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Global: ^IBM(361.1

Package: Integrated Billing

Global: ^IBM(361.1


Information

FileMan FileNo FileMan Filename Package
361.1 EXPLANATION OF BENEFITS Integrated Billing

Description

Accessed By FileMan Db Calls, Total: 44

Package Total Routines
Integrated Billing 25 IB20P530    IBCAPP2    IBCAPR    IBCAPR2    IBCECOB1    IBCECOB4    IBCECSA6    IBCEMQC
IBCEMRAA    IBCEMU1    IBCEMU2    IBCEMVU    IBCEOB    IBCEOB0    IBCEOB1    IBCEOB2
IBCEOB21    IBCEOB3    IBCEOB4    IBCEU0    IBJTAD    IBJTBA1    IBJTEP    IBJTPE
IBJTTC    
Accounts Receivable 19 RCDPARC    RCDPEAD1    RCDPEAD2    RCDPEAPQ    RCDPEM41    RCDPEM5    RCDPEM8    RCDPEMAP
RCDPEMAR    RCDPENE1    RCDPENR1    RCDPENR3    RCDPENR4    RCDPEU1    RCDPEU2    RCDPEV0
RCDPEWL0    RCDPEWLD    RCDPPLB    

Pointed To By FileMan Files, Total: 1

Package Total FileMan Files
Accounts Receivable 1 ELECTRONIC REMITTANCE ADVICE(#344.4)[#344.41(.02)]    

Pointer To FileMan Files, Total: 6

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)]    

Fields, Total: 109

Field # Name Loc Type Details
.01 BILL 0;1 POINTER TO BILL/CLAIMS FILE (#399)
************************REQUIRED FIELD************************
BILL/CLAIMS(#399)

  • LAST EDITED:  APR 20, 2020
  • HELP-PROMPT:  ENTER THE BILL # THAT THIS EOB IS FOR
  • DESCRIPTION:  
    This is the pointer to the bill # to which this EOB is associated.
  • CROSS-REFERENCE:  361.1^B
    1)= S ^IBM(361.1,"B",$E(X,1,30),DA)=""
    2)= K ^IBM(361.1,"B",$E(X,1,30),DA)
  • CROSS-REFERENCE:  361.1^ABB^MUMPS
    1)= N Z S Z=+$G(^IBM(361.1,DA,100)) I Z S ^IBM(361.1,"ABB",$E(X,1,30),Z,DA)=""
    2)= S Z=+$G(^IBM(361.1,DA,100)) I Z K ^IBM(361.1,"ABB",$E(X,1,30),Z,DA)
    3)= Do not delete
    Compound cross reference by batch and bill #
  • RECORD INDEXES:  ABD (#131), ABS (#132), AMCCF (#308)
.02 PAYER NAME 0;2 POINTER TO INSURANCE COMPANY FILE (#36) INSURANCE COMPANY(#36)

  • LAST EDITED:  MAY 28, 1999
  • HELP-PROMPT:  Enter the name of the payer who returned this EOB.
  • DESCRIPTION:  
    This is the name of the insurance company that provided this EOB for the bill.
  • NOTES:  TRIGGERED by the INSURANCE SEQUENCE field of the EXPLANATION OF BENEFITS File
.03 PAYER ID 0;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<1) X
  • LAST EDITED:  JUL 10, 2015
  • HELP-PROMPT:  Answer must be 1-20 characters in length.
  • DESCRIPTION:  
    This is the payer ID provided for the insurance co that returned this EOB.
  • CROSS-REFERENCE:  361.1^D
    1)= S ^IBM(361.1,"D",$E(X,1,30),DA)=""
    2)= K ^IBM(361.1,"D",$E(X,1,30),DA)
    3)= Do not delete
    This search cross reference on PAYER ID field. Reports for EOB file use PAYER ID as a search criteria and this index will speed up the ad-hoc reports.
  • RECORD INDEXES:  ATRID (#297)
.04 EOB TYPE 0;4 SET
  • '0' FOR NORMAL EOB;
  • '1' FOR MEDICARE MRA;

  • OUTPUT TRANSFORM:  S Y=$S(Y=0:"NORMAL EOB",1:"MRA") N Z S Z=$O(^(8,0)) I $O(^IBM(361.1,D0,8,Z),-1)'=Z S Y=Y_" (SPLIT TO MORE CLAIMS)"
  • LAST EDITED:  JUN 06, 2011
  • HELP-PROMPT:  Enter 1 if an MRA from MEDICARE
  • DESCRIPTION:  
    This field indicates whether this EOB contains actual payment data or is simply an MRA received from MEDICARE.
  • RECORD INDEXES:  AEDT (#988), AMRA (#307), ATRID (#297)
.05 ENTRY DATE/TIME 0;5 DATE
************************REQUIRED FIELD************************

  • INPUT TRANSFORM:  S %DT="ESTXR" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  AUG 10, 2015
  • HELP-PROMPT:  Enter the date and time this entry is added to the file
  • DESCRIPTION:  
    This is the date and time that this EOB entry was added to the Vista file. This is not mapped from the 835 transmission.
  • CROSS-REFERENCE:  361.1^AD^MUMPS
    1)= S ^IBM(361.1,"AD",+X,DA)=""
    2)= K ^IBM(361.1,"AD",+X,DA)
    3)= Please do not delete
    This index will be used to lookup EEOB by date the EEOB was entered into VistA to speed up report generation.
  • RECORD INDEXES:  AEDT (#988), AMCCF (#308), ATIN (#184)
.06 EOB PAID DATE 0;6 DATE

