- BAR50IT3 ; IHS/SD/LSL - CREATE AN ENTRY IN A/R EDI TRANSPORT FILE (3) ;
- ;;1.8;IHS ACCOUNTS RECEIVABLE;**21**;OCT 26, 2005
- ;
- ; IHS/SD/LSL - 08/01/2002 - V1.8 PATCH 21
- ; For HIPAA compliance. Make 835 v5010 entry in A/R EDI
- ; TRANSPORT FILE. This routine defines the Elements.
- ;
- ; ********************************************************************
- Q
- ; ********************************************************************
- ELEMENT ; EP
- ; Create Element Multiple w/in Segment Multiple in A/R EDI TRANSPORT
- S BARELCNT=0
- F D ELEMENT2 Q:BARELEM="END"
- Q
- ; ********************************************************************
- ELEMENT2 ;
- ; Loop Elements
- ;B:DUZ=398 "S+"
- S BARELCNT=BARELCNT+1
- S BARELEM=$P($T(@BARSEGID+BARELCNT),BARDELIM,2,9)
- Q:BARELEM="END"
- D ELEMENT3
- Q:'+BARELDA
- D:$P($P(BARELEM,BARDELIM,2)," ")="Composite" SUBELM^BAR50IT4
- Q
- ; ********************************************************************
- ELEMENT3 ;
- ; Create Segment multiple entry in A/R EDI TRANSPORT File
- K DA,DIC,X,Y
- S DA(2)=BAREDITR
- S DA(1)=BARSEGDA
- S DIC="^BAREDI(""1T"","_DA(2)_",10,"_DA(1)_",10,"
- S DIC(0)="LZ"
- S DIC("P")=$P(^DD(90056.0101,10,0),U,2)
- S X=$P(BARELEM,BARDELIM)
- S BARELID=X
- S BARPSTEL=$P(BARELEM,BARDELIM,8)
- I $P(BARSEG,BARDELIM)="2-060.B-REF",BARELID="REF02" S BARPSTEL="VVERMOD"
- I $P(BARSEG,BARDELIM)="3-040.B-REF",BARELID="REF02" S BARPSTEL="VPATHRN"
- I $P(BARSEG,BARDELIM)="2-080.A-N1",BARELID="N102" S BARPSTEL="VPAYER"
- I $P(BARSEG,BARDELIM)="2-100.A-N3" D
- . I BARELID="N301" S BARPSTEL="VPRADR"
- . I BARELID="N302" S BARPSTEL="VPRADR2"
- I $P(BARSEG,BARDELIM)="2-110.A-N4" D
- . I BARELID="N401" S BARPSTEL="VPRCITY"
- . I BARELID="N402" S BARPSTEL="VPRSTATE"
- . I BARELID="N403" S BARPSTEL="VPRZIP"
- . I BARELID="N404" S BARPSTEL="VPRCOUNT" ;COUNTRY CODE IHS/SD/TPF 8/30/2011 BAR*1.8*21 PAGE 2 HIPAA SPECS
- I $P(BARSEG,BARDELIM)="2-080.B-N1",BARELID="N102" S BARPSTEL="VPAYEE"
- S DIC("DR")=".02///^S X=$P(BARELEM,BARDELIM,2)"
- S DIC("DR")=DIC("DR")_";.03///^S X=$P(BARELEM,BARDELIM,3)"
- S:$P(BARELEM,BARDELIM,4)]"" DIC("DR")=DIC("DR")_";.04///^S X=$P(BARELEM,BARDELIM,4)"
- S:$P(BARELEM,BARDELIM,5)]"" DIC("DR")=DIC("DR")_";.05///^S X=$P(BARELEM,BARDELIM,5)"
- S:$P(BARELEM,BARDELIM,6)]"" DIC("DR")=DIC("DR")_";.06///^S X=$P(BARELEM,BARDELIM,6)"
- S:$P(BARELEM,BARDELIM,7)]"" DIC("DR")=DIC("DR")_";.09///^S X=$P(BARELEM,BARDELIM,7)"
- S:BARPSTEL]"" DIC("DR")=DIC("DR")_";.08///^S X=BARPSTEL"
- K DD,DO
- D FILE^DICN
- Q:+Y<0
- S BARELDA=+Y
- Q
- ; ********************************************************************
- ; The following is a table of elements per Segment as the segments are
- ; ordered in 1^BAREDIT2
- ; ********************************************************************
- ;;ELEM;;DESC;;SEQ;;DATA TYPE;;MIN;;MAX;;EDI TBL PTR;;PST EL
- ; ********************************************************************
- ISA ;;
- ;;ISA01;;Authorization Info Qualifier;;1;;ID;;2;;2;;1
- ;;ISA02;;Authorization Information;;2;;AN;;10;;10
- ;;ISA03;;Security Information Qualifier;;3;;ID;;2;;2;;2
- ;;ISA04;;Security Information;;4;;AN;;10;;10
- ;;ISA05;;Interchange ID Qualifier;;5;;ID;;2;;2;;3
- ;;ISA06;;Interchange Sender ID;;6;;AN;;15;;15
- ;;ISA07;;Interchange ID Qualifier;;7;;ID;;2;;2;;3
- ;;ISA08;;Interchange Receiver ID;;8;;AN;;15;;15
- ;;ISA09;;Interchange Date;;9;;DT;;6;;6
- ;;ISA10;;Interchange Time;;10;;TM;;4;;4
- ;;ISA11;;Control Standards Identifier;;11;;ID;;1;;1;;4
- ;;ISA12;;Control Version Number;;12;;ID;;5;;5;;5;;VVERNUM
- ;;ISA13;;Interchange Control Number;;13;;NO;;9;;9;;;;VCTRLNUM
- ;;ISA14;;Acknowlegment Requested;;14;;ID;;1;;1;;6;;VTEST
- ;;ISA15;;Usage Indicator;;15;;ID;;1;;1;;7
