Section 1
Command Line Translator Administration
Model C1A3F297
Standard License Product
Copyright (c) 1992-2006 Com1 Software Development
Com1 Software, Inc.
P.O. Box 482
Hudson, Ohio 44236
(330) 653-3771
Website: http://www.com1software.com
Email: information@com1software.com
IMPORTANT NOTICE
This computer program is protected by copyright law and
international treaties. Any unauthorized reproduction or
distribution of this program or any portion of it may result
in severe civil or criminal penalties, and will be prosecuted
under the maximum extent possible under the law.
This program and all support programs and documents are
provided "AS IS" without warranty of any kind, either
expressed or implied, including and not limited to the
implied warranties of merchantability and fitness for a
particular purpose. In no event shall Com1 Software, Inc.
or Com1 Software Development be liable for any damages
arising out of the use or inability to use this program,
support programs or documentation.
All prices and other information is subject to change without
notice. This program and support documents are for trial and
demonstration purposes. Any other use is strictly prohibited.
Section 2
The C1A3F297 Comand Line Translator is composed of
three seperate executable programs.
The C1A3F297.EXE is the Command Line Translator
Administration and is used to run, debug, veiw,
configure, and process conversions.
The C1C3F298.EXE is the Command Line Translator
Engine.
The C1D0F303.EXE is the Command Line Translator
Data Communications Package.
GENERAL CONCEPT
The Command Line Translator has been designed to
be a flexible yet practical computer application
program for the purpose of giving software developers,
systems integrators, and medical billing professions
a tool that will allow them to create solutions
and solve problems they might encountered in their
business processes relative to the scope of Elecronic
Data Interchange and health care.
THREE PART PROCESS
The Command Line translation process has three
basic parts, an import process, a varification
ajudication processing, and a compiled
output process. All processes are done using
the translators database. All processes are
defined out in what is called the Command File.
This file can be called any eight character name
followed with an extension of .CMD.
IMPORT PROCESS
The import processes available are:
- (BCU) Basic Conversion Utility
Used for:
DBF Files
ODBC Tables for databases like
ACCESS, SQL or spreadsheets
Charater seperated value file like
CSV
- (ACU) ANSII X12 Conversion Utility
Used for:
ANSI X12 Health Care Industry Formated
Data
- (FCU) Frame Conversion Utility
Used for:
Print Image ASCII Text Files
Blocked Data Formats
Report ASCII Text Files
SQL Files (BCU ODBC is preferred)
- (NCU) Nested Conversion Utility
Used for:
Nested Electronic Formats like:
(NSF) National Standard Format
or
Proprietary Flatline Nested formats.
NOTE: The name of the file to be imported
or dirctory containg files to be imported
is specified in the import mapping file.
NOTE: When the debug is turned on, the Command Log
can be used to view the data that has been
imported. Patient Accounts can be used as
well to view data after an import.Caution
should be used when debug is on for large
conversions.
PROCESSING
VARIFICATION and AJUDICATION
After an import has been completed, the processing
processing portion of the is begun.
The Processing portion of the translation
can first be defined according to a structure
of either carrier or clearing. Sub options of these
structures offered are batch or release. An example
of this is a CARRIERBATCH. A CARRIERBATCH is a batch
that has all data in it being processed because
of the primary coverage of the subscribers. There
are several ways to configure this type translatiion.
Issues such as the absents of critical data fields like
coverage name and order of coverage may play into
which design fators best deal with the data
quality. Another example of a processing command
id CARRIERRELEASE. This method can be used for
example to import in insurance claim data containing
a wide variety of insurance carries. Once imorted the
claims can be processed and output grouped by carrier
thus seperating the claims to go their appropriate
receiver or payer.
Some basic data elements are critical to properly
translate claims. Criticality of some data elements
will vary based on things like import data quality
and the nature of the business application problem that
is trying to be solved. If claim data that has been
imported that does not meet certain minimum requirements
that claim data will be removed by the processing
functions from the processing stream, and placed in
a suspended status and then noted in the suspend
log. The file is named SUSPEND.LOG and is in the
DATA DIRECTORY.
In Addition to the basic system verifications some
critical fields like birthdays and insurance ID's
can be check presence. This is configured in the
C1.INI in the DATA DIRECTORY.
COMPILING OUTPUT
There are several ways to configure the system to
generate output. The import process used in
conjuction with the quality of the import data
can dictate how to go about configuring the system
for output. The Insurance Carrier and Institution
databases contain information that can be
pre configured with names and IDs that are needed
to generate some output formats. All import
configurations can be set up using these databases
and the appropriate INSURANCE CONTRACT TABLE
configuration settings located in the Instistution
Data screen. If enough data is available, the BCU
and ACU can be configured to allow for full
configuration on the fly. This can allow for single
folder configuraions with multiple providers and
carriers being processed through.
INSTALLATION OF SOFTWARE:
The setup will install the executable programs
as well as any DLL's in a folder called \C1A3F297
located on the local C: of your computer.
The first time you run the Command Line
Administration program it will build a core
database in the \C1A3F297 folder. The \C1A3F297
folder will be refered to as your BASE FOLDER.
Upon completion of the database creation, you
will be asked if you would like to create a
Solo or Group Database. Select one.
DATABASE FOLDERS.
It is a good idea to keep your databases separate away from
your programs and your BASE database.
A separate folder on the same disk drive as the program EXE
BASE folder can be used as a DATA folder or DATA directory.
The subdirectory name may be as deep as 48 characters and
should have no more than 8 characters per directory name.
An example of this would be
\prod\prov1
or
\test\jones
In the DATA folder a data base is made or one can be copied
into the folder.
A shortcut to the C1A3F297 should be made on your desktop or in a
folder group. Once a BASE shortcut has been made, it can be copied
and modified via the properties area of windows. In the program tab
in the command line you will notice
C:\C1A3F297\C1A3F297.EXE
You can modify this to say
C:\C1A3F297\C1A3F297.EXE \prod\prov1
When you do this the new shortcut will run the F297 with the
\prod\prov1 as the DATA directory. This is the best way to set
up your databases, command files and configurations.
TRANSLATION MAPPING
The Model C1A3F297 uses a variety of different
import methods. When an import method has been
chosen it is mapped in the CMD file as well as its
C1 file. Some examples of mapping options are:
BCU Basic Conversion Utility
ACU ANSII X12 Conversion Utility
FCU Frame Conversion Utility
NCU Nested Conversion Utility
See the documentation of the specific mapping for additional
details. Also review the document on the Command Line
Language.
CONFIGURING A DATABASE
The database and translation process can be set up to
handle claims in a fashion that is either oriented to specific
insurance carriers or a clering service. Contract Tables or
Contract Data screens should have their appropriate
transmission format selected and the Control Mode should
be set to either test or production.
TRANSLATING A FILE
Once a core databases has been built and
a conversion method has been chosen, the
creation of the CMD file is the next step.
The CMD file is used to tell the translator what
to do and where to do it.
A file called EXAMPLE.CMD will be in the
\prod\prov1 folder and it might contain the following
data within the file.
display=yes
directory=\prod\prod1
path=\prod\prod1
purgedata=yes
convertfcu=carrierbatch
processdata=carrierbatch
compilex12837=yes
When this example is run if all goes well then a conversion
process will create a file ending in the extension TCF. A TCF
is the Transmission Claim File.
TO RUN THE TRANSLATION
- Run the C1A3F297 from a group or desktop icon that has had
the command line parameter used. an example:
C:\C1A3F297\C1A3F297.EXE \prod\prov1
- From the C1A3F297 in the ENTRIES menu
column select Execute C1C3F298.
- In the Command Parameter type in EXAMPLE or EXAMPLE.CMD.
If you do not use a .CMD or any extension CMD will be used by
default.
If all goes well your translator should be processing.
To run the C1C3F298 by itself without the use of the
C1A3F297 from a DOS prompt type in:
cd\c1a3F297
\c1a3F297\c1c3F298.exe \prod\prov1\example.cmd
This basic method of shelling out to the C1C3F298 can
have some deviation depending on the version of your
operating system. An example of this might be:
cd\c1a3F297
\c1a3F297\c1c3F298 example.cmd
Note: If using a shortcut the start in directory
should be c:\c1a3F297
After a translation process has been done the TCF
file is the usual expected output. Beyond this file
the COMMAND.LOG can be viewed for information
and the C1A3F297 claim and patient screens can be
used to see what data has converted.
Section 3
The Command Line Manipulation Language is used to configure
The Frame Conversion Utility or FCU allows you
*********************************************
The Nested Conversion Utility or NCU allows you
*********************************************
The Basic Conversion Utility or BCU allows you
With the C1.INI Editor customize the product to fit
The ANSII X12 837 format supported in the Com1 Software
AH - CLAIM DETAIL
The following is a list of examples
Com1 Software products that can use use command line scripts.
These products are:
(A) C1A3F297 Command Line Translator 32 bit Windows/GUI
(B) C1A3I297 Command Line Translator 32 bit DOS/Text
(C) C1A3K297 Command Line Translator 32 bit Linux/Text
(D) C1A3F341 Proxy Server 32 bit Windows/GUI
(E) C1A3I341 Proxy Server 32 bit DOS/TEXT
(F) C1A3K341 Proxy Server 32 bit Linux/Text
- - - - - - - - - - - - - - - - - - - - - - - -
DISPLAY=[option]
YES
OFF
ICON
For screen display.
Example: display=yes
PATH=[path]
For file copy source and destination.
Example: path=\example\testdata
DIRECTORY=[subdirectory]
For subdirectory of operations where databases reside.
Example: \example\testdata
PURGEDATA=[option]
YES
NO
For purging database of patient and claim data.
Example: purgedata=yes
LOGFILE=[option]
Yes
No
For creation of a logfile.txt in the operations subdirectory.
Example: logfile=yes
DOCUMENT
Example : DOCUMENT
Note: The SET data directory is used to
build a a file called DATABASE.HTM.
BASEDRIVE=[drive_letter]
C to Z
For setting the base disk drive.
Example: basedrive=c
DATADRIVE=[drive_letter]
C to Z
For setting the data disk drive.
Example: basedrive=c
INPATH=[path]
For directory of source file location.
Example: inpath=\example\testdata\input
INFILE=[filename]
Name of default input file.
Example: infile=input.dat
OUTPATH=[path]
For directory of output.
Example: outpath=\example\testdata\output
OUTFILE=[filename]
Name of default name of the output file.
Example: outfile=output.dat
PROVIDER=[option]
P0000001 to P0999999
For setting the Provider System ID
INSTITUTION=[option]
I0000001 to I0999999
For setting the Institution System ID
CARRIER=[option]
I0000001 to I0999999
For setting the Carrier System ID
JOBCONTROL=[option]
OFF
ON
For turning on Job Control File Funtions
This function generates an XML file with
processing status information.
Example: jobcontrol=on
JOBCONTROLDIRECTORY=[path]
For directory of job control file.
Example: jobcontroldirectory=\example\testdata\jobdata
JOBCONTROLFILE=[filename]
The name of the job control file to be created.
Example: jobcontrolfile=process.dat
JOB#=[data]
For storage of a job number
Example: job#=1234567
TITLE=[data]
For setting a title within a command file.
Example : title="Gerneral Processing Job"
Note: Quotes required
DESCRIPTION=[data]
For setting a decription within a command file.
Example : description="This job is used to process;
data and is used on Tuesday."
Note: Quotes required
FILEASSOCIATION=[filename]
The sets a file association for a command file.
Example: fileassociation=myfile.dat
DESTINATIONFILE=[fullfilename]
Coipies either the I0000001.tcf or the CS000001.tcf to the
specified destination file.
Example: destinationfile=\mydata\myfile.dat
- - - - - - - - - - - - - - - - - - - - - - - -
FORMAT
Example : FORMAT TEST.TCF,TEST.HTM,HTML
Valid Types: HTM or HTML
RTF
TXT
FORMTXT
Note: The X12 file must be located in the
SET data directory.
- - - - - - - - - - - - - - - - - - - - - - - -
CONVERTACU=CARRIER
RELEASE
For ANSI X12 Conversion Utility.
Example: convertacu=carrier
LOADACU=[filename]
For multi pass ANSI X12 Conversion Utility.
Example: loadacu=pass1.acu
loadacu=pass2.acu
CONVERTBCU=CARRIER
RELEASE
For Basic Conversion Utility.
Example: convertbcu=carrier
LOADBCU=[filename]
For multi pass Basic Conversion Utility.
Example: loadbcu=pass1.bcu
loadbcu=pass2.bcu
CONVERTFCU=[option]
CARRIERBATCH
RELEASE
For Frame Conversion Utility.
Example: convertfcu=carrierbatch
CONVERTNCU=[option]
CARRIERBATCH
RELEASE
For Nested Conversion Utility.
Example:convertncu=carrierbatch
- - - - - - - - - - - - - - - - - - - - - - - -
PROCESSDATA=[option] CARRIERBATCH
PRIMARYRELEASE
CLEARINGSERVICE
For Carrier Batch Processing of released claims brought
in from nested or frame converted data.
Example: processdata=primaryrelease
- - - - - - - - - - - - - - - - - - - - - - - -
PRINTHCFA1500=[option]
No
Do not print HCFA-1500 forms.
Yes
For carriers without contracts and
who are configured with a contarct
table control mode of CARRIER DEFAULT
or PRINT CLAIM FORM ONLY
Test
For carriers with contract table
control modes of Testing.
Prod
For carriers with contract table
control modes of Production.
All
Print all the claims in the batch.
For printing the carrier batch HCFA-1500 paper claim
forms to system printer LPT1. It is important to configure
the printer on the system before use of this feature. Use
the Device Configuration,under the Utilities menu in the
Command Line Translator Administration program.
Example: printhcfa1500=yes
COMPILE1500=[option]
YES
NO
For compiling of the carrier HCFA-1500 claim file. It is
important to configure the Insurance Contract Table.
Depending on if your database is a solo provider or institution
the appropriate contract table will need to be configured. It
is also important in the insurance contract table to configure
the Transmission Mode from Carrier Default to Production or
Test Transmission to Dialup.
Example: compile1500=yes
NOTE: The file containing the HCFA-1500 claim data be named base
on the internal system carrier ID with an extension ending
in TCF. An example of this would be I0000003.TCF.
COMPILENSF=[option]
YES
NO
For compiling of the carrier batch NSF claim file. It is
important to configure the Insurance Contract Table.
Depending on if your database is a solo provider or institution
the appropriate contract table will need to be configured. It
is also important in the insurance contract table to configure
the Transmission Mode from Carrier Default to Production or
Test Transmission to Dialup.
Example: compilensf=yes
NOTE: The file containing the NSF claim data be named base on
the internal system carrier ID with an extension ending
in TCF. An example of this would be I0000003.TCF.
COMPILEX12837=[option]
YES
NO
For compiling of the carrier batch ANSI X12 837 claim file. It is
important to configure the Insurance Contract Table.
Depending on if your database is a solo provider or institution
the appropriate contract table will need to be configured. It
is also important in the insurance contract table to configure
the Transmission Mode from Carrier Default to Production or
Test Transmission to Dialup.
Example: compilex12837=yes
NOTE: The file containing the X12 837 claim data be named base on
the internal system carrier ID with an extension ending
in TCF. An example of this would be I0000003.TCF.
- - - - - - - - - - - - - - - - - - - - - - - -
INFILECOPY=[source file,destination file]
Example:infilecopy=exam0012.dat,infile.dat
OUTFILECOPY=[source file,destination file]
Example:outfilecopy=exam0012.dat,outfile.dat
CLEANFILECOPY=[source file,destination file,configuration file]
Cleanfilecopy is a binary file copy routine that through its configu
tion
locates a string of unwanted characters in a file and then
removes them from the new file it creates. The configuration of this
routine is done using the decimal value of the character to match
followed by a comma or period. The value of 999 is used to represent
a wild card position. The length of the character string, in the
configuration, if matched is the length removed in the new file.
Example:cleanfilecopy=infile.dat,outfile.dat,config.txt
Example of config.txt: 27,69,27,999,999,999,72.
Section 4FCU Frame Conversion Utility
[Table of Contents]
to use a Com1 Software system with data received from
external sources. The FCU is a programmable interface.
Because it is programmable, software developers
can create simple and efficient interface files to fit
their own specifications.
Two files are required by the FCU, the C1.FCU file is
a sequential file that is used to store the programed
configuration of the FCU. You the user may create or
adapt this file to your specific need using notepad.
The second file used by the FCU is specified in the
C1.FCU file, and is the file containing the data
to be converted.
Note: Because claims assign Place of Service and
Type of Service at the claim level, PROPOS2
through PROPOS6 and PROTOS2 through PROTOS6 are
not supported on the CES platform. The primary
place and type of service are used for the entire
claim.
LEGEND: r=Row from top of frame.
c=Starting column with specified row.
w=Field width
n=number from 1 to 9
CONFIGURATION SECTION
Syntax : [CONFIG]
Operation Mode
Syntax : MODE=option
Options : ADD (default)
ALTID
ID
NAME
SSN
Usage : MODE=ALTID
Referring Source Control
Syntax : REFSOURCE=ON
NOTE : Default is set to off.
This feature allows you to add and lookup Referring Source
providers in the system database based on the insurance ID/
UPIN of the referring source.
Insurance Carrier
Syntax : CARRIER=system id.
CARRIER=multiple
This is a required field. The system ID must be a valid
insurance carrier already within the system.
Carrier Mode
Syntax : CARRIERMODE=option
Options : ERROR (default)
ADD1500PAPER
ADD1500IMAGE
ADDNSF
ADDX12
ADDX12ERRORON1500PAPER
Usage : CARRIERMODE=ADDX12
Conversion File
Syntax : FILE=filename.extension
or
Syntax : SELECFILE=scope
This is a required field. This is the file that the Frame
Conversion Utility will use as a data source for conversion
into the system. The conversion file must be a sequential
file with a maximum line length of eighty columns.
Scope is standard DOS DIR commands like : *.* or *.txt
Conversion Frame Length
Syntax : FRAMELEN=n
This is a required field. This is the number of lines per
frame. All field coordinates for R must not exceed the
frame length.
Conversion Frame Width
Syntax : FRAMEWIDTH=n
This is a required field. This is the number of lines per
frame. All field coordinates for C plus the additional value of
W must not exceed the frame width.
Frame Offset
Syntax : FRAMEOFFSET=n
This is optional field. The option of n is the number of lines
to offset the first frame by.
Frame Trailer
Syntax : FRAMETRAILER=n
This is optional field. The option of n is the number of lines
to add at the end of the last frame.
Default Place of Service
Syntax : DEFAULTPOS=nn
This field can be used for all claims converted if desired.
Default Type of Service
Syntax : DEFAULTTOS=n
This field can be used for all claims converted if desired.
Default Related To
Syntax : DEFAULTRELATEDTO=option
Options : ILLNESS
PREGNANCY
City State and Zip Control
Syntax : CITYSTATEZIP=option
Options : COMMA - Comma after city and space after state.
SPACE - Space after city.
Date of Sevice
Syntax : DOS=option
Options : MMDDYY
MMDDCCYY
DDMMYY
DDMMCCYY
This function is used to convert date of service information when
one of the optional formats is used. Note that dates with spaces,
hyphens, or slashes in their composition will convert without this
configuration.
Date of Birth
Syntax : DOB=option
Options :
MMDDYY
MMDDCCYY
DDMMYY
DDMMCCYY
This function is used to convert date of birth information when
one of the optional formats is used. Note that dates with spaces,
hyphens, or slashes in their composition will convert without this
configuration.
Set Epoch Date of Birth
Syntax: SETEPOCH=option
Options:
1800
1900 - Default
2000
2100
This function will allow for the seting of the century in dates
of birth where only the last two digits of the year are given.
This function can be used in conjunction with the Date of
Birth and the Set Pivot Date functions.
Set Pivot Date
Syntax: PIVOTDATE=MMDDYY
This function when set will add 100 years to any date of
birth greater than the pivot date. 00 is the lowest and 99
is the highest options for YY.
Phone Number
Syntax : PHONE=option
Options : MASKA
value= XXXXXXXXXX
Default
MASKB
value=XXX XXX-XXXX
position,len= 1,3 5,3 9,4
MASKC
value=(XXX) XXX-XXXX
position,len= 2,3 7,3 11,4
MASKD
value=XXX XXXXXXX
position,len= 1,3 5,7
This function is used to convert phone information when
one of the optional formats is used. Note data with spaces,
hyphens, slashes or brackets in its composition will convert
interchagably.
Diagnosis Decimal
Syntax : DIAGNOSISDECIMAL=option
Options : SPACE
AFTER1
AFTER2
AFTER3
AFTER4
This function is used to convert diagnosis codes where
spaces have been used in place of decimal points or
decimal points may be inserted in the data in a specific
position.
Diagnosis Link Fill
Syntax : DXLINK=FILL
This function will force fill a blank diagnosis procedure
link if it has been left blank. The procedure line will be
linked to the first diagnosis when applied.
Vertical Position Offset
Syntax: VPOSOFF=n
This function will add the value of n to the field mapping row settin
.
Horizontal Position Offset
Syntax: HPOSOFF=n
This function will add the value of n to the field mapping column set
ngs.
