ACHSEOBR ;IHS/SET/GTH - EOBR RECORD FORMATS ; [ 12/06/2002 10:36 AM ]
;;3.1;CONTRACT HEALTH MGMT SYSTEM;**5,22,23**;JUN 11, 2001;Build 43
;IHS/SET/GTH ACHS*3.1*5 12/06/2002 - New routine.
;
;;EXPLANATION OF BENEFITS RECORDS LAYOUTS
;; ( ALL RECORDS ARE 80 CHARACTERS )
;; Pieces of info identifying the claim, PO, CHECK, PATIENT
;; AUTHORIZING FACILITY, PROVIDER, ETC., ARE ON RECORD FORMATS A-E
;; FILLER ADDED AS NEEDED.
;;
;; DETAIL RECORDS ARE ON FORMAT F,G & J. POSSIBLE 999
;; LINES OF DETAIL PROCESSED UNDER A CLAIM CONTROL NUMBER (CCN).
;; IF A CLAIM HAS MORE THAN 999 LINES OF DETAIL, IT IS SPLIT USING
;; A "7" IN THE 6TH POSITION OF THE CCN WHERE A "0" NORMALLY
;; APPEARS. IT WOULD BE TRANSMITTED AS A SEPARATE EOBR. EACH
;; LINE HAS A NUMBER WHICH APPEARS ON FORMAT F FIELD 7. CLAIMS
;; ARE SPLIT FOR OTHER REASONS ALSO (MATERNITY CLAIMS WHERE THE
;; BILL INCLUDES CHARGES FOR MOM AND BABY, PROFESSIONAL FEES
;; BILLED ON A UB-82, BILLING CYCLE UB-82 WITH A PATIENT DISCHARGE
;; OF 30). THE MULTIPLE CLAIM INDICATOR IS NOT SENT ON THE EOBR.
;; HOWEVER, ANY CLAIM WITH A CCN THAT HAS A "7" IN THE SIXTH POSITION
;; IS A SPLIT CLAIM. THESE MAY NEED TO BE HANDLED IN SOME UNIQUE
;; WAY BY IHS TO POST THE PAYMENT TO THE CHS/MIS SYSTEM AND UPDATE
;; THE COMMITMENT REGISTER RECOGNIZING ANOTHER PAYMENT FOR THAT
;; PO NUMBER WILL BE FORTHCOMING.
;;
;; ANOTHER KEY ELEMENT MIGHT BE THE INTERIM/FINAL PAYMENT WHICH
;; APPEARS ON FORMAT C FIELD 13. THE FI'S SYSTEM IDENTIFIES THE
;; SPLIT CLAIMS AND SENDS THE EOBR AND PAYMENT DHR AS AN INTERIM
;; UNLESS IT IS THE LAST CLAIM PROCESSED WITH THAT PURCHASE ORDER
;; NUMBER WHICH BECOMES THE FINAL, AND CLOSES THE SHR424 OBLIGATION.
;; AN INTERIM DECREASES THE OBLIGATION AMOUNT BUT DOES NOT CLOSE IT.
;; EOBR AND DHR FOR BLANKET PO'S ARE REPORTED AS INTERIM PAYMENTS.
;;
;; A - HEADING
;; B - HEADING
;; C - HEADING
;; D - HEADING
;; E - HEADING
;; F - DETAIL
;; G - PROCEDURE CODES
;; H - SUMMARY
;; A - HEADING
;; NUM NAME PIC COMMENTS LOC
;; --- ------------------ ----- ----------------------- -----
;; 01 AREA OFFICE X(02) MUST BE A VALID AREA 01-02
;; 02 SERVICE UNIT X(02) 03-04
;; 03 FACILITY NUMBER X(02) 05-06
;; 04 FISCAL YEAR X(02) 07-08
;; 05 CLAIM NUMBER 9(10) 2ND PART OF CONTROL NBR 09-18
;; 06 RECORD TYPE X(01) ALWAYS 'A' 19-19
;; 07 SEQUENCE NUMBER 9(03) ALWAYS 001 20-22
;; 08 CLAIM SEQUENCE CNT 9(09) A COUNT ON 2ND LINE OF 23-31
;; REPORT
;; 09 CHECK NUMBER 9(07) 32-38
;; 10 REMITTANCE NBR 9(07) 39-45
;; 11 PAID DATE X(08) FORMAT CCYYMMDD 46-53
