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Routine: BAR50IT3

BAR50IT3.m

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