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Sub-Field: 368.0121

Package: Integrated Billing

HEALTH CARE CLAIM RFAI (277)(#368)-->368.0121

Sub-Field: 368.0121


Information

Parent File Name Number Package
HEALTH CARE CLAIM RFAI (277)(#368) STC-SVC LINE STAT INFO SEQ [D] 368.0121 Integrated Billing

Details

Field # Name Loc Type Details
.01 STC-SVC LINE STAT INFO SEQ [D] 0;1 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>9999999999)!(X<1)!(X?.E1"."1.N) X
  • LAST EDITED:  DEC 01, 2015
  • HELP-PROMPT:  Type a number between 1 and 9999999999, 0 decimal digits.
  • DESCRIPTION:  
    This field will contain the STC-SVC Line Status Information Seq field received from the FSC ASC X12N health Care Claim Request For Additional Information (277) HL7 message.
  • CROSS-REFERENCE:  368.0121^B
    1)= S ^IBA(368,DA(1),121,"B",$E(X,1,30),DA)=""
    2)= K ^IBA(368,DA(1),121,"B",$E(X,1,30),DA)
.02 PRODUCT/SERVICE ID QUAL [D] 0;2 POINTER TO X12 277 PRODUCT OR SERVICE ID QUAL FILE (#368.002) X12 277 PRODUCT OR SERVICE ID QUAL(#368.002)

  • LAST EDITED:  DEC 01, 2015
  • HELP-PROMPT:  Answer must be one of the existing entries.
  • DESCRIPTION:  
    This field is derived from the PRODUCT/SERVICE ID QUALIFIER field (#.02) within the STC-SVC LINE STAT INFO SEQ multiple field (#21).
.03 SERVICE IDENTIFICATION CODE 0;3 VARIABLE POINTER REVENUE CODE(#399.2)  CPT(#81)  NDC/UPN(#50.67)  

  • LAST EDITED:  DEC 01, 2015
  • HELP-PROMPT:  Answer must be one of the existing entries.
  • DESCRIPTION:  
    This field is derived from the SERVICE IDENTIFICATION CODE field (#.03) within the STC-SVC LINE STAT INFO SEQ multiple field (#21).
.04 PROCEDURE MODIFIER 1 [D] 0;4 POINTER TO CPT MODIFIER FILE (#81.3) CPT MODIFIER(#81.3)

  • LAST EDITED:  DEC 01, 2015
  • HELP-PROMPT:  Answer must be one of the existing entries.
  • DESCRIPTION:  
    This field is derived from the PROCEDURE MODIFIER 1 field (#.04) within the STC-SVC LINE STAT INFO SEQ multiple field (#21).
.05 PROCEDURE MODIFIER 2 [D] 0;5 POINTER TO CPT MODIFIER FILE (#81.3) CPT MODIFIER(#81.3)

  • LAST EDITED:  DEC 01, 2015
  • HELP-PROMPT:  Answer must be one of the existing entries.
  • DESCRIPTION:  
    This field is derived from the PROCEDURE MODIFIER 2 field (#.05) within the STC-SVC LINE STAT INFO SEQ multiple field (#21).
.06 PROCEDURE MODIFIER 3 [D] 0;6 POINTER TO CPT MODIFIER FILE (#81.3) CPT MODIFIER(#81.3)

  • LAST EDITED:  DEC 01, 2015
  • HELP-PROMPT:  Answer must be one of the existing entries.
  • DESCRIPTION:  
    This field is derived from the PROCEDURE MODIFIER 3 field (#.06) within the STC-SVC LINE STAT INFO SEQ multiple field (#21).
.07 PROCEDURE MODIFIER 4 [D] 0;7 POINTER TO CPT MODIFIER FILE (#81.3) CPT MODIFIER(#81.3)

  • LAST EDITED:  DEC 01, 2015
  • HELP-PROMPT:  Answer must be one of the existing entries.
  • DESCRIPTION:  
    This field is derived from the PROCEDURE MODIFIER 4 field (#.07) within the STC-SVC LINE STAT INFO SEQ multiple field (#21).
.08 LINE ITEM CHARGE AMOUNT [D] 0;8 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>999999999999999)!(X<0)!(X?.E1"."3.N) X
  • LAST EDITED:  NOV 12, 2015
  • HELP-PROMPT:  Type a dollar amount between 0 and 999999999999999, 2 decimal digits.
  • DESCRIPTION:  
    This field is derived from the LINE ITEM CHARGE AMOUT field (#.08) within the STC-SVC LINE STAT INFO SEQ multiple field (#21).
.09 REVENUE CODE 0;9 POINTER TO REVENUE CODE FILE (#399.2) REVENUE CODE(#399.2)

  • LAST EDITED:  DEC 01, 2015
  • HELP-PROMPT:  Answer must be one of the existing entries.
  • DESCRIPTION:  
    This field is derived from the REVENUE CODE field (#.09) within the STC-SVC LINE STAT INFO SEQ multiple field (#21).
.11 SERVICE LINE DATE 0;11 DATE

  • INPUT TRANSFORM:  S %DT="ESTX" D ^%DT S X=Y K:X<1 X
  • LAST EDITED:  DEC 01, 2015
  • HELP-PROMPT:  Enter the Service Line Date.
  • DESCRIPTION:  
    This field is derived from the SERVICE LINE DATE field (#.11) within the STC-SVC LINE STAT INFO SEQ multiple field (#21).
99 STC SEQ-SERVICE LINE [D] 99;0 Multiple #368.12199 368.12199

  • DESCRIPTION:  
    This field will contain the SEQ-Service Line field received from the FSC ASC X12N health Care Claim Request For Additional Information (277) HL7 message.
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