  • INPUT TRANSFORM:  S %DT="EX" D ^%DT S X=Y K:X<1 X
  • LAST EDITED:  FEB 09, 2015
  • HELP-PROMPT:  Enter the date the payer paid the claim
  • DESCRIPTION:  
    This is the effective date of money movement (paid date) from the payer, as indicated in the 835 transmission.
  • CROSS-REFERENCE:  361.1^E
    1)= S ^IBM(361.1,"E",$E(X,1,30),DA)=""
    2)= K ^IBM(361.1,"E",$E(X,1,30),DA)
    3)= Do not delete
    This is a search index on EOB PAID DATE field. Reports for EOB file use date ranges and this index will reduce the time necessary to generate ad-hoc reports.
  • RECORD INDEXES:  ABD (#131)
.07 TRACE NUMBER 0;7 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>50!($L(X)<1) X
  • LAST EDITED:  JUL 10, 2015
  • HELP-PROMPT:  Answer must be 1-50 characters in length.
  • DESCRIPTION:  
    This is the TRACE NUMBER from the 835 transaction for this EOB
  • TECHNICAL DESCR:  
    This is the data from the 835 data field (TRN-02)
  • RECORD INDEXES:  ATRID (#297)
.08 CROSSED OVER NAME 51;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>60!($L(X)<1) X
  • LAST EDITED:  JUN 19, 2010
  • HELP-PROMPT:  Answer must be 1-60 characters in length.
  • DESCRIPTION:  
    This is the name of the insurance company to which this claim was sent for COB purposes automatically.
  • TECHNICAL DESCR:  
    This is the data from the 835 data field (NM-103/Qualifier='DC')
.09 CROSSED OVER ID 0;9 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<1) X
  • LAST EDITED:  OCT 07, 1998
  • HELP-PROMPT:  Answer must be 1-20 characters in length.
  • DESCRIPTION:  
    This is the ID returned on the 835 for the CROSS-OVER payer.
  • TECHNICAL DESCR:  
    This is the data from the 835 data field (NM-109)
.1 DRG CODE USED 0;10 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>4!($L(X)<1) X
  • LAST EDITED:  OCT 07, 1998
  • HELP-PROMPT:  Answer must be 1-4 characters in length.
  • DESCRIPTION:  
    This is the DRG code used for pricing as reported from the payer for institutional claims only.
  • TECHNICAL DESCR:  
    This is the data from the 835 data field (CLP-11) or from manual entry of the amount
.11 DRG WEIGHT USED 0;11 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>9999999999)!(X<0)!(X?.E1"."5N.N) X
  • LAST EDITED:  MAR 03, 1999
  • HELP-PROMPT:  Type a Number between 0 and 9999999999, 4 Decimal Digits
  • DESCRIPTION:  
    This is the DRG weight used for pricing as reported from the payer for institutional claims only.
  • TECHNICAL DESCR:  
    This is the data from the 835 data field (CLP-12) or from manual entry of the amount
.12 DISCHARGE FRACTION 0;12 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>9999999999)!(X<0)!(X?.E1"."3N.N) X
  • LAST EDITED:  OCT 07, 1998
  • HELP-PROMPT:  Type a Number between 0 and 9999999999, 2 Decimal Digits
  • DESCRIPTION:  
    This is the DISCHARGE FRACTION field as reported by the payer for institutional claims only.
  • TECHNICAL DESCR:  
    This is the data from the 835 data field (CLP-13) or from manual entry of the amount
.13 CLAIM STATUS 0;13 SET
  • '1' FOR PROCESSED;
  • '2' FOR DENIED;
  • '3' FOR PENDED;
  • '4' FOR REVERSAL;
  • '5' FOR OTHER;

  • LAST EDITED:  OCT 07, 1998
  • HELP-PROMPT:  Enter the status of this EOB.
  • DESCRIPTION:  
    This is the status of this EOB. Only PROCESSED and DENIED claims will be sent to subsequent payers for COB purposes.
  • TECHNICAL DESCR:  
    This is the data from the 835 data field (CLP-02) or from manual entry of the amount
.14 ICN 0;14 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>50!($L(X)<1) X
  • LAST EDITED:  JUN 19, 2010
  • HELP-PROMPT:  Answer must be 1-50 characters in length.
  • DESCRIPTION:  
    This is the ICN as reported on the EOB from the payer.
  • TECHNICAL DESCR:  
    This data is found on the 835 in the CLP-07 data element.
.15 INSURANCE SEQUENCE 0;15 SET
************************REQUIRED FIELD************************
  • '1' FOR PRIMARY;
  • '2' FOR SECONDARY;
  • '3' FOR TERTIARY;

  • LAST EDITED:  NOV 15, 1999
  • HELP-PROMPT:  Enter the sequence for this insurance for this bill
  • DESCRIPTION:  
    This is the sequence for the insurance for this bill.
  • CROSS-REFERENCE:  ^^TRIGGER^361.1^.02
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^IBM(361.1,D0,0)):^(0),1:"") S X=$P(Y(1),U,2),X=X S DIU=X K Y X ^DD(361.1,.15,1,2,1.1) X ^DD(361.1,.15,1,2,1.4)
    1.1)= S X=DIV S X=+$P(^DGCR(399,+$G(^IBM(361.1,DA,0)),"M"),U,X),X=$S(X:X,1:"")
    1.4)= S DIH=$S($D(^IBM(361.1,DIV(0),0)):^(0),1:""),DIV=X S $P(^(0),U,2)=DIV,DIH=361.1,DIG=.02 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^IBM(361.1,D0,0)):^(0),1:"") S X=$P(Y(1),U,2),X=X S DIU=X K Y S X="" X ^DD(361.1,.15,1,2,2.4)
    2.4)= S DIH=$S($D(^IBM(361.1,DIV(0),0)):^(0),1:""),DIV=X S $P(^(0),U,2)=DIV,DIH=361.1,DIG=.02 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    3)= Please do not delete
    CREATE VALUE)= S X=+$P(^DGCR(399,+$G(^IBM(361.1,DA,0)),"M"),U,X),X=$S(X:X,1:"")
    DELETE VALUE)= @
    FIELD)= PAYER NAME
    This trigger forces the insurance company pointer into the PAYER NAME field when the COB sequence for the bill is entered.
  • RECORD INDEXES:  ABS (#132)
.16 REVIEW STATUS 0;16 SET
  • '0' FOR NOT REVIEWED;
  • '1' FOR REVIEW IN PROCESS;
  • '1.5' FOR COB PROCESSED, NOT AUTHORIZED;
  • '2' FOR ACCEPTED-INTERIM EOB;
  • '3' FOR ACCEPTED-COMPLETE EOB;
  • '4' FOR REJECTED;
  • '9' FOR CLAIM CANCELLED;

  • LAST EDITED:  SEP 15, 2004
  • DESCRIPTION:  
    This is the current processing status of the EOB/MRA. Only MRA claims can be in a REJECTED status.
  • CROSS-REFERENCE:  361.1^AREV
    1)= S ^IBM(361.1,"AREV",$E(X,1,30),DA)=""
    2)= K ^IBM(361.1,"AREV",$E(X,1,30),DA)
    3)= Do not delete
    This xref is used to pull out EOB's that are in various stages of review.
  • CROSS-REFERENCE:  ^^TRIGGER^361.1^100.03
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^IBM(361.1,D0,100)):^(100),1:"") S X=$P(Y(1),U,3),X=X S DIU=X K Y S X=DIV S X=$G(DUZ) S DIH=$G(^IBM(361.1,DIV(0),100)),DIV=X S $P(^(100),U,3)=DIV,DIH=361.1,DIG=100.03 D ^DICR
    2)= Q
    CREATE VALUE)= S X=$G(DUZ)
    DELETE VALUE)= NO EFFECT
    FIELD)= LAST EDITED BY
  • CROSS-REFERENCE:  ^^TRIGGER^361.1^100.04
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^IBM(361.1,D0,100)):^(100),1:"") S X=$P(Y(1),U,4),X=X S DIU=X K Y S X=DIV S X=$$NOW^XLFDT() S DIH=$G(^IBM(361.1,DIV(0),100)),DIV=X S $P(^(100),U,4)=DIV,DIH=361.1,DIG=100.04 D
    ^DICR
    2)= Q
    CREATE VALUE)= S X=$$NOW^XLFDT()
    DELETE VALUE)= NO EFFECT
    FIELD)= LAST EDITED DATE
  • RECORD INDEXES:  AMRA (#307)
.17 MANUAL ENTRY? 0;17 SET
  • '0' FOR NO;
  • '1' FOR YES;