- ;;ISA16;;Component Element Seperator;;16;;AN;;1;;1
- ;;END
- GS ;;
- ;;GS01;;Functional Identifier Code;;1;;ID;;2;;2;;8
- ;;GS02;;Application Sender's Code;;2;;AN;;2;;15
- ;;GS03;;Application Receiver's Code;;3;;AN;;2;;15
- ;;GS04;;Functional Group Creation Date;;4;;DT;;8;;8
- ;;GS05;;Functional Group Creation Time;;5;;TM;;4;;8
- ;;GS06;;Group Control Number;;6;;NO;;1;;9
- ;;GS07;;Responsible Agency Code;;7;;ID;;1;;2;;9
- ;;GS08;;Vers/Release/Industry ID Code;;8;;AN;;1;;12;;;;VVERSION
- ;;END
- ST ;;
- ;;ST01;;Transaction Set Identify Code;;1;;ID;;3;;3;;10
- ;;ST02;;Transaction Set Control Number;;2;;AN;;4;;9
- ;;END
- BPR ;;
- ;;BPR01;;Transaction Handling Code;;1;;ID;;1;;2;;11
- ;;BPR02;;Total Provider Payment;;2;;R;;1;;18
- ;;BPR03;;Credit/Debit Flag Code;;3;;ID;;1;;1;;12
- ;;BPR04;;Payment Method Code;;4;;ID;;3;;3;;13
- ;;BPR05;;Payment Format Code;;5;;ID;;1;;10;;14
- ;;BPR06;;DFI ID # Qualifier (sender);;6;;ID;;2;;2;;15
- ;;BPR07;;DFI ID # (sender);;7;;AN;;3;;12
- ;;BPR08;;Account # Qualifier (sender);;8;;ID;;1;;3;;16
- ;;BPR09;;Bank Account Number (sender);;9;;AN;;1;;35
- ;;BPR10;;Payer Identifier;;10;;AN;;10;;10
- ;;BPR11;;Payer Co. Supplimental Code;;11;;9;;9
- ;;BPR12;;DFI ID # Qualifier (receiver);;12;;ID;;2;;2;;15
- ;;BPR13;;DFI ID # (receiver);;13;;AN;;3;;12
- ;;BPR14;;Account # Qualifier (receiver);;14;;ID;;1;;3;;16
- ;;BPR15;;Bank Account Number (receiver);;15;;AN;;1;;35
- ;;BPR16;;Check Issue/EFT Effective Date;;16;;DT;;8;;8
- ;;END
- TRN ;;
- ;;TRN01;;Trace Type Code;;1;;ID;;1;;2;;17
- ;;TRN02;;Check or EFT Trace NUmber;;2;;AN;;1;;30;;;;VCHECK
- ;;TRN03;;Payer Identifier;;3;;AN;;10;;10
- ;;TRN04;;Payer Supplimental Code;;4;;AN;;1;;30
- ;;END
- CUR ;;
- ;;CUR01;;Entity Identifier Code;;1;;ID;;2;;3;;18
- ;;CUR02;;Currency Code;;2;;AN;;3;;3
- ;;CUR03;;Exchange Rate;;3;;R;;4;;10
- ;;END
- REF ;;
- ;;REF01;;Reference ID Qualifier;;1;;ID;;2;;3;;19
- ;;REF02;;Reference Identification;;2;;AN;;1;;30;;;;VREFID
- ;;END
- DTM ;;
- ;;DTM01;;Date/Time Qualifier;;1;;ID;;3;;3;;20
- ;;DTM02;;Date;;2;;DT;;8;;8;;;;VCLMDATE
- ;;END
- N1 ;;
- ;;N101;;Entity Identifier Code;;1;;ID;;2;;3;;18
- ;;N102;;Payer/Payee Name;;2;;AN;;1;;60;;;;VPAYNAME
- ;;N103;;Identification Code Qualifier;;3;;ID;;1;;2;;21
- ;;N104;;Identification Code;;4;;AN;;2;;80
- ;;END
- N3 ;;
- ;;N301;;Payer/Payee Address;;1;;AN;;1;;55
- ;;N302;;Payer/Payee Address;;2;;AN;;1;;55
- ;;END
- N4 ;;
- ;;N401;;Payer/Payee City;;1;;AN;;2;;30
- ;;N402;;Payer/Payee State or Province;;2;;AN;;2;;2
- ;;N403;;Payer/Payee Postal Code;;3;;Nn;;3;;15
- ;;N404;;Payer Country Code;;4;;Nn;;2;;3
- ;;END
- PER ;;
- ;;PER01;;Contact Function Code;;1;;ID;;2;;2;;22
- ;;PER02;;Contact Name;;2;;AN;;1;;60;;;;VPRCONAM
- ;;PER03;;Communication Number Qualifier;;3;;ID;;2;;2;;23;;VPRCONCD
- ;;PER04;;Contact Communication #;;4;;AN;;1;;80;;;;VPRCONBR
- ;;PER05;;Communication Number Qualifier;;5;;ID;;2;;2;;23;;VPRCONCD
- ;;PER06;;Contact Communication #;;6;;AN;;1;;80;;;;VPRCONBR
- ;;PER07;;Communication Number Qualifier;;5;;ID;;2;;2;;23;;VPRCONCD
- ;;PER08;;Contact Communication #;;6;;AN;;1;;80;;;;VPRCONBR
- ;;END
- ;;
- LX ;;
- ;;LX01;;Assigned Loop Number;;1;;NO;;1;;6
- ;;END
- TS3 ;;
- ;;TS301;;Provider Identifier;;1;;AN;;1;;30;;;;VNEWPRV
- ;;TS302;;Facility Type Code;;2;;AN;;1;;2
- ;;TS303;;Fiscal Period Date;;3;;DT;;8;;8
- ;;TS304;;Total Claim Count;;4;;R;;1;;15
- ;;TS305;;Total Submitted Charges ($);;5;;R;;1;;18
- ;;TS306;;Total Covered Charges ($);;6;;R;;1;;18
- ;;TS307;;Total Non-Covered Charges ($);;7;;R;;1;;18
- ;;TS308;;Total Denied Charges ($);;8;;R;;1;;18
- ;;TS309;;Total Provider Payment ($);;9;;R;;1;;18
- ;;TS310;;Total Interest ($);;10;;R;;1;;18
- ;;TS311;;Total Contractual Adjust ($);;11;;R;;1;;18
- ;;TS312;;Total Gramm-Rudman Reduct ($);;12;;R;;1;;18