;; 12 PURCHASE ORDER NBR X(12) FORMAT XX-XXX-XXXXX 54-65
;; 13 CERTIFICATE NBR X(07) 1ST PART OF CONTROL NBR 66-72
;; 14 FACILITY CODE X(06) 73-78
;; 15 DOCUMENTATION TYPE X(02) 79-80
;;
;; B - HEADING
;; NUM NAME PIC COMMENTS LOC
;; --- ------------------ ----- ----------------------- -----
;; 01 AREA OFFICE X(02) MUST BE A VALID AREA 01-02
;; 02 SERVICE UNIT X(02) 03-04
;; 03 FACILITY NUMBER X(02) 05-06
;; 04 FISCAL YEAR X(02) 07-08
;; 05 CLAIM NUMBER 9(10) 09-18
;; 06 RECORD TYPE X(01) ALWAYS 'B' 19-19
;; 07 SEQUENCE NUMBER 9(03) ALWAYS 001 20-22
;; 08 PATIENT NAME X(30) 23-52
;; 09 HEALTH RECORD NBR X(07) 53-59
;; 10 AUTHORIZATION DATE X(08) FORMAT CCYYMMDD 60-67
;; 11 ACTUAL DAYS 9(02) INPATIENT DAYS 68-69
;; 12 DRG 9(03) 70-72
;;ACHS*3.1*22 FIXED SCC
;; 14 SERVICE CLASS CODE X(04) 73-76
;; 15 FILLER X(02) 77-80
;;***PRIOR TO PATCH ACHS*3.1*22
;; 13 DISCHARGE STATUS X(02) 73-74
;; 14 SERVICE CLASS CODE X(04) 75-78
;; 15 FILLER X(02) 79-80
;;
;; C - HEADING
;; NUM NAME PIC COMMENTS LOC
;; --- ------------------ ----- ----------------------- -----
;; 01 AREA OFFICE X(02) MUST BE A VALID AREA 01-02
;; 02 SERVICE UNIT X(02) 03-04
;; 03 FACILITY NUMBER X(02) 05-06
;; 04 FISCAL YEAR X(02) 07-08
;; 05 CLAIM NUMBER 9(10) 09-18
;; 06 RECORD TYPE X(01) ALWAYS 'C' 19-19
;; 07 SEQUENCE NUMBER 9(03) 001 OR 002 20-22
;; For 001:
;; 08 COMMON ACCT NBR X(16) 23-38
;; 09 OBJECT CLASS CODE X(04) 39-42
;; 10 SERVICES BILLED X(01) A = PROF B = INPATIENT 43-43
;; C = OUTPAT D = DENTAL
;; 11 BLANKET INDICATOR X(01) Y = YES, ELSE NO 44-44
;; 12 CONTRACT NUMBER X(10) 45-54
;; 13 INTERIM/FINAL IND X(01) F = FINAL I = INTERIM 55-55
;; 16 VENDOR NUMBER X(13) PROVIDER ID - SUFFIX 56-68
;; FILLER 69-80
;; For 002:
;; 14 SERVICE START DATE X(08) FORMAT CCYYMMDD 23-30
;; 15 SERVICE END DATE X(08) FORMAT CCYYMMDD 31-38
;;
;; D - HEADING
;; NUM NAME PIC COMMENTS LOC
;; --- ------------------ ----- ----------------------- -----
;; 01 AREA OFFICE X(02) MUST BE A VALID AREA 01-02
;; 02 SERVICE UNIT X(02) 03-04
;; 03 FACILITY NUMBER X(02) 05-06
;; 04 FISCAL YEAR X(02) 07-08
;; 05 CLAIM NUMBER 9(10) 09-18
;; 06 RECORD TYPE X(01) ALWAYS 'D' 19-19
;; 07 SEQUENCE NUMBER 9(03) ALWAYS 001 20-22
;; 08 VENDOR NAME X(30) 23-52
;; 09 BILLED BY PROVIDER S9(07)V99 FIELD WILL CONTAIN 53-61
;; ALL '*' IF IT IS NOT
;; APPLICABLE
;; 10 ALLOWABLE AMOUNT S9(07)V99 62-70
;; 11 PAID BY 3RD PARTY S9(07)V99 71-79
;; 12 FILLER X(01) 80-80
;;
;; E - HEADING
;; NUM NAME PIC COMMENTS LOC
