STANDARD DATA DICTIONARY #351.9 -- CLAIMSMANAGER BILLS FILE 3/24/25 PAGE 1
STORED IN ^IBA(351.9, *** NO DATA STORED YET *** SITE: WWW.BMIRWIN.COM UCI: VISTA,VISTA (VERSION 2.0)
DATA NAME GLOBAL DATA
ELEMENT TITLE LOCATION TYPE
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This file contains information on bills that have been sent to the Ingenix ClaimsManager.
The entries in this file have matching entries in the BILL/CLAIMS file (399). The internal number in file 399 is the same as the
internal number in the CLAIMSMANAGER BILLS file.
Per VHA Directive 10-93-142, this file definition should not be modified.
DD ACCESS: @
RD ACCESS: @
WR ACCESS: @
DEL ACCESS: @
LAYGO ACCESS: @
AUDIT ACCESS: @
CROSS
REFERENCED BY: DATE/TIME LAST EDITED(ADE), LAST EDITED BY(AEB), ERROR CODE(AEC), ASSIGNED TO(ASN), STATUS(AST), CLAIM(B)
351.9,.01 CLAIM 0;1 POINTER TO BILL/CLAIMS FILE (#399) (Required)
INPUT TRANSFORM: S DINUM=X
LAST EDITED: DEC 28, 2000
DESCRIPTION:
This is a pointer to the BILL/CLAIMS file (#399).
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
CROSS-REFERENCE: 351.9^B
1)= S ^IBA(351.9,"B",$E(X,1,30),DA)=""
2)= K ^IBA(351.9,"B",$E(X,1,30),DA)
351.9,.02 STATUS 0;2 POINTER TO CLAIMSMANAGER STATUS FILE (#351.91)
LAST EDITED: JAN 11, 2001
DESCRIPTION:
This is a pointer to the CLAIMSMANAGER STATUS file (#351.91)
CROSS-REFERENCE: 351.9^AST
1)= S ^IBA(351.9,"AST",$E(X,1,30),DA)=""
2)= K ^IBA(351.9,"AST",$E(X,1,30),DA)
Cross reference of the Status field for lookup and reports.
351.9,.03 LAST SENT TO CLAIMSMANAGER 0;3 DATE
INPUT TRANSFORM: S %DT="ESTX" D ^%DT S X=Y K:Y<1 X
LAST EDITED: MAR 19, 2001
HELP-PROMPT: (No range limit on date)
DESCRIPTION:
This is the Date/time that the claim was last sent to ClaimsManager.
351.9,.04 TIMES SENT TO CLAIMSMANAGER 0;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<1) X
LAST EDITED: MAR 19, 2001
HELP-PROMPT: Answer will be a numeric value from 0 to 9999.
DESCRIPTION:
This will be a numeric value to track the number of times the claim was sent to ClaimsManager.
351.9,.05 SENT BY 0;5 POINTER TO NEW PERSON FILE (#200)
LAST EDITED: DEC 20, 2000
DESCRIPTION: This is a pointer to the New Person file (#200) to recored the identity of the last person to send
the claim to ClaimsManager.
351.9,.06 DATE/TIME ENTERED 0;6 DATE
INPUT TRANSFORM: S %DT="ESTX" D ^%DT S X=Y K:Y<1 X
LAST EDITED: DEC 20, 2000
DESCRIPTION: This is the date and time that the claim was originally entered into the CLAIMSMANAGER file
(351.9).
351.9,.07 ENTERED BY 0;7 POINTER TO NEW PERSON FILE (#200)
LAST EDITED: DEC 20, 2000
DESCRIPTION: This will point to the New Person file (#200) and will identify the person who originally
entered/edited the bill causing an entry in the CLAIMSMANAGER file (351.9).
351.9,.08 DATE/TIME LAST EDITED 0;8 DATE
INPUT TRANSFORM: S %DT="ESTX" D ^%DT S X=Y K:Y<1 X
LAST EDITED: JAN 11, 2001
DESCRIPTION:
This is the date/time that the claim was last edited.
CROSS-REFERENCE: 351.9^ADE
1)= S ^IBA(351.9,"ADE",$E(X,1,30),DA)=""
2)= K ^IBA(351.9,"ADE",$E(X,1,30),DA)
Cross reference of the DATE/TIME LAST EDITED for reports and to be used with list manager.
