File BILL_CLAIMS(399) Data List
| BILL NUMBER |
PATIENT NAME |
EVENT DATE |
LOCATION OF CARE |
BILL CLASSIFICATION |
TIMEFRAME OF BILL |
RATE TYPE |
PTF ENTRY NUMBER |
PROCEDURE CODING METHOD |
WHO'S RESPONSIBLE FOR BILL? |
STATUS |
STATUS DATE |
BILL COPIED FROM |
NON-VA DISCHARGE DATE |
PRIMARY BILL |
SC AT TIME OF CARE |
FORM TYPE |
AUTO |
CURRENT BILL PAYER SEQUENCE |
DEFAULT DIVISION |
UB-04 LOCATION OF CARE |
UB-04 BILL CLASSIFICATION |
UB-04 TIMEFRAME OF BILL |
BILL CHARGE TYPE |
INITIAL DATE OF SERVICE |
DATE ENTERED |
AUTHORIZATION DATE |
PRIMARY INSURANCE CARRIER |
SECONDARY INSURANCE CARRIER |
TERTIARY INSURANCE CARRIER |
MAILING ADDRESS NAME |
MAILING ADDRESS STREET |
MAILING ADDRESS STREET2 |
MAILING ADDRESS CITY |
MAILING ADDRESS STATE |
MAILING ADDRESS ZIP CODE |
AUTHORIZER |
*PATIENT SHORT MAILING ADDRESS |
RESPONSIBLE INSTITUTION |
PRIMARY INSURANCE POLICY |
SECONDARY INSURANCE POLICY |
TERTIARY INSURANCE POLICY |
DATE FIRST PRINTED |
MAILING ADDRESS STREET3 |
PRIMARY PROVIDER # |
SECONDARY PROVIDER # |
TERTIARY PROVIDER # |
PRIMARY BILL # |
SECONDARY BILL # |
TERTIARY BILL # |
PRIMARY ID QUALIFIER |
SECONDARY ID QUALIFIER |
FIRST PRINTED BY |
TERTIARY ID QUALIFIER |
BILL PAYER CARRIER |
BILL PAYER POLICY |
DATE LAST PRINTED |
PRIMARY PAYER-ALT ID TYPE |
PRIMARY PAYER-ALT ID |
SECONDARY PAYER-ALT ID TYPE |
SECONDARY PAYER-ALT ID |
TERTIARY PAYER-ALT ID TYPE |
TERTIARY PAYER-ALT ID |
LAST PRINTED BY |
STATEMENT COVERS FROM |
STATEMENT COVERS TO |
POWER OF ATTORNEY COMPLETED? |
WHOSE EMPLOYMENT INFO.? |
IS THIS A SENSITIVE RECORD? |
ASSIGNMENT OF BENEFITS |
R.O.I. FORM(S) COMPLETED? |
TYPE OF ADMISSION |
SOURCE OF ADMISSION |
NON-PTF ADMISSION HOUR |
CANCEL BILL? |
ACCIDENT HOUR |
DISCHARGE BEDSECTION |
DISCHARGE STATUS |
TREATMENT AUTHORIZATION CODE |
BC/BS PROVIDER # |
LENGTH OF STAY |
UNABLE TO WORK FROM |
UNABLE TO WORK TO |
*PLACE OF SERVICE |
*TYPE OF SERVICE |
DATE BILL CANCELLED |
PPS |
BILL CANCELLED BY |
REASON CANCELLED |
ENTERED/EDITED BY |
LAST AUSTIN CONFIRM DATE |
TOTAL CHARGES |
OFFSET AMOUNT |
OFFSET DESCRIPTION |
*UB82 FORM LOCATOR 2 |
*FORM LOCATOR 9 |
*FORM LOCATOR 27 |
*FORM LOCATOR 45 |
*BILL COMMENT |
*FISCAL YEAR 1 |
LAST ELECTRONIC EXTRACT DATE |
*FY 1 CHARGES |
*FISCAL YEAR 2 |
*FY 2 CHARGES |
*FORM LOCATOR 92 |
*FORM LOCATOR 93 |
ADMITTING DIAGNOSIS |
COVERED DAYS |
NON-COVERED DAYS |
PRIMARY PRIOR PAYMENT |
SECONDARY PRIOR PAYMENT |
MRA RECORDED DATE |
TERTIARY PRIOR PAYMENT |
CO-INSURANCE DAYS |
PROVIDER |
IS DUPLICATE? |
SECONDARY AUTHORIZATION CODE |
TERTIARY AUTHORIZATION CODE |
NON-VA FACILITY |
NON-VA CARE TYPE |
NON-VA CARE ID # |
LAB CLIA NUMBER |
HOMEBOUND |
DATE LAST SEEN |
SPECIAL PROGRAM INDICATOR |
PRIMARY EMC ID CARE UNIT |
CLAIM MRA STATUS |
SECONDARY EMC ID CARE UNIT |
TERTIARY EMC ID CARE UNIT |
MAMMOGRAPHY CERT NUMBER |
SERVICE FACILITY TAXONOMY |
NON-VA FACILITY TAXONOMY |
LAST XRAY DATE |
DATE OF INITIAL TREATMENT |
