
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 |