Section 1
HIPAA Compliant X12 Version 4010 and 4010A Utility
Model C1D0F431
Standard License
Copyright (c)1992-2008 Com1 Software Development
Com1 Software, Inc.
P.O. Box 482
Hudson, Ohio 44236
(330) 653-3771
Website: http://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
BASIC CONCEPT
The X12 Utility allows a users to display and print
the contents of standard ANSI X12 837,277,276,835,864,
and 997 files in a user friendly format.
837 Health Care Claims
276 Claim Status Inquiry
277 Claim Status
835 Remittance Advice
997 Functional Acknowledgement
864 Informational Report
Data is displayed in context sensitive screens relative
to their transaction set.
Data can be exported to a file using a CSV or
Comma Seperated Value format.
837 Health Care Claims can be printed on
CMS-1500 Forms.
837 Health Care Claims can be converted into 276 Claims
Status Inquries for submission.
Formats data as a HTML and loads the page
to your default browser.
Claims software of the users choice can be run from
within the X12 Utility. The X12 file created by the
claims software is detected and can processed by the
X12 Utility.
A script can be built so that the X12 file can then be sent
automatically using the X12 Utilities built in data
communications software.
837 Health Care Claims can be tracked and archived by date
and type. Other X12 transaction files associated with
the 837 are tracked as well.
FEATURES
- HIPAA Compliant X12 Version 4010 and 4010A
- View or Print Listings of Claims
- View or Print Data Sheet of Individual Claims
- View or Print Listings of Remittance
- View or Print Data Sheet of Remittance
- View or Print Functional Acknowledgements
- View or Print X12 Data in segmented lines
- Load 997 transactions on top of 837 claims transactions
for Line Level Identificartion of error information.
- Configurable screen display fields
- Configurable print and listing fields
- Tracks X12 837 files and their associated X12
responses.
- Creates 276 Claim Status Inquiry from an 837 file.
- Export and format X12 files.
- Interfaces into existing claims submission software.
- Built in data communications software.
SYSTEM SPECIFICATIONS
Requires a Microsoft Windows 32 bit Operating System.
Section 3
The HIPAA Compliant X12 Version 4010 and 4010A Utility is designed to
take the cryptic information contained in a X12 file and display it
in a simple format.
The X12 Utility can be used in two basic ways.
The first use for the X12 Utility is as a file reader that can format
and export x12 files into other formats like XML or CSV.
The second use for the X12 Utility is as an analytic and tracking tool
for your x12 files. All the X12 files in the X12 Directory can be scanne
into the X12 Utilities database. Once your x12 files have been scanned
u
can locate claims by patient/subscriber name or by claim number. A listi
of
totals by date can be generated as well as an export to CSV of the datab
e.
- - - -
When you click on the button with a picture of a magnifying glass,
you will be asked to select a file.
The X12 Utility will handle transactions that it recognizes
automatically and displays the data for that format in a
manner that is appropriate for that individual transaction
type.
The supported transaction types are:
- 837 Health Care Claim
- 276 Claim Status Inquiry
- 277 Claim Status
- 835 Remittance Advice
- 997 Functional Acknowledgement
- 864 Information Report
Data can also be displayed and printed in a formatted raw data
dump of the x12 transaction it self.
A file can be loaded into the X12 Utility either by:
- Selecting the file through the menu of the program. Select
Functions,then X12 Utility and then the file to be loaded.
- Paste the current clip board memory of the computer into
X12 Utility using the Paste and Load Utility under functions.
- Selecting the file using the magnifying glass icon on the
button bar
- Passing the file name to the program as a parameter at
the time that it is run.
Once a particular file has been loaded by the Utility, it will display
the appropriate screen for the transaction set.
If a file contains multiple X12 batches within it, that is
to say that there are multiple ISA's within a single file, the X12
Utility will ask the user, which batch to select.
If a batch contains multiple transaction sets or groups, the user
will be asked which set they wish to view.
- 837 Health Care Claim
When an 837 Health Care Claim file is loaded into the Utility, the
View X12 837 selection screen is displayed. Data within the
transaction set is displayed using the name of the subscriber,
the amount of the claim, and the ID of the subscriber.
Within this screen the user has the option selecting one of the claims
within the list for additional detail, listing the data to a printer,
viewing the data in segment form, and loading a 997 on top of the
already loaded 837 file.
The Listing button will preview before print a listing that is similar
to that of the View X12 837 screen.
The Select button is used to select the highlighted claim in the claim
ist. Once selected, the Claim Data screen is displayed. This screen
will display, in a dynamic list, any supported claim elements that
it can detect and identify. Print a form of this screen and Exits
are options.
Data detail displayed in this screen are the Subscriber, Patient
demographic information, Claim Totals, Referring and Rendering Physician
Data, and Individual Service line Data.
Once a 997 has been loaded on top of its appropriate 837, the View Data
an be used to look at the data in a segment format with any errors
in the 837 being identified by a * or ** to the left of the segments
data,indicating an error in association with that particular line.
- - - -
To use the X12 Utility to help you track and locate claims data.
Set the X12 File folder to the folder where you keep your X12 files.
Once the X12 directory is set you can click on the SCAN button and
the X12 files in the X12 directory and will be read and indexed
into the X12 Utilities database.
Once the process of scanning has been completed,
you can go to Locate and search for claims by either subscriber
using last name, first name middle initial or by claim ID.
Partial searches work with locate by subscriber name.
The claim can be selected for viewing in formated fashion as well
as by raw data segments.
- - - -
To create a custom map for the fields you would like to
export, load the x12 file that you will be mapping to into
the viewing portion of the utility.
Once the data has been displayed there will be an EXPORT button
available on the screen.
Select the EXPORT, and then select export type.
The export screen will be displayed with a basic list of available
fields for export.
When you hit the SAVE button a mapping configuration file is created.
The type of X12 file you are working with will determine the name of the
configuration file.
C1837I.XML Institutional 837
C1837P.XML Professional 837
C1837D.XML Dental 837
C1835.XML Remittance 835
These configuration files can be modified using notepad.
If you require more then the 10 service lines defined in
the default mapping, you can add up to 99 additional
service line fields using a text editor like notepad.
Section 4
This is a list of the fields supported for mapping and are
stored in an XML file called:
C1837I.XML for Institutional
C1837P.XML for Professional
C1837D.XML for Dental
Field names are placed inside the field tags of the xml.
Example :
- - - - - - - - - - - - - - - - - -
CLAIMID
Claim ID
Location : CLM Segment, Element 1
CLAIMAMTDDDDDD_CC
Claim Amount
Location : CLM Segment, Element 2
CLAIMAMT
Claim Amount
Location : CLM Segment, Element 2
CLEARINGIDNUMBER
Clearing Service ID
Location : REF Segment, Element 2
Qualifier D9
MULTICLAIMTOTAL
Multi Claim Total Amount
Location : CLM Segment, Element 2
PRIORAUTHORIZATIONNUMBER
Prior Authorization Number
Location : REF Segment, Element 3
Qualifier G1
ORDERDATE
Order Date
Location : DTP Segment, Element 3
Qualifier 938
INITIALTREATMENTDATE
Initial Treatment Date
Location : DTP Segment, Element 3
Qualifier 454
REFERRALDATE
Referral Date
Location : DTP Segment, Element 3
Qualifier 330
DATELASTSEEN
Date last Seen
Location : DTP Segment, Element 3
Qualifier 304
ONSETOFILLNESDATE
Onset of Current Symptoms or Illness Date
Location : DTP Segment, Element 3
Qualifier 431
ACUTEMANIFESTATIONDATE
Acute Manifestation of a Chronic Condition Date
Location : DTP Segment, Element 3
Qualifier 453
SIMILARILLNESSONSETDATE
Onset of Similar Symptoms or Illness Date
Location : DTP Segment, Element 3
Qualifier 438
ACCIDENTDATE
Accident Date
Location : DTP Segment, Element 3
Qualifier 439
LMPDATE
Last Menstrual Period Date
Location : DTP Segment, Element 3
Qualifier 484
LASTXRAYDATE
Last X-Ray Date
Location : DTP Segment, Element 3
Qualifier 455
ESTIMATEDDATEOFBIRTH
Estimated Date of Birth
