FileMan FileNo | FileMan Filename | Package |
---|---|---|
9002274.4 | 3P BILL | Third Party Billing |
Field # | Name | Loc | Type | Details |
---|---|---|---|---|
.01 | BILL NUMBER | 0;1 | FREE TEXT | ************************REQUIRED FIELD************************
|
.02 | BILL TYPE | 0;2 | FREE TEXT |
|
.022 | MANUAL,SPLIT CLAIM | 0;22 | SET |
|
.03 | VISIT LOCATION | 0;3 | POINTER TO LOCATION FILE (#9999999.06) | LOCATION(#9999999.06)
|
.04 | BILL STATUS | 0;4 | SET |
|
.05 | PATIENT | 0;5 | POINTER TO PATIENT FILE (#9000001) | PATIENT(#9000001)
|
.06 | EXPORT MODE | 0;6 | POINTER TO 3P EXPORT MODE FILE (#9002274.08) | 3P EXPORT MODE(#9002274.08)
|
.07 | VISIT TYPE | 0;7 | POINTER TO 3P VISIT TYPE FILE (#9002274.8) | 3P VISIT TYPE(#9002274.8)
|
.08 | ACTIVE INSURER | 0;8 | POINTER TO INSURER FILE (#9999999.18) | INSURER(#9999999.18)
|
.09 | PROCEDURE CODING METHOD | 0;9 | SET |
|
.1 | CLINIC | 0;10 | POINTER TO CLINIC STOP FILE (#40.7) | CLINIC STOP(#40.7)
|
.11 | CHART REVIEWED (Y/N) | 1;1 | SET |
|
.111 | BILL CANCELLED BY | 1;11 | POINTER TO NEW PERSON FILE (#200) | NEW PERSON(#200)
|
.112 | BILL CANCELLATION DATE | 1;12 | DATE |
|
.113 | REASON FOR CANCELLATION | 1;13 | POINTER TO 3P CANCEL BILL REASONS FILE (#9002274.47) | 3P CANCEL BILL REASONS(#9002274.47)
|
.114 | MASTER TAX ID# | 1;14 | FREE TEXT |
|
.115 | OTHER BILL IDENTIFIER | 1;15 | FREE TEXT |
|
.12 | REVIEWING OFFICIAL | 1;2 | POINTER TO NEW PERSON FILE (#200) | NEW PERSON(#200)
|
.1211 | PATIENT WEIGHT (LBS) | 12;11 | NUMBER |
|
.1212 | TYPE OF TRANSPORT | 12;12 | SET |
|
.1213 | TRANSPORTED TO/FOR | 12;13 | SET |
|
.1214 | POINT OF PICKUP MODIFIER | 12;14 | SET |
|
.1215 | MEDICAL NECESSITY IND | 12;15 | SET |
|
.1216 | DEST MODIFIER | 12;16 | SET |
|
.122 | POINT OF PICKUP ORIGIN | 12;2 | FREE TEXT |
|
.123 | POINT OF PICKUP ADDRESS | 12;3 | FREE TEXT |
|
.124 | POINT OF PICKUP CITY | 12;4 | FREE TEXT |
|
.125 | POINT OF PICKUP STATE | 12;5 | POINTER TO STATE FILE (#5) | STATE(#5)
|
.126 | POINT OF PICKUP ZIP | 12;6 | FREE TEXT |
|
.127 | DESTINATION | 12;7 | VARIABLE POINTER | PATIENT(#9000001) LOCATION(#9999999.06) VENDOR(#9999999.11)
|
.128 | COVERED MILEAGE | 12;8 | NUMBER |
|
.129 | NON-COVERED MILEAGE | 12;9 | NUMBER |
|
.13 | DATE REVIEWED | 1;3 | DATE |
|
.14 | APPROVING OFFICIAL | 1;4 | POINTER TO NEW PERSON FILE (#200) | NEW PERSON(#200)
|
.15 | DATE/TIME APPROVED | 1;5 | DATE |
|
.16 | EXPORT STATUS | 1;6 | SET |
|
.17 | EXPORT NUMBER | 1;7 | POINTER TO 3P TX STATUS FILE (#9002274.6) | 3P TX STATUS(#9002274.6)
|
.175 | EXPORT NUMBER RE-EXPORT | 74;0 | POINTER Multiple #9002274.4074 | 9002274.4074 |
.18 | DATE TX'ED TO AR | 1;8 | POINTER TO 3P AREA OFFICE EXPORT FILE (#9002274.9) | 3P AREA OFFICE EXPORT(#9002274.9)
|
.19 | BILLING LOCATION | 1;9 | POINTER TO LOCATION FILE (#9999999.06) | LOCATION(#9999999.06)
|
