| Parent File | Name | Number | Package | 
|---|---|---|---|
| BILL/CLAIMS(#399) | PROVIDER | 399.0222 | Integrated Billing | 
| Field # | Name | Loc | Type | Details | 
|---|---|---|---|---|
| .01 | FUNCTION | 0;1 | SET | ************************REQUIRED FIELD************************ 
 
  | 
| .02 | PERFORMED BY | 0;2 | VARIABLE POINTER | NEW PERSON(#200)  IB NON/OTHER VA BILLING PROVIDER(#355.93)  
  | 
| .03 | CREDENTIALS | 0;3 | FREE TEXT | 
  | 
| .04 | STATE | 0;4 | POINTER TO STATE FILE (#5) | STATE(#5)
  | 
| .05 | PRIMARY INS CO ID NUMBER | 0;5 | FREE TEXT | 
  | 
| .06 | SECONDARY INS CO ID NUMBER | 0;6 | FREE TEXT | 
  | 
| .07 | TERTIARY INS CO ID NUMBER | 0;7 | FREE TEXT | 
  | 
| .08 | SPECIALTY | 0;8 | FREE TEXT | 
  | 
| .09 | DELETE 2006 .09 | 0;9 | POINTER TO IB INS CO PROVIDER ID CARE UNIT FILE (#355.96) | ************************REQUIRED FIELD************************ IB INS CO PROVIDER ID CARE UNIT(#355.96)
  | 
| .1 | DELETE 2006 .1 | 0;10 | POINTER TO IB INS CO PROVIDER ID CARE UNIT FILE (#355.96) | ************************REQUIRED FIELD************************ IB INS CO PROVIDER ID CARE UNIT(#355.96)
  | 
| .11 | DELETE 2006 .11 | 0;11 | POINTER TO IB INS CO PROVIDER ID CARE UNIT FILE (#355.96) | ************************REQUIRED FIELD************************ IB INS CO PROVIDER ID CARE UNIT(#355.96)
  | 
| .12 | PRIM INS PROVIDER ID TYPE | 0;12 | POINTER TO IB PROVIDER ID # TYPE FILE (#355.97) | IB PROVIDER ID # TYPE(#355.97)
  | 
| .13 | SEC INS PROVIDER ID TYPE | 0;13 | POINTER TO IB PROVIDER ID # TYPE FILE (#355.97) | IB PROVIDER ID # TYPE(#355.97)
  | 
| .14 | TERT INS PROVIDER ID TYPE | 0;14 | POINTER TO IB PROVIDER ID # TYPE FILE (#355.97) | IB PROVIDER ID # TYPE(#355.97)
  | 
| .15 | TAXONOMY | 0;15 | POINTER TO PERSON CLASS FILE (#8932.1) | PERSON CLASS(#8932.1)
  | 
| 1.01 | DELETE 2006 1.01 | 1;1 | POINTER TO IB INS CO PROVIDER ID CARE UNIT FILE (#355.96) | IB INS CO PROVIDER ID CARE UNIT(#355.96)
  | 
| 1.02 | DELETE 2006 1.02 | 1;2 | POINTER TO IB INS CO PROVIDER ID CARE UNIT FILE (#355.96) | IB INS CO PROVIDER ID CARE UNIT(#355.96)
  | 
| 1.03 | DELETE 2006 1.03 | 1;3 | POINTER TO IB INS CO PROVIDER ID CARE UNIT FILE (#355.96) | IB INS CO PROVIDER ID CARE UNIT(#355.96)
  |