- ;;TS313;;Total MSP Payer Amount ($);;13;;R;;1;;18
- ;;TS314;;Total Blood Deductable ($);;14;;R;;1;;18
- ;;TS315;;Total Non-Lab Charge ($);;15;;R;;1;;18
- ;;TS316;;Total Coinsurance Amount ($);;16;;R;;1;;18
- ;;TS317;;Total HCPCS Submitted Charges;;17;;R;;1;;18
- ;;TS318;;Total HCPCS Payable Amount ($);;18;;R;;1;;18
- ;;TS319;;Total Deductible Amount ($);;19;;R;;1;;18
- ;;TS320;;Total Prof Comp Amount ($);;20;;R;;1;;18
- ;;TS321;;Total MSP Pat Liability Met($);;21;;R;;1;;18
- ;;TS322;;Total Pat Reimbursement ($);;22;;R;;1;;18
- ;;TS323;;Total PIP Claim Count;;23;;R;;1;;18
- ;;TS324;;Total PIP Adjustment ($);;24;;R;;1;;18
- ;;END
- TS2 ;;
- ;;TS201;;Total DRG Amount;;1;;R;;1;;18
- ;;TS202;;Total Federal Specific Amount;;2;;R;;1;;18
- ;;TS203;;Total Hospital Specific Amount;;3;;R;;1;;18
- ;;TS204;;Total Disproportionate Share;;4;;R;;1;;18
- ;;TS205;;Total Capital Amount;;5;;R;;1;;18
- ;;TS206;;Total Indirect Medical Edu Amt;;6;;R;;1;;18
- ;;TS207;;Total Outlier Day Count;;7;;R;;1;;15
- ;;TS208;;Total Day Outlier Amount;;8;;R;;1;;18
- ;;TS209;;Total Cost Outlier Amount;;9;;R;;1;;18
- ;;TS210;;Average DRG Length of Stay;;10;;R;;1;;15
- ;;TS211;;Total Discharge Count;;11;;R;;1;;15
- ;;TS212;;Total Cost Report Day Count;;12;;R;;1;;15
- ;;TS213;;Total Covered Day Count;;13;;R;;1;;15
- ;;TS214;;Total Non-Covered Day Count;;14;;R;;1;;15
- ;;TS215;;Total MSP Pass-Through Amt;;15;;R;;1;;18
- ;;TS216;;Average DRG Weight;;16;;R;;1;;15
- ;;TS217;;Total PPS Capital FSP DRG Amt;;17;;R;;1;;18
- ;;TS218;;Total PPS Capital HSP DRG Amt;;18;;R;;1;;18
- ;;TS219;;Total PPS DSH DRG Amount;;19;;R;;1;;18
- ;;END
- CLP ;;
- ;;CLP01;;Patient Control Number;;1;;AN;;1;;38;;;;VNEWBILL
- ;;CLP02;;Claim Status Code;;2;;ID;;1;;2;;24
- ;;CLP03;;Total Submitted Charges ($);;3;;R;;1;;18;;;;VCLMCHG
- ;;CLP04;;Claim Payment Amount ($);;4;;R;;1;;18;;;;VCLMPAY
- ;;CLP05;;Patient Responsibility Amt ($);;5;;R;;1;;18
- ;;CLP06;;Claim Filing Indicator Code;;6;;ID;;1;;2;;25
- ;;CLP07;;Payer Claim Control Number;;7;;AN;;1;;30;;;;VBILNUM
- ;;CLP08;;Facility Type Code;;8;;AN;;1;;2
- ;;CLP09;;Claim Frequency Code;;9;;AN;;1;;1
- ;;CLP10;;Patient Status Cod (blank);;10;;AN;;1;;2
- ;;CLP11;;DRG Code;;11;;AN;;1;;4
- ;;CLP12;;DRG Weight;;12;;R;;1;;15
- ;;CLP13;;Discharge Fraction (%);;13;;R;;1;;10
- ;;END
- CAS ;;
- ;;CAS01;;Claim Adjustment Group Code;;1;;ID;;1;;2;;26
- ;;CAS02;;Adjustment Reason Code;;2;;ID;;1;;5;;33;;VADJREA
- ;;CAS03;;Adjustment Amount;;3;;R;;1;;18;;;;VADJAMT
- ;;CAS04;;Adjustment Quantity;;4;;R;;1;;15
- ;;CAS05;;Adjustment Reason Code;;5;;ID;;1;;5;;33;;VADJREA
- ;;CAS06;;Adjustment Amount;;6;;R;;1;;18;;;;VADJAMT
- ;;CAS07;;Adjustment Quantity;;7;;R;;1;;15
- ;;CAS08;;Adjustment Reason Code;;8;;ID;;1;;5;;33;;VADJREA
- ;;CAS09;;Adjustment Amount;;9;;R;;1;;18;;;;VADJAMT
- ;;CAS10;;Adjustment Quantity;;10;;R;;1;;15
- ;;CAS11;;Adjustment Reason Code;;11;;ID;;1;;5;;33;;VADJREA
- ;;CAS12;;Adjustment Amount;;12;;R;;1;;18;;;;VADJAMT
- ;;CAS13;;Adjustment Quantity;;13;;R;;1;;15
- ;;CAS14;;Adjustment Reason Code;;14;;ID;;1;;5;;33;;VADJREA
- ;;CAS15;;Adjustment Amount;;15;;R;;1;;18;;;;VADJAMT
- ;;CAS16;;Adjustment Quantity;;16;;R;;1;;15
- ;;CAS17;;Adjustment Reason Code;;17;;ID;;1;;5;;33;;VADJREA
- ;;CAS18;;Adjustment Amount;;18;;R;;1;;18;;;;VADJAMT
- ;;CAS19;;Adjustment Quantity;;19;;R;;1;;15
- ;;END
- NM1 ;;
- ;;NM101;;Entity Identifier Code;;1;;ID;;2;;3;;18
- ;;NM102;;Entity Type Qualifier;;2;;ID;;1;;1;;27
- ;;NM103;;Last / Organization Name;;3;;AN;;1;;35;;;;VPATLN
- ;;NM104;;First Name;;4;;AN;;1;;23;;;;VPATFN
- ;;NM105;;Middle Name;;5;;AN;;1;;25;;;;VPATMID
- ;;NM106;;Name Prefix (blank);;6;;AN;;1;;10
- ;;NM107;;Name Suffix;;7;;AN;;1;;10
- ;;NM108;;Identification Code Qualifier;;8;;ID;;1;;2;;21