Location : DTP Segment, Element 3
Qualifier ABC
HEARINGVISIONPRESCRIPTIONDATE
Hearing and Vision Prescription Date
Location : DTP Segment, Element 3
Qualifier 471
DISABILITYBEGINDATE
Disability Begin Date
Location : DTP Segment, Element 3
Qualifier 360
DISABILITYENDDATE
Disability End Date
Location : DTP Segment, Element 3
Qualifier 361
DATELASTWORKED
Date Last Worked
Location : DTP Segment, Element 3
Qualifier 297
RETURNTOWORKDATE
Return to Work Date
Location : DTP Segment, Element 3
Qualifier 296
ASSUMEDCAREDATE
Assumed Care Start Date
Location : DTP Segment, Element 3
Qualifier 090
RELINQUISHEDCAREDATE
Relinquished Care End Date
Location : DTP Segment, Element 3
Qualifier 091
PROVSIGNATUREONFILE
Provider Signature
Location : CLM Segment, Element 6
PROVACCEPTASSIGNMENTCODE
Provider Assignment
Location : CLM Segment, Element 7
BENEFITINDICATOR
Benefit Indicator
Location : CLM Segment, Element 8
RELEASEOFINFORMATION
Release of Information
Location : CLM Segment, Element 9
RELATEDCAUSECODE
Related Cause
Location : CLM Segment, Element 11
RELATEDCAUSE
Related Cause
Location : CLM Segment, Element 11
DISCHARGEHOUR
Discharge Hour
Location : DTP Segment, Element 3
Qualifier 069
DISCHARGEDATE
Discharge Date
Location : CR6 Segment, Element 5
STATEMENTDATE
Statement Date
Location : DTP Segment, Element 3
Qualifier 434
ADMISSIONDATETIME
Addmission Date Time
Location : DTP Segment, Element 3
Qualifier 435
ADMISSIONTYPECODE
Addmission Type Code
Location : CL1 Segment, Element 1
Qualifier 435
ADMISSIONTYPE
Addmission Type
Location : CL1 Segment, Element 1
Qualifier 435
ADMISSIONSOURCECODE
Addmission Source Code
Location : CL1 Segment, Element 2
ADMISSIONSOURCE
Addmission Source
Location : CL1 Segment, Element 2
PATIENTSTATUSCODE
Patient Status Code
Location : CL1 Segment, Element 3
PATIENTSTATUS
Patient Status
Location : CL1 Segment, Element 3
MEDICALRECORDNUMBER
Medical Record Number
Location : REF Segment, Element 2
Qualifier EA
PATIENTAMOUNTPAID
Patient Amount Paid
Location : AMT Segment, Element 2
Qualifier F5
TOTALPURCHASEDSERVICEAMOUNT
Total Purchased Service Amount
Location : AMT Segment, Element 2
Qualifier NE
PAYERPRIORPAY
Payer Prior Pay
Location : AMT Segment, Element 2
Qualifier C4
OISUBORDER
Other Insurance Subscriber Order
Location : NM1 Segment, Element 1
OISUBID
Other Insurance Subscriber ID
Location : NM1 Segment, Element 9
Qualifier IL
OISUBLNAME
Other Insurance Subscriber Last Name
Location : NM1 Segment, Element 3
Qualifier IL
OISUBFNAME
Other Insurance Subscriber First Name
Location : NM1 Segment, Element 4
Qualifier IL
OISUBMI
Other Insurance Subscriber Middle Initial
Location : NM1 Segment, Element 5
Qualifier IL
OIPAYERADDR1
Other Insurance Subscriber Address 1
Location : N3 Segment, Element 1
OIPAYERADDR2
Other Insurance Subscriber Address 2
Location : N3 Segment, Element 2
OIPAYERCITY
Other Insurance Subscriber City
Location : N4 Segment, Element 1
OIPAYERSTATE
Other Insurance Subscriber State
Location : N4 Segment, Element 2
OIPAYERZIP
Other Insurance Subscriber Zip Code
Location : N4 Segment, Element 3
OIPAYERID
Other Insurance Payer ID
Location : NM1 Segment, Element 9
Qualifier PR
OIPAYERNAME
Other Insurance Payer Name
Location : NM1 Segment, Element 3
Qualifier PR
SEGMENTNOTE
Segment Note
Location : DMG Segment, Element 3
POSDESC
Place of Service Description
Location : CLM Segment, Element 6
FACILITYCODEVALUE
Facility Code Value
Location : CLM Segment, Element 6
FREQUENCYTYPECODE
Frequency Type Code
Location : CLM Segment, Element 6
POSCODE
Place of Service Description
Location : CLM Segment, Element 6
K3DATA
K3 Data
Location : K3 Segment, Element 1
NDCCODE
National Drug Code
Location : LIN Segment, Element 3
Qualifier N4
NDCUNITPRICE
NDC Drug Unit Price
Location : CTP Segment, Element 3
NDCUNITS
NDC Units
Location : CTP Segment, Element 4
TYPEOFBILL
Type of Bill
Location : CLM Segment, Element 6
FREQUENCYCODE
Frequency Type Code
Location : CLM Segment, Element 6
PRINCIPALDX
Principle Diagnosis
Location : HI Segment, Element 1
Qualifier BK
ADMITDX
Admitting Diagnosis
Location : HI Segment, Element 2
Qualifier BJ
ECODE
Vital Statistics E-Code
Location : HI Segment, Element 3
Qualifier BN
DRG
DRG
Location : HI Segment, Element 1
Qualifier DR
OTHERDX01 thru OTHERDX12
Other Diagnosis 1 thru 12
Location : HI Segment, Element 1
Qualifier BF
OTHERDXA01 thru OTHERDXY12
Other Diagnosis 1 thru 12
Multi Segment
Location : HI Segment, Element 1
Qualifier BF
PRINCIPLEPROCDATE
Principle Procedure Date
Location : HI Segment, Element 1
Qualifier BP,BR
PRINCIPLEPROC
Principle Procedure Date
Location : HI Segment, Element 1
Qualifier BP,BR
OTHERPROC01 thru OTHERPROC12
Other Procedures 1 thru 12
Location : HI Segment, Element 1
Qualifier BO,BQ
OTHERPROCA01 thru OTHERPROCY12
Other Procedures 1 thru 12
Multi Segment
Location : HI Segment, Element 1
Qualifier BO,BQ
OCCURRENCESPAN01 thru OCCURRENCESPAN12
Occurance Span 1 thru 12
Location : HI Segment, Element 1
Qualifier BI
OCCURRENCESPANA01 thru OCCURRENCESPANY12
Occurance Span 1 thru 12
Multi Segment
Location : HI Segment, Element 1
Qualifier BI
OCCURRENCECODE01 thru OCCURRENCECODE12
Occurance Code 1 thru 12
Location : HI Segment, Element 1
Qualifier BH
OCCURRENCECODEA01 thru OCCURRENCECODEY12
Occurance Code 1 thru 12
Multi Segment
Location : HI Segment, Element 1
Qualifier BH
OCCURRENCEDATE01 thru OCCURRENCEDATE12
Occurance Date 1 thru 12
Location : HI Segment, Element 1
Qualifier BH
OCCURRENCEDATEA01 thru OCCURRENCEDATEY12
Occurance Date 1 thru 12
Multi Segment
Location : HI Segment, Element 1
Qualifier BH
VALUECODE01 thru VALUECODE12
Value Codes 1 thru 12
Location : HI Segment, Element 1
Qualifier BE
VALUECODEA01 thru VALUECODEY12
Value Codes 1 thru 12
Multi Segment
Location : HI Segment, Element 1
Qualifier BE
VALUEAMOUNT01 thru VALUEAMOUNT12
Value Amounts 1 thru 12
Location : HI Segment, Element 1
Qualifier BE
VALUEAMOUNTA01 thru VALUEAMOUNTY12
Value Amounts 1 thru 12
Multi Segment
Location : HI Segment, Element 1
Qualifier BE
VALUEQTY01 thru VALUEQTY12
Value Quantity 1 thru 12
Location : HI Segment, Element 1
Qualifier BE
VALUEQTYA01 thru VALUEQTYY12
Value Quantity 1 thru 12
Multi segment
Location : HI Segment, Element 1
Qualifier BE
CONDITIONCODE01 thru CONDITIONCODE12
Condition Codes 1 thru 12
Location : HI Segment, Element 1
Qualifier BG
CONDITIONCODEA01 thru CONDITIONCODEY12
Condition Codes 1 thru 12
Multi Segment
Location : HI Segment, Element 1
Qualifier BG
CONDITIONDATE01 thru CONDITIONDATE12
Condition Dates 1 thru 12
Location : HI Segment, Element 1
Qualifier BG
CONDITIONDATEA01 thru CONDITIONDATEY12
Condition Dates 1 thru 12
Multi Segment
Location : HI Segment, Element 1
Qualifier BG
TREATMENTCODE01 thru TREATMENTCODE12
Treatment Codes 1 thru 12
Location : HI Segment, Element 1
Qualifier TC
TREATMENTCODEA01 thru TREATMENTCODEY12
Treatment Codes 1 thru 12
Multi Segment
Location : HI Segment, Element 1
Qualifier TC
SUBCLMTYPECODE
Submitter Claim Type
Location : SBR Segment, Element 9
SUBCLMTYPE
Submitter Claim Type
Location : SBR Segment, Element 9
SUBID
Submitter ID
Location : NM1 Segment, Element 9
Qualifier IL
SUBLNAME
Submitter Last Name
Location : NM1 Segment, Element 3
Qualifier IL
SUBFNAME
Submitter First Name
Location : NM1 Segment, Element 4
Qualifier IL
SUBMI
Submitter Middle Initial
Location : NM1 Segment, Element 5
Qualifier IL
SUBADDR1
Submitter Address 1
Location : N3 Segment, Element 1
SUBADDR2
Submitter Address 2
Location : N3 Segment, Element 2
SUBCITY
Submitter City
Location : N4 Segment, Element 1
SUBST
Submitter State
Location : N4 Segment, Element 2
SUBZIP
Submitter Zip
Location : N4 Segment, Element 3
SUBDOB
Submitter Date of Birth
Location : DMG Segment, Element 2
SUBNAMEPREFIX
Submitter Prefix
Location : NM1 Segment, Element 6
Qualifier IL
SUBNAMESUFIX
Submitter Suffix
Location : NM1 Segment, Element 6
Qualifier IL
SUBMSTATUS
Submitter Prefix
Location : DMG Segment, Element 4
SUBORDER
Submitter Coverage Order
Location : SBR Segment, Element 1
SUBREL
Submitter Relationship to Patient
Location : SBR Segment, Element 2
SUBGROUPNAME
Submitter Group Name
Location : SBR Segment, Element 3
SUBSEX
Submitter Gender
Location : DMG Segment, Element 3
PROPERYCASUALTYCLAIMNUMBER
Added Property Casuality Claim Number
Location : REF Segment, Element 2
Qualifier Y4
PAYERID
Payer ID
Location : NM1 Segment, Element 9
Qualifier PR
PAYERNAME
Payer Name
Location : NM1 Segment, Element 3
Qualifier PR
PAYERADDR1
Payer Address Line 1
Location : N3 Segment, Element 1
PAYERADDR2
Payer Address Line 2
Location : N3 Segment, Element 2
PAYERCITY
Payer City
Location : N4 Segment, Element 1
PAYERSTATE
Payer State
Location : N4 Segment, Element 2
PAYERZIP
Payer Zip Code
Location : N4 Segment, Element 3
PATLNAME
Patient Last Name
Location : NM1 Segment, Element 3
Qualifier QC
PATFNAME
Patient First Name
Location : NM1 Segment, Element 4
