Parent File | Name | Number | Package |
---|---|---|---|
CHS DENIAL DATA(#9002071) | DENIAL NUMBER | 9002071.01 | Contract Health Management Information System |
Field # | Name | Loc | Type | Details |
---|---|---|---|---|
.01 | DENIAL NUMBER | 0;1 | FREE TEXT | ************************REQUIRED FIELD************************
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2 | DATE DENIAL ISSUED | 0;2 | DATE |
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3 | ISSUED BY | 0;3 | POINTER TO NEW PERSON FILE (#200) | NEW PERSON(#200)
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4 | DATE OF MEDICAL SERVICE | 0;4 | DATE |
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5 | DATE REQUEST RECEIVED | 0;5 | DATE |
|
6 | IS THIS PATIENT REGISTERED? | 0;6 | SET |
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7 | REGISTERED PATIENT | 0;7 | POINTER TO PATIENT FILE (#9000001) | PATIENT(#9000001)
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8 | CANCELLED/REVERSED | 0;8 | SET |
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9 | SEND LETTER TO PATIENT? | 9;1 | SET | ************************REQUIRED FIELD************************
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9.5 | ALTERNATE RECIPIENT | 9.5;0 | WORD-PROCESSING #9002071.12 |
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10 | PATIENT NAME | 10;1 | FREE TEXT |
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11 | MAILING ADDRESS-STREET | 10;2 | FREE TEXT |
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12 | MAILING ADDRESS-CITY | 10;3 | FREE TEXT |
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13 | MAILING ADDRESS-STATE | 10;4 | POINTER TO STATE FILE (#5) | STATE(#5)
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14 | MAILING ADDRESS-ZIP | 10;5 | FREE TEXT |
|
15 | CHART # (OTHER FACILITY) | 10;6 | FREE TEXT |
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100 | IS PRIMARY PROVIDER ON FILE? | 100;1 | SET |
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102 | PRIMARY PROVIDER (ON-FILE) | 100;2 | POINTER TO VENDOR FILE (#9999999.11) | VENDOR(#9999999.11)
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103 | PRIMARY PROVIDER (NOT ON-FILE) | 100;3 | FREE TEXT |
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104 | MAILING ADDRESS-STREET | 100;4 | FREE TEXT |
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105 | MAILING ADDRESS-CITY | 100;5 | FREE TEXT |
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106 | MAILING ADDRESS-STATE | 100;6 | POINTER TO STATE FILE (#5) | STATE(#5)
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107 | MAILING ADDRESS-ZIP | 100;7 | FREE TEXT |
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108 | EST. CHARGE (PRIM. PROV.) | 100;8 | NUMBER |
|
109 | ACTUAL CHARGES (PRIM. PROV.) | 100;9 | NUMBER |
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110 | TYPE OF SERVICE | 100;10 | SET |
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200 | OTHER PROVIDER (ON-FILE) | 200;0 | POINTER Multiple #9002071.02 | 9002071.02 |
210 | OTHER PROVIDER (NOT ON-FILE) | 210;0 | Multiple #9002071.03 | 9002071.03 |
250 | PRIMARY DENIAL REASON | 250;1 | POINTER TO CHS DENIAL REASON FILE (#9002073) | CHS DENIAL REASON(#9002073)
|
252 | PRIMARY DENIAL REASON OPTION | 250;2 | FREE TEXT |
|
253 | PRIMARY DENIAL REASON AVAL FAC | 250;3 | POINTER TO LOCATION FILE (#9999999.06) | LOCATION(#9999999.06)
|
255 | PRIMARY DENIAL REASON COMMENT | 255;0 | WORD-PROCESSING #9002071.1255 | |
256 | PRIMARY DEN REASON ALT RES TYP | 256;0 | Multiple #9002071.1256 | 9002071.1256
|
260 | Medicare Resource | 260;0 | POINTER Multiple #9002071.13 | 9002071.13 |
300 | OTHER DENIAL REASONS | 300;0 | POINTER Multiple #9002071.04 | 9002071.04 |
320 | ALTERNATE RESOURCES | 320;0 | Multiple #9002071.13 | 9002071.13 |
400 | UNMET NEED TYPE | 400;1 | SET |
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401 | UNMET NEED COMMENT | 401;0 | WORD-PROCESSING #9002071.1401 |
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420 | MEDICAL PRIORITY CATEGORY | 400;2 | POINTER TO CHS MEDICAL PRIORITY FILE (#9002073.1) | ************************REQUIRED FIELD************************ CHS MEDICAL PRIORITY(#9002073.1)
|
430 | APPEAL STATUS | 400;3 | POINTER TO CHS DENIAL STATUS FILE (#9002074) | CHS DENIAL STATUS(#9002074)
|
431 | APPEAL TRANSACTION RECORD | 431;0 | DATE Multiple #9002071.1431 | 9002071.1431
|
440 | DENIAL FOR LACK OF FUNDS? | 400;4 | SET |
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500 | DIAGNOSIS (ICD) | 500;0 | POINTER Multiple #9002071.05 | 9002071.05
|
700 | PROCEDURE (CPT) | 700;0 | POINTER Multiple #9002071.07 | 9002071.07 |
800 | OTHER RESOURCES | 800;0 | POINTER Multiple #9002071.08 | 9002071.08
|
825 | OTHER IHS RESOURCES | 825;0 | POINTER Multiple #9002071.1825 | 9002071.1825 |
850 | DOCUMENT CONTROL | 850;1 | SET |
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851 | RECEIPT TYPE | 850;2 | SET |
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852 | DATE DENIAL RECEIVED | 850;3 | DATE |
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853 | PERSON RECEIVING DENIAL | 850;4 | FREE TEXT |
|
900 | CHS OFFICE COMMENTS | 900;0 | WORD-PROCESSING #9002071.09 | |
950 | PROVIDER ACCOUNT NUMBER | 950;0 | Multiple #9002071.11 | 9002071.11
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