351.9,.09 LAST EDITED BY 0;9 POINTER TO NEW PERSON FILE (#200)
LAST EDITED: JAN 11, 2001
DESCRIPTION:
This is a pointer to the New Person file (#200) to identify the person who last edited this claim.
CROSS-REFERENCE: 351.9^AEB
1)= S ^IBA(351.9,"AEB",$E(X,1,30),DA)=""
2)= K ^IBA(351.9,"AEB",$E(X,1,30),DA)
Cross reference of the LAST EDITED BY field for reports and list manager.
351.9,.1 OVERRIDDEN? 0;10 SET
'1' FOR YES;
LAST EDITED: DEC 20, 2000
DESCRIPTION: If the user chooses to override the ClaimsManager errors and send the claim "as is" this field will
be set to '1'.
351.9,.11 OVERRIDDEN BY 0;11 POINTER TO NEW PERSON FILE (#200)
LAST EDITED: DEC 20, 2000
DESCRIPTION: If OVERRIDDEN? is set to YES, then this field will contain the IEN for the NEW PERSON file (#200)
of the person who overrode the ClaimsManager errors.
351.9,.12 ASSIGNED TO 0;12 POINTER TO NEW PERSON FILE (#200)
LAST EDITED: MAR 07, 2001
DESCRIPTION: This field will point to the person that the biller assigns the bill to. The default will be the
biller.
CROSS-REFERENCE: 351.9^ASN
1)= S ^IBA(351.9,"ASN",$E(X,1,30),DA)=""
2)= K ^IBA(351.9,"ASN",$E(X,1,30),DA)
Cross reference of the ASSIGNED TO field for reports and lookups on who the claim is assigned to.
351.9,.13 COMMENT DATE/TIME 0;13 DATE
INPUT TRANSFORM: S %DT="EST" D ^%DT S X=Y K:Y<1 X
LAST EDITED: MAR 14, 2001
DESCRIPTION:
This will be the Date/Time stamp for when the comments were entered.
351.9,.14 COMMENT ENTERED BY 0;14 POINTER TO NEW PERSON FILE (#200)
LAST EDITED: MAR 14, 2001
DESCRIPTION:
This a pointer to the New Person file of the person who entered the comments.
351.9,.15 RECEIVED BY CLAIMSMANAGER 0;15 SET
'1' FOR YES;
'0' FOR NO;
LAST EDITED: MAR 22, 2001
DESCRIPTION: This field is used as a check to ensure that ClaimsManager received the bill without a comm error.
This is needed for the cancellation process.
351.9,1.01 ERROR CODE 1;0 Multiple #351.9001 (Add New Entry without Asking)
351.9001,.01 ERROR CODE 0;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>5!($L(X)<1) X
LAST EDITED: FEB 26, 2001
HELP-PROMPT: Answer must be 1-5 characters in length.
DESCRIPTION: The error code is the three character code that is returned by ClaimsManager when there is an
error.
CROSS-REFERENCE: 351.9001^B
1)= S ^IBA(351.9,DA(1),1,"B",$E(X,1,30),DA)=""
2)= K ^IBA(351.9,DA(1),1,"B",$E(X,1,30),DA)
CROSS-REFERENCE: 351.9^AEC
1)= S ^IBA(351.9,"AEC",$E(X,1,30),DA(1),DA)=""
2)= K ^IBA(351.9,"AEC",$E(X,1,30),DA(1),DA)
Cross reference for reports on Error Code field.
351.9001,.02 ERROR DATA 0;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>60!($L(X)<1) X
LAST EDITED: FEB 24, 2001
HELP-PROMPT: Answer must be 1-60 characters in length.
DESCRIPTION: This will contain additional data about the error contained in the zero node of the Z1 array with
the error message from ClaimsManager.
351.9001,.03 ERROR TEXT 1;0 WORD-PROCESSING #351.9004
LAST EDITED: FEB 24, 2001
DESCRIPTION:
This word processing field contains the text of the error message returned by ClaimsManager.
351.9,2.01 COMMENTS 2;0 WORD-PROCESSING #351.9002
LAST EDITED: DEC 20, 2000
DESCRIPTION:
This field will contain the comments entered when exiting or overriding.
351.9,3.01 PATIENT ID 3;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<9) X
LAST EDITED: DEC 20, 2000
HELP-PROMPT: Patient SSN must be 9-10 characters in length.
DESCRIPTION:
The patient's SSN will be the Patient ID for ClaimsManager. It may be 9 or 10 characters.