Qualifier QC
PATMI
Patient Middle Initial
Location : NM1 Segment, Element 5
Qualifier QC
PATADDR1
Patient Address 1
Location : N3 Segment, Element 1
PATADDR2
Patient Address 2
Location : N3 Segment, Element 2
PATCITY
Patient City
Location : N4 Segment, Element 1
PATST
Patient State
Location : N4 Segment, Element 2
PATZIP
Patient Zip
Location : N4 Segment, Element 3
PATDOB
Patient Date of Birth
Location : DMG Segment, Element 2
PATSEX
Patient Gender
Location : DMG Segment, Element 3
PATREL
Patient Relationship to Subscriber
Location : PAT Segment, Element 2
PATSIGNATURESOURCE
Patient Signature Source
Location : CLM Segment, Element 10
REFLNAME
Referring Provider Last Name
Location : NM1 Segment, Element 3
Qualifier DN
REFFNAME
Referring Provider First Name
Location : NM1 Segment, Element 4
Qualifier DN
REFID
Referring Provider ID
Location : NM1 Segment, Element 9
Qualifier DN
REFIDTYPE
Referring Provider ID Type
Location : NM1 Segment, Element 8
Qualifier DN
REFSECONDARYID
Referring Provider Secondary ID
Location : REF Segment, Element 3
REFSECONDARYIDCODE
Referring Provider Secondary ID Code
Location : REF Segment, Element 2
ATTENDLNAME
Attending Provider Last Name
Location : NM1 Segment, Element 3
Qualifier 71
ATTENDFNAME
Attending Provider First Name
Location : NM1 Segment, Element 4
Qualifier 71
ATTENDID
Attending Provider ID
Location : NM1 Segment, Element 9
Qualifier 71
ATTENDSECONDARYID
Attending Provider Secondary ID
Location : REF Segment, Element 2
ATTENDSECONDARYIDCODE
Attending Provider Secondary ID Code
Location : REF Segment, Element 1
OPERATELNAME
Operating Provider Last Name
Location : NM1 Segment, Element 3
Qualifier 72
OPERATEFNAME
Operating Provider First Name
Location : NM1 Segment, Element 4
Qualifier 72
OPERATEID
Operating Provider Last Name
Location : NM1 Segment, Element 3
Qualifier 72
OPERATESECONDARYID
Operating Provider Secondary ID
Location : REF Segment, Element 2
OPERATESECONDARYIDCODE
Operating Provider Secondary ID Code
Location : REF Segment, Element 1
RENLNAME
Rendering Provider Last Name
Location : NM1 Segment, Element 3
Qualifier 82
RENFNAME
Rendering Provider First Name
Location : NM1 Segment, Element 4
Qualifier 82
RENIDTYPECODE
Rendering Provider ID Type Code
Location : NM1 Segment, Element 8
Qualifier 82
RENIDTYPE
Rendering Provider ID Type
Location : NM1 Segment, Element 8
Qualifier 82
RENID
Rendering Provider ID
Location : NM1 Segment, Element 9
Qualifier 82
FACILITYNAME
Facility Name
Location : NM1 Segment, Element 3
Qualifier FA
FACILITYADDR1
Facility Address Line 1
Location : N3 Segment, Element 1
FACILITYADDR2
Facility Address Line 2
Location : N3 Segment, Element 2
FACILITYCITY
Facility City
Location : N4 Segment, Element 1
FACILITYST
Facility State
Location : N4 Segment, Element 2
FACILITYZIP
Facility Zip Code
Location : N4 Segment, Element 3
FACILITYIDTYPE
Facility ID Type
Location : NM1 Segment, Element 8
Qualifier FA
FACILITYIDCODE
Facility ID Code
Location : NM1 Segment, Element 8
Qualifier FA
FACILITYID
Facility ID
Location : NM1 Segment, Element 9
Qualifier FA
FACILITYSECONDARYIDTYPE
Facility Secondary ID Type
Location : REF Segment, Element 1
FACILITYSECONDARYIDCODE
Facility Secondary ID CODE
Location : REF Segment, Element 1
FACILITYSECONDARYID
Facility Secondary ID Type
Location : REF Segment, Element 2
SERVICELOCATIONNAME
Service Location Name
Location : NM1 Segment, Element 3
Qualifier 77
SERVICELOCATIONADDR1
Service Localtion Address Line 1
Location : N3 Segment, Element 1
SERVICELOCATIONADDR2
Service Localtion Address Line 2
Location : N3 Segment, Element 2
SERVICELOCATIONCITY
Service Localtion City
Location : N4 Segment, Element 1
SERVICELOCATIONST
Service Localtion State
Location : N4 Segment, Element 2
SERVICELOCATIONZIP
Service Localtion Zip Code
Location : N4 Segment, Element 4
SERVICELOCATIONID
Service Location Name
Location : NM1 Segment, Element 9
Qualifier 77
ILABNAME
Independent LAB Name
Location : NM1 Segment, Element 3
Qualifier LI
ILABADDR1
Independent LAB Address Line 1
Location : N3 Segment, Element 1
ILABADDR2
Independent LAB Address Line 2
Location : N3 Segment, Element 2
ILABCITY
Independent LAB City
Location : N4 Segment, Element 1
ILABST
Independent LAB State
Location : N4 Segment, Element 2
ILABZIP
Independent LAB Zip Code
Location : N4 Segment, Element 3
ILABID
Independent LAB Name
Location : NM1 Segment, Element 9
Qualifier LI
TLABNAME
Testing LAB Name
Location : NM1 Segment, Element 3
Qualifier TL
TLABADDR1
Testing LAB Address Line 1
Location : N3 Segment, Element 1
TLABADDR2
Testing LAB Address Line 2
Location : N3 Segment, Element 2
TLABCITY
Testing LAB City
Location : N4 Segment, Element 1
TLABST
Testing LAB State
Location : N4 Segment, Element 2
TLABZIP
Testing LAB Zip Code
Location : N4 Segment, Element 3
TLABID
Independent LAB Name
Location : NM1 Segment, Element 9
Qualifier TL
DX1_XX
Diagnosis Code 1
Location : HI Segment, Element 1
Sub Element 1
DX2_XX
Diagnosis Code 2
Location : HI Segment, Element 1
Sub Element 2
DX3_XX
Diagnosis Code 3
Location : HI Segment, Element 1
Sub Element 3
DX4_XX
Diagnosis Code 4
Location : HI Segment, Element 1
Sub Element 4
DX5_XX
Diagnosis Code 5
Location : HI Segment, Element 1
Sub Element 5
DX1
Diagnosis Code 1
Location : HI Segment, Element 1
Sub Element 1
DX2
Diagnosis Code 2
Location : HI Segment, Element 1
Sub Element 2
DX3
Diagnosis Code 3
Location : HI Segment, Element 1
Sub Element 3
DX4
Diagnosis Code 4
Location : HI Segment, Element 1
Sub Element 4
DX5
Diagnosis Code 5
Location : HI Segment, Element 1
Sub Element 5
MEDICALRECORDNUMBER
Medical Record Number
Location : REF Segment, Element 2
Qualifier EA
CLAIMBILLINGPROVIDERNAME
Claim Billing Provider Name
Location : NM1 Segment, Element 3
Qualifier 85
CLAIMBILLINGPROVIDERADDR1
Claim Billing Provider Address 1
Location : N3 Segment, Element 1
CLAIMBILLINGPROVIDERADDR2
Claim Billing Provider Address 2
Location : N3 Segment, Element 2
CLAIMBILLINGPROVIDERCITY
Claim Billing Provider City
Location : N4 Segment, Element 1
CLAIMBILLINGPROVIDERST
Claim Billing Provider State
Location : N4 Segment, Element 2
CLAIMBILLINGPROVIDERZIP
Claim Billing Provider Zip Code
Location : N4 Segment, Element 3
CLAIMBILLINGPROVIDERIDTYPE
Claim Billing Provider ID Type
Location : NM1 Segment, Element 8
Qualifier 85
CLAIMBILLINGPROVIDERIDCODE
Claim Billing Provider ID Code
Location : NM1 Segment, Element 8
Qualifier 85
CLAIMBILLINGPROVIDERID
Claim Billing Provider ID
Location : NM1 Segment, Element 9
Qualifier 85
CLAIMBILLINGPROVIDERSECONDARYIDTYPE
Claim Billing Provider Secondary ID Type
Location : REF Segment, Element 1
CLAIMBILLINGPROVIDERSECONDARYIDCODE
Claim Billing Provider Secondary ID Code
Location : REF Segment, Element 1
CLAIMBILLINGPROVIDERSECONDARYID
Claim Billing Provider Secondary ID
Location : REF Segment, Element 2
CLAIMPAYTOPROVIDERNAME
Claim Pay to Provider Name
Location : NM1 Segment, Element 3
Qualifier 87
CLAIMPAYTOPROVIDERADDR1
Claim Pay to Provider Address 1
Location : N3 Segment, Element 1
CLAIMPAYTOPROVIDERADDR2
Claim Pay to Provider Address 2
Location : N3 Segment, Element 2
CLAIMPAYTOPROVIDERCITY
Claim Pay to Provider City
Location : N4 Segment, Element 1
CLAIMPAYTOPROVIDERST
Claim Pay to Provider State
Location : N4 Segment, Element 2
CLAIMPAYTOPROVIDERZIP
Claim Pay to Provider Zip Code
Location : N4 Segment, Element 3
CLAIMPAYTOPROVIDERIDTYPE
Claim Pay to Provider ID Type
Location : NM1 Segment, Element 8
Qualifier 87
CLAIMPAYTOPROVIDERIDCODE
Claim Pay to Provider ID Code
Location : NM1 Segment, Element 8
Qualifier 87
CLAIMPAYTOPROVIDERID
Claim Pay to Provider ID
Location : NM1 Segment, Element 9
Qualifier 87
PRIMARYGROUPID
Primary Subscriber Group ID
Location : SBR Segment, Element 2
Qualifier P
PRIMARYGROUPNAME
Primary Subscriber Group Name
Location : SBR Segment, Element 3
Qualifier P
PRIMARYSUBID
Primary Subscriber ID
Location : NM1 Segment, Element 9
Qualifier IL
PRIMARYSUBLNAME
Primary Subscriber Last Name
Location : NM1 Segment, Element 3
Qualifier IL
PRIMARYSUBFNAME
Primary Subscriber First Name
Location : NM1 Segment, Element 4
Qualifier IL
PRIMARYSUBMI
Primary Subscriber Middle Initial
Location : NM1 Segment, Element 5
Qualifier IL
PRIMARYSUBADDR1
Primary Subscriber Address Line 1
Location : N3 Segment, Element 1
PRIMARYSUBADDR2
Primary Subscriber Address Line 2
Location : N3 Segment, Element 2
PRIMARYSUBCITY
Primary Subscriber City
Location : N4 Segment, Element 1
PRIMARYSUBSTATE
Primary Subscriber State
Location : N4 Segment, Element 2
PRIMARYSUBZIP
Primary Subscriber Zip Code
Location : N4 Segment, Element 3
PRIMARYSUBDOB
Primary Subscriber Date of Birth
Location : DMG Segment, Element 2
PRIMARYSUBSEX
Primary Subscriber Gender
Location : DMG Segment, Element 3
PRIMARYPAYERNAME
Primary Payer Name
Location : NM1 Segment, Element 3
Qualifier PR
PRIMARYPAYERADDR1
Primary Payer Address Line 1
