Parent File | Name | Number | Package |
---|---|---|---|
HCS REVIEW TRANSMISSION(#356.22) | PATIENT EVENT PROVIDER | 356.2213 | Integrated Billing |
Field # | Name | Loc | Type | Details |
---|---|---|---|---|
.01 | PROVIDER TYPE | 0;1 | POINTER TO X12 271 ENTITY IDENTIFIER CODE FILE (#365.022) | X12 271 ENTITY IDENTIFIER CODE(#365.022)
|
.02 | PERSON / NON-PERSON | 0;2 | SET |
|
.03 | PROVIDER | 0;3 | VARIABLE POINTER | NEW PERSON(#200) IB NON/OTHER VA BILLING PROVIDER(#355.93) INSTITUTION(#4)
|
.04 | PER LOOP IDENTIFIER | 0;4 | POINTER TO X12 271 LOOP ID FILE (#365.027) | X12 271 LOOP ID(#365.027)
|
.05 | CONTACT FUNCTION CODE | 0;5 | FREE TEXT |
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.06 | CONTACT NAME | 0;6 | FREE TEXT |
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.07 | COMMUNICATION NO. QUALIFIER-1 | 0;7 | POINTER TO X12 271 CONTACT QUALIFIER FILE (#365.021) | X12 271 CONTACT QUALIFIER(#365.021)
|
.08 | COMMUNICATION NO. QUALIFIER-2 | 0;8 | POINTER TO X12 271 CONTACT QUALIFIER FILE (#365.021) | X12 271 CONTACT QUALIFIER(#365.021)
|
.09 | COMMUNICATION NO. QUALIFIER-3 | 0;9 | POINTER TO X12 271 CONTACT QUALIFIER FILE (#365.021) | X12 271 CONTACT QUALIFIER(#365.021)
|
1 | CONTACT COMMUNICATION NUMBER-1 | 1;1 | FREE TEXT |
|
2 | CONTACT COMMUNICATION NUMBER-2 | 2;1 | FREE TEXT |
|
3 | CONTACT COMMUNICATION NUMBER-3 | 3;1 | FREE TEXT |
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4.01 | NM1 LOOP IDENTIFIER | 4;1 | POINTER TO X12 271 LOOP ID FILE (#365.027) | X12 271 LOOP ID(#365.027)
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4.02 | ENTITY IDENTIFIER CODE | 4;2 | POINTER TO X12 271 ENTITY IDENTIFIER CODE FILE (#365.022) | X12 271 ENTITY IDENTIFIER CODE(#365.022)
|
4.03 | ENTITY TYPE QUALIFIER | 4;3 | SET |
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4.04 | CONTACT LAST OR COMPANY NAME | 4;4 | FREE TEXT |
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4.05 | CONTACT FIRST NAME | 4;5 | FREE TEXT |
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4.06 | CONTACT MIDDLE NAME | 4;6 | FREE TEXT |
|
4.07 | CONTACT NAME SUFFIX | 4;7 | FREE TEXT |
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4.08 | IDENTIFICATION CODE QUALIFIER | 4;8 | POINTER TO X12 271 IDENTIFICATION QUALIFIER FILE (#365.023) | X12 271 IDENTIFICATION QUALIFIER(#365.023)
|
4.09 | IDENTIFICATION CODE | 4;9 | FREE TEXT |
|
5 | CONTACT ADDRESS LINE-1 | 5;1 | FREE TEXT |
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5.01 | CONTACT ADDRESS LINE-2 | 5;2 | FREE TEXT |
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5.02 | CONTACT CITY NAME | 5;3 | FREE TEXT |
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5.03 | CONTACT STATE OR PROVINCE | 5;4 | POINTER TO STATE FILE (#5) | STATE(#5)
|
5.04 | CONTACT ZIP CODE | 5;5 | FREE TEXT |
|
5.05 | CONTACT COUNTRY CODE | 5;6 | POINTER TO COUNTRY CODE FILE (#779.004) | COUNTRY CODE(#779.004)
|
5.06 | CONTACT COUNTRY SUBDIVISION | 5;7 | FREE TEXT |
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