  • LAST EDITED:  FEB 10, 1999
  • HELP-PROMPT:  Enter a 1 if this EOB was manually entered or 0 if it was entered electronically
  • DESCRIPTION:  
    This field indicates whether the EOB was added electronically or manually.
.18 MANUALLY ENTERED BY 0;18 POINTER TO NEW PERSON FILE (#200) NEW PERSON(#200)

  • LAST EDITED:  MAY 28, 1999
  • HELP-PROMPT:  Enter the name of the person entering the EOB
  • DESCRIPTION:  
    This is the name of the person responsible for the entry of this EOB.
.19 TRANSMIT BILL 0;19 POINTER TO EDI TRANSMIT BILL FILE (#364) EDI TRANSMIT BILL(#364)

  • INPUT TRANSFORM:  S DIC("S")="N Z S Z=$G(^(0)) I +Z=+$G(^IBM(361.1,DA,0)),$TR($P(Z,U,8),""PST"",""123"")=$P(^(0),U,15)" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
  • LAST EDITED:  NOV 10, 1999
  • HELP-PROMPT:  Enter the transmit bill that generated this EOB.
  • DESCRIPTION:  
    This is the transmit bill entry that was responsible for this EOB.
  • SCREEN:  S DIC("S")="N Z S Z=$G(^(0)) I +Z=+$G(^IBM(361.1,DA,0)),$TR($P(Z,U,8),""PST"",""123"")=$P(^(0),U,15)"
  • EXPLANATION:  Only for same bill entry and ins sequence
  • CROSS-REFERENCE:  361.1^AERR
    1)= S ^IBM(361.1,"AERR",$E(X,1,30),DA)=""
    2)= K ^IBM(361.1,"AERR",$E(X,1,30),DA)
    3)= Do not delete
.2 FINAL REVIEW ACTION 0;20 SET
  • 'C' FOR BILL CANCELLED - NO FURTHER ACTION;
  • 'F' FOR FILED - NO ACTION;
  • 'R' FOR CORRECTED/RESUBMITTED;
  • 'P' FOR COB PROCESSED;
  • 'O' FOR OTHER ACTION;

  • LAST EDITED:  JUL 03, 2003
  • HELP-PROMPT:  Enter the final review action for this EOB
  • DESCRIPTION:  
    This is the action that was taken to complete the review of this EOB.
.21 CLAIM STATUS CODE 0;21 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>2!($L(X)<1) X
  • LAST EDITED:  MAR 25, 2003
  • HELP-PROMPT:  Answer must be 1-2 characters in length.
  • DESCRIPTION:  
    This is the actual X12 claim status code that was received for this EOB.
.22 PARTIAL EOB 0;22 SET (BOOLEAN Data Type)
  • Does this MRA/EOB cover all lines submitted on claim? If not, it's a partial MRA and should be flagged as such.

  • LAST EDITED:  MAR 04, 2022
  • HELP-PROMPT:  Enter Yes if this MRA does not cover the entire claims.
  • DESCRIPTION:  
    Does this MRA/EOB cover all lines submitted on claim? If not, it's a partial MRA and should be flagged as such.
  • TECHNICAL DESCR:  This field is calculated when an MRA is received. The code checks to see what lines were sent out on the claim and which were returned and stores the result here when it is an incomplete MRA. It is needed because one of
    the administrative contractors does not return an MA15 when a claim is split so the software needs to figure it out. Otherwise, incomplete COB information is being send to subsequent payers.
1.01 PAYER PAID AMT 1;1 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>9999999999)!(X<0) X
  • LAST EDITED:  OCT 06, 1998
  • HELP-PROMPT:  Type a Dollar Amount between 0 and 9999999999, 2 Decimal Digits
  • DESCRIPTION:  
    This is the amount that was paid on this claim for this EOB
  • TECHNICAL DESCR:  
    This is the amount from the 835 data field (CLP-04) or from manual entry of the amount
1.02 PATIENT RESPONSIBILITY AMT 1;2 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>9999999999999.99)!(X<0) X
  • LAST EDITED:  JAN 22, 1999
  • HELP-PROMPT:  Type a Dollar Amount between 0 and 9999999999999.99, 2 Decimal Digits
  • DESCRIPTION:  
    This is the amount the insurance company/MRA dictates is the responsibility of the patient for this claim.
  • TECHNICAL DESCR:  
    This field is found from the data on the 835 in the CAS segment when the qualifier = 'PR'.
1.03 COVERED AMT 1;3 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>9999999999)!(X<0) X
  • LAST EDITED:  OCT 06, 1998
  • HELP-PROMPT:  Type a Dollar Amount between 0 and 9999999999, 2 Decimal Digits
  • DESCRIPTION:  
    This is the amount as reported by the payer.
  • TECHNICAL DESCR:  
    This is the amount from the 835 data field (AMT-02/Qualifier='AU') or from manual entry of the amount
1.04 DISCOUNT AMT 1;4 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>9999999999)!(X<0) X
  • LAST EDITED:  OCT 06, 1998
  • HELP-PROMPT:  Type a Dollar Amount between 0 and 9999999999, 2 Decimal Digits
  • DESCRIPTION:  
    This is the prompt pay discount amount as reported by the payer.
  • TECHNICAL DESCR:  
    This is the amount from the 835 data field (AMT-02/Qualifier='D8') or from manual entry of the amount
1.05 PER DAY LIMIT AMT 1;5 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>9999999999)!(X<0) X
  • LAST EDITED:  OCT 06, 1998
  • HELP-PROMPT:  Type a Dollar Amount between 0 and 9999999999, 2 Decimal Digits
  • DESCRIPTION:  
    This is the amount as reported by the payer.
  • TECHNICAL DESCR:  
    This is the amount from the 835 data field (AMT-02/Qualifier='DY') or from manual entry of the amount
1.07 INTEREST AMT 1;7 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>9999999999)!(X<0) X
  • LAST EDITED:  OCT 06, 1998
  • HELP-PROMPT:  Type a Dollar Amount between 0 and 9999999999, 2 Decimal Digits
  • DESCRIPTION:  
    This is the amount as reported by the payer.
  • TECHNICAL DESCR:  
    This is the amount from the 835 data field (AMT-02/Qualifier='I') or from manual entry of the amount
1.08 TAX AMT 1;8 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>9999999999)!(X<0) X
  • LAST EDITED:  OCT 06, 1998
  • HELP-PROMPT:  Type a Dollar Amount between 0 and 9999999999, 2 Decimal Digits
  • DESCRIPTION:  
    This is the amount as reported by the payer.
  • TECHNICAL DESCR:  
    This is the amount from the 835 data field (AMT-02/Qualifier='T') or from manual entry of the amount
1.09 TOTAL BEFORE TAXES AMT 1;9 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>9999999999)!(X<0) X
  • LAST EDITED:  OCT 06, 1998
  • HELP-PROMPT:  Type a Dollar Amount between 0 and 9999999999, 2 Decimal Digits
  • DESCRIPTION:  
    This is the amount as reported by the payer.
  • TECHNICAL DESCR:  
    This is the amount from the 835 data field (AMT-02/Qualifier='T2') or from manual entry of the amount
1.1 STATEMENT START DATE 1;10 DATE