Location : N3 Segment, Element 1
PRIMARYPAYERADDR2
Primary Payer Address Line 2
Location : N3 Segment, Element 2
PRIMARYPAYERCITY
Primary Payer City
Location : N4 Segment, Element 1
PRIMARYPAYERSTATE
Primary Payer State
Location : N4 Segment, Element 2
PRIMARYPAYERZIP
Primary Payer Zip Code
Location : N4 Segment, Element 3
PRIMARYPAYERID
Primary Payer ID
Location : NM1 Segment, Element 9
Qualifier PR
SECONDARYGROUPID
Secondary Subscriber Group ID
Location : SBR Segment, Element 2
Qualifier S
SECONDARYGROUPNAME
Secondary Subscriber Group Name
Location : SBR Segment, Element 3
Qualifier S
SECONDARYSUBID
Secondary Subscriber ID
Location : NM1 Segment, Element 9
Qualifier IL
SECONDARYSUBLNAME
Secondary Subscriber Last Name
Location : NM1 Segment, Element 3
Qualifier IL
SECONDARYSUBFNAME
Secondary Subscriber First Name
Location : NM1 Segment, Element 4
Qualifier IL
SECONDARYSUBMI
Secondary Subscriber Middle Initial
Location : NM1 Segment, Element 5
Qualifier IL
SECONDARYSUBADDR1
Secondary Subscriber Address Line 1
Location : N3 Segment, Element 1
SECONDARYSUBADDR2
Secondary Subscriber Address Line 2
Location : N3 Segment, Element 2
SECONDARYSUBCITY
Secondary Subscriber City
Location : N4 Segment, Element 1
SECONDARYSUBSTATE
Secondary Subscriber State
Location : N4 Segment, Element 2
SECONDARYSUBZIP
Secondary Subscriber Zip Code
Location : N4 Segment, Element 3
SECONDARYSUBDOB
Secondary Subscriber Date of Birth
Location : DMG Segment, Element 2
SECONDARYSUBSEX
Secondary Subscriber Gender
Location : DMG Segment, Element 3
SECONDARYPAYERNAME
Secondary Payer Name
Location : NM1 Segment, Element 3
Qualifier PR
SECONDARYPAYERADDR1
Secondary Payer Address Line 1
Location : N3 Segment, Element 1
SECONDARYPAYERADDR2
Secondary Payer Address Line 2
Location : N3 Segment, Element 2
SECONDARYPAYERCITY
Secondary Payer City
Location : N4 Segment, Element 1
SECONDARYPAYERSTATE
Secondary Payer State
Location : N4 Segment, Element 2
SECONDARYPAYERZIP
Secondary Payer Zip Code
Location : N4 Segment, Element 3
SECONDARYPAYERID
Secondary Payer ID
Location : NM1 Segment, Element 9
Qualifier PR
TERTIARYGROUPID
Tertiary Subscriber Group ID
Location : SBR Segment, Element 2
Qualifier T
TERTIARYGROUPNAME
Tertiary Subscriber Group Name
Location : SBR Segment, Element 3
Qualifier T
TERTIARYSUBID
Tertiary Subscriber ID
Location : NM1 Segment, Element 9
Qualifier IL
TERTIARYSUBLNAME
Tertiary Subscriber Last Name
Location : NM1 Segment, Element 3
Qualifier IL
TERTIARYSUBFNAME
Tertiary Subscriber First Name
Location : NM1 Segment, Element 4
Qualifier IL
TERTIARYSUBMI
Tertiary Subscriber Middle Initial
Location : NM1 Segment, Element 5
Qualifier IL
TERTIARYSUBADDR1
Tertiary Subscriber Address Line 1
Location : N3 Segment, Element 1
TERTIARYSUBADDR2
Tertiary Subscriber Address Line 2
Location : N3 Segment, Element 2
TERTIARYSUBCITY
Tertiary Subscriber City
Location : N4 Segment, Element 1
TERTIARYSUBSTATE
Tertiary Subscriber State
Location : N4 Segment, Element 2
TERTIARYSUBZIP
Tertiary Subscriber Zip Code
Location : N4 Segment, Element 3
TERTIARYSUBDOB
Tertiary Subscriber Date of Birth
Location : DMG Segment, Element 2
TERTIARYSUBSEX
Tertiary Subscriber Gender
Location : DMG Segment, Element 3
TERTIARYPAYERNAME
Tertiary Payer Name
Location : NM1 Segment, Element 3
Qualifier PR
TERTIARYPAYERADDR1
Tertiary Payer Address Line 1
Location : N3 Segment, Element 1
TERTIARYPAYERADDR2
Tertiary Payer Address Line 2
Location : N3 Segment, Element 2
TERTIARYPAYERCITY
Tertiary Payer City
Location : N4 Segment, Element 1
TERTIARYPAYERSTATE
Tertiary Payer State
Location : N4 Segment, Element 2
TERTIARYPAYERZIP
Tertiary Payer Zip Code
Location : N4 Segment, Element 3
TERTIARYPAYERID
Tertiary Payer ID
Location : NM1 Segment, Element 9
Qualifier PR
HIERARCHIALCLAIMBILLINGPROVIDERNAME
Hierarchial Claim Billing Provider Name
Location : NM1 Segment, Element 3
Qualifier 85
HIERARCHIALCLAIMBILLINGPROVIDERADDR1
Hierarchial Claim Billing Provider Address Line 1
Location : N3 Segment, Element 1
HIERARCHIALCLAIMBILLINGPROVIDERADDR2
Hierarchial Claim Billing Provider Address Line 2
Location : N3 Segment, Element 2
HIERARCHIALCLAIMBILLINGPROVIDERCITY
Hierarchial Claim Billing Provider City
Location : N4 Segment, Element 1
HIERARCHIALCLAIMBILLINGPROVIDERST
Hierarchial Claim Billing Provider State
Location : N4 Segment, Element 2
HIERARCHIALCLAIMBILLINGPROVIDERZIP
Hierarchial Claim Billing Provider Zip Code
Location : N4 Segment, Element 3
HIERARCHIALCLAIMBILLINGPROVIDERIDTYPE
Hierarchial Claim Billing Provider ID Type
Location : NM1 Segment, Element 8
Qualifier 85
HIERARCHIALCLAIMBILLINGPROVIDERIDCODE
Hierarchial Claim Billing Provider ID Code
Location : NM1 Segment, Element 8
HIERARCHIALCLAIMBILLINGPROVIDERID
Hierarchial Claim Billing Provider ID
Location : NM1 Segment, Element 9
HIERARCHIALCLAIMPAYTOPROVIDERNAME
Hierarchial Claim Pay to Provider Provider Name
Location : NM1 Segment, Element 3
Qualifier 87
HIERARCHIALCLAIMPAYTOPROVIDERADDR1
Hierarchial Claim Pay to Provider Provider Address Line 1
Location : N3 Segment, Element 1
HIERARCHIALCLAIMPAYTOPROVIDERADDR2
Hierarchial Claim Pay to Provider Provider Address Line 2
Location : N3 Segment, Element 2
HIERARCHIALCLAIMPAYTOPROVIDERCITY
Hierarchial Claim Pay to Provider Provider City
Location : N4 Segment, Element 1
HIERARCHIALCLAIMPAYTOPROVIDERST
Hierarchial Claim Pay to Provider Provider State
Location : N4 Segment, Element 2
HIERARCHIALCLAIMPAYTOPROVIDERZIP
Hierarchial Claim Pay to Provider Provider Zip Code
Location : N4 Segment, Element 3
HIERARCHIALCLAIMPAYTOPROVIDERIDTYPE
Hierarchial Claim Pay to Provider Provider ID Type
Location : NM1 Segment, Element 8
Qualifier 87
HIERARCHIALCLAIMPAYTOPROVIDERIDCODE
Hierarchial Claim Pay to Provider Provider ID Code
Location : NM1 Segment, Element 8
Qualifier 87
HIERARCHIALCLAIMPAYTOPROVIDERID
Hierarchial Claim Pay to Provider Provider ID
Location : NM1 Segment, Element 9
Qualifier 87
TSCONTROLNUMBER
Batch Conrol Number
Location : ST Segment, Element 2
BHTREFID
BHT Segment Reference Identification
Location : BHT Segment, Element 4
SUBMITTERNAME
Submitter Name
Location : NM1 Segment, Element 3
Qualifier 41
SUBMITTERADDR1
Submitter Address Line 1
Location : N3 Segment, Element 1
SUBMITTERADDR2
Submitter Address Line 2
Location : N3 Segment, Element 2
SUBMITTERCITY
Submitter City
Location : N4 Segment, Element 1
SUBMITTERST
Submitter State
Location : N4 Segment, Element 2
SUBMITTERZIP
Submitter Zip Code
Location : N4 Segment, Element 3
SUBMITTERCONTACT
Submitter Contact
Location : PER Segment, Element 2
SUBMITTERID
Submitter ID
Location : NM1 Segment, Element 9
Qualifier 41
RECEIVERID
Receiver
Location : NM1 Segment, Element 9
Qualifier 41
RECEIVERNAME
Receiver Name
Location : NM1 Segment, Element 3
Qualifier 40
RECEIVERADDITIONALNAME
Receiver Additional Name
Location : N2 Segment, Element 1
RECEIVERADDR1
Receiver Address Line 1
Location : N3 Segment, Element 1
RECEIVERADDR2
Receiver Address Line 2
Location : N3 Segment, Element 2
RECEIVERCITY
Receiver Address City
Location : N4 Segment, Element 1
RECEIVERST
Receiver Address State
Location : N4 Segment, Element 2
RECEIVERZIP
Receiver Address Zip Code
Location : N4 Segment, Element 3
BILLINGPROVIDERNAME
Billing Provider Name
Location : NM1 Segment, Element 3
Qualifier 85
BILLINGPROVIDERADDR1
Billing Provider Address Line 1
Location : N3 Segment, Element 1
BILLINGPROVIDERADDR2
Billing Provider Address Line 2
Location : N3 Segment, Element 2
BILLINGPROVIDERCITY
Billing Provider City
Location : N4 Segment, Element 1
BILLINGPROVIDERST
Billing Provider State
Location : N4 Segment, Element 2
BILLINGPROVIDERZIP
Billing Provider Zip Code
Location : N4 Segment, Element 3
BILLINGPROVIDERIDTYPE
Billing Provider ID Type
Location : NM1 Segment, Element 8
Qualifier 85
BILLINGPROVIDERIDCODE
Billing Provider ID Code
Location : NM1 Segment, Element 8
Qualifier 85
BILLINGPROVIDERID
Billing Provider ID
Location : NM1 Segment, Element 9
Qualifier 85
PAYTOPROVIDERNAME
Pay to Provider Name
Location : NM1 Segment, Element 3
Qualifier 87
PAYTOPROVIDERADDR1
Pay to Provider Address Line 1
Location : N3 Segment, Element 1
PAYTOPROVIDERADDR2
Pay to Provider Address Line 2
Location : N3 Segment, Element 2
PAYTOPROVIDERCITY
Pay to Provider City
Location : N4 Segment, Element 1
PAYTOPROVIDERST
Pay to Provider State
Location : N4 Segment, Element 2
PAYTOPROVIDERZIP
Pay to Provider Zip Code
Location : N4 Segment, Element 3
PAYTOPROVIDERIDTYPE
Pay to Provider ID Type
Location : NM1 Segment, Element 8
Qualifier 87
PAYTOPROVIDERIDCODE
Pay to Provider ID Code
Location : NM1 Segment, Element 8
Qualifier 87
PAYTOPROVIDERID
Pay to Provider ID
Location : NM1 Segment, Element 9
Qualifier 87
Section 5
This is a list of the fields supported for mapping and are
stored in an XML file called C1835.XML. Field names are placed
inside the field tags of the xml.
