LIGHTHOUSE IIV RESPONSE FILE ICR ICR (7308)

Name

Value

NUMBER

7308

IA #

7308

FILE NUMBER

365

GLOBAL ROOT

IBCN(365,

DATE CREATED

2021/10/15

CUSTODIAL PACKAGE

INTEGRATED BILLING

USAGE

Private

TYPE

File

NAME

LIGHTHOUSE IIV RESPONSE FILE ICR

GENERAL DESCRIPTION

Lighthouse requires access to the IIV RESPONSE file
#365 to support the AMCMS/WellHive Insurance Capture initiative.

GLOBAL REFERENCE

FIELD NUMBER

GLOBAL DESCRIPTION

IBCN(365,D0,0)

FIELD NUMBER	ACCESS	FIELD NAME	LOCATION
.01	Both R/W w/Fileman	MESSAGE CONTROL ID	0;1
.02	Both R/W w/Fileman	PATIENT	0;2
.03	Both R/W w/Fileman	PAYER	0;3
.04	Read w/Fileman	BUFFER ENTRY	0;4
.05	Read w/Fileman	TRANSMISSION QUEUE	0;5
.06	Both R/W w/Fileman	TRANSMISSION STATUS	0;6
.07	Both R/W w/Fileman	DATE/TIME RECEIVED	0;7
.08	Both R/W w/Fileman	DATE/TIME CREATED	0;8
.09	Both R/W w/Fileman	TRACE NUMBER	0;9
.1	Both R/W w/Fileman	RESPONSE TYPE	0;10
.11	Read w/Fileman	DO NOT PURGE	0;11
.12	Both R/W w/Fileman	INSUR RECORD IEN	0;12
.13	Both R/W w/Fileman	EIV AUTO-UPDATE	0;13

IBCN(365,D0,1)

FIELD NUMBER	ACCESS	FIELD NAME	LOCATION
1.02	Both R/W w/Fileman	INSURED DOB	1;2
1.03	Both R/W w/Fileman	INSURED SSN	1;3
1.04	Both R/W w/Fileman	INSURED SEX	1;4
1.08	Both R/W w/Fileman	WHOSE INSURANCE	1;8
1.09	Both R/W w/Fileman	PT RELATIONSHIP TO INSURED	1;9
1.1	Both R/W w/Fileman	SERVICE DATE	1;10
1.11	Both R/W w/Fileman	EFFECTIVE DATE	1;11
1.12	Both R/W w/Fileman	EXPIRATION DATE	1;12
1.13	Both R/W w/Fileman	COORDINATION OF BENEFITS	1;13
1.14	Both R/W w/Fileman	ERROR CONDITION	1;14
1.15	Both R/W w/Fileman	ERROR ACTION	1;15
1.16	Both R/W w/Fileman	DATE OF DEATH	1;16
1.17	Both R/W w/Fileman	CERTIFICATION DATE	1;17
1.18	Both R/W w/Fileman	MEMBER ID	1;18
1.19	Both R/W w/Fileman	PAYER UPDATED POLICY	1;19
1.2	Both R/W w/Fileman	POLICY NUMBER	1;20

IBCN(365,D0,2,D1,0)

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-365.02)

IBCN(365,D0,2,D1,1)

FIELD NUMBER	ACCESS	FIELD NAME	LOCATION
1.01	Both R/W w/Fileman	PROCEDURE CODING METHOD	1;1
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

IBCN(365,D0,2,D1,3)

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
ENTITY ID QUALIFIER	Read w/Fileman	ENTITY ID QUALIFIIER
3.05	Both R/W w/Fileman	ENTITY ID QUALIFIER	3;5
3.06	Both R/W w/Fileman	ENTITY RELATIONSHIP CODE	3;6

IBCN(365,D0,2,D1,4)

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

IBCN(365,D0,2,D1,5)

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

IBCN(365,D0,2,D1,6,D2,0)

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

CONTACT INFORMATION (Multiple-365.26)

IBCN(365,D0,2,D1,6,D2,1)

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

IBCN(365,D0,2,D1,7,D2,0)

FIELD NUMBER	ACCESS	FIELD NAME	LOCATION
.01	Both R/W w/Fileman	SEQUENCE	0;1
.02	Both R/W w/Fileman	BENEFIT QUANTITY	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;7
.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-365.27)

