Ì i 2
batch
[bch.edi.group,bch.urn]
*(HP7)HPIB[peg,pib]
Field Name Len Dat Typ J DPM Offset/Local/VAL
bch.edi.group 8 FREE L PBR.EDI.GROUP peg
bch.urn 10 URN L pib
bch.ansi.hl.number 4 PINT R *(HP7)HPIB[peg,pib]|12
bch.batched.struc 1 YN L *(HP7)HPIB[peg,pib]|10
bch.chg.noncov.tot 9 MONEY R *(HP7)HPIB[peg,pib]|13
bch.chg.total 9 MONEY R *(HP7)HPIB[peg,pib]|6
bch.claim.total 7 INT R *(HP7)HPIB[peg,pib]|7
bch.dept 10 FREE L PBR.DBB *(HP7)HPIB[peg,pib]|11
bch.doctor 8 FREE L PBR.DOCTOR *(HP7)HPIB[peg,pib]|3
bch.file 10 URN L *(HP7)HPIB[peg,pib]|0
bch.file.entry 5 INT R *(HP7)HPIB[peg,pib]|1
bch.ins 10 FREE L PBR.INS *(HP7)HPIB[peg,pib]|2
bch.loc 8 FREE L PBR.LOCATION *(HP7)HPIB[peg,pib]|9
bch.rec.cnt 7 INT R *(HP7)HPIB[peg,pib]|5
bch.svc.ln.cnt 7 INT R *(HP7)HPIB[peg,pib]|4
bch.test.prod 1 CHOICE L *(HP7)HPIB[peg,pib]|8
bch.tmp.dr.dept 10 FREE L PBR.DBB *(HP7)HPIB[peg,pib]|20
Ì € i 2
batch.begin
[bch.edi.group,bch.urn, bch.b.rec.name,bch.b.line]
*(HP7)HPIB[peg,pib]B[piRCN,piLN]
Field Name Len Dat Typ J DPM Offset/Local/VAL
bch.b.rec.name 5 FREE L piRCN
bch.b.line 4 FREE L piLN
bch.b.record 160 FREE L *(HP7)HPIB[peg,pib]B[piRCN,piLN]
Ì € i 2
batch.detail
[bch.edi.group,bch.urn, bch.seq]
*(HP7)HPIB[peg,pib]D[pibSQ]
Field Name Len Dat Typ J DPM Offset/Local/VAL
bch.seq 5 FREE L pibSQ
bch.acct 44 URN L PBR.ACT *(HP7)HPIB[peg,pib]D[pibSQ]|0
bch.batched.urn 7 URN L *(HP7)HPIB[peg,pib]D[pibSQ]|2
bch.claim.urn 5 URN L *(HP7)HPIB[peg,pib]D[pibSQ]|1
bch.x12.urn 7 URN L *(HP7)HPIB[peg,pib]D[pibSQ]|3
Ì € i 2
batch.end
[bch.edi.group,bch.urn, bch.e.rec.name,bch.e.line]
*(HP7)HPIB[peg,pib]E[piRCN,piLN]
Field Name Len Dat Typ J DPM Offset/Local/VAL
bch.e.rec.name 5 FREE L piRCN
bch.e.line 4 FREE L piLN
bch.e.record 160 FREE L *(HP7)HPIB[peg,pib]E[piRCN,piLN]
Ì i 2
claim.errs
[errs.edi.group,errs.ins,errs.account,errs.urn,errs.errors,errs.type,errs.txns]
*(HP7)HPIR[peg,pdi,pz,ppi,piR,pirTY,pzT]
Field Name Len Dat Typ J DPM Offset/Local/VAL
errs.edi.group 8 FREE L PBR.EDI.GROUP peg
errs.ins 10 FREE L PBR.INS pdi
errs.account 44 URN L PBR.ACT pz
errs.urn 5 URN L ppi
errs.errors 10 FREE L piR
errs.type 1 CHOICE L pirTY
errs.txns 5 URN L pzT
Ì i 2
claims.ns
[ns.edi.group,ns.ins,ns.sort.key,ns.acct,ns.urn]
*(HP7)HPIS[peg,pdei,nKY,pz,ppi]
Field Name Len Dat Typ J DPM Offset/Local/VAL
ns.edi.group 8 FREE L PBR.EDI.GROUP peg
ns.ins 10 FREE L PBR.INS pdei
ns.sort.key 6 FREE L nKY
ns.acct 44 URN L PBR.ACT pz
ns.urn 5 URN L ppi
ns.batch 5 URN L *(HP7)HPIS[peg,pdei,nKY,pz,ppi]|0
ns.batch.entry 5 INT R *(HP7)HPIS[peg,pdei,nKY,pz,ppi]|1
ns.chg.total 9 MONEY R *(HP7)HPIS[peg,pdei,nKY,pz,ppi]|4
ns.claim.number 10 INT R *(HP7)HPIS[peg,pdei,nKY,pz,ppi]|6
ns.doctor 8 FREE L PBR.DOCTOR *(HP7)HPIS[peg,pdei,nKY,pz,ppi]|7
ns.hold.clm 1 FREE L *(HP7)HPIS[peg,pdei,nKY,pz,ppi]|9
ns.loc 8 FREE L PBR.LOCATION *(HP7)HPIS[peg,pdei,nKY,pz,ppi]|8
ns.rec.cnt 7 INT R *(HP7)HPIS[peg,pdei,nKY,pz,ppi]|3
ns.svc.ln.cnt 7 INT R *(HP7)HPIS[peg,pdei,nKY,pz,ppi]|2
ns.test.prod 1 CHOICE L *(HP7)HPIS[peg,pdei,nKY,pz,ppi]|5
Ì € i 2
claims.ns.detail
[ns.edi.group,ns.ins,ns.sort.key,ns.acct,ns.urn, ns.rec.name,ns.line]