Example :
- - - - - - - - - - - - - - - - - -
SETCONTROLNUMBER
Transaction Set Control Number
Location : ST Segment, Element 2
CLAIMPATCTL
Claim Patient Control Number
Location : CLP Segment, Element 1
CLAIMSTATUSCODE
Claim Staus Code
Location : CLP Segment, Element 2
CLAIMSTATUSDESC
Claim Status Description
Location : CLP Segment, Element 2
CLAIMTOTALCHARGE
Claim Total Charge
Location : CLP Segment, Element 3
CLAIMTOTALPAID
Claim Total Paid
Location : CLP Segment, Element 4
PATRESPONSIBLE
Patient Responsibility
Location : CLP Segment, Element 5
FILIND
Filing Indicator
Location : CLP Segment, Element 6
FILINDDESC
Filing Indicator Description
Location : CLP Segment, Element 6
PAYERCLAIMCODE
Payer Claim Code
Location : CLP Segment, Element 7
FACILITYTYPECODE
Facility Type Code
Location : CLP Segment, Element 8
PAYERCLAIMCODE
Payer Claim Code
Location : CLP Segment, Element 8
CLAIMFREQ
Claim Frequency Code
Location : CLP Segment, Element 9
PATSTATCODE
Patient Status Code
Location : CLP Segment, Element 10
DRGCODE
Diagnosis Related Group (DRG) Code
Location : CLP Segment, Element 11
DRGQTY
Diagnosis Related Group (DRG) Weight
Location : CLP Segment, Element 12
DISCHGPCT
Discharge Fraction
Location : CLP Segment, Element 13
CLMADJGRPCODE
Claim Adjustment Group Code
Location : CAS Segment, Element 1
CLMADJGRPDESC
Claim Adjustment Group Code Description
Location : CAS Segment, Element 1
CLMADJCODE
Location : CAS Segment, Element 2
Loop 2100
CLMADJAMT
Location : CAS Segment, Element 3
Loop 2100
CLMADJQTY
Location : CAS Segment, Element 4
Loop 2100
CLMADJCODEn
Claim Adjustment Code 1 thru 99
n = 1 to 99
Location : CAS Segment, Element 2
CLMADJAMTn
Claim Adjustment Amount 1 thru 99
n = 1 to 99
Location : CAS Segment, Element 3
CLMADJQTYn
Claim Adjustment Quantity 1 thru 99
n = 1 to 99
Location : CAS Segment, Element 4
CLAIMDATEEXP
Claim Expiration Date
Location : DTM Segment, Element 2
Element 1 Qualifier 036
CLAIMDATEREC
Claim Date Received
Location : DTM Segment, Element 2
Element 1 Qualifier 050
CLAIMMSTATEMENTPERIODSTART
Claim Statement Period Start
Location : DTM Segment, Element 2
Element 1 Qualifier 232
CLAIMMSTATEMENTPERIODEND
Claim Statement Period End
Location : DTM Segment, Element 2
Element 1 Qualifier 233
TRANSHANDCODE
Transaction Handling Code
Location : BPR Segment, Element 1
TRANSTOTALPAYAMT
Total Actual Provider Payment Amount
Location : BPR Segment, Element 2
TRANSDC
Transaction Type Credit/Debit
Location : BPR Segment, Element 3
TRANSPAYMETHOD
Transaction Payment Method
Location : BPR Segment, Element 4
TRANSDATE
Transaction Date
Location : BPR Segment, Element 16
TRACEREFRENCEID
Trace Reference Identification
Location : TRN Segment, Element 4
TRACEREFID
Trace Reference Identification
Location : TRN Segment, Element 2
TRACEORGID
Trace Originating Identifier
Location : TRN Segment, Element 4
XOVERCARRIER
CROSSOVER CARRIER NAME
Location : NM1 Segment, Element 3
Element 1 Qualifier TT
PAYEEADID
PAYEE ADDITIONAL IDENTIFICATION
Location : REF Segment, Element 2
RECEIVERID
Receiver ID
Location : REF Segment, Element 2
Element 1 Qualifier EV
PRODDATE
Production Date
Location : DTM Segment, Element 2
Element 1 Qualifier 405
PAYERNAME
Payer Name
Location : N1 Segment, Element 2
Element 1 Qualifier PR
PAYERADDRESS1
Payer Address 1
Location : N3 Segment, Element 1
PAYERADDRESS2
Payer Address 2
Location : N3 Segment, Element 2
PAYERCITY
Payer City
Location : N4 Segment, Element 1
PAYERSTATE
Payer State
Location : N4 Segment, Element 2
PAYERZIPCODE
Payer Zip Code
Location : N4 Segment, Element 3
PAYEEIDQUAL
Payee ID Code Qualifier
Location : N1 Segment, Element 3
Element 1 Qualifier PE
PAYEEID
Payee ID Code Qualifier
Location : N1 Segment, Element 4
Element 1 Qualifier PE
PAYEEADIDQUAL
Payee ID Code Qualifier
Location : N1 Segment, Element 3
Element 1 Qualifier PE
PAYEEADID
Payee Additional ID Code
Location : REF Segment, Element 2
PAYEENAME
Payee Name
Location : N1 Segment, Element 2
PAYEEADDRESS1
Payee Address 1
Location : N3 Segment, Element 1
PAYEEADDRESS2
Payee Address 2
Location : N3 Segment, Element 3
PAYEECITY
Payee City
Location : N4 Segment, Element 1
PAYEESTATE
Payee State
Location : N4 Segment, Element 2
PAYEEZIPCODE
Payee Zip Code
Location : N4 Segment, Element 3
SERVICEPROVIDER
Service Provider
Location : NM1 Segment, Element 3
Element 1 Qualifier 82
SERVICEPROVIDERID
Service Provider
Location : NM1 Segment, Element 9
Element 1 Qualifier 82
SERVICEPROVIDERIDQUAL
Service Provider
Location : NM1 Segment, Element 3
Element 1 Qualifier 82
PRIMARYCLAIMPATCTL
Claim Patient Control Number
Location : CLP Segment, Element 1
PRIMARYCLAIMSTATUSCODE
Claim Staus Code
Location : CLP Segment, Element 2
PRIMARYCLAIMSTATUSDESC
Claim Status Description
Location : CLP Segment, Element 2
PRIMARYCLAIMTOTALCHARGE
Claim Total Charge
Location : CLP Segment, Element 3
PRIMARYCLAIMTOTALPAID
Claim Total Paid
Location : CLP Segment, Element 4
PRIMARYPATRESPONSIBLE
Patient Responsibility
Location : CLP Segment, Element 5
PRIMARYFILIND
Filing Indicator
Location : CLP Segment, Element 6
PRIMARYFILINDDESC
Filing Indicator Description
Location : CLP Segment, Element 6
PRIMARYPAYERCLAIMCODE
Payer Claim Code
Location : CLP Segment, Element 7
PRIMARYFACILITYTYPECODE
Facility Type Code
Location : CLP Segment, Element 8
PRIMARYPAYERCLAIMCODE
Payer Claim Code
Location : CLP Segment, Element 8
PRIMARYCLAIMFREQ
Claim Frequency Code
Location : CLP Segment, Element 9
PRIMARYPATSTATCODE
Patient Status Code
Location : CLP Segment, Element 10
PRIMARYDRGCODE
Diagnosis Related Group (DRG) Code
Location : CLP Segment, Element 11
PRIMARYDRGQTY
Diagnosis Related Group (DRG) Weight
Location : CLP Segment, Element 12
PRIMARYDISCHGPCT
Discharge Fraction
Location : CLP Segment, Element 13
SECONDARYCLAIMPATCTL
Claim Patient Control Number
Location : CLP Segment, Element 1
SECONDARYCLAIMSTATUSCODE
Claim Staus Code
Location : CLP Segment, Element 2
SECONDARYCLAIMSTATUSDESC
Claim Status Description
Location : CLP Segment, Element 2
SECONDARYCLAIMTOTALCHARGE
Claim Total Charge
Location : CLP Segment, Element 3
SECONDARYCLAIMTOTALPAID
Claim Total Paid
Location : CLP Segment, Element 4
SECONDARYPATRESPONSIBLE
Patient Responsibility
Location : CLP Segment, Element 5
SECONDARYFILIND
Filing Indicator
Location : CLP Segment, Element 6
SECONDARYFILINDDESC
Filing Indicator Description
Location : CLP Segment, Element 6
SECONDARYPAYERCLAIMCODE
Payer Claim Code
Location : CLP Segment, Element 7
SECONDARYFACILITYTYPECODE
Facility Type Code
Location : CLP Segment, Element 8
SECONDARYPAYERCLAIMCODE
Payer Claim Code
Location : CLP Segment, Element 8
SECONDARYCLAIMFREQ
Claim Frequency Code
Location : CLP Segment, Element 9
SECONDARYPATSTATCODE
Patient Status Code
Location : CLP Segment, Element 10
SECONDARYDRGCODE
Diagnosis Related Group (DRG) Code
Location : CLP Segment, Element 11
SECONDARYDRGQTY
Diagnosis Related Group (DRG) Weight
Location : CLP Segment, Element 12
SECONDARYDISCHGPCT
Discharge Fraction
Location : CLP Segment, Element 13
TERTIARYCLAIMPATCTL
Claim Patient Control Number
Location : CLP Segment, Element 1
TERTIARYCLAIMSTATUSCODE
Claim Staus Code
Location : CLP Segment, Element 2
TERTIARYCLAIMSTATUSDESC
Claim Status Description
Location : CLP Segment, Element 2
TERTIARYCLAIMTOTALCHARGE
Claim Total Charge
Location : CLP Segment, Element 3
TERTIARYCLAIMTOTALPAID
Claim Total Paid
Location : CLP Segment, Element 4
TERTIARYPATRESPONSIBLE
Patient Responsibility
Location : CLP Segment, Element 5
TERTIARYFILIND
Filing Indicator
Location : CLP Segment, Element 6
TERTIARYFILINDDESC
Filing Indicator Description
Location : CLP Segment, Element 6
TERTIARYPAYERCLAIMCODE
Payer Claim Code
Location : CLP Segment, Element 7
TERTIARYFACILITYTYPECODE
Facility Type Code
Location : CLP Segment, Element 8
TERTIARYPAYERCLAIMCODE
Payer Claim Code
Location : CLP Segment, Element 8
TERTIARYCLAIMFREQ
Claim Frequency Code
Location : CLP Segment, Element 9
TERTIARYPATSTATCODE
Patient Status Code
Location : CLP Segment, Element 10
TERTIARYDRGCODE
Diagnosis Related Group (DRG) Code
Location : CLP Segment, Element 11
TERTIARYDRGQTY
Diagnosis Related Group (DRG) Weight
Location : CLP Segment, Element 12
TERTIARYDISCHGPCT
Discharge Fraction
Location : CLP Segment, Element 13
SUBFNAME
Subscribers First Name
Location : NM1 Segment, Element 4
Element 1 Qualifier IL
SUBLNAME
Subscribers Last Name
Location : NM1 Segment, Element 3
Element 1 Qualifier IL
SUBMI
Subscribers Middle Initial
Location : NM1 Segment, Element 5
Element 1 Qualifier IL
SUBID
Subscribers ID
Location : NM1 Segment, Element 9
Element 1 Qualifier IL
SUBIDQUAL
Subscribers ID Qualifier