351.9,3.02 PT LAST NAME 3;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>40!($L(X)<1) X
LAST EDITED: DEC 20, 2000
HELP-PROMPT: Answer must be 1-40 characters in length.
DESCRIPTION:
This field will contain the last name of the patient.
351.9,3.03 PT MIDDLE NAME 3;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>20!($L(X)<1) X
LAST EDITED: DEC 20, 2000
HELP-PROMPT: Answer must be 1-20 characters in length.
DESCRIPTION:
This field will contain the middle name of the patient, if one exists.
351.9,3.04 PT FIRST NAME 3;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>20!($L(X)<1) X
LAST EDITED: DEC 20, 2000
HELP-PROMPT: Answer must be 1-20 characters in length.
DESCRIPTION:
This field contains the first name of the patient.
351.9,3.05 PT DOB 3;5 FREE TEXT
INPUT TRANSFORM: K:$L(X)>16!($L(X)<1) X
LAST EDITED: DEC 20, 2000
HELP-PROMPT: Answer must be 1-16 characters in length.
DESCRIPTION:
This field contains the patient's Date of Birth.
351.9,3.06 PT GENDER 3;6 FREE TEXT
INPUT TRANSFORM: K:$L(X)>1!($L(X)<1) X
LAST EDITED: DEC 20, 2000
HELP-PROMPT: Answer must be 1 character in length.
DESCRIPTION:
This is a one character abbreviation to identify the patient's gender.
351.9,3.07 ENTRY DATE/TIME 3;7 FREE TEXT
INPUT TRANSFORM: K:$L(X)>16!($L(X)<1) X
LAST EDITED: DEC 20, 2000
HELP-PROMPT: Answer must be 1-16 characters in length.
DESCRIPTION:
This is the Date/time that the claim was entered into Vista.
351.9,3.08 REF PHYS ID 3;8 FREE TEXT
INPUT TRANSFORM: K:$L(X)>20!($L(X)<1) X
LAST EDITED: DEC 20, 2000
HELP-PROMPT: Answer must be 1-20 characters in length.
DESCRIPTION:
This is the Referring Physician's ID in the format expected by ClaimsManager.
351.9,3.09 REF PHYS LAST NAME 3;9 FREE TEXT
INPUT TRANSFORM: K:$L(X)>40!($L(X)<1) X
LAST EDITED: DEC 20, 2000
HELP-PROMPT: Answer must be 1-40 characters in length.
DESCRIPTION:
This is the Referring Physician's last name.
351.9,3.1 REF PHYS MIDDLE NAME 3;10 FREE TEXT
INPUT TRANSFORM: K:$L(X)>20!($L(X)<1) X
LAST EDITED: DEC 20, 2000
HELP-PROMPT: Answer must be 1-20 characters in length.
DESCRIPTION:
This is the Referring Physician's middle name, if one exists.
351.9,3.11 REF PHYS FIRST NAME 3;11 FREE TEXT
INPUT TRANSFORM: K:$L(X)>20!($L(X)<1) X
LAST EDITED: DEC 20, 2000
HELP-PROMPT: Answer must be 1-20 characters in length.
DESCRIPTION:
This is the Referring Physician's first name.
351.9,3.12 REF PHYS TITLE 3;12 FREE TEXT
INPUT TRANSFORM: K:$L(X)>5!($L(X)<1) X
LAST EDITED: DEC 20, 2000
HELP-PROMPT: Answer must be 1-5 characters in length.
DESCRIPTION:
This is the Referring Physicians Title.
351.9,4.01 REF PHYS DEPT 4;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>20!($L(X)<1) X
LAST EDITED: DEC 20, 2000
HELP-PROMPT: Answer must be 1-20 characters in length.
DESCRIPTION:
This will identify the department for the Referring Physician.
351.9,4.02 REF PHYS SPEC 4;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<1) X
LAST EDITED: DEC 20, 2000
HELP-PROMPT: Answer must be 1-10 characters in length.
DESCRIPTION:
This is the Referring Physician's Specialty
351.9,4.03 REF PHYS DEGREE ID 4;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<1) X
LAST EDITED: DEC 20, 2000
HELP-PROMPT: Answer must be 1-10 characters in length.
DESCRIPTION:
This is the Referring Physician's Degree ID.
351.9,4.04 REF PHYS UPIN 4;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<1) X
LAST EDITED: DEC 20, 2000
HELP-PROMPT: Answer must be 1-10 characters in length.
