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Sub-Field: 356.22168

Package: Integrated Billing

HCS REVIEW TRANSMISSION(#356.22)-->356.2216-->356.22168

Sub-Field: 356.22168


Information

Parent File Name Number Package
356.2216 SERVICE PROVIDER 356.22168 Integrated Billing

Details

Field # Name Loc Type Details
.01 PROVIDER TYPE 0;1 POINTER TO X12 271 ENTITY IDENTIFIER CODE FILE (#365.022) X12 271 ENTITY IDENTIFIER CODE(#365.022)

  • INPUT TRANSFORM:  S DIC("S")="I $$SPROVTYP^IBTRH5H()" D ^DIC K DIC S DIC=$G(DIE),X=+Y K:Y<0 X
  • OUTPUT TRANSFORM:  PROVIDER TYPE:DESCRIPTION
  • LAST EDITED:  FEB 20, 2015
  • HELP-PROMPT:  Enter a valid Provider Type code.
  • DESCRIPTION:  
    The Provider Type (entity identifier code) for this service line.
  • SCREEN:  S DIC("S")="I $$SPROVTYP^IBTRH5H()"
  • EXPLANATION:  Enter a valid Provider Type.
  • CROSS-REFERENCE:  356.22168^B
    1)= S ^IBT(356.22,DA(2),16,DA(1),8,"B",$E(X,1,30),DA)=""
    2)= K ^IBT(356.22,DA(2),16,DA(1),8,"B",$E(X,1,30),DA)
.02 PERSON / NON-PERSON 0;2 SET

  • LAST EDITED:  JAN 06, 2015
  • HELP-PROMPT:  Enter 1 if the selected Provider is a Person or N otherwise.
  • DESCRIPTION:  
    Determines whether or not the selected Provider for this service line is a Person or a Non-Person (e.g. a Facility).
.03 PROVIDER 0;3 VARIABLE POINTER NEW PERSON(#200)  IB NON/OTHER VA BILLING PROVIDER(#355.93)  INSTITUTION(#4)  

  • LAST EDITED:  FEB 23, 2016
  • HELP-PROMPT:  Enter a valid Provider.
  • DESCRIPTION:  
    The Provider for this service line.
.04 PER LOOP IDENTIFIER 0;4 POINTER TO X12 271 LOOP ID FILE (#365.027) X12 271 LOOP ID(#365.027)

  • LAST EDITED:  JAN 02, 2015
  • HELP-PROMPT:  Enter a valid Per Loop Identifier.
  • DESCRIPTION:  
    The PER Loop Identifier for this Service Line.
.05 CONTACT FUNCTION CODE 0;5 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>2!($L(X)<2) X
  • LAST EDITED:  DEC 31, 2014
  • HELP-PROMPT:  Enter the 2-character Contact Function Code (PER01).
  • DESCRIPTION:  
    The code identifying the major duty or responsibility of the person or group named.
.06 CONTACT NAME 0;6 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>60!($L(X)<1) X
  • LAST EDITED:  DEC 31, 2014
  • HELP-PROMPT:  Enter the 1-60 character free-form name (PER02).
  • DESCRIPTION:  
    The Free-form name of the Contact.
  • TECHNICAL DESCR:  
    Required when the response must be directed to a particular contact and when the name of the entity to contact is not already defined or is different than the name within the prior name segment (e.g., N1 or NM1).
.07 COMMUNICATION NO. QUALIFIER-1 0;7 POINTER TO X12 271 CONTACT QUALIFIER FILE (#365.021) X12 271 CONTACT QUALIFIER(#365.021)

  • INPUT TRANSFORM:  S DIC("S")="I $$COMQUAL^IBTRH5I()" D ^DIC K DIC S DIC=$G(DIE),X=+Y K:Y<0 X
  • LAST EDITED:  DEC 31, 2014
  • HELP-PROMPT:  Enter a valid Communication Qualifier code.
  • DESCRIPTION:  
    The Communication Qualifier to identify what kind of reference the related Contact Communication Number is.
  • TECHNICAL DESCR:  
    Required when PER02 is not valued in order to transmit a contact communication number.
  • SCREEN:  S DIC("S")="I $$COMQUAL^IBTRH5I()"
  • EXPLANATION:  To screen for valid Communication Qualifiers.
.08 COMMUNICATION NO. QUALIFIER-2 0;8 POINTER TO X12 271 CONTACT QUALIFIER FILE (#365.021) X12 271 CONTACT QUALIFIER(#365.021)