Vertical Frame Tracking Field
Syntax: VFTF=fieldname,+/-,max,value
This fuction will use a field that has been specified in the fields se
ion
of the C1.FCU to evaluate for frame inconsistancy. If the field speci
ed
in the fieldname parameter has a value the current frame starting pos
ion
will be left alone. If a blank is found the next forward or the next
ckward
record will be evaluated based on the setting of the second parameter
The third parameter is the number of records to be tested.
The fourth parameter if populated is a value to match.
Examples :
VFTF=carriername,+/-,4
Checks for a carriername. If it is blank then the
ata is check
forwared one record , then backwared one record u
il data
is found. It will repeat the forward, backward pr
ess,
incrementing by one till it has evaluated forward
our records
and backward four records,
VFTF=carriername,+,4,MEDICARE
Checks forward only up til four also checks to ma
sure
carriername is set to the value MEDICARE.
FIELDS SECTION
Syntax : [FIELDS]
Provider Name
Syntax : PROVNAME=r,c,w
First Name
Last Name
Middle Initial
Provider ID
Syntax : PROVID=r,c,w
Provider First Name
Syntax : PROVFNAME=r,c,w
Provider Last Name
Syntax : PROVLNAME=r,c,w
Provider Middle Initial
Syntax : PROVMI=r,c,w
Provider Social Security Number
Syntax : PROVSSN=r,c,w
Provider Tax ID
Syntax : PROVTAXID=r,c,w
Provider NPI
Syntax : PROVNPI=r,c,w
Carrier Box Line 1 to 4
Syntax : CARRIERBOXLINE1=r,c,w
CARRIERBOXLINE2=r,c,w
CARRIERBOXLINE3=r,c,w
CARRIERBOXLINE4=r,c,w
Note : Populates Name, Address line 1,
Address line 2, City, State and
Zip Code.
Carrier ID is detected on line 1
and will use the value detected
between the ( and the ). If the
( and the ) are not used the Carrier
ID will be populated with the
Carrier Name. If an ID is not detected
using the ( and the ) and the CARRIERID
is mapped then Carrier ID from the mapping
will be used.
Carrier Name
Syntax : CARRIERNAME=r,c,w
Carrier ID
Syntax : CARRIERID=r,c,w
Carrier Type
Syntax :CARRIERTYPE=r,c,v1,r,c,v2,r,c,v3,r,c,v4,r,c,v5,r,c,v6,
c,v7
v1 = Medicare
v2 = Medicaid
v3 = CHAMPUS
v4 = CHAMPUSVA
v5 = Group Plan
v6 = FECA Black Lung
v7 = Other
Note: Group plan will set as Other by default. See Tables section in
document for additional information.
Primary Place of Service
Syntax : PRIMARYPOS=r,c
This field is the same as PROPOS1=.
Primary Type of Service
Syntax : PRIMARYTOS=r,c,w
This field is the same as PROTOS1=.
System ID
Syntax : SYSID=r,c,w
Alternate ID
Syntax : ALTID=r,c,w
Social Security Number
Syntax : SSN=r,c,w
Patient Full Name
Syntax : PATNAME=r,c,w
Usage : (Last Name), (First Name)_(Middle Initial)
Patient Address Line 1
Syntax : PATADDR1=r,c,w
Patient City
Syntax : PATCITY=r,c,w
Patient State
Syntax : PATST=r,c,w
Patient Zip Code
Syntax : PATZIP=r,c,w
Patient Phone Home Phone Number
Syntax : PATPHONE=r,c,w
Note : All non numeric data will be removed.
Patient Date of Birth
Syntax : PATDOB=r,c,w
Patient Gender
Syntax : PATSEX=r,c,v1,r,c,v2
v1 = Male
v2 = Female
Patient Relation to Insured
Syntax : PATREL=r,c,v1,r,c,v2,r,c,v3,r,c,v4
v1 = Self
v2 = Spouse
v3 = Child
v4 = Other
Patient Status
Syntax : PATSTAT=r,c,v1,r,c,v2,r,c,v3
v1 = Single
v2 = Married
v3 = Other
Condition Related To
Syntax : CONDREL=r,c,v1,r,c,v2,r,c,v3
v1 = Employment Yes
v2 = Auto Accident Yes
v3 = Other Yes
Insured's I.D. Number
Syntax : INSID=r,c,w
Insured's Name
Syntax : INSNAME=r,c,w
Insured's Address Line 1
Syntax : INSADDR1=r,c,w
Insured's City
Syntax : INSCITY=r,c,w
Insured's State
Syntax : INSST=r,c,w
Insured's Zip Code
Syntax : INSZIP=r,c,w
Insured's Home Phone Number
Syntax : INSPHONE=r,c,w
Insured's Group Number
Syntax : INSGPN=r,c,w
Insured's Date of Birth
Syntax : INSDOB=r,c,w
Insured's Sex
Syntax : INSSEX=r,c,v1,r,c,v2
v1 = Male
v2 = Female
Insurance Plan or Program Name
Syntax : PLANNAME=r,c,w
Other Carrier Name
Syntax : SCARRIERNAME=r,c,w
Other Carrier ID
Syntax : SCARRIERID=r,c,w
Other Carrier Type
Syntax :SCARRIERTYPE=r,c,v1,r,c,v2,r,c,v3,r,c,v4,r,c,v5,r,c,v6
,c,v7
v1 = Medicare
v2 = Medicaid
v3 = CHAMPUS
v4 = CHAMPUSVA
v5 = Group Plan
v6 = FECA Black Lung
v7 = Other
Note: Group plan will set as Other by default. See Tables section in
document for additional information.
Other Insured's I.D. Number
Syntax : INSID=r,c,w
Other Insured's Name
Syntax : SINSNAME=r,c,w
Other Insured's First Name
Syntax : SINSFNAME=r,c,w
Other Insured's Last Name
Syntax : SINSLNAME=r,c,w
Other Insured's Address Line 1
Syntax : SINSADDR1=r,c,w
Other Insured's City
Syntax : SINSCITY=r,c,w
Other Insured's State
Syntax : SINSST=r,c,w
Other Insured's Zip Code
Syntax : SINSZIP=r,c,w
Other Insured's Home Phone Number
Syntax : SINSPHONE=r,c,w
Other Insured's Group Number
Syntax : SINSGPN=r,c,w
Other Insured's Date of Birth
Syntax : SINSDOB=r,c,w
Other Insured's Sex
Syntax : SINSSEX=r,c,v1,r,c,v2
v1 = Male
v2 = Female
Other Insurance Group
Syntax : SINSGRP=r,c,w
Other Insured's Alternate ID
Syntax : SINSALTID=r,c,w
Other Insured's Social Security Number
Syntax : SINSSSN=r,c,w
Other Onsured's Relation to Insured
Syntax : SPATREL=r,c,v1,r,c,v2,r,c,v3,r,c,v4
v1 = Self
v2 = Spouse
v3 = Child
v4 = Other
Other Insured's Marital Status
Syntax : SINSSTAT=r,c,v1,r,c,v2,r,c,v3
v1 = Single
v2 = Married
v3 = Other
Diagnosis Date
Syntax : DXDT=r,c,w
Syntax : DXDTMM=r,c,w
Syntax : DXDTDD=r,c,w
Syntax : DXDTCCYY=r,c,w
Syntax : DXDTYY=r,c,w
Pre Authorization
Syntax : PREAUTH=r,c,w
Referral Number
Syntax : REFERRALNUMBER=r,c,w
Referring Provider Name
Syntax : REFNAME=r,c,w
This will convert name as First and then Last. If a
comma is present then the name will be converted
as Last then First
Referring Provider First Name
Syntax : REFFNAME=r,c,w
Referring Provider Last Name
Syntax : REFLNAME=r,c,w
Referring Provider ID
Syntax : REFID=r,c,w
Primary Diagnosis
Syntax : DX1=r,c,w
Second Diagnosis
Syntax : DX2=r,c,w
Third Diagnosis
Syntax : DX3=r,c,w
Fourth Diagnosis
Syntax : DX4=r,c,w
First Procedure Date of Service From
Syntax : PRODOSF1=r,c,w
First Procedure Date of Service From Month
Syntax : PRODOSF1MM=r,c,w
First Procedure Date of Service From Day
Syntax : PRODOSF1DD=r,c,w
First Procedure Date of Service From Year
Syntax : PRODOSF1YY=r,c,w
First Procedure Date of Service From Century and Year
Syntax : PRODOSF1CCYY=r,c,w
First Procedure Date of Service To
Syntax : PRODOST1=r,c,w
First Procedure Date of Service To Month
Syntax : PRODOST1MM=r,c,w
First Procedure Date of Service To Day
Syntax : PRODOST1DD=r,c,w
First Procedure Date of Service To Year
Syntax : PRODOST1YY=r,c,w
First Procedure Date of Service To Century and Year
Syntax : PRODOST1CCYY=r,c,w
First Procedure Place of Service
Syntax : PROPOS1=r,c,w
First Procedure Type of Service
Syntax : PROTOS1=r,c,w
First Procedure Code
Syntax : PROCODE1=r,c,w
First Procedure, First Modifier
Syntax : PROMODA1=r,c,w
First Procedure, Second Modifier
Syntax : PROMODB1=r,c,w
First Procedure, Third Modifier
Syntax : PROMODC1=r,c,w
First Procedure Link to Diagnosis
Syntax : PRODXLNK1=r,c,w
First Procedure Amount
Syntax : PROAMT1=r,c,w
First Procedure Units Value
Syntax : PROUNIT1=r,c,w
Second Procedure Date of Service From
Syntax : PRODOSF2=r,c,w
Second Procedure Date of Service From Month
Syntax : PRODOSF2MM=r,c,w
Second Procedure Date of Service From Day
Syntax : PRODOSF2DD=r,c,w
Second Procedure Date of Service From Year
Syntax : PRODOSF2YY=r,c,w
Second Procedure Date of Service From Century and Year
Syntax : PRODOSF2CCYY=r,c,w
Second Procedure Date of Service To
Syntax : PRODOST2=r,c,w
Second Procedure Date of Service To Month
Syntax : PRODOST2MM=r,c,w
Second Procedure Date of Service To Day
Syntax : PRODOST2DD=r,c,w
Second Procedure Date of Service To Year
Syntax : PRODOST2YY=r,c,w
Second Procedure Date of Service To Century and Year
Syntax : PRODOST2CCYY=r,c,w
Second Procedure Place of Service
Syntax : PROPOS2=r,c,w
Second Procedure Type of Service
Syntax : PROTOS2=r,c,w
Second Procedure Code
Syntax : PROCODE2=r,c,w
Second Procedure, First Modifier
Syntax : PROMODA2=r,c,w
Second Procedure, Second Modifier
Syntax : PROMODB2=r,c,w
Second Procedure, Third Modifier
Syntax : PROMODC2=r,c,w
Second Procedure Link to Diagnosis
Syntax : PRODXLNK2=r,c,w
Second Procedure Amount
Syntax : PROAMT2=r,c,w
Second Procedure Units Value
Syntax : PROUNIT2=r,c,w
Third Procedure Date of Service From
Syntax : PRODOSF3=r,c,w
Third Procedure Date of Service From Month
Syntax : PRODOSF3MM=r,c,w
Third Procedure Date of Service From Day
Syntax : PRODOSF3DD=r,c,w
Third Procedure Date of Service From Year
Syntax : PRODOSF3YY=r,c,w
Third Procedure Date of Service From Century and Year
Syntax : PRODOSF3CCYY=r,c,w
Third Procedure Date of Service To
Syntax : PRODOST3=r,c,w
Third Procedure Date of Service To Month
Syntax : PRODOST3MM=r,c,w
Third Procedure Date of Service To Day
Syntax : PRODOST3DD=r,c,w
Third Procedure Date of Service To Year
Syntax : PRODOST3YY=r,c,w
Third Procedure Date of Service To Century and Year
Syntax : PRODOST3CCYY=r,c,w
Third Procedure Place of Service
Syntax : PROPOS3=r,c,w
Third Procedure Type of Service
Syntax : PROTOS3=r,c,w
Third Procedure Code
Syntax : PROCODE3=r,c,w
Third Procedure, First Modifier
Syntax : PROMODA3=r,c,w
Third Procedure, Second Modifier
Syntax : PROMODB3=r,c,w
Third Procedure, Third Modifier
Syntax : PROMODC3=r,c,w
Third Procedure Link to Diagnosis
Syntax : PRODXLNK3=r,c,w
Third Procedure Amount
Syntax : PROAMT3=r,c,w
Third Procedure Units Value
Syntax : PROUNIT3=r,c,w
Fourth Procedure Date of Service From
Syntax : PRODOSF4=r,c,w
Fourth Procedure Date of Service From Month
Syntax : PRODOSF4MM=r,c,w
Fourth Procedure Date of Service From Day
Syntax : PRODOSF4DD=r,c,w
Fourth Procedure Date of Service From Year
Syntax : PRODOSF4YY=r,c,w
Fourth Procedure Date of Service From Century and Year
Syntax : PRODOSF4CCYY=r,c,w
Fourth Procedure Date of Service To Month
Syntax : PRODOST4MM=r,c,w
Fourth Procedure Date of Service To Day
Syntax : PRODOST4DD=r,c,w
Fourth Procedure Date of Service To Year
Syntax : PRODOST4YY=r,c,w
Fourth Procedure Date of Service To Century and Year
Syntax : PRODOST4CCYY=r,c,w
Fourth Procedure Date of Service To
Syntax : PRODOST4=r,c,w
Fourth Procedure Place of Service
Syntax : PROPOS4=r,c,w
Fourth Procedure Type of Service
Syntax : PROTOS4=r,c,w
Fourth Procedure Code
Syntax : PROCODE4=r,c,w
Fourth Procedure, First Modifier
Syntax : PROMODA4=r,c,w
Fourth Procedure, Second Modifier
Syntax : PROMODB4=r,c,w
Fourth Procedure, Third Modifier
Syntax : PROMODC4=r,c,w
Fourth Procedure Link to Diagnosis
Syntax : PRODXLNK4=r,c,w
Fourth Procedure Amount
Syntax : PROAMT4=r,c,w
Fourth Procedure Units Value
Syntax : PROUNIT4=r,c,w
Fifth Procedure Date of Service From
Syntax : PRODOSF5=r,c,w
Fifth Procedure Date of Service From Month
Syntax : PRODOSF5MM=r,c,w
Fifth Procedure Date of Service From Day
Syntax : PRODOSF5DD=r,c,w
Fifth Procedure Date of Service From Year
Syntax : PRODOSF5YY=r,c,w
Fifth Procedure Date of Service From Century and Year
Syntax : PRODOSF5CCYY=r,c,w
Fifth Procedure Date of Service To
Syntax : PRODOST5=r,c,w
Fifth Procedure Date of Service To Month
Syntax : PRODOST5MM=r,c,w
Fifth Procedure Date of Service To Day
Syntax : PRODOST5DD=r,c,w
Fifth Procedure Date of Service To Year
Syntax : PRODOST5YY=r,c,w
Fifth Procedure Date of Service To Century and Year
Syntax : PRODOST5CCYY=r,c,w
Fifth Procedure Place of Service
Syntax : PROPOS5=r,c,w
Fifth Procedure Type of Service
Syntax : PROTOS5=r,c,w
Fifth Procedure Code
Syntax : PROCODE5=r,c,w
Fifth Procedure, First Modifier
Syntax : PROMODA5=r,c,w
Fifth Procedure, Second Modifier
Syntax : PROMODB5=r,c,w
Fifth Procedure, Third Modifier
Syntax : PROMODC5=r,c,w
Fifth Procedure Link to Diagnosis
Syntax : PRODXLNK5=r,c,w
Fifth Procedure Amount
Syntax : PROAMT5=r,c,w
Fifth Procedure Units Value
Syntax : PROUNIT5=r,c,w
Sixth Procedure Date of Service From
Syntax : PRODOSF6=r,c,w
Sixth Procedure Date of Service From Month
Syntax : PRODOSF6MM=r,c,w
Sixth Procedure Date of Service From Day
Syntax : PRODOSF6DD=r,c,w
Sixth Procedure Date of Service From Year
Syntax : PRODOSF6YY=r,c,w
Sixth Procedure Date of Service From Century and Year
Syntax : PRODOSF6CCYY=r,c,w
Sixth Procedure Date of Service To
Syntax : PRODOST6=r,c,w
Sixth Procedure Date of Service To Month
Syntax : PRODOST6MM=r,c,w
Sixth Procedure Date of Service To Day
Syntax : PRODOST6DD=r,c,w
Sixth Procedure Date of Service To Year
Syntax : PRODOST6YY=r,c,w
Sixth Procedure Date of Service To Century and Year
Syntax : PRODOST6CCYY=r,c,w
Sixth Procedure Place of Service
Syntax : PROPOS6=r,c,w
Sixth Procedure Type of Service
Syntax : PROTOS6=r,c,w
Sixth Procedure Code
Syntax : PROCODE6=r,c,w
Sixth Procedure, First Modifier
Syntax : PROMODA6=r,c,w
Sixth Procedure, Second Modifier
Syntax : PROMODB6=r,c,w
Sixth Procedure, Third Modifier
Syntax : PROMODC6=r,c,w
Sixth Procedure Link to Diagnosis
Syntax : PRODXLNK6=r,c,w
Sixth Procedure Amount
Syntax : PROAMT6=r,c,w
Sixth Procedure Units Value
Syntax : PROUNIT6=r,c,w
Facility Name
Syntax::FACILITYNAME=r,c,w
Facility Address Line 1
Syntax:: FACILITYADDR1=r,c,w
Facility Address Line 2
Syntax::FACILITYADDR2=r,c,w
Facility City
Syntax::FACILITYCITY=r,c,w
Facility State
Syntax::FACILITYST=r,c,w
Facility Zip Code
Syntax::FACILITYZIP=r,c,w
Facility City, State, and Zip
Syntax::FACILITYCSZ=r,c,w
- - - - - - - - - - - - - - - - - - - -
TABLES SECTION
Syntax : [TABLES]
Table Field Definitions
CARRIERTYPE=option,R,C,W,definition
Options : This is the character string
being compared to the data loaded
in the frame If the option
matches the data then the definition
is used to the translation of the
data that will be applied to the
database.
Definitions : Description - - - - - - - - - - - - Definition
Standard Private..........................1
Medicare......................................2
Medicaid......................................3
CHAMPUS...................................4
CHAMPVA...................................5
FECA Black Lung........................6
Workers Compensation................7
Self Pay........................................8
Other Federal Program..................9
Blue Cross/Blue Shield...............10
HMO...........................................11
Federal Employee's Program.......12
Central Certification.....................13
Self Administered.........................14
Family or Friends..........................15
Managed Care - Non-HMO..........16
Blue Cross....................................17
Title V...........................................18
Veteran Administration Plan..........19
Other............................................20
CARRIERID=valuein,valueout
: If the value of the carrier ID matches the
the value stated in the valuein then tha valueout
will be sustituted in its place.
Section 5FCU Example of C1.FCU (CMS-1500)
[Table of Contents]
***** (c) 1995 Com1 Software, Inc.
***** HCFA-1500/CMS-1500 (12/90) Image
*********************************************
[config]
carrier=I0000001
file=EXAM0011.dat
framelen=66
mode=altid
defaultrelatedto=illness
[fields]
altid=55,25,10
patname=9,2,20
pataddr1=11,2,20
patcity=13,2,12
patst=13,28,2
patzip=15,2,9
patphone=15,14,14
patdob=9,32,8
patsex=9,43,MX*,9,48,FX*
patrel=11,34,X*,11,39,X*,11,43,X*,11,48,X*
patstat=13,36,X*,13,42,X*,13,48,X*
condrel=19,36,X*,21,36,X*,23,36,X*
insid=7,52,16
insname=9,52,20
insaddr1=11,52,20
inscity=13,52,16
insst=13,77,2
inszip=15,52,9
insphone=15,67,12
insgpn=17,52,20
insdob=19,55,10
inssex=19,69,MX*,19,76,FX*
planname=23,52,20
dxdt=31,2,10
refname=33,2,18
refid=33,28,16
dx1=37,4,6
dx2=39,4,6
dx3=37,32,6
dx4=39,32,6
prodosf1=43,2,8
prodost1=43,11,8
propos1=43,20,2
protos1=43,23,2
procode1=43,26,6
promoda1=43,33,2
promodb1=43,35,2
promodc1=43,37,2
prodxlnk1=43,44,4
proamt1=43,51,8
prounit1=43,60,3
prodosf2=45,2,8
prodost2=45,11,8
propos2=45,20,2
protos2=45,23,2
procode2=45,26,6
promoda2=45,33,2
promodb2=45,35,2
promodc2=45,37,2
prodxlnk2=45,44,4
proamt2=45,51,8
prounit2=48,60,3
prodosf3=47,2,8
prodost3=47,11,8
propos3=47,20,2
protos3=47,23,2
procode3=47,26,6
promoda3=47,33,2
promodb3=47,35,2
promodc3=47,37,2
prodxlnk3=47,44,4
proamt3=47,51,8
prounit3=47,60,3
prodosf4=49,2,8
prodost4=49,11,8
propos4=49,20,2
protos4=49,23,2
procode4=49,26,6
promoda4=49,33,2
promodb4=49,35,2
promodc4=49,37,2
prodxlnk4=49,44,4
proamt4=49,51,8
prounit4=49,60,3
prodosf5=51,2,8
prodost5=51,11,8
propos5=51,20,2
protos5=51,23,2
procode5=51,26,6
promoda5=51,33,2
promodb5=51,35,2
promodc5=51,37,2
prodxlnk5=51,44,4
proamt5=51,51,8
prounit5=51,60,3
prodosf6=53,2,8
prodost6=53,11,8
propos6=53,20,2
protos6=53,23,2
procode6=53,26,6
promoda6=53,33,2
promodb6=53,35,2
promodc6=53,37,2
prodxlnk6=53,44,4
proamt6=53,51,8
prounit6=53,60,3
Section 6NCU Nested Conversion Utility
[Table of Contents]
to import or convert data from an electronic media
claim file.
