LIGHTHOUSE PATIENT INSURANCE TYPE SUBFILE ICR ICR (7307)

Name

Value

NUMBER

7307

IA #

7307

FILE NUMBER

2.312

GLOBAL ROOT

DPT(D0,.312,

DATE CREATED

2021/10/15

CUSTODIAL PACKAGE

INTEGRATED BILLING

USAGE

Private

TYPE

File

NAME

LIGHTHOUSE PATIENT INSURANCE TYPE SUBFILE ICR

GENERAL DESCRIPTION

Lighthouse requires access to the Patient Insurance
Type sub-file #2.312 to support the AMCMS/WellHive Insurance Capture
initiative.

GLOBAL REFERENCE

FIELD NUMBER

GLOBAL DESCRIPTION

DPT(D0,.312,D1,0)

FIELD NUMBER	ACCESS	FIELD NAME	LOCATION
.01	Both R/W w/Fileman	INSURANCE TYPE	0;1
.18	Both R/W w/Fileman	GROUP PLAN	0;18
.2	Both R/W w/Fileman	COORDINATION OF BENEFITS	0;20
3	Both R/W w/Fileman	INSURANCE EXPIRATION DATE	0;4
6	Both R/W w/Fileman	WHOSE INSURANCE	0;6
8	Both R/W w/Fileman	EFFECTIVE DATE OF POLICY	0;8
16	Both R/W w/Fileman	PT. RELATIONSHIP TO INSURED	0;16

DPT(D0,.312,D1,1)

FIELD NUMBER	ACCESS	FIELD NAME	LOCATION
1.01	Both R/W w/Fileman	DATE ENTERED	1;1
1.02	Both R/W w/Fileman	ENTERED BY	1;2
1.03	Both R/W w/Fileman	DATE LAST VERIFIED	1;3
1.04	Both R/W w/Fileman	VERIFIED BY	1;4
1.05	Both R/W w/Fileman	DATE LAST EDITED	1;5
1.06	Both R/W w/Fileman	LAST EDITED BY	1;6
1.09	Both R/W w/Fileman	SOURCE OF INFORMATION	1;9
1.1	Both R/W w/Fileman	DATE OF SOURCE OF INFORMATION	1;10

DPT(D0,.312,D1,2)

FIELD NUMBER	ACCESS	FIELD NAME	LOCATION
2.01	Both R/W w/Fileman	SEND BILL TO EMPLOYER	2;1
2.015	Both R/W w/Fileman	SUBSCRIBER'S EMPLOYER NAME	2;9
2.02	Both R/W w/Fileman	EMPLOYER CLAIMS STREET ADDRESS	2;2
2.03	Both R/W w/Fileman	EMPLOY CLAIM ST ADDRESS LINE 2	2;3
2.04	Both R/W w/Fileman	EMPLOY CLAIM ST ADDRESS LINE 3	2;4
2.05	Both R/W w/Fileman	EMPLOYER CLAIMS CITY	2;5
2.06	Both R/W w/Fileman	EMPLOYER CLAIMS STATE	2;6
2.07	Both R/W w/Fileman	EMPLOYER CLAIMS ZIP CODE	2;7
2.08	Both R/W w/Fileman	EMPLOYER CLAIMS PHONE	2;8
2.1	Both R/W w/Fileman	EMPLOYMENT STATUS	2;11
2.12	Both R/W w/Fileman	RETIREMENT DATE	2;12

DPT(D0,.312,D1,3)

FIELD NUMBER	ACCESS	FIELD NAME	LOCATION
3.01	Both R/W w/Fileman	INSURED'S DOB	3;1
3.02	Both R/W w/Fileman	INSURED'S BRANCH	3;2
3.03	Both R/W w/Fileman	INSURED'S RANK	3;3
3.04	Both R/W w/Fileman	STOP POLICY FROM BILLING	3;4
3.05	Both R/W w/Fileman	INSURED'S SSN	3;5
3.06	Both R/W w/Fileman	INSURED'S STREET 1	3;6
3.07	Both R/W w/Fileman	INSURED'S STREET 2	3;7
3.08	Both R/W w/Fileman	INSURED'S CITY	3;8
3.09	Both R/W w/Fileman	INSURED'S STATE	3;9
3.1	Both R/W w/Fileman	INSURED'S ZIP	3;10
3.11	Both R/W w/Fileman	INSURED'S PHONE	3;11
3.12	Both R/W w/Fileman	INSURED'S SEX	3;12
3.13	Both R/W w/Fileman	INSURED'S COUNTRY	3;13
3.14	Both R/W w/Fileman	INSURED'S COUNTRY SUBDIVISION	3;14