*(HP7)HPIS[peg,pdei,nKY,pz,ppi]D[piRCN,piLN]
Field Name Len Dat Typ J DPM Offset/Local/VAL
ns.rec.name 5 FREE L piRCN
ns.line 4 FREE L piLN
ns.record 160 FREE L *(HP7)HPIS[peg,pdei,nKY,pz,ppi]D[piRCN,piLN]
Ì i 2
claims.nsf
[nsf.edi.group,nsf.ins,nsf.doctor,nsf.acct,nsf.urn]
*(HP7)HPIN[peg,pdei,pdd,pz,ppi]
Field Name Len Dat Typ J DPM Offset/Local/VAL
nsf.edi.group 8 FREE L PBR.EDI.GROUP peg
nsf.ins 10 FREE L PBR.INS pdei
nsf.doctor 8 FREE L PBR.DOCTOR pdd
nsf.acct 44 URN L PBR.ACT pz
nsf.urn 5 URN L ppi
nsf.batch 5 URN L *(HP7)HPIN[peg,pdei,pdd,pz,ppi]|0
nsf.batch.entry 5 INT R *(HP7)HPIN[peg,pdei,pdd,pz,ppi]|1
nsf.chg.total 9 MONEY R *(HP7)HPIN[peg,pdei,pdd,pz,ppi]|4
nsf.claim.number 10 INT R *(HP7)HPIN[peg,pdei,pdd,pz,ppi]|6
nsf.rec.cnt 7 INT R *(HP7)HPIN[peg,pdei,pdd,pz,ppi]|3
nsf.svc.ln.cnt 7 INT R *(HP7)HPIN[peg,pdei,pdd,pz,ppi]|2
nsf.test.prod 1 CHOICE L *(HP7)HPIN[peg,pdei,pdd,pz,ppi]|5
Ì € i 2
claims.nsf.detail
[nsf.edi.group,nsf.ins,nsf.doctor,nsf.acct,nsf.urn, nsf.rec.name,nsf.line]
*(HP7)HPIN[peg,pdei,pdd,pz,ppi]D[piRCN,piLN]
Field Name Len Dat Typ J DPM Offset/Local/VAL
nsf.rec.name 5 FREE L piRCN
nsf.line 4 FREE L piLN
nsf.record 160 FREE L *(HP7)HPIN[peg,pdei,pdd,pz,ppi]D[piRCN,piLN]
Ì i 2
claims.x12
[x12.edi.group,x12.urn]
*(HP7)HPIX[peg,pix]
Field Name Len Dat Typ J DPM Offset/Local/VAL
x12.edi.group 8 FREE L PBR.EDI.GROUP peg
x12.urn 7 FREE L pix
x12.acct 44 URN L PBR.ACT *(HP7)HPIX[peg,pix]|0
x12.claim.number 10 INT R *(HP7)HPIX[peg,pix]|6
x12.claim.urn 5 URN L *(HP7)HPIX[peg,pix]|1
x12.dept 10 FREE L PBR.DBB *(HP7)HPIX[peg,pix]|7
x12.doctor 8 FREE L PBR.DOCTOR *(HP7)HPIX[peg,pix]|3
x12.ins 10 FREE L PBR.INS *(HP7)HPIX[peg,pix]|2
x12.location 8 FREE L PBR.LOCATION *(HP7)HPIX[peg,pix]|4
x12.sort.key 6 FREE L *(HP7)HPIX[peg,pix]|5
Ì i 2
claims.x12.ca
[x12.ca.edi.group,x12.ca.doctor.db.lvl.b,x12.ca.location,x12.ca.acct,x12.ca.urn]
*(HP7)HPIXC[peg,pdg,pdl2,pz,ppi]
Field Name Len Dat Typ J DPM Offset/Local/VAL
x12.ca.edi.group 8 FREE L PBR.EDI.GROUP peg
x12.ca.doctor.db.lvl.b 10 FREE L PBR.DBB pdg
x12.ca.location 8 FREE L PBR.LOCATION pdl2
x12.ca.acct 44 URN L PBR.ACT pz
x12.ca.urn 5 URN L ppi
x12.ca.batch 5 URN L *(HP7)HPIXC[peg,pdg,pdl2,pz,ppi]|0
x12.ca.batch.entry 5 INT R *(HP7)HPIXC[peg,pdg,pdl2,pz,ppi]|1
x12.ca.chg.total 9 MONEY R *(HP7)HPIXC[peg,pdg,pdl2,pz,ppi]|4
x12.ca.claim.number 10 INT R *(HP7)HPIXC[peg,pdg,pdl2,pz,ppi]|6
x12.ca.doctor 8 FREE L PBR.DOCTOR *(HP7)HPIXC[peg,pdg,pdl2,pz,ppi]|8
x12.ca.grp.id 16 FREE L *(HP7)HPIXC[peg,pdg,pdl2,pz,ppi]|9
x12.ca.ins 10 FREE L PBR.INS *(HP7)HPIXC[peg,pdg,pdl2,pz,ppi]|7
x12.ca.rec.cnt 7 INT R *(HP7)HPIXC[peg,pdg,pdl2,pz,ppi]|3
x12.ca.svc.ln.cnt 7 INT R *(HP7)HPIXC[peg,pdg,pdl2,pz,ppi]|2
x12.ca.test.prod 1 CHOICE L *(HP7)HPIXC[peg,pdg,pdl2,pz,ppi]|5
Ì i 2
file
[file.urn]
*(HP7)HPIF[pif]
Field Name Len Dat Typ J DPM Offset/Local/VAL
file.urn 10 URN L pif
file.bch.cnt 4 INT R *(HP7)HPIF[pif]|6
file.chg.total 9 MONEY R *(HP7)HPIF[pif]|4
file.claim.total 7 INT R *(HP7)HPIF[pif]|5
file.date 8 DATE L *(HP7)HPIF[pif]|0
file.edi.group 8 FREE L PBR.EDI.GROUP *(HP7)HPIF[pif]|7
file.rec.cnt 7 INT R *(HP7)HPIF[pif]|3
