ABME3XA0 ; IHS/ASDST/DMJ - HCFA-1500 NSF3.01 RECORD XA0 (Claim Trailer) ;
Source file <ABME3XA0.m>
| Name | Comments | DBIA/ICR reference |
|---|---|---|
| 150 | ;92-98 Total Disallowed Other Charges
|
|
| 210 | ;134-140 Total Purchase Service Charges
|
|
| 190 | ;120-126 Total Payor Amount Paid
|
|
| 60 | ;25-26 Record Type Dxx Count
|
|
| 130 | ;78-84 Total Claim Charges
|
|
| 110 | ;35-37 Physical Record Count
|
|
| 80 | ;29-30 Record Type Fxx Count
|
|
| 230 | ;157-259 Remarks
|
|
| 250 | ;291-320 Filler (Local)
|
|
| 170 | ;106-112 Total Deductible Amount
|
|
| 20 | ;4-5 Filler
|
|
| 40 | ;
|
|
| 180 | ;113-119 Total Coinsurance Amount
|
|
| 200 | ;127-133 Patient Amount Payed
|
|
| 140 | ;85-91 Total Disallowed Cost Cont Chgs
|
|
| 120 | ;38-77 Reserved
|
|
| START | ;START HERE
|
|
| 240 | ;260-290 Filler (National)
|
|
| 70 | ;27-28 Record Type Exx Count
|
|
| 90 | ;31-32 Record Type Gxx Count
|
|
| 100 | ;33-34 Record Type Hxx Count
|
|
| 160 | ;99-105 Total Allowed Amount
|
|
| 220 | ;141-156 Provider Discount Information
|
|
| 10 | ;1-3 Record ID
|
|
| 30 | ;6-22 Patient Control Number
|
|
| 50 | ;23-24 Record Type Cxx Count
|
|
| LOOP | ;LOOP HERE
|
| Name | Line Occurrences (* Changed, ! Killed) |
|---|---|
| ^ABMDBILL( | 200+1 |
| ^ABMEXLM("AA" | LOOP+3 |
| Name | Line Occurrences |
|---|---|
| @( | LOOP+2, LOOP+3 |
| LOOP | START+3 |
| Name | Field # of Occurrence |
|---|---|
| ^( | LOOP+3 |
| >> | Not killed explicitly |
| * | Changed |
| ! | Killed |
| ~ | Newed |
| Name | Field # of Occurrence |
|---|---|
| ABM | START+7! |
| ABME | START+7! |
| ABME("RTYPE" | START+2* |
| >> ABMP("BDFN" | 200+1 |
| >> ABMP("EXP" | LOOP+3 |
| >> ABMP("INS" | LOOP+3 |
| >> ABMP("NOFMT" | LOOP+4 |
| >> ABMP("PAYED" | 190+1 |
| >> ABMP("PCN" | 30+1 |
| >> ABMR(90 | LOOP+4, 10+1*, 20+1*, 20+2*, 30+1*, 30+2*, 40+1*, 50+1*, 60+1*, 70+1* , 80+1*, 90+1*, 100+1*, 110+1*, 120+1*, 120+2*, 130+1*, 140+1*, 140+2*, 150+1* , 150+2*, 160+1*, 160+2*, 170+1*, 170+2*, 180+1*, 180+2*, 190+1*, 190+2*, 200+1* , 200+2*, 210+1*, 210+2*, 220+1*, 220+2*, 230+1*, 230+2*, 240+1*, 240+2*, 250+1* , 250+2* |
| >> ABMREC(90 | START+1!, LOOP+4* |
| >> ABMRT(90 | START+5, START+7!, 50+1, 60+1, 70+1, 80+1, 90+1, 100+1, 110+1, 130+1 , 160+1 |
| >> ABMRT(95 | START+5*, START+6* |
| DUZ(2 | 200+1 |
| >> I | START+4*, START+5, LOOP+1*, LOOP+2, LOOP+3, LOOP+4 |