The NCU is a programmable interface.
Because it is programmable, software developers
can create simple and efficient interface files to fit
their own specifications. Providers and system integrators
may also use this feature to add functionality, such as
the ability to enhance the value to an existing practice
management system that is capable of producing an NSF
electronic claim format version 1.02 and would like
to submit electronically to other payers who require NSF
version 3.01. Note that the complete opposite can also
be accomodated where the payor accepts NSF version 1.02
and the practice manager is generating NSF version 3.01.
Two files are required by the NCU, the C1.NCU file is
a sequential file that is used to store the programed
configuration of the NCU. You the user may create or
adapt this file to your specific need using a common
word processor or text editor. The second file used
by the NCU is specified in the C1.NCU file, and is the
file containing the data to be converted.
The C1.NCU has four sections. These sections are:
Configuration [CONFIG]
Record Definition [RECORDS]
Field Record Definition [FIELDS]
Table Field Definition [TABLES]
LEGEND: c=Starting column within specified record.
w=Field width
n=number from 1 to 9
- - - - - - - - - - - - - - - - - - - -
CONFIGURATION SECTION
Syntax : [CONFIG]
Operation Mode
Syntax : MODE=option
Options : ADD (default)
ALTID
ID
NAME
SSN
Usage : MODE=ALTID
Referring Source Control
Syntax : REFSOURCE=option
Options : ADD (default)
NAME
ID
This feature allows you to add and lookup Referring Source
providers in the system database based on the insurance ID/
UPIN of the referring source.
Provider Data
Syntax : PROVIDERMODE=option
Options : ERROR (default)
ADD
This feature allows you to add a provider at the time of
conversion. Activity relative to this function will be
recorded in the command.log.
Insurance Carrier
Syntax : CARRIER=system id.
CARRIER=multiple
or
CARRIER=multiple+n
Where n is the number 1 to 5. This will set the carrier
level verification. If CARRIER=MULTIPLE+1 is set the
address line 1 must match, set to MULTIPLE+2 the address
line 2 must match as well, and so on through city, state
and zip. Normal multiple will check a match on the name only.
This is a required field. If the system ID is used it must
be a valid insurance carrier already within the system.
Syntax: CARRIERMODE=option
Options: ERROR (default)
ADD1500PAPER
ADD1500IMAGE
ADDNSF
ADDX12
The Carriermode feature allows you to set the method used when
the carrier function has been set to multiple. If a carrier is
in the database, that carrier will be used. If the carrier is
not in the database, the carriermode will be used to determine
whether or not to add the carrier to the database and which
output method should be configured for that new carrier. The
command.log will reflect any activity relative to this feature.
Clearing Service
Syntax : CLEARINGSERVICE=system id.
Example : CLEARINGSERVICE=CS000001
This is a required field. If the system ID is used it must
be a valid insurance carrier already within the system.
Conversion File
Syntax : FILE=filename.extension
This is a required field. This is the file that the Nested
Conversion Utility will use as a data source for conversion
into the system. The conversion file must be a sequential
file with a maximum line length of eighty columns.
Conversion Record Length
Syntax : RECORDLENGTH=n
This is a required field. This is the number of bytes per
record. All field coordinates for R must not exceed the
frame length.
Conversion Record Depth
Syntax : RECORDDEPTH=n
This is an optional field. Record depth is a fixed number
of additional filler records between a record. Records from
within the record depth are concatenated onto the end of
their primary record to form a single record. The total
length of all concatenated records for a set cannot
exceed the record length
Conversion Top Record Offset
Syntax : TOPOFFSET=n
This is an optional field. This is the number of records
to skip at the begining of a file.
Default Place of Service
Syntax : DEFAULTPOS=nn
This field can be used for all claims converted if desired.
Default Type of Service
Syntax : DEFAULTTOS=n
This field can be used for all claims converted if desired.
Default Related To
Syntax : DEFAULTRELATEDTO=option
Options : ILLNESS
PREGNANCY
Demographics Handling Control
Syntax : DEMOGRAPHICS=option
Options : NORMAL
CROSSFILLALLBLANKS
CROSSFILLBLANKADDRESS
This feature allows for the ability to deal with
problem source data files that may not have enough
patient or insureds demographic information for some
conversions or where patient or insureds demographic
information is inconsistant.
Debug for NCU
Syntax : DEBUG=option
Options : ON
OFF
- - - - - - - - - - - - - - - - - - - -
RECORDS SECTION
Syntax : [RECORDS]
Record Definition
Syntax : RECORDSET=id,class
ID : Is the character string associated
with this record. It is also defined
in the Field Record Definition.
CLASS : 1101 - File Header Class
1201 - Batch Header Class
1301 - Patient Record Class
1401 - Coverage Record Class
1501 - Claim Record Class
1601 - Claim Detail Reord Class
1699 - Claim Detail Record Sub Class
1701 - Certification Record Class
1801 - Documentation Record Class
9701 - Claim Trailer Record Class
9801 - Batch Trailer Record Class
9901 - File Trailer Record Class
- - - - - - - - - - - - - - - - - - - -
FIELDS SECTION
Syntax : [FIELDS]
Provider Name
Syntax : PROVNAME=c,w
Provider Last Name
Syntax : PROVLNAME=c,w
Provider First Name
Syntax : PROVFNAME=c,w
Provider Middle Initial
Syntax : PROVMI=c,w
Provider Provider Insurance ID
Syntax : PROVID=c,w
Provider Social Security Number
Syntax : PROVSSN=c,w
Provider NPI
Syntax : PROVNPI=c,w
Provider Taxonomy Code
Syntax : PROVTAXONOMYCODE=c,w
Referring Provider Last Name
Syntax : REFLNAME=c,w
Referring Provider First Name
Syntax : REFFNAME=c,w
Referring Provider Middle Initial
Syntax : REFMI=c,w
Referring Provider ID
Syntax : REFID=c,w
Referring Provider NPI
Syntax : REFNPI=c,w
Ordering Provider Last Name
Syntax : ORDLNAME=c,w
Ordering Provider First Name
Syntax : ORDFNAME=c,w
Ordering Provider Middle Initial
Syntax : ORDMI=c,w
Ordering Provider ID
Syntax : ORDID=c,w
Ordering Provider NPI
Syntax : ORDNPI=c,w
Rendering Provider Last Name
Syntax : RENLNAME=c,w
Rendering Provider First Name
Syntax : RENFNAME=c,w
Rendering Provider Middle Initial
Syntax : RENMI=c,w
Rendering Provider ID
Syntax : RENID=c,w
Rendering Provider NPI
Syntax : RENNPI=c,w
Supervising Provider Last Name
Syntax : SUPLNAME=c,w
Supervising Provider First Name
Syntax : SUPFNAME=c,w
Supervising Provider Middle Initial
Syntax : SUPMI=c,w
Supervising Provider ID
Syntax : SUPID=c,w
Supervising Provider NPI
Syntax : SUPNPI=c,w
Selected Provider Type
Syntax :XPROVTYPE=c,w
Selected Provider Type Insurance ID
Syntax :XPROVID=c,w
Selected Provider Type Last Name
Syntax :XPROVLNAME=c,w
Selected Provider Type First Name
Syntax :XPROVFNAME=c,w
Selected Provider Type Middle Initial
Syntax :XPROVMI=c,w
Selected Provider Type Address Line 1
Syntax :XPROVADDR1=c,w
Selected Provider Type Addrss Line 2
Syntax :XPROVADDR2=c,w
Selected Provider Type Insurance City
Syntax :XPROVCITY=c,w
Selected Provider Type State
Syntax :XPROVSTATE=c,w
Selected Provider Type Zip Code
Syntax :XPROVZIP=c,w
Selected Provider Type NPI
Syntax :XPROVNPI=c,w
Facility Name
Syntax : FACILITYNAME=c,w
Facility Address Line 1
Syntax : FACILITYADDR1=c,w
Facility Address Line 2
Syntax : FACILITYADDR2=c,w
Facility City
Syntax : FACILITYCITY=c,w
Facility State
Syntax : FACILITYST=c,w
Facility Zip Code
Syntax : FACILITYZIP=c,w
Facility National Provider ID
Syntax : FACILITYNPI=c,w
Facility ID Type
Syntax : FACILITYIDTYPE=c,w
Facility ID
Syntax : FACILITYID=c,w
Facility Place of Service
Syntax : FACILITYPOS=c,w
Service Facility Name
Syntax : SERVICEFACILITYNAME=c,w
Service Facility Address Line 1
Syntax : SERVICEFACILITYADDR1=c,w
Service Address Line 2
Syntax : SERVICEFACILITYADDR2=c,w
Service Facility City
Syntax : SERVICEFACILITYCITY=c,w
Service Facility State
Syntax : SERVICEFACILITYST=c,w
Service Facility Zip Code
Syntax : SERVICEFACILITYZIP=c,w
Service Facility ID Type
Syntax : SERVICEFACILITYIDTYPE=c,w
Service Facility ID
Syntax : SERVICEFACILITYID=c,w
Service Facility Place of Service
Syntax : SERVICEFACILITYPOS=c,w
Carrier Name
Syntax : CARRIERNAME=c,w
Carrier Address Line 1
Syntax : CARRIERADDR1=c,w
Carrier Address Line 2
Syntax : CARRIERADDR2=c,w
Carrier City
Syntax : CARRIERCITY=c,w
Carrier State
Syntax : CARRIERST=c,w
Carrier Zip Code
Syntax : CARRIERZIP=c,w
Patient System ID
Syntax : PATSYSID=c,w
Patient Alternate ID
Syntax : PATALTID=c,w
Patient Social Security Number
Syntax : PATSSN=c,w
Patient First Name
Syntax : PATFNAME=c,w
Patient Last Name
Syntax : PATLNAME=,c,w
Patient Middle Initial
Syntax : PATMI=c,w
Patient Address Line 1
Syntax : PATADDR1=c,w
Patient City
Syntax : PATCITY=c,w
Patient State
Syntax : PATST=c,w
Patient Zip Code
Syntax : PATZIP=c,w
Patient Home Phone Number
Syntax : PATPHONE=c,w
Note : All non numeric data will be removed.
Patient Date of Birth
Syntax : PATDOB=c,w
Patient Gender
Syntax : PATSEX=c,w
Patient Status
Syntax : PATSTAT=c,w
Patient Relation to Insured
Syntax : PATREL=c,w
Insured's I.D. Number
Syntax : INSID=c,w
Insured's First Name
Syntax : INSFNAME=c,w
Insured's Last Name
Syntax : INSLNAME=c,w
Insured's Address Line 1
Syntax : INSADDR1=c,w
Insured's City
Syntax : INSCITY=c,w
Insured's State
Syntax : INSST=c,w
Insured's Zip Code
Syntax : INSZIP=c,w
Insured's Home Phone Number
Syntax : INSPHONE=c,w
Insured's Group Number
Syntax : INSGPN=c,w
Insured's Date of Birth
Syntax : INSDOB=c,w
Insured's Sex
Syntax : INSSEX=r,c
Insurance Plan or Program Name
Syntax : PLANNAME=c,w
Secondary Patient Relation to Insured
Syntax :SPATREL=c,w
Secondary Insured's I.D. Number
Syntax : SINSID=c,w
Secondary Insured's First Name
Syntax : SINSFNAME=c,w
Secondary Insured's Last Name
Syntax : SINSLNAME=c,w
Secondary Insured's Address Line 1
Syntax : SINSADDR1=c,w
Secondary Insured's City
Syntax : SINSCITY=c,w
Secondary Insured's State
Syntax : SINSST=c,w
Secondary Insured's Zip Code
Syntax : SINSZIP=c,w
Secondary Insured's Home Phone Number
Syntax : SINSPHONE=c,w
Secondary Insured's Group Number
Syntax : SINSGPN=c,w
Secondary Insured's Date of Birth
Syntax : SINSDOB=c,w
Secondary Insured's Sex
Syntax : SINSSEX=r,c
Secondary Insurance Group Number
Syntax : SINSGRP=c,w
Secondary Insured's Alternate ID
Syntax : SINSALTID=c,w
Secondary Insured's Social Security Number
Syntax : SINSSN=c,w
Secondary Carrier Name
Syntax : SCARRIERNAME=c,w
Secondary Carrier Address Line 1
Syntax : SCARRIERADDR1=c,w
Secondary Carrier Address Line 2
Syntax : SCARRIERADDR2=c,w
Secondary Carrier City
Syntax : SCARRIERCITY=c,w
Secondary Carrier State
Syntax : SCARRIERST=c,w
Secondary Carrier Zip Code
Syntax : SCARRIERZIP=c,w
Secondary Carrier Type
Syntax : SCARTYPE=c,w
Tertiery Patient Relation to Insured
Syntax :TPATREL=c,w
Tertiery Insured's I.D. Number
Syntax : TINSID=c,w
Tertiery Insured's First Name
Syntax : TINSFNAME=c,w
Tertiery Insured's Last Name
Syntax : TINSLNAME=c,w
Tertiery Insured's Address Line 1
Syntax : TINSADDR1=c,w
Tertiery Insured's City
Syntax : TINSCITY=c,w
Tertiery Insured's State
Syntax : TINSST=c,w
Tertiery Insured's Zip Code
Syntax : TINSZIP=c,w
Tertiery Insured's Home Phone Number
Syntax : TINSPHONE=c,w
Tertiery Insured's Group Number
Syntax : TINSGPN=c,w
Tertiery Insured's Date of Birth
Syntax : TINSDOB=c,w
Tertiery Insured's Sex
Syntax : TINSSEX=r,c
Tertiery Insurance Group Number
Syntax : TINSGRP=c,w
Tertiery Insured's Alternate ID
Syntax : TINSALTID=c,w
Tertiery Insured's Social Security Number
Syntax : TINSSN=c,w
Tertiery Carrier Name
Syntax : TCARRIERNAME=c,w
Tertiery Carrier Address Line 1
Syntax : TCARRIERADDR1=c,w
Tertiery Carrier Address Line 2
Syntax : TCARRIERADDR2=c,w
Tertiery Carrier City
Syntax : TCARRIERCITY=c,w
Tertiery Carrier State
Syntax : TCARRIERST=c,w
Tertiery Carrier Zip Code
Syntax : TCARRIERZIP=c,w
Tertiery Carrier Type
Syntax : TCARTYPE=c,w
Quadinary Patient Relation to Insured
Syntax :QPATREL=c,w
Quadinary Insured's I.D. Number
Syntax : QINSID=c,w
Quadinary Insured's First Name
Syntax : QINSFNAME=c,w
Quadinary Insured's Last Name
Syntax : QINSLNAME=c,w
Quadinary Insured's Address Line 1
Syntax : QINSADDR1=c,w
Quadinary Insured's City
Syntax : QINSCITY=c,w
Quadinary Insured's State
Syntax : QINSST=c,w
Quadinary Insured's Zip Code
Syntax : QINSZIP=c,w
Quadinary Insured's Home Phone Number
Syntax : QINSPHONE=c,w
Quadinary Insured's Group Number
Syntax : QINSGPN=c,w
Quadinary Insured's Date of Birth
Syntax : QINSDOB=c,w
Quadinary Insured's Sex
Syntax : QINSSEX=r,c
Quadinary Insurance Group Number
Syntax : QINSGRP=c,w
Quadinary Insured's Alternate ID
Syntax : QINSALTID=c,w
Quadinary Insured's Social Security Number
Syntax : QINSSN=c,w
Quadinary Carrier Name
Syntax : QCARRIERNAME=c,w
Quadinary Carrier Address Line 1
Syntax : QCARRIERADDR1=c,w
Quadinary Carrier Address Line 2
Syntax : QCARRIERADDR2=c,w
Quadinary Carrier City
Syntax : QCARRIERCITY=c,w
Quadinary Carrier State
Syntax : QCARRIERST=c,w
Quadinary Carrier Zip Code
Syntax : QCARRIERZIP=c,w
Quadinary Carrier Type
Syntax : QCARTYPE=c,w
Additional or Supporting Documentation
At the Claim level
Syntax : XDOC=c,w
Additional or Supporting Documentation
At the Service Line Level
Syntax : XDOCLINE=c,w
Primary Place of Service
Syntax : PRIMARYPOS=c,w
This field is the same as PROPOS1=.
Primary Type of Service
Syntax : PRIMARYTOS=c,w
This field is the same as PROTOS1=
Hospital From Date
Syntax : HOSPITALFROMDATE=c,w
Hospital To Date
Syntax : HOSPITALTODATE=c,w
Primary Diagnosis
Syntax : DX1=c,w
Second Diagnosis
Syntax : DX2=c,w
Third Diagnosis
Syntax : DX3=c,w
Fourth Diagnosis
Syntax : DX4=c,w
Diagnosis Date
Syntax : DXDT=c,w
Condition Related To
Syntax : CONDREL=c,w
Procedure Date of Service From
Syntax : PRODOSF=c,w
Procedure Date of Service To
Syntax : PRODOST=c,w
Procedure Place of Service
Syntax : PROPOS=c,w
Procedure Type of Service
Syntax : PROTOS=c,w
Procedure Code
Syntax : PROCODE=c,w
Procedure, First Modifier
Syntax : PROMODA=c,w
Procedure, Second Modifier
Syntax : PROMODB=c,w
Procedure, Third Modifier
Syntax : PROMODC=c,w
Procedure Link to Diagnosis
Syntax : PRODXLNK=c,w
Procedure Supporting Link to First Diagnosis
Syntax : PROSUPA=c,w
Procedure Supporting Link to Second Diagnosis
Syntax : PROSUPB=c,w
Procedure Supporting Link to Third Diagnosis
Syntax : PROSUPC=c,w
Procedure Supporting Link to Fourth Diagnosis
Syntax : PROSUPD=c,w
Procedure Amount
Syntax : PROAMT=c,w
Procedure Units Value
Syntax : PROUNIT=c,w
Durable Mediical Equipment
Cerificate of Medical Necissity Transmission Code
Syntax : DMECMNTRANS=c,w
Table Required
Durable Mediical Equipment
Certification Type
Syntax : DMECERTYPE=c,w
Table Required
Durable Mediical Equipment
Certification Measurement Basis
Syntax : DMECERBAS=c,w
Durable Mediical Equipment
Certification Quantity
Syntax : DMECERQTY=c,w
Durable Mediical Equipment
Oxygen Therapy Certification Type
Syntax : DMEOTCTYPE=c,w
Table Required
Durable Mediical Equipment
Oxygen Therapy Certification Quantity
Syntax : DMEOTCQTY=c,w
Durable Mediical Equipment
Oxygen Therapy Certification Arterial Blood Gas Quantity
Syntax : DMEOTCABGQ=c,w
Durable Mediical Equipment
Oxygen Therapy Certification Oxygen Saturation Quantity
Syntax : DMEOTCOSQ=c,w
Durable Mediical Equipment
Oxygen Therapy Certification Test Condition Code
Syntax : DMEOTCTCOD=c,w
Durable Mediical Equipment
Oxygen Therapy Certification Findings Code A
Syntax : DMEOTCACOD=c,w
Durable Mediical Equipment
Oxygen Therapy Certification Findings Code B
Syntax : DMEOTCBCOD=c,w
Durable Mediical Equipment
Oxygen Therapy Certification Findings Code C
Syntax : DMEOTCCCOD=c,w
Ambulance Transport Information
Ambulance Transport Code
Syntax : ATIC=c,w
Table Required
Ambulance Transport Information
Ambulance Transport Reason Code
Syntax : ATIRC=c,w
Table Required
Ambulance Transport Information
Ambulance Transport Patient Weight
Syntax : ATIPATLBS=c,w
Ambulance Transport Information
Ambulance Transport Milage Distance
Syntax : ATIMILES=c,w
Ambulance Transport Information
Ambulance Transport Note
Syntax : ATINOTE=c,w
Ambulance Transport Information
Ambulance Transport Address Information 1
Syntax : ATIADDR1=c,w
Ambulance Transport Information
Ambulance Transport Address Information 2
Syntax : ATIADDR2=c,w
Ambulance Transport Information
Ambulance Transport Stretcher Information
Syntax : ATISTRECHER=c,w
Spinal Manipulation Service Information
Spinal Manipulation Condition Code
Syntax : SMSICC=c,w
Table Required
Spinal Manipulation Service Information
Spinal Manipulation Complication Indicator
Syntax : SMSICI=c,w
Table Required
Spinal Manipulation Service Information
Spinal Manipulation X-Ray Indicator
Syntax : SMSIXRAY=c,w
Table Required
Spinal Manipulation Service Information
Spinal Manipulation Subluxation Level Code
Syntax : SMSISLC=c,w
Table Required
Spinal Manipulation Service Information
Spinal Manipulation Subluxation Level Code Additional
Syntax : SMSISLCA=c,w
Table Required
Spinal Manipulation Service Information
Spinal Manipulation Treatment Series Number
Syntax : SMSITSN=c,w
Spinal Manipulation Service Information
Spinal Manipulation Treatment Series Total
Syntax : SMSITST=c,w
Total number of treatment in the
current series.