file.svc.ln.cnt 7 INT R *(HP7)HPIF[pif]|2
file.test.prod 1 CHOICE L *(HP7)HPIF[pif]|8
file.time 4 HHMM L *(HP7)HPIF[pif]|9
file.xmit.date 8 DATE L *(HP7)HPIF[pif]|1
Ì € i 2
file.begin
[file.urn, file.b.rec.name,file.b.line]
*(HP7)HPIF[pif]B[piRCN,piLN]
Field Name Len Dat Typ J DPM Offset/Local/VAL
file.b.rec.name 5 FREE L piRCN
file.b.line 4 FREE L piLN
file.b.record 160 FREE L *(HP7)HPIF[pif]B[piRCN,piLN]
Ì € i 2
file.detail
[file.urn, file.seq]
*(HP7)HPIF[pif]D[pifSQ]
Field Name Len Dat Typ J DPM Offset/Local/VAL
file.seq 5 PINT R pifSQ
file.batch 10 URN L *(HP7)HPIF[pif]D[pifSQ]|0
Ì € i 2
file.end
[file.urn, file.e.rec.name,file.e.line]
*(HP7)HPIF[pif]E[piRCN,piLN]
Field Name Len Dat Typ J DPM Offset/Local/VAL
file.e.rec.name 5 FREE L piRCN
file.e.line 4 FREE L piLN
file.e.record 160 FREE L *(HP7)HPIF[pif]E[piRCN,piLN]
Ì i 2
nsf
*(HP7)HPIN
Field Name Len Dat Typ J DPM Offset/Local/VAL
nsf.last.claim.id 6 INT R *(HP7)HPIN|0
Ì i 2
remit
[rem.urn]
*(HP7)HPH[ph]
Field Name Len Dat Typ J DPM Offset/Local/VAL
rem.urn 10 URN L ph
rem.date 8 DATE L *(HP7)HPH[ph]|0
rem.edi.grp 8 FREE L PBR.EDI.GROUP *(HP7)HPH[ph]|1
rem.file.num 3 PINT R *(HP7)HPH[ph]|2
rem.pc.file.name 50 FREE L *(HP7)HPH[ph]|7
rem.status 14 CHOICE L *(HP7)HPH[ph]|3
rem.user 10 FREE L MIS.USER *(HP7)HPH[ph]|4
rem.user.date 8 DATE L *(HP7)HPH[ph]|5
rem.user.time 4 TIME L *(HP7)HPH[ph]|6
remf.create.date 8 DATE L *(HP7)HPH[ph]A|8
remf.payor.id 10 FREE L *(HP7)HPH[ph]A|2
remf.rec.id 16 FREE L *(HP7)HPH[ph]A|3
remf.submit.id 16 FREE L *(HP7)HPH[ph]A|5
remf.submit.name 33 FREE L *(HP7)HPH[ph]A|7
remf.ver.code 5 FREE L *(HP7)HPH[ph]A|9
remft.act.pay.payee 12 MONEY R *(HP7)HPH[ph]A["U"]A|3
remft.act.pay.prov 12 MONEY R *(HP7)HPH[ph]A["U"]A|2
remft.allowed 12 MONEY R *(HP7)HPH[ph]A["U"]|12
remft.amt.pat.owes 12 MONEY R *(HP7)HPH[ph]A["U"]A|5
remft.amt.pat.paid 12 MONEY R *(HP7)HPH[ph]A["U"]A|6
remft.amt.pd.other 12 MONEY R *(HP7)HPH[ph]A["U"]|17
remft.batches 5 INT R *(HP7)HPH[ph]A["U"]|7
remft.calc.pay.payee 12 MONEY R *(HP7)HPH[ph]A["U"]|20
remft.calc.pay.prov 12 MONEY R *(HP7)HPH[ph]A["U"]|19
remft.coins 12 MONEY R *(HP7)HPH[ph]A["U"]|14
remft.deduct 12 MONEY R *(HP7)HPH[ph]A["U"]|13
remft.dis.cost.cont 12 MONEY R *(HP7)HPH[ph]A["U"]|10
remft.dis.non.cov 12 MONEY R *(HP7)HPH[ph]A["U"]|11
remft.grm.rdmn.red 12 MONEY R *(HP7)HPH[ph]A["U"]|16
remft.int.paid 12 MONEY R *(HP7)HPH[ph]A["U"]|15
remft.late.file.red 12 MONEY R *(HP7)HPH[ph]A["U"]A|4
remft.pat.records 6 INT R *(HP7)HPH[ph]A["U"]|8
remft.payor.id 10 FREE L *(HP7)HPH[ph]A["U"]|2
remft.prev.pay.payee 12 MONEY R *(HP7)HPH[ph]A["U"]A|1
remft.prev.pay.prov 12 MONEY R *(HP7)HPH[ph]A["U"]A|0
remft.prov.adj 12 MONEY R *(HP7)HPH[ph]A["U"]|18
remft.prov.adj.recs 6 INT R *(HP7)HPH[ph]A["U"]A|7
remft.rec.id 16 FREE L *(HP7)HPH[ph]A["U"]|3
remft.subm.chgs 12 MONEY R *(HP7)HPH[ph]A["U"]|9
remft.subm.id 16 FREE L *(HP7)HPH[ph]A["U"]|5
remft.tot.prov.adj.amt 12 MONEY R *(HP7)HPH[ph]A["U"]A|8
Ì € i 2
remit.batch
[rem.urn, remb.num]
*(HP7)HPH[ph]B[phB]
Field Name Len Dat Typ J DPM Offset/Local/VAL
remb.num 5 PINT R phB
remb.bch.no 9 PINT R *(HP7)HPH[ph]B[phB]|5