  • INPUT TRANSFORM:  S %DT="EX" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  JAN 28, 2004
  • HELP-PROMPT:  Enter the date the payer reported as the starting date of service.
  • DESCRIPTION:  
    This is the date the payer reported as the starting date of service for the claim.
1.11 STATEMENT END DATE 1;11 DATE

  • INPUT TRANSFORM:  S %DT="EX" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  JAN 28, 2004
  • HELP-PROMPT:  Enter the date the payer reported as the ending date of service.
  • DESCRIPTION:  
    This is the date the payer reported as the ending date of service for the claim.
1.12 CLAIM RECEIVED DATE 50;1 DATE

  • INPUT TRANSFORM:  S %DT="EX" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  JUN 18, 2010
  • HELP-PROMPT:  Enter the date the payer received the claim.
  • DESCRIPTION:  
    This is the date the payer received the claim.
  • TECHNICAL DESCR:  
    From 835 record: 2100 DTM02 where DTM01 = "050"
1.13 COVERAGE EXPIRATION DATE 50;2 DATE

  • INPUT TRANSFORM:  S %DT="EX" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  JUN 21, 2010
  • HELP-PROMPT:  Enter the date the insurance coverage expires.
  • DESCRIPTION:  
    This is the date the insurance coverage expires.
  • TECHNICAL DESCR:  
    From 835 record: 2100 DTM02 where DTM01= "036"
1.14 CORRECTED PRIORITY PAYER NAME 50;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>60!($L(X)<1) X
  • LAST EDITED:  JUN 21, 2010
  • HELP-PROMPT:  Enter the corrected name (1-60 characters) of the priority payer.
  • DESCRIPTION:  
    This is the corrected name of the priority payer for this claim.
  • TECHNICAL DESCR:  
    From 835 record: 2100NM103 where NM101 = "PR"
1.15 CORRECTED PRIORITY PAYER TYPE 50;4 SET
  • 'AD' FOR BLUE CROSS/BLUE SHIELD ASSOC;
  • 'FI' FOR FEDERAL TAXPAYER;
  • 'NI' FOR NAIC;
  • 'PP' FOR PHARMACY PROCESSOR NUMBER;
  • 'XV' FOR CENTERS FOR MEDICARE/MEDICAID;
  • 'PI' FOR PAYER ID;

