FileMan FileNo | FileMan Filename | Package |
---|---|---|
361.1 | EXPLANATION OF BENEFITS | Integrated Billing |
Package | Total | FileMan Files |
---|---|---|
Accounts Receivable | 1 | ELECTRONIC REMITTANCE ADVICE(#344.4)[#344.41(.02)] |
Package | Total | FileMan Files |
---|---|---|
Integrated Billing | 5 | BILL/CLAIMS(#399)[.01, #361.1101(.04), #361.11016(.01), #361.18(.03)] REVENUE CODE(#399.2)[#361.115(.1)] INSURANCE COMPANY(#36)[.02] EDI TRANSMIT BILL(#364)[.19] EDI TRANSMISSION BATCH(#364.1)[100.01] |
Kernel | 1 | NEW PERSON(#200)[.18, 100.03, #361.1101(.02), #361.121(.02)] |
Field # | Name | Loc | Type | Details |
---|---|---|---|---|
.01 | BILL | 0;1 | POINTER TO BILL/CLAIMS FILE (#399) | ************************REQUIRED FIELD************************ BILL/CLAIMS(#399)
|
.02 | PAYER NAME | 0;2 | POINTER TO INSURANCE COMPANY FILE (#36) | INSURANCE COMPANY(#36)
|
.03 | PAYER ID | 0;3 | FREE TEXT |
|
.04 | EOB TYPE | 0;4 | SET |
|
.05 | ENTRY DATE/TIME | 0;5 | DATE | ************************REQUIRED FIELD************************
|
.06 | EOB PAID DATE | 0;6 | DATE |
|
.07 | TRACE NUMBER | 0;7 | FREE TEXT |
|
.08 | CROSSED OVER NAME | 51;2 | FREE TEXT |
|
.09 | CROSSED OVER ID | 0;9 | FREE TEXT |
|
.1 | DRG CODE USED | 0;10 | FREE TEXT |
|
.11 | DRG WEIGHT USED | 0;11 | NUMBER |
|
.12 | DISCHARGE FRACTION | 0;12 | NUMBER |
|
.13 | CLAIM STATUS | 0;13 | SET |
|
.14 | ICN | 0;14 | FREE TEXT |
|
.15 | INSURANCE SEQUENCE | 0;15 | SET | ************************REQUIRED FIELD************************
|
.16 | REVIEW STATUS | 0;16 | SET |
|
.17 | MANUAL ENTRY? | 0;17 | SET |
|
.18 | MANUALLY ENTERED BY | 0;18 | POINTER TO NEW PERSON FILE (#200) | NEW PERSON(#200)
|
.19 | TRANSMIT BILL | 0;19 | POINTER TO EDI TRANSMIT BILL FILE (#364) | EDI TRANSMIT BILL(#364)
|
.2 | FINAL REVIEW ACTION | 0;20 | SET |
|
.21 | CLAIM STATUS CODE | 0;21 | FREE TEXT |
|
.22 | PARTIAL EOB | 0;22 | SET (BOOLEAN Data Type) |
|
1.01 | PAYER PAID AMT | 1;1 | NUMBER |
|
1.02 | PATIENT RESPONSIBILITY AMT | 1;2 | NUMBER |
|
1.03 | COVERED AMT | 1;3 | NUMBER |
|
1.04 | DISCOUNT AMT | 1;4 | NUMBER |
|
1.05 | PER DAY LIMIT AMT | 1;5 | NUMBER |
|
1.07 | INTEREST AMT | 1;7 | NUMBER |
|
1.08 | TAX AMT | 1;8 | NUMBER |