remb.chk.eft.issue.date 8 DATE L *(HP7)HPH[ph]B[phB]|9
remb.chk.eft.no 15 FREE L *(HP7)HPH[ph]B[phB]|8
remb.emc.prov.id 15 FREE L *(HP7)HPH[ph]B[phB]|4
remb.payor.id 10 FREE L *(HP7)HPH[ph]B[phB]|2
remb.pmt.fmt.code 3 FREE L *(HP7)HPH[ph]B[phB]|17
remb.pmt.meth.code 3 FREE L *(HP7)HPH[ph]B[phB]|16
remb.prov.name 33 FREE L *(HP7)HPH[ph]B[phB]|6
remb.prov.no 15 FREE L *(HP7)HPH[ph]B[phB]|7
remb.pyr.proc.date 8 DATE L *(HP7)HPH[ph]B[phB]|10
remb.rec.acct.no 15 FREE L *(HP7)HPH[ph]B[phB]|12
remb.rec.bank.id 15 FREE L *(HP7)HPH[ph]B[phB]|11
remb.rec.typ.acct 2 FREE L *(HP7)HPH[ph]B[phB]|18
remb.send.acct.no 15 FREE L *(HP7)HPH[ph]B[phB]|14
remb.send.bank.id 15 FREE L *(HP7)HPH[ph]B[phB]|13
remb.sop 1 FREE L *(HP7)HPH[ph]B[phB]|3
remb.txn.hand.code 1 FREE L *(HP7)HPH[ph]B[phB]|15
rembt.act.pay.payee 10 MONEY R *(HP7)HPH[ph]B[phB]U|23
rembt.act.pay.prov 10 MONEY R *(HP7)HPH[ph]B[phB]U|22
rembt.allowed 10 MONEY R *(HP7)HPH[ph]B[phB]U|11
rembt.amt.pat.owes 10 MONEY R *(HP7)HPH[ph]B[phB]U["A"]|0
rembt.amt.pat.paid 10 MONEY R *(HP7)HPH[ph]B[phB]U["A"]|3
rembt.amt.pd.other 10 MONEY R *(HP7)HPH[ph]B[phB]U|16
rembt.batch.no 4 INT R *(HP7)HPH[ph]B[phB]U|5
rembt.calc.pay.payee 10 MONEY R *(HP7)HPH[ph]B[phB]U|19
rembt.calc.pay.prov 10 MONEY R *(HP7)HPH[ph]B[phB]U|18
rembt.clm.records 5 INT R *(HP7)HPH[ph]B[phB]U|6
rembt.coins 10 MONEY R *(HP7)HPH[ph]B[phB]U|13
rembt.deduct 10 MONEY R *(HP7)HPH[ph]B[phB]U|12
rembt.dis.cost.cont 10 MONEY R *(HP7)HPH[ph]B[phB]U|9
rembt.dis.non.cov 10 MONEY R *(HP7)HPH[ph]B[phB]U|10
rembt.emc.prov.id 15 FREE L *(HP7)HPH[ph]B[phB]U|4
rembt.grm.rdmn.red 10 MONEY R *(HP7)HPH[ph]B[phB]U|15
rembt.int.paid 10 MONEY R *(HP7)HPH[ph]B[phB]U|14
rembt.late.file.red 10 MONEY R *(HP7)HPH[ph]B[phB]U|24
rembt.payor.id 10 FREE L *(HP7)HPH[ph]B[phB]U|2
rembt.prev.pay.payee 10 MONEY R *(HP7)HPH[ph]B[phB]U|21
rembt.prev.pay.prov 10 MONEY R *(HP7)HPH[ph]B[phB]U|20
rembt.prov.adj 10 MONEY R *(HP7)HPH[ph]B[phB]U|17
rembt.serv.data.rec 5 FREE L *(HP7)HPH[ph]B[phB]U|7
rembt.sop 1 FREE L *(HP7)HPH[ph]B[phB]U|3
rembt.subm.chgs 10 MONEY R *(HP7)HPH[ph]B[phB]U|8
rembt.tot.prov.adj.amt 10 MONEY R *(HP7)HPH[ph]B[phB]U["A"]|2
rembt.tot.prov.adj.recs 5 FREE L *(HP7)HPH[ph]B[phB]U["A"]|1
Ì € i 2
remit.batch.adj
[rem.urn,remb.num, remba.urn]
*(HP7)HPH[ph]B[phB]A[phBA]
Field Name Len Dat Typ J DPM Offset/Local/VAL
remba.urn 5 URN L phBA
remba.adj.amt 8 MONEY R *(HP7)HPH[ph]B[phB]A[phBA]|7
remba.adj.rsn 2 FREE L *(HP7)HPH[ph]B[phB]A[phBA]|6
remba.fin.ctrl.no 17 FREE L *(HP7)HPH[ph]B[phB]A[phBA]|8
remba.hic.no 25 FREE L *(HP7)HPH[ph]B[phB]A[phBA]|4
remba.pat.acct.no 17 FREE L *(HP7)HPH[ph]B[phB]A[phBA]|5
remba.payor.id 10 FREE L *(HP7)HPH[ph]B[phB]A[phBA]|2
remba.seq.no 4 INT R *(HP7)HPH[ph]B[phB]A[phBA]|3
Ì € i 2
remit.batch.payee.id
[rem.urn,remb.num, rembi.urn]
*(HP7)HPH[ph]B[phB]I[phBI]
Field Name Len Dat Typ J DPM Offset/Local/VAL
rembi.urn 4 URN L phBI
rembi.addr1 35 FREE L *(HP7)HPH[ph]B[phB]I[phBI]|2
rembi.addr2 35 FREE L *(HP7)HPH[ph]B[phB]I[phBI]|3
rembi.city 30 FREE L *(HP7)HPH[ph]B[phB]I[phBI]|4
rembi.name 35 FREE L *(HP7)HPH[ph]B[phB]I[phBI]|0
rembi.payor.id 20 FREE L *(HP7)HPH[ph]B[phB]I[phBI]|1