- ;;NM109;;Identification Code;;9;;AN;;2;;80;;;;VPATHIC
- ;;END
- MIA ;;
- ;;MIA01;;Covered Days;;1;;R;;1;;15
- ;;MIA02;;PPS Operating Outlier Amt;;2;;R;;1;;15
- ;;MIA03;;Lifetime Psychiatric Days;;3;;R;;1;;15
- ;;MIA04;;Claim DRG Amount ($);;4;;R;;1;;18
- ;;MIA05;;Remark Code;;5;;ID;;1;;30;;34
- ;;MIA06;;Disproportionate Share Amt;;6;;R;;1;;18
- ;;MIA07;;MSP Pass-through Amt ($);;7;;R;;1;;18
- ;;MIA08;;PPS-Capital Amount ($);;8;;R;;1;;18
- ;;MIA09;;PPS-Capital FSP DRG Amt ($);;9;;R;;1;;18
- ;;MIA10;;PPS-Capital HSP DRG Amt ($);;10;;R;;1;;18
- ;;MIA11;;PPS-Capital DSH DRG Amt ($);;11;;R;;1;;18
- ;;MIA12;;Old Capital Amount ($);;12;;R;;1;;18
- ;;MIA13;;PPS-Capital IME Amt ($);;13;;R;;1;;18
- ;;MIA14;;PPS/Hosp Specific DRG Amt ($);;14;;R;;1;;18
- ;;MIA15;;Cost Report Day Count;;15;;R;;1;;15
- ;;MIA16;;PPS/Operating Fed Spec DRG Amt;;16;;R;;1;;18
- ;;MIA17;;PPS-Capital Outlier Amt ($);;17;;R;;1;;18
- ;;MIA18;;Indirect Teaching Amount ($);;18;;R;;1;;18
- ;;MIA19;;Nonpayable Prof Comp Amt ($);;19;;R;;1;;18
- ;;MIA20;;Remark Code;;20;;ID;;1;;30;;34
- ;;MIA21;;Remark Code;;21;;ID;;1;;30;;34
- ;;MIA22;;Remark Code;;22;;ID;;1;;30;;34
- ;;MIA23;;Remark Code;;23;;ID;;1;;30;;34
- ;;MIA24;;PPS-Capital Exception Amt ($);;24;;R;;1;;18
- ;;END
- MOA ;;
- ;;MOA01;;Reimbursement Rate (%);;1;;R;;1;;10
- ;;MOA02;;Claim HCPCS Payable Amt ($);;2;;R;;1;;18
- ;;MOA03;;Remark Code;;3;;ID;;1;;30;;34
- ;;MOA04;;Remark Code;;4;;ID;;1;;30;;34
- ;;MOA05;;Remark Code;;5;;ID;;1;;30;;34
- ;;MOA06;;Remark Code;;6;;ID;;1;;30;;34
- ;;MOA07;;Remark Code;;7;;ID;;1;;30;;34
- ;;MOA08;;Claim ESRD Payment Amt ($);;8;;R;;1;;18
- ;;MOA09;;Nonpayable Prof Comp Amt ($);;9;;R;;1;;18
- ;;END
- AMT ;;
- ;;AMT01;;Amount Qualifier Code;;1;;ID;;1;;3;;28
- ;;AMT02;;Amount;;2;;R;;1;;18
- ;;END
- QTY ;;
- ;;QTY01;;Quantity Qualifier;;1;;ID;;2;;2;;29
- ;;QTY02;;Quantity;;2;;R;;1;;15
- ;;END
- SVC ;;
- ;;SVC01;;Composite Medical Procedure Id;;1;;AN;;2;;100
- ;;SVC02;;Line Item Charge Amt ($);;2;;R;;1;;18
- ;;SVC03;;Line Item Prov Paid Amt ($);;3;;R;;1;;18
- ;;SVC04;;Revenue Code;;4;;AN;;1;;48
- ;;SVC05;;Units of Service Paid (cnt);;5;;R;;1;;15
- ;;SVC06;;Composite Medical Procedure Id;;6;;AN;;2;;100
- ;;SVC07;;Orig Units of Service (cnt);;7;;R;;1;;15
- ;;END
- LQ ;;
- ;;LQ01;;Remark Code List Qualifier;;1;;ID;;1;;3;;30
- ;;LQ02;;Remark Code (Line Level);;2;;AN;;1;;30
- ;;END
- PLB ;;
- ;;PLB01;;Provider Identifier;;1;;AN;;1;;30;;;;VPRVNUM
- ;;PLB02;;Fiscal Period Date;;2;;DT;;8;;8
- ;;PLB03;;Composite Adjustment Id;;3;;AN;;2;;33
- ;;PLB04;;Provider Adjustment Amt;;4;;R;;1;;18
- ;;PLB05;;Composite Adjustment Id;;5;;AN;;2;;33
- ;;PLB06;;Provider Adjustment Amt;;6;;R;;1;;18
- ;;PLB07;;Composite Adjustment Id;;7;;AN;;2;;33
- ;;PLB08;;Provider Adjustment Amt;;8;;R;;1;;18
- ;;PLB09;;Composite Adjustment Id;;9;;AN;;2;;33
- ;;PLB10;;Provider Adjustment Amt;;10;;R;;1;;18
- ;;PLB11;;Composite Adjustment Id;;11;;AN;;2;;33
- ;;PLB12;;Provider Adjustment Amt;;12;;R;;1;;18
- ;;PLB13;;Composite Adjustment Id;;13;;AN;2;33
- ;;PLB14;;Provider Adjustment Amt;;14;;R;;1;;18
- ;;END
- SE ;;
- ;;SE01;;Transaction Segment Count;;1;;NO;;1;;10
- ;;SE02;;Transaction Set Control Number;;2;;AN;;4;;9
- ;;END
- GE ;;
- ;;GE01;;Functional Group Set Count;;1;;NO;;1;;6
- ;;GE02;;Group Control Number;;2;;NO;;1;;9
- ;;END
- IEA ;;
- ;;IEA01;;Interchange Group Count;;1;;NO;;1;;5
- ;;IEA02;;Interchange Control Number;;2;;NO;;9;;9
- ;;END
- BAR50IT3 ; IHS/SD/LSL - CREATE AN ENTRY IN A/R EDI TRANSPORT FILE (3) ;
- +1 ;;1.8;IHS ACCOUNTS RECEIVABLE;**21**;OCT 26, 2005
- +2 ;
- +3 ; IHS/SD/LSL - 08/01/2002 - V1.8 PATCH 21
- +4 ; For HIPAA compliance. Make 835 v5010 entry in A/R EDI
- +5 ; TRANSPORT FILE. This routine defines the Elements.
