IBCE835 ;ALB/TMP/PJH - 835 EDI EXPLANATION OF BENEFITS MSG PROCESSING ; 7/15/10 4:40pm
Source file <IBCE835.m>
| action | A | extended action | Ea | event driver | Ed | subscriber | Su | protocol | O | limited protocol | LP | run routine | RR | broker | B | edit | E | server | Se | P | screenman | SM | inquire | I |
| Name | Comments | DBIA/ICR reference |
|---|---|---|
| HDR(IBCLNO,IBD) | ;Process header data
; INPUT: ; IBCLNO = claim # |
|
| 5(IBD) | ; Process claim patient ID data
; INPUT: ; IBD must be passed by reference = entire message line |
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| 6(IBD) | ; Process 06 record type for corrected name and/or ID# - IB*2*377 - 1/14/08
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| 10(IBD) | ; Process claim status data
; INPUT: ; IBD must be passed by reference = entire message line |
|
| 15(IBD) | ; Process claim status data
; INPUT: ; IBD must be passed by reference = entire message line |
|
| 20(IBD) | ; Process claim level adjustment data
; Claim must have been referenced by a previous '05' level |
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| 37(IBD) | ; Process claim level adjustment data for Inpatient MEDICARE
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| 40(IBD) | ; Process service line data
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| 45(IBD) | ; Process service line adjustment data
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| 11(IBD) | ; Process claim status rendering provider data segment
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| 12(IBD) | ; Process claim status corrected priority payer data segment
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| 13(IBD) | ; Process claim status other subscriber data segment
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| 17(IBD) | ; Process claim contact data segment
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| 30(IBD) | ; Process MEDICARE inpatient adjudication data (part 1)
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| 35(IBD) | ; Process MEDICARE inpatient adjudication data (part 2)
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| 41(IBD) | ; Process service line data (part 2)
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| 42(IBD) | ; Process service line data (part 3)
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| 46(IBD) | ; Process Adjustment Policy Reference segment
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| 99(IBD) | ; Process trailer record for non-MRA EOB
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| XX(IBD,IBID) | ; Store non-displayed data nodes in TMP array
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| GETHCT(IBCLNO) | ;
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| CHCT(IBCLNO) | ;
|
| Name | Line Occurrences (* Changed, ! Killed) |
|---|---|
| ^DGCR(399 - [#399] | HDR+35 |