  • LAST EDITED:  JAN 21, 2016
  • HELP-PROMPT:  Enter code for type of corrected priority payer.
  • DESCRIPTION:  
    This is the type of the corrected priority payer.
  • TECHNICAL DESCR:  
    From 835 record: 2100 NM108 where NM101 = "PR"
1.16 CORRECTED PRIORITY PAYER ID 50;5 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>80!($L(X)<1) X
  • LAST EDITED:  JUN 21, 2010
  • HELP-PROMPT:  Enter the ID (1-80 characters) of the corrected priority payer.
  • DESCRIPTION:  
    This is the ID of the corrected priority payer.
  • TECHNICAL DESCR:  
    From 835 record: 2100 NM109 where NM101= "PR"
1.17 OTHER SUBSCRIBER NAME 51;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>122!($L(X)<1) X
  • LAST EDITED:  JUN 14, 2010
  • HELP-PROMPT:  Enter the name (1-122 characters) of the other subscriber for this claim.
  • DESCRIPTION:  
    This is the name of the other subscriber for this claim.
  • TECHNICAL DESCR:  
    From 835 record: 2100 NM104 where NM101 = "GB" or NM101 = "GN"
2.03 TOTAL ALLOWED AMT 2;3 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>9999999999)!(X<0) X
  • LAST EDITED:  OCT 06, 1998
  • HELP-PROMPT:  Type a Dollar Amount between 0 and 9999999999, 2 Decimal Digits
  • DESCRIPTION:  
    This is a data element from a MEDICARE electronic remittance advice.
  • TECHNICAL DESCR:  
    This is the amount from the 835 data field (AMT-02/Qualifier='B6')
2.04 TOTAL SUBMITTED CHARGES 2;4 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>9999999999)!(X<0) X
  • LAST EDITED:  OCT 06, 1998
  • HELP-PROMPT:  Type a Dollar Amount between 0 and 9999999999, 2 Decimal Digits
  • DESCRIPTION:  
    This is a data element from a MEDICARE electronic remittance advice.
  • TECHNICAL DESCR:  
    This is the amount from the 835 data field (AMT-02/Qualifier='T3')
2.05 NEGATIVE REIMBURSEMENT AMT 2;5 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?."-".N.1".".2N!(X>9999999999)!(X<-9999999999)!(X?.E1"."3.N) X
  • LAST EDITED:  AUG 15, 2003
  • HELP-PROMPT:  Type a Dollar amount between -9999999999 and 9999999999, 2 Decimal Digits
  • DESCRIPTION:  
    This is the amount of negative reimbursement on a claim as reported by MEDICARE.
  • TECHNICAL DESCR:  
    This data can be found on the electronic EOB (835) in the AMT-02 (qualifier 'NL') data element.
2.06 HPID/OEID 2;6 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>10 X
  • LAST EDITED:  MAY 08, 2014
  • HELP-PROMPT:  Answer must be 10 characters in length.
  • DESCRIPTION:  The HPID/OEID is a 10-digit, all-numeric identifier following the ISO Standard 7812 format with a Luhn check-digit as the tenth digit. The start digit of the HPID/OEID signals whether the identifier has been provided to a
    health plan and not to an "other entity". If the start digit is a seven (7) then it is an HPID and identifies a health plan, a six (6) indicates an "other entity" (OEID). The OEID serves as the identifier for entities
    that are not health plans, healthcare providers, or individuals (persons) who are not eligible for the HPID or National Provider Identifier (NPI), yet they need to be identified in standard transactions and for other
    lawful purposes.
    UNEDITABLE
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
3.01 M-CARE OUTP REIMBURS. RATE 3;1 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>1)!(X<0)!(X?.E1"."5.N) X
  • LAST EDITED:  JUN 25, 2003
  • HELP-PROMPT:  Type a number between 0 and 1, 4 Decimal Digits
  • DESCRIPTION:  
    This is a data element from a MEDICARE electronic remittance advice.
  • TECHNICAL DESCR:  
    This is the amount from the 835 data field (MOA-01)
3.02 M-CARE OUTP HCPCS PAYMNT AMT 3;2 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>9999999999)!(X<0) X
  • LAST EDITED:  OCT 06, 1998
  • HELP-PROMPT:  Type a Dollar Amount between 0 and 9999999999, 2 Decimal Digits
  • DESCRIPTION:  
    This is a data element from a MEDICARE electronic remittance advice.
  • TECHNICAL DESCR:  
    This is the amount from the 835 data field (MOA-02)
3.03 M-CARE OUTP REMARKS CODE-1 3;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>10!($L(X)<1) X
  • LAST EDITED:  OCT 06, 1998
  • HELP-PROMPT:  Answer must be 1-10 characters in length.
  • DESCRIPTION:  
    This is a data element from a MEDICARE electronic remittance advice.
  • TECHNICAL DESCR:  
    This is the amount from the 835 data field (MOA-03)
3.04 M-CARE OUTP REMARKS CODE-2 3;4 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>10!($L(X)<1) X
  • LAST EDITED:  OCT 06, 1998
  • HELP-PROMPT:  Answer must be 1-10 characters in length.
  • DESCRIPTION:  
    This is a data element from a MEDICARE electronic remittance advice.
  • TECHNICAL DESCR:  
    This is the amount from the 835 data field (MOA-04)
3.05 M-CARE OUTP REMARKS CODE-3 3;5 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>10!($L(X)<1) X
  • LAST EDITED:  OCT 06, 1998
  • HELP-PROMPT:  Answer must be 1-10 characters in length.
  • DESCRIPTION:  
    This is a data element from a MEDICARE electronic remittance advice.
  • TECHNICAL DESCR:  
    This is the amount from the 835 data field (MOA-05)
3.06 M-CARE OUTP REMARKS CODE-4 3;6 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>10!($L(X)<1) X
  • LAST EDITED:  OCT 06, 1998
  • HELP-PROMPT:  Answer must be 1-10 characters in length.
  • DESCRIPTION:  
    This is a data element from a MEDICARE electronic remittance advice.
  • TECHNICAL DESCR:  
    This is the amount from the 835 data field (MOA-06)
3.07 M-CARE OUTP REMARKS CODE-5 3;7 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>10!($L(X)<1) X
  • LAST EDITED:  OCT 06, 1998
  • HELP-PROMPT:  Answer must be 1-10 characters in length.
  • DESCRIPTION:  
    This is a data element from a MEDICARE electronic remittance advice.
  • TECHNICAL DESCR:  
    This is the amount from the 835 data field (MOA-07)
3.08 M-CARE ESRD PAID AMT 3;8 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>9999999999)!(X<0) X
  • LAST EDITED:  JAN 12, 1999
  • HELP-PROMPT:  Type a Dollar Amount between 0 and 9999999999, 2 Decimal Digits
  • DESCRIPTION:  
    This is a data element from a MEDICARE electronic remittance advice.
  • TECHNICAL DESCR:  
    This is the amount from the 835 data field (MOA-08)
3.09 M-CARE NON-PAYABLE PROF COMP 3;9 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>9999999999)!(X<0) X
  • LAST EDITED:  JAN 12, 1999
  • HELP-PROMPT:  Type a Dollar Amount between 0 and 9999999999, 2 Decimal Digits
  • DESCRIPTION:  
    This is a data element from a MEDICARE electronic remittance advice.
  • TECHNICAL DESCR:  
    This is the amount from the 835 data field (MOA-09)
4.01 M-CARE INP COV. DAYS/VISIT CT 4;1 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>9999)!(X<0)!(X?.E1"."1N.N) X
  • LAST EDITED:  OCT 06, 1998
  • HELP-PROMPT:  Type a Number between 0 and 9999, 0 Decimal Digits
  • DESCRIPTION:  
    This is a data element from a MEDICARE electronic remittance advice.
  • TECHNICAL DESCR:  
    This is the amount from the 835 data field (MIA-01)
4.02 M-CARE INP LIFETM PSYCH DY CT 4;2 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>9999)!(X<0)!(X?.E1"."1N.N) X
  • LAST EDITED:  OCT 06, 1998
  • HELP-PROMPT:  Type a Number between 0 and 9999, 0 Decimal Digits
  • DESCRIPTION:  
    This is a data element from a MEDICARE electronic remittance advice.
  • TECHNICAL DESCR:  
    This is the amount from the 835 data field (MIA-03)
4.03 M-CARE INP CLAIM DRG AMT 4;3 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>9999999999)!(X<0) X
  • LAST EDITED:  OCT 06, 1998
  • HELP-PROMPT:  Type a Dollar Amount between 0 and 9999999999, 2 Decimal Digits
  • DESCRIPTION:  
    This is a data element from a MEDICARE electronic remittance advice.
  • TECHNICAL DESCR:  
    This is the amount from the 835 data field (MIA-04)
4.04 M-CARE INP CAP EXCEPTION AMT 4;4 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>9999999999)!(X<0) X
  • LAST EDITED:  OCT 06, 1998
  • HELP-PROMPT:  Type a Dollar Amount between 0 and 9999999999, 2 Decimal Digits
  • DESCRIPTION:  
    This is a data element from a MEDICARE electronic remittance advice.
  • TECHNICAL DESCR:  
    This is the amount from the 835 data field (MIA-24)
4.05 M-CARE INP DISPROP. SHARE AMT 4;5 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>9999999999)!(X<0) X
  • LAST EDITED:  OCT 06, 1998
  • HELP-PROMPT:  Type a Dollar Amount between 0 and 9999999999, 2 Decimal Digits
  • DESCRIPTION:  
    This is a data element from a MEDICARE electronic remittance advice.
  • TECHNICAL DESCR:  
    This is the amount from the 835 data field (MIA-06)
4.06 M-CARE INP MSP PASS THRU AMT 4;6 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>9999999999)!(X<0) X
  • LAST EDITED:  OCT 06, 1998
  • HELP-PROMPT:  Type a Dollar Amount between 0 and 9999999999, 2 Decimal Digits
  • DESCRIPTION:  
    This is a data element from a MEDICARE electronic remittance advice.
  • TECHNICAL DESCR:  
    MIA-07
4.07 M-CARE INP PPS CAPITAL AMT 4;7 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>9999999999)!(X<0) X
  • LAST EDITED:  OCT 06, 1998
  • HELP-PROMPT:  Type a Dollar Amount between 0 and 9999999999, 2 Decimal Digits
  • DESCRIPTION:  
    This is a data element from a MEDICARE electronic remittance advice.
  • TECHNICAL DESCR:  
    This is the amount from the 835 data field (MIA-08)
4.08 M-CARE INP PPS CAP FSP-DRG AMT 4;8 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>9999999999)!(X<0) X
  • LAST EDITED:  OCT 06, 1998
  • HELP-PROMPT:  Type a Dollar Amount between 0 and 9999999999, 2 Decimal Digits
  • DESCRIPTION:  
