Name |
START |
END |
FIELD TYPE |
BILL
HISTORY field NAME |
DESCRIPTION |
GROUP
SUBDIVISIONS DEFINITION
OF LEGAL VALUES |
Case Number |
1 |
9 |
CHAR/9 |
BIL-HIS-CASE-NO |
Unique Number Assigned To
Each Case By The Responsible District Office |
|
Payee Number |
10 |
18 |
CHAR/9 |
BIL-HIS-PAYEE-NO |
Unique Identifier Assigned
To Each Provider (Ssn Or Tax
Id) |
|
Service From |
19 |
26 |
DATE/8 |
BIL-HIS-SVC-FR |
Beginning Date Of Service |
YYYYMMDD |
Service To Date |
27 |
34 |
DATE/8 |
BIL-HIS-SVC-TO |
Ending Date Of Service |
YYYYMMDD |
Record Type |
35 |
35 |
CHAR/1 |
BIL-HIS-RECORD-TYPE |
Type Of Record |
B = Normal Bill Paid By
System C = Cancelled Check/Adj. D = Cash Receipt M = Manual Payment |
Payee Data |
36 |
44 |
CHAR/9 |
BIL-HIS-R-PAYEE-NO |
Claimant’s Id Number |
|
Payee Name |
45 |
79 |
CHAR/35 |
|
Claimant’s Name |
|
Filler |
45 |
77 |
CHAR/33 |
|
|
Blank |
Name Suffix |
78 |
79 |
CHAR/2 |
BIL-HIS-PAYEE-DIR-NAME-SFX |
|
This Data Is Available For
Bills Paid Prior To 9/4/03 |
Payee Address |
80 |
114 |
CHAR/35 |
BIL-HIS-PAYEE-ADD1 |
Payee’s Address |
|
Payee Address |
115 |
149 |
CHAR/35 |
BIL-HIS-PAYEE-ADD2 |
Payee’s Address |
|
Payee Address |
150 |
179 |
CHAR/35 |
BIL-HIS-PAYEE-ADD3 |
Payee’s Address |
|
Payee’s City |
180 |
199 |
CHAR/20 |
BIL-HIS-PAYEE-CITY |
|
|
Payee’s State |
200 |
201 |
CHAR/2 |
BIL-HIS-PAYEE-STATE |
|
|
Payee’s Zip Code |
202 |
206 |
CHAR/5 |
BIL-HIS-PAYEE-ZIP |
|
|
4-Digit Zip Reserve |
207 |
210 |
CHAR/4 |
BIL-HIS-PAYEE-ZIP-RESERVE |
|
|
Provider Type |
211 |
211 |
CHAR/1 |
BIL-HIS-PROV-TYPE |
|
F = PHARMACY H = HOSPITAL P = PHYSICIAN |
Reimbursement Code |
212 |
212 |
CHAR/1 |
BIL-HIS-REIMB-CD |
Indicates Payment Made To
The Claimant |
Blank = Provider R = Claimant |
Pharmacy Number |
213 |
219 |
CHAR/7 |
BIL-HIS-PHARMACY-NO |
Pharmacy NABP Number |
|
Pay Center Code |
220 |
225 |
CHAR/6 |
BIL-HIS-PAY-CENTER-CODE |
Code Used To Identify A Central Payment Center For A Pharmacy Chain |
This Data Is Available For
Bills Paid Prior To 9/4/03 |
Clearing House Id |
226 |
228 |
CHAR/3 |
BIL-HIS-CLEAR-HOUSE-ID |
Clearinghouse Id Number |
This Data Is Available For
Bills Paid Prior To 9/4/03 |
Employee Last Name |
229 |
238 |
CHAR/10 |
BIL-HIS-EMP-LAST-NAME |
Claimant’s Last Name |
|
Employee First Initial |
239 |
239 |
CHAR/1 |
BIL-HIS-EMP-FIRST-INIT |
Claimant’s First Initial |
|
Area Code |
240 |
243 |
CHAR/4 |
BIL-HIS-AREA-CODE |
SMSA/MSA Identifier |
Per FIPS Code Table |
Physician Bill Redefine Area |
Procedure Code |
244 |
248 |
CHAR/5 |
BIL-HIS-PROC-CODE-1-5 |
Billed Procedure Code |