- +6 ;
- +7 ; ********************************************************************
- +8 QUIT
- +9 ; ********************************************************************
- ELEMENT ; EP
- +1 ; Create Element Multiple w/in Segment Multiple in A/R EDI TRANSPORT
- +2 SET BARELCNT=0
- +3 FOR
- DO ELEMENT2
- IF BARELEM="END"
- QUIT
- +4 QUIT
- +5 ; ********************************************************************
- ELEMENT2 ;
- +1 ; Loop Elements
- +2 ;B:DUZ=398 "S+"
- +3 SET BARELCNT=BARELCNT+1
- +4 SET BARELEM=$PIECE($TEXT(@BARSEGID+BARELCNT),BARDELIM,2,9)
- +5 IF BARELEM="END"
- QUIT
- +6 DO ELEMENT3
- +7 IF '+BARELDA
- QUIT
- +8 IF $PIECE($PIECE(BARELEM,BARDELIM,2)," ")="Composite"
- DO SUBELM^BAR50IT4
- +9 QUIT
- +10 ; ********************************************************************
- ELEMENT3 ;
- +1 ; Create Segment multiple entry in A/R EDI TRANSPORT File
- +2 KILL DA,DIC,X,Y
- +3 SET DA(2)=BAREDITR
- +4 SET DA(1)=BARSEGDA
- +5 SET DIC="^BAREDI(""1T"","_DA(2)_",10,"_DA(1)_",10,"
- +6 SET DIC(0)="LZ"
- +7 SET DIC("P")=$PIECE(^DD(90056.0101,10,0),U,2)
- +8 SET X=$PIECE(BARELEM,BARDELIM)
- +9 SET BARELID=X
- +10 SET BARPSTEL=$PIECE(BARELEM,BARDELIM,8)
- +11 IF $PIECE(BARSEG,BARDELIM)="2-060.B-REF"
- IF BARELID="REF02"
- SET BARPSTEL="VVERMOD"
- +12 IF $PIECE(BARSEG,BARDELIM)="3-040.B-REF"
- IF BARELID="REF02"
- SET BARPSTEL="VPATHRN"
- +13 IF $PIECE(BARSEG,BARDELIM)="2-080.A-N1"
- IF BARELID="N102"
- SET BARPSTEL="VPAYER"
- +14 IF $PIECE(BARSEG,BARDELIM)="2-100.A-N3"
- Begin DoDot:1
- +15 IF BARELID="N301"
- SET BARPSTEL="VPRADR"
- +16 IF BARELID="N302"
- SET BARPSTEL="VPRADR2"
- End DoDot:1
- +17 IF $PIECE(BARSEG,BARDELIM)="2-110.A-N4"
- Begin DoDot:1
- +18 IF BARELID="N401"
- SET BARPSTEL="VPRCITY"
- +19 IF BARELID="N402"
- SET BARPSTEL="VPRSTATE"
- +20 IF BARELID="N403"
- SET BARPSTEL="VPRZIP"
- +21 ;COUNTRY CODE IHS/SD/TPF 8/30/2011 BAR*1.8*21 PAGE 2 HIPAA SPECS
- IF BARELID="N404"
- SET BARPSTEL="VPRCOUNT"
- End DoDot:1
- +22 IF $PIECE(BARSEG,BARDELIM)="2-080.B-N1"
- IF BARELID="N102"
- SET BARPSTEL="VPAYEE"
- +23 SET DIC("DR")=".02///^S X=$P(BARELEM,BARDELIM,2)"
- +24 SET DIC("DR")=DIC("DR")_";.03///^S X=$P(BARELEM,BARDELIM,3)"
- +25 IF $PIECE(BARELEM,BARDELIM,4)]""
- SET DIC("DR")=DIC("DR")_";.04///^S X=$P(BARELEM,BARDELIM,4)"
- +26 IF $PIECE(BARELEM,BARDELIM,5)]""
- SET DIC("DR")=DIC("DR")_";.05///^S X=$P(BARELEM,BARDELIM,5)"
- +27 IF $PIECE(BARELEM,BARDELIM,6)]""
- SET DIC("DR")=DIC("DR")_";.06///^S X=$P(BARELEM,BARDELIM,6)"
- +28 IF $PIECE(BARELEM,BARDELIM,7)]""
- SET DIC("DR")=DIC("DR")_";.09///^S X=$P(BARELEM,BARDELIM,7)"
- +29 IF BARPSTEL]""
- SET DIC("DR")=DIC("DR")_";.08///^S X=BARPSTEL"
- +30 KILL DD,DO
- +31 DO FILE^DICN
- +32 IF +Y<0
- QUIT
- +33 SET BARELDA=+Y
- +34 QUIT
- +35 ; ********************************************************************
- +36 ; The following is a table of elements per Segment as the segments are
- +37 ; ordered in 1^BAREDIT2
- +38 ; ********************************************************************
- +39 ;;ELEM;;DESC;;SEQ;;DATA TYPE;;MIN;;MAX;;EDI TBL PTR;;PST EL
- +40 ; ********************************************************************
- ISA ;;
- +1 ;;ISA01;;Authorization Info Qualifier;;1;;ID;;2;;2;;1
- +2 ;;ISA02;;Authorization Information;;2;;AN;;10;;10
- +3 ;;ISA03;;Security Information Qualifier;;3;;ID;;2;;2;;2
- +4 ;;ISA04;;Security Information;;4;;AN;;10;;10
- +5 ;;ISA05;;Interchange ID Qualifier;;5;;ID;;2;;2;;3
- +6 ;;ISA06;;Interchange Sender ID;;6;;AN;;15;;15
- +7 ;;ISA07;;Interchange ID Qualifier;;7;;ID;;2;;2;;3
- +8 ;;ISA08;;Interchange Receiver ID;;8;;AN;;15;;15
- +9 ;;ISA09;;Interchange Date;;9;;DT;;6;;6
- +10 ;;ISA10;;Interchange Time;;10;;TM;;4;;4
- +11 ;;ISA11;;Control Standards Identifier;;11;;ID;;1;;1;;4
- +12 ;;ISA12;;Control Version Number;;12;;ID;;5;;5;;5;;VVERNUM
- +13 ;;ISA13;;Interchange Control Number;;13;;NO;;9;;9;;;;VCTRLNUM
- +14 ;;ISA14;;Acknowlegment Requested;;14;;ID;;1;;1;;6;;VTEST
