FileMan FileNo | FileMan Filename | Package |
---|---|---|
368 | HEALTH CARE CLAIM RFAI (277) | Integrated Billing |
Package | Total | FileMan Files |
---|---|---|
Integrated Billing | 6 | BILL/CLAIMS(#399)[111.01] REVENUE CODE(#399.2)[#368.0121(.03), #368.0121(.09)] INSURANCE COMPANY(#36)[101.01] X12 271 CONTACT QUALIFIER(#365.021)[102.01, 102.02, 102.03, 116.01, 116.02, 116.03] X12 277 CLAIM STATUS CATEGORY(#368.001)[#368.0113(1.01), #368.0113(10.01), #368.0113(11.01), #368.12199(1.01), #368.12199(10.01), #368.12199(11.01)] X12 277 PRODUCT OR SERVICE ID QUAL(#368.002)[#368.0121(.02)] |
Kernel | 3 | STATE(#5)[120.04] NEW PERSON(#200)[200.03, 200.06, #368.0201(.02)] ZIP CODE(#5.11)[120.05] |
CPT HCPCS Codes | 2 | CPT MODIFIER(#81.3)[#368.0121(.04), #368.0121(.05), #368.0121(.06), #368.0121(.07)] CPT(#81)[#368.0121(.03)] |
Health Level Seven | 1 | COUNTRY CODE(#779.004)[120.06] |
National Drug File | 1 | NDC/UPN(#50.67)[#368.0121(.03)] |
Registration | 1 | PATIENT(#2)[109.01] |
Field # | Name | Loc | Type | Details |
---|---|---|---|---|
.01 | MESSAGE CONTROL ID | 0;1 | FREE TEXT | ************************REQUIRED FIELD************************
|
.02 | REQUEST DATE/TIME | 0;2 | FREE TEXT |
|
.03 | TRANSACTION DATE/TIME | 0;3 | FREE TEXT |
|
1.01 | PAYER NAME | 1;1 | FREE TEXT |
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1.02 | PAYER IDENTIFIER | 1;2 | FREE TEXT |
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1.03 | PAYER CONTACT NAME | 1;3 | FREE TEXT |
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2.01 | PAYER CONTACT COMM TYPE 1 | 2;1 | FREE TEXT |
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2.02 | PAYER CONTACT COMM TYPE 2 | 2;2 | FREE TEXT |
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2.03 | PAYER CONTACT COMM TYPE 3 | 2;3 | FREE TEXT |
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3.01 | PAYER CONTACT COMMUNICATION 1 | 3;1 | FREE TEXT |
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4.01 | PAYER CONTACT COMMUNICATION 2 | 4;1 | FREE TEXT |
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5.01 | PAYER CONTACT COMMUNICATION 3 | 5;1 | FREE TEXT |
|
6.01 | INFORMATION RECEIVER NAME | 6;1 | FREE TEXT |
|
6.02 | INFORMATION RECEIVER ID | 6;2 | FREE TEXT |
|
7.01 | SERVICE PROVIDER NAME | 7;1 | FREE TEXT |
|
7.02 | SERVICE PROV FED TAXPAYER CODE | 7;2 | FREE TEXT |
|
8.01 | SERVICE PROVIDER ID | 8;1 | FREE TEXT |
|
9.01 | PATIENT NAME | 9;1 | FREE TEXT |
|
10.01 | PATIENT PRIMARY IDENTIFIER | 10;1 | FREE TEXT |
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11.01 | PATIENT CONTROL NUMBER | 11;1 | FREE TEXT |
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11.02 | PAYER CLAIM CONTROL NUMBER | 11;2 | FREE TEXT |
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11.03 | MEDICAL RECORD NUMBER | 11;3 | FREE TEXT |
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11.04 | CLEARINGHOUSE TRACE NUMBER | 11;4 | FREE TEXT |