Valid Cpt-4, HCPC’s, Revenue
Center Or OWCP Procedure Code Indicating Services Provided |
Modifier Code |
249 |
250 |
CHAR/2 |
BIL-HIS-MODIFIER-CODE |
Indicates Different Level Of
Service |
|
Appeals Code |
251 |
251 |
CHAR/1 |
BIL-HIS-APPEALS-CODE |
Fee Schedule Appeal Code |
B,F,G,W,1-7,Blank |
Filler |
252 |
253 |
CHAR/2 |
|
|
Blank |
Rx Bills Redefine Area |
Rx Number |
244 |
250 |
CHAR/7 |
BIL-HIS-RX-NO |
Prescription Number |
|
Rx Appeal |
251 |
251 |
CHAR/1 |
BIL-HIS-RX-APPEAL |
Rx Appealed |
|
Rx Refills |
252 |
253 |
CHAR/2 |
BIL-HIS-RX-REFILL |
Number Of Refills |
|
Medical Bills Redefine Area |
Diagnosed Related Group
Number |
244 |
246 |
CHAR/3 |
BIL-HIS-DRG-NO |
Diagnosis Related Group For
Inpatient Bills |
|
Filler |
247 |
250 |
CHAR/4 |
|
|
Blank |
Appeal |
251 |
251 |
CHAR/1 |
BIL-HIS-APPEAL |
Medical Bill Appealed |
Y = Yes N = No |
Filler |
252 |
253 |
CHAR/2 |
|
|
Blank |
Fund Adjustment Redefine Area |
Transfer Indicator |
244 |
244 |
CHAR/1 |
BIL-HIS-FUND-TRANSFER-IND |
Funds Have Been Transferred |
This Data Is Available For
Bills Paid Prior To 9/4/03 |
Adjustment Indicator |
245 |
245 |
CHAR/1 |
BIL-HIS-MAINT-ADJUD-IND |
Adjustment Has Been Made |
This Data Is Available For
Bills Paid Prior To 9/4/03 |
Filler |
246 |
253 |
CHAR/8 |
|
|
Blank |
Return to All |
Category Code |
254 |
254 |
CHAR/1 |
BIL-HIS-CATEGORY-CODE |
Procedure Code Category |
A = Anesthesia E = Evaluation/Management M = Medicine P = Pathology/Laboratory R = Radiology/Nuclear Med/ Diagnostic Ultrasound S = Surgery |
Work Unit Value |
255 |
257 |
CHAR/3 |
BIL-HIS-WORK-UNIT-VAL |
Work Relative Value Unit |
000/Refer to EXPANDED RECORD |
Practice Unit Value |
258 |
260 |
CHAR/3 |
BIL-HIS-PRACT-UNIT-VAL |
Practice Expense Relative
Value Unit |
000/Refer to EXPANDED RECORD |
Malpractice Unit Value |
261 |
263 |
CHAR/3 |
BIL-HIS-MALPRACT-UNIT-VAL |
Malpractice Relative Value
Unit |
000/Refer to EXPANDED RECORD |
Unit Cost |
264 |
266 |
CHAR/3 |
BIL-HIS-UNIT-COST |
Conversion Factor |
000/Refer to EXPANDED RECORD |
1-4, Ix Value |
267 |
269 |
CHAR/3 |
BIL-HIS-1-4-IX-VAL |
Work Geographic Adjustment
Factor |
000/Refer to EXPANDED RECORD |
Practice Ix Value |
270 |
272 |
CHAR/3 |
BIL-HIS-PRACT-IX-VAL |
Practice Expense Geographic
Adjustment Factor |
000/Refer to EXPANDED RECORD |
Malpractice Ix Unit |
273 |
275 |
CHAR/3 |
BIL-HIS-MALPRACT-IX-VAL |
Malpractice Expense
Geographic Adjustment Factor |
000/Refer to EXPANDED RECORD |
Percent Modifier |
276 |
277 |
CHAR/2 |
BIL-HIS-MODIFIER-PERCENT |
Adjustment Factor For
Procedure Code Modifier |