Location : NM1 Segment, Element 8
Element 1 Qualifier IL
PATFNAME
Patient First Name
Location : NM1 Segment, Element 4
Element 1 Qualifier QC
PATLNAME
Patient Last Name
Location : NM1 Segment, Element 3
Element 1 Qualifier QC
PATMI
Patient Middle Initial
Location : NM1 Segment, Element 5
Element 1 Qualifier QC
PATID
Patient ID
Location : NM1 Segment, Element 9
Element 1 Qualifier QC
PATIDQUAL
Patient ID Qualifier
Location : NM1 Segment, Element 8
Element 1 Qualifier QC
MEDICALRECORDIDNUMBER
OTHER CLAIM RELATED IDENTIFICATION
Medical Record Identification Number
Location : REF Segment, Element 2
Element 1 Qualifier EA
GROUPPOLICYNUMBER
OTHER CLAIM RELATED IDENTIFICATION
Group or Policy Number
Location : REF Segment, Element 2
Element 1 Qualifier 1L
MEMBERIDNUMBER
OTHER CLAIM RELATED IDENTIFICATION
Member Identification Number
Location : REF Segment, Element 2
Element 1 Qualifier 1W
REPRICECLAIMREFNUMBER
OTHER CLAIM RELATED IDENTIFICATION
Repriced Claim Reference Number
Location : REF Segment, Element 2
Element 1 Qualifier 9a
ADJREPRICECLAIMREFNUMBER
OTHER CLAIM RELATED IDENTIFICATION
Adjusted Repriced Claim Reference Number
Location : REF Segment, Element 2
Element 1 Qualifier 9c
EMPLOYEEIDNUMBER
OTHER CLAIM RELATED IDENTIFICATION
Employee Identification Number
Location : REF Segment, Element 2
Element 1 Qualifier A6
AUTHORIZATIONNUMBER
OTHER CLAIM RELATED IDENTIFICATION
Authorization Number
Location : REF Segment, Element 2
Element 1 Qualifier BB
CLASSCONTRACTCODE
OTHER CLAIM RELATED IDENTIFICATION
Class of Contract Code
Location : REF Segment, Element 2
Element 1 Qualifier CE
ORIGINALREFNUMBER
OTHER CLAIM RELATED IDENTIFICATION
Original Reference Number
Location : REF Segment, Element 2
Element 1 Qualifier FB
PRIORAUTHORIZATIONMUMBER
OTHER CLAIM RELATED IDENTIFICATION
Prior Authorization Number
Location : REF Segment, Element 2
Element 1 Qualifier G1
BENEFITIDNUMBER
OTHER CLAIM RELATED IDENTIFICATION
Predetermination of Benefits Identification Number
Location : REF Segment, Element 2
Element 1 Qualifier G3
INSURANCEPOLICYNUMBER
OTHER CLAIM RELATED IDENTIFICATION
Insurance Policy Number
Location : REF Segment, Element 2
Element 1 Qualifier IG
SSN
OTHER CLAIM RELATED IDENTIFICATION
Social Security Number
Location : REF Segment, Element 2
Element 1 Qualifier SY
RENPROVBLUECROSSID
RENDERING PROVIDER INFORMATION
Blue Cross Provider Number
Location : REF Segment, Element 2
Element 1 Qualifier 1A
RENPROVBLUESHIELDID
RENDERING PROVIDER INFORMATION
Blue Shield Provider Number
Location : REF Segment, Element 2
Element 1 Qualifier 1B
RENPROVMEDICAREID
RENDERING PROVIDER INFORMATION
Medicare Provider Number
Location : REF Segment, Element 2
Element 1 Qualifier 1C
RENPROVMEDICAIDID
RENDERING PROVIDER INFORMATION
Medicaid Provider Number
Location : REF Segment, Element 2
Element 1 Qualifier 1D
RENPROVUPINID
RENDERING PROVIDER INFORMATION
UPIN Provider Number
Location : REF Segment, Element 2
Element 1 Qualifier 1G
RENPROVCHAMUSID
RENDERING PROVIDER INFORMATION
Champus Provider Number
Location : REF Segment, Element 2
Element 1 Qualifier 1H
RENPROVFACILITYID
RENDERING PROVIDER INFORMATION
Facility Provider Number
Location : REF Segment, Element 2
Element 1 Qualifier 1J
RENPROVNPIID
RENDERING PROVIDER INFORMATION
Natioanl Provider ID Number
Location : REF Segment, Element 2
Element 1 Qualifier HPI
RENPROVTAXID
RENDERING PROVIDER INFORMATION
Federal Tax ID Number
Location : REF Segment, Element 2
Element 1 Qualifier TJ
CLAIMSUPPLEMENTALCA
Claim Supplemental Quantity Information Covered - Actual
Location : REF Segment, Element 2
Element 1 Qualifier CA
CLAIMSUPPLEMENTALCD
Claim Supplemental Quantity Information Co-insured - Actual
Location : REF Segment, Element 2
Element 1 Qualifier CD
CLAIMSUPPLEMENTALLA
Claim Supplemental Quantity Information Life-time Reserve - Actual
Location : REF Segment, Element 2
Element 1 Qualifier LA
CLAIMSUPPLEMENTALLE
Claim Supplemental Quantity Information Life-time Reserve - Estimate
Location : REF Segment, Element 2
Element 1 Qualifier LE
CLAIMSUPPLEMENTALNA
Claim Supplemental Quantity Information Number of Non-covered Days
Location : REF Segment, Element 2
Element 1 Qualifier NA
CLAIMSUPPLEMENTALNE
Claim Supplemental Quantity Information Non-Covered - Estimated
Location : REF Segment, Element 2
Element 1 Qualifier NE
CLAIMSUPPLEMENTALNR
Claim Supplemental Quantity Information Not Replaced Blood Units
Location : REF Segment, Element 2
Element 1 Qualifier NR
CLAIMSUPPLEMENTALOU
Claim Supplemental Quantity Information Outlier Days
Location : REF Segment, Element 2
Element 1 Qualifier OU
CLAIMSUPPLEMENTALPS
Claim Supplemental Quantity Information Prescription
Location : REF Segment, Element 2
Element 1 Qualifier PS
CLAIMSUPPLEMENTALVS
Claim Supplemental Quantity Information Visits
Location : REF Segment, Element 2
Element 1 Qualifier VS
CLAIMSUPPLEMENTALZK
Claim Supplemental Quantity Information Federal
Medicare or Medicaid Payment Mandate - Category 1
Location : REF Segment, Element 2
Element 1 Qualifier ZK
CLAIMSUPPLEMENTALZL
Claim Supplemental Quantity Information Federal
Medicare or Medicaid Payment Mandate - Category 2
Location : REF Segment, Element 2
Element 1 Qualifier ZL
CLAIMSUPPLEMENTALZM
Claim Supplemental Quantity Information Federal
Medicare or Medicaid Payment Mandate - Category 3
Location : REF Segment, Element 2
Element 1 Qualifier ZM
CLAIMSUPPLEMENTALZN
Claim Supplemental Quantity Information Federal
Medicare or Medicaid Payment Mandate - Category 4
Location : REF Segment, Element 2
Element 1 Qualifier ZN
CLAIMSUPPLEMENTALZO
Claim Supplemental Quantity Information Federal
Medicare or Medicaid Payment Mandate - Category 5
Location : REF Segment, Element 2
Element 1 Qualifier ZO
- - - - - - - - - - - - - -
Service Line Level
01 to 99
- - - - - - - - - - - - - -
DATEOFSERVICE01
Date of Service
Location : DTM Segment, Element 2
Element 1 Qualifier 472
PROCEDURE01
Procedure
Location : SVC Segment, Element 1
Subvalue 2
PROCEDUREMODA01
Procedure Modifier
Location : SVC Segment, Element 1
Subvalue 3
PROCEDUREMODB01
Procedure Modifier
Location : SVC Segment, Element 1
Subvalue 4
PROCEDUREMODC01
Procedure Modifier
Location : SVC Segment, Element 1
Subvalue 5
PROCEDUREMODD01
Procedure Modifier
Location : SVC Segment, Element 1
Subvalue 6
PROCBILLEDAMT01
Procedure Billed Amount
Location : SVC Segment, Element 2
PROCPAYAMT01
Procedure Paid Amount
Location : SVC Segment, Element 3
PROCREVENUECODE01
Procedure Revenue Code
Location : SVC Segment, Element 4
PROCUNITSPAID01
Procedure Units Paid
Location : SVC Segment, Element 5
PROCUNITS01
Procedure Original Units
Location : SVC Segment, Element 7
PROCEDUREDESCRIPTION
Procedure Code Description
Location : SVC Segment, Element 1
Subelement 7
PROCALLOWEDAMT01
Procedure Allowed Amount
Location : AMT Segment, Element 2
Element 1 Qualifier B6
PROCPERDAYLIMITAMT01
Procedure Per Day Limit
Location : AMT Segment, Element 2
Element 1 Qualifier DY
PROCDEDUCTIONAMT01
Procedure Deduction Amount
Location : AMT Segment, Element 2
Element 1 Qualifier KH
PROCNETBILLEDAMT01
Procedure Net Billed
Location : AMT Segment, Element 2
Element 1 Qualifier NE
PROCTAXAMT01
Procedure Tax
Location : AMT Segment, Element 2
Element 1 Qualifier T
PROCTOTALBEFORETAXESAMT01
Procedure Total Claim Before Taxes
Location : AMT Segment, Element 2
Element 1 Qualifier T2
PROCPAYAMT01
Procedure Pay Amount
Location : CAS Segment, Element 3
Element 1 Qualifier PR
PROCDEDUCTAMT01
Procedure Deductable Amount
Location : CAS Segment, Element 1
Element 1 Qualifier PR
PROCCOINSAMT01
Procedure Coinsurance Amount Amount
Location : CAS Segment, Element 2
Element 1 Qualifier PR
PROCCOADJAMT01
Location : CAS Segment, Element 3
Element 1 Qualifier CO
PROCPROTHERAM01
Location : CAS Segment, Element 2,5
Element 1 Qualifier PR
PROCCOPAYAMT01
Location : CAS Segment, Element 3
Element 1 Qualifier PR
SERVICEDATEFROM01
Service Date From
Location : DTM Segment, Element 2
Element 1 Qualifier 150
SERVICEDATETO01
Service Date From
Location : DTM Segment, Element 2
Element 1 Qualifier 151
PROCPRIORAUTHNUMBER01
Prior Auth
Location : REF Segment, Element 2
Element 1 Qualifier G1
PROCCTLNUMBER01
Procedur Line Control Number
Location : REF Segment, Element 2
Element 1 Qualifier 6R
PROCADJGRPCODE01
Procedure Adjustemt Group Code
Location : CAS Segment, Element 2
PROCADJCODE01
Procedure Adjustemt Code
Location : CAS Segment, Element 3
PROCREMARKCODE01
Procedure Remark Code
Location : LQ Segment, Element 1
- - - - - - - - - - - - - -
Provider Adjustment
- - - - - - - - - - - - - -
PROVADJREFID
Provider Adjustment Provider Reference ID
Location : PLB Segment, Element 1
PROVADJPERIOD