DPT(D0,.312,D1,4)

FIELD NUMBER	ACCESS	FIELD NAME	LOCATION
4.01	Both R/W w/Fileman	PRIMARY CARE PROVIDER	4;1
4.02	Both R/W w/Fileman	PRIMARY PROVIDER PHONE	4;2
4.03	Both R/W w/Fileman	PT. RELATIONSHIP - HIPAA	4;3
4.04	Both R/W w/Fileman	EIV AUTO-UPDATE	4;4
4.05	Both R/W w/Fileman	PHARMACY RELATIONSHIP CODE	4;5
4.06	Both R/W w/Fileman	PHARMACY PERSON CODE	4;6

DPT(D0,.312,D1,5)

FIELD NUMBER	ACCESS	FIELD NAME	LOCATION
5.01	Both R/W w/Fileman	PATIENT ID	5;1
5.02	Both R/W w/Fileman	SUBSCRIBER'S SEC QUALIFIER(1)	5;2
5.03	Both R/W w/Fileman	SUBSCRIBER'S SEC ID(1)	5;3
5.04	Both R/W w/Fileman	SUBSCRIBER'S SEC QUALIFIER(2)	5;4
5.05	Both R/W w/Fileman	SUBSCRIBER'S SEC ID(2)	5;5
5.06	Both R/W w/Fileman	SUBSCRIBER'S SEC QUALIFIER(3)	5;6
5.07	Both R/W w/Fileman	SUBSCRIBER'S SEC ID(3)	5;7
5.08	Both R/W w/Fileman	PATIENT'S SEC QUALIFIER(1)	5;8
5.09	Both R/W w/Fileman	PATIENT'S SECONDARY ID(1)	5;9
5.1	Both R/W w/Fileman	PATIENT'S SEC QUALIFIER(2)	5;10
5.11	Both R/W w/Fileman	PATIENT'S SECONDARY ID(2)	5;11
5.12	Both R/W w/Fileman	PATIENT'S SEC QUALIFIER(3)	5;12
5.13	Both R/W w/Fileman	PATIENT'S SECONDARY ID(3)	5;13

DPT(D0,.312,D1,6,D2,0)

FIELD NUMBER	ACCESS	FIELD NAME	LOCATION
.01	Both R/W w/Fileman	EB NUMBER	0;1
.02	Both R/W w/Fileman	ELIGIBILITY/BENEFIT INFO	0;2
.03	Both R/W w/Fileman	COVERAGE LEVEL	0;3
.05	Both R/W w/Fileman	INSURANCE TYPE	0;5
.06	Both R/W w/Fileman	PLAN COVERAGE DESCRIPTION	0;6
.07	Both R/W w/Fileman	TIME PERIOD QUALIFIER	0;7
.08	Both R/W w/Fileman	MONETARY AMOUNT	0;8
.09	Both R/W w/Fileman	PERCENT	0;9
.1	Both R/W w/Fileman	QUANTITY QUALIFIER	0;10
.11	Both R/W w/Fileman	QUANTITY	0;11
.12	Both R/W w/Fileman	AUTHORIZATION/CERTIFICATION	0;12
.13	Both R/W w/Fileman	IN PLAN	0;13

ELIGIBILITY/BENEFIT (Multiple-2.322)

DPT(D0,.312,D1,6,D2,1)

FIELD NUMBER	ACCESS	FIELD NAME	LOCATION
1.01	Both R/W w/Fileman	PROCEDURE CODING METHOD	1;2
1.02	Both R/W w/Fileman	PROCEDURE CODE	1;2
1.03	Both R/W w/Fileman	PROCEDURE MODIFIER 1	1;3
1.04	Both R/W w/Fileman	PROCEDURE MODIFIER 2	1;4
1.05	Both R/W w/Fileman	PROCEDURE MODIFIER 3	1;5
1.06	Both R/W w/Fileman	PROCEDURE MODIFIER 4	1;6

DPT(D0,.312,D1,6,D2,3)

