| Parent File | Name | Number | Package |
|---|---|---|---|
| AO PVT-INS ACCOUNT(#9002270.02) | DATE OF SERVICE | 9002270.21 | Third Party Tracking |
| Field # | Name | Loc | Type | Details |
|---|---|---|---|---|
| .01 | DATE OF SERVICE | 0;1 | DATE | ************************REQUIRED FIELD************************
|
| .02 | BILL ID | 0;2 | FREE TEXT | ************************REQUIRED FIELD************************
|
| .03 | WRITE-OFF | 0;3 | NUMBER |
|
| .04 | VISIT TYPE | 0;4 | SET | ************************REQUIRED FIELD************************
|
| .05 | DAYS OR VISITS | 0;5 | NUMBER |
|
| .06 | INSURANCE COMPANY | 0;6 | POINTER TO INSURER FILE (#9999999.18) | ************************REQUIRED FIELD************************ INSURER(#9999999.18)
|
| .062 | POLICY HOLDER'S NAME | 0;8 | FREE TEXT | ************************REQUIRED FIELD************************
|
| .064 | POLICY NUMBER | 0;9 | FREE TEXT | ************************REQUIRED FIELD************************
|
| .07 | CLAIM AMOUNT | 0;7 | NUMBER | ************************REQUIRED FIELD************************
|
| .11 | DATE CLAIM ENTERED AT FACILITY | 0;11 | DATE | ************************REQUIRED FIELD************************
|
| .115 | DATE EXTRACTED FROM FACILITY | 0;12 | DATE | ************************REQUIRED FIELD************************
|
| .12 | AGE OF CLAIM (ENTRY) | COMPUTED |
|
|
| .13 | AGE OF CLAIM (EXPORT) | COMPUTED |
|
|
| .17 | AGE OF CLAIM (VISIT) | COMPUTED |
|
|
| .18 | CLAIM STATUS | 0;17 | SET | ************************REQUIRED FIELD************************
|
| .19 | DATE OF DENIAL | 0;18 | DATE | ************************REQUIRED FIELD************************
|