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Sub-Field: 368.013

Package: Integrated Billing

HEALTH CARE CLAIM RFAI (277)(#368)-->368.013

Sub-Field: 368.013


Information

Parent File Name Number Package
HEALTH CARE CLAIM RFAI (277)(#368) STC SEQ 368.013 Integrated Billing

Details

Field # Name Loc Type Details
.01 STC SEQ 0;1 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>9999999999)!(X<1)!(X?.E1"."1.N) X
  • LAST EDITED:  DEC 01, 2015
  • HELP-PROMPT:  Type a number between 1 and 9999999999, 0 decimal digits.
  • DESCRIPTION:  
    This field will contain the sequence number for the STC SEQ multiple field.
  • CROSS-REFERENCE:  368.013^B
    1)= S ^IBA(368,DA(1),13,"B",$E(X,1,30),DA)=""
    2)= K ^IBA(368,DA(1),13,"B",$E(X,1,30),DA)
.02 STATUS INFO EFFECTIVE DATE 0;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>8!($L(X)<1) X
  • LAST EDITED:  DEC 01, 2015
  • HELP-PROMPT:  Answer must be 1-8 characters in length.
  • DESCRIPTION:  
    This is the Status Information Effective Date field received from the FSC ASC X12N health Care Claim Request For Additional Information (277) message.  The value is received via the OBX-14 segment of the 277 HL message.
1.01 HEALTH CARE CLAIM STATUS CAT 1;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<1) X
  • LAST EDITED:  DEC 01, 2015
  • HELP-PROMPT:  Answer must be 1-30 characters in length.
  • DESCRIPTION:  This is the Health Care Claim Status Category Code field received from the FSC ASC X12N health Care Claim Request For Additional Information (277) message. The value is received via the OBX-3.4 segment of the 277 HL
    message.
1.02 ADDTL INFO REQUEST MOD 1;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<1) X
  • LAST EDITED:  DEC 01, 2015
  • HELP-PROMPT:  Answer must be 1-30 characters in length.
  • DESCRIPTION:  This is the Additional Information Request Modifier field received from the FSC ASC X12N health Care Claim Request For Additional Information (277) message. The value is received via the OBX-3.1 segment of the 277 HL
    message.
1.04 CODE LIST QUALIFIER CODE 1;4 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>3!($L(X)<1) X
  • LAST EDITED:  DEC 01, 2015
  • HELP-PROMPT:  Answer must be 1-3 characters in length.
  • DESCRIPTION:  
    This is the Code List Qualifier Code field received from the FSC ASC X12N health Care Claim Request For Additional Information (277) message.  The value is received via the OBX-3.3 segment of the 277 HL message.
10.01 HEALTH CARE CLAIM STATUS CAT 10;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<1) X
  • LAST EDITED:  DEC 01, 2015
  • HELP-PROMPT:  Answer must be 1-30 characters in length.
  • DESCRIPTION:  This is the Health Care Claim Status Category Code field received from the FSC ASC X12N health Care Claim Request For Additional Information (277) message. The value is received via the OBX-3.4 segment of the 277 HL
    message.
10.02 ADDTL INFO REQUEST MOD 10;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<1) X
  • LAST EDITED:  DEC 01, 2015
  • HELP-PROMPT:  Answer must be 1-30 characters in length.
  • DESCRIPTION:  This is the Additional Information Request Modifier field received from the FSC ASC X12N health Care Claim Request For Additional Information (277) message. The value is received via the OBX-3.1 segment of the 277 HL
    message.
10.04 CODE LIST QUALIFIER CODE 10;4 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>3!($L(X)<1) X
  • LAST EDITED:  DEC 01, 2015
  • HELP-PROMPT:  Answer must be 1-3 characters in length.
  • DESCRIPTION:  
    This is the Code List Qualifier Code field received from the FSC ASC X12N health Care Claim Request For Additional Information (277) message.  The value is received via the OBX-3.3 segment of the 277 HL message.
11.01 HEALTH CARE CLAIM STATUS CAT 11;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<1) X
  • LAST EDITED:  DEC 01, 2015
  • HELP-PROMPT:  Answer must be 1-30 characters in length.
  • DESCRIPTION:  This is the Health Care Claim Status Category Code field received from the FSC ASC X12N health Care Claim Request For Additional Information (277) message. The value is received via the OBX-3.4 segment of the 277 HL
    message.
11.02 ADDTL INFO REQUEST MOD 11;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<1) X
  • LAST EDITED:  DEC 01, 2015
  • HELP-PROMPT:  Answer must be 1-30 characters in length.
  • DESCRIPTION:  This is the Additional Information Request Modifier field received from the FSC ASC X12N health Care Claim Request For Additional Information (277) message. The value is received via the OBX-3.1 segment of the 277 HL
    message.
11.04 CODE LIST QUALIFIER CODE 11;4 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>3!($L(X)<1) X
  • LAST EDITED:  DEC 01, 2015
  • HELP-PROMPT:  Answer must be 1-3 characters in length.
  • DESCRIPTION:  
    This is the Code List Qualifier Code field received from the FSC ASC X12N health Care Claim Request For Additional Information (277) message.  The value is received via the OBX-3.3 segment of the 277 HL message.
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