Data SnapShot - Payor

Field

Description

Values

SEQNO

Unique identifier for the payer.

Numeric - 8 digits

DEFAULTSTATUS

Default Billing Status

0: Send to Payer via Clearinghouse
1: User Print and Mail to Payer
2: Charges at Payer
3: Charges on Hold
4: Waiting for Review
5: Due Patient

DONTPRINTADDR_0805

The Do NOT print the payer address on the top of the form option for the payer.

0: Disabled
1: Enabled

H0805BOX24

The Print the following supplemental info in Box 24 option for the payer.

0: Narrative Notes
2: Anesthesia Start/Stop Times

OPTIONINS1A

The Remove the insured's ID# from Box 1A option for the payer.

N: Disabled
Y: Enabled

OPTION3

The Send anesthesia start/stop times in a line note option for the payer.

N: Disabled
Y: Enabled

OPTION4

The Show separate configurations for each office location option for the payer.

N: Enabled
Y: Disabled

OPTION6

The Use the office address as the pay-to address option for the payer.

N: Disabled
Y: Enabled

OPTION7

The Only send the pay-to address option for the payer.

N: Disabled
Y: Enabled

OPTION1_0805

The Print the license number in Box 31 option for the payer.

N: Disabled
Y: Enabled

OPTION2_0805

The Send minutes instead of units on anesthesia claims option for the payer.

N: Disabled
Y: Enabled

PAYORTYPE

Payer Type

0: Self Pay
1: Worker's Compensation
2: Medicare
3: Medicaid
4: Other Federal Program
5: Commercial Insurance Company
6: Blue Cross Blue Shield
7: Tricare/Champus
8: HMO
9: Federal Employees Program
10: Central Certification
11: Self Administered Group
12: Family or Friends
13: Managed Care (non-HMO)
14: Blue Cross
15: Title V
16: Veteran Administration Plan
17: Corporate Account
18: Other
19: Vendor
20: Aetna
21: Humana
22: Cigna
23: United Healthcare
24: Attorney
25: Auto
26: Other Non-Federal Programs
27: Preferred Provider Organization (PPO)
28: Point of Service (POS)
29: Exclusive Provider Organization (EPO)
30: Indemnity Insurance
31: Health Maintenance Organization (HMO) Medicare Risk
32: Automobile Medical
33: Disability
34: Liability
35: Liability Medical

PROCESSMODE

Processing Mode

0: The clearinghouse will send the claims electronically
1: The clearinghouse will print and mail the claims
2: Do not send claims to the clearinghouse for processing

PROF_EXCLUDE_PAT_PAYMENTS

The Exclude patient payments from Box 29 option for the payer.

0: Disabled
1: Enabled

UB04BOX38

The Print the following in Box 38 option for the payer.

0: Leave blank
1: Print insured's address
2: Print payer's address

UB04BOX76

The Print referring physician in Box 76 option for the payer.

N: Disabled
Y: Enabled

UB04BOX80

The Print the following in Box 80 option for the payer.

0: Print insured's address
1: Print payer's address
2: Print remarks

ORBILLPRV

The Override billing provider with rendering provider option for the payer.

N: Disabled
Y: Enabled