rembi.state 2 FREE L *(HP7)HPH[ph]B[phB]I[phBI]|5
rembi.zip 11 FREE L *(HP7)HPH[ph]B[phB]I[phBI]|6
Ì € i 2
remit.batch.prov.stats
[rem.urn,remb.num, rembs.urn]
*(HP7)HPH[ph]B[phB]S[phBS]
Field Name Len Dat Typ J DPM Offset/Local/VAL
rembs.urn 4 URN L phBS
rembs.act.pay.prov 15 MONEY R *(HP7)HPH[ph]B[phB]S[phBS]|6
rembs.allowed 15 MONEY R *(HP7)HPH[ph]B[phB]S[phBS]|5
rembs.clm.records 15 INT R *(HP7)HPH[ph]B[phB]S[phBS]|3
rembs.int.paid 15 MONEY R *(HP7)HPH[ph]B[phB]S[phBS]|7
rembs.prov.fiscal.year 6 FREE L *(HP7)HPH[ph]B[phB]S[phBS]|2
rembs.prov.no 30 FREE L *(HP7)HPH[ph]B[phB]S[phBS]|0
rembs.subm.chgs 15 MONEY R *(HP7)HPH[ph]B[phB]S[phBS]|4
rembs.type.of.bill 2 FREE L *(HP7)HPH[ph]B[phB]S[phBS]|1
Ì € i 2
remit.patient.data
[rem.urn,remb.num, remp.ctrl.no,remp.ctrl.counter]
*(HP7)HPH[ph]B[phB]P[phP,phC]
Field Name Len Dat Typ J DPM Offset/Local/VAL
remp.ctrl.no 17 FREE L phP
remp.ctrl.counter 2 INT R phC
remp.chk.eft.issue.date 8 DATE L *(HP7)HPH[ph]B[phB]P[phP,phC]|5
remp.chk.eft.no 15 FREE L *(HP7)HPH[ph]B[phB]P[phP,phC]|4
remp.claim.status 2 FREE L *(HP7)HPH[ph]B[phB]P[phP,phC]|19
remp.clm.msg.1 5 FREE L *(HP7)HPH[ph]B[phB]P[phP,phC]A|2
remp.clm.msg.2 5 FREE L *(HP7)HPH[ph]B[phB]P[phP,phC]A|3
remp.clm.msg.3 5 FREE L *(HP7)HPH[ph]B[phB]P[phP,phC]A|4
remp.clm.msg.4 5 FREE L *(HP7)HPH[ph]B[phB]P[phP,phC]A|5
remp.clm.msg.5 5 FREE L *(HP7)HPH[ph]B[phB]P[phP,phC]A|6
remp.comp.ins.flg 1 FREE L *(HP7)HPH[ph]B[phB]P[phP,phC]|18
remp.cor.ins.id.ind 1 FREE L *(HP7)HPH[ph]B[phB]P[phP,phC]|8
remp.emp.id 12 FREE L *(HP7)HPH[ph]B[phB]P[phP,phC]|12
remp.grp.policy.no 20 FREE L *(HP7)HPH[ph]B[phB]P[phP,phC]|6
remp.ins.first.name 12 FREE L *(HP7)HPH[ph]B[phB]P[phP,phC]|10
remp.ins.last.name 20 FREE L *(HP7)HPH[ph]B[phB]P[phP,phC]|9
remp.ins.mid.init 1 FREE L *(HP7)HPH[ph]B[phB]P[phP,phC]|11
remp.insured.id.no 25 FREE L *(HP7)HPH[ph]B[phB]P[phP,phC]|7
remp.integrity.err 1 FREE L *(HP7)HPH[ph]B[phB]P[phP,phC]A|7
remp.med.rec.no 17 FREE L *(HP7)HPH[ph]B[phB]P[phP,phC]A|0
remp.pat.dob 10 BDATE L *(HP7)HPH[ph]B[phB]P[phP,phC]|17
remp.pat.first.name 12 FREE L *(HP7)HPH[ph]B[phB]P[phP,phC]|14
remp.pat.last.name 20 FREE L *(HP7)HPH[ph]B[phB]P[phP,phC]|13
remp.pat.mid.init 1 FREE L *(HP7)HPH[ph]B[phB]P[phP,phC]|15
remp.pat.sex 1 FREE L *(HP7)HPH[ph]B[phB]P[phP,phC]|16
remp.payor.id 10 FREE L *(HP7)HPH[ph]B[phB]P[phP,phC]|2
remp.pyr.clm.ctrl.no 17 FREE L *(HP7)HPH[ph]B[phB]P[phP,phC]A|1
remp.pyr.phone.no 10 FREE L *(HP7)HPH[ph]B[phB]P[phP,phC]|20
rempt.act.pay.payee 8 MONEY R *(HP7)HPH[ph]B[phB]P[phP,phC]U|20
rempt.act.pay.prov 8 MONEY R *(HP7)HPH[ph]B[phB]P[phP,phC]U|19
rempt.allowed 8 MONEY R *(HP7)HPH[ph]B[phB]P[phP,phC]U|8
rempt.amt.pat.owes 8 MONEY R *(HP7)HPH[ph]B[phB]P[phP,phC]U|23
rempt.amt.pat.paid 8 MONEY R *(HP7)HPH[ph]B[phB]P[phP,phC]U["A"]|4
rempt.amt.pd.other 8 MONEY R *(HP7)HPH[ph]B[phB]P[phP,phC]U|13
rempt.calc.pay.payee 8 MONEY R *(HP7)HPH[ph]B[phB]P[phP,phC]U|16
rempt.calc.pay.prov 8 MONEY R *(HP7)HPH[ph]B[phB]P[phP,phC]U|15
rempt.car.sup.ins.name.1 33 FREE L *(HP7)HPH[ph]B[phB]P[phP,phC]U["A"]|0
rempt.car.sup.ins.name.2 33 FREE L *(HP7)HPH[ph]B[phB]P[phP,phC]U["A"]|2