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12.01 | RESPONSE DUE DATE | 12;1 | FREE TEXT |
|
12.02 | REPORT TRANSMISSION CODE | 12;2 | FREE TEXT |
|
13 | STC SEQ | 13;0 | Multiple #368.013 | 368.013
|
14.03 | CLAIM SERVICE START DATE | 14;3 | FREE TEXT |
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14.04 | CLAIM SERVICE END DATE | 14;4 | FREE TEXT |
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14.05 | CLAIM SERVICE PERIOD | 14;5 | FREE TEXT |
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15.01 | PAYER RESPONSE CONTACT NAME | 15;1 | FREE TEXT |
|
16.01 | PAYER RESP CONTACT COMM TYPE 1 | 16;1 | FREE TEXT |
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16.02 | PAYER RESP CONTACT COMM TYPE 2 | 16;2 | FREE TEXT |
|
16.03 | PAYER RESP CONTACT COMM TYPE 3 | 16;3 | FREE TEXT |
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17.01 | PAYER RESPONSE CONTACT COMM 1 | 17;1 | FREE TEXT |
|
18.01 | PAYER RESPONSE CONTACT COMM 2 | 18;1 | FREE TEXT |
|
19.01 | PAYER RESPONSE CONTACT COMM 3 | 19;1 | FREE TEXT |
|
20.01 | PAYER RESP CONTACT ADDR LINE 1 | 20;1 | FREE TEXT |
|
20.02 | PAYER RESP CONTACT ADDR LINE 2 | 20;2 | FREE TEXT |
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20.03 | PAYER RESP CONTACT CITY | 20;3 | FREE TEXT |
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20.04 | PAYER RESP CONTACT STATE | 20;4 | FREE TEXT |
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20.05 | PAYER RESP CONTACT ZIP CODE | 20;5 | FREE TEXT |
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20.06 | PAYER RESP CONTACT COUNTRY | 20;6 | FREE TEXT |
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20.07 | PAYER RESP CONT CNTRY SUBDIV | 20;7 | FREE TEXT |
|
21 | STC-SVC LINE STAT INFO SEQ | 21;0 | Multiple #368.021 | 368.021
|
22.03 | PRIMARY LOINC | 22;3 | FREE TEXT |
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25.01 | REFERENCE ID-INST TYPE OF BILL | 25;1 | FREE TEXT |
|
26.01 | PAYER CONTACT COMM 1 EXTENSION | 26;1 | FREE TEXT |
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27.01 | PAYER CONTACT COMM 2 EXTENSION | 27;1 | FREE TEXT |
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28.01 | PAYER CONTACT COMM 3 EXTENSION | 28;1 | FREE TEXT |
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29.01 | PAYER RESP CONTACT COMM 1 EXT | 29;1 | FREE TEXT |
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30.01 | PAYER RESP CONTACT COMM 2 EXT | 30;1 | FREE TEXT |
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31.01 | PAYER RESP CONTACT COMM 3 EXT | 31;1 | FREE TEXT |
|
80.01 | PAYER ENTITY IDENTIFIER CODE | 80;1 | FREE TEXT |
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80.02 | PAYER ENTITY TYPE QUALIFIER | 80;2 | FREE TEXT |
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80.03 | PAYER ID CODE QUALIFIER | 80;3 | FREE TEXT |
|
80.04 | PAYER CONTACT FUNCTION CODE | 80;4 | FREE TEXT |
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80.05 | INFORMATION RECEIVER ENTITY ID | 80;5 | FREE TEXT |
