Ì € 2
main
[mnemonic]
&(HP)HPDC[pdc]
Field Name Len Dat Typ J DPM Offset/Local/VAL
mnemonic 10 FREE L pdc
active 1 YN L &(HP)HPDC[pdc]|0
alt.provider 1 PINT R &(HP)HPDC[pdc]|5
claim.ind 2 FREE L &(HP)HPDC[pdc]|10
clinical.priority 1 YN L &(HP)HPDC[pdc]|9
ess.mnemonic 14 FREE L PBR.ESS.CAT &(HP)HPDC[pdc]|11
gl.component 7 FREE L &(HP)HPDC[pdc]|8
name 30 FREE L &(HP)HPDC[pdc]|1
prt.zero.stmt 1 YN L &(HP)HPDC[pdc]|6
purchased 1 CHOICE L &(HP)HPDC[pdc]|3
service.cat 3 CHOICE L &(HP)HPDC[pdc]|2
split.claim.key 8 FREE L &(HP)HPDC[pdc]|4
type 3 CHOICE L &(HP)HPDC[pdc]|7
Ì € 2
payors
[mnemonic, payor]
&(HP)HPDC[pdc]P[pdy]
Field Name Len Dat Typ J DPM Offset/Local/VAL
payor 10 FREE L PBR.PAYOR pdy
payor.loc.use 15 FREE L &(HP)HPDC[pdc]P[pdy]|0
payor.print.qty 1 YN L &(HP)HPDC[pdc]P[pdy]|1
Ì € 2
payor.modifiers
[mnemonic,payor, payor.mod]
&(HP)HPDC[pdc]P[pdy]M[pdcPM]
Field Name Len Dat Typ J DPM Offset/Local/VAL
payor.mod 2 FREE L pdcPM
Ì € 2
payor.modifiers.invalid
[mnemonic,payor, payor.mod.invalid]
&(HP)HPDC[pdc]P[pdy]I[pdcPI]
Field Name Len Dat Typ J DPM Offset/Local/VAL
payor.mod.invalid 2 FREE L pdcPI
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