|
1.09 | TOTAL BEFORE TAXES AMT | 1;9 | NUMBER |
|
1.1 | STATEMENT START DATE | 1;10 | DATE |
|
1.11 | STATEMENT END DATE | 1;11 | DATE |
|
1.12 | CLAIM RECEIVED DATE | 50;1 | DATE |
|
1.13 | COVERAGE EXPIRATION DATE | 50;2 | DATE |
|
1.14 | CORRECTED PRIORITY PAYER NAME | 50;3 | FREE TEXT |
|
1.15 | CORRECTED PRIORITY PAYER TYPE | 50;4 | SET |
|
1.16 | CORRECTED PRIORITY PAYER ID | 50;5 | FREE TEXT |
|
1.17 | OTHER SUBSCRIBER NAME | 51;1 | FREE TEXT |
|
2.03 | TOTAL ALLOWED AMT | 2;3 | NUMBER |
|
2.04 | TOTAL SUBMITTED CHARGES | 2;4 | NUMBER |
|
2.05 | NEGATIVE REIMBURSEMENT AMT | 2;5 | NUMBER |
|
2.06 | HPID/OEID | 2;6 | FREE TEXT |
|
3.01 | M-CARE OUTP REIMBURS. RATE | 3;1 | NUMBER |
|
3.02 | M-CARE OUTP HCPCS PAYMNT AMT | 3;2 | NUMBER |
|
3.03 | M-CARE OUTP REMARKS CODE-1 | 3;3 | FREE TEXT |
|
3.04 | M-CARE OUTP REMARKS CODE-2 | 3;4 | FREE TEXT |
|
3.05 | M-CARE OUTP REMARKS CODE-3 | 3;5 | FREE TEXT |
|
3.06 | M-CARE OUTP REMARKS CODE-4 | 3;6 | FREE TEXT |
|
3.07 | M-CARE OUTP REMARKS CODE-5 | 3;7 | FREE TEXT |
|
3.08 | M-CARE ESRD PAID AMT | 3;8 | NUMBER |
|
3.09 | M-CARE NON-PAYABLE PROF COMP | 3;9 | NUMBER |
|
4.01 | M-CARE INP COV. DAYS/VISIT CT | 4;1 | NUMBER |
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4.02 | M-CARE INP LIFETM PSYCH DY CT | 4;2 | NUMBER |
|
4.03 | M-CARE INP CLAIM DRG AMT | 4;3 | NUMBER |
|
4.04 | M-CARE INP CAP EXCEPTION AMT | 4;4 | NUMBER |
|
4.05 | M-CARE INP DISPROP. SHARE AMT | 4;5 | NUMBER |
|
4.06 | M-CARE INP MSP PASS THRU AMT | 4;6 | NUMBER |
|
4.07 | M-CARE INP PPS CAPITAL AMT | 4;7 | NUMBER |
|
4.08 | M-CARE INP PPS CAP FSP-DRG AMT | 4;8 | NUMBER |
|
4.09 | M-CARE INP PPS CAP HSP-DRG AMT | 4;9 | NUMBER |
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4.1 | M-CARE INP PPS CAP DSH-DRG AMT | 4;10 | NUMBER |
|
4.11 | M-CARE INP OLD CAPITAL AMT | 4;11 | NUMBER |
|
4.12 | M-CARE INP PPS CAPITAL IME AMT | 4;12 | NUMBER |
|
4.13 | M-CARE INP PPS OP HOS DRG AMT | 4;13 | NUMBER |
|
4.14 | M-CARE INP COST REPORT DAY CT | 4;14 | NUMBER |
|
4.15 | M-CARE INP PPS OP FED DRG AMT | 4;15 | NUMBER |
|
4.16 | M-CARE INP PPS CAP OUTLIER AMT | 4;16 | NUMBER |
|
4.17 | M-CARE INP INDIRECT TEACH AMT | 4;17 | NUMBER |
|