DESCRIPTION:
This is the Referring Physician's UPIN number.
351.9,5.01 LINE SEGMENT 5;0 Multiple #351.9003 (Add New Entry without Asking)
DESCRIPTION:
This is the number assigned to a specific line segment for transmission to ClaimsManager.
351.9003,.01 LINE SEGMENT 0;1 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>999)!(X<1)!(X?.E1"."1N.N) X
LAST EDITED: DEC 20, 2000
HELP-PROMPT: Type a Number between 1 and 999, 0 Decimal Digits
DESCRIPTION:
This is the number assigned to a specific line segment.
CROSS-REFERENCE: 351.9003^B
1)= S ^IBA(351.9,DA(1),5,"B",$E(X,1,30),DA)=""
2)= K ^IBA(351.9,DA(1),5,"B",$E(X,1,30),DA)
351.9003,.02 EXT LINE ID 0;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>25!($L(X)<1) X
LAST EDITED: DEC 20, 2000
HELP-PROMPT: Answer must be 1-25 characters in length.
DESCRIPTION:
This is the User's transaction/line item identifier. (Required)
351.9003,.03 ORG GROUP ID 0;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>20!($L(X)<1) X
LAST EDITED: DEC 20, 2000
HELP-PROMPT: Answer must be 1-20 characters in length.
DESCRIPTION: This is the Organization Group Identifier for the claim. (Optional) If a null value is sent, CM
will internally store a default value of 1.
351.9003,.04 ORG ID 0;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>20!($L(X)<1) X
LAST EDITED: DEC 20, 2000
HELP-PROMPT: Answer must be 1-20 characters in length.
DESCRIPTION: This is the Organization identifier for the claim. (Optional) If the value is null, ClaimsManager
will store a default value of 1.
351.9003,.05 LINE STATUS 0;5 SET
'A' FOR ACTIVE;
'P' FOR PROFILED;
'D' FOR DELETED;
LAST EDITED: DEC 20, 2000
DESCRIPTION: Default values are 'A' for Active, 'P' for Profiled and 'D' for Deleted. (Required) The user can
supply other values at setup within ClaimsManager. PLEASE NOTE: If other codes are added within
ClaimsManager, they must also be added to this field.
351.9003,.06 BEG DATE OF SERVICE 0;6 FREE TEXT
INPUT TRANSFORM: K:$L(X)>16!($L(X)<1) X
LAST EDITED: DEC 20, 2000
HELP-PROMPT: Answer must be 1-16 characters in length.
DESCRIPTION:
This is the Beginning Date of Service in (YYYYMMDD) format. (Required)
351.9003,.07 END DATE OF SERVICE 0;7 FREE TEXT
INPUT TRANSFORM: K:$L(X)>16!($L(X)<1) X
LAST EDITED: DEC 20, 2000
HELP-PROMPT: Answer must be 1-16 characters in length.
DESCRIPTION:
This is the End Date of Service in (YYYYMMDD) format. (Required)
351.9003,.08 PLACE OF SERVICE 0;8 FREE TEXT
INPUT TRANSFORM: K:$L(X)>3!($L(X)<1) X
LAST EDITED: DEC 20, 2000
HELP-PROMPT: Answer must be 1-3 characters in length.
DESCRIPTION:
This is the identifier for Place of Service. (Required)
351.9003,.09 SUBMITTED PROCEDURE CODE 0;9 FREE TEXT
INPUT TRANSFORM: K:$L(X)>25!($L(X)<1) X
LAST EDITED: DEC 20, 2000
HELP-PROMPT: Answer must be 1-25 characters in length.
DESCRIPTION:
This field contains the Submitted Procedure Code. (Required)
351.9003,.1 ADJUSTED PROCEDURE CODE 0;10 FREE TEXT
INPUT TRANSFORM: K:$L(X)>25!($L(X)<1) X
LAST EDITED: DEC 20, 2000
HELP-PROMPT: Answer must be 1-25 characters in length.
DESCRIPTION:
This field contains the Adjusted Procedure Code. (Optional)
351.9003,.11 SUBMITTED AMOUNT 0;11 FREE TEXT
INPUT TRANSFORM: K:$L(X)>15!($L(X)<1) X
LAST EDITED: DEC 20, 2000
HELP-PROMPT: Answer must be 1-15 characters in length.
