Parent File | Name | Number | Package |
---|---|---|---|
3P CLAIM DATA(#9002274.3) | AMBULANCE SERVICE | 9002274.3047 | Third Party Billing |
Field # | Name | Loc | Type | Details |
---|---|---|---|---|
.01 | AMBULANCE SERVICE | 0;1 | POINTER TO CPT FILE (#81) | CPT(#81)
|
.02 | REVENUE CODE | 0;2 | POINTER TO REVENUE CODES FILE (#9999999.72) | REVENUE CODES(#9999999.72)
|
.03 | UNITS | 0;3 | NUMBER | ************************REQUIRED FIELD************************
|
.04 | UNIT CHARGE | 0;4 | NUMBER | ************************REQUIRED FIELD************************
|
.05 | MODIFIER | 0;5 | FREE TEXT |
|
.06 | CORRESPONDING DIAGNOSIS | 0;6 | FREE TEXT |
|
.07 | SERVICE FROM DATE/TIME | 0;7 | DATE |
|
.08 | SECOND MODIFIER | 0;8 | FREE TEXT |
|
.09 | THIRD MODIFIER | 0;9 | FREE TEXT |
|
.12 | SERVICE TO DATE/TIME | 0;12 | DATE |
|
.13 | IN-HOUSE CLIA# | 0;13 | FREE TEXT |
|
.14 | REFERENCE LAB CLIA# | 0;14 | POINTER TO 3P REFERENCE LAB LOCATIONS FILE (#9002274.35) | 3P REFERENCE LAB LOCATIONS(#9002274.35)
|
.15 | HCFA POS | 0;15 | POINTER TO 3P CODES FILE (#9002274.03) | 3P CODES(#9002274.03)
|
.16 | HCFA TOS | 0;16 | POINTER TO 3P CODES FILE (#9002274.03) | 3P CODES(#9002274.03)
|
.17 | DATA SOURCE | 0;17 | FREE TEXT |
|
.23 | PRINT ORDER | 0;23 | NUMBER |
|
22 | CPT NARRATIVE | 2;2 | FREE TEXT |
|