00/Refer to EXPANDED RECORD |
National Drug Code |
278 |
288 |
CHAR/11 |
BIL-HIS-NDC-NO |
National Drug Code |
|
2 Yr
High Price |
289 |
293 |
CHAR/5 |
BIL-HIS-PRICE-2YR-HIGH |
Not Used |
This Data Is Available For
Bills Paid Prior To 9/4/03 |
Dispense Fee |
294 |
295 |
CHAR/2 |
BIL-HIS-DISPENSE-RATE |
Allowed Dispensing Fee For
Prescription |
00/Refer to EXPANDED RECORD |
Allowed Fee |
296 |
300 |
CHAR/5 |
BIL-HIS-ALLOWED-FEE-AMT |
Allowable Cost For
Prescription |
00000/Refer to EXPANDED
RECORD |
Drg Amount |
296 |
300 |
CHAR/5 |
BIL-HIS-DRG-AMT |
Actual Cost, Calculated By Diagnostic
Related Group For Inpatient Bills |
|
Servicing State |
301 |
302 |
CHAR/2 |
BIL-HIS-SVC-STATE |
State Where Service Was
Performed |
|
Zip Code |
303 |
307 |
CHAR/5 |
BIL-HIS-ZIP-CODE |
Zip Code Where Service Was
Performed |
|
Prompt Payment |
308 |
308 |
CHAR/1 |
BIL-HIS-PROMPT-PMT |
Prompt Payment Flag
Indicating Contractual Payment Obligation |
This Data Is Available For
Bills Paid Prior To 9/4/03 |
Bill Number |
309 |
320 |
CHAR/12 |
BIL-HIS-BILL-NO |
|
This Data Is Available For
Bills Paid Prior To 9/4/03 |
Invoice Type |
321 |
321 |
CHAR/1 |
BIL-HIS-INVOICE-TYPE |
Type Of Invoice |
This Data Is Available For
Bills Paid Prior To 9/4/03 |
Invoice Number |
322 |
329 |
CHAR/8 |
BIL-HIS-INVOICE-NO |
Invoice Number |
This Data Is Available For
Bills Paid Prior To 9/4/03 |
Invoice Date |
322 |
329 |
GROUP (8) |
BIL-HIS-INVOICE-DATE |
If Invoice Type=D, Date
Provider Created The Bill If Invoice Type=N, Providers
Unique Id Number For The Bill |
This Data Is Available For
Bills Paid Prior To 9/4/03 |
Tcn |
309 |
325 |
CHAR/17 |
BIL-HIS-TCN |
Unique Transaction Control
Number |
This Data Is Unavailable For
Bills Paid Prior To 9/4/03 |
Dispense Rate2 |
326 |
329 |
CHAR/4 |
BIL-HIS-DISP-RATE-ACS |
Dispensing Rate |
This Data Is Unavailable For
Bills Paid Prior To 9/4/03 0000/Refer to EXPANDED RECORD |
Charge Amount |
330 |
334 |
CHAR/5 |
BIIL-HIS-CHARGE-AMT |
Amount Charged By Provider |
00000/Refer to EXPANDED
RECORD |
Ineligible Amt |
335 |
339 |
CHAR/5 |
BIL-HIS-INEL-AMT |
Amount Not Covered |
00000/Refer to EXPANDED
RECORD |
Ineligible Code |
340 |
340 |
CHAR/1 |
BIL-HIS-INEL-CODE |
Ineligible Payment Code |
|
Fee Reduction Amt |
341 |
345 |
CHAR/5 |
BIL-HIS-FEE-REDUCTION-AMT |
Amount Fee Reduced |
00000/Refer to EXPANDED
RECORD |
Payment Amount |
346 |
350 |
CHAR/5 |
BIL-HIS-PAYMENT-AMT |
Net Amount Paid |
00000/Refer to EXPANDED
RECORD |
Units |
351 |
355 |
CHAR/5 |
BIL-HIS-UNITS |
Service Units Billed |
00000/Refer to EXPANDED