;; --- ------------------ ----- ----------------------- -----
;; 01 AREA OFFICE X(02) MUST BE A VALID AREA 01-02
;; 02 SERVICE UNIT X(02) 03-04
;; 03 FACILITY NUMBER X(02) 05-06
;; 04 FISCAL YEAR X(02) 07-08
;; 05 CLAIM NUMBER 9(10) 09-18
;; 06 RECORD TYPE X(01) ALWAYS 'E' 19-19
;; 07 SEQUENCE NUMBER 9(03) ALWAYS 001 20-22
;; 08 IHS COST S9(09)V99 23-31
;; 09 OBLIGATION IND X(01) 1=P.O. NBR, 2=SHR 424 32-32
;; 10 OBLIGATION AMOUNT S9(09)V99 FIELD WILL CONTAIN 33-41
;; ALL '*' IF IT IS NOT
;; APPLICABLE
;; 11 ADJUSTMENT AMOUNT S9(09)V99 FIELD WILL CONTAIN 42-50
;; ALL '*' IF IT IS NOT
;; APPLICABLE
;; 12 DIAGNOSIS CODE 1 X(06) 51-56 ;ACHS*3.1*23
;; 13 DIAGNOSIS CODE 2 X(06) 57-62 ;ACHS*3.1*23
;; 14 DIAGNOSIS CODE 3 X(06) 63-68 ;ACHS*3.1*23
;; 15 DIAGNOSIS CODE 4 X(06) 69-74 ;ACHS*3.1*23
;; 16 DIAGNOSIS CODE 5 X(06) 75-80 ;ACHS*3.1*23
;;
;; F - DETAIL
;; NUM NAME PIC COMMENTS LOC
;; --- ------------------ ----- ----------------------- -----
;; 01 AREA OFFICE X(02) MUST BE A VALID AREA 01-02
;; 02 SERVICE UNIT X(02) 03-04
;; 03 FACILITY NUMBER X(02) 05-06
;; 04 FISCAL YEAR X(02) 07-08
;; 05 CLAIM NUMBER 9(10) 09-18
;; 06 RECORD TYPE X(01) ALWAYS 'F' 19-19
;; 07 SEQUENCE NUMBER 9(03) FROM 001 TO 999 20-22
;; 08 FROM DATE OF SVC X(08) FORMAT CCYYMMDD 23-30
;; 09 TO DATE OF SVC X(09) FORMAT CCYYMMDD 31-38
;; 10 PROCEDURE CODE X(05) 39-43
;; 11 UNITS BILLED 9(03) 44-46
;; 12 BILLED CHARGES S9(07)V99 47-55
;; 13 ALLOWABLE CHARGES S9(07)V99 56-64
;; 14 MESSAGE X(04) 65-68
;; 15 TOOTH NUMBER X(02) 69-70
;; 16 TOOTH SURFACE X(05) 71-75
;; 17 FILLER X(05) 76-80
;;
;; G - PROCEDURES
;; NUM NAME PIC COMMENTS LOC
;; --- ------------------ ----- ----------------------- -----
;; 01 AREA OFFICE X(02) MUST BE A VALID AREA 01-02
;; 02 SERVICE UNIT X(02) 03-04
;; 03 FACILITY NUMBER X(02) 05-06
;; 04 FISCAL YEAR X(02) 07-08
;; 05 CLAIM NUMBER 9(10) 09-18
;; 06 RECORD TYPE X(01) ALWAYS 'G' 19-19
;; 07 SEQUENCE NUMBER 9(03) ALWAYS 001 20-22
;; 08 PROCEDURE CODE 1 9(07) 23-29 ;ACHS*3.1*23
;; 09 PROCEDURE CODE 2 9(07) 30-36 ;ACHS*3.1*23
;; 10 PROCEDURE CODE 3 9(07) 37-43 ;ACHS*3.1*23
;; 09 PROCEDURE CODE 4 9(07) 44-50 ;ACHS*3.1*23
;; 10 PROCEDURE CODE 5 9(07) 51-57 ;ACHS*3.1*23
;; 11 FILLER X(23) 58-80 ;ACHS*3.1*23
;;
;; I-INTEREST INFO FOR A GIVEN CLAIM
;; NUM NAME PIC COMMENTS LOC
;; --- ------------------ ----- ----------------------- -----
;; 01 AREA OFFICE X(02) MUST BE A VALID AREA 01-02
;; 02 SERVICE UNIT X(02) 03-04
;; 03 FACILITY NUMBER X(02) 05-06
;; 04 FISCAL YEAR X(02) 07-08
;; 05 CLAIM NUMBER 9(10) 09-18
