| Parent File | Name | Number | Package |
|---|---|---|---|
| 9002274.091 | REPLACE INSURER EFFECTIVE DATE | 9002274.09112 | Third Party Billing |
| Field # | Name | Loc | Type | Details |
|---|---|---|---|---|
| .01 | REPLACE INSURER EFFECTIVE DATE | 0;1 | DATE |
|
| .02 | END DATE | 0;2 | DATE |
|
| .03 | REPLACEMENT INSURER | 0;3 | POINTER TO 3P INSURER FILE (#9002274.09) | 3P INSURER(#9002274.09)
|
| .04 | REPLACEMENT VISIT TYPE | 0;4 | POINTER TO 3P VISIT TYPE FILE (#9002274.8) | 3P VISIT TYPE(#9002274.8)
|