Spinal Manipulation Service Information
Spinal Manipulation Treatment Measurements
Syntax : SMSIMEASURE=c,w
Table Required
Spinal Manipulation Service Information
Spinal Manipulation Treatment Period Count
Syntax : SMSITPC=c,w
Spinal Manipulation Service Information
Spinal Manipulation Treatment Number in Month
Syntax : SMSITNIM=c,w
Spinal Manipulation Service Information
Spinal Manipulation Patient Condition Description
Syntax : SMSIPCD=c,w
Spinal Manipulation Service Information
Spinal Manipulation Patient Condition Description Additional
Syntax : SMSIPCDA=c,w
- - - - - - - - - - - - - - - - - - - -
TABLES SECTION
Syntax : [TABLES]
Table Field Definitions
PATSEX=option,definition
INSSEX=option,definition
Options : This is the character string
being compared to the data loaded
in the field. If the option
matches the data then the definition
is applied to the translation of the
data that will be applied to the
database.
Definitions : Description - - - - - - - - - - - - Definition
NOT SURE.................................0
MALE.....................................1
FEMALE...................................2
PATREL=option,definition
Options : This is the character string
being compared to the data loaded
in the PATREL field. If the option
matches the data then the definition
is applied to the translation of the
data that will be applied to the
database.
Definitions :Description - - - - - - - - - - - - Definition
NOT SURE................................00
SELF....................................11
SPOUSE..................................12
CHILD...................................13
GUARDIAN................................14
PATSTAT=option,definition
Options : This is the character string
being compared to the data loaded
in the PATSTAT field. If the option
matches the data then the definition
is applied to the translation of the
data that will be applied to the
database.
Definitions :Description - - - - - - - - - - - - Definition
NOT SURE...............................0
SINGLE.................................1
MARRIED................................2
CONDREL=option,definition
Options : This is the character string
being compared to the data loaded
in the CONDREL field. If the option
matches the data then the definition
is applied to the translation of the
data that will be applied to the
database.
Definitions :Description - - - - - - - - - - - - Definition
EMPLOYMENT.............................0
AUTO...................................1
OTHER..................................2
PROPOS=option,definition
Options : This is the character string
being compared to the data loaded
in the POSPOS field. If the option
matches the data then the definition
is applied to the translation of the
data that will be applied to the
database.
Definitions: Description - - - - - - - - - - - - Definition
Not sure ................................... 0000
Inpatient Hospital ......................... 1001
Outpatient Hospital ........................ 1002
Doctor's Office ............................ 1003
Patient's Home ............................. 1004
Day Care Facility Part Hospital ............ 1005
Nursing Home ............................... 1006
Skilled Nursing Facility ................... 1007
Ambulance Land ............................. 1008
Other Location ............................. 1009
Independent Lab ............................ 1010
Ambulatory Surgical Center ................. 1011
Residential Treatment Center ............... 1012
Specialized Treatment Facility ............. 1013
Comprehensive Outpatient Rehab. Facility ... 1014
Indep. Kidney Disease Treatment Center ..... 1015
Emergency Room Hospital .................... 1016
Birthing Center ............................ 1017
Military Treatment Center .................. 1018
Custodial Care Facility .................... 1019
Hospice .................................... 1020
Ambulance - Air or Water ................... 1021
Inpatient (PSY) Facility ................... 1022
Community Mental Health Center ............. 1023
Psychiatric Residential Treatment Center ... 1024
Comprehensive Inpatient Rehab. Facility .... 1025
PROTOS=option,definition
Options : This is the character string
being compared to the data loaded
in the PROTOS field. If the option
matches the data then the definition
is applied to the translation of the
data that will be applied to the
database.
Definition:Description - - - - - - - - - - - - - - - - Definitio
Not sure........................................101
Medical Care....................................102
Surgical........................................103
Consultation....................................104
Diagnostic X-Ray................................105
Diagnostic Laboratory...........................106
Radiation Therapy...............................107
Anesthesia......................................108
Assistance at Surgery...........................109
Other Medical Services..........................110
Blood on Packed Red Cells.......................111
Used DME........................................112
Ambulatory Surgical Center......................113
Hospice.........................................114
Rented Supplies in the Home.....................115
Alternate Payment for Maintenance Dialysis......116
Kidney Donor....................................117
Pneumococcal Vaccine............................118
Second Opinion or Elective Surgery..............119
Third Opinion or Elective Surgery...............120
XPROVTYPE=option,definition
Options : This is the character string
being compared to the data loaded
in the field. If the option
matches the data then the definition
is applied to the translation of the
data that will be applied to the
database.
Definition:Description - - - - - - - - - - - - - - - - Definitio
Ordering Provider...............................101
Rendering Provider..............................102
Supervising Provider............................103
Surrogate Provider..............................104
Consulting Provider.............................105
Attending Provider..............................106
Other Ordering Provider.........................107
Performing Provider.............................108
Refering Provider...............................109
SCARTYPE=option,definition
TCARTYPE=option,definition
QCARTYPE=option,definition
Options : This is the character string
being compared to the data loaded
in the field. If the option
matches the data then the definition
is applied to the translation of the
data that will be applied to the
database.
Definitions: Description - - - - - - - - - - - - Definition
Standard Private ........................000
Medicare ................................... 101
Medicaid ................................... 102
CHAMPUS................................. 103
CHAMPVA................................. 104
FECA Black Lung....................... 105
Workers Compensation.............. 106
Self Pay ................................... 107
Other Federal Program............... 108
Blue Cross/Blue Shield.............. 109
HMO ................................... 110
Federal Employee Program......... 111
Central Certification.................... 112
Self Admin.................................. 113
Family or Friends......................... 114
Managed Care Non-HMO........... 115
Blue Cross ............................... 116
Title V ................................... 117
Veterans Admin........................... 118
Other....... ................................... 119
SIGNATURE=option,definition
Options : This is the character string
being compared to the data loaded
in the SIGNATURE field. If the option
matches the data then the definition
is applied to the translation of the
data that will be applied to the
database.
Definitions :Description - - - - - - - - - - - - Definition
None ..................................0
Signed HCFA-1500 Form .................1
Signed Box 12 .........................2
Signed Box 13 .........................3
Signed Box 12 and 13 ..................4
Provider Generated ....................5
BENEFIT=option,definition
Options : This is the character string
being compared to the data loaded
in the BENEFIT field. If the option
matches the data then the definition
is applied to the translation of the
data that will be applied to the
database.
Definitions :Description - - - - - - - - - - - - Definition
None ..................................0
Yes Benefit Assigned to Provider ......1
No Benefit Not assigned ...............2
Pay Other .............................3
Section 7NCU Example of C1.NCU (NSF)
[Table of Contents]
***** (c) 2000 Com1 Software, Inc.
***** NSF Version 3.01
*************** A basic conversion of NSF
*********************************************
[config]
carrier=I0000001
sourcefile=i0000001.tcf
recordlength=320
mode=add
defaultrelatedto=illness
[records]
recordset=AA0,1101
recordset=BA0,1201
recordset=CA0,1301
recordset=DA0,1401
recordset=EA0,1501
recordset=FA0,1601
recordset=XA0,9701
recordset=YA0,9801
recordset=ZA0,9901
[fields]
field=AA0,id,1,3,AA0
field=BA0,id,1,3,BA0
field=CA0,id,1,3,CA0
field=CA0,patid,6,17
field=CA0,patlname,23,20
field=CA0,patfname,43,12
field=CA0,patmi,55,1
field=CA0,patdob,59,8
field=CA0,patsex,67,1
field=CA0,pataddr1,69,30
field=CA0,pataddr2,99,30
field=CA0,patcity,129,20
field=CA0,patst,149,2
field=CA0,patzip,151,9
field=CA0,patphone,160,10
field=CA0,patstat,170,1
field=DA0,id,1,3,DA0
field=DA0,carriername,36,33
field=DA0,patrel,155,2
field=DA0,insid,157,25
field=DA0,inslname,182,20
field=DA0,insfname,202,12
field=DA0,inssex,218,1
field=DA0,insdob,219,8
field=EA0,id,1,3,EA0
field=EA0,condrel,23,1,Y
field=EA0,refid,80,15
field=EA0,reflname,120,20
field=EA0,reffname,140,12
field=EA0,refmi,152,1
field=EA0,dx1,179,5
field=EA0,dx2,184,5
field=EA0,dx3,189,5
field=EA0,dx4,194,5
field=FA0,id,1,3,FA0
field=FA0,prodosf,40,8
field=FA0,prodost,49,8
field=FA0,propos,56,2
field=FA0,protos,58,2
field=FA0,procode,60,5
field=FA0,promoda,65,2
field=FA0,promodb,67,2
field=FA0,promodc,69,2
field=FA0,prodxlnk,78,1
field=FA0,proamt,71,7
field=FA0,prounit,82,4
field=FA0,dz,1,1
field=XA0,id,1,3,XA0
field=YA0,id,1,3,YA0
field=ZA0,id,1,3,ZA0
[tables]
patsex=M,1
patsex=F,2
inssex=M,1
inssex=F,2
patrel=01,11
patrel=02,12
patrel=03,13
patrel=04,14
patstat=01,11
patstat=02,12
propos=21,1001
propos=11,1002
propos=22,1003
propos=12,1004
propos=52,1005
propos=32,1006
propos=31,1007
propos=41,1008
propos=99,1009
propos=81,1010
propos=24,1011
propos=55,1012
propos=54,1013
propos=62,1014
propos=65,1015
propos=23,1016
propos=25,1017
propos=26,1018
propos=33,1019
propos=34,1020
propos=42,1021
propos=51,1022
propos=53,1023
propos=61,1024
protos=1,101
protos=2,102
protos=3,103
protos=4,104
protos=5,105
protos=6,106
protos=7,107
protos=8,108
protos=9,109
protos=0,110
protos=A,111
protos=F,112
protos=H,113
protos=L,114
protos=M,115
protos=N,116
protos=V,117
protos=Y,118
protos=Z,119
Section 8BCU Basic Conversion Utility
[Table of Contents]
to import or convert data from a dbf file.
In the F Model products such as the C1A3F297
Command Line Translator, import from ODBC data
sources is supported.
The BCU is a programmable interface. Because it
is programmable, software developers can create
simple and efficient interface files to fit
their own specifications.
Two files are required by the BCU, the C1.BCU file is
a sequential file that is used to store the programmed
configuration of the BCU. You, the user may create or
adapt this file to your specific need using a common
word processor or text editor. The second file used
by the BCU is specified in the C1.BCU file, and is the
file containing the data to be converted.
The basic concept of the BCU is that fields defined within
a DBF or a ODBC data source have a set ordered position
within the definition of fields that make up the databases
structure. If a database has 50 different fields then these
fields can be identified as 1 thru 50. In the [FIELDS]
section of the BCU you will have field definitions that will
have syntax of:
FIELD=pos,PROVNAME,C
or
FIELD=pos,PROVNAME,C,len,parse,ssp,ls
Each field definition is numbered with a POS that
is relative to the field position within the record set.
The use of LEN and PARSE are used when a delimited file
type is being used. LEN is the width of the field, and
PARSE is the parse position of the data within a multi
valued data set.
The use of the SSP (Starting Substring Positions) and LS
(Length of Substring) allows you to substring a portion
of the data for the mapped field.
Database field names used in the database have
no impact BCU process.
The C1.BCU has four sections. These sections are:
Configuration [CONFIG]
Field Record Definition [FIELDS]
Table Field Definition [TABLES]
LEGEND: c=Starting column within specified record.
w=Field width
n=number from 1 to 9
- - - - - - - - - - - - - - - - - - - -
CONFIGURATION SECTION
Syntax : [CONFIG]
Institution Data
Syntax : INSITUTIOMODE=option
Options : ADD
This feature allows you to add an incorperated
institutional practice at the time of conversion.
Activity relative to this function will berecorded
in the command.log.
Provider Mode
Syntax : PROVIDERMODE=option
Options : ERROR (default)
ADD
ID
NAME
ALTID
SYSTEMID
This feature allows you to add a provider at the time of
conversion. Activity relative to this function will be
recorded in the command.log.
Referring Source Control
Syntax : REFSOURCE=ON
NOTE : Default is set to off.
This feature allows you to add and lookup Referring Source
providers in the system database based on the insurance ID/
UPIN of the referring source.
Insurance Carrier
Syntax : CARRIER=system id.
CARRIER=multiple
or
CARRIER=multiple+n
or
CARRIER=altid
Where n is the number 1 to 5. This will set the carrier
level verification. If CARRIER=MULTIPLE+1 is set the
address line 1 must match, set to MULTIPLE+2 the address
line 2 must match as well, and so on through city, state
and zip. Normal multiple will check a match on the name only.
When the CARRIER=ALTID is used, if the CARRIERALTID field is
used and populated, then the carrier is looked up and
associated with the converted data. If it is not in the database
then it will be added. If the CARRIER=ALTID is on and the
CARRIERALTID field is empty, then the carrier will be added
to the database.
This is a required field. If the system ID is used it must
be a valid insurance carrier already within the system.
Syntax: CARRIERMODE=option
Options: ERROR (default)
ADD1500PAPER
ADD1500IMAGE
ADDNSF
ADDX12
The Carriermode feature allows you to set the method used when
the carrier function has been set to multiple. If a carrier is
in the database, that carrier will be used. If the carrier is
not in the database, the carriermode will be used to determine
whether or not to add the carrier to the database and which
output method should be configured for that new carrier. The
command.log will reflect any activity relative to this feature.
Clearing Source
Syntax : CLEARINGSOURCE=system id.
Example : clearingsource=cs000001
The Clearing Source is set when submitting multiple carriers
claims within a single output file or process.
Provider
Syntax : PROVIDER=system id.
Example : PROVIDER=P0000001
The Provider is set to a specific provider in the provider
database.
NOTE: PROVIDERMODE must be set to SYSTEMID
Operation Mode (patient)
Syntax : MODE=option
Options : ADD (default)
ALTID
ID
NAME
SSN
Usage : MODE=ALTID
Conversion File
Syntax : SOURCEFILE=filename.extension
This is the file that the Basic Conversion Utility
will use as a data source for conversion into the system.
This is function is mutally exclusive of the
SOURCEFILEDIRIN function.
Conversion Source Directory
Syntax : SOURCEFILEDERIN=directory
Example : SOURCEFILEDERIN=\testdata
This is used to read in multiple files that the Basic
Conversion Utility will use as a data source for conversion
into the system. This is function is mutally exclusive of the
SOURCEFILE function.
Conversion of ODBC File
Syntax : SOURCEODBCDSN=dsn
Syntax : SOURCETABLE=tablename
This feature is available only in F Model products such as
the C1A3F297.
The SOURCEDSN and the SOURCETABLE within the SOURCEDSN are
the names of the ODBC data source configured on the machine
where the application program is being run.
Conversion File Type
Syntax : SOURCETYPE=option
Options : DBF (default)
ODBC
DELIMITED
XML
The default import data type for the BCU is a DBF.
Record Parse for delimited files.
Syntax : RECORDPARSE=option
Options : OFF (default)
ON
Used in conjunction with delimited source files.
Record Delimiter.
Syntax : RECORDDELIMITER=ascii character value
Example : RECORDDELIMITER=13
Used in conjunction with delimited source files.
Parse Delimiter.
Syntax : PARSEDELIMITER=ascii character value
Example : PARSEDELIMITER=32
Used in conjunction with delimited source files.
Record Field Count.
Syntax : RECORDFIDCOUNT=n
Example : RECORDFIDCOUNT=185
Used in conjunction with delimited source files to
set a blocking factor within a multi claim file.
Provider Name Name Mask.
Syntax : PROVIDERNAMEMASK=option
Example : PROVIDERNAMEMASK=A
Options : A - First Mi Last (space delimited)
This field is used to parse the PROVNAME fields
data into seperate first, last and Middle inital
data fields.
Default Place of Service
Syntax : DEFAULTPOS=nn
This field can be used for all claims converted if desired.
Default Type of Service
Syntax : DEFAULTTOS=n
This field can be used for all claims converted if desired.
Default Related To
Syntax : DEFAULTRELATEDTO=option
Options : ILLNESS
PREGNANCY
Fill Diagnosis Procedure Link
Syntax : DXLINK=option
Options : FILL
Fill Units
Syntax : UNITS=option
Options : FILL
Fill Patient Relationship to Insured
Syntax : PATREL=option
Options : SELF
Debug for BCU
Syntax : DEBUG=option
Options : ON
OFF
Process records break
Syntax : BREAK=n
Example : BREAK=10
This will allow for the import of records up to the break
point.
Process records skip
Syntax : SKIP=n
Example : SKIP=5
This will allow for the import of records to start
after the skiped records.
- - - - - - - - - - - - - - - - - - - -
FIELDS SECTION
The fields section of the configuration is based on defining a field
relative to it's position in the database structure. A field definitio
contains the position of the field, the field description, and the fie
type.
Syntax : [FIELDS]
INSTITUTIONNAME
The Name of the Practice
Type : Character
Example :
field=1,insitutionname,c
INSTITUTIONADDR1
The First Address line of the Practice
Type : Character
Example :
field=2,insitutionaddr1,c
INSTITUTIONADDR2
The Second Address line of the Practice
Type : Character
Example :
field=3,insitutionaddr2,c
INSTITUTIONCITY
The name of the city of the Practice
Type : Character
Example :
field=4,insitutioncity,c
INSTITUTIONSTATE
The name of the state of the Practice
Type : Character
Example :
field=1,insitutionstate,c
INSTITUTIONZIP
The zip code of the Practice
Type : Character
Example :
field=1,insitutionzip,c
INSTITUTIONPHONE
The phone number of the Practice
Type : Character
Example :
field=1,insitutionphone,c
INSTITUTIONTAXID
The federal tax id of the Practice
Type : Character
Example :
field=1,insitutiontaxid,c
INSTITUTIONTAXONOMYCODE
The taxonomy code of the Practice
Type : Character
Example :
field=1,insitutiontaxonomycode,c
INSTITUTIONNPI
NPI
Type : Character
Example :
field=1,insitutiontaxid,c
INSTITUTIONIDQUALIFIER
Institution ID Qualifier
Type : Character
Example :
field=1,insitutionidqualifier,c
SUBMITTERIDQUALIFIER
The submitters ID Qualifier
Type : Character
Example :
field=10,submitteridqulifier,c
SUBMITTERNUMBER
The submitters submitter number
Type : Character
Example :
field=10,submitternumber,c
SUBMITTERNAME
The name of the submitter.
Type : Character
Example :
field=10,submittername,c
SUBMITTERADDR1
The first address line of the submitter.
Type : Character
Example :
field=10,submitteraddr1,c
SUBMITTERADDR2
The second address line of the submitter.
Type : Character
Example :
field=10,submitteraddr2,c
SUBMITTERCITY
The city of the submitter.
Type : Character
Example :
field=10,submittercity,c
SUBMITTERSTATE
The state of the submitter.
Type : Character
Example :
field=10,submitterstate,c
SUBMITTERZIP
The zip code of the submitter.
Type : Character
Example :
field=10,submitterzip,c
SUBMITTERPHONE
The phone number of the submitter.
Type : Character
Example :
field=10,submitterphone,c
SUBMITTERCONTACT
The contact person of the submitter.
Type : Character
Example :
field=10,submittercontact,c
PROVIDQUALIFIER
Provider ID Qualifier
Type : Character
Example :
field=1,provideridqualifier,c
PROVNAME
Provider Name
Type : Character
Example :
field=1,provname,c
PROVFNAME
Provider First Name
Type : Character
Example :
field=1,provfname,c
PROVLNAME
Provider Last Name
Type : Character
Example:
field=2,provlname,c
PROVMI
Provider Middle Initial
Type : Character
Example:
field=2,provmi,c
PROVNPI
Provider NPI
Type : Character
Example:
field=2,provssn,c
PROVSSN
Provider Social Security Number
Type : Character
Example:
field=2,provssn,c
PROVTAXID
Provider tax ID
Type : Character
Example:
field=2,provtaxid,c
PROVTAXONOMYCODE
Provider Taxonomy Code
Type : Character
Example:
field=2,provtaxonomycode,c
PROVALTID
Provider Alternate ID
Type : Character
Example:
field=2,provaltid,c
PROVID
Provider Insurance ID
Type : Character
Example:
field=2,provid,c
PROVPOS
Provider Place of Service Code
Type : Character
Example:
field=2,provpos,c
CARRIERNAME
Carrier Name
Type : Character
Example :
field=3,carriername,c
CARRIERADDR1
Carrier First Addess Line
Type : Character
Example :
field=3,carrieraddr1,c
CARRIERADDR2
Carrier Second Addess Line
Type : Character
Example :
field=3,carrieraddr2,c
CARRIERCITY
Carrier City
Type : Character
Example :
field=3,carriercity,c
CARRIERST
Carrier State
Type : Character
Example :
field=3,carrierst,c
CARRIERZIP
Carrier Zip Code
Type : Character
Example :
field=3,carrierzip,c
CARRIERCSZ
Carrier City State and Zip code.
