| FileMan FileNo | FileMan Filename | Package |
|---|---|---|
| 9000003 | MEDICARE ELIGIBLE | IHS Patient |
| Package | Total | FileMan Files |
|---|---|---|
| IHS Patient | 1 | MEDICARE CLAIMS(#9000003.01)[.02] |
| Package | Total | FileMan Files |
|---|---|---|
| Utility Tables | 3 | EMPLOYER GROUP INSURANCE(#9999999.77)[#9000003.11(.11)] INSURER(#9999999.18)[.02, #9000003.11(.04)] MEDICARE SUFFIX(#9999999.32)[.04] |
| IHS Patient | 1 | PATIENT(#9000001)[.01] |
| Field # | Name | Loc | Type | Details |
|---|---|---|---|---|
| .01 | PATIENT NAME | 0;1 | POINTER TO PATIENT FILE (#9000001) | ************************REQUIRED FIELD************************ PATIENT(#9000001)
|
| .02 | INSURER POINTER | 0;2 | POINTER TO INSURER FILE (#9999999.18) | ************************REQUIRED FIELD************************ INSURER(#9999999.18)
|
| .03 | MEDICARE NUMBER | 0;3 | FREE TEXT | ************************REQUIRED FIELD************************
|
| .04 | SUFFIX | 0;4 | POINTER TO MEDICARE SUFFIX FILE (#9999999.32) | ************************REQUIRED FIELD************************ MEDICARE SUFFIX(#9999999.32)
|
| .05 | MEDICARE SECONDARY PAYER | 0;5 | DATE |
|
| .07 | DATE OF LAST UPDATE | 0;7 | DATE |
|
| .08 | QMB/SLMB | 0;8 | SET |
|
| .09 | *IMP MSG FORM MCR SIG OBTAINED | 0;9 | DATE |
|
| .14 | PRIMARY CARE PROVIDER | 0;14 | FREE TEXT |
|
| .15 | MEDICARE CARD COPY ON FILE | 0;15 | SET |
|
| .16 | DATE MEDICARE CC WAS OBTAINED | 0;16 | DATE |
|
| 1101 | ELIGIBILITY | 11;0 | DATE Multiple #9000003.11 | 9000003.11 |
| 1201 | IMP MSG FORM MCR SIG OBTAINED | 12;0 | DATE Multiple #9000003.01201 | 9000003.01201 |
| 1301 | ADVANCE BENEFICIARY NOTICE | 13;0 | DATE Multiple #9000003.13 | 9000003.13 |
| 2101 | MEDICARE NAME | 21;1 | FREE TEXT |
|
| 2102 | MEDICARE DATE OF BIRTH | 21;2 | DATE |
|