rempt.clm.filing.ind 1 FREE L *(HP7)HPH[ph]B[phB]P[phP,phC]U|24
rempt.clm.rsn.code.1 6 FREE L *(HP7)HPH[ph]B[phB]P[phP,phC]U["A"]|5
rempt.clm.rsn.code.2 6 FREE L *(HP7)HPH[ph]B[phB]P[phP,phC]U["A"]|6
rempt.clm.rsn.code.3 6 FREE L *(HP7)HPH[ph]B[phB]P[phP,phC]U["A"]|7
rempt.coins 8 MONEY R *(HP7)HPH[ph]B[phB]P[phP,phC]U|10
rempt.deduct 8 MONEY R *(HP7)HPH[ph]B[phB]P[phP,phC]U|9
rempt.dis.cost.cont 8 MONEY R *(HP7)HPH[ph]B[phB]P[phP,phC]U|6
rempt.dis.non.cov 8 MONEY R *(HP7)HPH[ph]B[phB]P[phP,phC]U|7
rempt.dollar.amt.1 8 MONEY R *(HP7)HPH[ph]B[phB]P[phP,phC]U["A"]|8
rempt.dollar.amt.2 8 MONEY R *(HP7)HPH[ph]B[phB]P[phP,phC]U["A"]|9
rempt.dollar.amt.3 8 MONEY R *(HP7)HPH[ph]B[phB]P[phP,phC]U["A"]|10
rempt.grm.rdmn.red 8 MONEY R *(HP7)HPH[ph]B[phB]P[phP,phC]U|12
rempt.id.no.1 15 FREE L *(HP7)HPH[ph]B[phB]P[phP,phC]U["A"]|1
rempt.id.no.2 15 FREE L *(HP7)HPH[ph]B[phB]P[phP,phC]U["A"]|3
rempt.int.paid 8 MONEY R *(HP7)HPH[ph]B[phB]P[phP,phC]U|11
rempt.late.file.red 8 MONEY R *(HP7)HPH[ph]B[phB]P[phP,phC]U|22
rempt.line.items 3 INT R *(HP7)HPH[ph]B[phB]P[phP,phC]U|4
rempt.pat.ctrl.no 17 FREE L *(HP7)HPH[ph]B[phB]P[phP,phC]U|3
rempt.payor.id 10 FREE L *(HP7)HPH[ph]B[phB]P[phP,phC]U|2
rempt.prev.pay.payee 8 MONEY R *(HP7)HPH[ph]B[phB]P[phP,phC]U|18
rempt.prev.pay.prov 8 MONEY R *(HP7)HPH[ph]B[phB]P[phP,phC]U|17
rempt.prov.adj 8 MONEY R *(HP7)HPH[ph]B[phB]P[phP,phC]U|14
rempt.pyr.clm.ctrl.no 17 FREE L *(HP7)HPH[ph]B[phB]P[phP,phC]U|21
rempt.subm.chgs 8 MONEY R *(HP7)HPH[ph]B[phB]P[phP,phC]U|5
Ì € i 2
remit.detail
[rem.urn,remb.num,remp.ctrl.no,remp.ctrl.counter, remd.urn]
*(HP7)HPH[ph]B[phB]P[phP,phC]T[phT]
Field Name Len Dat Typ J DPM Offset/Local/VAL
remd.urn 5 URN L phT
remd.act.pay.payee 8 MONEY R *(HP7)HPH[ph]B[phB]P[phP,phC]T[phT]A|1
remd.act.pay.prov 8 MONEY R *(HP7)HPH[ph]B[phB]P[phP,phC]T[phT]A|0
remd.allowed 8 MONEY R *(HP7)HPH[ph]B[phB]P[phP,phC]T[phT]|21
remd.amt.pat.owes 8 MONEY R *(HP7)HPH[ph]B[phB]P[phP,phC]T[phT]B|8
remd.amt.pat.paid 8 MONEY R *(HP7)HPH[ph]B[phB]P[phP,phC]T[phT]B|24
remd.amt.pd.other 8 MONEY R *(HP7)HPH[ph]B[phB]P[phP,phC]T[phT]|26
remd.calc.pay.payee 8 MONEY R *(HP7)HPH[ph]B[phB]P[phP,phC]T[phT]|29
remd.calc.pay.prov 8 MONEY R *(HP7)HPH[ph]B[phB]P[phP,phC]T[phT]|28
remd.coins 8 MONEY R *(HP7)HPH[ph]B[phB]P[phP,phC]T[phT]|23
remd.deduct 8 MONEY R *(HP7)HPH[ph]B[phB]P[phP,phC]T[phT]|22
remd.dis.cost.cont 8 MONEY R *(HP7)HPH[ph]B[phB]P[phP,phC]T[phT]|19
remd.dis.non.cov 8 MONEY R *(HP7)HPH[ph]B[phB]P[phP,phC]T[phT]|20
remd.dollar.amt.1 8 MONEY R *(HP7)HPH[ph]B[phB]P[phP,phC]T[phT]B|10
remd.dollar.amt.2 8 MONEY R *(HP7)HPH[ph]B[phB]P[phP,phC]T[phT]B|11
remd.dollar.amt.3 8 MONEY R *(HP7)HPH[ph]B[phB]P[phP,phC]T[phT]B|12
remd.dollar.amt.4 8 MONEY R *(HP7)HPH[ph]B[phB]P[phP,phC]T[phT]B|13
remd.dollar.amt.5 8 MONEY R *(HP7)HPH[ph]B[phB]P[phP,phC]T[phT]B|14
remd.dollar.amt.6 8 MONEY R *(HP7)HPH[ph]B[phB]P[phP,phC]T[phT]B|22
remd.dollar.amt.7 8 MONEY R *(HP7)HPH[ph]B[phB]P[phP,phC]T[phT]B|23
remd.dollar.amt.8 8 MONEY R *(HP7)HPH[ph]B[phB]P[phP,phC]T[phT]C|1
remd.dollar.amt.9 8 MONEY R *(HP7)HPH[ph]B[phB]P[phP,phC]T[phT]C|3
remd.fac.sup.id 15 FREE L *(HP7)HPH[ph]B[phB]P[phP,phC]T[phT]A|4