- +15 ;;ISA15;;Usage Indicator;;15;;ID;;1;;1;;7
- +16 ;;ISA16;;Component Element Seperator;;16;;AN;;1;;1
- +17 ;;END
- GS ;;
- +1 ;;GS01;;Functional Identifier Code;;1;;ID;;2;;2;;8
- +2 ;;GS02;;Application Sender's Code;;2;;AN;;2;;15
- +3 ;;GS03;;Application Receiver's Code;;3;;AN;;2;;15
- +4 ;;GS04;;Functional Group Creation Date;;4;;DT;;8;;8
- +5 ;;GS05;;Functional Group Creation Time;;5;;TM;;4;;8
- +6 ;;GS06;;Group Control Number;;6;;NO;;1;;9
- +7 ;;GS07;;Responsible Agency Code;;7;;ID;;1;;2;;9
- +8 ;;GS08;;Vers/Release/Industry ID Code;;8;;AN;;1;;12;;;;VVERSION
- +9 ;;END
- ST ;;
- +1 ;;ST01;;Transaction Set Identify Code;;1;;ID;;3;;3;;10
- +2 ;;ST02;;Transaction Set Control Number;;2;;AN;;4;;9
- +3 ;;END
- BPR ;;
- +1 ;;BPR01;;Transaction Handling Code;;1;;ID;;1;;2;;11
- +2 ;;BPR02;;Total Provider Payment;;2;;R;;1;;18
- +3 ;;BPR03;;Credit/Debit Flag Code;;3;;ID;;1;;1;;12
- +4 ;;BPR04;;Payment Method Code;;4;;ID;;3;;3;;13
- +5 ;;BPR05;;Payment Format Code;;5;;ID;;1;;10;;14
- +6 ;;BPR06;;DFI ID # Qualifier (sender);;6;;ID;;2;;2;;15
- +7 ;;BPR07;;DFI ID # (sender);;7;;AN;;3;;12
- +8 ;;BPR08;;Account # Qualifier (sender);;8;;ID;;1;;3;;16
- +9 ;;BPR09;;Bank Account Number (sender);;9;;AN;;1;;35
- +10 ;;BPR10;;Payer Identifier;;10;;AN;;10;;10
- +11 ;;BPR11;;Payer Co. Supplimental Code;;11;;9;;9
- +12 ;;BPR12;;DFI ID # Qualifier (receiver);;12;;ID;;2;;2;;15
- +13 ;;BPR13;;DFI ID # (receiver);;13;;AN;;3;;12
- +14 ;;BPR14;;Account # Qualifier (receiver);;14;;ID;;1;;3;;16
- +15 ;;BPR15;;Bank Account Number (receiver);;15;;AN;;1;;35
- +16 ;;BPR16;;Check Issue/EFT Effective Date;;16;;DT;;8;;8
- +17 ;;END
- TRN ;;
- +1 ;;TRN01;;Trace Type Code;;1;;ID;;1;;2;;17
- +2 ;;TRN02;;Check or EFT Trace NUmber;;2;;AN;;1;;30;;;;VCHECK
- +3 ;;TRN03;;Payer Identifier;;3;;AN;;10;;10
- +4 ;;TRN04;;Payer Supplimental Code;;4;;AN;;1;;30
- +5 ;;END
- CUR ;;
- +1 ;;CUR01;;Entity Identifier Code;;1;;ID;;2;;3;;18
- +2 ;;CUR02;;Currency Code;;2;;AN;;3;;3
- +3 ;;CUR03;;Exchange Rate;;3;;R;;4;;10
- +4 ;;END
- REF ;;
- +1 ;;REF01;;Reference ID Qualifier;;1;;ID;;2;;3;;19
- +2 ;;REF02;;Reference Identification;;2;;AN;;1;;30;;;;VREFID
- +3 ;;END
- DTM ;;
- +1 ;;DTM01;;Date/Time Qualifier;;1;;ID;;3;;3;;20
- +2 ;;DTM02;;Date;;2;;DT;;8;;8;;;;VCLMDATE
- +3 ;;END
- N1 ;;
- +1 ;;N101;;Entity Identifier Code;;1;;ID;;2;;3;;18
- +2 ;;N102;;Payer/Payee Name;;2;;AN;;1;;60;;;;VPAYNAME
- +3 ;;N103;;Identification Code Qualifier;;3;;ID;;1;;2;;21
- +4 ;;N104;;Identification Code;;4;;AN;;2;;80
- +5 ;;END
- N3 ;;
- +1 ;;N301;;Payer/Payee Address;;1;;AN;;1;;55
- +2 ;;N302;;Payer/Payee Address;;2;;AN;;1;;55
- +3 ;;END
- N4 ;;
- +1 ;;N401;;Payer/Payee City;;1;;AN;;2;;30
- +2 ;;N402;;Payer/Payee State or Province;;2;;AN;;2;;2
- +3 ;;N403;;Payer/Payee Postal Code;;3;;Nn;;3;;15
- +4 ;;N404;;Payer Country Code;;4;;Nn;;2;;3
- +5 ;;END
- PER ;;
- +1 ;;PER01;;Contact Function Code;;1;;ID;;2;;2;;22
- +2 ;;PER02;;Contact Name;;2;;AN;;1;;60;;;;VPRCONAM
- +3 ;;PER03;;Communication Number Qualifier;;3;;ID;;2;;2;;23;;VPRCONCD
- +4 ;;PER04;;Contact Communication #;;4;;AN;;1;;80;;;;VPRCONBR
- +5 ;;PER05;;Communication Number Qualifier;;5;;ID;;2;;2;;23;;VPRCONCD
- +6 ;;PER06;;Contact Communication #;;6;;AN;;1;;80;;;;VPRCONBR
- +7 ;;PER07;;Communication Number Qualifier;;5;;ID;;2;;2;;23;;VPRCONCD
- +8 ;;PER08;;Contact Communication #;;6;;AN;;1;;80;;;;VPRCONBR
- +9 ;;END
- +10 ;;
- LX ;;
- +1 ;;LX01;;Assigned Loop Number;;1;;NO;;1;;6
- +2 ;;END
- TS3 ;;
- +1 ;;TS301;;Provider Identifier;;1;;AN;;1;;30;;;;VNEWPRV
- +2 ;;TS302;;Facility Type Code;;2;;AN;;1;;2
- +3 ;;TS303;;Fiscal Period Date;;3;;DT;;8;;8
- +4 ;;TS304;;Total Claim Count;;4;;R;;1;;15
- +5 ;;TS305;;Total Submitted Charges ($);;5;;R;;1;;18
- +6 ;;TS306;;Total Covered Charges ($);;6;;R;;1;;18
- +7 ;;TS307;;Total Non-Covered Charges ($);;7;;R;;1;;18
- +8 ;;TS308;;Total Denied Charges ($);;8;;R;;1;;18
- +9 ;;TS309;;Total Provider Payment ($);;9;;R;;1;;18
