Parent File | Name | Number | Package |
---|---|---|---|
PATIENT(#2) | INSURANCE TYPE | 2.312 | Registration |
Field # | Name | Loc | Type | Details |
---|---|---|---|---|
.01 | INSURANCE TYPE | 0;1 | POINTER TO INSURANCE COMPANY FILE (#36) | INSURANCE COMPANY(#36)
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.18 | GROUP PLAN | 0;18 | POINTER TO GROUP INSURANCE PLAN FILE (#355.3) | GROUP INSURANCE PLAN(#355.3)
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.2 | COORDINATION OF BENEFITS | 0;20 | SET |
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1 | *SUBSCRIBER ID | 0;2 | FREE TEXT |
|
1.01 | DATE ENTERED | 1;1 | DATE |
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1.02 | ENTERED BY | 1;2 | POINTER TO NEW PERSON FILE (#200) | NEW PERSON(#200)
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1.03 | DATE LAST VERIFIED | 1;3 | DATE |
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1.04 | VERIFIED BY | 1;4 | POINTER TO NEW PERSON FILE (#200) | NEW PERSON(#200)
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1.05 | DATE LAST EDITED | 1;5 | DATE |
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1.06 | LAST EDITED BY | 1;6 | POINTER TO NEW PERSON FILE (#200) | NEW PERSON(#200)
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1.08 | *COMMENT - PATIENT POLICY | 1;8 | FREE TEXT |
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1.09 | SOURCE OF INFORMATION | 1;9 | POINTER TO SOURCE OF INFORMATION FILE (#355.12) | SOURCE OF INFORMATION(#355.12)
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1.1 | DATE OF SOURCE OF INFORMATION | 1;10 | DATE |
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1.18 | COMMENT - SUBSCRIBER POLICY | 13;0 | DATE Multiple #2.342 | 2.342
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2 | *GROUP NUMBER | 0;3 | FREE TEXT |
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2.01 | SEND BILL TO EMPLOYER | 2;1 | SET |
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2.015 | SUBSCRIBER'S EMPLOYER NAME | 2;9 | FREE TEXT |
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2.02 | EMPLOYER CLAIMS STREET ADDRESS | 2;2 | FREE TEXT |
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2.03 | EMPLOY CLAIM ST ADDRESS LINE 2 | 2;3 | FREE TEXT |
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2.04 | EMPLOY CLAIM ST ADDRESS LINE 3 | 2;4 | FREE TEXT |
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2.05 | EMPLOYER CLAIMS CITY | 2;5 | FREE TEXT |
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2.06 | EMPLOYER CLAIMS STATE | 2;6 | POINTER TO STATE FILE (#5) | STATE(#5)
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2.07 | EMPLOYER CLAIMS ZIP CODE | 2;7 | FREE TEXT |
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2.08 | EMPLOYER CLAIMS PHONE | 2;8 | FREE TEXT |
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2.1 | ESGHP | 2;10 | SET |
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2.11 | EMPLOYMENT STATUS | 2;11 | SET |
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2.12 | RETIREMENT DATE | 2;12 | DATE |
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3 | INSURANCE EXPIRATION DATE | 0;4 | DATE |
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3.01 | INSURED'S DOB | 3;1 | DATE |
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3.02 | INSURED'S BRANCH | 3;2 | POINTER TO BRANCH OF SERVICE FILE (#23) | BRANCH OF SERVICE(#23)
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3.03 | INSURED'S RANK | 3;3 | FREE TEXT |
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3.04 | STOP POLICY FROM BILLING | 3;4 | SET |
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3.05 | INSURED'S SSN | 3;5 | FREE TEXT |
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3.06 | INSURED'S STREET 1 | 3;6 | FREE TEXT |
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3.07 | INSURED'S STREET 2 | 3;7 | FREE TEXT |
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3.08 | INSURED'S CITY | 3;8 | FREE TEXT |
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3.09 | INSURED'S STATE | 3;9 | POINTER TO STATE FILE (#5) | STATE(#5)
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3.1 | INSURED'S ZIP | 3;10 | FREE TEXT |
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3.11 | INSURED'S PHONE | 3;11 | FREE TEXT |
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3.12 | INSURED'S SEX | 3;12 | SET |
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3.13 | INSURED'S COUNTRY | 3;13 | FREE TEXT |
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3.14 | INSURED'S COUNTRY SUBDIVISION | 3;14 | FREE TEXT |
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4.01 | PRIMARY CARE PROVIDER | 4;1 | FREE TEXT |