FIELD NUMBER	ACCESS	FIELD NAME	LOCATION
3.01	Both R/W w/Fileman	ENTITY ID CODE	3;1
3.02	Both R/W w/Fileman	ENTITY TYPE	3;2
3.03	Both R/W w/Fileman	NAME	3;3
3.04	Both R/W w/Fileman	ENTITY ID	3;4
3.05	Both R/W w/Fileman	ENTITY ID QUALIFIER	3;5
3.06	Both R/W w/Fileman	ENTITY RELATIONSHIP CODE	3;6

DPT(D0,.312,D1,6,D2,4)

FIELD NUMBER	ACCESS	FIELD NAME	LOCATION
4.01	Both R/W w/Fileman	ADDRESS LINE 1	4;1
4.02	Both R/W w/Fileman	ADDRESS LINE 2	4;2
4.03	Both R/W w/Fileman	CITY	4;3
4.04	Both R/W w/Fileman	STATE	4;4
4.05	Both R/W w/Fileman	ZIP	4;5
4.06	Both R/W w/Fileman	COUNTRY CODE	4;6
4.07	Both R/W w/Fileman	LOCATION	4;7
4.08	Both R/W w/Fileman	LOCATION QUALIFIER	4;8
4.09	Both R/W w/Fileman	SUBDIVISION CODE	4;9

DPT(D0,.312,D1,6,D2,5)

FIELD NUMBER	ACCESS	FIELD NAME	LOCATION
5.01	Both R/W w/Fileman	PROVIDER CODE	5;1
5.02	Both R/W w/Fileman	REFERENCE ID	5;2
5.03	Both R/W w/Fileman	REFERENCE ID QUALIFIER	5;3

DPT(D0,.312,D1,6,D2,8,D3,0)

FIELD NUMBER	ACCESS	FIELD NAME	LOCATION
.01	Both R/W w/Fileman	SEQUENCE	0;1
.02	Both R/W w/Fileman	DATE	0;2
.03	Both R/W w/Fileman	DATE QUALIFIER	0;3
.04	Both R/W w/Fileman	DATE FORMAT	0;4

SUBSCRIBER DATES (Multiple-2.3228)

DPT(D0,.312,D1,6,D2,6,D3,0)

FIELD NUMBER	ACCESS	FIELD NAME	LOCATION
.01	Both R/W w/Fileman	SEQUENCE	0;1
.02	Both R/W w/Fileman	NAME	0;2
.04	Both R/W w/Fileman	COMMUNICATION QUALIFIER	0;4
1	Both R/W w/Fileman	COMMUNICATION NUMBER	1;1

CONTACT INFORMATION (Multiple-2.3226)

DPT(D0,.312,D1,6,D2,6,D3,1)

FIELD NUMBER	ACCESS	FIELD NAME	LOCATION
1	Both R/W w/Fileman	COMMUNICATION NUMBER	1;1

DPT(D0,.312,D1,6,D2,7,D3,0)

FIELD NUMBER	ACCESS	FIELD NAME	LOCATION
.01	Both R/W w/Fileman	SEQUENCE	0;1
.02	Both R/W w/Fileman	BENEFIT	0;2
.03	Both R/W w/Fileman	QUANTITY QUALIFIER	0;3
.04	Both R/W w/Fileman	SAMPLE SELECTION MODULUS	0;4
.05	Both R/W w/Fileman	UNITS OF MEASUREMENT	0;5
.06	Both R/W w/Fileman	TIME PERIODS	0;6
.07	Both R/W w/Fileman	TIME PERIOD QUALIFIER	0;7
.08	Both R/W w/Fileman	DELIVERY FREQUENCY	0;8
.09	Both R/W w/Fileman	DELIVERY PATTERN	0;9

HEALTHCARE SERVICES DELIVERY (Multiple-2.3227)

DPT(D0,.312,D1,6,D2,9,D3,0)

FIELD NUMBER	ACCESS	FIELD NAME	LOCATION
.01	Both R/W w/Fileman	SEQUENCE	0;1
.02	Both R/W w/Fileman	PLACE OF SERVICE	0;2
.03	Both R/W w/Fileman	DIAGNOSIS	0;3
.04	Both R/W w/Fileman	QUALIFIER	0;4
.05	Both R/W w/Fileman	NATURE OF INJURY CODE	0;5
.06	Both R/W w/Fileman	NATURE OF INJURY CATEGORY	0;6
.07	Both R/W w/Fileman	NATURE OF INJURY TEXT	0;7

