Parent File | Name | Number | Package |
---|---|---|---|
3P BILL(#9002274.4) | PAYMENT | 9002274.403 | Third Party Billing |
Field # | Name | Loc | Type | Details |
---|---|---|---|---|
.001 | PAYMENT NUMBER | NUMBER |
|
|
.01 | PAYMENT DATE | 0;1 | DATE |
|
.02 | AMOUNT | 0;2 | NUMBER | ************************REQUIRED FIELD************************
|
.03 | DEDUCTIBLE AMOUNT | 0;3 | NUMBER |
|
.04 | CO-INSURANCE AMOUNT | 0;4 | NUMBER |
|
.05 | DENIAL REASON | 0;5 | POINTER TO 3P DENIAL REASONS FILE (#9002274.7) | 3P DENIAL REASONS(#9002274.7)
|
.06 | WRITE OFF | 0;6 | NUMBER |
|
.07 | NON-COVERED | 0;7 | NUMBER |
|
.08 | IMPORTED FROM AO TRK | 0;8 | SET |
|
.09 | PENALTY AMOUNT | 0;9 | NUMBER |
|
.1 | PAYMENTS FROM A/R | 0;10 | NUMBER |
|
.11 | PREVIOUS PAYMENTS FROM 3PB | 0;11 | NUMBER |
|
.12 | GROUPER ALLOWANCE | 0;12 | NUMBER |
|
.13 | REFUND | 0;13 | NUMBER |
|
.14 | PAYMENT ADJUSTMENTS FROM A/R | 0;14 | NUMBER |
|
.15 | ADJUSTMENT CATEGORY | 0;15 | POINTER TO A/R TABLE TYPE/IHS FILE (#90052.01) | A/R TABLE TYPE/IHS(#90052.01)
|
.16 | ADJUSTMENT TYPE | 0;16 | POINTER TO A/R TABLE ENTRY/IHS FILE (#90052.02) | A/R TABLE ENTRY/IHS(#90052.02)
|
.17 | STD ADJUSTMENT REASON | 0;17 | POINTER TO A/R EDI STND CLAIM ADJ REASONS FILE (#90056.06) | A/R EDI STND CLAIM ADJ REASONS(#90056.06)
|
.18 | INCLUDE AMT IN BILL BALANCE? | 0;18 | SET |
|