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4.02 | PRIMARY PROVIDER PHONE | 4;2 | FREE TEXT |
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4.03 | PT. RELATIONSHIP - HIPAA | 4;3 | SET | ************************REQUIRED FIELD************************
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4.04 | EIV AUTO-UPDATE | 4;4 | SET |
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4.05 | PHARMACY RELATIONSHIP CODE | 4;5 | POINTER TO BPS NCPDP PATIENT RELATIONSHIP CODE FILE (#9002313.19) | BPS NCPDP PATIENT RELATIONSHIP CODE(#9002313.19)
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4.06 | PHARMACY PERSON CODE | 4;6 | FREE TEXT |
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5.01 | PATIENT ID | 5;1 | FREE TEXT |
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5.02 | SUBSCRIBER'S SEC QUALIFIER(1) | 5;2 | SET |
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5.03 | SUBSCRIBER'S SEC ID(1) | 5;3 | FREE TEXT |
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5.04 | SUBSCRIBER'S SEC QUALIFIER(2) | 5;4 | SET |
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5.05 | SUBSCRIBER'S SEC ID(2) | 5;5 | FREE TEXT |
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5.06 | SUBSCRIBER'S SEC QUALIFIER(3) | 5;6 | SET |
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5.07 | SUBSCRIBER'S SEC ID(3) | 5;7 | FREE TEXT |
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5.08 | PATIENT'S SEC QUALIFIER(1) | 5;8 | SET |
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5.09 | PATIENT'S SECONDARY ID(1) | 5;9 | FREE TEXT |
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5.1 | PATIENT'S SEC QUALIFIER(2) | 5;10 | SET |
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5.11 | PATIENT'S SECONDARY ID(2) | 5;11 | FREE TEXT |
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5.12 | PATIENT'S SEC QUALIFIER(3) | 5;12 | SET |
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5.13 | PATIENT'S SECONDARY ID(3) | 5;13 | FREE TEXT |
|
6 | WHOSE INSURANCE | 0;6 | SET | ************************REQUIRED FIELD************************
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7.01 | NAME OF INSURED | 7;1 | FREE TEXT | ************************REQUIRED FIELD************************
|
7.02 | SUBSCRIBER ID | 7;2 | FREE TEXT |
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7.03 | SUBSCRIBER ID ROLLBACK | 7;3 | FREE TEXT |
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7.04 | PATIENT ID ROLLBACK | 7;4 | FREE TEXT |
|
8 | EFFECTIVE DATE OF POLICY | 0;8 | DATE |
|
8.01 | REQUESTED SERVICE DATE | 8;1 | DATE |
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8.02 | REQUESTED SERVICE TYPE | 8;2 | POINTER TO X12 271 SERVICE TYPE FILE (#365.013) | X12 271 SERVICE TYPE(#365.013)
|
8.03 | EB DISPLAY ENTRY | 8;3 | POINTER TO IIV RESPONSE FILE (#365) | IIV RESPONSE(#365)
|
9 | GROUP REFERENCE INFORMATION | 9;0 | Multiple #2.3129 | 2.3129
|
10 | GROUP PROVIDER INFO | 10;0 | Multiple #2.332 | 2.332
|
11 | HEALTH CARE CODE INFORMATION | 11;0 | Multiple #2.31211 | 2.31211
|
12.01 | MILITARY INFO STATUS CODE | 12;1 | POINTER TO X12 271 MILITARY PERSONNEL INFO STATUS CODE FILE (#365.039) | X12 271 MILITARY PERSONNEL INFO STATUS CODE(#365.039)
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12.02 | MILITARY EMPLOYMENT STATUS | 12;2 | POINTER TO X12 271 MILITARY EMPLOYMENT STATUS CODE FILE (#365.046) | X12 271 MILITARY EMPLOYMENT STATUS CODE(#365.046)
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12.03 | MILITARY GOVT AFFILIATION CODE | 12;3 | POINTER TO X12 271 MILITARY GOVT SERVICE AFFILIATION FILE (#365.041) | X12 271 MILITARY GOVT SERVICE AFFILIATION(#365.041)
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12.04 | MILITARY PERSONNEL DESCRIPTION | 12;4 | FREE TEXT |
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12.05 | MILITARY SERVICE RANK CODE | 12;5 | POINTER TO X12 271 MILITARY SERVICE RANK FILE (#365.042) | X12 271 MILITARY SERVICE RANK(#365.042)
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12.06 | DATE TIME PERIOD FORMAT QUAL | 12;6 | POINTER TO X12 271 DATE FORMAT QUALIFIER FILE (#365.032) | X12 271 DATE FORMAT QUALIFIER(#365.032)
|
12.07 | DATE TIME PERIOD | 12;7 | FREE TEXT |
|
15 | *GROUP NAME | 0;15 | FREE TEXT |
|
16 | PT. RELATIONSHIP TO INSURED | 0;16 | SET | ************************REQUIRED FIELD************************
|
17 | *NAME OF INSURED | 0;17 | FREE TEXT | ************************REQUIRED FIELD************************
|
20 | NEW GROUP NAME | COMPUTED |
|
|
21 | NEW GROUP NUMBER | COMPUTED |
|
|
60 | ELIGIBILITY/BENEFIT | 6;0 | Multiple #2.322 | 2.322
|