;; 06 RECORD TYPE X(01) ALWAYS 'I' 19-19
;; 07 SEQUENCE NUMBER 9(03) ALWAYS 001 20-22
;; 08 INTEREST CAN X(07) 23-29
;; 09 INTEREST OCC X(04) 30-33
;; 10 INTEREST RATE S9(05)V999 34-38
;; 11 DAYS ELIGIBLE 9(03) 39-41
;; 12 INTEREST PAID S9(09)V99 42-50
;; 13 ADD'L PENALTY PAID S9(06)V99 51-56
;; 14 TOT PD THIS CLAIM S9(10)V99 57-66
;; 15 FILLER X(14) 67-80
;;
;; H-SUMMARY
;; NUM NAME PIC COMMENTS LOC
;; --- ------------------ ----- ----------------------- -----
;; 01 AREA OFFICE X(02) MUST BE A VALID AREA 01-02
;; 02 SERVICE UNIT X(02) 03-04
;; 03 FACILITY NUMBER X(02) 05-06
;; 04 FISCAL YEAR X(02) 07-08
;; 05 CLAIM NUMBER 9(10) 09-18
;; 06 RECORD TYPE X(01) ALWAYS 'H' 19-19
;; 07 SEQUENCE NUMBER 9(03) 001 OR 002 20-22
;; For 001:
;; 08 FACILITY CODE X(06) 23-28
;; FILLER X(12) 29-40
;; 11 TYPE 43 CLAIMS 9(05) 41-45
;; 12 TYPE 57 CLAIMS 9(05) 46-50
;; 13 TYPE 64 CLAIMS 9(05) 51-55
;; 14 TOTAL OF PAYMENTS S9(10)V99 56-65
;; 16 # OF OCC4319 PYMTS 9(05) 66-70
;; 15 TOT INT/LATE PEN S9(10)V99 71-80
;; For 002:
;; 09 PERIOD FROM DATE X(08) FORMAT CCYYMMDD 23-30
;; 10 PERIOD TO DATE X(08) FORMAT CCYYMMDD 31-38
;;
;; J-HEADING ;ACHS*3.1*23 ICD-10 REC
;; NUM NAME PIC COMMENTS LOC
;; --- ------------------ ----- ----------------------- -----
;; 01 AREA OFFICE X(02) MUST BE A VALID AREA 01-02
;; 02 SERVICE UNIT X(02) 03-04
;; 03 FACILITY NUMBER X(02) 05-06
;; 04 FISCAL YEAR X(02) 07-08
;; 05 CLAIM NUMBER 9(10) 09-18
;; 06 RECORD TYPE X(01) ALWAYS 'J' 19-19
;; 07 SEQUENCE NUMBER 9(03) ALWAYS 001 20-22
;; 08 IHS COST S9(07)V99 23-31
;; 09 OBLIGATION IND X(01) 1=P.O. NBR, 2=SHR 424 32-32
;; 10 OBLIGATION AMOUNT S9(07)V99 FIELD WILL CONTAIN 33-41
;; ALL '*' IF IT IS NOT
;; APPLICABLE
;; 11 ADJUSTMENT AMOUNT S9(07)V99 FIELD WILL CONTAIN 42-50
;; ALL '*' IF IT IS NOT
;; APPLICABLE
;; 12 DIAGNOSIS CODE 1 X(08) 51-58
;; 13 DIAGNOSIS CODE 2 X(08) 59-66
;; 14 DIAGNOSIS CODE 3 X(08) 67-74
;; 15 FILLER X(06) 75-80
;;
ACHSEOBR ;IHS/SET/GTH - EOBR RECORD FORMATS ; [ 12/06/2002 10:36 AM ]
+1 ;;3.1;CONTRACT HEALTH MGMT SYSTEM;**5,22,23**;JUN 11, 2001;Build 43
+2 ;IHS/SET/GTH ACHS*3.1*5 12/06/2002 - New routine.
+3 ;
+4 ;;EXPLANATION OF BENEFITS RECORDS LAYOUTS
+5 ;; ( ALL RECORDS ARE 80 CHARACTERS )
+6 ;; Pieces of info identifying the claim, PO, CHECK, PATIENT
+7 ;; AUTHORIZING FACILITY, PROVIDER, ETC., ARE ON RECORD FORMATS A-E
+8 ;; FILLER ADDED AS NEEDED.
+9 ;;
+10 ;; DETAIL RECORDS ARE ON FORMAT F,G & J. POSSIBLE 999
+11 ;; LINES OF DETAIL PROCESSED UNDER A CLAIM CONTROL NUMBER (CCN).
