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Sub-Field: 368.021

Package: Integrated Billing

HEALTH CARE CLAIM RFAI (277)(#368)-->368.021

Sub-Field: 368.021


Information

Parent File Name Number Package
HEALTH CARE CLAIM RFAI (277)(#368) STC-SVC LINE STAT INFO SEQ 368.021 Integrated Billing

Details

Field # Name Loc Type Details
.01 STC-SVC LINE STAT INFO 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-SVC Line Stat Info Seq multiple field.
  • CROSS-REFERENCE:  368.021^B
    1)= S ^IBA(368,DA(1),21,"B",$E(X,1,30),DA)=""
    2)= K ^IBA(368,DA(1),21,"B",$E(X,1,30),DA)
.02 PRODUCT/SERVICE ID QUALIFIER 0;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>2!($L(X)<1) X
  • LAST EDITED:  NOV 09, 2015
  • HELP-PROMPT:  Answer must be 1-2 characters in length.
  • DESCRIPTION:  
    This is the Product/Service ID Qualifier field received from the FSC ASC X12N Health Care Claim Request For Additional Information (277) message.  The value is received via the PSL-6.1 segment of the 277 HL7 message.
.03 SERVICE IDENTIFICATION CODE 0;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>48!($L(X)<1) X
  • LAST EDITED:  NOV 09, 2015
  • HELP-PROMPT:  Answer must be 1-48 characters in length.
  • DESCRIPTION:  
    This is the Service Identification Code field received from the FSC ASC X12N Health Care Claim Request For Additional Information (277) message.  The value is received via the PSL-7.1 segment of the 277 HL7 message.
.04 PROCEDURE MODIFIER 1 0;4 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>2!($L(X)<1) X
  • LAST EDITED:  NOV 09, 2015
  • HELP-PROMPT:  Answer must be 1-2 characters in length.
  • DESCRIPTION:  
    This is the Procedure Modifier field received from the FSC ASC X12N Health Care Claim Request For Additional Information (277) message.  The value is received via the PSL-8.1 segment of the 277 HL7 message.
.05 PROCEDURE MODIFIER 2 0;5 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>2!($L(X)<1) X
  • LAST EDITED:  NOV 09, 2015
  • HELP-PROMPT:  Answer must be 1-2 characters in length.
  • DESCRIPTION:  
    This is the Procedure Modifier field received from the FSC ASC X12N Health Care Claim Request For Additional Information (277) message.  The value is received via the PSL-8.1 segment of the 277 HL7 message.
.06 PROCEDURE MODIFIER 3 0;6 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>2!($L(X)<1) X
  • LAST EDITED:  NOV 09, 2015
  • HELP-PROMPT:  Answer must be 1-2 characters in length.
  • DESCRIPTION:  
    This is the Procedure Modifier field received from the FSC ASC X12N Health Care Claim Request For Additional Information (277) message.  The value is received via the PSL-8.1 segment of the 277 HL7 message.
.07 PROCEDURE MODIFIER 4 0;7 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>2!($L(X)<1) X
  • LAST EDITED:  NOV 09, 2015
  • HELP-PROMPT:  Answer must be 1-2 characters in length.
  • DESCRIPTION:  
    This is the Procedure Modifier field received from the FSC ASC X12N Health Care Claim Request For Additional Information (277) message.  The value is received via the PSL-8.1 segment of the 277 HL7 message.
.08 LINE ITEM CHARGE AMOUNT 0;8 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>18!($L(X)<1) X
  • LAST EDITED:  NOV 09, 2015
  • HELP-PROMPT:  Answer must be 1-18 characters in length.
  • DESCRIPTION:  
    This is the Line Item Charge Amount field received from the FSC ASC X12N Health Care Claim Request For Additional Information (277) message.  The value is received via the PSL-16.1.1 segment of the 277 HL7 message.
.09 REVENUE CODE 0;9 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>48!($L(X)<1) X
  • LAST EDITED:  NOV 09, 2015
  • HELP-PROMPT:  Answer must be 1-48 characters in length.
  • DESCRIPTION:  
    This is the Revenue Code field received from the FSC ASC X12N Health Care Claim Request For Additional Information (277) message.  The value is received via the PSL-22.1 segment of the 277 HL7 message.
.1 LINE ITEM CONTROL NUMBER 0;10 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>50!($L(X)<1) X
  • LAST EDITED:  NOV 09, 2015
  • HELP-PROMPT:  Answer must be 1-50 characters in length.
  • DESCRIPTION:  
    This is the Line Item Control Number field received from the FSC ASC X12N Health Care Claim Request For Additional Information (277) message.  The value is received via the PSL 1.1 segment of the 277 HL7 message.
.11 SERVICE LINE DATE 0;11 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>35!($L(X)<1) X
  • LAST EDITED:  NOV 09, 2015
  • HELP-PROMPT:  Answer must be 1-35 characters in length.
  • DESCRIPTION:  
    This is the Service Line Date field received from the FSC ASC X12N Health Care Claim Request For Additional Information (277) message.  The value is received via the PSL 26.1 segment of the 277 HL7 message.
1.01 SERVICE LINE REF ID QUALIFIER 1;1 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 field will contain the Service Line Reference ID Qualifier received from the FSC ASC X12N health Care Claim Request For Additional Information (277) HL7 message.
99 STC SEQ-SERVICE LINE 99;0 Multiple #368.2199 368.2199

  • DESCRIPTION:  
    This multiple field will contain Service Line Status Information received from the FSC ASC X12N HEALTH Care Claim Request For Additional Information (277) HL message.
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