IBCN(365,D0,2,D1,8,D2,0)

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-365.28)

IBCN(365,D0,2,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	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-365.29)

IBCN(365,D0,2,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	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-365.291)

IBCN(365,D0,2,D1,14,D2,0)

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

SERVICE TYPES (Multiple-365.292)

IBCN(365,D0,3,D1,0)

FIELD NUMBER	ACCESS	FIELD NAME	LOCATION
.01	Both R/W w/Fileman	CONTACT PERSON	0;1
.02	Both R/W w/Fileman	COMMUNICATION QUALIFIER #1	0;2
.04	Both R/W w/Fileman	COMMUNICATION QUALIFIER #2	0;4
.06	Both R/W w/Fileman	COMMUNICATION QUALIFIER #3	0;6

CONTACT PERSON (Multiple-365.03)

IBCN(365,D0,3,D1,2)

FIELD NUMBER	ACCESS	FIELD NAME	LOCATION
2	Both R/W w/Fileman	COMMUNICATION NUMBER #2	2;1

IBCN(365,D0,3,D1,1)

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

IBCN(365,D0,3,D1,3)

FIELD NUMBER	ACCESS	FIELD NAME	LOCATION
3	Both R/W w/Fileman	COMMUNICATION NUMBER #3	3;1

IBCN(365,D0,4)

FIELD NUMBER	ACCESS	FIELD NAME	LOCATION
4.01	Both R/W w/Fileman	ERROR TEXT	4;1

IBCN(365,D0,5)

FIELD NUMBER	ACCESS	FIELD NAME	LOCATION
5.01	Both R/W w/Fileman	SUBSCRIBER ADDRESS LINE 1	5;1
5.02	Both R/W w/Fileman	SUBSCRIBER ADDRESS LINE 2	5;2
5.03	Both R/W w/Fileman	SUBSCRIBER ADDRESS CITY	5;3
5.04	Both R/W w/Fileman	SUBSCRIBER ADDRESS STATE	5;4
5.05	Both R/W w/Fileman	SUBSCRIBER ADDRESS ZIP	5;5
5.06	Both R/W w/Fileman	SUBSCRIBER ADDRESS COUNTRY	5;6
5.07	Both R/W w/Fileman	SUBSCRIBER ADDRESS SUBDIVISION	5;7

IBCN(365,D0,6,D1,0)

FIELD NUMBER	ACCESS	FIELD NAME	LOCATION
.01	Both R/W w/Fileman	SEQUENCE	0;1
.02	Both R/W w/Fileman	ERROR LOCATION	0;2
.03	Both R/W w/Fileman	REJECT REASON	0;3
.04	Both R/W w/Fileman	ACTION CODE	0;4
.05	Both R/W w/Fileman	LOOP ID	0;5
.06	Both R/W w/Fileman	SOURCE	0;6

REJECT REASONS (Multiple-365.06)

IBCN(365,D0,6,D1,1,D2,0)

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

ADDITIONAL MSGS (Multiple-365.061)

IBCN(365,D0,7,D1,0)

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	LOOP ID	0;4

SUBSCRIBER DATES (Multiple-365.07)

IBCN(365,D0,8)

FIELD NUMBER	ACCESS	FIELD NAME	LOCATION
8.01	Both R/W w/Fileman	PT. RELATIONSHIP - HIPAA	8;1

IBCN(365,D0,9,D1,0)

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-365.09)

IBCN(365,D0,10,D1,0)

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 (Multiple-365.04)

IBCN(365,D0,11,D1,0)

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-365.01)

IBCN(365,D0,12)

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

IBCN(365,D0,13)

FIELD NUMBER	ACCESS	FIELD NAME	LOCATION
13.01	Both R/W w/Fileman	NAME OF INSURED	13;1
13.02	Both R/W w/Fileman	SUBSCRIBER ID	13;2

IBCN(365,D0,14)

FIELD NUMBER	ACCESS	FIELD NAME	LOCATION
14.01	Both R/W w/Fileman	GROUP NAME	14;1
14.02	Both R/W w/Fileman	GROUP NUMBER	14;2

STATUS

Withdrawn

DURATION

Till Otherwise Agreed

IBCN(365,

SUBSCRIBING PACKAGE

LIGHTHOUSE