DATE OF ACUTE MANIFESTATION |
PATIENT CONDITION CODE |
PRV DIAGNOSIS (1) |
REQUEST AN MRA? |
PRV DIAGNOSIS (2) |
PRV DIAGNOSIS (3) |
BILLING PROVIDER TAXONOMY |
PRIMARY REFERRAL NUMBER |
SECONDARY REFERRAL NUMBER |
TERTIARY REFERRAL NUMBER |
PRINTED VIA EDI? |
COB TOTAL NON-COVERED AMOUNT |
PROPERTY/CASUALTY CLAIM NUMBER |
PROP/CAS DATE OF 1ST CONTACT |
DISABILITY START DATE |
DISABILITY END DATE |
PRIMARY SURGICAL PROC CODE |
SECONDARY SURGICAL PROC CODE |
PROPERTY/CASUALTY CONTACT NAME |
PROP/CAS COMMUNICATION NUMBER |
PROP/CAS EXTENSION NUMBER |
FORCE CLAIM TO PRINT |
AMBULANCE P/U ADDRESS 1 |
AMBULANCE P/U ADDRESS 2 |
AMBULANCE P/U CITY |
AMBULANCE P/U STATE |
AMBULANCE P/U ZIP |
AMBULANCE D/O LOCATION |
AMBULANCE D/O ADDRESS 1 |
AMBULANCE D/O ADDRESS 2 |
AMBULANCE D/O CITY |
FORCE PRINT MRA SECONDARY |
MRA REVIEW STATUS |
AMBULANCE D/O STATE |
AMBULANCE D/O ZIP |
ASSUMED CARE DATE |
RELINQUISHED CARE DATE |
ATTACHMENT CONTROL NUMBER |
ATTACHMENT REPORT TYPE |
ATTACHMENT REPORT TRANS CODE |
PATIENT WEIGHT (LB) |
TRANSPORT REASON CODE |
AMBULANCE TRANSPORT DISTANCE |
BILL CLONED TO |
ROUND TRIP PURPOSE DESCRIPTION |
STRETCHER PURPOSE DESCRIPTION |
AMBULANCE CONDITION INDICATOR |
INITIAL REVIEW |
BILL CLONED FROM |
PRIMARY NODE |
SECONDARY NODE |
TERTIARY NODE |
PROCEDURES |
DATE BILL CLONED |
BILL CLONED BY |
REASON CLONED |
AUTO PROCESSED FROM CLAIM |
AUTO PROCESS |
AUTO PROCESS REASON |
REMOVED FROM WORKLIST BY |
ON TAS PCR? |
PRIMARY NODE 7 |
SECONDARY NODE 7 |
TERTIARY NODE 7 |
REMOVED FROM WORKLIST HOW |
REMOVED FROM WORKLIST DATE |
INITIAL REVIEW DATE |
CONDITION CODE |
BLOCK 31 |
BILL REMARKS |
OCCURRENCE CODE |
REVENUE CODE |
OP VISITS DATE(S) |
REASON(S) DISAPPROVED-INITIAL |
REASON(S) DISAPPROVED-SECOND |
FORM LOCATOR 64A |
FORM LOCATOR 64B |
FORM LOCATOR 64C |
*FORM LOCATOR 57 |
*FORM LOCATOR 78 |
FORM LOC 19-UNSPECIFIED DATA |
RETURNED LOG DATE/TIME |
ECME NUMBER |
ECME APPROVAL |
VALUE CODE |
PRIMARY INSURANCE HPID |
SECONDARY INSURANCE HPID |
TERTIARY INSURANCE HPID |
PRIMARY HPID EDIT DATE/TIME |
PRIMARY HPID CHANGES MADE BY |
SECONDARY HPID EDIT DATE/TIME |
SECONDARY HPID CHANGES MADE BY |
TERTIARY HPID EDIT DATE/TIME |
TERTIARY HPID CHANGES MADE BY |
OTHER CARE |
INITIAL REVIEWER |
*CPT PROCEDURE CODE (1) |
*CPT PROCEDURE CODE (2) |
*CPT PROCEDURE CODE (3) |
*ICD PROCEDURE CODE (1) |
*ICD PROCEDURE CODE (2) |
*ICD PROCEDURE CODE (3) |
*HCFA PROCEDURE CODE (1) |
*HCFA PROCEDURE CODE (2) |
*HCFA PROCEDURE CODE (3) |
SECONDARY REVIEW |
OUTPATIENT DIAGNOSIS |
*PROCDEDURE DATE (1) |
*PROCEDURE DATE (2) |
*PROCEDURE DATE (3) |
*ICD DIAGNOSIS CODE (2) |
*ICD DIAGNOSIS CODE (3) |
*ICD DIAGNOSIS CODE (4) |
*ICD DIAGNOSIS CODE (5) |
MRA REQUESTED DATE |
MRA REQUEST CLAIM COMMENTS |
EOB CLAIM COMMENTS |
MRA REQUESTOR |
AUTHORIZE BILL GENERATION? |
BANDING DATE |
TREATMENT MONTHS COUNT |
TREATMENT MONTHS REMAINING |
TREATMENT INDICATOR |
TOOTH NUMBER |
DENTAL CLAIM NOTE |