+12 ;; IF A CLAIM HAS MORE THAN 999 LINES OF DETAIL, IT IS SPLIT USING
+13 ;; A "7" IN THE 6TH POSITION OF THE CCN WHERE A "0" NORMALLY
+14 ;; APPEARS. IT WOULD BE TRANSMITTED AS A SEPARATE EOBR. EACH
+15 ;; LINE HAS A NUMBER WHICH APPEARS ON FORMAT F FIELD 7. CLAIMS
+16 ;; ARE SPLIT FOR OTHER REASONS ALSO (MATERNITY CLAIMS WHERE THE
+17 ;; BILL INCLUDES CHARGES FOR MOM AND BABY, PROFESSIONAL FEES
+18 ;; BILLED ON A UB-82, BILLING CYCLE UB-82 WITH A PATIENT DISCHARGE
+19 ;; OF 30). THE MULTIPLE CLAIM INDICATOR IS NOT SENT ON THE EOBR.
+20 ;; HOWEVER, ANY CLAIM WITH A CCN THAT HAS A "7" IN THE SIXTH POSITION
+21 ;; IS A SPLIT CLAIM. THESE MAY NEED TO BE HANDLED IN SOME UNIQUE
+22 ;; WAY BY IHS TO POST THE PAYMENT TO THE CHS/MIS SYSTEM AND UPDATE
+23 ;; THE COMMITMENT REGISTER RECOGNIZING ANOTHER PAYMENT FOR THAT
+24 ;; PO NUMBER WILL BE FORTHCOMING.
+25 ;;
+26 ;; ANOTHER KEY ELEMENT MIGHT BE THE INTERIM/FINAL PAYMENT WHICH
+27 ;; APPEARS ON FORMAT C FIELD 13. THE FI'S SYSTEM IDENTIFIES THE
+28 ;; SPLIT CLAIMS AND SENDS THE EOBR AND PAYMENT DHR AS AN INTERIM
+29 ;; UNLESS IT IS THE LAST CLAIM PROCESSED WITH THAT PURCHASE ORDER
+30 ;; NUMBER WHICH BECOMES THE FINAL, AND CLOSES THE SHR424 OBLIGATION.
+31 ;; AN INTERIM DECREASES THE OBLIGATION AMOUNT BUT DOES NOT CLOSE IT.
+32 ;; EOBR AND DHR FOR BLANKET PO'S ARE REPORTED AS INTERIM PAYMENTS.
+33 ;;
+34 ;; A - HEADING
+35 ;; B - HEADING
+36 ;; C - HEADING
+37 ;; D - HEADING
+38 ;; E - HEADING
+39 ;; F - DETAIL
+40 ;; G - PROCEDURE CODES
+41 ;; H - SUMMARY
+42 ;; A - HEADING
+43 ;; NUM NAME PIC COMMENTS LOC
+44 ;; --- ------------------ ----- ----------------------- -----
+45 ;; 01 AREA OFFICE X(02) MUST BE A VALID AREA 01-02
+46 ;; 02 SERVICE UNIT X(02) 03-04
+47 ;; 03 FACILITY NUMBER X(02) 05-06
+48 ;; 04 FISCAL YEAR X(02) 07-08
+49 ;; 05 CLAIM NUMBER 9(10) 2ND PART OF CONTROL NBR 09-18
+50 ;; 06 RECORD TYPE X(01) ALWAYS 'A' 19-19
+51 ;; 07 SEQUENCE NUMBER 9(03) ALWAYS 001 20-22
+52 ;; 08 CLAIM SEQUENCE CNT 9(09) A COUNT ON 2ND LINE OF 23-31
+53 ;; REPORT
+54 ;; 09 CHECK NUMBER 9(07) 32-38
+55 ;; 10 REMITTANCE NBR 9(07) 39-45
+56 ;; 11 PAID DATE X(08) FORMAT CCYYMMDD 46-53
+57 ;; 12 PURCHASE ORDER NBR X(12) FORMAT XX-XXX-XXXXX 54-65
+58 ;; 13 CERTIFICATE NBR X(07) 1ST PART OF CONTROL NBR 66-72
+59 ;; 14 FACILITY CODE X(06) 73-78
+60 ;; 15 DOCUMENTATION TYPE X(02) 79-80
+61 ;;
+62 ;; B - HEADING
+63 ;; NUM NAME PIC COMMENTS LOC
+64 ;; --- ------------------ ----- ----------------------- -----
+65 ;; 01 AREA OFFICE X(02) MUST BE A VALID AREA 01-02
