| Parent File | Name | Number | Package |
|---|---|---|---|
| 9002270.22 | DATES OF SERVICE COVERED | 9002270.222 | Third Party Tracking |
| Field # | Name | Loc | Type | Details |
|---|---|---|---|---|
| .01 | DATE OF SERVICE | 0;1 | DATE | ************************REQUIRED FIELD************************
|
| 1 | CLAIM POINTER | 0;2 | NUMBER | ************************REQUIRED FIELD************************
|
| 2 | PENALTY APPLIED | 0;3 | NUMBER |
|
| 3 | NON-COVERED APPLIED | 0;4 | NUMBER |
|
| 4 | DEDUCTIBLE APPLIED | 0;5 | NUMBER |
|
| 5 | PAYMENT APPLIED | 0;6 | NUMBER |
|