Parent File | Name | Number | Package |
---|---|---|---|
AZP PRV AREA TRACKING(#2001060.03) | CLAIM NUMBER | 2001060.31 | Portland Private Insurance package |
Field # | Name | Loc | Type | Details |
---|---|---|---|---|
.01 | CLAIM NUMBER | 0;1 | FREE TEXT | ************************REQUIRED FIELD************************
|
.02 | BEGINNING DOS | 0;2 | DATE |
|
.03 | ENDING DOS | 0;3 | DATE |
|
.04 | CLAIM AMOUNT | 0;4 | NUMBER | ************************REQUIRED FIELD************************
|
.05 | AMOUNT COLLECTED | 0;5 | NUMBER |
|
.06 | AMOUNT OF DEDUCTIBLE | 0;6 | NUMBER |
|
.07 | DATE SENT TO INS | 0;7 | DATE |
|
.08 | DATE COLLECTED | 0;8 | DATE |
|
.09 | FACILITY | COMPUTED |
|