSURANCE PRIOR PAYMENT    NAME: N-HCFA 1500 SERVICE LINE (EDI)    NAME: N-CURR INSURANCE CO PROV #    NAME: N-OTH INSURANCE PROVIDER #    NAME: N-CURRENT INSURANCE CO 837 ID    
NAME: N-REFER PROV QUAL (HCFA 1500)    NAME: N-RECORD ID    NAME: N-CUR ILL QUAL (HCFA 1500)    NAME: N-STATEMENT COVERS TO DATE    NAME: N-SITE NUMBER    NAME: N-COMMON BILL REMARKS    NAME: N-SEGMENT DELIMITER    NAME: N-MAILING ADDRESS NAME    
NAME: N-MAILING ADDRESS FULL    NAME: N-OTHER DATE QUAL (HCFA 1500)    NAME: N-CUR ILL DATE (HCFA 1500)    NAME: N-OTHER DATE (HCFA 1500)    NAME: N-PRINT BILL SUBMIT STATUS    NAME: N-PATIENT SSN    NAME: N-OTHER INSURANCE EXISTS    NAME: N-HCFA 1500 BOX 12    
NAME: N-HCFA 1500 BOX 13    NAME: N-HCFA 1500 BOX 18 (FR)    NAME: N-HCFA 1500 BOX 19    NAME: N-DIAGNOSIS IND    NAME: N-HCFA 1500 OUTSIDE LAB    NAME: N-HCFA 1500 EIN FLAG (BOX 25)    NAME: N-TOTAL CHARGES LESS OFFSET    NAME: N-HCFA 1500 BOX 31    
NAME: N-HCFA 1500 SERVICES (PRINT)    NAME: N-FACILITY STREET ADDRESS 2    NAME: N-PRIOR PAYMENTS    NAME: N-PATIENT STREET ADDRESS 1-3    NAME: N-CURRENT INSURED RELATIONSHIP    NAME: N-AUTO ACCIDENT STATE    NAME: N-HCFA 1500 BOX 18 (TO)    NAME: N-DIAGNOSIS CODE 5 (HCFA 1500)    
NAME: N-DIAGNOSIS CODE 2 (HCFA 1500)    NAME: N-DIAGNOSIS CODE 3 (HCFA 1500)    NAME: N-DIAGNOSIS CODE 4 (HCFA 1500)    NAME: N-DATE OF SERVICE FROM    NAME: N-DATE OF SERVICE TO    NAME: N-HCFA 1500 PLACE OF SERVICE    NAME: N-HCFA 1500 TYPE OF SERVICE    NAME: N-HCFA 1500 PROCEDURES    
NAME: N-DIAGNOSIS CODE REFS    NAME: N-HCFA 1500 CHARGES    NAME: N-HCFA 1500 UNITS    NAME: N-HCFA 1500 BALANCE DUE BOX    NAME: N-HCFA BOX 24H FREE TEXT    NAME: N-HCFA BOX 24I FREE TEXT    NAME: N-HCFA BOX 24J FREE TEXT    NAME: N-HCFA BOX 24K FREE TEXT    
NAME: N-HCFA 1500 MODIFIERS    NAME: N-LINES BOX 24 (HCFA 1500)    NAME: N-COLUMNS BOX 24 (HCFA 1500)    NAME: N-UB92 SIG REQ REMINDER    NAME: N-DIAGNOSIS CODE 6 (HCFA 1500)    NAME: N-LOCATION OF CARE    NAME: N-BILL CLASSIFICATION    NAME: N-TIMEFRAME OF BILL    
NAME: N-UB92 FORM LOCATOR 11    NAME: N-PATIENT SHORT ADDRESS    NAME: N-CMS-1500 BOX 24I ID QUAL    NAME: N-CMS-1500 24J REND PROV ID    NAME: N-OCCURRENCE CODES    NAME: N-UB-04 FORM LOCATOR 64    NAME: N-CURR INS CO FULL ADDRESS    NAME: N-UB-04 SERVICE LINE (PRINT)    
NAME: N-ALL INSURANCE COMPANIES    NAME: N-ALL INSURANCE CO PROV NUM    NAME: N-ALL INSURED FULL NAMES    NAME: N-ALL INSURED PT RELATION    NAME: N-ALL INSURANCE NUMBER    NAME: N-ALL INSURANCE GROUP NAME    NAME: N-ALL INSURANCE GROUP NUMBER    NAME: N-ALL INSURED EMPLOYER INFO    
NAME: N-ALL INSURED EMPLOY STATUS    NAME: N-PROCEDURE CODING METHD    NAME: N-BILL RATE TYPE    NAME: N-CLAIM FORM SIGNER    NAME: N-CLAIM FORM SIGNER TITLE    NAME: N-FORM REMARKS    NAME: N-BILL COMMENT    NAME: N-DATE FIRST PRINTED    
NAME: N-AR BILL NUMBER    NAME: N-INSURED SERVICE BRANCH    NAME: N-INSURED SERVICE RANK    NAME: N-DIAGNOSIS CODE 7 (HCFA 1500)    NAME: N-CURR INSURED SSN    NAME: N-CURR INSURED PHONE    NAME: N-PRIOR BILLS    NAME: N-OFFSET AMOUNT    