RECORD |
Locator Code |
356 |
358 |
CHAR/3 |
BIL-HIS-LOCATOR-CODE |
UB92 Loc 4; Code Indicates
Type Of Institution |
|
Presciber’s Name |
359 |
368 |
CHAR/10 |
BIL-HIS-PRESCRIBER-NAME |
Physician’s Name |
|
Date Received |
369 |
376 |
CHAR/8 |
BIL-HIS-DATE-RCVD |
Date Bill Was Received |
YYYYMMDD |
Date Keyed |
377 |
384 |
CHAR/8 |
BIL-HIS-DATE-KEYED |
Date Bill Was Keyed For
Payment |
YYYYMMDD |
Date Paid |
385 |
392 |
CHAR/8 |
BIL-HIS-DATE-OF PAY |
Date Bill Was Paid (Check
Date) |
YYYYMMDD |
Adjustment Date |
393 |
400 |
CHAR/8 |
BIL-HIS-DATE-OF-ADJUSTMENT |
Date An Adjustment Transaction
Was Entered Against A Bill |
YYYYMMDD |
Authorizing Official |
401 |
403 |
CHAR/3 |
BIL-HIS-AUTH-OFFICIAL |
Conditional; System
Generated Id |
3 Character Alpha |
Bypass Code |
404 |
404 |
CHAR/1 |
BIL-HIS-BYPASS-CODE |
Indicates Type Of Payment Or
Adjustment |
|
District Office Input Code |
405 |
406 |
CHAR/2 |
BIL-HIS-DIST-OFF-INPUT |
District Office Code |
|
District Office Control Code |
407 |
408 |
CHAR/2 |
BIL-HIS-DIST-OFF-CNTL |
District Office Sequent Code |
This Data Is Available For
Bills Paid Prior To 9/4/03 |
Error Code |
409 |
409 |
CHAR/1 |
BIL-HIS-ERROR-CODE |
Not Used |
|
Batch Id Number |
410 |
415 |
CHAR/6 |
BIL-HIS-BATCH-NO |
The Batch The Bill Was Keyed
With |
This Data Is Available For
Bills Paid Prior To 9/4/03 |
Operator Identifier |
416 |
423 |
CHAR/8 |
BIL-HIS-OPERATOR-IDENT |
System Generated Logon Id |
This Data Is Available For
Bills Paid Prior To 9/4/03 |
Tcn To Credit |
407 |
423 |
CHAR/17 |
BIL-HIS-TCN-TO-CREDIT |
Original Case Number |
This Data Is Unavailable For
Bills Paid Prior To 9/4/03 |
Payee Case From Code |
424 |
424 |
CHAR/1 |
BIL-HIS-PAYEE-CASE-FROM-CD |
Code indicates if a change
to a case number or provider id |
|
Payee Case From |
425 |
433 |
CHAR/9 |
BIL-HIS-PAYEE-CASE-FROM |
Original Case Number Or
Provider Id |
|
Payee Case To Code |
434 |
434 |
CHAR/1 |
BIL-HIS-PAYEE-CASE-TO-CD |
Code Indicates If A Change
To A Case Number Or Provider Id |
|
Payee Case To |
435 |
443 |
CHAR/9 |
BIL-HIS-PAYEE-CASE-TO |
Corrected Case Number Or
Provider Id |
|
Bill Id Number |
444 |
445 |
CHAR/2 |
BIL-HIS-BILL-ID-NO |
Not used |
000 |
Bill Line Number |
446 |
448 |
CHAR/4 |
BIL-HIS-BILL-LINE-ITEM-NO |
Not used |
000 |
Record Sequence |
449 |
450 |
CHAR/2 |
BIL-HIS-RECORD-SEQ |
Not used |
00 |
Resolver Id |
451 |
453 |
CHAR/8 |
BIL-HIS-RESOLVER-IDENT |
|
|
Irslevy Flag |
454 |
458 |
CHAR/1 |
BIL-HIS-IRS-LEVY-FLAG |
Not used |
Blank |
New Tcn |
459 |
475 |
CHAR/16 |
BIL-HST-NEW-TCN |
Not used |
Blank |