Field | Description | Values |
SEQNO
| Unique identifier for the claim.
| Numeric - 8 or 9 digits
|
AUTHNO1
| The primary insurance Authorization # set on the claim.
| Alphanumeric - Up to 30 characters
|
AUTHNO2
| The secondary insurance Authorization # set on the claim.
| Alphanumeric - Up to 30 characters
|
AUTHNO3
| The tertiary insurance Authorization # set on the claim.
| Alphanumeric - Up to 30 characters
|
BILLPROV
| The ID of the billing provider set on the claim.
| Numeric - 8 digits
|
BILLTO
| The current status of the claim
| 0: On Hold
1: Send to Insurance via Clearinghouse
2: Claim at Insurance
3: Balance Due Patient
5: Paid
6: Incomplete
7: User Print and Mail to Insurance
A: Deleted
C: Pending Insurance
D: Collection
E: Pending Patient
F: Appeal at Insurance
G: Waiting for Review
H: Denied at Insurance
J: Pending Physician
L: Rejected at Clearinghouse
|
BOX10D
| The Claim Codes set on the claim.
| Alphanumeric - Up to 20 characters
|
BOX11B
| The Other Claim ID set on the claim.
| Alphanumeric - Up to 28 characters
|
BOX19
| The Additional Claim Information set on the claim.
| Alphanumeric - Up to 83 characters
|
CLAIM_NOTE
| The Claim Note set on the claim.
(This deals with the field under the Additional Info tab, not with patient notes added to claims.)
| Alphanumeric - Up to 80 characters
|
CLAIMTYPE
| The claim's type (professional or institutional)
| P: Professional
I: Institutional
|
CTRLNO1
| The primary insurance Orig Claim # set on the claim.
| Alphanumeric - Up to 50 characters
|
CTRLNO2
| The secondary insurance Orig Claim # set on the claim.
| Alphanumeric - Up to 50 characters
|
CTRLNO3
| The tertiary insurance Orig Claim # set on the claim.
| Alphanumeric - Up to 50 characters
|
ENTERED
| The date/time that the claim was entered into CollaborateMD.
| Date/Time
|
FACILITY
| The ID of the facility set on the claim.
| Numeric - 8 digits
|
FOLLOWUP
| The Follow Up Date set on the claim.
| Date
|
FROMDATE
| The "From" date of service of the claim.
| Date
|
INSGRPID1
| The primary insurance Group Number set on the claim.
| Alphanumeric - Up to 29 characters
|
INSGRPID2
| The secondary insurance Group Number set on the claim.
| Alphanumeric - Up to 29 characters
|
INSGRPID3
| The tertiary insurance Group Number set on the claim.
| Alphanumeric - Up to 29 characters
|
INITTREATMENT
| The Initial Treatment Date set on the claim.
| Date
|
INSID1
| The primary insurance Member ID set on the claim.
| Alphanumeric - Up to 20 characters
|
INSID2
| The secondary insurance Member ID set on the claim.
| Alphanumeric - Up to 20 characters
|
INSID3
| The tertiary insurance Member ID set on the claim.
| Alphanumeric - Up to 20 characters
|
LASTSEENDT
| The Date Last Seen set on the claim.
| Date
|
LMP
| The Last Menstrual Period set on the claim.
| Date
|
MCAID90CODE
| The Delay Reason Code set on the claim.
| 1: Proof of Eligibility Unknown or Unavailable
2: Litigation
3: Authorization Delays
4: Delay in Certifying Provider
5: Delay in Supplying Billing Forms
6: Delay in Delivery of Custom-made Appliances
7: Third Party Processing Delay
8: Delay in Eligibility Determination
9: Original Claim Rejected or Denied Due to a Reason Unrelated to the Billing Limitation Rules
10: Administration Delay in the Prior Approval Process
12: Other
15: Natural Disaster
|
NONWORKFRDT
| The Unable to Work From Date set on the claim.
| Date
|
NONWORKTODT
| The Unable to Work To Date set on the claim.
| Date
|
ONSETDATE
| The Accident/Illness Date set on the claim.
| Date
|
ORDERING
| The ID of the ordering provider set on the claim.
(This represents the other provider on institutional claims.)
| Numeric - 8 digits
|
PATIENT
| The ID (account number) of the patient set on the claim.
| Numeric - 8 or 9 digits
|
PAYOR1
| The ID of the primary payer set on the claim.
| Numeric - 8 digits
|
PAYOR2
| The ID of the secondary payer set on the claim.
| Numeric - 8 digits
|
PAYOR3
| The ID of the tertiary payer set on the claim.
| Numeric - 8 digits
|
REFERRING
| The ID of the referring provider set on the claim.
| Numeric - 8 digits
|
RENDERING
| The ID of the rendering provider set on the claim.
(This represents the attending provider on institutional claims.)
| Numeric - 8 digits
|
SUPERVISING
| The ID of the supervising provider set on the claim.
(This represents the operating provider on institutional claims.)
| Numeric - 8 digits
|
TODATE
| The "To" date of service of the claim.
| Date
|