NAME: N-COINSURANCE DAYS    NAME: N-DIAGNOSIS CODE 8 (HCFA 1500)    NAME: N-MEDICARE PROVIDER NUMBER    NAME: N-UB-04 TIMEFRAME OF BILL    NAME: N-UB-04 LOCATION OF CARE    NAME: N-UB-04 BILL CLASSIFICATION    NAME: N-SET 837 INS CO HDR NODE    NAME: N-COB CLAIM LEVEL AMOUNTS    
NAME: N-MEDICARE INPT CLAIM COB AMTS    NAME: N-MEDICARE OUTPT CLAIM COB AMT    NAME: N-COB CLAIM LEVEL ADJUSTMENTS    NAME: N-HCFA EMERGENCY INDICATOR    NAME: N-BILLING SITE    NAME: N-FACILITY SITE NUMBER    NAME: N-EVENT DATE    NAME: N-CURRENT INSURANCE CO TYPE    
NAME: N-OTHER INSURANCE CO TYPES    NAME: N-CURRENT INS POLICY TYPE    NAME: N-OTH INS POL TYPES    NAME: N-DIAGNOSIS CODE 9 (HCFA 1500)    NAME: N-EDI SITE CONTACT PHONE    NAME: N-ATTENDING PHYSICIAN ID    NAME: N-REFERRING PROVIDER NAME    NAME: N-REFERRING PROVIDER ID    
NAME: N-OPERATING PHYSICIAN NAME    NAME: N-OPERATING PHYSICIAN ID    NAME: N-RENDERING PROVIDER NAME    NAME: N-RENDERING PROVIDER ID    NAME: N-UB-04 FORM LOCATOR 64B    NAME: N-UB-04 FORM LOCATOR 64C    NAME: N-REFERRING PROVIDER SPECIALTY    NAME: N-ATT/REND PHYSICIAN SPEC    
NAME: N-OTHER PHYSICIAN SPEC    NAME: N-OPERATING PHYSICIAN SPEC    NAME: N-OTHER PROVIDER ID    NAME: N-DIAGNOSIS E-CODE    NAME: N-AMBULANCE PU ADDR LINE 1    NAME: N-SITE CONTACT PHONE    NAME: N-ALL INSURANCE CO 837 ID    NAME: N-DRG USED    
NAME: N-MEDICARE GROUP NUMBER    NAME: N-AMBULANCE PU ADDR LINE 2    NAME: N-FIRST TRANSMIT DATE    NAME: N-ATT/REND PROVIDER ID    NAME: N-CURRENT AUTHORIZATION CODE    NAME: N-SECONDARY AUTH CODE    NAME: N-TERTIARY AUTH CODE    NAME: N-ALL AUTH CODES    
NAME: N-OTHER INSURED AUTH CODES    NAME: N-DATE FIRST PRINTED OR SENT    NAME: N-OUTSIDE FACILITY NAME    NAME: N-AMBULANCE PU CITY    NAME: N-LAST MENSTRUAL PERIOD    NAME: N-LAB CLIA #    NAME: N-NON VA PROVIDER ID    NAME: N-PURCHASED SERVICE TYPE    
NAME: N-NON VA FACILITY    NAME: N-RENDERING INSTITUTION    NAME: N-NON VA CARE TYPE    NAME: N-ALL ATT/RENDERING PROV ID    NAME: N-ALL REFERRING PROV ID    NAME: N-ALL OPERATING PROV ID    NAME: N-CURR INSURANCE MAILING NAME    NAME: N-EOB ENTRIES    
NAME: N-PURCHASED SERVICE TOTAL    NAME: N-OUTSIDE LAB TOTAL    NAME: N-SPECIAL PROGRAM    NAME: N-DATE LAST SEEN    NAME: N-HOMEBOUND    NAME: N-HCFA 1500 BOX 19 RAW DATA    NAME: N-PROVIDER INFORMATION    NAME: N-SPECIALTY CODE    
NAME: N-CURRENT INSURANCE CO EMC ID#    NAME: N-UB92 FL 82 PROVIDER    NAME: N-PATIENT DATE OF DEATH    NAME: N-ACCIDENT DATE    NAME: N-ALL INSURANCE CO TYPE    NAME: N-ALL PROVIDERS    NAME: N-FACILITY NAME FOR BILLING    NAME: N-ALL PROCEDURES    
NAME: N-AGENT CASHIER STREET LINE 2    NAME: N-TYPE INSURANCE CO ID    NAME: N-SPRVSING PROV FULL NAME    NAME: N-OTHER PAYER FULL ADDRESS    NAME: N-OUTSIDE LAB TOTAL (EDI)    NAME: N-OTHER INSURED FULL ADDRESS    NAME: N-OTHER INSURED QUALIF/ID ALL    NAME: N-OTH PAYER PATIENT ID QUALIF    