SUBSCRIBER ADDITIONAL INFO (Multiple-2.3229)

DPT(D0,.312,D1,6,D2,10,D3,0)

FIELD NUMBER	ACCESS	FIELD NAME	LOCATION
.01	Both R/W w/Fileman	SEQUENCE	0;1
.02	Both R/W w/Fileman	REFERENCE ID	0;2
.03	Both R/W w/Fileman	REFERENCE ID QUALIFIER	0;3
.04	Both R/W w/Fileman	DESCRIPTION	0;4

SUBSCRIBER REFERENCE ID (Multiple-2.32291)

DPT(D0,.312,D1,6,D2,11,D3,0)

FIELD NUMBER	ACCESS	FIELD NAME	LOCATION
.01	Both R/W w/Fileman	SERVICE TYPE	0;1

SERVICE TYPES (Multiple-2.32292)

DPT(D0,.312,D1,7)

FIELD NUMBER	ACCESS	FIELD NAME	LOCATION
7.01	Both R/W w/Fileman	NAME OF INSURED	7;1
7.02	Both R/W w/Fileman	SUBSCRIBER ID	7;2
7.03	Both R/W w/Fileman	SUBSCRIBER ID ROLLBACK	7;3
7.04	Both R/W w/Fileman	PATIENT ID ROLLBACK	7;4

DPT(D0,.312,D1,8)

FIELD NUMBER	ACCESS	FIELD NAME	LOCATION
8.01	Both R/W w/Fileman	REQUESTED SERVICE DATE	8;1
8.02	Both R/W w/Fileman	REQUESTED SERVICE TYPE	8;2
8.03	Both R/W w/Fileman	EB DISPLAY ENTRY	8;3

DPT(D0,.312,D1,9,D2,0)

FIELD NUMBER	ACCESS	FIELD NAME	LOCATION
.01	Both R/W w/Fileman	SEQUENCE	0;1
.02	Both R/W w/Fileman	REFERENCE ID (GROUP)	0;2
.03	Both R/W w/Fileman	REF ID QUALIFIER (GROUP)	0;3
.04	Both R/W w/Fileman	DESCRIPTION	0;4

GROUP REFERENCE INFORMATION (Multiple-2.3129)

DPT(D0,.312,D1,10,D2,0)

FIELD NUMBER	ACCESS	FIELD NAME	LOCATION
.01	Both R/W w/Fileman	SEQUENCE	0;1
.02	Both R/W w/Fileman	PROVIDER CODE	0;2
.03	Both R/W w/Fileman	PROV REFERENCE ID	0;3

GROUP PROVIDER INFO (Mulitple-2.332)

DPT(D0,.312,D1,11,D2,0)

FIELD NUMBER	ACCESS	FIELD NAME	LOCATION
.01	Both R/W w/Fileman	SEQUENCE	0;1
.02	Both R/W w/Fileman	DIAGNOSIS CODE	0;2
.03	Both R/W w/Fileman	DIAGNOSIS CODE QUALIFIER	0;3
.04	Both R/W w/Fileman	PRIMARY OR SECONDARY	0;4

HEALTH CARE CODE INFORMATION (Multiple-2.31211)

DPT(D0,.312,D1,12)

FIELD NUMBER	ACCESS	FIELD NAME	LOCATION
12.01	Both R/W w/Fileman	MILITARY INFO STATUS CODE	12;1
12.02	Both R/W w/Fileman	MILITARY EMPLOYMENT STATUS	12;2
12.03	Both R/W w/Fileman	MILITARY GOVT AFFILIATION CODE	12;3
12.04	Both R/W w/Fileman	MILITARY PERSONNEL DESCRIPTION	12;4
12.05	Both R/W w/Fileman	MILITARY SERVICE RANK CODE	12;5
12.06	Both R/W w/Fileman	DATE TIME PERIOD FORMAT QUAL	12;6
12.07	Both R/W w/Fileman	DATE TIME PERIOD	12;7

DPT(D0,.312,D1,13,D2,1)

FIELD NUMBER	ACCESS	FIELD NAME	LOCATION
.03	Both R/W w/Fileman	COMMENT	1;1

STATUS

Withdrawn

DURATION

Till Otherwise Agreed

DPT(D0,.312,