.21 | BILL AMOUNT | 2;1 | NUMBER |
|
.22 | INSURER TYPE | 2;2 | FREE TEXT |
|
.23 | GROSS AMOUNT | 2;3 | NUMBER |
|
.24 | REBILL WRITE-OFF | 2;4 | SET |
|
.25 | *UNCOLLECTED BALANCE | 2;5 | NUMBER |
|
.26 | A/R BILL LOCATION | 2;6 | FREE TEXT |
|
.27 | ORIGINAL BILL AMOUNT | 2;7 | NUMBER |
|
.28 | FLAT RATE AMOUNT | 2;8 | NUMBER |
|
.29 | LINE ITEM CONTROL# - FLAT RATE | 2;9 | FREE TEXT |
|
.43 | NUMBER X-RAYS INCLUDED | 4;3 | NUMBER |
|
.44 | ORTHODONTIC RELATED | 4;4 | SET |
|
.45 | ORTHODONTIC PLACEMENT DATE | 4;5 | DATE |
|
.46 | PROTHESIS INCLUDED | 4;6 | SET |
|
.47 | PRIOR PLACEMENT DATE | 4;7 | DATE |
|
.48 | CASE NUMBER | 4;8 | FREE TEXT |
|
.49 | RESUBMISSION (CONTROL) NUMBER | 4;9 | FREE TEXT |
|
.51 | ADMISSION TYPE | 5;1 | POINTER TO 3P CODES FILE (#9002274.03) | 3P CODES(#9002274.03)
|
.511 | REFERRAL NUMBER | 5;11 | FREE TEXT |
|
.512 | PRIOR AUTHORIZATION NUMBER | 5;12 | FREE TEXT |
|
.52 | ADMISSION SOURCE/NEWBORN CODE | 5;2 | POINTER TO 3P CODES FILE (#9002274.03) | 3P CODES(#9002274.03)
|
.525 | NEWBORN DAYS | 5;10 | NUMBER |
|
.53 | DISCHARGE STATUS | 5;3 | POINTER TO 3P CODES FILE (#9002274.03) | 3P CODES(#9002274.03)
|
.54 | PSRO APPROVAL CODE | 5;4 | POINTER TO 3P CODES FILE (#9002274.03) | 3P CODES(#9002274.03)
|
.55 | PSRO APPROVED STAY FROM | 5;5 | DATE |
|
.56 | PSRO APPROVED STAY THRU | 5;6 | DATE |
|
.57 | PROF COMP DAYS | 5;7 | NUMBER |
|
.58 | PRO AUTHORIZATION NUMBER | 5;8 | FREE TEXT |
|
.59 | ADMITTING DIAGNOSIS | 5;9 | POINTER TO ICD DIAGNOSIS FILE (#80) | ICD DIAGNOSIS(#80)
|
.61 | ADMISSION DATE | 6;1 | DATE |
|
.62 | ADMISSION HOUR | 6;2 | NUMBER |
|
.63 | DISCHARGE DATE | 6;3 | DATE |
|
.64 | DISCHARGE HOUR | 6;4 | NUMBER |
|
.66 | NON-COVERED DAYS | 6;6 | NUMBER |
|
.67 | CO-INSURANCE DAYS | 6;7 | NUMBER |
|
.68 | LIFETIME RESERVE DAYS | 6;8 | NUMBER |
|
.69 | NUMBER OF OUTPATIENT VISITS | 6;9 | NUMBER |
|
.71 | SERVICE DATE FROM | 7;1 | DATE |
|
.711 | RELEASE OF INFORMATION DATE | 7;11 | DATE |
|
.712 | ASSIGNMENT OF BENEFITS DATE | 7;12 | DATE |
|
.713 | PROPERTY/CASUALTY CLAIM NUMBER | 7;13 | FREE TEXT |
|
.714 | HEARING/VISION RX DATE | 7;14 | DATE |
|
.715 | START DISABILITY DATE | 7;15 | DATE |
|
.716 | END DISABILITY DATE | 7;16 | DATE |
|
.717 | DATE LAST WORKED | 7;17 | DATE |
|
.718 | DATE AUTH TO RETURN TO WORK | 7;18 | DATE |
|
.719 | ASSUMED CARE DATE | 7;19 | DATE |
|
.72 | SERVICE DATE TO | 7;2 | DATE |
|
.721 | RELINQUISHED CARE DATE | 7;21 | DATE |
|
.722 | PROP/CASUALTY DT 1ST CONTACT | 7;22 | DATE |
|
.723 | PATIENT PAID AMOUNT | 7;23 | NUMBER |
|
.724 | SPINAL MANIPULATION COND CODE | 7;24 | SET |
|
.725 | PROP/CASUAL PATIENT ID | 7;25 | SET |
|
.726 | PROP/CASUAL PATIENT NUMBER | 7;26 | FREE TEXT |
|
.727 | ACUTE MANIFESTATION DATE | 7;27 | DATE |
|
.73 | COVERED DAYS | 7;3 | NUMBER |
|
.74 | RELEASE OF INFORMATION | 7;4 | SET |
|