Type : Character
Example :
field=3,carriercsz,c
CARRIERASSIGN
Carrier Accept Assignment Indicator
Type : Character
Example :
field=3,carrierassign,c
CARRIERTYPE
Carrier Type
Type : Character
Example :
field=3,carriertype,c
RECEIVERID
The receiver ID of the Insurance Carrier.
Type : Character
Example :
field=10,receiverid,c
CARRIERID
Carrier ID Number
Type : Character
Example :
field=3,carrierid,c
CARRIERALTID
Carrier Alternate ID
Type : Character
Example :
field=3,carrieraltid,c
PATID
Patient Id
Type : Character
Example :
field=4,patid,c
PATFNAME
Patient First Name
Type : Character
Example :
field=5,patfname,c
PATLNAME
Patient Last Name
Type : Character
Example :
field=6,patlname,c
PATMI
Patient Middle Initial
Type : Character
Example :
field=7,patmi,c
PATADDR1
Patient First Address Line
Type : Character
Example :
field=8,pataddr1,c
PATADDR2
Patient Second Address Line
Type : Character
Example :
field=9,pataddr2,c
PATCITY
Patient City
Type : Character
Example :
field=10,patcity,c
PATST
Patient State
Type : Character
Example :
field=11,patst,c
PATZIP
Patient Zip Code
Type : Character
Example :
field=12,patzip,c
PATPHONE
Patient Phone Number
Type : Character
Example :
field=13,patphone,c
PATDOB
Patient Date of Birth
Type : Character
Example :
field=14,patdob,d
PATDOBCCYY-MM-DD
Patient Date of Birth Formated
Type : Character
Example :
field=14,patdobccyy-mm-dd,d
PATSEX
Patient Sex
Type : Character
Example :
field=15,patsex,c
PATREL
Patient Relationship to Insured
Type : Character
Example :
field=16,patrel,c
PATSTAT
Patient Status
Type : Character
Example :
field=17,patstat,c
CONDREL
Patient Condition Related to
Type : Character
Example :
field=18,condrel,c
INSID
Insured's ID
Type : Character
Example :
field=19,insid,c
INSLNAME
Insured's Last Name
Type : Character
Example :
field=20,inslname,c
INSFNAME
Insured's First Name
Type : Character
Example :
field=21,insfname,c
INSADDR1
Insured's First Address Line
Type : Character
Example :
field=22,insaddr1,c
INSADDR2
Insured's Second Address Line
Type : Character
Example :
field=23,insaddr2,c
INSCITY
Insured's City
Type : Character
Example :
field=24,inscity,c
INSST
Insured's State
Type : Character
Example :
field=25,insst,c
INSZIP
Insured's Zip Code
Type : Character
Example :
field=26,inszip,c
INSPHONE
Insured's Phone Number
Type : Character
Example :
field=27,insphone,c
INSGPN
Insured's Group Number
Type : Character
Example :
field=28,insgpn,c
PLANNAME
Insured's Plan Name
Type : Character
Example :
field=28,planname,c
INSDOB
Insured's Date of Birth
Type : Character
Example :
field=29,insdob,d
INSDOBCCYY-MM-DD
Insured's Date of Birth Formated
Type : Character
Example :
field=29,insdobccyy-mm-dd,d
INSSEX
Insured's Sex
Type : Character
Example :
field=30,inssex,c
SPATREL
Secondary Patient Relationship to Insured
Type : Character
Example :
field=16,spatrel,c
SINSID
Secondary Insured's ID
Type : Character
Example :
field=19,sinsid,c
SINSLNAME
Secondary Insured's Last Name
Type : Character
Example :
field=20,sinslname,c
SINSFNAME
Secondary Insured's First Name
Type : Character
Example :
field=21,sinsfname,c
SINSADDR1
Secondary Insured's First Address Line
Type : Character
Example :
field=22,sinsaddr1,c
SINSADDR2
Secondary Insured's Second Address Line
Type : Character
Example :
field=23,sinsaddr2,c
SINSCITY
Secondary Insured's City
Type : Character
Example :
field=24,sinscity,c
SINSST
Secondary Insured's State
Type : Character
Example :
field=25,sinsst,c
SINSZIP
Secondary Insured's Zip Code
Type : Character
Example :
field=26,sinszip,c
SINSPHONE
Secondary Insured's Phone Number
Type : Character
Example :
field=27,sinsphone,c
SINSGPN
Secondary Insured's Group Number
Type : Character
Example :
field=28,sinsgpn,c
SINSDOB
Secondary Insured's Date of Birth
Type : Character
Example :
field=29,sinsdob,d
SINSSEX
Secondary Insured's Sex
Type : Character
Example :
field=30,sinssex,c
SINSSSN
Secondary Insured's Social Security Number
Type : Character
Example :
field=29,sinsssn,d
SINSALTID
Secondary Insured's Alternate ID Number
Type : Character
Example :
field=30,sinsaltid,c
SCARRIERNAME
Secondary Carrier Name
Type : Character
Example :
field=3,scarriername,c
SCARRIERADDR1
Secondary Carrier First Addess Line
Type : Character
Example :
field=3,scarrieraddr1,c
SCARRIERADDR2
Secondary Carrier Second Addess Line
Type : Character
Example :
field=3,scarrieraddr2,c
SCARRIERCITY
Secondary Carrier City
Type : Character
Example :
field=3,scarriercity,c
SCARRIERST
Secondary Carrier State
Type : Character
Example :
field=3,scarrierst,c
SCARRIERZIP
Secondary Carrier Zip Code
Type : Character
Example :
field=3,scarrierzip,c
SCARRIERTYPE
Secondary Carrier Type
Type : Character
Example :
field=3,scarriertype,c
TPATREL
Tertiary Patient Relationship to Insured
Type : Character
Example :
field=16,tpatrel,c
TINSID
Tertiary Insured's ID
Type : Character
Example :
field=19,tinsid,c
TINSLNAME
Tertiary Insured's Last Name
Type : Character
Example :
field=20,tinslname,c
TINSFNAME
Tertiary Insured's First Name
Type : Character
Example :
field=21,tinsfname,c
TINSADDR1
Tertiary Insured's First Address Line
Type : Character
Example :
field=22,tinsaddr1,c
TINSADDR2
Tertiary Insured's Second Address Line
Type : Character
Example :
field=23,tinsaddr2,c
TINSCITY
Tertiary Insured's City
Type : Character
Example :
field=24,tinscity,c
TINSST
Tertiary Insured's State
Type : Character
Example :
field=25,tinsst,c
TINSZIP
Tertiary Insured's Zip Code
Type : Character
Example :
field=26,tinszip,c
TINSPHONE
Tertiary Insured's Phone Number
Type : Character
Example :
field=27,tinsphone,c
TINSGPN
Tertiary Insured's Group Number
Type : Character
Example :
field=28,tinsgpn,c
TINSDOB
Tertiary Insured's Date of Birth
Type : Character
Example :
field=29,tinsdob,d
TINSSEX
Tertiary Insured's Sex
Type : Character
Example :
field=30,tinssex,c
TINSSSN
Tertiary Insured's Social Security Number
Type : Character
Example :
field=29,tinsssn,d
TINSALTID
Tertiary Insured's Alternate ID Number
Type : Character
Example :
field=30,tinsaltid,c
TCARRIERNAME
Tertiary Carrier Name
Type : Character
Example :
field=3,tcarriername,c
TCARRIERADDR1
Tertiary Carrier First Addess Line
Type : Character
Example :
field=3,tcarrieraddr1,c
TCARRIERADDR2
Tertiary Carrier Second Addess Line
Type : Character
Example :
field=3,tcarrieraddr2,c
TCARRIERCITY
Tertiary Carrier City
Type : Character
Example :
field=3,tcarriercity,c
TCARRIERST
Tertiary Carrier State
Type : Character
Example :
field=3,tcarrierst,c
TCARRIERZIP
Tertiary Carrier Zip Code
Type : Character
Example :
field=3,tcarrierzip,c
TCARRIERTYPE
Tertiary Carrier Type
Type : Character
Example :
field=3,tcarriertype,c
QPATREL
Quadinary Patient Relationship to Insured
Type : Character
Example :
field=16,qpatrel,c
QINSID
Quadinary Insured's ID
Type : Character
Example :
field=19,qinsid,c
QINSLNAME
Quadinary Insured's Last Name
Type : Character
Example :
field=20,qinslname,c
QINSFNAME
Quadinary Insured's First Name
Type : Character
Example :
field=21,qinsfname,c
QINSADDR1
Quadinary Insured's First Address Line
Type : Character
Example :
field=22,qinsaddr1,c
QINSADDR2
Quadinary Insured's Second Address Line
Type : Character
Example :
field=23,qinsaddr2,c
QINSCITY
Quadinary Insured's City
Type : Character
Example :
field=24,qinscity,c
QINSST
Quadinary Insured's State
Type : Character
Example :
field=25,qinsst,c
QINSZIP
Quadinary Insured's Zip Code
Type : Character
Example :
field=26,qinszip,c
QINSPHONE
Quadinary Insured's Phone Number
Type : Character
Example :
field=27,qinsphone,c
QINSGPN
Quadinary Insured's Group Number
Type : Character
Example :
field=28,qinsgpn,c
QINSDOB
Quadinary Insured's Date of Birth
Type : Character
Example :
field=29,qinsdob,d
QINSSEX
Quadinary Insured's Sex
Type : Character
Example :
field=30,qinssex,c
QINSSSN
Quadinary Insured's Social Security Number
Type : Character
Example :
field=29,qinsssn,d
QINSALTID
Quadinary Insured's Alternate ID Number
Type : Character
Example :
field=30,qinsaltid,c
QCARRIERNAME
Quadinary Carrier Name
Type : Character
Example :
field=3,qcarriername,c
QCARRIERADDR1
Quadinary Carrier First Addess Line
Type : Character
Example :
field=3,qcarrieraddr1,c
QCARRIERADDR2
Quadinary Carrier Second Addess Line
Type : Character
Example :
field=3,qcarrieraddr2,c
QCARRIERCITY
Quadinary Carrier City
Type : Character
Example :
field=3,qcarriercity,c
QCARRIERST
Quadinary Carrier State
Type : Character
Example :
field=3,qcarrierst,c
QCARRIERZIP
Quadinary Carrier Zip Code
Type : Character
Example :
field=3,qcarrierzip,c
QCARRIERTYPE
Quadinary Carrier Type
Type : Character
Example :
field=3,qcarriertype,c
REFNAME
Refering Source Name
Type : Character
Example :
field=32,refname,c
REFFNAME
Refering Source First Name
Type : Character
Example :
field=32,reffname,c
REFLNAME
Refering Source Last Name
Type : Character
Example :
field=33,reflname,c
REFID
Refering Source Insurance ID
Type : Character
Example :
field=34,refid,c
REFALTID
Refering Source Alternate ID
Type : Character
Example :
field=32,refaltid,c
REFNPI
Refering Source NPI
Type : Character
Example :
field=32,refaltid,c
RENNAME
Renering Source Name
Type : Character
Example :
field=32,RENname,c
RENFNAME
Renering Source First Name
Type : Character
Example :
field=32,RENfname,c
RENLNAME
Renering Source Last Name
Type : Character
Example :
field=33,RENlname,c
RENID
Renering Source Insurance ID
Type : Character
Example :
field=34,RENid,c
RENALTID
RENering Source Alternate ID
Type : Character
Example :
field=32,RENaltid,c
RENNPI
Renering Source NPI
Type : Character
Example :
field=32,RENaltid,c
DX1
Primary Diagnosis Code
Type : Character
Example :
field=35,dx1,c
DX2
Second Diagnosis Code
Type : Character
Example :
field=36,dx2,c
DX3
Third Diagnosis Code
Type : Character
Example :
field=37,dx3,c
DX4
Fourth Diagnosis Code
Type : Character
Example :
field=38,dx4,c
DIAGNOSISDATE
Date of the original diagnosis or the date
of the onset of Illness
Type : Character
Example :
field=38,diagnosisdate,c
DATELASTSEEN
The date that the patient was last seen.
Type : Character
Example :
field=38,datelastseen,c
ADMITTINGDATE
The date that the patient was admitted to the facility.
Type : Character
Example :
field=38,admittingdate,c
DISCHARGEDATE
The date that the patient was discharged from the facility.
Type : Character
Example :
field=38,dischargedate,c
ADMISSIONTYPE
Admission Type.
Type : Character
Example :
field=38,admissiontype,c
ADMISSIONSOURCE
Admission Source
Type : Character
Example :
field=38,admissionsource,c
STATEMENTDATE
Statemant Date.
Type : Character
Example :
field=38,statementdate,c
MEDICALRECORDNUMBER
Medical Record Number.
Type : Character
Example :
field=38,medicalrecordnumber,c
PRINCIPLEDX
Principle Diagnosis
Type : Character
Example :
field=38,principledx,c
ADMITDX
Admitting Diagnosis.
Type : Character
Example :
field=38,admitdx,c
PRINCIPLEPROCDATE
Principle Procedure Date.
Type : Character
Example :
field=38,principleprocdate,c
PRINCIPLEPROC
Principle Procedure
Type : Character
Example :
field=38,principleproc,c
ATTENDLNAME
Attending Provider Last Name.
Type : Character
Example :
field=38,attendlname,c
ATTENDFNAME
Attending Provider First Name.
Type : Character
Example :
field=38,attendfname,c
ATTENDIDTYPE
Attending Provider ID Type.
Type : Character
Example :
field=38,attendidtype,c
ATTENDID
Attending Provider
Type : Character
Example :
field=38,attendid,c
OPERATELNAME
Operating Provider Last Name.
Type : Character
Example :
field=38,operatelname,c
OPERATEFNAME
Operating Provider First Name.
Type : Character
Example :
field=38,operatefname,c
OPERATEIDTYPE
Operating Provider ID Type.
Type : Character
Example :
field=38,operateidtype,c
OPERATEID
Operating Provider ID.
Type : Character
Example :
field=38,operateid,c
PROPERYCASUALTYCLAIMNUMBER
Property Casuality Claim Number
Type : Character
Example :
field=38,propertycasultyclaimnumber,c
XDOC
Documentation Narative Note.
Type : Character
Example :
field=38,xdoc,c
REQCAT
Utilization Review Request Category.
Type : Character
Example :
field=38,REQCAT,c
CERTTYPE
Utilization Review Request Type.
Type : Character
Example :
field=38,certtype,c
TRACENUM
Tracer Number.
Type : Character
Example :
field=38,TRACENUM,c
SOURCETYPE
Source Type of Review Request
Type : Character
Example :
field=38,SOURCETYPE,c
LOSERV
Level of Service
Type : Character
Example :
field=38,LOSERV,c
FACNAME
Facility Name
Type : Character
Example :
field=32,facname,c
FACADDR1
Facility First Address Line
Type : Character
Example :
field=32,facaddr1,c
FACADDR2
Facility Second Address Line
Type : Character
Example :
field=32,facaddr2,c
FACCITY
Facility City
Type : Character
Example :
field=32,faccity,c
FACST
Facility State
Type : Character
Example :
field=32,facst,c
FACZIP
Facility Zip Code
Type : Character
Example :
field=32,faczip,c
FACALTID
Facility Alternate ID
Type : Character
Example :
field=32,facaltid,c
FACPOS
Facility Place of Service Code
Type : Character
Example :
field=32,facpos,c
FACCODEQUAL
Facility Place of Service Code Qualifier
Type : Character
Example :
field=32,faccodequal,c
COBPAYERPAIDAMT
COB Payer Paid Amount
Type : Character
Example :
field=32,cobpayerpaidamt,c
COBAPPROVEREDAMT
COB Approved Amount
Type : Character
Example :
field=32,cobapprovedamt,c
COBALLOWEDDAMT
COB Allowed Amount
Type : Character
Example :
field=32,coballowedamt,c
COBPATRESPONSIBILITY
COB Patient Responsibility
Type : Character
Example :
field=32,cobpatresponsibility,c
----------------- Procedure Line Fields ---------
Procedure lines are defined with n being any
line number between 1 and 99. Configurations
must be built in consecutive order starting
with 1.
PRODOSFn
Procedure Line From Date of Service
Type : Character
Example :
field=39,prodosf1,d
PRODOSTn
Procedure Line To Date of Service
Type : Character
Example :
field=40,prodost1,d
PRODOSFCCYY-MM-DDn
Procedure Line From Date of Service Formated
Type : Character
Example :
field=39,prodosfccyy-mm-dd1,d
PRODOSTCCYY-MM-DDn
Procedure Line To Date of Service Formated
Type : Character
Example :
field=40,prodostccyy-mm-dd1,d
PROPOSn
Procedure Line Place of Service
Type : Character
Example :
field=41,propos1,c
PROTOSn
Procedure Line Type of Service
Type : Character
Example :
field=42,protos1,c
REVCODEn
Revenue Code
Type : Character
Example :
field=43,revcode1,c
PROCODEn
Procedure Line Procedure Code
Type : Character
Example :
field=43,procode1,c
PROMODAn
Procedure Line Modifier 1
Type : Character
Example :
field=44,promoda1,c
PROMODBn
Procedure Line Modifier 2
Type : Character
Example :
field=45,promodb1,c
PROMODCn
Procedure Line Modifier 3
Type : Character
Example :
field=46,promodc1,c
PRODXLNKn
Procedure Line Diagnosis Link
Type : Character
Example :
field=47,prodxlnk1,n
PROAMTn
Procedure Line Amount
Type : Character
Example :
field=48,proamt1,n
PROUNITn
Procedure Line Units
Type : Character
Example :
field=49,prounit1,n
APPROVEDAMOUNTn
Approved amount
Type : Character
Example :
field=32,approvedamount1,c
PRORENNPI
Procedure Line Rendering Provider ID
Type : Character
Example :
field=49,prorennpi1,n
- - - - - - - - - - - - - - - - - - - -
TABLES SECTION
Syntax : [TABLES]
Table Field Definitions
PATSEX=option,definition
Options : This is the character string
being compared to the data loaded
in the PATSEX field. If the option
matches the data then the definition
is applied to the translation of the
data that will be applied to the
database.
Definitions : Description - - - - - - - - - - - - Definition
NOT SURE.................................0
MALE.....................................1
FEMALE...................................2
INSSEX=option,definition
Options : This is the character string
being compared to the data loaded
in the INSSEX field. If the option
matches the data then the definition
is applied to the translation of the
data that will be applied to the
database.
Definitions : Description - - - - - - - - - - - - Definition
NOT SURE.................................0
MALE.....................................1
FEMALE...................................2
PATREL=option,definition
Options : This is the character string
being compared to the data loaded
in the PATREL field. If the option
matches the data then the definition
is applied to the translation of the
data that will be applied to the
database.
Definitions :Description - - - - - - - - - - - - Definition
NOT SURE................................00
SELF....................................11
SPOUSE..................................12
CHILD...................................13
GUARDIAN................................14
PATSTAT=option,definition
Options : This is the character string
being compared to the data loaded
in the PATSTAT field. If the option
matches the data then the definition
is applied to the translation of the
data that will be applied to the
database.
Definitions :Description - - - - - - - - - - - - Definition
NOT SURE...............................0
SINGLE.................................1
MARRIED................................2
CONDREL=option,definition
Options : This is the character string
being compared to the data loaded
in the CONDREL field. If the option
matches the data then the definition
is applied to the translation of the
data that will be applied to the
database.
Definitions :Description - - - - - - - - - - - - Definition
EMPLOYMENT.............................0
AUTO...................................1
OTHER..................................2
PROPOS=option,definition
Options : This is the character string
being compared to the data loaded
in the POSPOS field. If the option
matches the data then the definition
is applied to the translation of the
data that will be applied to the
database.
Definitions: Description - - - - - - - - - - - - Definition
Not sure ................................... 0000
Inpatient Hospital ......................... 1001
Outpatient Hospital ........................ 1002
Doctor's Office ............................ 1003
Patient's Home ............................. 1004
Day Care Facility Part Hospital ............ 1005
Nursing Home ............................... 1006
Skilled Nursing Facility ................... 1007
Ambulance Land ............................. 1008
Other Location ............................. 1009
Independent Lab ............................ 1010
Ambulatory Surgical Center ................. 1011
Residential Treatment Center ............... 1012
Specialized Treatment Facility ............. 1013
Comprehensive Outpatient Rehab. Facility ... 1014
Indep. Kidney Disease Treatment Center ..... 1015
Emergency Room Hospital .................... 1016
Birthing Center ............................ 1017
Military Treatment Center .................. 1018
Custodial Care Facility .................... 1019
Hospice .................................... 1020
Ambulance - Air or Water ................... 1021
Inpatient (PSY) Facility ................... 1022
Community Mental Health Center ............. 1023
Psychiatric Residential Treatment Center ... 1024
Comprehensive Inpatient Rehab. Facility .... 1025
PROTOS=option,definition
Options : This is the character string
being compared to the data loaded
in the PROTOS field. If the option
matches the data then the definition
is applied to the translation of the
data that will be applied to the
database.