- +10 ;;TS310;;Total Interest ($);;10;;R;;1;;18
- +11 ;;TS311;;Total Contractual Adjust ($);;11;;R;;1;;18
- +12 ;;TS312;;Total Gramm-Rudman Reduct ($);;12;;R;;1;;18
- +13 ;;TS313;;Total MSP Payer Amount ($);;13;;R;;1;;18
- +14 ;;TS314;;Total Blood Deductable ($);;14;;R;;1;;18
- +15 ;;TS315;;Total Non-Lab Charge ($);;15;;R;;1;;18
- +16 ;;TS316;;Total Coinsurance Amount ($);;16;;R;;1;;18
- +17 ;;TS317;;Total HCPCS Submitted Charges;;17;;R;;1;;18
- +18 ;;TS318;;Total HCPCS Payable Amount ($);;18;;R;;1;;18
- +19 ;;TS319;;Total Deductible Amount ($);;19;;R;;1;;18
- +20 ;;TS320;;Total Prof Comp Amount ($);;20;;R;;1;;18
- +21 ;;TS321;;Total MSP Pat Liability Met($);;21;;R;;1;;18
- +22 ;;TS322;;Total Pat Reimbursement ($);;22;;R;;1;;18
- +23 ;;TS323;;Total PIP Claim Count;;23;;R;;1;;18
- +24 ;;TS324;;Total PIP Adjustment ($);;24;;R;;1;;18
- +25 ;;END
- TS2 ;;
- +1 ;;TS201;;Total DRG Amount;;1;;R;;1;;18
- +2 ;;TS202;;Total Federal Specific Amount;;2;;R;;1;;18
- +3 ;;TS203;;Total Hospital Specific Amount;;3;;R;;1;;18
- +4 ;;TS204;;Total Disproportionate Share;;4;;R;;1;;18
- +5 ;;TS205;;Total Capital Amount;;5;;R;;1;;18
- +6 ;;TS206;;Total Indirect Medical Edu Amt;;6;;R;;1;;18
- +7 ;;TS207;;Total Outlier Day Count;;7;;R;;1;;15
- +8 ;;TS208;;Total Day Outlier Amount;;8;;R;;1;;18
- +9 ;;TS209;;Total Cost Outlier Amount;;9;;R;;1;;18
- +10 ;;TS210;;Average DRG Length of Stay;;10;;R;;1;;15
- +11 ;;TS211;;Total Discharge Count;;11;;R;;1;;15
- +12 ;;TS212;;Total Cost Report Day Count;;12;;R;;1;;15
- +13 ;;TS213;;Total Covered Day Count;;13;;R;;1;;15
- +14 ;;TS214;;Total Non-Covered Day Count;;14;;R;;1;;15
- +15 ;;TS215;;Total MSP Pass-Through Amt;;15;;R;;1;;18
- +16 ;;TS216;;Average DRG Weight;;16;;R;;1;;15
- +17 ;;TS217;;Total PPS Capital FSP DRG Amt;;17;;R;;1;;18
- +18 ;;TS218;;Total PPS Capital HSP DRG Amt;;18;;R;;1;;18
- +19 ;;TS219;;Total PPS DSH DRG Amount;;19;;R;;1;;18
- +20 ;;END
- CLP ;;
- +1 ;;CLP01;;Patient Control Number;;1;;AN;;1;;38;;;;VNEWBILL
- +2 ;;CLP02;;Claim Status Code;;2;;ID;;1;;2;;24
- +3 ;;CLP03;;Total Submitted Charges ($);;3;;R;;1;;18;;;;VCLMCHG
- +4 ;;CLP04;;Claim Payment Amount ($);;4;;R;;1;;18;;;;VCLMPAY
- +5 ;;CLP05;;Patient Responsibility Amt ($);;5;;R;;1;;18
- +6 ;;CLP06;;Claim Filing Indicator Code;;6;;ID;;1;;2;;25
- +7 ;;CLP07;;Payer Claim Control Number;;7;;AN;;1;;30;;;;VBILNUM
- +8 ;;CLP08;;Facility Type Code;;8;;AN;;1;;2
- +9 ;;CLP09;;Claim Frequency Code;;9;;AN;;1;;1
- +10 ;;CLP10;;Patient Status Cod (blank);;10;;AN;;1;;2
- +11 ;;CLP11;;DRG Code;;11;;AN;;1;;4
- +12 ;;CLP12;;DRG Weight;;12;;R;;1;;15
- +13 ;;CLP13;;Discharge Fraction (%);;13;;R;;1;;10
- +14 ;;END
- CAS ;;
- +1 ;;CAS01;;Claim Adjustment Group Code;;1;;ID;;1;;2;;26
- +2 ;;CAS02;;Adjustment Reason Code;;2;;ID;;1;;5;;33;;VADJREA
- +3 ;;CAS03;;Adjustment Amount;;3;;R;;1;;18;;;;VADJAMT
- +4 ;;CAS04;;Adjustment Quantity;;4;;R;;1;;15
- +5 ;;CAS05;;Adjustment Reason Code;;5;;ID;;1;;5;;33;;VADJREA
- +6 ;;CAS06;;Adjustment Amount;;6;;R;;1;;18;;;;VADJAMT
- +7 ;;CAS07;;Adjustment Quantity;;7;;R;;1;;15
- +8 ;;CAS08;;Adjustment Reason Code;;8;;ID;;1;;5;;33;;VADJREA
- +9 ;;CAS09;;Adjustment Amount;;9;;R;;1;;18;;;;VADJAMT
- +10 ;;CAS10;;Adjustment Quantity;;10;;R;;1;;15
- +11 ;;CAS11;;Adjustment Reason Code;;11;;ID;;1;;5;;33;;VADJREA
- +12 ;;CAS12;;Adjustment Amount;;12;;R;;1;;18;;;;VADJAMT
- +13 ;;CAS13;;Adjustment Quantity;;13;;R;;1;;15
- +14 ;;CAS14;;Adjustment Reason Code;;14;;ID;;1;;5;;33;;VADJREA
- +15 ;;CAS15;;Adjustment Amount;;15;;R;;1;;18;;;;VADJAMT
- +16 ;;CAS16;;Adjustment Quantity;;16;;R;;1;;15
- +17 ;;CAS17;;Adjustment Reason Code;;17;;ID;;1;;5;;33;;VADJREA
- +18 ;;CAS18;;Adjustment Amount;;18;;R;;1;;18;;;;VADJAMT
- +19 ;;CAS19;;Adjustment Quantity;;19;;R;;1;;15
- +20 ;;END
- NM1 ;;
- +1 ;;NM101;;Entity Identifier Code;;1;;ID;;2;;3;;18
- +2 ;;NM102;;Entity Type Qualifier;;2;;ID;;1;;1;;27
- +3 ;;NM103;;Last / Organization Name;;3;;AN;;1;;35;;;;VPATLN
