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Sub-Field: 355.14

Package: Integrated Billing

TYPE OF PLAN(#355.1)-->355.14

Sub-Field: 355.14


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


Field # Name Loc Type Details

  • 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).
  • 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
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