DESCRIPTION:
This is the Submitted Amount. (Optional)
351.9003,.12 PRE AUTHORIZATION CODE 0;12 FREE TEXT
INPUT TRANSFORM: K:$L(X)>15!($L(X)<1) X
LAST EDITED: DEC 20, 2000
HELP-PROMPT: Answer must be 1-15 characters in length.
DESCRIPTION:
This is the Pre-Authorization Code. (Optioinal)
351.9003,.13 SERVICE PROVIDER ID 0;13 FREE TEXT
INPUT TRANSFORM: K:$L(X)>20!($L(X)<1) X
LAST EDITED: DEC 20, 2000
HELP-PROMPT: Answer must be 1-20 characters in length.
DESCRIPTION: This is the Servicing Provider ID. (Optional)
Identifies a provider reccord stored in the database. If ClaimsManager finds no match, it adds
this ID to the PROVIDER table. If an ID is supplied, a DEPARTMENT must also be supplied.
351.9003,1.01 SRVC PRV LAST NAME 1;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>40!($L(X)<1) X
LAST EDITED: DEC 20, 2000
HELP-PROMPT: Answer must be 1-40 characters in length.
DESCRIPTION:
This is the Service Providers Last Name. (Optional)
351.9003,1.02 SRVC PRV MIDDLE NAME 1;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>20!($L(X)<1) X
LAST EDITED: DEC 20, 2000
HELP-PROMPT: Answer must be 1-20 characters in length.
DESCRIPTION:
This is the Service Providers Middle Name. (Optional)
351.9003,1.03 SRVC PRV FIRST NAME 1;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>20!($L(X)<1) X
LAST EDITED: DEC 20, 2000
HELP-PROMPT: Answer must be 1-20 characters in length.
DESCRIPTION:
This is the Service Providers First Name. (Optional)
351.9003,1.04 SRVC PRV TITLE 1;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>5!($L(X)<1) X
LAST EDITED: DEC 20, 2000
HELP-PROMPT: Answer must be 1-5 characters in length.
DESCRIPTION:
This is the Service Providers Title. (Optional)
351.9003,1.05 SRVC PRV DEPT 1;5 FREE TEXT
INPUT TRANSFORM: K:$L(X)>20!($L(X)<1) X
LAST EDITED: DEC 20, 2000
HELP-PROMPT: Answer must be 1-20 characters in length.
DESCRIPTION: This is the Servicing Providers Department. (Optional)
Identifies a department record stored in the database. If CM finds no match, it 'could' add this
department ID to the Reference table.
351.9003,1.06 SRVC PRV SPEC 1;6 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<1) X
LAST EDITED: DEC 20, 2000
HELP-PROMPT: Answer must be 1-10 characters in length.
DESCRIPTION: This is the Servicing Provider Specialty. (Optional)
Identifies a specialty record stored in the database. If CM finds no match, it 'could' add this
specialty to the Reference table.
If this ID is supplied, a Department must also be present.
351.9003,1.07 SRVC PRV DEGREE ID 1;7 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<1) X
LAST EDITED: DEC 20, 2000
HELP-PROMPT: Answer must be 1-10 characters in length.
DESCRIPTION:
This is the Servicing Providers Degree ID. (Optional)
351.9003,1.08 SRVC PRV UPIN 1;8 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<1) X
LAST EDITED: DEC 20, 2000
HELP-PROMPT: Answer must be 1-10 characters in length.
DESCRIPTION:
This is the Servicing Provider UPIN code. (Optional)
351.9003,1.09 BILL PRV ID 1;9 FREE TEXT
INPUT TRANSFORM: K:$L(X)>20!($L(X)<1) X
LAST EDITED: DEC 20, 2000
HELP-PROMPT: Answer must be 1-20 characters in length.
DESCRIPTION: This is the Billing Provider Identifier. (Required)
Identifies a provider record stored in the database. If CM finds no match, it adds this ID to
the PROVIDER table.
If no ID is supplied, CM stored the default provider. DFLT is supplied but the User can change
this string at setup in CM. Only one string is used for all physicians.
If an ID is supplied, a Department must also be present.
351.9003,2.01 BILL PRV LAST NAME 2;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>40!($L(X)<1) X
LAST EDITED: DEC 20, 2000
HELP-PROMPT: Answer must be 1-40 characters in length.