.75 | ASSIGNMENT OF BENEFITS | 7;5 | SET |
|
.76 | PINTS OF BLOOD FURNISHED | 7;6 | NUMBER |
|
.77 | PINTS OF BLOOD REPLACED | 7;7 | NUMBER |
|
.78 | PINTS OF BLOOD NOT REPLACED | 7;8 | NUMBER |
|
.79 | BLOOD DEDUCTIBLE PINTS | 7;9 | NUMBER |
|
.81 | OUTSIDE LAB CHARGES | 8;1 | NUMBER |
|
.816 | ACCIDENT STATE | 8;16 | POINTER TO STATE FILE (#5) | STATE(#5)
|
.82 | INJURY DATE | 8;2 | DATE |
|
.821 | VISION CONDITION INFO | 8;21 | SET |
|
.822 | VISION CERT. CONDITION IND | 8;22 | SET |
|
.823 | INITIAL TREATMENT DATE | 8;23 | DATE |
|
.824 | EXP35 FL 17 PROVIDER NAME | 8;24 | FREE TEXT |
|
.825 | EXP35 FL17 PROVIDER TYPE | 8;25 | SET |
|
.826 | EXP35 FL17 PROVIDER NPI | 8;26 | FREE TEXT |
|
.83 | ACCIDENT TYPE | 8;3 | SET |
|
.84 | ACCIDENT HOUR | 8;4 | NUMBER |
|
.85 | EMERGENCY (Y/N) | 8;5 | SET |
|
.855 | EMERGENCY ROOM SUR-CHARGE | 8;10 | NUMBER |
|
.857 | E-CODE | 8;12 | POINTER TO ICD DIAGNOSIS FILE (#80) | ICD DIAGNOSIS(#80)
|
.858 | E-CODE (2) | 8;19 | POINTER TO ICD DIAGNOSIS FILE (#80) | ICD DIAGNOSIS(#80)
|
.859 | E-CODE (3) | 8;20 | POINTER TO ICD DIAGNOSIS FILE (#80) | ICD DIAGNOSIS(#80)
|
.86 | DATE OF FIRST SYMPTOM | 8;6 | DATE |
|
.87 | DATE OF FIRST CONSULTATION | 8;7 | DATE |
|
.88 | REFERRING PHYSICIAN | 8;8 | FREE TEXT |
|
.884 | REFERRING PHYS ID QUALIFIER | 8;18 | SET |
|
.885 | REFER PHYSICIAN ID NO. | 8;11 | FREE TEXT |
|
.886 | REFER PHYSICIAN PERSON CLASS | 8;13 | POINTER TO PERSON CLASS FILE (#8932.1) | PERSON CLASS(#8932.1)
|
.887 | REF PHYSICIAN PROVIDER CLASS | 8;14 | POINTER TO PROVIDER CLASS FILE (#7) | PROVIDER CLASS(#7)
|
.888 | REFER PHYSICIAN TAXONOMY CODE | 8;15 | POINTER TO 3P PROVIDER TAXONOMY FILE (#9002274.95) | 3P PROVIDER TAXONOMY(#9002274.95)
|
.889 | REFER PROV NPI | 8;17 | FREE TEXT |
|
.89 | DATE OF SIMILIAR SYMPTOM | 8;9 | DATE |
|
.91 | EMPLOYMENT RELATED (Y/N) | 9;1 | SET |
|
.911 | DATE LAST SEEN | 9;11 | DATE |
|
.912 | SUPERVISING PROV(FL19) | 9;12 | FREE TEXT |
|
.913 | DATE OF LAST X-RAY | 9;13 | DATE |
|
.914 | HOMEBOUND INDICATOR | 9;14 | SET |
|
.915 | HOSPICE EMPLOYED PROVIDER | 9;15 | SET |
|
.916 | DELAYED REASON CODE | 9;16 | POINTER TO 3P CODES FILE (#9002274.03) | 3P CODES(#9002274.03)
|
.918 | ORAL IMAGES | 9;18 | NUMBER |
|
.919 | MODEL(S) | 9;19 | NUMBER |
|
.92 | DATE ABLE TO WORK | 9;2 | DATE |
|
.921 | OTHER DENTAL CHARGES | 9;21 | NUMBER |
|
.922 | IN-HOUSE CLIA# | 9;22 | FREE TEXT |
|
.923 | REFERENCE LAB CLIA# | 9;23 | POINTER TO 3P REFERENCE LAB LOCATIONS FILE (#9002274.35) | 3P REFERENCE LAB LOCATIONS(#9002274.35)
|
.93 | TOTAL DISABILITY FROM DATE | 9;3 | DATE |
|
.94 | TOTAL DISABILITY TO DATE | 9;4 | DATE |
|
.95 | PARTIAL DISABILITY FROM DATE | 9;5 | DATE |
|
.96 | PARTIAL DISABILITY TO DATE | 9;6 | DATE |
|
.97 | *REVENUE CODE | 9;7 | POINTER TO REVENUE CODES FILE (#9999999.72) | REVENUE CODES(#9999999.72)
|
