File INSURANCE_COMPANY(36) Data List

NAME INACTIVE ALLOW MULTIPLE BEDSECTIONS DIFFERENT REVENUE CODES TO USE ONE OPT. VISIT ON BILL ONLY AMBULATORY SURG. REV. CODE ATTENDING PHYSICIAN ID. *HOSPITAL PROVIDER NUMBER STREET ADDRESS [LINE 1] STREET ADDRESS [LINE 2] STREET ADDRESS [LINE 3] CITY STATE ZIP CODE BILLING COMPANY NAME FAX NUMBER FILING TIME FRAME CLAIMS (INPT) STREET ADDRESS 1 CLAIMS (INPT) STREET ADDRESS 2 CLAIMS (INPT) STREET ADDRESS 3 CLAIMS (INPT) PROCESS CITY CLAIMS (INPT) PROCESS STATE CLAIMS (INPT) PROCESS ZIP CLAIMS (INPT) COMPANY NAME ANOTHER CO. PROCESS IP CLAIMS? CLAIMS (INPT) FAX TYPE OF COVERAGE PHONE NUMBER CLAIMS (RX) PHONE NUMBER BILLING PHONE NUMBER PRECERTIFICATION PHONE NUMBER PRECERTIFICATION PORTAL VERIFICATION PHONE NUMBER CLAIMS (INPT) PHONE NUMBER CLAIMS (OPT) PHONE NUMBER APPEALS PHONE NUMBER INQUIRY PHONE NUMBER PRECERT COMPANY NAME APPEALS ADDRESS ST. [LINE 1] APPEALS ADDRESS ST. [LINE 2] APPEALS ADDRESS ST. [LINE 3] APPEALS ADDRESS CITY APPEALS ADDRESS STATE APPEALS ADDRESS ZIP APPEALS COMPANY NAME ANOTHER CO. PROCESS APPEALS? APPEALS FAX PRESCRIPTION REFILL REV. CODE INQUIRY ADDRESS ST. [LINE 1] INQUIRY ADDRESS ST. [LINE 2] INQUIRY ADDRESS ST. [LINE 3] INQUIRY ADDRESS CITY INQUIRY ADDRESS STATE INQUIRY ADDRESS ZIP CODE INQUIRY COMPANY NAME ANOTHER CO. PROCESS INQUIRIES? INQUIRY FAX REPOINT PATIENTS TO CLAIMS (OPT) STREET ADDRESS 1 CLAIMS (OPT) STREET ADDRESS 2 CLAIMS (OPT) STREET ADDRESS 3 CLAIMS (OPT) PROCESS CITY CLAIMS (OPT) PROCESS STATE CLAIMS (OPT) PROCESS ZIP CLAIMS (OPT) COMPANY NAME ANOTHER CO. PROCESS OP CLAIMS? CLAIMS (OPT) FAX PROFESSIONAL PROVIDER NUMBER ANOTHER CO. PROCESS PRECERTS? STANDARD FTF CLAIMS (RX) STREET ADDRESS 1 CLAIMS (RX) STREET ADDRESS 2 CLAIMS (RX) STREET ADDRESS 3 CLAIMS (RX) CITY CLAIMS (RX) STATE CLAIMS (RX) ZIP CLAIMS (RX) COMPANY NAME ANOTHER CO. PROCESS RX CLAIMS? CLAIMS (RX) FAX STANDARD FTF VALUE CLAIMS (DENTAL) STREET ADDR 1 CLAIMS (DENTAL) PHONE NUMBER CLAIMS (DENTAL) STREET ADDR 2 BLANK CLAIMS (DENTAL) PROCESS CITY CLAIMS (DENTAL) PROCESS STATE CLAIMS (DENTAL) PROCESS ZIP CLAIMS (DENTAL) COMPANY NAME ANOTHER CO. PROC DENT CLAIMS? CLAIMS (DENTAL) FAX REIMBURSE? SYNONYM REMARKS PLAN TYPES NO BILL PRV SEC ID ALTERNATE INST PAYER ID TYPE ALTERNATE PROF PAYER ID TYPE 277EDI ID NUMBER SIGNATURE REQUIRED ON BILL? TRANSMIT ELECTRONICALLY EDI ID NUMBER - PROF BIN NUMBER EDI ID NUMBER - INST LAST EXTRACT DATE FOR TEST MAX NUMBER TEST BILLS PER DAY NUMBER TEST BILLS FOR LAST DT ELECTRONIC INSURANCE TYPE PAYER INS COMPANY LINK TYPE INS COMPANY LINK PARENT EDI ID NUMBER - DENTAL PERF PROV SECOND ID TYPE 1500 PERF PROV SECOND ID TYPE UB SECONDARY ID REQUIREMENTS REF PROV SEC ID DEF CMS-1500 REF PROV SEC ID REQ ON CLAIMS ATT/REND ID BILL SEC ID PROF *SEND LAB OR FAC IDS FOR VAMC ATT/REND ID BILL SEC ID INST PERF PROV CARE UNIT PROMPT DELETE 2006 4.1 *USE VAMC AS BILL PROV ON 1500 *USE VAMC AS BILL PROV ON UB04 *USE BILL PROV VAMC ADDRESS SCHEDULED FOR DELETION REPOINT DELETED COMPANY TO EDI INST SECONDARY ID QUAL(1) EDI INST SECONDARY ID(1) EDI INST SECONDARY ID QUAL(2) EDI INST SECONDARY ID(2) EDI PROF SECONDARY ID QUAL(1) EDI PROF SECONDARY ID(1) EDI PROF SECONDARY ID QUAL(2) EDI PROF SECONDARY ID(2) PRINT SEC/TERT AUTO CLAIMS? PRINT SEC MED CLAIMS W/O MRA? EDI - UMO (278) ID HPID/OEID CHP/SHP PARENT CHP (HPID) NIF ID