4.18 | M-CARE INP NON-PAY PROF COMP | 4;18 | NUMBER |
|
4.19 | MEDICARE NON-COVERED DAYS | 4;19 | NUMBER |
|
5.01 | M-CARE INP PYMNT REMARK CODE-1 | 5;1 | FREE TEXT |
|
5.011 | REMARK CODE-1 SHORT TEXT | RM1;1 | FREE TEXT |
|
5.02 | M-CARE INP PYMNT REMARK CODE-2 | 5;2 | FREE TEXT |
|
5.021 | REMARK CODE-2 SHORT TEXT | RM2;1 | FREE TEXT |
|
5.03 | M-CARE INP PYMNT REMARK CODE-3 | 5;3 | FREE TEXT |
|
5.031 | REMARK CODE-3 SHORT TEXT | RM3;1 | FREE TEXT |
|
5.04 | M-CARE INP PYMNT REMARK CODE-4 | 5;4 | FREE TEXT |
|
5.041 | REMARK CODE-4 SHORT TEXT | RM4;1 | FREE TEXT |
|
5.05 | M-CARE INP PYMNT REMARK CODE-5 | 5;5 | FREE TEXT |
|
5.051 | REMARK CODE-5 SHORT TEXT | RM5;1 | FREE TEXT |
|
6.01 | NEW PATIENT NAME | 6;1 | FREE TEXT |
|
6.02 | NEW PATIENT ID | 6;2 | FREE TEXT |
|
6.03 | CORRECTED DATA MESSAGE | 6;3 | FREE TEXT |
|
7.01 | TRANSFERRED IN | 7;1 | FREE TEXT |
|
8 | AR AMOUNTS DISTRIBUTION | 8;0 | Multiple #361.18 | 361.18
|
10 | 835 CLAIM LEVEL ADJUSTMENTS | 10;0 | SET Multiple #361.11 | 361.11
|
15 | 835 LINE LEVEL ADJUSTMENTS | 15;0 | Multiple #361.115 | 361.115
|
20 | MESSAGE STORAGE ERRORS | ERR;0 | WORD-PROCESSING #361.12 |
|
21 | REVIEW DATE/TIME | 21;0 | DATE Multiple #361.121 | 361.121
|
25.01 | PAYER CONTACT NAME | 25;1 | FREE TEXT |
|
25.02 | CONTACT NUMBER 1 | 25;2 | FREE TEXT |
|
25.03 | CONTACT TYPE 1 | 25;3 | SET |
|
25.04 | CONTACT NUMBER 2 | 25;4 | FREE TEXT |
|
25.05 | CONTACT TYPE 2 | 25;5 | SET |
|
25.06 | CONTACT NUMBER 3 | 25;6 | FREE TEXT |
|
25.07 | CONTACT TYPE 3 | 25;7 | SET |
|
30.01 | AUTO BILL MESSAGE | 30;1 | FREE TEXT |
|
30.02 | AUTO BILL MESSAGE DATE/TIME | 30;2 | DATE |
|
61.01 | ORIGINAL 06 RECORD DATA | 6.1;E1,200 | FREE TEXT |
|
62.01 | MAILMAN HEADER INFORMATION | 6.2;E1,200 | FREE TEXT |
|
100.01 | BATCH NUMBER | 100;1 | POINTER TO EDI TRANSMISSION BATCH FILE (#364.1) | EDI TRANSMISSION BATCH(#364.1)
|
100.02 | RETURN MESSAGE ID | 100;2 | FREE TEXT |
|
100.03 | LAST EDITED BY | 100;3 | POINTER TO NEW PERSON FILE (#200) | NEW PERSON(#200)
|
100.04 | LAST EDITED DATE | 100;4 | DATE |
|
100.05 | MESSAGE CHECKSUM | 100;5 | FREE TEXT |
|
101 | MOVE/COPY/REMOVE HISTORY | 101;0 | DATE Multiple #361.1101 | 361.1101
|
102 | EEOB REMOVED | 102;1 | SET |
|