NAME: N-OTH PAYER PAT ID QUALIF 1-3    NAME: N-TYPE INSURANCE CO ID-ALL    NAME: N-TYPE INSURANCE CO NUMBER-ALL    NAME: N-ALL ATT/RENDERING PROV SSN    NAME: N-OPERATING PHYSICIAN DATA    NAME: N-ALL OTH PROV SECONDARY ID    NAME: N-ALL CUR/OTH PROVIDER INFO    NAME: N-PURCHASED SERVICE ALL    
NAME: N-OTH INSURANCE CO IEN 36    NAME: N-OTH INSURANCE ADDRESS    NAME: N-OTH INSURED NAMES SUFF    NAME: N-ALL OUTSIDE FAC PROVIDER INF    NAME: N-ALL ATT/REND PROV SSN/EI    NAME: N-STATION NUMBER    NAME: N-PROVIDER TAXONOMIES    NAME: N-ORGANIZATION NPI CODES    
NAME: N-ORGANIZATION TAXONOMIES    NAME: N-PROVIDER NPI CODES    NAME: N-AMBULANCE PU STATE    NAME: N-AMBULANCE PU ZIP    NAME: N-AMBULANCE DO ADDR LINE 1    NAME: N-AMBULANCE DO ADDR 2    NAME: N-AMBULANCE DO CITY    NAME: N-AMBULANCE DO STATE    
NAME: N-AMBULANCE DO ZIP    NAME: N-AMBULANCE DO LOCATION    NAME: N-PROP/CAS DATE OF 1ST CONTACT    NAME: N-DISABILITY DATE QUALIFIER    NAME: N-DISABILITY START DATE    NAME: N-DISABILITY END DATE    NAME: N-ASSUME CARE DATE    NAME: N-RELINQUISH CARE DATE    
NAME: N-PRIMARY REFERRAL NUMBER    NAME: N-SECONDARY REFERRAL NUMBER    NAME: N-TERTIARY REFERRAL NUMBER    NAME: N-CURRENT REFERRAL NUMBER    NAME: N-ATT RPT TYPE    NAME: N-ATT RPT TRX CODE    NAME: N-ATT CONTROL NUM    NAME: N-PROP/CAS CLAIM NUMBER    
NAME: N-PROP/CAS CONTACT NAME    NAME: N-PROP/CAS CONTACT TELEPHONE    NAME: N-PROP/CAS CONTACT EXTENSION    NAME: N-PRI SURG PROC CODE    NAME: N-SEC SURG PROC CODE    NAME: N-COB TOTAL NON-COVERED AMOUNT    NAME: N-RENDERING PHYSICIAN NAME    NAME: N-ALL REFERRAL NUMBERS    
NAME: N-OTHER PAYER REF NUM    NAME: N-DIAGNOSIS CODE 10(HCFA 1500)    NAME: N-DIAGNOSIS CODE 11(HCFA 1500)    NAME: N-EOB OTHER PAYER INFO    NAME: N-CURRENT AUTH/REFERRAL CODE    NAME: N-ALL AUTH/REFERRAL CODES    NAME: N-ATTENDING PHYSICIAN NAME    NAME: N-LAB/FAC CONTACT NAME    
NAME: N-LAB/FAC CONTACT PHONE    NAME: N-LAB/FAC CONTACT EXT    NAME: N-REFERRING PROVIDER NAME BR    NAME: N-OPERATING PHYSICIAN NAME BR    NAME: N-SPRVSING PROV FULL NAME BR    NAME: N-OPERATING PHYSICIAN DATA BR    NAME: N-RENDERING PHYSICIAN NAME BR    NAME: N-ATTENDING PHYSICIAN NAME BR    
NAME: N-ATT/REND PHYSICIAN NAME BR    NAME: N-CMS-1500 BOX 24I ID QUAL BR    NAME: N-CMS-1500 24J REND PROV ID BR    NAME: N-OI4 COB SETUP    NAME: N-VALUE CODE GROUP    NAME: N-ALL PROVIDERS 1    NAME: N-DIAGNOSIS CODE 12(HCFA 1500)    NAME: N-PROVIDER NAME (HCFA 1500)    
NAME: N-ORTHO BANDING QUALIFIER    NAME: N-ORTHO BANDING DATE    NAME: N-ORTHO TX MTHS COUNT    NAME: N-ORTHO TX MTHS COUNT TRANSFER    NAME: N-ORTHO TX INDICATOR    NAME: N-TOOTH NUMBER    NAME: N-HCFA J430D SERV LINE (EDI)    NAME: N-CMN RECORD ID 'LQ '    
NAME: N-HCFA SERVICE LINE CALLABLE    NAME: N-CMN RECORD ID 'FRM '    NAME: N-CMN RECORD ID 'CMN '    NAME: N-CMN RECORD ID 'MEA '    
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