    This is a data element from a MEDICARE electronic remittance advice.
  • TECHNICAL DESCR:  
    This is the amount from the 835 data field (MIA-09)
4.09 M-CARE INP PPS CAP HSP-DRG AMT 4;9 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>9999999999)!(X<0) X
  • LAST EDITED:  OCT 06, 1998
  • HELP-PROMPT:  Type a Dollar Amount between 0 and 9999999999, 2 Decimal Digits
  • DESCRIPTION:  
    This is a data element from a MEDICARE electronic remittance advice.
  • TECHNICAL DESCR:  
    This is the amount from the 835 data field (MIA-10)
4.1 M-CARE INP PPS CAP DSH-DRG AMT 4;10 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>9999999999)!(X<0) X
  • LAST EDITED:  OCT 06, 1998
  • HELP-PROMPT:  Type a Dollar Amount between 0 and 9999999999, 2 Decimal Digits
  • DESCRIPTION:  
    This is a data element from a MEDICARE electronic remittance advice.
  • TECHNICAL DESCR:  
    This is the amount from the 835 data field (MIA-11)
4.11 M-CARE INP OLD CAPITAL AMT 4;11 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>9999999999)!(X<0) X
  • LAST EDITED:  OCT 06, 1998
  • HELP-PROMPT:  Type a Dollar Amount between 0 and 9999999999, 2 Decimal Digits
  • DESCRIPTION:  
    This is a data element from a MEDICARE electronic remittance advice.
  • TECHNICAL DESCR:  
    This is the amount from the 835 data field (MIA-12)
4.12 M-CARE INP PPS CAPITAL IME AMT 4;12 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>9999999999)!(X<0) X
  • LAST EDITED:  OCT 06, 1998
  • HELP-PROMPT:  Type a Dollar Amount between 0 and 9999999999, 2 Decimal Digits
  • DESCRIPTION:  
    This is a data element from a MEDICARE electronic remittance advice.
  • TECHNICAL DESCR:  
    This is the amount from the 835 data field (MIA-13)
4.13 M-CARE INP PPS OP HOS DRG AMT 4;13 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>9999999999)!(X<0) X
  • LAST EDITED:  OCT 06, 1998
  • HELP-PROMPT:  Type a Dollar Amount between 0 and 9999999999, 2 Decimal Digits
  • DESCRIPTION:  
    This is a data element from a MEDICARE electronic remittance advice.
  • TECHNICAL DESCR:  
    This is the amount from the 835 data field (MIA-14)
4.14 M-CARE INP COST REPORT DAY CT 4;14 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>999)!(X<0)!(X?.E1"."1N.N) X
  • LAST EDITED:  OCT 06, 1998
  • HELP-PROMPT:  Type a Number between 0 and 999, 0 Decimal Digits
  • DESCRIPTION:  
    This is a data element from a MEDICARE electronic remittance advice.
  • TECHNICAL DESCR:  
    This is the amount from the 835 data field (MIA-15)
4.15 M-CARE INP PPS OP FED DRG AMT 4;15 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>9999999999)!(X<0) X
  • LAST EDITED:  OCT 06, 1998
  • HELP-PROMPT:  Type a Dollar Amount between 0 and 9999999999, 2 Decimal Digits
  • DESCRIPTION:  
    This is a data element from a MEDICARE electronic remittance advice.
  • TECHNICAL DESCR:  
    This is the amount from the 835 data field (MIA-16)
4.16 M-CARE INP PPS CAP OUTLIER AMT 4;16 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>9999999999)!(X<0) X
  • LAST EDITED:  OCT 06, 1998
  • HELP-PROMPT:  Type a Dollar Amount between 0 and 9999999999, 2 Decimal Digits
  • DESCRIPTION:  
    This is a data element from a MEDICARE electronic remittance advice.
  • TECHNICAL DESCR:  
    This is the amount from the 835 data field (MIA-17)
4.17 M-CARE INP INDIRECT TEACH AMT 4;17 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>9999999999)!(X<0) X
  • LAST EDITED:  OCT 06, 1998
  • HELP-PROMPT:  Type a Dollar Amount between 0 and 9999999999, 2 Decimal Digits
  • DESCRIPTION:  
    This is a data element from a MEDICARE electronic remittance advice.
  • TECHNICAL DESCR:  
    This is the amount from the 835 data field (MIA-18)
4.18 M-CARE INP NON-PAY PROF COMP 4;18 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>9999999999)!(X<0) X
  • LAST EDITED:  OCT 06, 1998
  • HELP-PROMPT:  Type a Dollar Amount between 0 and 9999999999, 2 Decimal Digits
  • DESCRIPTION:  
    This is a data element from a MEDICARE electronic remittance advice.
  • TECHNICAL DESCR:  
    This is the amount from the 835 data field (MIA-19)
4.19 MEDICARE NON-COVERED DAYS 4;19 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>9999)!(X<0)!(X?.E1"."1N.N) X
  • LAST EDITED:  APR 12, 2001
  • HELP-PROMPT:  Type a Number between 0 and 9999, 0 Decimal Digits
  • DESCRIPTION:  
    This is a data element from a MEDICARE electronic remittance advice
  • TECHNICAL DESCR:  
    This is the amount from the 835 data field (QTY with qualifier 'NA')
5.01 M-CARE INP PYMNT REMARK CODE-1 5;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>10!($L(X)<1) X
  • LAST EDITED:  OCT 06, 1998
  • HELP-PROMPT:  Answer must be 1-10 characters in length.
  • DESCRIPTION:  
    This is a data element from a MEDICARE electronic remittance advice.
  • TECHNICAL DESCR:  
    This is the amount from the 835 data field (MIA-05)
5.011 REMARK CODE-1 SHORT TEXT RM1;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>190!($L(X)<1) X
  • LAST EDITED:  FEB 05, 1999
  • HELP-PROMPT:  Answer must be 1-190 characters in length.
  • DESCRIPTION:  
    This is the abbreviated text for remark code # 1, if available This applies to EITHER inpatient or outpatient remark codes from MEDICARE.
5.02 M-CARE INP PYMNT REMARK CODE-2 5;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>10!($L(X)<1) X
  • LAST EDITED:  OCT 06, 1998
  • HELP-PROMPT:  Answer must be 1-10 characters in length.
  • DESCRIPTION:  
    This is a data element from a MEDICARE electronic remittance advice.
  • TECHNICAL DESCR:  
    This is the amount from the 835 data field (MIA-20)
5.021 REMARK CODE-2 SHORT TEXT RM2;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>190!($L(X)<1) X
  • LAST EDITED:  FEB 05, 1999
  • HELP-PROMPT:  Answer must be 1-190 characters in length.
  • DESCRIPTION:  
    This is the abbreviated text for remark code # 2, if available This applies to EITHER inpatient or outpatient remark codes from MEDICARE.
5.03 M-CARE INP PYMNT REMARK CODE-3 5;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>10!($L(X)<1) X
  • LAST EDITED:  OCT 06, 1998
  • HELP-PROMPT:  Answer must be 1-10 characters in length.
  • DESCRIPTION:  
    This is a data element from a MEDICARE electronic remittance advice.
  • TECHNICAL DESCR:  
    This is the amount from the 835 data field (MIA-21)
5.031 REMARK CODE-3 SHORT TEXT RM3;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>190!($L(X)<1) X
  • LAST EDITED:  FEB 05, 1999
  • HELP-PROMPT:  Answer must be 1-190 characters in length.
  • DESCRIPTION:  
    This is the abbreviated text for remark code # 3, if available This applies to EITHER inpatient or outpatient remark codes from MEDICARE.
5.04 M-CARE INP PYMNT REMARK CODE-4 5;4 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>10!($L(X)<1) X
  • LAST EDITED:  OCT 06, 1998
  • HELP-PROMPT:  Answer must be 1-10 characters in length.
  • DESCRIPTION:  
    This is a data element from a MEDICARE electronic remittance advice.
  • TECHNICAL DESCR:  
    This is the amount from the 835 data field (MIA-22)
5.041 REMARK CODE-4 SHORT TEXT RM4;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>190!($L(X)<1) X
  • LAST EDITED:  FEB 05, 1999
  • HELP-PROMPT:  Answer must be 1-190 characters in length.
  • DESCRIPTION:  
    This is the abbreviated text for remark code # 4, if available This applies to EITHER inpatient or outpatient remark codes from MEDICARE.
5.05 M-CARE INP PYMNT REMARK CODE-5 5;5 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>10!($L(X)<1) X
  • LAST EDITED:  OCT 06, 1998
  • HELP-PROMPT:  Answer must be 1-10 characters in length.
  • DESCRIPTION:  
    This is a data element from a MEDICARE electronic remittance advice.
  • TECHNICAL DESCR:  
    This is the amount from the 835 data field (MIA-23)
5.051 REMARK CODE-5 SHORT TEXT RM5;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>190!($L(X)<1) X
  • LAST EDITED:  FEB 05, 1999
  • HELP-PROMPT:  Answer must be 1-190 characters in length.
  • DESCRIPTION:  
    This is the abbreviated text for remark code # 5, if available This applies to EITHER inpatient or outpatient remark codes from MEDICARE.
6.01 NEW PATIENT NAME 6;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<1) X
  • LAST EDITED:  FEB 08, 1999
  • HELP-PROMPT:  Answer must be 1-30 characters in length.
  • DESCRIPTION:  
    This is the 'new' patient name as reported on the electronic EOB.
6.02 NEW PATIENT ID 6;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<1) X
  • LAST EDITED:  FEB 08, 1999
  • HELP-PROMPT:  Answer must be 1-20 characters in length.
  • DESCRIPTION:  
    This is the 'new' patient ID as reported on the electronic EOB.
6.03 CORRECTED DATA MESSAGE 6;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>190!($L(X)<1) X
  • LAST EDITED:  JAN 16, 2008
  • HELP-PROMPT:  Answer must be 1-190 characters in length
  • DESCRIPTION:  This is a free text message describing the results of the processing of the "06" record type on the incoming 835 transmission. The "06" record type is where the payer can send back the corrected patient name and/or the
    corrected patient ID#. VistA will accept this information and attempt to the update the patient insurance files with this data.
7.01 TRANSFERRED IN 7;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>64!($L(X)<1) X
  • LAST EDITED:  JAN 13, 2003
  • HELP-PROMPT:  Answer must be 1-64 characters in length.
  • DESCRIPTION:  
    This is the site that this EOB was transferred into this site from.
  • RECORD INDEXES:  ATIN (#184)
8 AR AMOUNTS DISTRIBUTION 8;0 Multiple #361.18 361.18