remd.grm.rdmn.red 8 MONEY R *(HP7)HPH[ph]B[phB]P[phP,phC]T[phT]|25
remd.int.paid 8 MONEY R *(HP7)HPH[ph]B[phB]P[phP,phC]T[phT]|24
remd.late.file.red 8 MONEY R *(HP7)HPH[ph]B[phB]P[phP,phC]T[phT]B|7
remd.line.ctrl.no 17 FREE L *(HP7)HPH[ph]B[phB]P[phP,phC]T[phT]|4
remd.line.ctrl.no.2 17 FREE L *(HP7)HPH[ph]B[phB]P[phP,phC]T[phT]B|4
remd.line.itm.st.code 2 FREE L *(HP7)HPH[ph]B[phB]P[phP,phC]T[phT]|6
remd.mod.1 2 FREE L *(HP7)HPH[ph]B[phB]P[phP,phC]T[phT]|14
remd.mod.2 2 FREE L *(HP7)HPH[ph]B[phB]P[phP,phC]T[phT]|15
remd.mod.3 2 FREE L *(HP7)HPH[ph]B[phB]P[phP,phC]T[phT]|16
remd.mod.4 2 FREE L *(HP7)HPH[ph]B[phB]P[phP,phC]T[phT]A|14
remd.ntl.drug.code 11 FREE L *(HP7)HPH[ph]B[phB]P[phP,phC]T[phT]B|15
remd.org.proc.code 5 FREE L *(HP7)HPH[ph]B[phB]P[phP,phC]T[phT]B|9
remd.org.units 4 FREE L *(HP7)HPH[ph]B[phB]P[phP,phC]T[phT]B|25
remd.orig.paid.amt 8 MONEY R *(HP7)HPH[ph]B[phB]P[phP,phC]T[phT]C|5
remd.orig.pay.date 8 DATE L *(HP7)HPH[ph]B[phB]P[phP,phC]T[phT]C|6
remd.orig.sub.chg 8 MONEY R *(HP7)HPH[ph]B[phB]P[phP,phC]T[phT]C|4
remd.pat.ctrl.no 17 FREE L *(HP7)HPH[ph]B[phB]P[phP,phC]T[phT]|3
remd.pat.ctrl.no.2 17 FREE L *(HP7)HPH[ph]B[phB]P[phP,phC]T[phT]B|3
remd.payor.id 10 FREE L *(HP7)HPH[ph]B[phB]P[phP,phC]T[phT]|2
remd.payor.id.2 10 FREE L *(HP7)HPH[ph]B[phB]P[phP,phC]T[phT]B|2
remd.perf.prov.id 15 FREE L *(HP7)HPH[ph]B[phB]P[phP,phC]T[phT]A|5
remd.pmt.lvl.by.pct 5 INT R *(HP7)HPH[ph]B[phB]P[phP,phC]T[phT]A|2
remd.pos 2 FREE L *(HP7)HPH[ph]B[phB]P[phP,phC]T[phT]|11
remd.ppo.hmo.ind 1 FREE L *(HP7)HPH[ph]B[phB]P[phP,phC]T[phT]A|3
remd.prev.pay.payee 8 MONEY R *(HP7)HPH[ph]B[phB]P[phP,phC]T[phT]|31
remd.prev.pay.prov 8 MONEY R *(HP7)HPH[ph]B[phB]P[phP,phC]T[phT]|30
remd.procedure 5 FREE L *(HP7)HPH[ph]B[phB]P[phP,phC]T[phT]|13
remd.prov.adj 8 MONEY R *(HP7)HPH[ph]B[phB]P[phP,phC]T[phT]|27
remd.pyr.clm.ctrl.no 17 FREE L *(HP7)HPH[ph]B[phB]P[phP,phC]T[phT]A|13
remd.pyr.clm.ctrl.no.2 17 FREE L *(HP7)HPH[ph]B[phB]P[phP,phC]T[phT]B|6
remd.pyr.rcp.date 8 DATE L *(HP7)HPH[ph]B[phB]P[phP,phC]T[phT]|9
remd.remark.code.1 5 FREE L *(HP7)HPH[ph]B[phB]P[phP,phC]T[phT]B|16
remd.remark.code.2 5 FREE L *(HP7)HPH[ph]B[phB]P[phP,phC]T[phT]B|17
remd.remark.code.3 5 FREE L *(HP7)HPH[ph]B[phB]P[phP,phC]T[phT]B|18
remd.remark.code.4 5 FREE L *(HP7)HPH[ph]B[phB]P[phP,phC]T[phT]B|19
remd.remark.code.5 5 FREE L *(HP7)HPH[ph]B[phB]P[phP,phC]T[phT]B|20
remd.remark.code.date 8 DATE L *(HP7)HPH[ph]B[phB]P[phP,phC]T[phT]B|21
remd.rev.code 5 FREE L *(HP7)HPH[ph]B[phB]P[phP,phC]T[phT]A|15
remd.rsn.code.1 6 FREE L *(HP7)HPH[ph]B[phB]P[phP,phC]T[phT]A|6
remd.rsn.code.2 6 FREE L *(HP7)HPH[ph]B[phB]P[phP,phC]T[phT]A|7
remd.rsn.code.3 6 FREE L *(HP7)HPH[ph]B[phB]P[phP,phC]T[phT]A|8
remd.rsn.code.4 6 FREE L *(HP7)HPH[ph]B[phB]P[phP,phC]T[phT]A|9
remd.rsn.code.5 6 FREE L *(HP7)HPH[ph]B[phB]P[phP,phC]T[phT]A|10
remd.rsn.code.6 6 FREE L *(HP7)HPH[ph]B[phB]P[phP,phC]T[phT]A|11
remd.rsn.code.7 6 FREE L *(HP7)HPH[ph]B[phB]P[phP,phC]T[phT]A|12
remd.rsn.code.8 7 FREE L *(HP7)HPH[ph]B[phB]P[phP,phC]T[phT]C|0
remd.rsn.code.9 7 FREE L *(HP7)HPH[ph]B[phB]P[phP,phC]T[phT]C|2