  • INPUT TRANSFORM:  S DIC("S")="I $$COMQUAL^IBTRH5I()" D ^DIC K DIC S DIC=$G(DIE),X=+Y K:Y<0 X
  • LAST EDITED:  DEC 31, 2014
  • HELP-PROMPT:  Enter a valid Communication Qualifier code.
  • DESCRIPTION:  
    The Communication Qualifier to identify what kind of reference the related Contact Communication Number is.
  • TECHNICAL DESCR:  
    Required when a telephone extension or multiple communication types are available.
  • SCREEN:  S DIC("S")="I $$COMQUAL^IBTRH5I()"
  • EXPLANATION:  To screen for valid Communication Qualifiers.
.09 COMMUNICATION NO. QUALIFIER-3 0;9 POINTER TO X12 271 CONTACT QUALIFIER FILE (#365.021) X12 271 CONTACT QUALIFIER(#365.021)

  • INPUT TRANSFORM:  S DIC("S")="I $$COMQUAL^IBTRH5I()" D ^DIC K DIC S DIC=$G(DIE),X=+Y K:Y<0 X
  • LAST EDITED:  DEC 31, 2014
  • HELP-PROMPT:  Enter a valid Communication Qualifier code.
  • DESCRIPTION:  
    The Communication Qualifier to identify what kind of reference the related Contact Communication Number is.
  • TECHNICAL DESCR:  
    Required when a telephone extension or multiple communicaton types are available.
  • SCREEN:  S DIC("S")="I $$COMQUAL^IBTRH5I()"
  • EXPLANATION:  To screen for valid Communication Qualifiers.
1 CONTACT COMMUNICATION NUMBER-1 1;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>250!($L(X)<1) X
  • LAST EDITED:  DEC 31, 2014
  • HELP-PROMPT:  Enter the 1-250 character Communication Number (PER04).
  • DESCRIPTION:  
    The Complete communications number including country or area code when applicable.
  • TECHNICAL DESCR:  
    Required when PER02 is not valued to transmit a contact communication number.
2 CONTACT COMMUNICATION NUMBER-2 2;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>250!($L(X)<1) X
  • LAST EDITED:  DEC 31, 2014
  • HELP-PROMPT:  Enter the 1-250 character Communication Number (PER06).
  • DESCRIPTION:  
    The Complete communications number including country or area code when applicable.
  • TECHNICAL DESCR:  
    Required when the telephone extension or multiple communication numbers are available.
3 CONTACT COMMUNICATION NUMBER-3 3;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>250!($L(X)<1) X
  • LAST EDITED:  DEC 31, 2014
  • HELP-PROMPT:  Enter the 1-250 character Communication Number (PER08).
  • DESCRIPTION:  
    The Complete communications number including country or area code when applicable.
  • TECHNICAL DESCR:  
    Required when the telephone extension or multiple communication numbers are available.
4.01 NM1 LOOP IDENTIFIER 4;1 POINTER TO X12 271 LOOP ID FILE (#365.027) X12 271 LOOP ID(#365.027)

  • LAST EDITED:  JAN 02, 2015
  • HELP-PROMPT:  Enter a valid NM1 Loop Identifier code.
  • DESCRIPTION:  
    The NM1 Loop Identifier.
4.02 ENTITY IDENTIFIER CODE 4;2 POINTER TO X12 271 ENTITY IDENTIFIER CODE FILE (#365.022) X12 271 ENTITY IDENTIFIER CODE(#365.022)

  • LAST EDITED:  DEC 31, 2014
  • HELP-PROMPT:  Enter the 2-3 character identifier code (NM101).
  • DESCRIPTION:  
    The code identifying an organizational entity, a physical location, property or an individual.
4.03 ENTITY TYPE QUALIFIER 4;3 SET

  • LAST EDITED:  DEC 31, 2014
  • HELP-PROMPT:  Enter the 1-digit code to qualify the Entity Type (NM102).
  • DESCRIPTION:  
    The code qualifying the type of entity.
  • TECHNICAL DESCR:  
    NM102 qualifies NM103.
4.04 CONTACT LAST OR COMPANY NAME 4;4 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>60!($L(X)<1) X
  • LAST EDITED:  JAN 02, 2015
  • HELP-PROMPT:  Enter 1-60 characters for the Contact Last/Company Name (NM103).
  • DESCRIPTION:  
    The individual last name or organizational name.
  • TECHNICAL DESCR:  
    Required when name information is used by the UMO to identify the requester.
4.05 CONTACT FIRST NAME 4;5 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>35!($L(X)<1) X
  • LAST EDITED:  JAN 02, 2015
  • HELP-PROMPT:  Enter 1-35 characters for the Contact First Name (NM104).
  • DESCRIPTION:  
    The individual first name.
  • TECHNICAL DESCR:  
    Required when name information is used by the UMO to identify the requester and the requester is a person.
4.06 CONTACT MIDDLE NAME 4;6 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>25!($L(X)<1) X
  • LAST EDITED:  JAN 02, 2015
  • HELP-PROMPT:  Enter 1-25 characters for the Contact Middle Name (NM105).
  • DESCRIPTION:  
    The individual middle name or initial.
  • TECHNICAL DESCR:  
    Required when NM104 is present and the middle name/initial of the person is known.
4.07 CONTACT NAME SUFFIX 4;7 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>10!($L(X)<1) X
  • LAST EDITED:  DEC 31, 2014
  • HELP-PROMPT:  Enter 1-10 characters for the Contact Name Suffix (NM107).
  • DESCRIPTION:  
    The Suffix to the individual name.
  • TECHNICAL DESCR:  
    Required when NM104 is valued and the suffix of the individual's name is known; e.g., Sr., Jr., or III.
4.08 IDENTIFICATION CODE QUALIFIER 4;8 POINTER TO X12 271 IDENTIFICATION QUALIFIER FILE (#365.023) X12 271 IDENTIFICATION QUALIFIER(#365.023)

