Field | Description | Values |
|
ACCTTYPE
| The patient's account type.
| 0: Other
1: Insurance
2: Worker's Comp
3: Corporate
4: Self Pay
5: Courtesy
6: Collection
7: Pre-collection
8: Type I
9: Type II
10: Payment Plan
11: Payment Plan Collection
12: Auto |
ETHNICITY
| The patient's ethnicity.
| 0: Unknown
1: Hispanic or Latino
2: Not Hispanic or Latino |
GRNTORRELATION
| The guarantor's relationship to the patient.
| N: None
S: Spouse
P: Parent
C: Child
R: Relative
O: Other |
INSEMGCP1
| Not Used / Ignore
|
N/A
|
INSEMGCP2
| Not Used / Ignore
|
N/A
|
INSEMGCP3
| Not Used / Ignore
|
N/A
|
ISSNO
| Insured SSN
| Numeric Field
|
MAILTOPATIENT
| Mail To (Statements)
|
N: Insured
Y: Patient
O: Other Insured
P: Primary Insurance
S: Secondary Insurance
G: Patient Guarantor
|
OADDR1
| Other Insured Address Line 1
| Text Field
|
OADDR2
| Other Insured Address Line 2
| Text Field
|
OBDATE
| Other Insured Date of Birth
| Date Field
|
OCITY
| Other Insured City
| Text Field
|
OEMPLOY
| Other Insured Employment Status
|
0: Employed full-time
1: Employed part-time
2: Not employed
3: Self Employed
4: Retired
5: On active military duty
|
OEMPNAME
| Other Insured Employer Name
| Text Field
|
OFIRST
| Other Insured First Name
| Text Field
|
OHOMEPH
| Other Insured Home Phone
| Numeric Field
|
OLAST
| Other Insured Last Name
| Text Field
|
OMI
| Other Insured Middle Name
| Text Field
|
ORELATION
| Other Insured Relationship to Patient
|
0: Unknown
1: Spouse
2: Child
3: Other
4: Self
|
OSEX
| Other Insured Sex
|
0: Female
1: Male
|
OSSNO
| Other Insured SSN
| Numeric Field
|
OSTATE
| Other Insured State
| Text Field
|
OWORKPH
| Other Insured Work Phone
| Numeric Field
|
OZIPCODE
| Other Insured Zip Code
| Numeric Field
|
PATHASSEC
| Internal flag used to differentiate patients with two (2) insurances under the same policy holder versus two (2) insurances under different individuals
|
Boolean |
PEMPLOY
| Employment Status
|
0: Employed full-time
1: Employed part-time
2: Not employed
3: Self employed
4: Retired
5: On active military duty
6: Unknown
|
PHYSREFEREDBY
| Referral Type
|
00: None
01: Friend
02: Physician
03: Newspaper
04: Radio
05: Television
06: Driving By
07: Mailing
08: Internet
09: Phonebook
10: Other
11: Insurance Company
12: Family
13: Screening
14: Lecture
|
PLANG
| Language
|
0: English
1: Spanish
2: Other
|
PMARITAL
| Marital Status
|
0: Married
1: Single
2: Divorced
3: Widowed
4: Legally Separated
5: Unknown
|
POLICY1
| Primary Payer Policy Type
|
0: Auto Insurance Policy
1: Group Policy
2: Individual Policy
3: Long Term Policy
4: Litigation
5: Unknown
6: Medicare Primary
7: Other
8: Self Payment (Cash)
9: Supplemental Policy
|
POLICY2
| Secondary Payer Policy Type
|
00: Auto Insurance Policy
01: Group Policy
02 - Individual Policy
03 - Long Term Policy
04 - Litigation
05 - Medigap Policy
06 - Unknown
07 - Other
08 - Self Payment (Cash)
09 - Supplemental Policy
10 - MEDICARE SECONDARY - Working Ages beneficiary/spouse
11 - MEDICARE SECONDARY - ESRD beneficiary with group health plan
12 - MEDICARE SECONDARY - No fault insurance
13 - MEDICARE SECONDARY - Workers Compensation
14 - MEDICARE SECONDARY - PHS or other federal agency
15 - MEDICARE SECONDARY - Black Lung
16 - MEDICARE SECONDARY - VA
17 - MEDICARE SECONDARY - Disabled beneficiary under age 65 with LGHP
18 - MEDICARE SECONDARY - Any liability insurance
|
POLICY3
| Tertiary Payer Policy Type
| See values above (Same as POLICY2)
|
PRESIDENCE
| Residence Type
|
0: Private Home
1: Nursing Home
2: Residential Treatment Patient
3: Skilled Nursing Home
|
PSEX
| Patient Sex
|
0: Female
1: Male
|
PSTUDENT
| Student Status
| 0: Not a student
1: Full-time student
2: Part-time student |
RACE
| Race
|
0: Unknown
1: American Indian or Eskimo or Aleut
2: Asian or Native Hawaiian or Pacific Islander
3: Black or African American
4: White
5: Other Race
6: Refused to Answer
|
RADDR1
| Insured Address Line 1
| Text Field
|
RADDR2
| Insured Address Line 2
| Text Field
|
RCITY
| Insured City
| Text Field
|
RELATION
| Insured Relationship to Patient
|
0: Unknown
1: Self
2: Spuse
3: Child
4: Other
|
RFIRST
| Insured First Name
| Text Field
|
RLAST
| Insured Last Name
| Text Field
|
RSTATE
| Insured State
| Text Field
|
RZIPCODE
| Insured Zip Code
| Numeric Field
|
STMTTYPE
| Statement Type
|
0: Single
1: Family
|