DESCRIPTION:
This is the Billing Provider Last name. (Optional)
351.9003,2.02 BILL PRV MIDDLE NAME 2;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>20!($L(X)<1) X
LAST EDITED: DEC 20, 2000
HELP-PROMPT: Answer must be 1-20 characters in length.
DESCRIPTION:
This is the Billing Provider Middle name. (Optional)
351.9003,2.03 BILL PRV FIRST NAME 2;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>20!($L(X)<1) X
LAST EDITED: DEC 20, 2000
HELP-PROMPT: Answer must be 1-20 characters in length.
DESCRIPTION:
This is the Billing Provider First name. (Optional)
351.9003,2.04 BILL PRV TITLE 2;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>5!($L(X)<1) X
LAST EDITED: DEC 20, 2000
HELP-PROMPT: Answer must be 1-5 characters in length.
DESCRIPTION:
This is the Billing Provider Title. (Optional)
351.9003,2.05 BILL PRV DEPT 2;5 FREE TEXT
INPUT TRANSFORM: K:$L(X)>20!($L(X)<1) X
LAST EDITED: DEC 20, 2000
HELP-PROMPT: Answer must be 1-20 characters in length.
DESCRIPTION: This is the Billing Provider Department. (Required)
Identifies a Department record stored in the database. If CM finds no match, it 'could' add this
Department ID to the Reference table.
351.9003,2.06 BILL PRV SPEC 2;6 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<1) X
LAST EDITED: DEC 20, 2000
HELP-PROMPT: Answer must be 1-10 characters in length.
DESCRIPTION: This is the Billing Provider Specialty. (Required)
Identifies a Specialty record stored in the database. If CM finds no match, it 'could' add this
specialty to the Reference table.
351.9003,2.07 BILL PRV DEGREE ID 2;7 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<1) X
LAST EDITED: DEC 20, 2000
HELP-PROMPT: Answer must be 1-10 characters in length.
DESCRIPTION:
This is the Billing Provider Degree ID. (Optional)
351.9003,2.08 BILL PRV UPIN 2;8 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<1) X
LAST EDITED: DEC 20, 2000
HELP-PROMPT: Answer must be 1-10 characters in length.
DESCRIPTION:
This is the Billing Provider UPIN code. (Optional)
351.9003,2.09 PRIMARY PAYER ID 2;9 FREE TEXT
INPUT TRANSFORM: K:$L(X)>20!($L(X)<1) X
LAST EDITED: DEC 20, 2000
HELP-PROMPT: Answer must be 1-20 characters in length.
DESCRIPTION:
This is the Primary Payer or FSC identifier. (Required)
351.9003,2.1 SECONDARY PAYER ID 2;10 FREE TEXT
INPUT TRANSFORM: K:$L(X)>20!($L(X)<1) X
LAST EDITED: DEC 20, 2000
HELP-PROMPT: Answer must be 1-20 characters in length.
DESCRIPTION:
This is the Secondary Payer or FSC identifier. (Optional)
351.9003,2.11 TYPE OF SERVICE 2;11 FREE TEXT
INPUT TRANSFORM: K:$L(X)>3!($L(X)<1) X
LAST EDITED: DEC 20, 2000
HELP-PROMPT: Answer must be 1-3 characters in length.
DESCRIPTION:
This is the Type of Service. (Optional)
351.9003,2.12 UNITS 2;12 FREE TEXT
INPUT TRANSFORM: K:$L(X)>5!($L(X)<1) X
LAST EDITED: DEC 20, 2000
HELP-PROMPT: Answer must be 1-5 characters in length.
DESCRIPTION:
This is the number of units for this line item. (Required)
351.9003,3.01 MODIFIERS 3;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>60!($L(X)<1) X
LAST EDITED: MAR 25, 2001
HELP-PROMPT: Answer must be 1-60 characters in length.
DESCRIPTION: This is a storage location for the comma delimited string of CPT Modifiers for the associated
line segment.
FILES POINTED TO FIELDS
BILL/CLAIMS (#399) CLAIM (#.01)
CLAIMSMANAGER STATUS (#351.91) STATUS (#.02)
NEW PERSON (#200) SENT BY (#.05)
ENTERED BY (#.07)
LAST EDITED BY (#.09)
OVERRIDDEN BY (#.11)
ASSIGNED TO (#.12)
COMMENT ENTERED BY (#.14)
INPUT TEMPLATE(S):
PRINT TEMPLATE(S):
SORT TEMPLATE(S):
FORM(S)/BLOCK(S):