- +4 ;;NM104;;First Name;;4;;AN;;1;;23;;;;VPATFN
- +5 ;;NM105;;Middle Name;;5;;AN;;1;;25;;;;VPATMID
- +6 ;;NM106;;Name Prefix (blank);;6;;AN;;1;;10
- +7 ;;NM107;;Name Suffix;;7;;AN;;1;;10
- +8 ;;NM108;;Identification Code Qualifier;;8;;ID;;1;;2;;21
- +9 ;;NM109;;Identification Code;;9;;AN;;2;;80;;;;VPATHIC
- +10 ;;END
- MIA ;;
- +1 ;;MIA01;;Covered Days;;1;;R;;1;;15
- +2 ;;MIA02;;PPS Operating Outlier Amt;;2;;R;;1;;15
- +3 ;;MIA03;;Lifetime Psychiatric Days;;3;;R;;1;;15
- +4 ;;MIA04;;Claim DRG Amount ($);;4;;R;;1;;18
- +5 ;;MIA05;;Remark Code;;5;;ID;;1;;30;;34
- +6 ;;MIA06;;Disproportionate Share Amt;;6;;R;;1;;18
- +7 ;;MIA07;;MSP Pass-through Amt ($);;7;;R;;1;;18
- +8 ;;MIA08;;PPS-Capital Amount ($);;8;;R;;1;;18
- +9 ;;MIA09;;PPS-Capital FSP DRG Amt ($);;9;;R;;1;;18
- +10 ;;MIA10;;PPS-Capital HSP DRG Amt ($);;10;;R;;1;;18
- +11 ;;MIA11;;PPS-Capital DSH DRG Amt ($);;11;;R;;1;;18
- +12 ;;MIA12;;Old Capital Amount ($);;12;;R;;1;;18
- +13 ;;MIA13;;PPS-Capital IME Amt ($);;13;;R;;1;;18
- +14 ;;MIA14;;PPS/Hosp Specific DRG Amt ($);;14;;R;;1;;18
- +15 ;;MIA15;;Cost Report Day Count;;15;;R;;1;;15
- +16 ;;MIA16;;PPS/Operating Fed Spec DRG Amt;;16;;R;;1;;18
- +17 ;;MIA17;;PPS-Capital Outlier Amt ($);;17;;R;;1;;18
- +18 ;;MIA18;;Indirect Teaching Amount ($);;18;;R;;1;;18
- +19 ;;MIA19;;Nonpayable Prof Comp Amt ($);;19;;R;;1;;18
- +20 ;;MIA20;;Remark Code;;20;;ID;;1;;30;;34
- +21 ;;MIA21;;Remark Code;;21;;ID;;1;;30;;34
- +22 ;;MIA22;;Remark Code;;22;;ID;;1;;30;;34
- +23 ;;MIA23;;Remark Code;;23;;ID;;1;;30;;34
- +24 ;;MIA24;;PPS-Capital Exception Amt ($);;24;;R;;1;;18
- +25 ;;END
- MOA ;;
- +1 ;;MOA01;;Reimbursement Rate (%);;1;;R;;1;;10
- +2 ;;MOA02;;Claim HCPCS Payable Amt ($);;2;;R;;1;;18
- +3 ;;MOA03;;Remark Code;;3;;ID;;1;;30;;34
- +4 ;;MOA04;;Remark Code;;4;;ID;;1;;30;;34
- +5 ;;MOA05;;Remark Code;;5;;ID;;1;;30;;34
- +6 ;;MOA06;;Remark Code;;6;;ID;;1;;30;;34
- +7 ;;MOA07;;Remark Code;;7;;ID;;1;;30;;34
- +8 ;;MOA08;;Claim ESRD Payment Amt ($);;8;;R;;1;;18
- +9 ;;MOA09;;Nonpayable Prof Comp Amt ($);;9;;R;;1;;18
- +10 ;;END
- AMT ;;
- +1 ;;AMT01;;Amount Qualifier Code;;1;;ID;;1;;3;;28
- +2 ;;AMT02;;Amount;;2;;R;;1;;18
- +3 ;;END
- QTY ;;
- +1 ;;QTY01;;Quantity Qualifier;;1;;ID;;2;;2;;29
- +2 ;;QTY02;;Quantity;;2;;R;;1;;15
- +3 ;;END
- SVC ;;
- +1 ;;SVC01;;Composite Medical Procedure Id;;1;;AN;;2;;100
- +2 ;;SVC02;;Line Item Charge Amt ($);;2;;R;;1;;18
- +3 ;;SVC03;;Line Item Prov Paid Amt ($);;3;;R;;1;;18
- +4 ;;SVC04;;Revenue Code;;4;;AN;;1;;48
- +5 ;;SVC05;;Units of Service Paid (cnt);;5;;R;;1;;15
- +6 ;;SVC06;;Composite Medical Procedure Id;;6;;AN;;2;;100
- +7 ;;SVC07;;Orig Units of Service (cnt);;7;;R;;1;;15
- +8 ;;END
- LQ ;;
- +1 ;;LQ01;;Remark Code List Qualifier;;1;;ID;;1;;3;;30
- +2 ;;LQ02;;Remark Code (Line Level);;2;;AN;;1;;30
- +3 ;;END
- PLB ;;
- +1 ;;PLB01;;Provider Identifier;;1;;AN;;1;;30;;;;VPRVNUM
- +2 ;;PLB02;;Fiscal Period Date;;2;;DT;;8;;8
- +3 ;;PLB03;;Composite Adjustment Id;;3;;AN;;2;;33
- +4 ;;PLB04;;Provider Adjustment Amt;;4;;R;;1;;18
- +5 ;;PLB05;;Composite Adjustment Id;;5;;AN;;2;;33
- +6 ;;PLB06;;Provider Adjustment Amt;;6;;R;;1;;18
- +7 ;;PLB07;;Composite Adjustment Id;;7;;AN;;2;;33
- +8 ;;PLB08;;Provider Adjustment Amt;;8;;R;;1;;18
- +9 ;;PLB09;;Composite Adjustment Id;;9;;AN;;2;;33
- +10 ;;PLB10;;Provider Adjustment Amt;;10;;R;;1;;18
- +11 ;;PLB11;;Composite Adjustment Id;;11;;AN;;2;;33
- +12 ;;PLB12;;Provider Adjustment Amt;;12;;R;;1;;18
- +13 ;;PLB13;;Composite Adjustment Id;;13;;AN;2;33
- +14 ;;PLB14;;Provider Adjustment Amt;;14;;R;;1;;18
- +15 ;;END
- SE ;;
- +1 ;;SE01;;Transaction Segment Count;;1;;NO;;1;;10
- +2 ;;SE02;;Transaction Set Control Number;;2;;AN;;4;;9
- +3 ;;END
- GE ;;
- +1 ;;GE01;;Functional Group Set Count;;1;;NO;;1;;6
- +2 ;;GE02;;Group Control Number;;2;;NO;;1;;9
- +3 ;;END
- IEA ;;
- +1 ;;IEA01;;Interchange Group Count;;1;;NO;;1;;5
- +2 ;;IEA02;;Interchange Control Number;;2;;NO;;9;;9
- +3 ;;END