+66 ;; 02 SERVICE UNIT X(02) 03-04
+67 ;; 03 FACILITY NUMBER X(02) 05-06
+68 ;; 04 FISCAL YEAR X(02) 07-08
+69 ;; 05 CLAIM NUMBER 9(10) 09-18
+70 ;; 06 RECORD TYPE X(01) ALWAYS 'B' 19-19
+71 ;; 07 SEQUENCE NUMBER 9(03) ALWAYS 001 20-22
+72 ;; 08 PATIENT NAME X(30) 23-52
+73 ;; 09 HEALTH RECORD NBR X(07) 53-59
+74 ;; 10 AUTHORIZATION DATE X(08) FORMAT CCYYMMDD 60-67
+75 ;; 11 ACTUAL DAYS 9(02) INPATIENT DAYS 68-69
+76 ;; 12 DRG 9(03) 70-72
+77 ;;ACHS*3.1*22 FIXED SCC
+78 ;; 14 SERVICE CLASS CODE X(04) 73-76
+79 ;; 15 FILLER X(02) 77-80
+80 ;;***PRIOR TO PATCH ACHS*3.1*22
+81 ;; 13 DISCHARGE STATUS X(02) 73-74
+82 ;; 14 SERVICE CLASS CODE X(04) 75-78
+83 ;; 15 FILLER X(02) 79-80
+84 ;;
+85 ;; C - HEADING
+86 ;; NUM NAME PIC COMMENTS LOC
+87 ;; --- ------------------ ----- ----------------------- -----
+88 ;; 01 AREA OFFICE X(02) MUST BE A VALID AREA 01-02
+89 ;; 02 SERVICE UNIT X(02) 03-04
+90 ;; 03 FACILITY NUMBER X(02) 05-06
+91 ;; 04 FISCAL YEAR X(02) 07-08
+92 ;; 05 CLAIM NUMBER 9(10) 09-18
+93 ;; 06 RECORD TYPE X(01) ALWAYS 'C' 19-19
+94 ;; 07 SEQUENCE NUMBER 9(03) 001 OR 002 20-22
+95 ;; For 001:
+96 ;; 08 COMMON ACCT NBR X(16) 23-38
+97 ;; 09 OBJECT CLASS CODE X(04) 39-42
+98 ;; 10 SERVICES BILLED X(01) A = PROF B = INPATIENT 43-43
+99 ;; C = OUTPAT D = DENTAL
+100 ;; 11 BLANKET INDICATOR X(01) Y = YES, ELSE NO 44-44
+101 ;; 12 CONTRACT NUMBER X(10) 45-54
+102 ;; 13 INTERIM/FINAL IND X(01) F = FINAL I = INTERIM 55-55
+103 ;; 16 VENDOR NUMBER X(13) PROVIDER ID - SUFFIX 56-68
+104 ;; FILLER 69-80
+105 ;; For 002:
+106 ;; 14 SERVICE START DATE X(08) FORMAT CCYYMMDD 23-30
+107 ;; 15 SERVICE END DATE X(08) FORMAT CCYYMMDD 31-38
+108 ;;
+109 ;; D - HEADING
+110 ;; NUM NAME PIC COMMENTS LOC
+111 ;; --- ------------------ ----- ----------------------- -----
+112 ;; 01 AREA OFFICE X(02) MUST BE A VALID AREA 01-02
+113 ;; 02 SERVICE UNIT X(02) 03-04
+114 ;; 03 FACILITY NUMBER X(02) 05-06
+115 ;; 04 FISCAL YEAR X(02) 07-08
+116 ;; 05 CLAIM NUMBER 9(10) 09-18
+117 ;; 06 RECORD TYPE X(01) ALWAYS 'D' 19-19
+118 ;; 07 SEQUENCE NUMBER 9(03) ALWAYS 001 20-22
+119 ;; 08 VENDOR NAME X(30) 23-52
+120 ;; 09 BILLED BY PROVIDER S9(07)V99 FIELD WILL CONTAIN 53-61
+121 ;; ALL '*' IF IT IS NOT
+122 ;; APPLICABLE
+123 ;; 10 ALLOWABLE AMOUNT S9(07)V99 62-70
+124 ;; 11 PAID BY 3RD PARTY S9(07)V99 71-79
+125 ;; 12 FILLER X(01) 80-80
+126 ;;
+127 ;; E - HEADING
+128 ;; NUM NAME PIC COMMENTS LOC
+129 ;; --- ------------------ ----- ----------------------- -----