Provider Adjustment Period
Location : PLB Segment, Element 2
PROVADJRESONCODE1
Provider Adjustment Reason Code
Location : PLB Segment, Element 3
SubValue 1
PROVADJREASONID1
Provider Adjustment Reason ID
Location : PLB Segment, Element 3
SubValue 2
PROVADJAMT1
Provider Adjustment Amount
Location : PLB Segment, Element 4
PROVADJRESONCODE2
Provider Adjustment Reason Code
Location : PLB Segment, Element 5
SubValue 1
PROVADJREASONID2
Provider Adjustment Reason ID
Location : PLB Segment, Element 5
SubValue 2
PROVADJAMT2
Provider Adjustment Amount
Location : PLB Segment, Element 6
PROVADJRESONCODE3
Provider Adjustment Reason Code
Location : PLB Segment, Element 7
SubValue 1
PROVADJREASONID3
Provider Adjustment Reason ID
Location : PLB Segment, Element 7
SubValue 2
PROVADJAMT3
Provider Adjustment Amount
Location : PLB Segment, Element 8
PROVADJRESONCODE4
Provider Adjustment Reason Code
Location : PLB Segment, Element 9
SubValue 1
PROVADJREASONID4
Provider Adjustment Reason ID
Location : PLB Segment, Element 9
SubValue 2
PROVADJAMT4
Provider Adjustment Amount
Location : PLB Segment, Element 10
PROVADJRESONCODE5
Provider Adjustment Reason Code
Location : PLB Segment, Element 11
SubValue 1
PROVADJREASONID5
Provider Adjustment Reason ID
Location : PLB Segment, Element 11
SubValue 2
PROVADJAMT5
Provider Adjustment Amount
Location : PLB Segment, Element 12
PROVADJRESONCODE6
Provider Adjustment Reason Code
Location : PLB Segment, Element 13
SubValue 1
PROVADJREASONID6
Provider Adjustment Reason ID
Location : PLB Segment, Element 13
SubValue 2
PROVADJAMT6
Provider Adjustment Amount
Location : PLB Segment, Element 14
- - - - - - - - - - - - - -
Medicare Inpatient Adjudication
- - - - - - - - - - - - - -
MIACOVDVC
Covered Days or Visits Count
Location : MIA Segment, Element 1
MIAOPOUTAMT
PPS Operating Outlier Amount
Location : MIA Segment, Element 2
MIALIFPSYDAYS
Lifetime Psychiatric Days Count
Location : MIA Segment, Element 3
MIADRGAMT
Claim DRG Amount
Location : MIA Segment, Element 4
MIAREMARK1
Remark Code
Location : MIA Segment, Element 5
MIASHAREAMT
Claim Disproportionate Share Amount
Location : MIA Segment, Element 6
MIAMSPPASSAMT
Claim MSP Pass-through Amount
Location : MIA Segment, Element 7
MIAPPSCAPAMT
Claim PPS Capital Amount
Location : MIA Segment, Element 8
MIAFSPDRGAMT
PPS-Capital FSP DRG Amount
Location : MIA Segment, Element 9
MIAHSPDRGAMT
PPS-Capital HSP DRG Amount 10
Location : MIA Segment, Element
MIADHSDRGAMT
PPS-Capital DSH DRG Amount
Location : MIA Segment, Element 11
MIAOLDCAPAMT
Old Capital Amount
Location : MIA Segment, Element 12
MIAIMEAMT
PPS-Capital IME amount
Location : MIA Segment, Element 13
MIAOHSDRG
PPS-Operating Hospital Specific DRG Amount
Location : MIA Segment, Element 14
MIACOSTRPTDATCNT
Cost Report Day Count
Location : MIA Segment, Element 15
MIAOFSDRG
PPS-Operating Federal Specific DRG Amount
Location : MIA Segment, Element 16
MIAPPSCAPOUTAMT
Claim PPS Capital Outlier Amount
Location : MIA Segment, Element 17
MIAINDTEACHAMT
Claim Indirect Teaching Amount
Location : MIA Segment, Element 18
MIANONPAYPROAMT
Nonpayable Professional Component Amount
Location : MIA Segment, Element 19
MIAREMARK2
Remark Code
Location : MIA Segment, Element 20
MIAREMARK3
Remark Code
Location : MIA Segment, Element 21
MIAREMARK4
Remark Code
Location : MIA Segment, Element 22
MIAREMARK5
Remark Code
Location : MIA Segment, Element 23
MIACAPEXCPAMT
PPS-Capital Exception Amount
Location : MIA Segment, Element 24
- - - - - - - - - - - - - -
Medicare Outpatient Adjudication
- - - - - - - - - - - - - -
MOAPERCENT
Medicare Outpatient Adjudication Percent
Location : MOA Segment, Element 1
MOAMOUNTPAYABLE"
Medicare Outpatient Adjudication Amount
Location : MOA Segment, Element 2
MOAREMARK1
Medicare Outpatient Adjudication Remark 1
Location : MOA Segment, Element 3
MOAREMARK2
Medicare Outpatient Adjudication Remark 2
Location : MOA Segment, Element 4
MOAREMARK3
Medicare Outpatient Adjudication Remark 3
Location : MOA Segment, Element 5
MOAREMARK4
Medicare Outpatient Adjudication Remark 4
Location : MOA Segment, Element 6
MOAREMARK5
Medicare Outpatient Adjudication Remark 5
Location : MOA Segment, Element 7
MOAPAYMENT
Medicare Outpatient Adjudication Payment Amount
Location : MOA Segment, Element 8
MOANONPAYABLE
Medicare Outpatient Adjudication Non Payable Amount
Location : MOA Segment, Element 9
Section 6
The X12 Utility is capable sending and tracking X12 837 files.
The X12 Utility can be configured to run your favorite electronic
claims software that you are using to create X12 837 claim files,
transmit the files created from that system, archive the file, and
then track its progress relative to aging and received X12 files.
Section 7
Data Communications
Provides asynchronous communications for the uploading and
downloading of claim data via a Hayes compatible modem.
There is support for the C1Script Language so that you may
write automated logons to host computers. It also supplies
integrated access to the Mail Application Programming
Interface MAPI.
1) Select Data Communications (UTILITES MENU) to display the
Data Communications Package menu:
- Functions
- Help
- Exit
Functions Menu contains:
- Port Settings
- Terminal Emulator
- Launch Web Browser
- Send MAPI Email
PORT SETTINGS
2) Select Port Settings to display the Data Communications
Port Configuration screen. This screen displays a listbox
with the following fields:
- Port Type
- Port Number
- Modem Speed
- Word Length
- Parity
- Stop Bits
3) Click on the ADD PORT button to display the Data Communications
Port Editor. Each of the fields have a gray button to click
on to select the appropriate option:
Port - select from COM1 through COM10 to set the port
your modem uses for communication.
Speed - select from 300,1200, 2400, 4800, 9600, 19200,
38400, 57600, 115200 and 230400 to set the
modem communications speed.
Word Length - select from 5, 6, 7 or 8 bit to set word
length.
Parity - select from None, Even, Odd, Mark or Space the
type of parity to be used.
Stop Bits - select from 1 or 2 stop bits the number of
stop bits used.
Port Type - select from Direct Connect Serial Communications
or Hayes Compatible modem type.
Important Note: To verify proper com port numbers and to determine
that the ports selected are working properly,
e
the Control Panel and then Modems.
TERMINAL EMULATOR
4) Click on Terminal Emulator button to display the Data
Communications Port Configuration screen. The Port Settings
you selected will display in the list box.
Click the SELECT button to display the Terminal Emulator
(Type 1) screen.
Section 8
************************************** Basic Script
***************************************************
***************************************************
****************************************** Top Menu
top:
set menu item a to "Send Claim File" sendemc
set menu item b to "View Claim File" view
set menu item c to "Exit Script" end
popup menu "Basic Script"end
goto end
************************************ Send file
sendemc:
set port to select
transmit "ATZ0^M"
waitfor "OK" 20 sendemca sendemcz
sendemca:
transmit "AT\N1^M"
waitfor "OK" 20 sendemcb sendemcz
sendemcb:
transmit "ATDT"
transmit $phonenumber
transmit "^M"
waitfor "CONNECT" 240 sendemcc sendemcz
sendemcc:
pause 5
send xmodem checksum $sendfile
sendemcm:
message "Transmission Successful"
goto end
sendemcz:
message "Send Fail"
goto end
******************************** View or Print Transmission File
view:
print file "Transmission" 132 $sendfile
goto top
******************************* End of Script
end:
quit
Section 9
************** (c) 1992-2007 Com1 Software Development
****************** (c) 1992-2005 Com1 Software Development
****************** (c) 1992-2005 Com1 Software Development
You can order the Model C1D0F431 X12 Utility online at:
******************************************************
************************* GPNet Dialup Script
************************* Ohio West Virginia Medicare
*************************
***************************************************
***************************************************
*
****************************************** Top Menu
topmenu:
set menu item a to "Send Claims" send837
set menu item b to "Receive Files" receiveque
set menu item c to "Exit Script" end
popup menu "TrailBlaizers EDI Script Main Menu"
goto end
**************************************************** Send 837
send837:
set port to select
**************************** option to clear modem
**transmit "ATZ0^M"
**waitfor "OK"
transmit "ATDT"
transmit $phonenumber
transmit "^M"
waitfor "CONNECT" 240 send837a
message "Dial Up Failure."