  • DESCRIPTION:  
    This is the list of bills that AR has determined will apply to this ERA along with the amount that was paid/retracted.
10 835 CLAIM LEVEL ADJUSTMENTS 10;0 SET Multiple #361.11 361.11

  • LAST EDITED:  OCT 06, 1998
  • DESCRIPTION:  
    This is the list of claim level adjustments, including general category of adjustment, reason code, amount and quantity.
  • TECHNICAL DESCR:  
    This data is received from the EOB on the 835 data segment 'CAS' on a claim level basis.
15 835 LINE LEVEL ADJUSTMENTS 15;0 Multiple #361.115 361.115

  • DESCRIPTION:  
    This is the list of line level adjustments, including general category of adjustment, reason code, amount and quantity.
  • TECHNICAL DESCR:  
    This data is received from the EOB on the 835 data segment 'CAS' on a line level basis.
20 MESSAGE STORAGE ERRORS ERR;0 WORD-PROCESSING #361.12

  • LAST EDITED:  JUN 26, 2003
  • HELP-PROMPT:  Enter the text of the error message
  • DESCRIPTION:  
    This is the text of all the errors encountered for this EOB when attempting to load it from the EDI MESSAGES file.
21 REVIEW DATE/TIME 21;0 DATE Multiple #361.121 361.121

  • LAST EDITED:  AUG 25, 1999
25.01 PAYER CONTACT NAME 25;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<1) X
  • LAST EDITED:  MAR 24, 2003
  • HELP-PROMPT:  Answer must be 1-30 characters in length.
  • DESCRIPTION:  
    This is the name of the contact the payer has provided for questions concerning this particular claim's adjudication.
25.02 CONTACT NUMBER 1 25;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>60!($L(X)<1) X
  • LAST EDITED:  AUG 02, 2010
  • HELP-PROMPT:  Answer must be 1-60 characters in length.
  • DESCRIPTION:  
    This is a phone #/telephone extension or email address for the contact.
25.03 CONTACT TYPE 1 25;3 SET
  • 'EM' FOR E-MAIL;
  • 'FX' FOR FAX;
  • 'TE' FOR TELEPHONE;
  • 'EX' FOR TELEPHONE EXTENSION;

  • LAST EDITED:  MAR 24, 2003
  • HELP-PROMPT:  Enter the code for the type of contact information.
  • DESCRIPTION:  
    This is the code that describes the type of contact information provided in the CONTACT NUMBER 1 field.
25.04 CONTACT NUMBER 2 25;4 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>60!($L(X)<1) X
  • LAST EDITED:  AUG 02, 2010
  • HELP-PROMPT:  Answer must be 1-60 characters in length.
  • DESCRIPTION:  
    This is a phone #/telephone extension or email address for the contact.
25.05 CONTACT TYPE 2 25;5 SET
  • 'EM' FOR E-MAIL;
  • 'FX' FOR FAX;
  • 'TE' FOR TELEPHONE;
  • 'EX' FOR TELEPHONE EXTENSION;

  • LAST EDITED:  MAR 24, 2003
  • HELP-PROMPT:  Enter the code for the type of contact information.
  • DESCRIPTION:  
    This is the code that describes the type of contact information provided in the CONTACT NUMBER 2 field.
25.06 CONTACT NUMBER 3 25;6 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>60!($L(X)<1) X
  • LAST EDITED:  AUG 02, 2010
  • HELP-PROMPT:  Answer must be 1-60 characters in length.
  • DESCRIPTION:  
    This is a phone #/telephone extension or email address for the contact.
25.07 CONTACT TYPE 3 25;7 SET
  • 'EM' FOR E-MAIL;
  • 'FX' FOR FAX;
  • 'TE' FOR TELEPHONE;
  • 'EX' FOR TELEPHONE EXTENSION;

