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MVAH Insurance ICR (6891)

MVAH Insurance    ICR (6891)

Name Value
NUMBER 6891
IA # 6891
FILE NUMBER 355.33
GLOBAL ROOT IBA(355.33
DATE CREATED 2018/03/21
CUSTODIAL PACKAGE INTEGRATED BILLING
USAGE Controlled Subscription
TYPE File
NAME MVAH Insurance
GENERAL DESCRIPTION 
This IA is for the mobilehealth package to be able to
submit insurance information to the insurance buffer for processing
GLOBAL REFERENCE
GLOBAL REFERENCE FIELD NUMBER
IBA(355.33,D0,0)
FIELD NUMBER ACCESS FIELD NAME LOCATION
.01 Both R/W w/Fileman DATE ENTERED 0;1
.02 Both R/W w/Fileman ENTERED BY 0;2
.03 Both R/W w/Fileman SOURCE OF INFORMATION 0;3
.04 Both R/W w/Fileman STATUS 0;4
.13 Both R/W w/Fileman OVERRIDE FRESHNESS FLAG 0;13
.18 Both R/W w/Fileman SERVICE DATE 0;18
IBA(355.33,D0,60)
FIELD NUMBER ACCESS FIELD NAME LOCATION
60.01 Both R/W w/Fileman PATIENT NAME 60;1
60.04 Both R/W w/Fileman *SUBSCRIBER ID 60;4
60.07 Both R/W w/Fileman *NAME OF INSURED 60;7
60.14 Both R/W w/Fileman PT. RELATIONSHIP - HIPAA 60;14
60.08 Both R/W w/Fileman INSURED'S DOB 60;8
60.05 Both R/W w/Fileman WHOSE INSURANCE 60;5
IBA(355.33,D0,20)
FIELD NUMBER ACCESS FIELD NAME LOCATION
20.01 Both R/W w/Fileman INSURANCE COMPANY NAME 20;1
20.02 Both R/W w/Fileman PHONE NUMBER 20;2
20.04 Both R/W w/Fileman PRECERTIFICATION PHONE NUMBER 20;4
20.03 Both R/W w/Fileman BILLING PHONE NUMBER 20;3
IBA(355.33,D0,21)
FIELD NUMBER ACCESS FIELD NAME LOCATION
21.01 Both R/W w/Fileman STREET ADDRESS [LINE 1] 21;1
21.02 Both R/W w/Fileman STREET ADDRESS [LINE 2] 21;2
21.04 Both R/W w/Fileman CITY 21;4
21.05 Both R/W w/Fileman STATE 21;5
21.06 Both R/W w/Fileman ZIP CODE 21;6
IBA(355.33,D0,80)
FIELD NUMBER ACCESS FIELD NAME LOCATION
80.01 Both R/W w/Fileman INQ SERVICE TYPE CODE 1 80;1
IBA(355,33,D0,40)
FIELD NUMBER ACCESS FIELD NAME LOCATION
40.09 Both R/W w/Fileman TYPE OF PLAN 40;9
40.1 Both R/W w/Fileman BANKING IDENTIFICATION NUMBER 40;10
40.11 Both R/W w/Fileman PROCESSOR CONTROL NUMBER (PCN) 40;11
IBA(355.33,D0,62)
FIELD NUMBER ACCESS FIELD NAME LOCATION
62.07 Both R/W w/Fileman SUBSCRIBER ADDRESS COUNTRY 62;7
62.02 Both R/W w/Fileman SUBSCRIBER ADDRESS LINE 1 62;2
62.03 Both R/W w/Fileman SUBSCRIBER ADDRESS LINE 2 62;3
62.04 Both R/W w/Fileman SUBSCRIBER ADDRESS CITY 62;4
62.05 Both R/W w/Fileman SUBSCRIBER ADDRESS STATE 62;5
62.06 Both R/W w/Fileman SUBSCRIBER ADDRESS ZIP 62;6
62.09 Both R/W w/Fileman SUBSCRIBER PHONE 62;9
IBA(355.33,D0,90)
FIELD NUMBER ACCESS FIELD NAME LOCATION
90.01 Both R/W w/Fileman GROUP NAME 90;1
90.02 Both R/W w/Fileman GROUP NUMBER 90;2
90.03 Both R/W w/Fileman SUBSCRIBER ID 90;3
STATUS Pending
KEYWORDS
  • MVAH
  • IB
  • INSURANCE
  • MOBILEHEALTH
  • REMEDIATION
DURATION Till Otherwise Agreed
ID IBA(355.33
SUBSCRIBING PACKAGE MOBILE SCHEDULING APPLICATIONS SUITE