goto send837z
*****************************
SEND837a:
waitfor "login:" 60 send837b
message "Login Failure"
goto send837z
*****************************
SEND837b:
transmit $logon
transmit "^M"
waitfor "Password" 60 send837c
message "Password Failure"
goto end
****************************
SEND837c:
transmit $password
transmit "^M"
waitfor "continue" 60 send837d
message "
goto end
****************************
SEND837d:
transmit "^M"
waitfor "Selection" 60 send837e
message "Main Menu Selection Failure"
goto end
****************************
SEND837e:
transmit "2"
transmit "^M"
waitfor "Select Protocol" 60 send837f
message "Select Protocol Failure"
goto end
****************************
SEND837f:
pause 3
transmit "Z"
waitfor "ZMODEM" 60 send837g
message "Zmodem Selection Response Failure"
goto end
****************************
SEND837g:
send zmodem $sendfile
waitfor "SUCCESSFULLY" 60 send837h
message "Zmodem Send File Failure"
goto end
****************************
SEND837h:
transmit "^M"
waitfor "Selection" 60 send837i
message "Main Menu Selection Failure"
goto end
****************************
SEND837I:
transmit "Q"
transmit "^M"
message "Transmission Successful"
goto end
****************************************************************
**************************************************** receive que
receiveque:
set port to select
**************************** option to clear modem
**transmit "ATZ0^M"
**waitfor "OK"
transmit "ATDT"
transmit $phonenumber
transmit "^M"
waitfor "CONNECT" 240 receivequea
message "Dial Up Failure."
goto receivequez
*****************************
receivequea:
waitfor "login:" 60 receivequeb
message "Login Failure"
goto receivequez
*****************************
receivequeb:
transmit $logon
transmit "^M"
waitfor "Password" 60 receivequec
message "Password Failure"
goto end
****************************
receivequec:
transmit $password
transmit "^M"
waitfor "continue" 60 receivequed
message "
goto end
****************************
receivequed:
transmit "^M"
waitfor "Selection" 60 receivequee
message "Main Menu Selection Failure"
goto end
****************************
receivequee:
transmit "1"
transmit "^M"
waitfor "Select Protocol" 60 receivequef
message "Select Protocol Failure"
goto end
****************************
receivequef:
pause 3
transmit "Z"
waitfor "(Y/N)" 60 receivequeg
message "Y/N Failure"
goto end
****************************
receivequeg:
pause 3
transmit "Y"
waitfor "ZMODEM" 60 receivequei
message "ZMODEM STRART Failure"
goto end
****************************
receivequei:
pause 3
RECEIVE ZMODEM QUE "I0000001"
waitfor "SUCCESSFULLY" 60 receivequej
message "Zmodem receive File Failure"
goto end
****************************
receivequej:
transmit "^M"
waitfor "Selection" 60 receivequek
message "Main Menu Selection Failure"
goto end
****************************
receivequek:
transmit "Q"
transmit "^M"
message "Transmission Successful"
goto end
*************************************************
********************************************* End
end:
quit
********
Section 10Anthem BCBS Zmodem Dialup Script
[Table of Contents]
*****************************************
********************************************** Anthem BCBS
*****************************************
***************************************** Basic Dial Up
***************************************** Script.
*************************************************************
*****************************************
***************************************** Built and tested
***************************************** August 2005.
*****************************************
*************************************************************
**************************************************** Top Menu
top:
set menu item a to "Send 837 Claims " send837
set menu item b to "Receive Reports" reports
set menu item c to "Receive Remmitance" remit
set menu item d to "Activity Log" logs
set menu item e to "Complete Session" session
set menu item f to "Exit Script" end
popup menu "Anthem BCBS Script Main Menu"end
goto end
**************************************************** Send 837
send837:
set port to select
**transmit "ATZ0^M"
**waitfor "OK"
transmit "ATDT"
transmit $phonenumber
transmit "^M"
waitfor "CONNECT" 240 send837a
message "Dial Up Failure."
goto send837z
*****************************
SEND837a:
waitfor "login:" 60 send837b
message "Login Failure"
goto send837z
*****************************
SEND837b:
transmit $logon
transmit "^M"
waitfor "Password:" 60 send837c
message "Password Failure"
goto send837z
****************************
SEND837c:
transmit $password
transmit "^M"
waitfor "AECN: START" 60 send837d
message "AECN:Start Failure"
goto send837z
****************************
SEND837d:
transmit "@sndzmodem^M"
waitfor "rz ready" 60 send837e
message "Zmodem Ready Failure"
goto send837z
****************************
SEND837e:
send zmodem $sendfile
waitfor "RECEIVED CLAIMS" 60 send837f
message "Zmodem Send File Failure"
goto send837z
****************************
SEND837f:
transmit "MAILIT^M"
****************************
SEND837y:
message "Send 837 Successful"
goto TOP
****************************
send837z:
message "Send 837 Fail"
goto TOP
********************************************** Reports
reports:
set port to select
**transmit "ATZ0^M"
**waitfor "OK"
transmit "ATDT"
transmit $phonenumber
transmit "^M"
waitfor "CONNECT" 240 reportsa
message "Dial Up Failure."
goto reportsz
*****************************
reportsa:
waitfor "login:" 60 reportsb
message "Login Failure"
goto reportsz
*****************************
reportsb:
transmit $logon
transmit "^M"
waitfor "Password:" 60 reportsc
message "Password Failure"
goto repotsz
****************************
reportsc:
transmit $password
transmit "^M"
waitfor "AECN: START" 60 reportsd
message "AECN:Start Failure"
goto reportsz
****************************
reportsd:
transmit "@rcvzmodem^M"
waitfor "AECN: SENDING REPORT/MAIL" 60 reportse
message "Zmodem Ready Failure"
goto reportsz
****************************
reportse:
receive zmodem que $que
waitfor "AECN: REPORT SENT" 60 reportsf
message "Zmodem Send File Failure"
goto reportsz
****************************
reportsf:
transmit "MAILIT^M"
****************************
reportsy:
message "Reports Successful"
goto TOP
****************************
reportsz:
message "Reports Fail"
goto TOP
********************************************** remit
remit:
********************************************** Activity Log
logs:
***********
************************** Session
session:
********************************************* End
end:
quit
********
Section 11Anthem BCBS Kermit Dialup Script
[Table of Contents]
*****************************************
********************************************** Anthem BCBS
***************************************** Using Kermit
***************************************** Basic Dial Up
***************************************** Script.
*************************************************************
*****************************************
***************************************** Built and tested
***************************************** August 2005.
*****************************************
****************************************** Kermit Que not working
*************************************************************
**************************************************** Top Menu
top:
set menu item a to "Send 837 Claims " send837
set menu item b to "Receive Reports" reports
set menu item c to "Receive Remmitance" remit
set menu item d to "Activity Log" logs
set menu item e to "Exit Script" end
popup menu "Anthem BCBS KERMIT Script Main Menu"end
goto end
**************************************************** Send 837
send837:
set port to select
**transmit "ATZ0^M"
**waitfor "OK"
transmit "ATDT"
transmit $phonenumber
transmit "^M"
waitfor "CONNECT" 240 send837a
message "Dial Up Failure."
goto send837z
*****************************
SEND837a:
waitfor "login:" 60 send837b
message "Login Failure"
goto send837z
*****************************
SEND837b:
transmit $logon
transmit "^M"
waitfor "Password:" 60 send837c
message "Password Failure"
goto send837z
****************************
SEND837c:
transmit $password
transmit "^M"
waitfor "AECN: START" 60 send837d
message "AECN:Start Failure"
goto send837z
****************************
SEND837d:
transmit "@sndkermit^M"
waitfor "KERMIT READY" 60 send837e
message "Kermit Ready Failure"
goto send837z
****************************
SEND837e:
send kermit $sendfile
waitfor "RECEIVED CLAIMS" 60 send837f
message "Kermit Send File Failure"
goto send837z
****************************
SEND837f:
transmit "MAILIT^M"
****************************
SEND837y:
message "Kermit Send 837 Successful"
goto TOP
****************************
send837z:
message "Kermit Send 837 Fail"
goto TOP
********************************************** Reports
reports:
set port to select
**transmit "ATZ0^M"
**waitfor "OK"
transmit "ATDT"
transmit $phonenumber
transmit "^M"
waitfor "CONNECT" 240 reportsa
message "Dial Up Failure."
goto reportsz
*****************************
reportsa:
waitfor "login:" 60 reportsb
message "Login Failure"
goto reportsz
*****************************
reportsb:
transmit $logon
transmit "^M"
waitfor "Password:" 60 reportsc
message "Password Failure"
goto repotsz
****************************
reportsc:
transmit $password
transmit "^M"
waitfor "AECN: START" 60 reportsd
message "AECN:Start Failure"
goto reportsz
****************************
reportsd:
transmit "@rcvkermit^M"
waitfor "AECN: SENDING REPORT/MAIL" 60 reportse
message "Kermit Ready Failure"
goto reportsz
****************************
reportse:
receive kermit que $que
waitfor "AECN: REPORT SENT" 60 reportsf
message "Kermit Reports Sent Failure"
goto reportsz
****************************
reportsf:
transmit "MAILIT^M"
****************************
reportsy:
message "Reports Successful"
goto TOP
****************************
reportsz:
message "Reports Fail"
goto TOP
********************************************** remit
remit:
********************************************** Activity Log
logs:
set port to select
transmit "ATDT"
transmit $phonenumber
transmit "^M"
waitfor "CONNECT" 240 logsa
message "Dial Up Failure."
goto logsz
*****************************
logsa:
waitfor "login:" 30 logsb
message "Login Failure"
goto logsz
*****************************
logsb:
transmit $logon
transmit "^M"
waitfor "Password:" 30 logsc
message "Password Failure"
goto logsz
****************************
logsc:
transmit $password
transmit "^M"
waitfor "AECN: START" 30 logsd
message "AECN:Start Failure"
goto logsz
****************************
logsd:
transmit "@rcvkermit^M"
waitfor "AECN: SENDING ACTIVITY REPORT" 30 logse
message "Kermit Ready Failure"
goto logsz
****************************
logse:
waitfor "KERMIT READY" 30 logsf
message "Kermit Logs Sent Failure"
goto logsz
****************************
logsf:
receive kermit que $que
****************************
logsy:
message "Activity Logs Successful"
goto end
****************************
logsz:
message "Activity Logs Fail"
goto end
***********
********************************************* End
end:
quit
********
Section 12Order Form Model F431
[Table of Contents]
http://com1software.com
(c) 1992-2010 Com1 Software, Inc.