Sub-Field: 355.14

Parent File	Name	Number	Package
TYPE OF PLAN(#355.1)	EFFECTIVE DATE	355.14	Integrated Billing

Details

Field # Name Loc Type Details

Field #	Name	Loc	Type	Details
.01	EFFECTIVE DATE	0;1	DATE	INPUT TRANSFORM: `S %DT="EX" D ^%DT S X=Y K:Y<1 X` LAST EDITED: `MAY 10, 2011` HELP-PROMPT: `Enter the date the Type Of Plan Percentages paid became effective.` DESCRIPTION: `This is the date on which the coverage amounts paid by a supplemental Type of Plan go into effect. The percentages paid are stored by Date, Group Code and Reason Code. When these percentages change, a new effective` `date should be entered along with each Group and Reason Code for which this plan pays. If there is no effective date entry or the effective date is AFTER the claim service From date, the secondary balance due will be` `calculated as 100% of Patient Responsibility as indicated on the Medicare-equivalent Remittance Advice (MRA).` `UNEDITABLE` CROSS-REFERENCE: `355.14^B` `1)= S ^IBE(355.1,DA(1),14,"B",$E(X,1,30),DA)=""` `2)= K ^IBE(355.1,DA(1),14,"B",$E(X,1,30),DA)`
1	GROUP CODE	1;0	SET Multiple #355.141	355.141 DESCRIPTION: `These are the group code(s) for which this type of plan pays all or a percentage of the adjustments made to the original claim by the payer during adjudication. For example, if there is an entry for Group Code CO, this` `plan pays all or part of Excess Charges.` TECHNICAL DESCR: `If the claim's Type of Plan entry has an effective date on or before the claim service From date, the balance due for the secondary claim will be based on the patient responsibility multiplied by any percentages stored` `in the effective date multiple, plus excess charges if the Group Code CO is contained within this multiple. Claim Service From Date is: File #399 Field #151 FIELD NAME: STATEMENT COVERS FROM Global Location:U;1`

.01

EFFECTIVE DATE

0;1

DATE

INPUT TRANSFORM: S %DT="EX" D ^%DT S X=Y K:Y<1 X
LAST EDITED: MAY 10, 2011
HELP-PROMPT: Enter the date the Type Of Plan Percentages paid became effective.
DESCRIPTION: This is the date on which the coverage amounts paid by a supplemental Type of Plan go into effect. The percentages paid are stored by Date, Group Code and Reason Code. When these percentages change, a new effective
date should be entered along with each Group and Reason Code for which this plan pays. If there is no effective date entry or the effective date is AFTER the claim service From date, the secondary balance due will be
calculated as 100% of Patient Responsibility as indicated on the Medicare-equivalent Remittance Advice (MRA).
UNEDITABLE
CROSS-REFERENCE: 355.14^B
1)= S ^IBE(355.1,DA(1),14,"B",$E(X,1,30),DA)=""
2)= K ^IBE(355.1,DA(1),14,"B",$E(X,1,30),DA)

GROUP CODE

1;0

SET Multiple #355.141

355.141

DESCRIPTION: These are the group code(s) for which this type of plan pays all or a percentage of the adjustments made to the original claim by the payer during adjudication. For example, if there is an entry for Group Code CO, this
plan pays all or part of Excess Charges.
TECHNICAL DESCR: If the claim's Type of Plan entry has an effective date on or before the claim service From date, the balance due for the secondary claim will be based on the patient responsibility multiplied by any percentages stored
in the effective date multiple, plus excess charges if the Group Code CO is contained within this multiple. Claim Service From Date is: File #399 Field #151 FIELD NAME: STATEMENT COVERS FROM Global Location:U;1

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Package: Integrated Billing

TYPE OF PLAN(#355.1)-->355.14

Sub-Field: 355.14

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