| ^TMP("IBMSG" | HDR+32*, HDR+39*, HDR+41*, HDR+42*, 5+19, 5+23*, 5+25*, 5+26*, 6+8, 6+11* , 6+12*, 6+13*, 6+14*, 6+17*, 6+18*, 10+22, 10+36*, 10+37*, 10+38*, 15+20 , 15+22*, 15+23*, 20+20, 20+22*, 20+24*, 20+25*, 20+26*, XX+20*, XX+21*, GETHCT+1 , CHCT+2 |
| ^TMP("IBMSGH" | HDR+19 |
| Name | Line Occurrences |
|---|---|
| $$CHCT | 5+17, 6+5, 10+19, 15+17, 20+17 |
| $$GETHCT | 6+5, 10+19, 15+17, 20+17, XX+16 |
| HDR | 5+19, 6+8, 10+22, 15+20 |
| XX | 11+1, 12+1, 13+1, 17+1, 30+1, 35+1, 41+1, 42+1, 99+1 |
| Name | Field # of Occurrence |
|---|---|
| ^( | CHCT+2* |
| >> | Not killed explicitly |
| * | Changed |
| ! | Killed |
| ~ | Newed |
| Name | Field # of Occurrence |
|---|---|
| %DT | HDR+18~, HDR+22* |
| CT | HDR+18~, HDR+26*, HDR+28*, HDR+30, HDR+33, 10+14~, 10+24*, 10+27*, 10+29*, 10+32* , 10+34, 10+39 |
| IB399 | HDR+18~, HDR+35*, HDR+37 |
| IBBILL | HDR+18~, HDR+37*, HDR+39, 5+14~, 5+15*, 5+17*, 5+19, 5+23, 5+25, 5+26 |
| IBCLM | 6+1~, 6+2*, 6+3, 6+5, 6+6*, 6+8, 6+11, 6+12, 6+13, 6+14 , 6+17, 6+18, 10+14~, 10+15*, 10+16, 10+19, 10+20*, 10+22, 10+36, 10+37 , 10+38, 15+12~, 15+13*, 15+14, 15+17, 15+18*, 15+20, 15+22, 15+23, 20+13~ , 20+14*, 20+17, 20+18*, 20+20, 20+22, 20+24, 20+25, 20+26, XX+12~, XX+13* , XX+16, XX+17*, XX+20, XX+21 |
| IBCLNO | HDR~, HDR+32, HDR+35, HDR+39, HDR+41, HDR+42, GETHCT~, GETHCT+1, CHCT~, CHCT+2 |
| IBD | HDR~, 5~, 5+15, 5+19, 5+21, 5+23, 5+25, 5+26, 6~, 6+2 , 6+8, 6+11, 6+12, 6+13, 6+14, 6+17, 6+18, 10~, 10+15, 10+22 , 10+25, 10+29, 10+31, 10+32, 10+37, 10+38, 15~, 15+13, 15+20, 15+22 , 15+23, 20~, 20+14, 20+22, 20+24, 20+25, 20+26, 37~, 37+1, 40~ , 40+1, 45~, 45+1, 11~, 11+1, 12~, 12+1, 13~, 13+1, 17~ , 17+1, 30~, 30+1, 35~, 35+1, 41~, 41+1, 42~, 42+1, 46~ , 46+1, 99~, 99+1, XX~, XX+13, XX+20, XX+21 |
| IBD("DATE" | HDR+23*, HDR+39 |
| IBD("LINE" | HDR+19*, HDR+33*, 5+22*, 5+23, 6+10, 6+15*, 10+35, 10+39*, 20+21*, 20+22 , 20+23*, 20+24, 20+25, 20+26, XX+19*, XX+20, XX+21 |
| IBD("MRA" | HDR+24* |
| IBD("MSG#" | HDR+39 |
| IBD("SUBJ" | HDR+39 |
| IBD("X12" | HDR+25* |
| IBD0 | HDR+18~, HDR+19*, HDR+20, HDR+21, HDR+24, HDR+25, HDR+28, HDR+41, HDR+42 |
| IBDATA | 10+14~, 15+12~ |
| IBHCT | 5+14~, 5+17*, 6+1~, 6+5*, 6+6, 10+14~, 10+19*, 10+20, 15+12~, 15+17* , 15+18, 20+13~, 20+17*, 20+18, XX+16*, XX+17, CHCT+1~, CHCT+2*, CHCT+3 |
| IBID | XX~, XX+20, XX+21 |
| IBSTAT | 10+14~, 10+26*, 10+27, 10+28 |
| L | HDR+18~, HDR+31*, HDR+32*, 10+14~, 10+35*, 10+36* |
| LINE | HDR+18~, 10+14~ |
| LINE( | HDR+28*, HDR+32, 10+27*, 10+29*, 10+32*, 10+36 |
| U | HDR+21, HDR+24, HDR+25, HDR+28, HDR+39, 5+15, 5+21, 5+23, 6+2, 6+11 , 6+12, 6+13, 6+14, 10+15, 10+25, 10+27, 10+29, 10+31, 10+32, 15+13 , 20+14, 20+22, 20+24, XX+13 |
| X | HDR+18~, HDR+21*, HDR+22 |
| Y | HDR+18~, HDR+23 |
| Z | HDR+18~, HDR+31*, HDR+32*, 6+1~, 6+10*, 6+11*, 6+12*, 6+13*, 6+14*, 6+15 , 10+14~, 10+25*, 10+26, 10+35*, 10+36*, 15+12~ |
| Z0 | 10+14~, 15+12~ |