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80.06 | INFO RECEIVER ENTITY TYPE | 80;6 | FREE TEXT |
|
80.07 | INFO RECEIVER ID QUALIFIER | 80;7 | FREE TEXT |
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80.08 | SERVICE PROV ENTITY ID CODE | 80;8 | FREE TEXT |
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80.09 | SERVICE PROV ENTITY TYPE QUAL | 80;9 | FREE TEXT |
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80.1 | SERVICE PROVIDER ID QUALIFIER | 80;10 | FREE TEXT |
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80.11 | PATIENT ENTITY IDENTIFIER CODE | 80;11 | FREE TEXT |
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80.12 | PATIENT ENTITY TYPE QUALIFIER | 80;12 | FREE TEXT |
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80.13 | PATIENT ID CODE QUALIFIER | 80;13 | FREE TEXT |
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80.14 | PAYER CLAIM TRACE TYPE CODE | 80;14 | FREE TEXT |
|
80.18 | REFERENCE ID QUALIFIER-PT CRTL | 80;18 | FREE TEXT |
|
80.19 | REFERENCE ID QUALIFIER-INST | 80;19 | FREE TEXT |
|
80.2 | REFERENCE ID QUALIFIER-MRN | 80;20 | FREE TEXT |
|
80.21 | REFERENCE ID QUALIFIER-CTN | 80;21 | FREE TEXT |
|
80.22 | CLAIM SERVICE DT/TM QUALIFIER | 80;22 | FREE TEXT |
|
80.23 | CLAIM SERV DT/TM PERIOD QUAL | 80;23 | FREE TEXT |
|
80.24 | RESPONSE DUE DT/TM QUALIFIER | 80;24 | FREE TEXT |
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80.25 | RESPONSE DUE DT/TM PERIOD QUAL | 80;25 | FREE TEXT |
|
80.26 | CLAIM SUPP INFO REPORT TYPE | 80;26 | FREE TEXT |
|
80.27 | PAYER RESP CONTACT FUNC CODE | 80;27 | FREE TEXT |
|
80.29 | SERVICE LINE DT/TM QUALIFIER | 80;29 | FREE TEXT |
|
80.3 | SERVICE LINE DT/TM PERIOD QUAL | 80;30 | FREE TEXT |
|
100.02 | REQUEST DATE/TIME [D] | 100;2 | DATE |
|
100.03 | MESSAGE DATE/TIME [D] | 100;3 | DATE |
|
101.01 | PAYER NAME [D] | 101;1 | POINTER TO INSURANCE COMPANY FILE (#36) | INSURANCE COMPANY(#36)
|
102.01 | PAYER CONTACT COMM TYPE 1 [D] | 102;1 | POINTER TO X12 271 CONTACT QUALIFIER FILE (#365.021) | X12 271 CONTACT QUALIFIER(#365.021)
|
102.02 | PAYER CONTACT COMM TYPE 2 [D] | 102;2 | POINTER TO X12 271 CONTACT QUALIFIER FILE (#365.021) | X12 271 CONTACT QUALIFIER(#365.021)
|
102.03 | PAYER CONTACT COMM TYPE 3 [D] | 102;3 | POINTER TO X12 271 CONTACT QUALIFIER FILE (#365.021) | X12 271 CONTACT QUALIFIER(#365.021)
|
109.01 | PATIENT NAME [D] | 109;1 | POINTER TO PATIENT FILE (#2) | PATIENT(#2)
|
111.01 | PATIENT CONTROL NUMBER [D] | 111;1 | POINTER TO BILL/CLAIMS FILE (#399) | BILL/CLAIMS(#399)
|
112.01 | RESPONSE DUE DATE [D] | 112;1 | DATE |
|
113 | STC SEQ [D] | 113;0 | Multiple #368.0113 | 368.0113
|
114.03 | CLAIM SERVICE START DATE [D] | 114;3 | DATE |
|
114.04 | CLAIM SERVICE END DATE [D] | 114;4 | DATE |
|
116.01 | PAYER RESP CONT COM TYPE 1 [D] | 116;1 | POINTER TO X12 271 CONTACT QUALIFIER FILE (#365.021) | X12 271 CONTACT QUALIFIER(#365.021)
|