103 | PLB DUPLICATE | 102;2 | SET |
|
104 | ERA DETAIL | 102;3 | FREE TEXT |
|
ICR LINK | Subscribing Package(s) | Fields Referenced | Description |
---|---|---|---|
ICR #4051 | BILL (.01). Access: Direct Global Read & w/Fileman |
||
ICR #7017 | ERA DETAIL (104). Access: Direct Global Read & w/Fileman |
Name | Line Occurrences (* Changed, ! Killed) |
---|---|
^DD( | .15(XREF 2n1.4), .15(XREF 2n2.4) |
^DD(361.1 | .15(XREF 2S), .15(XREF 2K) |
^DGCR(399 - [#399] | .15(XREF 2n1.1) |
^IBM(361.1 - [#361.1] | IXABDSL+1*, IXABDKL+1!, IXABDKEIC+1!, IXABSSL+1*, IXABSKL+1!, IXABSKEIC+1!, IXAEDTSL+1*, IXAEDTKL+1!, IXAEDTKEIC+1!, IXAMRASL+1* , IXAMRAKL+1!, IXAMRAKEIC+1!, IXATINSL+1*, IXATINKL+1!, IXATINKEIC+1!, IXATRIDSL+1*, IXATRIDKL+1!, IXATRIDKEIC+1!, .01(XREF 1S), .01(XREF 1K) , .01(XREF 3S), .01(XREF 3K), .03(XREF 1S), .03(XREF 1K), .04OT+1, .05(XREF 2S), .05(XREF 2K), .06(XREF 1S), .06(XREF 1K), .15(XREF 2S) , .15(XREF 2n1.1), .15(XREF 2n1.4), .15(XREF 2K), .15(XREF 2n2.4), .16(XREF 1S), .16(XREF 1K), .16(XREF 2S), .16(XREF 3S), .19(XREF 1S), .19(XREF 1K) , 100.02(XREF 1S), 100.02(XREF 1K) |
>> | Not killed explicitly |
* | Changed |
! | Killed |
~ | Newed |
Name | Field # of Occurrence |
---|---|
>> %DT | .05+1*, .06+1*, 1.1+1*, 1.11+1*, 1.12+1*, 1.13+1*, 30.02+1*, 100.04+1* |
%Y | IDW+1~* |
>> D0 | .04OT+1, .15(XREF 2S), .15(XREF 2K), .16(XREF 2S), .16(XREF 3S) |
>> DA | IXABDSL+1, IXABDKL+1, IXABSSL+1, IXABSKL+1, IXAEDTSL+1, IXAEDTKL+1, IXAMCCFSL+1, IXAMRASL+1, IXAMRAKL+1, IXATINSL+1 , IXATINKL+1, IXATRIDSL+1, IXATRIDKL+1, .01(XREF 1S), .01(XREF 1K), .01(XREF 3S), .01(XREF 3K), .03(XREF 1S), .03(XREF 1K), .05(XREF 2S) , .05(XREF 2K), .06(XREF 1S), .06(XREF 1K), .15(XREF 2S), .15(XREF 2n1.1), .15(XREF 2K), .16(XREF 1S), .16(XREF 1K), .16(XREF 2S), .16(XREF 3S) , .19(XREF 1S), .19(XREF 1K), 100.02(XREF 1S), 100.02(XREF 1K) |
DIC | .19+1!* |
DIC("S" | .19+1*, .19SCR+1* |
>> DIE | .19+1 |
>> DIG | .15(XREF 2n1.4), .15(XREF 2n2.4), .16(XREF 2S), .16(XREF 3S) |
>> DIH | .15(XREF 2n1.4), .15(XREF 2n2.4), .16(XREF 2S), .16(XREF 3S) |
>> DIU | .15(XREF 2S), .15(XREF 2K), .16(XREF 2S), .16(XREF 3S) |
DIV | .15(XREF 2S), .15(XREF 2n1.1), .15(XREF 2n1.4), .15(XREF 2K), .15(XREF 2n2.4), .16(XREF 2S), .16(XREF 3S) |