  • LAST EDITED:  DEC 31, 2014
  • HELP-PROMPT:  Enter 1-2 characters for the Identification Code Qualifier (NM108).
  • DESCRIPTION:  
    The code designating the system/method of code structure used for Identification Code (67).
4.09 IDENTIFICATION CODE 4;9 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>80!($L(X)<2) X
  • LAST EDITED:  DEC 31, 2014
  • HELP-PROMPT:  Enter 2-80 characters for the Identification Code (NM109).
  • DESCRIPTION:  
    The code identifying a party or other code.
5 CONTACT ADDRESS LINE-1 5;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>55!($L(X)<1) X
  • LAST EDITED:  JAN 02, 2015
  • HELP-PROMPT:  Enter 1-55 characters of Line 1 of Address (N301).
  • DESCRIPTION:  
    The first line of Address Information.
  • TECHNICAL DESCR:  
    Use this element for the first line of the requester's address.
5.01 CONTACT ADDRESS LINE-2 5;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>55!($L(X)<1) X
  • LAST EDITED:  DEC 31, 2014
  • HELP-PROMPT:  Enter 1-55 characters of Line 2 of Address (N302).
  • DESCRIPTION:  
    The second line of Address Information.
  • TECHNICAL DESCR:  
    Use this element for the second line of the requester's address.
5.02 CONTACT CITY NAME 5;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<2) X
  • LAST EDITED:  DEC 31, 2014
  • HELP-PROMPT:  Enter 2-30 characters for the City Name (N401).
  • DESCRIPTION:  
    The Free-form text for the city name.
  • TECHNICAL DESCR:  
    A combination of either N401 through N404, or N405 and N406 may be adequate to specify a location.
5.03 CONTACT STATE OR PROVINCE 5;4 POINTER TO STATE FILE (#5) STATE(#5)

  • LAST EDITED:  DEC 31, 2014
  • HELP-PROMPT:  Enter 2 characters to identify the State or Province (N402).
  • DESCRIPTION:  
    The code (Standard or State/Province) as defined by the appropriate government agency.
  • TECHNICAL DESCR:  
    Required when the address is in the United States of America, including its territories, or Canada.
5.04 CONTACT ZIP CODE 5;5 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>15!($L(X)<3) X
  • LAST EDITED:  DEC 31, 2014
  • HELP-PROMPT:  Enter 3-15 characters for the Zip Code (N403).
  • DESCRIPTION:  
    The code defining international postal zone code excluding punctuation and blanks (zip code for United States).
  • TECHNICAL DESCR:  
    Required when the address is in the United States of America, including its territories, or Canada, or when a postal code exists for the country in N404.
5.05 CONTACT COUNTRY CODE 5;6 POINTER TO COUNTRY CODE FILE (#779.004) COUNTRY CODE(#779.004)

  • LAST EDITED:  DEC 31, 2014
  • HELP-PROMPT:  Enter 2-3 characters for the Country Code (NM404).
  • DESCRIPTION:  
    The Code identifying the country.
  • TECHNICAL DESCR:  
    Required when the address is outside the United States of America.
5.06 CONTACT COUNTRY SUBDIVISION 5;7 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>3!($L(X)<1) X
  • LAST EDITED:  DEC 31, 2014
  • HELP-PROMPT:  Enter 1-3 characters for the Country Subdivision Code (NM407).
  • DESCRIPTION:  
    The code identifying the country subdivision.
  • TECHNICAL DESCR:  Required when the address is not in the United States of America, including its territories, or Canada, and the country in N404 has administrative subdivisions such as but not limited to states, provinces, cantons,
    etc. Use the country subdivision codes from Part 2 of ISO 3166.
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