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 |
|