+130 ;; 01 AREA OFFICE X(02) MUST BE A VALID AREA 01-02
+131 ;; 02 SERVICE UNIT X(02) 03-04
+132 ;; 03 FACILITY NUMBER X(02) 05-06
+133 ;; 04 FISCAL YEAR X(02) 07-08
+134 ;; 05 CLAIM NUMBER 9(10) 09-18
+135 ;; 06 RECORD TYPE X(01) ALWAYS 'E' 19-19
+136 ;; 07 SEQUENCE NUMBER 9(03) ALWAYS 001 20-22
+137 ;; 08 IHS COST S9(09)V99 23-31
+138 ;; 09 OBLIGATION IND X(01) 1=P.O. NBR, 2=SHR 424 32-32
+139 ;; 10 OBLIGATION AMOUNT S9(09)V99 FIELD WILL CONTAIN 33-41
+140 ;; ALL '*' IF IT IS NOT
+141 ;; APPLICABLE
+142 ;; 11 ADJUSTMENT AMOUNT S9(09)V99 FIELD WILL CONTAIN 42-50
+143 ;; ALL '*' IF IT IS NOT
+144 ;; APPLICABLE
+145 ;; 12 DIAGNOSIS CODE 1 X(06) 51-56 ;ACHS*3.1*23
+146 ;; 13 DIAGNOSIS CODE 2 X(06) 57-62 ;ACHS*3.1*23
+147 ;; 14 DIAGNOSIS CODE 3 X(06) 63-68 ;ACHS*3.1*23
+148 ;; 15 DIAGNOSIS CODE 4 X(06) 69-74 ;ACHS*3.1*23
+149 ;; 16 DIAGNOSIS CODE 5 X(06) 75-80 ;ACHS*3.1*23
+150 ;;
+151 ;; F - DETAIL
+152 ;; NUM NAME PIC COMMENTS LOC
+153 ;; --- ------------------ ----- ----------------------- -----
+154 ;; 01 AREA OFFICE X(02) MUST BE A VALID AREA 01-02
+155 ;; 02 SERVICE UNIT X(02) 03-04
+156 ;; 03 FACILITY NUMBER X(02) 05-06
+157 ;; 04 FISCAL YEAR X(02) 07-08
+158 ;; 05 CLAIM NUMBER 9(10) 09-18
+159 ;; 06 RECORD TYPE X(01) ALWAYS 'F' 19-19
+160 ;; 07 SEQUENCE NUMBER 9(03) FROM 001 TO 999 20-22
+161 ;; 08 FROM DATE OF SVC X(08) FORMAT CCYYMMDD 23-30
+162 ;; 09 TO DATE OF SVC X(09) FORMAT CCYYMMDD 31-38
+163 ;; 10 PROCEDURE CODE X(05) 39-43
+164 ;; 11 UNITS BILLED 9(03) 44-46
+165 ;; 12 BILLED CHARGES S9(07)V99 47-55
+166 ;; 13 ALLOWABLE CHARGES S9(07)V99 56-64
+167 ;; 14 MESSAGE X(04) 65-68
+168 ;; 15 TOOTH NUMBER X(02) 69-70
+169 ;; 16 TOOTH SURFACE X(05) 71-75
+170 ;; 17 FILLER X(05) 76-80
+171 ;;
+172 ;; G - PROCEDURES
+173 ;; NUM NAME PIC COMMENTS LOC
+174 ;; --- ------------------ ----- ----------------------- -----
+175 ;; 01 AREA OFFICE X(02) MUST BE A VALID AREA 01-02
+176 ;; 02 SERVICE UNIT X(02) 03-04
+177 ;; 03 FACILITY NUMBER X(02) 05-06
+178 ;; 04 FISCAL YEAR X(02) 07-08
+179 ;; 05 CLAIM NUMBER 9(10) 09-18
+180 ;; 06 RECORD TYPE X(01) ALWAYS 'G' 19-19
+181 ;; 07 SEQUENCE NUMBER 9(03) ALWAYS 001 20-22
+182 ;; 08 PROCEDURE CODE 1 9(07) 23-29 ;ACHS*3.1*23
+183 ;; 09 PROCEDURE CODE 2 9(07) 30-36 ;ACHS*3.1*23
+184 ;; 10 PROCEDURE CODE 3 9(07) 37-43 ;ACHS*3.1*23
+185 ;; 09 PROCEDURE CODE 4 9(07) 44-50 ;ACHS*3.1*23
+186 ;; 10 PROCEDURE CODE 5 9(07) 51-57 ;ACHS*3.1*23
+187 ;; 11 FILLER X(23) 58-80 ;ACHS*3.1*23
+188 ;;
+189 ;; I-INTEREST INFO FOR A GIVEN CLAIM