remd.ser.frm.date 8 DATE L *(HP7)HPH[ph]B[phB]P[phP,phC]T[phT]|7
remd.ser.to.date 8 DATE L *(HP7)HPH[ph]B[phB]P[phP,phC]T[phT]|8
remd.serv.line.no 3 INT R *(HP7)HPH[ph]B[phB]P[phP,phC]T[phT]|5
remd.serv.line.no.2 3 INT R *(HP7)HPH[ph]B[phB]P[phP,phC]T[phT]B|5
remd.sub.line.chg 8 MONEY R *(HP7)HPH[ph]B[phB]P[phP,phC]T[phT]|18
remd.tos 2 FREE L *(HP7)HPH[ph]B[phB]P[phP,phC]T[phT]|12
remd.txn.bch.err 1 CHOICE L *(HP7)HPH[ph]B[phB]P[phP,phC]T[phT]|1
remd.txn.bch.stat 1 CHOICE L *(HP7)HPH[ph]B[phB]P[phP,phC]T[phT]|0
remd.units 4 FREE L *(HP7)HPH[ph]B[phB]P[phP,phC]T[phT]|17
Ì € i 2
remit.detail.rsn.codes
[rem.urn,remb.num,remp.ctrl.no,remp.ctrl.counter,remd.urn, remdr.urn]
*(HP7)HPH[ph]B[phB]P[phP,phC]T[phT]R[phTR]
Field Name Len Dat Typ J DPM Offset/Local/VAL
remdr.urn 2 URN L phTR
remdr.amt 8 MONEY R *(HP7)HPH[ph]B[phB]P[phP,phC]T[phT]R[phTR]|1
remdr.code 7 FREE L *(HP7)HPH[ph]B[phB]P[phP,phC]T[phT]R[phTR]|0
remdr.qty 2 INT R *(HP7)HPH[ph]B[phB]P[phP,phC]T[phT]R[phTR]|2
Ì € i 2
remit.patient.rsn.codes
[rem.urn,remb.num,remp.ctrl.no,remp.ctrl.counter, rempr.urn]
*(HP7)HPH[ph]B[phB]P[phP,phC]R[phPR]
Field Name Len Dat Typ J DPM Offset/Local/VAL
rempr.urn 2 URN L phPR
rempr.amt 8 MONEY R *(HP7)HPH[ph]B[phB]P[phP,phC]R[phPR]|1
rempr.code 7 FREE L *(HP7)HPH[ph]B[phB]P[phP,phC]R[phPR]|0
rempr.qty 2 INT R *(HP7)HPH[ph]B[phB]P[phP,phC]R[phPR]|2
Ì i 2
remit.error
[rem.err.date,rem.err.edi.grp,rem.err.file.num,rem.err.status,rem.err.count]
*(HP7)HPHERR[pherD,pherG,pherN,pherS,pherC]
Field Name Len Dat Typ J DPM Offset/Local/VAL
rem.err.date 8 DATE L pherD
rem.err.edi.grp 8 FREE L pherG
rem.err.file.num 3 PINT R pherN
rem.err.status 7 CHOICE L pherS
rem.err.count 3 PINT R pherC
rem.err.bch.num 5 PINT R *(HP7)HPHERR[pherD,pherG,pherN,pherS,pherC]|0
rem.err.detail 10 MONEY R *(HP7)HPHERR[pherD,pherG,pherN,pherS,pherC]|3
rem.err.pat.ctrl.co 2 INT R *(HP7)HPHERR[pherD,pherG,pherN,pherS,pherC]|2
rem.err.pat.ctrl.no 17 FREE L *(HP7)HPHERR[pherD,pherG,pherN,pherS,pherC]|1
rem.err.trailer 10 MONEY R *(HP7)HPHERR[pherD,pherG,pherN,pherS,pherC]|4
Ì i 2
tmp.claim.list
[tcl.edi.group,tcl.ins,tcl.acct,tcl.urn]
/HPIHC[peg,pdi,pz,ppi]
Field Name Len Dat Typ J DPM Offset/Local/VAL
tcl.edi.group 8 FREE L PBR.EDI.GROUP peg
tcl.ins 10 FREE L PBR.INS pdi
tcl.acct 44 URN L PBR.ACT pz
tcl.urn 5 URN L ppi
tcl.chg.total 9 MONEY R /HPIHC[peg,pdi,pz,ppi]|0
tcl.claim.total 7 INT R /HPIHC[peg,pdi,pz,ppi]|1
Ì i 2
tmp.diag
[dx.seq,dx.txn.urn]
/HPIDX[piDX,piTX]
Field Name Len Dat Typ J DPM Offset/Local/VAL
dx.seq 3 INT R piDX
dx.txn.urn 5 URN L piTX
dx 6 FREE L PBR.DIAGNOSIS /HPIDX[piDX,piTX]|0
Index Files Subscripts/Physical Base
claims.ns.bch.key.x [ns.edi.group,ns.ins,bch.sort.key,ns.acct,ns.urn] = ns.sort.key
?(HP)HPISC[peg,pdei,bKY,pz,ppi]
claims.prop.bch.key.x [prop.edi.group,prop.ins,bch.sort.key,prop.acct,prop.urn] = prop.doctor
?(HP)HPIPC[peg,pdei,bKY,pz,ppi]
file.x [file.date,file.urn]
?(HP)HPIFD[pifD,pif]
remit.file.date.x [remf.create.date,remft.subm.chgs]
?(HP)HPHD[phfcD,phfsC]
remit.file.id.x [rem.date,rem.edi.grp,rem.file.num] = rem.urn
?(HP)HPHI[phD,peg,phN]
|
|
| | | | | | | | | | | | | | | | | | | | | | | | | | |