.98 | *REVENUE CHARGE | 9;8 | NUMBER |
|
.99 | PRE-PAYMENT AMOUNT | 9;9 | NUMBER |
|
3 | PAYMENT | 3;0 | DATE Multiple #9002274.403 | 9002274.403 |
8.5 | VISION CONDITION INDICATORS | 8.5;0 | SET Multiple #9002274.4085 | 9002274.4085 |
10 | HCFA 1500-B LINE 19 | 10;1 | FREE TEXT |
|
11 | PCC Visit | 11;0 | POINTER Multiple #9002274.4011 | 9002274.4011
|
13 | Insurer | 13;0 | POINTER Multiple #9002274.4013 | 9002274.4013 |
14 | MED NECESSITY COND | 14;0 | POINTER Multiple #9002274.414 | 9002274.414 |
15 | APC Visit | 15;0 | POINTER Multiple #9002274.4015 | 9002274.4015 |
17 | Diagnosis | 17;0 | POINTER Multiple #9002274.4017 | 9002274.4017 |
19 | ICD Procedure | 19;0 | POINTER Multiple #9002274.4019 | 9002274.4019
|
21 | Med/Surg Procedure | 21;0 | POINTER Multiple #9002274.4021 | 9002274.4021 |
23 | Pharmacy | 23;0 | POINTER Multiple #9002274.4023 | 9002274.4023 |
25 | Revenue Code | 25;0 | POINTER Multiple #9002274.4025 | 9002274.4025
|
27 | Medical Procedures | 27;0 | POINTER Multiple #9002274.4027 | 9002274.4027
|
33 | Dental | 33;0 | POINTER Multiple #9002274.4033 | 9002274.4033 |
35 | Radiology | 35;0 | POINTER Multiple #9002274.4035 | 9002274.4035 |
37 | Laboratory | 37;0 | POINTER Multiple #9002274.4037 | 9002274.4037 |
39 | Anesthesia | 39;0 | POINTER Multiple #9002274.4039 | 9002274.4039 |
41 | Providers | 41;0 | POINTER Multiple #9002274.4041 | 9002274.4041 |
43 | Misc. Services | 43;0 | POINTER Multiple #9002274.4043 | 9002274.4043 |
45 | Charge Master | 45;0 | POINTER Multiple #9002274.4045 | 9002274.4045
|
47 | AMBULANCE SERVICE | 47;0 | POINTER Multiple #9002274.4047 | 9002274.4047 |
51 | Occurrence Code | 51;0 | POINTER Multiple #9002274.4051 | 9002274.4051
|
53 | Condition Code | 53;0 | POINTER Multiple #9002274.4053 | 9002274.4053 |
55 | Value Codes | 55;0 | POINTER Multiple #9002274.4055 | 9002274.4055 |
57 | Occurance Span Code | 57;0 | POINTER Multiple #9002274.4057 | 9002274.4057
|
59 | Special Program Code | 59;0 | POINTER Multiple #9002274.4059 | 9002274.4059
|
61 | REMARKS | 61;0 | Multiple #9002274.4061 | 9002274.4061 |
65 | ACTIVE BILLS | 65;0 | POINTER Multiple #9002274.4065 | 9002274.4065 |
67 | DATE STMT WAS PRINTED | 67;0 | DATE Multiple #9002274.4067 | 9002274.4067 |
69 | UFMS TRANSMISSION DATE | 69;0 | POINTER Multiple #9002274.469 | 9002274.469 |
73 | POS REJECTIONS | 73;0 | Multiple #9002274.4073 | 9002274.4073 |
121 | MSP REASON | 12;1 | SET |
|
411 | RESUBMISSION (CONTROL) NOTE | 4;11 | FREE TEXT |
|
412 | PT STMT MESSAGE | 4;12 | FREE TEXT |
|
413 | ORTHO TRTMT MTHS REMAINING | 4;13 | NUMBER |
|
710 | CLAIM ATTACHMENTS | 71;0 | POINTER Multiple #9002274.4071 | 9002274.4071 |
924 | SUPERVISING PROVIDER | 9;24 | FREE TEXT |
|
925 | SUPERVISING PRV NPI | 9;25 | FREE TEXT |
|
1217 | ORIGINAL MSP REASON | 12;17 | FREE TEXT |
|
1218 | AMBULANCE PATIENT COUNT | 12;18 | NUMBER |
|