116.02 | PAYER RESP CONT COM TYPE 2 [D] | 116;2 | POINTER TO X12 271 CONTACT QUALIFIER FILE (#365.021) | X12 271 CONTACT QUALIFIER(#365.021)
|
116.03 | PAYER RESP CONT COM TYPE 3 [D] | 116;3 | POINTER TO X12 271 CONTACT QUALIFIER FILE (#365.021) | X12 271 CONTACT QUALIFIER(#365.021)
|
120.04 | PAYER RESP CONTACT ADDR ST [D] | 120;4 | POINTER TO STATE FILE (#5) | STATE(#5)
|
120.05 | PAYER RESP CONT POSTAL/ZIP [D] | 120;5 | POINTER TO ZIP CODE FILE (#5.11) | ZIP CODE(#5.11)
|
120.06 | PAYER RESP CONTACT COUNTRY [D] | 120;6 | POINTER TO COUNTRY CODE FILE (#779.004) | COUNTRY CODE(#779.004)
|
121 | STC-SVC LINE STAT INFO SEQ [D] | 121;0 | Multiple #368.0121 | 368.0121
|
200.01 | DELETED FLAG | 200;1 | SET |
|
200.02 | DELETED DATE/TIME | 200;2 | DATE |
|
200.03 | DELETED BY | 200;3 | POINTER TO NEW PERSON FILE (#200) | NEW PERSON(#200)
|
200.04 | REVIEW STATUS | 200;4 | SET |
|
200.05 | REVIEW STATUS DATE/TIME | 200;5 | DATE |
|
200.06 | REVIEW STATUS BY | 200;6 | POINTER TO NEW PERSON FILE (#200) | NEW PERSON(#200)
|
201 | RFAI WORKLIST COMMENTS | 201;0 | DATE Multiple #368.0201 | 368.0201
|
>> | Not killed explicitly |
* | Changed |
! | Killed |
~ | Newed |
Name | Field # of Occurrence |
---|---|
% | 200.04(XREF 1S) |
>> %DT | 100.02+1*, 100.03+1*, 112.01+1*, 114.03+1*, 114.04+1*, 200.02+1*, 200.05+1* |
%H | 200.04(XREF 1S) |
%I | 200.04(XREF 1S) |
>> D0 | 200.04(XREF 1S), 200.04(XREF 2S) |
>> DA | .01(XREF 1S), .01(XREF 1K), .03(XREF 1S), .03(XREF 1K), 111.01(XREF 1S), 111.01(XREF 1K), 200.01(XREF 1S), 200.01(XREF 1K), 200.04(XREF 1S), 200.04(XREF 2S) |
>> DIG | 200.04(XREF 1S), 200.04(XREF 2S) |
>> DIH | 200.04(XREF 1S), 200.04(XREF 2S) |
>> DIU | 200.04(XREF 1S), 200.04(XREF 2S) |
DIV | 200.04(XREF 1S), 200.04(XREF 2S) |
DIV(0 | 200.04(XREF 1S), 200.04(XREF 2S) |
DUZ | 200.04(XREF 2S) |
U | 200.04(XREF 1S), 200.04(XREF 2S) |
X | .01+1!, .01(XREF 1S), .01(XREF 1K), .02+1!, .03+1!, .03(XREF 1S), .03(XREF 1K), 1.01+1!, 1.02+1!, 1.03+1! , 2.01+1!, 2.02+1!, 2.03+1!, 3.01+1!, 4.01+1!, 5.01+1!, 6.01+1!, 6.02+1!, 7.01+1!, 7.02+1! , 8.01+1!, 9.01+1!, 10.01+1!, 11.01+1!, 11.02+1!, 11.03+1!, 11.04+1!, 12.01+1!, 12.02+1!, 14.03+1! , 14.04+1!, 14.05+1!, 15.01+1!, 16.01+1!, 16.02+1!, 16.03+1!, 17.01+1!, 18.01+1!, 19.01+1!, 20.01+1! , 20.02+1!, 20.03+1!, 20.04+1!, 20.05+1!, 20.06+1!, 20.07+1!, 22.03+1!, 25.01+1!, 26.01+1!, 27.01+1! , 28.01+1!, 29.01+1!, 30.01+1!, 31.01+1!, 80.01+1!, 80.02+1!, 80.03+1!, 80.04+1!, 80.05+1!, 80.06+1! , 80.07+1!, 80.08+1!, 80.09+1!, 80.1+1!, 80.11+1!, 80.12+1!, 80.13+1!, 80.14+1!, 80.18+1!, 80.19+1! , 80.2+1!, 80.21+1!, 80.22+1!, 80.23+1!, 80.24+1!, 80.25+1!, 80.26+1!, 80.27+1!, 80.29+1!, 80.3+1! , 100.02+1*!, 100.03+1*!, 111.01(XREF 1S), 111.01(XREF 1K), 112.01+1*!, 114.03+1*!, 114.04+1*!, 200.01(XREF 1S), 200.01(XREF 1K), 200.02+1*! , 200.04(XREF 1S), 200.04(XREF 2S), 200.05+1*! |
Y | 100.02+1, 100.03+1, 112.01+1, 114.03+1, 114.04+1, 200.02+1, 200.04(XREF 1S), 200.04(XREF 2S), 200.05+1 |
Y(1 | 200.04(XREF 1S), 200.04(XREF 2S) |