+190 ;; NUM NAME PIC COMMENTS LOC
+191 ;; --- ------------------ ----- ----------------------- -----
+192 ;; 01 AREA OFFICE X(02) MUST BE A VALID AREA 01-02
+193 ;; 02 SERVICE UNIT X(02) 03-04
+194 ;; 03 FACILITY NUMBER X(02) 05-06
+195 ;; 04 FISCAL YEAR X(02) 07-08
+196 ;; 05 CLAIM NUMBER 9(10) 09-18
+197 ;; 06 RECORD TYPE X(01) ALWAYS 'I' 19-19
+198 ;; 07 SEQUENCE NUMBER 9(03) ALWAYS 001 20-22
+199 ;; 08 INTEREST CAN X(07) 23-29
+200 ;; 09 INTEREST OCC X(04) 30-33
+201 ;; 10 INTEREST RATE S9(05)V999 34-38
+202 ;; 11 DAYS ELIGIBLE 9(03) 39-41
+203 ;; 12 INTEREST PAID S9(09)V99 42-50
+204 ;; 13 ADD'L PENALTY PAID S9(06)V99 51-56
+205 ;; 14 TOT PD THIS CLAIM S9(10)V99 57-66
+206 ;; 15 FILLER X(14) 67-80
+207 ;;
+208 ;; H-SUMMARY
+209 ;; NUM NAME PIC COMMENTS LOC
+210 ;; --- ------------------ ----- ----------------------- -----
+211 ;; 01 AREA OFFICE X(02) MUST BE A VALID AREA 01-02
+212 ;; 02 SERVICE UNIT X(02) 03-04
+213 ;; 03 FACILITY NUMBER X(02) 05-06
+214 ;; 04 FISCAL YEAR X(02) 07-08
+215 ;; 05 CLAIM NUMBER 9(10) 09-18
+216 ;; 06 RECORD TYPE X(01) ALWAYS 'H' 19-19
+217 ;; 07 SEQUENCE NUMBER 9(03) 001 OR 002 20-22
+218 ;; For 001:
+219 ;; 08 FACILITY CODE X(06) 23-28
+220 ;; FILLER X(12) 29-40
+221 ;; 11 TYPE 43 CLAIMS 9(05) 41-45
+222 ;; 12 TYPE 57 CLAIMS 9(05) 46-50
+223 ;; 13 TYPE 64 CLAIMS 9(05) 51-55
+224 ;; 14 TOTAL OF PAYMENTS S9(10)V99 56-65
+225 ;; 16 # OF OCC4319 PYMTS 9(05) 66-70
+226 ;; 15 TOT INT/LATE PEN S9(10)V99 71-80
+227 ;; For 002:
+228 ;; 09 PERIOD FROM DATE X(08) FORMAT CCYYMMDD 23-30
+229 ;; 10 PERIOD TO DATE X(08) FORMAT CCYYMMDD 31-38
+230 ;;
+231 ;; J-HEADING ;ACHS*3.1*23 ICD-10 REC
+232 ;; NUM NAME PIC COMMENTS LOC
+233 ;; --- ------------------ ----- ----------------------- -----
+234 ;; 01 AREA OFFICE X(02) MUST BE A VALID AREA 01-02
+235 ;; 02 SERVICE UNIT X(02) 03-04
+236 ;; 03 FACILITY NUMBER X(02) 05-06
+237 ;; 04 FISCAL YEAR X(02) 07-08
+238 ;; 05 CLAIM NUMBER 9(10) 09-18
+239 ;; 06 RECORD TYPE X(01) ALWAYS 'J' 19-19
+240 ;; 07 SEQUENCE NUMBER 9(03) ALWAYS 001 20-22
+241 ;; 08 IHS COST S9(07)V99 23-31
+242 ;; 09 OBLIGATION IND X(01) 1=P.O. NBR, 2=SHR 424 32-32
+243 ;; 10 OBLIGATION AMOUNT S9(07)V99 FIELD WILL CONTAIN 33-41
+244 ;; ALL '*' IF IT IS NOT
+245 ;; APPLICABLE
+246 ;; 11 ADJUSTMENT AMOUNT S9(07)V99 FIELD WILL CONTAIN 42-50
+247 ;; ALL '*' IF IT IS NOT
+248 ;; APPLICABLE
+249 ;; 12 DIAGNOSIS CODE 1 X(08) 51-58
+250 ;; 13 DIAGNOSIS CODE 2 X(08) 59-66
+251 ;; 14 DIAGNOSIS CODE 3 X(08) 67-74
+252 ;; 15 FILLER X(06) 75-80
+253 ;;
