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Sub-Field: 355.141

Package: Integrated Billing

TYPE OF PLAN(#355.1)-->355.14-->355.141

Sub-Field: 355.141


Information

Parent File Name Number Package
355.14 GROUP CODE 355.141 Integrated Billing

Details

Field # Name Loc Type Details
.01 GROUP CODE 0;1 SET
************************REQUIRED FIELD************************
  • 'CO' FOR Contractual Obligations;
  • 'CR' FOR Corrections and Reversals;
  • 'OA' FOR Other Adjustments;
  • 'PI' FOR Payor Initiated Reductions;
  • 'PR' FOR Patient Responsibility;
  • 'MM' FOR Medicare Message;

  • LAST EDITED:  MAY 12, 2011
  • HELP-PROMPT:  Enter a valid group code covered by this type of plan.
  • DESCRIPTION:  This is the group code 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.
    UNEDITABLE
  • CROSS-REFERENCE:  355.141^B
    1)= S ^IBE(355.1,DA(2),14,DA(1),1,"B",$E(X,1,30),DA)=""
    2)= K ^IBE(355.1,DA(2),14,DA(1),1,"B",$E(X,1,30),DA)
1 REASON CODE 1;0 Multiple #355.1411 355.1411

  • DESCRIPTION:  This multiple stores the Reason Code(s) for which, when associated with the correct Group Code, 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 of Reason Code 1 with the Group Code of PR, then this plan pays all or a percentage of the Patient's Deductable as indicated on the Medicare-equivalent Remittance Advice (MRA).
  • 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 and is associated with the correct Reason Code.
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