Ì € 2
main
[mnemonic]
&(HP)HPDY[pdy]
Field Name Len Dat Typ J DPM Offset/Local/VAL
mnemonic 10 FREE L pdy
active 1 CHOICE L &(HP)HPDY[pdy]|0
alt.pc.eff.date 10 DATE L &(HP)HPDY[pdy]|8
alt.procedure.code 2 PINT R &(HP)HPDY[pdy]|4
alt.tax.id.pin 10 FREE L MIS.INS.PIN &(HP)HPDY[pdy]|13
claim.form 10 FREE L PBR.CLAIM.FORM &(HP)HPDY[pdy]|3
combine.with.payor 10 FREE L PBR.PAYOR &(HP)HPDY[pdy]|7
dunning.msg.series 10 FREE L PBR.DUN.MSG &(HP)HPDY[pdy]|9
ear.hold.all 1 YN L &(HP)HPDY[pdy]0|1
ear.hold.mult.diag 1 YN L &(HP)HPDY[pdy]0|3
ear.hold.mult.diag.proc 1 YN L &(HP)HPDY[pdy]0|4
ear.hold.mult.proc 1 YN L &(HP)HPDY[pdy]0|2
edi.bao.prov.no 2 CHOICE L &(HP)HPDY[pdy]|28
edi.bch.prov.no.1 2 CHOICE L &(HP)HPDY[pdy]E|0
edi.bch.prov.no.2 2 CHOICE L &(HP)HPDY[pdy]E|1
edi.cao.prov.no 2 CHOICE L &(HP)HPDY[pdy]|24
edi.claim.edit.ind 1 FREE L &(HP)HPDY[pdy]|16
edi.claim.sop 1 FREE L &(HP)HPDY[pdy]|17
edi.clm.lvl.prov.no 2 CHOICE L &(HP)HPDY[pdy]|21
edi.clm.rend.prov.no.1 2 CHOICE L &(HP)HPDY[pdy]E|2
edi.clm.rend.prov.no.2 2 CHOICE L &(HP)HPDY[pdy]E|3
edi.dme 1 YN L &(HP)HPDY[pdy]0|0
edi.group 8 FREE L PBR.EDI.GROUP &(HP)HPDY[pdy]|14
edi.org.name 2 CHOICE L &(HP)HPDY[pdy]|22
edi.provider.no 1 CHOICE L &(HP)HPDY[pdy]|19
edi.secondary 1 YN L &(HP)HPDY[pdy]|23
edi.txn.rend.prov.no.1 2 CHOICE L &(HP)HPDY[pdy]E|4
edi.txn.rend.prov.no.2 2 CHOICE L &(HP)HPDY[pdy]E|5
emc.prov.id 2 CHOICE L &(HP)HPDY[pdy]|20
ess.mnemonic 14 FREE L PBR.ESS.PYR &(HP)HPDY[pdy]|25
gl.component 6 FREE L &(HP)HPDY[pdy]|18
hcfa.12.msg 2 CHOICE L &(HP)HPDY[pdy]HCFA|26
hcfa.accident.dft 1 CHOICE L &(HP)HPDY[pdy]HCFA|19
hcfa.below.box.33 1 CHOICE L &(HP)HPDY[pdy]HCFA|14
hcfa.box.10d 1 CHOICE L &(HP)HPDY[pdy]HCFA|15
hcfa.box.21 1 CHOICE L &(HP)HPDY[pdy]HCFA|17
hcfa.box.24.desc 1 YN L &(HP)HPDY[pdy]HCFA|27
hcfa.box.24d.fmt 1 CHOICE L &(HP)HPDY[pdy]HCFA|8
hcfa.box.24f 1 YN L &(HP)HPDY[pdy]HCFA|22
hcfa.box.24h.epsdt 2 FREE L &(HP)HPDY[pdy]HCFA|21
hcfa.box.24h.fam.plan 2 FREE L &(HP)HPDY[pdy]HCFA|20
hcfa.box.24i 1 FREE L &(HP)HPDY[pdy]HCFA|28
hcfa.box.24k 2 CHOICE L &(HP)HPDY[pdy]HCFA|9
hcfa.box.25.msg 1 CHOICE L &(HP)HPDY[pdy]HCFA|5