Definition:Description - - - - - - - - - - - - - - - - Definitio
Not sure........................................101
Medical Care....................................102
Surgical........................................103
Consultation....................................104
Diagnostic X-Ray................................105
Diagnostic Laboratory...........................106
Radiation Therapy...............................107
Anesthesia......................................108
Assistance at Surgery...........................109
Other Medical Services..........................110
Blood on Packed Red Cells.......................111
Used DME........................................112
Ambulatory Surgical Center......................113
Hospice.........................................114
Rented Supplies in the Home.....................115
Alternate Payment for Maintenance Dialysis......116
Kidney Donor....................................117
Pneumococcal Vaccine............................118
Second Opinion or Elective Surgery..............119
Third Opinion or Elective Surgery...............120
CARRIERTYPE=option,definition
Options : This is the character string
being compared to the data loaded
in the CARRIERTYPE field. If the option
matches the data then the definition
is applied to the translation of the
data that will be applied to the
database.
Definition:Description - - - - - - - - - - - - - - - - Definitio
Standard Private................................101
Medicare........................................102
Medicaid........................................103
CHAMPUS.........................................104
CHAMPVA.........................................105
FECA Black Lung.................................106
Workers Compensation............................107
Self Pay........................................108
Other Federal Program...........................109
Blue Cross/Blue Shield..........................110
HMO.............................................111
Federal Employee's Program......................112
Central Certification...........................113
Self Administered...............................114
Family or Friends...............................115
Managed Care - Non-HMO..........................116
Blue Cross......................................117
Title V.........................................118
Veteran Administration Plan.....................119
Other...........................................120
REQCAT=option,definition
Options : This is the character string
being compared to the data loaded
in the REQCAT field. If the option
matches the data then the definition
is applied to the translation of the
data that will be applied to the
database.
Definitions : Description - - - - - - - - - - - - Definition
NOT SURE.................................0
Admission Review ........................1
Health Services Review...................2
Specialty Care Review....................3
CERTTYPE=option,definition
Options : This is the character string
being compared to the data loaded
in the CERTTYPE field. If the option
matches the data then the definition
is applied to the translation of the
data that will be applied to the
database.
Definitions : Description - - - - - - - - - - - - Definition
NOT SURE.................................0
Appeal - Immediate ......................1
Appeal - Standard........................2
Cancel...................................3
Extension................................4
Initial..................................5
Renewal..................................6
Revised..................................7
Example of a tables section:
[TABLES]
patsex=M,1
patsex=F,2
inssex=M,1
inssex=F,2
patstat=01,11
patstat=02,12
propos=21,1001
propos=11,1002
propos=22,1003
propos=12,1004
propos=52,1005
propos=32,1006
propos=31,1007
propos=41,1008
propos=99,1009
propos=81,1010
propos=24,1011
propos=55,1012
propos=54,1013
propos=62,1014
propos=65,1015
propos=23,1016
propos=25,1017
propos=26,1018
propos=33,1019
propos=34,1020
propos=42,1021
propos=51,1022
propos=53,1023
propos=61,1024
protos=01,101
protos=02,102
protos=03,103
protos=04,104
protos=05,105
protos=06,106
protos=07,107
protos=08,108
protos=09,109
protos=10,110
carriertype=MEDICARE,102
carriertype=MEDICAID,103
Section 9ACU ANSII X12 Conversion Utility
[Table of Contents]
The ANSII X12 837 Conversion Utility or ACU allows you
to import or convert data from an electronic media
claim file.
The ACU is a programmable interface.
Because it is programmable, software developers
can create simple and efficient interface files to fit
their own specifications.
Two files are required by the ACU, the C1.ACU file is
a sequential file that is used to store the programed
configuration of the ACU. You the user may create or
adapt this file to your specific need using a common
word processor or text editor. The second file used
by the ACU is specified in the C1.ACU file, and is the
file containing the data to be converted.
The C1.ACU has four sections. These sections are:
Configuration [CONFIG]
Segment Definition [SEGMENTS]
Field Element Definition [ELEMENTS]
Table Field Definition [TABLES]
LEGEND:
n=number from 1 to 9
- - - - - - - - - - - - - - - - - - - -
CONFIGURATION SECTION
Syntax : [CONFIG]
Conversion Type
Syntax : CONVERSIONTYPE=option
Options : Standard
Parser
This feature lets you map your X12 using the
standard option or let the system map for you
automatically using the parser option.
Segment Separator
Syntax : SEGMENTSEPARATOR=0
Data Element Separator
Syntax : DATAELEMENTSEPARATOR=0
Operation Mode
Syntax : MODE=option
Options : ADD (default)
ALTID
ID
NAME
SSN
Usage : MODE=ALTID
Referring Source Control
Syntax : REFSOURCE=ON
NOTE : Default is set to off.
This feature allows you to add and lookup Referring Source
providers in the system database based on the insurance ID/
UPIN of the referring source.
Provider Data
Syntax : PROVIDERMODE=option
Options : ERROR (default)
ADD
ADD+
DEFAULT
This feature allows you to add a provider at the time of
conversion. Activity relative to this function will be
recorded in the command.log.
Insurance Carrier
Syntax : CARRIER=system id.
CARRIER=payorid
CARRIER=multiple
or
CARRIER=multiple+n
Multiple uses the carriers name as the lookup for the carrier.
Where n is the number 1 to 5. This will set the carrier
level verification. If CARRIER=MULTIPLE+1 is set the
address line 1 must match, set to MULTIPLE+2 the address
line 2 must match as well, and so on through city, state
and zip. Normal multiple will check a match on the name only.
This is a required field. If the system ID is used it must
be a valid insurance carrier already within the system.
Payorid uses the payorid as the lookup for the carrier.
Syntax: CARRIERMODE=option
Options: ERROR (default)
ADD1500PAPER
ADD1500IMAGE
ADDNSF
ADDX12
The Carriermode feature allows you to set the method used when
the carrier function has been set to multiple. If a carrier is
in the database, that carrier will be used. If the carrier is
not in the database, the carriermode will be used to determine
whether or not to add the carrier to the database and which
output method should be configured for that new carrier. The
command.log will reflect any activity relative to this feature.
Conversion File
Syntax : FILE=filename.extension
This is a required field. This is the file that the Nested
Conversion Utility will use as a data source for conversion
into the system. The conversion file must be a sequential
file with a maximum line length of eighty columns.
Conversion Record Length
Syntax : RECORDLEN=n
This is a required field. This is the number of bytes per
record. All field coordinates for R must not exceed the
frame length.
Default Place of Service
Syntax : DEFAULTPOS=nn
This field can be used for all claims converted if desired.
Default Type of Service
Syntax : DEFAULTTOS=n
This field can be used for all claims converted if desired.
Default Related To
Syntax : DEFAULTRELATEDTO=option
Options : ILLNESS
PREGNANCY
Debug for ACU
Syntax : DEBUG=option
Options : ON
OFF
Patient Relationship to Insured
Syntax : PATREL=option
Options : ADD - Will add Guarntor
ID - Will locate by Insurance ID
NAME - Will locate by Lastname, Firstname, Mi
- - - - - - - - - - - - - - - - - - - -
SEGMENT SECTION
Syntax : [SEGMENTS]
SEGMENT Definition
Syntax : SEGMENTSET=id,segclass
ID : Is the character string associated
with this SEGMENT. It is also defined
in the Field SEGMENT Definition.
SEGCLASS : 1101 - File Header Class
1201 - Batch Header Class
1301 - Patient SEGMENT Class
1401 - Coverage SEGMENT Class
1501 - Claim SEGMENT Class
1601 - Claim Detail Reord Class
1701 - Certification SEGMENT Class
1801 - Documentation SEGMENT Class
9701 - Claim Trailer SEGMENT Class
9801 - Batch Trailer SEGMENT Class
9901 - File Trailer SEGMENT Class
- - - - - - - - - - - - - - - - - - - -
ELEMENTS SECTION
Syntax : [ELEMENTS]
ELEMENT Definition
Syntax :
ELEMENT=segclass,id,field_pos,field_data,qual_pos,qual_value,mvfpos,mv
os,mvqpos,mvqval,pseg,pqp,pqv
SEGCLASS : ID used to define class in the Segment Class Se
tion.
ID : Is the X12 Segment Name
FIELD_POS : The data element position to be defined.
FIELD_DATA : The Com1 Software database field varaible to be
assiged
with this element.
QUAL_POS : A qualifying data element position (optional) I
used QUAL_VALUE
must be used.
QUAL_VALUE : The qualifying value that must appear in the QU
L_POS of the
segment. (optional) If used QUAL_POS must be us
d.
MVFPOS : The Multi Value Field Position is used if the D
TA_FIELD is
multi valued. If used is usually the same value
as the FIELD_POS.
MVPOS : The Multi Value Position is the position within
the multi valued
field to be returned to the FIELD_DATA field va
iable.
MVQPOS : The Multi Value Qualifying Position is the posi
ion within the
multi valued field to qualify.
MVQVAL : The Multi Value Qualifying Value is the qualify
ng value that
must appear in the MVQPOS of the multi valued
lement.
(optional) If used MVQPOS must be used.
PSEG : Parent Segment.
PQP : Parent Qualifying Position.
PQV : Parent Qualifying Value.
EXAMPLES:
element=LOOP2100,N4,2,patcity,,,,,,,NM1,2,QC
element=LOOP2100,NM1,4,carriername,2,PR
element=LOOP2300,CLM,1,id
element=LOOP2300,CLM,6,propos,,,6,1
element=LOOP2300,HI,2,dx1,,,2,2,1,BK
Primary Place of Service
Syntax : ELEMENT=segset,id,,PRIMARYPOS
This field is the same as PROPOS1=.
Primary Type of Service
Syntax : PRIMARYTOS=c,w
This field is the same as PROTOS1=.
Provider Last Name
FIELD_DATA variable Name : PROVLNAME:
Provider First Name
FIELD_DATA variable Name : PROVFNAME
Provider Middle Initial
Syntax : PROVMI=c,w
PAYORID
Syntax : PAYORID=c,w
Carrier Name
Syntax : CARRIERNAME=c,w
Carrier Address Line 1
Syntax : CARRIERADDR1=c,w
Carrier Address Line 2
Syntax : CARRIERADDR2=c,w
Carrier City
Syntax : CARRIERCITY=c,w
Carrier State
Syntax : CARRIERST=c,w
Carrier Zip Code
Syntax : CARRIERZIP=c,w
Patient System ID
Syntax : PATSYSID=c,w
Patient Alternate ID
Syntax : PATALTID=c,w
Patient Social Security Number
Syntax : PATSSN=c,w
Patient First Name
Syntax : PATFNAME=c,w
Patient Last Name
Syntax : PATLNAME=,c,w
Patient Middle Initial
Syntax : PATMI=c,w
Patient Address Line 1
Syntax : PATADDR1=c,w
Patient City
Syntax : PATCITY=c,w
Patient State
Syntax : PATST=c,w
Patient Zip Code
Syntax : PATZIP=c,w
Patient Home Phone Number
Syntax : PATPHONE=c,w
Note : All non numeric data will be removed.
Patient Date of Birth
Syntax : PATDOB=c,w
Patient Gender
Syntax : PATSEX=c,w
Patient Relation to Insured
Syntax : PATREL=c,w
Patient Status
Syntax : PATSTAT=c,w
Condition Related To
Syntax : CONDREL=c,w
Insured's I.D. Number
Syntax : INSID=c,w
Insured's First Name
Syntax : INSFNAME=c,w
Insured's Last Name
Syntax : INSLNAME=c,w
Insured's Address Line 1
Syntax : INSADDR1=c,w
Insured's City
Syntax : INSCITY=c,w
Insured's State
Syntax : INSST=c,w
Insured's Zip Code
Syntax : INSZIP=c,w
Insured's Home Phone Number
Syntax : INSPHONE=c,w
Insured's Group Number
Syntax : INSGPN=c,w
Insured's Date of Birth
Syntax : INSDOB=c,w
Insured's Sex
Syntax : INSSEX=r,c
Insurance Plan or Program Name
Syntax : PLANNAME=c,w
Diagnosis Date
Syntax : DXDT=c,w
Referring Provider Name
Syntax : REFNAME=c,w
Referring Provider ID
Syntax : REFID=c,w
Additional or Supporting Documentation
Syntax : XDOC=c,w
Primary Diagnosis
Syntax : DX1=c,w
Second Diagnosis
Syntax : DX2=c,w
Third Diagnosis
Syntax : DX3=c,w
Fourth Diagnosis
Syntax : DX4=c,w
Procedure Date of Service From
Syntax : PRODOSF=c,w
Procedure Date of Service To
Syntax : PRODOST=c,w
Procedure Place of Service
Syntax : PROPOS=c,w
Procedure Type of Service
Syntax : PROTOS=c,w
Procedure Code
Syntax : PROCODE=c,w
Procedure, First Modifier
Syntax : PROMODA=c,w
Procedure, Second Modifier
Syntax : PROMODB=c,w
Procedure, Third Modifier
Syntax : PROMODC=c,w
Procedure Link to Diagnosis
Syntax : PRODXLNK=c,w
Procedure Amount
Syntax : PROAMT=c,w
Procedure Units Value
Syntax : PROUNIT=c,w
- - - - - - - - - - - - - - - - - - - -
TABLES SECTION
Syntax : [TABLES]
Table Field Definitions
PATSEX=option,definition
Options : This is the character string
being compared to the data loaded
in the PATSEX field. If the option
matches the data then the definition
is applied to the translation of the
data that will be applied to the
database.
Definitions : Description - - - - - - - - - - - - Definition
NOT SURE.................................0
MALE.....................................1
FEMALE...................................2
INSSEX=option,definition
Options : This is the character string
being compared to the data loaded
in the INSSEX field. If the option
matches the data then the definition
is applied to the translation of the
data that will be applied to the
database.
Definitions : Description - - - - - - - - - - - - Definition
NOT SURE.................................0
MALE.....................................1
FEMALE...................................2
PATREL=option,definition
Options : This is the character string
being compared to the data loaded
in the PATREL field. If the option
matches the data then the definition
is applied to the translation of the
data that will be applied to the
database.
Definitions :Description - - - - - - - - - - - - Definition
NOT SURE................................00
SELF....................................11
SPOUSE..................................12
CHILD...................................13
GUARDIAN................................14
PATSTAT=option,definition
Options : This is the character string
being compared to the data loaded
in the PATSTAT field. If the option
matches the data then the definition
is applied to the translation of the
data that will be applied to the
database.
Definitions :Description - - - - - - - - - - - - Definition
NOT SURE...............................0
SINGLE.................................1
MARRIED................................2
CONDREL=option,definition
Options : This is the character string
being compared to the data loaded
in the CONDREL field. If the option
matches the data then the definition
is applied to the translation of the
data that will be applied to the
database.
Definitions :Description - - - - - - - - - - - - Definition
EMPLOYMENT.............................0
AUTO...................................1
OTHER..................................2
PROPOS=option,definition
Options : This is the character string
being compared to the data loaded
in the POSPOS field. If the option
matches the data then the definition
is applied to the translation of the
data that will be applied to the
database.
Definitions: Description - - - - - - - - - - - - Definition
Not sure ................................... 0000
Inpatient Hospital ......................... 1001
Outpatient Hospital ........................ 1002
Doctor's Office ............................ 1003
Patient's Home ............................. 1004
Day Care Facility Part Hospital ............ 1005
Nursing Home ............................... 1006
Skilled Nursing Facility ................... 1007
Ambulance Land ............................. 1008
Other Location ............................. 1009
Independent Lab ............................ 1010
Ambulatory Surgical Center ................. 1011
Residential Treatment Center ............... 1012
Specialized Treatment Facility ............. 1013
Comprehensive Outpatient Rehab. Facility ... 1014
Indep. Kidney Disease Treatment Center ..... 1015
Emergency Room Hospital .................... 1016
Birthing Center ............................ 1017
Military Treatment Center .................. 1018
Custodial Care Facility .................... 1019
Hospice .................................... 1020
Ambulance - Air or Water ................... 1021
Inpatient (PSY) Facility ................... 1022
Community Mental Health Center ............. 1023
Psychiatric Residential Treatment Center ... 1024
Comprehensive Inpatient Rehab. Facility .... 1025
PROTOS=option,definition
Options : This is the character string
being compared to the data loaded
in the PROTOS field. If the option
matches the data then the definition
is applied to the translation of the
data that will be applied to the
database.
Definition:Description - - - - - - - - - - - - - - - - Definiti
n
Not sure........................................101
Medical Care....................................102
Surgical........................................103
Consultation....................................104
Diagnostic X-Ray................................105
Diagnostic Laboratory...........................106
Radiation Therapy...............................107
Anesthesia......................................108
Assistance at Surgery...........................109
Other Medical Services..........................110
Blood on Packed Red Cells.......................111
Used DME........................................112
Ambulatory Surgical Center......................113
Hospice.........................................114
Rented Supplies in the Home.....................115
Alternate Payment for Maintenance Dialysis......116
Kidney Donor....................................117
Pneumococcal Vaccine............................118
Second Opinion or Elective Surgery..............119
Third Opinion or Elective Surgery...............120
Section 10Customizing Products through the C1.INI
[Table of Contents]
specifications, format or add functionality
to the system.
Check the Overview document to determine which sections apply.
The standard text sequential file is located in the product base
and data subdirectory and is loaded from the data subdirectory
upon start up of the program.
Sections and respective commands are set in this file as needed.
- - - - - - - - - - - - - - - - - - - - - - - - - - - -
[SYSTEM]
DATADIRECTORY=foldername
For use in the c1.ini in the base directory only.
Allows you to set the data directory the product
will use. This function can be used when folder names
that have embeded spaces.
CLEARINGSERVICE=SINGLE
Allows you to enter only one clearing service.
The default is single.
CLEARINGSERVICE=MULTI
Allows you to enter multiple clearing services.
UNITS=WHOLE
Calculates charges based on units being whole integers.
Default.
UNITS=FRACTIONAL
Calculates charges based on units being one tenth
of the units value.
UNITS=FREEFORM
Calculates charges based on a single unit. Any value
entered in the units field will be displayed on the
form.
PURGESYSTEM=ON
With this setting the System Purge function of the Purge
Utilities will allow you to purge the patient and claim
database completely.
Primary use is for when system is being used to process data off
of other systems.
PURGESYSTEM=CLEARINGSOLO
Purges patient and claim database similar to PURGESYSTEM=ON
in addition it purges the Insurance Carrier Database. This
setting is only applicable to systems with import or data translatio
capabilities.
PURGESYSTEM=CLEARINGGROUP
Purges patient and claim database the same as the
PURGESYSTEM=CLEARINGSOLO with the addition that it
purges the Provider Database. This setting is only applicable
to systems with import or data translation capabilities.
PURGESYSTEM=CARRIERSOLO
Purges patient and claim database similar to PURGESYSTEM=ON.
PURGESYSTEM=CARRIERGROUP
Purges patient and claim database the same as the
PURGESYSTEM=CARRIEROLO with the addition that it
purges the Provider Database. This setting is only applicable
to systems with import or data translation capabilities.
PASSWORD=YES
When configured, a password will be required to access
the data sub-directory. The file that contains
the password is: P00000000.PF and can be deleted to reset
the password.
DATACOMMUNICATIONS=application
The application is an externally called EXE or program that
will be run in place of standard data communications that is
supplied with some Com1 Software systems.
COMMUNICATIONSDIRECTORY=folder
The folder is the location of the application being run when the
command DATACOMMUNICATIONS= is used. The drive should
not be specified in this command.
OPTION=DME
In the Claim Screen Procedure Line Additional Info Screen
an addition button will be displayed that will allow for the
entry of DME Related data.
OPTION=DME
In the Claim Screen Procedure Line Additional Info Screen
an addition button will be displayed that will allow for the
entry of DME Related data.
OPTION=AMBULANCE
In the Claim Screen Procedure Line Additional Info Screen
an addition button will be displayed that will allow for the
entry of ambulance related data.
OPTION=ANESTHESIA
Contact Com1 Software
OPTION=CHIROPRACTIC
Contact Com1 Software
- - - - - - - - -
[PROCESSING]
CHECKNAME=OFF
CHECKNAME=ON
Checks patient name field for entry. Suspends claim if blank.
CHECKSSN=OFF
CHECKSSN=ON
Checks patient Social Security for entry. Suspends claim if
short or blank.
CHECKDOB=OFF
CHECKDOB=ON
Checks patient date of birth field for entry. Suspends if blank.
CHECKADDRESS=OFF
CHECKADDRESS=ON
Checks patient address field 1 for entry. Suspends if blank.
