File BPS_CLAIMS(9002313.02) Data List
| CLAIM ID |
ELECTRONIC PAYER |
TRANSMIT FLAG |
TRANSMITTED ON |
CREATED ON |
AUTO REVERSE FLAG |
TRANSACTION |
PATIENT NAME |
GROUP INSURANCE PLAN |
IIN NUMBER |
VERSION/RELEASE NUMBER |
PATIENT ID STATE/PROVINCE |
TRANSACTION CODE |
PROCESSOR CONTROL NUMBER |
PATIENT COUNTRY CODE |
VETERINARY USE INDICATOR |
TRANSACTION COUNT |
SOFTWARE VENDOR/CERT ID |
MEDICAID SUBROGATION ICN/TCN |
MEDICAID ID NUMBER |
MEDICAID AGENCY NUMBER |
PATIENT STREET ADDRESS LINE 1 |
PATIENT STREET ADDRESS LINE 2 |
SERVICE PROVIDER ID |
SERV PROVIDER ID QUALIFIER |
PATIENT ID ASSOC COUNTRY CODE |
SPECIES |
PATIENT MIDDLE NAME |
PATIENT NAME PREFIX |
PATIENT NAME SUFFIX |
GROUP ID |
CARDHOLDER ID |
PERSON CODE |
DATE OF BIRTH |
PATIENT GENDER CODE |
PATIENT RELATIONSHIP CODE |
PLACE OF SERVICE |
ELIGIBILITY CLARIFICATION CODE |
PATIENT FIRST NAME |
PATIENT LAST NAME |
CARDHOLDER FIRST NAME |
CARDHOLDER LAST NAME |
HOME PLAN |
PATIENT STREET ADDRESS |
PATIENT CITY ADDRESS |
PATIENT STATE/PROVINCE ADDRESS |
PATIENT ZIP/POSTAL ZONE |
PATIENT TELEPHONE NUMBER |
PATIENT ID QUALIFIER |
PATIENT ID |
EMPLOYER ID |
SMOKER/NONSMOKER |
PREGNANCY INDICATOR |
FACILITY ID |
PATIENT E-MAIL ADDRESS |
OTHER PAYER CARDHOLDER ID |
MEDIGAP ID |
MEDICAID INDICATOR |
PROVIDER ACCEPT ASSGNMT INDCTR |
PATIENT RESIDENCE |
TRANSACTIONS |
DATE OF SERVICE |
PLAN ID |
PATIENT ID COUNT |
CLOSED |
DATE CLOSED |
CLOSED BY |
CLOSED REASON |
DROP TO PAPER |
DATE REOPENED |
REOPENED BY |
REOPENED COMMENT |
OTHER PAYER BIN NUMBER |
OTHER PAYER PROC CONTROL NUM |
OTHER PAYER GROUP ID |
CMS PART D DEFND QLFD FACILITY |
RAW DATA SENT |