hcfa.box.29 6 FREE L &(HP)HPDY[pdy]HCFA|16
hcfa.box.31.date 1 CHOICE L &(HP)HPDY[pdy]HCFA|7
hcfa.box.31.signature 1 CHOICE L &(HP)HPDY[pdy]HCFA|10
hcfa.box.31.title 1 YN L &(HP)HPDY[pdy]HCFA|11
hcfa.box.33.grp 2 CHOICE L &(HP)HPDY[pdy]HCFA|13
hcfa.box.33.pin 2 CHOICE L &(HP)HPDY[pdy]HCFA|12
hcfa.box.9.msg 30 FREE L &(HP)HPDY[pdy]HCFA|6
hcfa.codes.in.col.d 1 YN L &(HP)HPDY[pdy]HCFA|3
hcfa.col.h 2 FREE L &(HP)HPDY[pdy]HCFA|4
hcfa.employment.dflt 1 YN L &(HP)HPDY[pdy]HCFA|2
hcfa.ins.addr 2 CHOICE L &(HP)HPDY[pdy]HCFA|18
hcfa.line1 1 CHOICE L &(HP)HPDY[pdy]HCFA|23
hcfa.line2 5 CHOICE L &(HP)HPDY[pdy]HCFA|24
hcfa.line3 4 CHOICE L &(HP)HPDY[pdy]HCFA|25
hcfa.type 12 CHOICE L &(HP)HPDY[pdy]HCFA|0
hcfa.type.character 1 FREE L &(HP)HPDY[pdy]HCFA|1
hold.unbill.pri.days 3 INT R &(HP)HPDY[pdy]|10
hold.unbill.reset.age 1 YN L &(HP)HPDY[pdy]|12
hold.unbill.sec.days 3 INT R &(HP)HPDY[pdy]|11
init.claim.delay 2 INT R &(HP)HPDY[pdy]|27
last.update 10 PINT R &(HP)HPDY[pdy]UPD
name 30 FREE L &(HP)HPDY[pdy]|1
new.claim.key 5 FREE L &(HP)HPDY[pdy]|6
payor.type 10 CHOICE L &(HP)HPDY[pdy]|2
referring.id.pin 10 FREE L MIS.INS.PIN &(HP)HPDY[pdy]|5
special.use 1 CHOICE L &(HP)HPDY[pdy]|26
submit.if.zero.remain 1 YN L &(HP)HPDY[pdy]|15
ub92.box.1 1 CHOICE L &(HP)HPDY[pdy]UB|3
ub92.box.20 1 FREE L &(HP)HPDY[pdy]UB|4
ub92.box.51 1 CHOICE L &(HP)HPDY[pdy]UB|0
ub92.box.54 2 FREE L &(HP)HPDY[pdy]UB|5
ub92.box.55 6 FREE L &(HP)HPDY[pdy]UB|2
ub92.box.82 2 CHOICE L &(HP)HPDY[pdy]UB|1
Ì € 2
alt.claim.forms
[mnemonic, alt.claim.excp]
&(HP)HPDY[pdy]A[pec]
Field Name Len Dat Typ J DPM Offset/Local/VAL
alt.claim.excp 10 FREE L PBR.CLAIM.EXCP pec
alt.claim.edi.grp 8 FREE L PBR.EDI.GROUP &(HP)HPDY[pdy]A[pec]|1
alt.claim.form 10 FREE L PBR.CLAIM.FORM &(HP)HPDY[pdy]A[pec]|0
Ì € 2
edi.rules
[mnemonic, edi.rule]
&(HP)HPDY[pdy]Q[pbi]
Field Name Len Dat Typ J DPM Offset/Local/VAL
edi.rule 10 FREE L PBR.EDI.RULES pbi
Ì € 2
rules
[mnemonic, rule]
&(HP)HPDY[pdy]R[pbr]
Field Name Len Dat Typ J DPM Offset/Local/VAL
rule 10 FREE L PBR.INS.RULES pbr
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