DIV(0 | .15(XREF 2S), .15(XREF 2n1.4), .15(XREF 2K), .15(XREF 2n2.4), .16(XREF 2S), .16(XREF 3S) |
DUZ | .16(XREF 2S) |
U | IDW+1, .15(XREF 2S), .15(XREF 2n1.1), .15(XREF 2n1.4), .15(XREF 2K), .15(XREF 2n2.4), .16(XREF 2S), .16(XREF 3S) |
X | IXABDSCC+1*, IXABDKCC+1*, IXABSSCC+1*, IXABSKCC+1*, IXATRIDSCC+1*, .01(XREF 1S), .01(XREF 1K), .01(XREF 3S), .01(XREF 3K), .03+1! , .03(XREF 1S), .03(XREF 1K), .05+1*!, .05(XREF 2S), .05(XREF 2K), .06+1*!, .06(XREF 1S), .06(XREF 1K), .07+1!, .08+1! , .09+1!, .1+1!, .11+1!, .12+1!, .14+1!, .15(XREF 2S), .15(XREF 2n1.1), .15(XREF 2n1.4), .15(XREF 2K), .15(XREF 2n2.4) , .16(XREF 1S), .16(XREF 1K), .16(XREF 2S), .16(XREF 3S), .19+1*!, .19(XREF 1S), .19(XREF 1K), .21+1!, 1.01+1*!, 1.02+1*! , 1.03+1*!, 1.04+1*!, 1.05+1*!, 1.07+1*!, 1.08+1*!, 1.09+1*!, 1.1+1*!, 1.11+1*!, 1.12+1*!, 1.13+1*! , 1.14+1!, 1.16+1!, 1.17+1!, 2.03+1*!, 2.04+1*!, 2.05+1*!, 2.06+1!, 3.01+1!, 3.02+1*!, 3.03+1! , 3.04+1!, 3.05+1!, 3.06+1!, 3.07+1!, 3.08+1*!, 3.09+1*!, 4.01+1!, 4.02+1!, 4.03+1*!, 4.04+1*! , 4.05+1*!, 4.06+1*!, 4.07+1*!, 4.08+1*!, 4.09+1*!, 4.1+1*!, 4.11+1*!, 4.12+1*!, 4.13+1*!, 4.14+1! , 4.15+1*!, 4.16+1*!, 4.17+1*!, 4.18+1*!, 4.19+1!, 5.01+1!, 5.011+1!, 5.02+1!, 5.021+1!, 5.03+1! , 5.031+1!, 5.04+1!, 5.041+1!, 5.05+1!, 5.051+1!, 6.01+1!, 6.02+1!, 6.03+1!, 7.01+1!, 25.01+1! , 25.02+1!, 25.04+1!, 25.06+1!, 30.01+1!, 30.02+1*!, 61.01+1!, 62.01+1!, 100.02+1!, 100.02(XREF 1S), 100.02(XREF 1K) , 100.04+1*!, 100.05+1!, 104+1! |
X(1 | IXAEDTSL+1, IXAEDTKL+1, IXAMRASL+1, IXAMRAKL+1, IXATINSL+1, IXATINKL+1, IXATRIDSL+1, IXATRIDKL+1 |
X(2 | IXAEDTSL+1, IXAEDTKL+1, IXAMRASL+1, IXAMRAKL+1, IXATINSL+1, IXATINKL+1, IXATRIDSL+1, IXATRIDKL+1 |
X(3 | IXATRIDSCC+1 |
>> X1(1 | IXABDKL+1, IXABDKCC+1, IXABSKL+1, IXABSKCC+1 |
>> X1(2 | IXABDKL+1, IXABDKCC+1, IXABSKL+1, IXABSKCC+1 |
>> X2(1 | IXABDSL+1, IXABDSCC+1, IXABSSL+1, IXABSSCC+1 |
>> X2(2 | IXABDSL+1, IXABDSCC+1, IXABSSL+1, IXABSSCC+1 |
Y | .04OT+1*, .05+1, .06+1, .15(XREF 2S), .15(XREF 2K), .16(XREF 2S), .16(XREF 3S), .19+1, 1.1+1, 1.11+1 , 1.12+1, 1.13+1, 30.02+1, 100.04+1 |
Y(0 | .04OT+1* |
Y(1 | .15(XREF 2S), .15(XREF 2K), .16(XREF 2S), .16(XREF 3S) |
Z | .01(XREF 3S), .01(XREF 3K), .04OT+1~* |