CHECKINSID=OFF
CHECKINSID=ON
Checks patient Insured's ID for entry. Suspends if blank.
CHECKALTID=OFF
CHECKALTID=ON
Checks patients Alternate ID for entry. Suspends if blank.
CHECKREFID=OFF
CHECKREFID=ON
Checks patient's Referring Source Insurance ID for entry.
Suspends if blank.
- - - - - - - - - - - - - - - - - - - - - - - - - - - -
Section Command :
[CMS1500]
or
[CMS1500-I0000001] where I0000001 is the Carrier System ID
or
[HCFA1500]
or
[HCFA1500-I0000001]
BOX4=OFF
Suppresses boxs 4 and 7.
BOX4=YESALWAYS
Overides use of SAME when the Patient is the same as
the Guarantor for boxs 4 and 7.
BOX6=OFF
Suppresses box 6.
BOX8=OFF
Suppresses box 8.
BOX9=OFF
Suppresses box 9 and its associated Other Insurance
Fields 9a through 9d.
BOX9=YESALWAYS
Overides medicare print supression of box 9 and its
associated Other Insurance Fields 9a through 9d.
BOX10=OFF
Suppresses box 10.
BOX11=OFF
Suppresses box 11.
BOX12=ONFILE **
Will cause the Patient or Authorized Signature to display
SIGNATURE ON FILE in the box for all claims.
BOX12=DATEOFF **
Will leave the date field in box 12 off.
BOX12=TODAY **
Will place the system date in the date field of box 12 for
patient signature on file.
BOX13=ONFILE **
The Insured's Authorized Signature will display SIGNATURE
ON FILE in the box for all claims.
BOX14=OFF
Supresses the printing of information in box 14.
BOX21=OFF
Suppresses the printing of box 21.
BOX21=DECIMALON
Leaves the decimal point in the diagnoses codes displayed
in Box 21.
BOX24B=1992
Standard two character Place of Service.(default)
BOX24B=1984
Previously used one character Place of Service.
BOX24B=OFF
Supresses the printing of box 24b, the Place of Service.
SETPOS=x
Sets the Place of Service to whatever characters are in position
BOX24C=OFF
Supresses the printing of box 24c, the Type of Service.
SETTOS=x
Sets the Type of Service to the characters are in x.
Example: SETTOS=12
SETTOSUDFn=x
This function allows you to create up to 5 user defined types of se
ice
where n represents the user defined funtion 1 through 5 and will se
the
type of service to the characters set in x. The user defined type o
service
is also set in the User Defaults and where the Type of Service is s
at the
claim level.
Example: SETTOSUDF1=18
BOX24D=DESCRIPTION
Uses procedure code discription instead of the procedure code.
BOX24E=DX
Uses the DX code instead of related item number.,
i.e. 1,2,3,4
BOX24E=OFF
Supresses the printing of box 24e diagnosis code link.
BOX24G=NORMAL
Standard central right justified printing of units
on form. Prints the right two characters in field.
Maximum value to display is 99.
Default setting.
BOX24G=MAX
Standard right justified printing of units on form.
Prints full three chracter width in field. Maximum value
to display is 999.
BOX24G=TWOPOS
Units are zero filled and displayed in a right justified
two position format.
BOX24G=THREEPOS
Units are zero filled and displayed in a right justified
three position format.
BOX24K=PROVINSID
Solo Version-will display the Provider Insurance ID#
based on data entered in the Provider Insurance Contract
Table.
Institution Version-will display the Provider Insurance
ID# based on data entered in the Provider Insurance ID
Editor.
BOX24K=REFSINSID
Will display the Referring Source Insurance ID# based on
data entered in the Referring Source Insurance ID Data
Screen.
BOX24K=INSTINSID
Will display the Institution Insurance ID# based on
data entered in the Institution Insurance Contract Table.
BOX25=OFF
Suppresses federal tax ID or social security number and
the checking of the associated box.
BOX26=ALTID
Uses the patient Alternate ID instead of the system
generated ID#.
BOX26=SSN
Use the patient Social Security Number instead of the
system generated ID#.
BOX27=OFF
Turns off Accept Assignment Box 27.
BOX27=YESALWAYS
Set accept assignment to say yes on all claims.
BOX29=OFF
Suppresses Amount Paid box.
BOX30=OFF
Suppresses Balance Due box.
BOX30=BOX28 **
Balance Due Box is equal to Box 28 the Total Charges
BOX31=OFF
Turns of all Data in box.
BOX31=DATEONLY
Print system Date
BOX32=ONALWAYS
Alternate Facility will display on all claims.
BOX33=OFF
Suppresses printing of name, address, pin# and group#.
DATECTL=MMDDYY
Will cause 6-digit dates in field items 12,14,15,16,18,
24a,and 31 on the form.
DATECTL=MMDDCCYY
Will cause 8-digit dates in field items 12,14,15,16,18,
24a,and 31 on the form.
NOTE for DATECTL:
All dates of birth field items 3, 9b, and 11a are
set to 8-digit dates.
FORM=PREPRINTEDNOCHOICE
Use HCFA pre-printed forms only, it doesn't offer the
user the Options choice.
FORM=PREPRINTED
Use pre-printed forms as the default in the Options.
FORM=ARTWORK
Generate an artwork form with your color printer.
FORM=UPPERELITE
Will cause all data printed on form to appear in
10 character per inch upper case letters.
FORMREVISION=0805 **
Will use the 0805 CMS-1500 Form
FORMREVISION=1290 **
Will use the 1290 CMS-1500 Form
TEXTFORMCONTROL=FLAT **
For ASCII text file creation of CMS-1500 data.
Set for 80 characters wide with 72 lines.
TEXTFORMCONTROL=FORMFEED **
For ASCII text file creation of CMS-1500 data.
Set for 80 characters wide with 65 lines followed
with a form feed.
PROCLINE=DESC10
Used to display the first ten characters of a procedure
description starting in 24d, to the right of the procedure
code using Modifier field.
PROCLINE=DESC16
Used to display the first sixteen characters of a procedure
description starting in 24h through 24k.
TOP=OFF
Will control carrier address and ID's top of the HCFA form.
Default is on with internal system ID dislayed. Options are:
OFF
- Address is not printed
SYSTEMIDON
- Address with internal system ID
SUBMITTERIDON
- Address with EMC Submitter ID
INSURANCEIDON
- Address with Insurance/UPIN ID
IDOFF
- Address with out ID
TOPOFFSET=n
Allows for the left to right placement of the carriers name,
address,and ID information on the top of the form. Options
for N are: 0,5,10,15,20,25,30,35,40,45,50,55,60. Offset
increments are equal to one half inch increments. 0 represents
that the original system position is being used. The default
position of the carrier name is at 33. Offsets other than 0
are based on position from the left edge of the form. To move
the name to the right use 35 or greater.
FONT=ARIAL8
Will set the size and font used to print the insurance
form. Options are:
ARIAL8
COURRIERNEW8
TIMESNEWROMAN8
SANSERIEF8
ARIAL10
COURRIERNEW10
TIMESNEWROMAN10
SANSERIEF10
ARIAL12
COURRIERNEW12
TIMESNEWROMAN12
SANSERIEF12
EXAMPLE
In this example, the following text is entered into the
C1.INI editor and saved. This will allow the default of the form
to have Signatures on File with today's date using full eight
digit dates:
[HCFA1500]
BOX12=ONFILE
BOX12=TODAY
BOX13=ONFILE
DATECTL=MMDDCCYY
Note:
** Indicates availability in X12 to CMS-1500 Conversions
- - - - - - - - - - - - - - - - - - - - - - - - - - - -
Section Command:
[X12]
or
[X12-I0000000] where I0000001 is the Carrier System ID
- - - - - - - - - - - - - - - - - -
FIELD COMMANDS:
Transaction Segment Offset.
TRANSACTIONSEGOFFSET=n
Interchange Control
INTERCHANGECONTROL=
Functional Group
FUNCTIONALGROUP=
Transaction Set
TRANSACTIONSET=
Provider Hierarchial Configuration.
PROVIDERHIERARCH=option
Option: SINGLE
MULTIPLE
Interchange Number Configuration
INTERCHANGENUMBERING=
Options:
TYPEA
Nine didget batch number generated by
system. Leading Zeroes
TYPEB
Eight didget batch number generated by
system with a leading one added in front
for a nine digit number.
TYPEC
Four digit Year plus Month of year
plus Day of the Month
TYPED
Two digit Year plus Month of year
plus Day of the Month
TYPEE
Four digit Year plus Month of year
plus Day of the Month plus Hour of
the Day plus the Minutes of the Hour
TYPEF
Nine didget batch number generated by
system. Leading Zeroes
TYPEG
Incremental batch number generated by the
system. Each run under the specified data
directory will increment the batch number.
Created File Extension
EXTENSION=option
Option:TCF
TYPE
Batch Type
BATCHTYPE=option
Option:PROFESSIONAL
INSTITUTIONAL
National Provider Id Control
NPI=option
Option:ON (default)
OFF
- - - - - - - - - - - - - - - - - - - - - - - - - - - -
[X12VIEWER]
- For configuration of general use functions.
SETEXTENSION=scope
This allows you to filter the selection files based on
file extention or on other supported wild card parameters.
Example:
setextension=*.tcf,*.837,*,835
TEXTFORMCONTROL=option
This allows you to set the CMS-1500/UB Formating
TEXTFORMCONTROL=option
Option:FLAT (default)
FORMFEED
- - - - - - - - - - - - - - - - - - - - -
----------------------------------------------------------------------
Section 12ANSI X12 837 Configuration
[Table of Contents]
product line is highly configurable.
The C1.CFG file is the file used to map a Com1 Software
products X12 output.
The C1.CFG is a standard text sequential file and is
located in a data directory.
Sections and respective commands are set in this file as needed.
A configuration file will typically have
Section Command
Segment Control
Data Element Control
The Section Command is manditory and only once.
The Segment Control name is the same name as the X12 segment.
The Data Element Control follows it's associated Segment Control
and has a two position number in its name. There can be many Segment
controls and their associated Data Element Controls in a
configuration.
Segment and Data Element Controls can and typically
do have a Configuration Class Key associated with them. These
class keys are placed to the left of the of the segment and data element
controls and are seperated by a period.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
SECTION COMMAND:
[X12837]
- This is the section command.
- - - - - -
SEGMENT CONTROL:
ISA=ON
- This is the segment on control
- - - - - -
SEGMENT AND DATA ELEMENT CONTROL:
ISA01=ON
- This is the data element on control.
- - - - - - -
ST=ON
ST01=ON
ST02=ON,0021
- This is the ST segment on control with the first
and second data element on controls. ST02 is
set to 0021.
- - - - - -
AE.SBR=ON
AE.SBR01=ON
AE.NM1=ON
AE.NM101=ON
AE.NM102=ON
- This is the SBR segment followed by an associated
NM1 segment both using the configuration
class key AE .
- This is an example of adding hardcoded multi-refs
to the rendering provider loop.
AJ.REF=ON
AJ.REF01=ON
AJ.REF02=ON
AJ.1.REF=ON
AJ.1.REF01=ON
AJ.1.REF02=ON
AJ.2.REF=ON
AJ.2.REF01=ON
AJ.2.REF02=ON
The AJ class is the only supported class with this
propery.
- - - - - - - - - - - - - - - - - - - - - -
DELIMITER CONTROL
X12ST=x
The Segment Terminator is the character value of X.
X12DS=x
The Data Seperator is the character value of X.
X12SS=x
The Segment Seperator is the character value of X.
EXAMPLE:
X12ST=~
X12DS=*
X12SS=>
Delimiters characters can also be set to characters
defined in X12 as the Base Control Set
7 - BEL bell
9 - HT horizontal tab
10 - LF line feed
11 - VT vertical
12 - FF form feed
13 - CR carriage return
28 - FS file separator
29 - GS group separator
30 - RS record separator
31 - US unit separator
X12ST=10
- - - - - - - - - - - - - - - - - - - - - -
Supported ANSI ASC X12 837 Elements
ISA - Interchange Start Control Header
GS - Group Start Control Header
ST - Transaction Start Control Header
BGN - Beginning Segment
BHT - Beginning of Hierarchical Transaction
REF - Reference Numbers
NM1 - Submitter (LOOP 1000)
N3 - Address Information
N4 - Address information
HL - Hierarchical Level
PRV - Billing Provider (LOOP 2000)
SBR - Subscriber Information (LOOP 2100)
PAT - Patient Information (LOOP 2200)
CLM - Health Claim (LOOP 2300)
CLM - Detail Loop (LOOP 2400)
- Other Insurance (LOOP 2500)
SE - Transaction End Control Trailer
GE - Group End Control Trailer
IEA - Interchange End Control Trailer
- - - - - - - - - - - - - - - - - - - - - -
CONFIGURATION CLASS KEYS:
AA - SUBMITTER
AB - RECEIVER
AC - BILLING PROVIDER
AD - PAY TO PROVIDER
AE - SUBSCRIBER/GUARANTOR
AF - PATIENT
AG - CLAIM HEADER
AH - CLAIM DETAIL HEADER
AI - REFERRING PROVIDER CLAIM LEVEL
AJ - RENDERING PROVIDER
AK - SERVICE FACILITY
AL - PAYOR/CARRIER
AM - OTHER SUBSCRIBER/GUARANTOR
AN - OTHER INSURANCE
AO - PURCHASED SEVICE POVIDER
AP - LINE PRICING AND AJUDICATION
AQ - CLAIM PRICING AND AJUDICATION
AR - PURCHASED SERVICE FACILITY
AS - REFERRING PROVIDER LINE LEVEL
AT - ATTENDING PROVIDER
AU - OPERATING PROVIDER
- - - - - - - - - - - - - - - - - - - - - -
LOOKUP TABLES:
Lookup Tables allow you to lookup and replace data
based on matching of the first field within the lookup
and substituting the data found in the second field
to the output.
- - - - - -
Lookup tables can be used in conjunction
with an import mapping strategy that uses a single or
minimal data fields.
An example of mapping in an NCU import that could be
used to set data for a lookup table in the C1.CFG
file.
field=BA0,renid,4,10
field=BA0,renlname,4,10
field=BA0,renfname,4,10
field=BA0,renssn,4,12
Note: All rendering fields being used are
mapped to the same location to populate
them with the rendering providers ID.
- - - - - -
In the C1.CFG in the rendering providers NM1 data
elements, we have added after the =ON statements
%ren lookup fields.
Syntax:
class.element&position=status,%lookupfield
*********************** rendering provider
AJ.NM1=ON
AJ.NM101=ON
AJ.NM102=ON
AJ.NM103=ON,%renfname
AJ.NM104=ON,%renlname
AJ.NM105=ON
AJ.NM106=ON
AJ.NM107=ON
AJ.NM108=ON,24
AJ.NM109=ON,%renss
When the value populated in the %ren lookup field
is matched in the table section of the C1.CFG then
it will return the associated value.
- - - - - -
C1.CFG Tables Example:
Syntax:
fieldname=lookup_value,return_value
[tables]
renssn=55555555,123456789
renfname=555555555,Joe
renlname=555555555,Smith
renssn=777777777,987654321
renfname=777777777,George
renlname=77777777,Jones
renssn=999999999,211222112
renfname=999999999,Jan
renlname=999999999,West
- - - - - - - - - - - - - - - - - - - - - -
SUBSTITUTION FIELDS:
When the X12 file is being created, certain fields
within the process reside in memory for the
duration of their applicable claim. These fields
data can be used to populate x12 fields other than the
ones that they might be typicaly used for.
Syntax:
class.element&position=status,%substitution_field
Example:
AI.NM109=ON,$refupin
Valid Fields:
$CARRIERID - Carrier ID
$ALTBATCHID - Alternat Batch ID
$RENPROVID - Rendering Provider ID
$PROVID - Provider ID
$PROVTAXID - Provider Tax ID
$PROVSSN - Provider Social Security Number
$PROVALTID - Provider Alternate ID
$PROVNPI - Provider NPI
Valid Segments:
NM1
REF
Section 13ANSI X12 837 Claim Detail
[Table of Contents]
LX ASSIGNED NUMBER
Config: AH.LX=ON
Info: Loop 2400
LX01 - ASSIGNED NUMBER
Config: AH.LX01=ON
Info: Loop 2400
SV1 - PROFESSIONAL SERVICE
Config: AH.SV1=ON
Info: Loop 2400
SV101 - PRODUCT/SERVICE ID QUALIFIER
Config: AH.SV101=ON
Info: Loop 2400
SV102 - PRODUCT/SERVICE ID
Config: AH.SV102=ON
Info: Loop 2400
SV103 - MONETARY AMOUNT
Config: AH.SV103=ON
Info: Loop 2400
SV104 - UNIT OR BASIS FOR MEASUREMENT CODE
Config: AH.SV104=ON
Info: Loop 2400
SV105 - QUANTITY
Config: AH.SV105=ON
Info: Loop 2400
SV106 - FACILITY CODE
Config: AH.SV106=ON
Info: Loop 2400
SV107 - SERVICE TYPE CODE - NOT USED
Config: AH.SV107=ON
Info: Loop 2400
SV108 - DIAGNOSIS CODE POINTER 1
Config: AH.SV108=ON
Info: Loop 2400
SV109 - PROCEDURE MODIFIER
Config: AH.SV109=ON
Info: Loop 2400
SV110 - DIAGNOSIS CODE POINTER 2
Config: AH.SV110=ON
Info: Loop 2400
SV111 - PROCEDURE MODIFIER 2
Config: AH.SV111=ON
Info: Loop 2400
SV112 - PROCEDURE MODIFIER 3
Config: AH.SV112=ON
Info: Loop 2400
SV113 - DESCRIPTION - NOT USED
Config: AH.SV113=ON
Info: Loop 2400
SV114 - MONETARY AMOUNT - INDEPENDENT LAB CHARGES
Config: AH.SV114=ON
Info: Loop 2400
SV115 - YES/NO CONDITION OR RESPONSE CODE
Config: AH.SV115=ON
Info: Loop 2400
SV116 - MULTIPLE PROCEDURE CODE
Config: AH.SV116=ON
Info: Loop 2400
SV117 - YES/NO CONDITION OR RESPONSE CODE
Config: AH.SV117=ON
Info: Loop 2400
SV118 - YES/NO CONDITION OR RESPONSE CODE
Config: AH.SV118=ON
Info: Loop 2400
SV119 - REVIEW CODE
Config: AH.SV119=ON
Info: Loop 2400
SV120 - NATIONAL/LOCAL ASSIGNMENT REVIEW VALUE - NOT USED
Config: AH.SV120=ON
Info: Loop 2400
SV121 - COPAY STATUS CODE - NOT USED
Config: AH.SV121=ON
Info: Loop 2400
SV122 - HC PROFESSIONAL SHORTAGE AREA
Config: AH.SV122=ON
Info: Loop 2400
SV123 - REFERENCE NUMBER - HPSA FACILITY ID
Config: AH.SV123=ON
Info: Loop 2400
SV124 - ZIP CODE
Config: AH.SV124=ON
Info: Loop 2400
SV125 - MONETARY AMOUNT - NOT USED
Config: AH.SV125=ON
Info: Loop 2400
SV126 - LEVEL OF CARE CODE - NOT USED
Config: AH.SV126=ON
Info: Loop 2400
SV127 - PROVIDER AGREEMENT CODE - NOT USED
Config: AH.SV127=ON
Info: Loop 2400
SV6 - ANESTHESIA
NOT SUPPORTED
CD2 - MULTI-VALUED CHARACTERISTICS (ADDITIONAL DXS)
Config: AH.CD2=ON
Info: Loop 2400
CD201 - CODE CATEGORY
Config: AH.CD201=ON
Info: Loop 2400
CD202 - PRODUCT/SERVICE ID QUALIFIER
Config: AH.CD202=ON
Info: Loop 2400
CD203 - MEDICAL CODE VALUE
Config: AH.CD203=ON
Info: Loop 2400
CD204 - MEDICAL CODE VALUE
Config: AH.CD204=ON
Info: Loop 2400
CD205 - MEDICAL CODE VALUE - NOT USED
Config: AH.CD205=ON
Info: Loop 2400
CD206 - MEDICAL CODE VALUE - NOT USED
Config: AH.CD206=ON
Info: Loop 2400
DTP - DATE OR TIME PERIOD (SERVICE DATES)
Config: AH.DTP=ON
Info: Loop 2400
DTP01 - DATE/TIME QUALIFIER
Config: AH.DTP01=ON
Info: Loop 2400
DTP02 - DATE FORMAT CCYYMMDD
Config: AH.DTP02=ON
Info: Loop 2400
DTP03 - DATE/TIME PERIOD
Config: AH.DTP03=ON
Info: Loop 2400
REF - REFERENCE NUMBERS
AMT - MONETARY AMOUNT (PAID AMOUNT - PAYOR)
AMT01 - AMOUNT QUALIFIER CODE
AMT02 - MONETARY AMOUNT
NTE - NOTE/SPECIAL INSTRUCTION
NTE01 - NOTE REFERENCE CODE
NTE02 - FREE FORM MESSAGE
LS - LOOP HEADER
AI - REFERRING SOURCE
NM1 - INDIVIDUAL OR ORGANIZATIONAL NAME (REFERRING PROVIDER)
Config: AI.NM1=ON
Info: Loop 2420.B
NM101 - ENTITY IDENTIFIER CODE
Config: AI.NM101=ON
Info: Loop 2420.B
NM102 - ENTITY TYPE QUALIFIER
Config: AI.NM102=ON
Info: Loop 2420.B
NM103 - REFERRING SOURCE NAME
Config: AI.NM103=ON
Info: Loop 2420.B
NM104 - FIRST NAME - NOT USED
NM105 - MIDDLE INITIAL- NOT USED
NM106 - NAME PREFIX - NOT USED
NM107 - NAME SUFFIX - NOT USED
NM108 - IDENTIFICATION CODE QUALIFIER
NM109 - REFERRING PROVIDER ID
N3 - ADDRESS INFORMATION
N301 - ADDRESS
N302 - ADDRESS
N4 - GEOGRAPHIC LOCATION
N401 - CITY
N402 - STATE
N403 - ZIP CODE
N404 - NOT USED
N405 - LOCATION QUALIFIER
N406 - LOCATION IDENTIFIER
LOOP 2420.E - SUPERVISING PROVIDER
NM1 - INDIVIDUAL OR ORGANIZATIONAL NAME
NM101 - ENTITY IDENTIFIER CODE
NM102 - ENTITY TYPE QUALIFIER
NM103 - PROVIDER NAME
NM104 - FIRST NAME - NOT USED
NM105 - MIDDLE INITIAL- NOT USED
NM106 - NAME PREFIX - NOT USED
NM107 - NAME SUFFIX - NOT USED
NM108 - IDENTIFICATION CODE QUALIFIER
NM109 - SUPERVISING PROVIDER ID
N3 - ADDRESS INFORMATION
N301 - ADDRESS
N302 - ADDRESS
N4 - GEOGRAPHIC LOCATION
N401 - CITY
N402 - STATE
N403 - ZIP CODE
N404 - NOT USED
N405 - LOCATION QUALIFIER
N406 - LOCATION IDENTIFIER
LE - LOOP TRAILER
LE01 - LOOP IDENTIFIER CODE
Section 14Tutorial 1 : CMS-1500 to X12 837P (Clearing)
[Table of Contents]
In this tutorial we will outline the steps required to
to convert a CMS-1500 image file to an X12 837 professional
claims file using the Command Line Translator.