  • LAST EDITED:  MAR 24, 2003
  • HELP-PROMPT:  Enter the code for the type of contact information.
  • DESCRIPTION:  
    This is the code that describes the type of contact information provided in the CONTACT NUMBER 3 field.
30.01 AUTO BILL MESSAGE 30;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>200!($L(X)<2) X
  • LAST EDITED:  MAY 15, 2003
  • HELP-PROMPT:  Answer must be 2-200 characters in length
  • DESCRIPTION:  
    This field contains reason messages or error messages that describe why this EOB record was not automatically turned into a secondary or tertiary bill.
30.02 AUTO BILL MESSAGE DATE/TIME 30;2 DATE

  • INPUT TRANSFORM:  S %DT="ESTX" D ^%DT S X=Y K:X<1 X
  • LAST EDITED:  MAY 15, 2003
  • DESCRIPTION:  
    This is the date/time that the automatic bill generation failure message was filed.
61.01 ORIGINAL 06 RECORD DATA 6.1;E1,200 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>200!($L(X)<1) X
  • LAST EDITED:  JAN 17, 2008
  • HELP-PROMPT:  Answer must be 1-200 characters in length
  • DESCRIPTION:  
    This field contains the original "06" record type on the 835 transmission from Austin. It contains the corrected patient name and/or the corrected patient ID directly from the payer.
62.01 MAILMAN HEADER INFORMATION 6.2;E1,200 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>200!($L(X)<1) X
  • LAST EDITED:  JAN 17, 2008
  • HELP-PROMPT:  Answer must be 1-200 characters in length
  • DESCRIPTION:  
    This field contains MailMan header data which is returned from the MailMan utility $$NET^XMRENT.
100.01 BATCH NUMBER 100;1 POINTER TO EDI TRANSMISSION BATCH FILE (#364.1) EDI TRANSMISSION BATCH(#364.1)

  • LAST EDITED:  JUL 08, 1999
  • HELP-PROMPT:  Enter the batch number the bill was in when the EOB was received
  • DESCRIPTION:  
    This is the number of the batch the bill was in when the EOB message was received.
100.02 RETURN MESSAGE ID 100;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<1) X
  • LAST EDITED:  FEB 11, 1999
  • HELP-PROMPT:  Answer must be 1-20 characters in length.
  • DESCRIPTION:  
    This is the ID of the return message that this EOB was delivered in. It is used to ensure these EOB messages don't get added to this file more than once.
  • CROSS-REFERENCE:  361.1^AC
    1)= S ^IBM(361.1,"AC",$E(X,1,30),DA)=""
    2)= K ^IBM(361.1,"AC",$E(X,1,30),DA)
    3)= Please do not delete
    Used to assure messages only update this file once.
100.03 LAST EDITED BY 100;3 POINTER TO NEW PERSON FILE (#200) NEW PERSON(#200)

  • LAST EDITED:  MAY 28, 1999
  • HELP-PROMPT:  Enter the name of the person who last edited this EOB record.
  • DESCRIPTION:  
    This is the name of the person who last edited this EOB record.
  • NOTES:  TRIGGERED by the REVIEW STATUS field of the EXPLANATION OF BENEFITS File
100.04 LAST EDITED DATE 100;4 DATE

  • INPUT TRANSFORM:  S %DT="ETXR" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  MAY 28, 1999
  • HELP-PROMPT:  Enter the last date/time this EOB record was edited.
  • DESCRIPTION:  
    This is the last date/time this EOB record was edited.
  • NOTES:  TRIGGERED by the REVIEW STATUS field of the EXPLANATION OF BENEFITS File
100.05 MESSAGE CHECKSUM 100;5 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>10!($L(X)<1) X
  • LAST EDITED:  MAY 08, 2003
  • HELP-PROMPT:  Answer must be 1-10 characters in length.
  • DESCRIPTION:  This field contains the calculated checksum value of the X12 835 transaction data from the payer. It is a unique number which is mathematically generated based on the actual data in the 835 flat file received from Austin.
    This number will be used to identify and eliminate duplicate 835 transmissions into VistA.
  • TECHNICAL DESCR:  
    This field should not be set manually.
101 MOVE/COPY/REMOVE HISTORY 101;0 DATE Multiple #361.1101 361.1101

  • LAST EDITED:  JAN 23, 2014
  • DESCRIPTION:  
    This multiple contains a record for each time an EEOB is moved or copied. Removing an EEOB also creates a record in this multiple.
  • TECHNICAL DESCR:  
    Updated from EEOB Move/Copy/Remove option and Worklist Split/Edit Line protocol.
  • INDEXED BY:  DATE/TIME EEOB MOVED (AMCCF)
102 EEOB REMOVED 102;1 SET
  • '1' FOR REMOVED;

  • LAST EDITED:  MAY 06, 2014
  • HELP-PROMPT:  Enter 1 to indicate that the EEOB has been removed.
  • DESCRIPTION:  
    This field indicates that the ELECTRONIC EXPLANATION OF BENEFITS (EEOB) detail on the record has been filed against the wrong claim and should be ignored by all reporting options.
  • RECORD INDEXES:  AMCCF (#308)
103 PLB DUPLICATE 102;2 SET
  • '1' FOR DUPLICATE;

  • LAST EDITED:  APR 04, 2017
  • HELP-PROMPT:  Enter 1 if the EOB is a duplicate from an ERA with a PLB adjustment
  • DESCRIPTION:  
    This field indicates if the EOB is a potential duplicate. THe field is populated if an EOB on an incoming ERA has the same checksum as an existing EOB and the ERA has a Payer Level Balance (PLB) adjustment.
  • TECHNICAL DESCR:  
    This field is used to suppress secondary claim generation if a duplicate EOB is the result of an ERA with a Payer Level Balance (PLB) adjustment.
104 ERA DETAIL 102;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<4)!'(X?1N.N1","1N.N1",") X
    MAXIMUM LENGTH: 20
  • LAST EDITED:  FEB 06, 2019
  • HELP-PROMPT:  Enter the ERA detail reference in the form nn,nnnnn,
  • DESCRIPTION:  If the EOB was created from an electronic payment, the ERA DETAIL field will contain a reference to the ERA detail line from which it was created. The ERA DETAIL field will remain the same through moves and copies of the
    EOB providing a method of a linking the EOB back to the detail line that created it.
  • TECHNICAL DESCR:  This is a free text field linking EOB to the ERA detail line from which it was created. It has the form "IEN34441,IEN3444," where IEN34441 is the internal entry number from sub-file 344.41 and IEN3444 is the internal entry
    number from file 344.4. The field will be automatically populated by the system.

ICR, Total: 2

ICR LINK Subscribing Package(s) Fields Referenced Description
ICR #4051
  • Accounts Receivable
    		•  BILL (.01).
    Access: Direct Global Read & w/Fileman
    ICR #7017
  • Accounts Receivable
    		•  ERA DETAIL (104).
    Access: Direct Global Read & w/Fileman
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