In our tutorial we will be setting it up to send claims to a
clearing house.
Since a CMS-1500 does not have all the fields required to
create a proper x12 file, we will be using the Command Line
Translator Administration to enter basic data such as
practice and clearing house information into the system.
You will need create a data folder on the same drive that
the software is installed on.
In our tutorail we will call our data folder \prod\prov1.
Download and unzip the tutorial data into the \prod\prov1 folder.
A shortcut to the C1A3F297 should be made on your desktop or in a
folder group. Once a BASE shortcut has been made, it can be copied
and modified via the properties area of windows. In the program tab
in the command line you will notice
C:\C1A3F297\C1A3F297.EXE
You should modify this to say
C:\C1A3F297\C1A3F297.EXE \prod\prov1
When you do this the new shortcut will run the F297 with the
\prod\prov1 as the DATA directory. This is the best way to set
up your databases, command files and configurations.
- - - - - - - - - - - - - - - - - - - - - - - - - -
Trading Partner Contact
- - - - - - - - - - - - - - - - - - - - - - - - - -
Establish contact with the EDI department of the
insurance carrier that you are going to be
submitting claims to. If you are submitting to a
clearing house the same steps will apply.
You will need to get.
1) A sender ID.
2) A receiver ID.
3) Application Sender Code.
4) A phone number or website for testing.
- Logons, passwords, and procedures on
how to use the dialup bulletin board
or website should be provided by the
insurance carrier or clearing house.
5) Implementation Matrix Guide
A document issued by the insurance carrier
that outlines their implementation of the
X12 837 and their requirements for specific
elements, segments and loops.
- - - - - - - - - - - - - - - - - - - - - - - - - -
Product Configuring and Installation.
- - - - - - - - - - - - - - - - - - - - - - - - - -
1) Upon installation you will be asked if you are going
to use a Solo or Group database.
- Solo is for practices that receive their payments and file
their taxes under a Social Security Number.
- Group is for practices that receive their payments and file
their taxes under an Incorporation.
In this tutorial we will be selecting Group Practice.
2) Add a Clearing Service to the Clearing Service Database
- Clearing Service Name is required
3) - Complete filing in the fields in the
Institution Data Screen.
5) In the Clearing Service Data Editor select Contract Data.
On the left side of the Clearing Service Contract Editor
five small buttons with their associated x12 function
and configuration status are displayed.
When you select an X12 function the configuration
screen is displayed
A) Set Control Mode to Test Transmission
B) Interchange Sender ID is used to populate the
ISA segment in element 6.
C) Interchange Receiver ID is used to populate the
ISA segment in element 8.
D) Application Receiver Code is used to populate the
NM1 segment in element 9 of the 1000B Loop.
C) Submission Data Button
In the Submission Data Screen.
- Submitter ID is used to populate the
GS segment in element 1 and in the
NM1 segment in element 9 of the 1000A Loop.
- Complete al fields in the Submitter Data Screen and
Save.
6) Under Utilities select the C1.CFG Editor.
Generate and X12 837 Professional configuration
and then save it.
- - - - - - - - - - - - - - - - - - - - - - - - - -
Basic Files.
- - - - - - - - - - - - - - - - - - - - - - - - - -
The important files to note:
EXAMPLE.CMD is the command file.
Please note: The PATH and DIRECTORY statements
within this file MUST match the data folder.
Verify in the Command Editor can be used to set
these fields to match the current data directory.
The C1.FCU file is the Frame Conversion Utility Map and is the
import mapping. The import/source file is defined in the config
section of the this file.
The C1.INI is a file that may be used to control processing
and purge functions.
The C1.CFG is the outbound X12 mapping file.
The X12 837 file created is called CS000001.TCF. It will be located in
the Data Directory.
- - - - - - - - - - - - - - - - - - - - - - - - - -
Running the Conversion
- - - - - - - - - - - - - - - - - - - - - - - - - -
To run the conversion simply click on the picture of the
person running. When the job is complete click on the picture
of the magnifying glass with the X12 on it.
Section 15Tutorial 2 : CSV to X12 837 (Clearing)
[Table of Contents]
In this tutorial we will outline the steps required to
to convert a CSV Comma Separated Value file to an X12 837 professional
claims file using the Command Line Translator.
The claims will be sent to a clearing house and the Command Line
Translator Administration will be used to enter basic data such as
practice and clearing house information into the system.
You will need create a data folder on the same drive that
the software is installed on.
We will call our data folder \prod\prov1.
Download and unzip the example 21 data into the \prod\prov1 folder.
A shortcut to the C1A3F297 should be made on your desktop or in a
folder group. Once a BASE shortcut has been made, it can be copied
and modified via the properties area of windows. In the program tab
in the command line you will notice
C:\C1A3F297\C1A3F297.EXE
You should modify this to say
C:\C1A3F297\C1A3F297.EXE \prod\prov1
When you do this the new shortcut will run the F297 with the
\prod\prov1 as the DATA directory. This is the best way to set
up your databases, command files and configurations.
- - - - - - - - - - - - - - - - - - - - - - - - - -
Trading Partner Contact
- - - - - - - - - - - - - - - - - - - - - - - - - -
From your clearing house you will need to get.
1) A sender ID.
2) A receiver ID.
3) Application Sender Code.
4) A phone number or website for testing.
- Logons, passwords, and procedures on
how to use the dialup bulletin board
or website should be provided by the
clearing house.
5) Implementation Matrix Guide
A document issued by the clearing house
that outlines their implementation of the
X12 837 and their requirements for specific
elements, segments and loops.
- - - - - - - - - - - - - - - - - - - - - - - - - -
Product Configuring and Installation.
- - - - - - - - - - - - - - - - - - - - - - - - - -
1) Upon installation you will be asked if you are going
to use a Solo or Group database.
- Solo is for practices that receive their payments and file
their taxes under a Social Security Number.
- Group is for practices that receive their payments and file
their taxes under an Incorporation.
In this tutorial we will be selecting Group Practice.
2) Add a Clearing Service to the Clearing Service Database
- Clearing Service Name is required
3) - Complete filing in the fields in the
Institution Data Screen.
5) In the Clearing Service Data Editor select Contract Data.
On the left side of the Clearing Service Contract Editor
five small buttons with their associated x12 function
and configuration status are displayed.
When you select an X12 function the configuration
screen is displayed
A) Set Control Mode to Test Transmission
B) Interchange Sender ID is used to populate the
ISA segment in element 6.
C) Interchange Receiver ID is used to populate the
ISA segment in element 8.
D) Application Receiver Code is used to populate the
NM1 segment in element 9 of the 1000B Loop.
C) Submission Data Button
In the Submission Data Screen.
- Submitter ID is used to populate the
GS segment in element 1 and in the
NM1 segment in element 9 of the 1000A Loop.
- Complete all fields in the Submitter Data Screen and
Save.
6) Under Utilities select the C1.CFG Editor.
Generate and X12 837 Professional configuration
and then save it.
- - - - - - - - - - - - - - - - - - - - - - - - - -
Basic Files.
- - - - - - - - - - - - - - - - - - - - - - - - - -
The important files to note:
EXAMPLE.CMD is the command file.
Please note: The PATH and DIRECTORY statements
within this file MUST match the data folder.
Verify in the Command Editor can be used to set
these fields to match the current data directory.
The C1.BCU file is the Basic Conversion Utility Map and is the
import mapping. The import/source file is defined in the configuration
section of the this file.
The C1.INI is a file that may be used to control processing
and purge functions.
The C1.CFG is the outbound X12 mapping file.
The X12 837 file created is called CS000001.TCF. It will be located in
the Data Directory.
- - - - - - - - - - - - - - - - - - - - - - - - - -
Running the Conversion
- - - - - - - - - - - - - - - - - - - - - - - - - -
To run the conversion simply click on the picture of the
person running. When the job is complete click on the picture
of the magnifying glass with the X12 on it.
Section 16Tutorial 2.1 : CSV to X12 837P (Carrier)
[Table of Contents]
In this tutorial we will outline the steps required to
to convert a CSV Comma separate Value file to an X12 837 professional
claims file using the Command Line Translator.
In our tutorial we will be setting it up to send claims to a
single insurance carrier.
In this example we will be using the Command Line
Translator Administration to enter basic data such as
practice and insurance carrier information into the system.
You will need create a data folder on the same drive that
the software is installed on.
In our tutorial we will call our data folder \prod\medicare
Download and unzip the tutorial data into the \prod\medicare folder.
A shortcut to the C1A3F297 should be made on your desktop or in a
folder group. Once a BASE shortcut has been made, it can be copied
and modified via the properties area of windows. In the program tab
in the command line you will notice
C:\C1A3F297\C1A3F297.EXE
You should modify this to say
C:\C1A3F297\C1A3F297.EXE \prod\medicare
When you do this the new shortcut will run the F297 with the
\prod\medicare as the DATA directory. This is the best way to set
up your databases, command files and configurations.
Important Note:
If you produce a separate source file for each insurance
carrier that you want to send electronic claims, a separate
data directory for each insurance carrier may be the best
option. A shortcut can be created for each Insurance carrier
and there is no limit on the number of data directories
you create.
- - - - - - - - - - - - - - - - - - - - - - - - - -
Trading Partner Contact
- - - - - - - - - - - - - - - - - - - - - - - - - -
Establish contact with the EDI department of the
insurance carrier that you are going to be
submitting claims to. If you are submitting to a
clearing house the same steps will apply.
You will need to get.
1) A sender ID.
2) A receiver ID.
3) Application Sender Code.
4) A phone number or website for testing.
- Logons, passwords, and procedures on
how to use the dialup bulletin board
or website should be provided by the
insurance carrier or clearing house.
5) Implementation Matrix Guide
A document issued by the insurance carrier
that outlines their implementation of the
X12 837 and their requirements for specific
elements, segments and loops.
- - - - - - - - - - - - - - - - - - - - - - - - - -
Product Configuring and Installation.
- - - - - - - - - - - - - - - - - - - - - - - - - -
1) Upon installation you will be asked if you are going
to use a Solo or Group database.
- Solo is for practices that receive their payments and file
their taxes under a Social Security Number.
- Group is for practices that receive their payments and file
their taxes under an Incorporation.
In this tutorial we will be selecting Group Practice.
2) Add an Insurance Carrier to the Insurance Carrier Database
- Insurance Carrier Name is required
3) - Complete filing in the fields in the
Institution Data Screen.
4) In the Institution Editor select Insurance Contract Table .
Add a Contract and select the Insurance Carrier that
was previously entered into the database.
On the left side of the Institution Insurance Contract Editor
five small buttons with their associated x12 function
and configuration status are displayed.
When you select an X12 function the configuration
screen is displayed
A) Set Control Mode to Test Transmission
B) Interchange Sender ID is used to populate the
ISA segment in element 6.
C) Interchange Receiver ID is used to populate the
ISA segment in element 8.
D) Application Receiver Code is used to populate the
NM1 segment in element 9 of the 1000B Loop.
C) Submission Data Button
In the Submission Data Screen.
- Submitter ID is used to populate the
GS segment in element 1 and in the
NM1 segment in element 9 of the 1000A Loop.
- Complete all fields in the Submitter Data Screen and
Save.
5) Under Utilities select the C1.CFG Editor.
Generate and X12 837 Professional configuration
and then save it.
- - - - - - - - - - - - - - - - - - - - - - - - - -
Basic Files.
- - - - - - - - - - - - - - - - - - - - - - - - - -
The important files to note:
EXAMPLE.CMD is the command file.
Please note: The PATH and DIRECTORY statements
within this file MUST match the data folder.
Verify in the Command Editor can be used to set
these fields to match the current data directory.
The C1.BCU file is the Basic Conversion Utility Map and is the
import mapping. The import/source file is defined in the config
section of the this file.
The C1.INI is a file that may be used to control processing
and purge functions.
The C1.CFG is the outbound X12 mapping file.
The X12 837 file created is called I0000001.TCF. It will be located in
the Data Directory.
- - - - - - - - - - - - - - - - - - - - - - - - - -
Running the Conversion
- - - - - - - - - - - - - - - - - - - - - - - - - -
To run the conversion simply click on the picture of the
person running. When the job is complete click on the picture
of the magnifying glass with the X12 on it.
Section 17Tutorial 2.2 : MDB to 837P ODBC (Carrier)
[Table of Contents]
In this tutorial we will outline the steps required to
to convert a Microsoft Access Database MDB to an X12 837 professional
claims file using the Command Line Translator.
In our tutorial we will be setting it up to send claims to a
single insurance carrier.
In this example we will be using the Command Line
Translator Administration to enter basic data such as
practice and insurance carrier information into the system.
You will need create a data folder on the same drive that
the software is installed on.
In our tutorial we will call our data folder \prod\carrier1
Download and unzip the tutorial data into the \prod\carrier1 folder.
A shortcut to the C1A3F297 should be made on your desktop or in a
folder group. Once a BASE shortcut has been made, it can be copied
and modified via the properties area of windows. In the program tab
in the command line you will notice
C:\C1A3F297\C1A3F297.EXE
You should modify this to say
C:\C1A3F297\C1A3F297.EXE \prod\carrier1
When you do this the new shortcut will run the F297 with the
\prod\carrier1 as the DATA directory. This is the best way to set
up your databases, command files and configurations.
Important Note:
If you produce a separate source file for each insurance
carrier that you want to send electronic claims, a separate
data directory for each insurance carrier may be the best
option. A shortcut can be created for each Insurance carrier
and there is no limit on the number of data directories
you create.
- - - - - - - - - - - - - - - - - - - - - - - - - -
Trading Partner Contact
- - - - - - - - - - - - - - - - - - - - - - - - - -
Establish contact with the EDI department of the
insurance carrier that you are going to be
submitting claims to. If you are submitting to a
clearing house the same steps will apply.
You will need to get.
1) A sender ID.
2) A receiver ID.
3) Application Sender Code.
4) A phone number or website for testing.
- Logons, passwords, and procedures on
how to use the dialup bulletin board
or website should be provided by the
insurance carrier or clearing house.
5) Implementation Matrix Guide
A document issued by the insurance carrier
that outlines their implementation of the
X12 837 and their requirements for specific
elements, segments and loops.
- - - - - - - - - - - - - - - - - - - - - - - - - -
Product Configuring and Installation.
- - - - - - - - - - - - - - - - - - - - - - - - - -
1) Upon installation you will be asked if you are going
to use a Solo or Group database.
- Solo is for practices that receive their payments and file
their taxes under a Social Security Number.
- Group is for practices that receive their payments and file
their taxes under an Incorporation.
In this tutorial we will be selecting Group Practice.
2) Add an Insurance Carrier to the Insurance Carrier Database
- Insurance Carrier Name is required
3) - Complete filing in the fields in the
Institution Data Screen.
4) In the Institution Editor select Insurance Contract Table .
Add a Contract and select the Insurance Carrier that
was previously entered into the database.
On the left side of the Institution Insurance Contract Editor
five small buttons with their associated x12 function
and configuration status are displayed.
When you select an X12 function the configuration
screen is displayed
A) Set Control Mode to Test Transmission
B) Interchange Sender ID is used to populate the
ISA segment in element 6.
C) Interchange Receiver ID is used to populate the
ISA segment in element 8.
D) Application Receiver Code is used to populate the
NM1 segment in element 9 of the 1000B Loop.
C) Submission Data Button
In the Submission Data Screen.
- Submitter ID is used to populate the
GS segment in element 1 and in the
NM1 segment in element 9 of the 1000A Loop.
- Complete all fields in the Submitter Data Screen and
Save.
5) Under Utilities select the C1.CFG Editor.
Generate and X12 837 Professional configuration
and then save it.
- - - - - - - - - - - - - - - - - - - - - - - - - -
Basic Files.
- - - - - - - - - - - - - - - - - - - - - - - - - -
The important files to note:
EXAMPLE.CMD is the command file.
Please note: The PATH and DIRECTORY statements
within this file MUST match the data folder.
Verify in the Command Editor can be used to set
these fields to match the current data directory.
The C1.BCU file is the Basic Conversion Utility Map and is the
import mapping. The import/source file is defined in the config
section of the this file.
The C1.INI is a file that may be used to control processing
and purge functions.
The C1.CFG is the outbound X12 mapping file.
The X12 837 file created is called I0000001.TCF. It will be located in
the Data Directory.
- - - - - - - - - - - - - - - - - - - - - - - - - -
Running the Conversion
- - - - - - - - - - - - - - - - - - - - - - - - - -
To run the conversion simply click on the picture of the
person running. When the job is complete click on the picture
of the magnifying glass with the X12 on it.
Section 19Command Line Translator Examples
[Table of Contents]
an their descriptions that have been
compiled to show the Command Line
Translators functionality.
Examples are distributed via a zip
file. The file will contain all
databases, mapping configurations
and test data.
Once the example zip file has been
extracted to a data folder, the PATH
and DIRECTORY commands located
in the EXAMPLE.CMD file need to be
modified to reflect the name of the
data folder. It is suggested that
folder names be kept to eight characters
or less and the full path name be
less than 48 characters. Drive letters
are not supported in the PATH and
DIRECTORY commands.
------------------------------------
EX1= - FCU Frame Conversion CMS-1500 Image
- Solo Provider
- Carrier Level
- NSF Out
EX2= - NCU Nested Conversion NSF In
- Solo Provider
- Carrier Level
- X12 837 Out
EX3= - ACU ANSI X12 Conversion 837 4010
- Solo Provider
- Carrier Level
- CMS-1500 Image Out
EX4=STA4
EX5=STA5
EX6=STA6
EX7=STA7
EX8=STA8
EX9=STA9
EX10=demoa
EX11=demob
EX12= - Group Carrier Translator Example
- FCU Preload of patient/insured data
- NCU Load of NSF
- Process Carrier
- Out X12 837
EX13= - Group Carrier Translator Example
- FCU Preload of Refering Providers
- NCU Load of NSF
- Process Carrier
- Out X12 837
EX14= - BCU Group Carrier Translator Example
- MDB Access
- X12 837 Out
EX15= - BCU Group Carrier Translator Example
- Comma Seperated Value
- Out X12
EX16= - BCU Group Carrier Translator
- Pipe (chr124) seperated Value
- X12 Out
EX17= - BCU Group Carrier Translator
- Multi Pass BCU
- Sub Parsed BCU
- X12 Out
EX18= -FCU Frame Conversion CMS-1500 Image
- Group Practce
- Carrier Level
- X12 837 Out
EX19=- NCU Nested Conversion NSF In
- Group Practice
- Carrier Level
- X12 837 Out
EX20=- ACU ANSI X12 Conversion 837 4010
- Group Practice Provider
- Carrier Level
- CMS-1500 Preview Print
EX21= - BCU Group Carrier Translator Example Large File
- Comma Seperated Value
- Out X12
(c) 1992-2010 Com1 Software, Inc.