Section 1
X12 Database Parser
Model C1D0U485 64 bit
Model C1D0N485 32 bit
Standard License
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Section 2
The X12 Database Parser allows you to take X12 files like 837 claims and 835 remittances and convert them into a single table or multi table sql relational database. The X12 Database Parser can be run from either a windows user interface or from a command prompt or other application using parameters to specify the schema and the input file or directory. The Database Parser uses the same mapping files as the Inline Parser. Tables,fields,maps, and options are defined in the schema. The Database Parser uses a variety of access methods to create and populate tables either directly with the database or via an ODBC driver. Some of the databases supported by the Database Parser are: - MSSQL - Microsoft Access Driver mdb accdb - MySQL - DBF,NTX and CDX - Oracle
Section 3
The Database Parser can be run in two ways, either in the screen interface mode or using a command line call. Before you can parse a file you will need to generate a mapping file using the Mapping Tool and then a schema using Schema Generator. The Database Parser is based on the X12 Inline Parser and thus uses its mapping system. Any database/table layouts are based on the schema. All fields used in the schema must have a valid field in one of its X12 Inline Parser maps. USER INTERFACE SCREEN The PARSE.LOG can be viewed to verify and troubleshoot the results of the process. COMMAND LINE INTERFACE The Command Line Interface allows for two types of operation. If a single parameter is passed to the Database Parser it will use that as the Data/Working folder and will run the user interface. C:\C1D0U485\C1D0U485 \qadb\project1 If two parameters are passed to the Database Parser it will execute the application using the database schema provided in the first parameter and parse the source file provided in the second parameter to the database defined in the schema. C:\C1D0U485\C1D0U485 schema.dbs source.x12
Section 4
One easy way to get started with the Database Parser is to use a pre-built schema and maps available through the Database Parser Examples. From the Functions dropdown menu, select Database Parser Examples. There will be the option to download a list of available examples. Select and download the example you are interested in. After the download it will be displayed in your local examples list. Select one of your local examples to load the user interface to the database parser with the example you have selected. Use the Text Edit within the Schema Generator to modify and save any data options such as the DSN,password, and logins. If you are using an example that requires an ODBC configuration make sure that you configure the ODBC DSN using the Windows ODBC Data Source Administrator. The next step is to build tables. Click on the Build Tables button. Once the tables have been successfully built, click Begin to start the Database Parser. There is an SQL ODBC Viewer and DBF Viewer available to let you review test results. The PARSER.LOG can be used to review results and for troubleshooting.
Section 5
The Database parser has several database drivers available. - SDDODBC SQL Database Driver ODBC - DBF with DBFNTX - RDD DBF CDX In the Database Paser schema several options are related to the database portion of the system. --- DRIVER In windows the ODBC driver name can be determined using the ODBC Source Administrator and the USER DSN screen. It is important to get the exact spelling of the driver correct including the spacing. Some examples of odbc driver names are: DRIVER=MySQL ODBC 5.2 ANSI Driver DRIVER=SQL Server DRIVER=Oracle in XE DRIVER=Microsoft Access Driver (*.mdb, *.accdb) The database parser is capable of creating a dbf database as well. DRIVER=DBF --- DSN The DSN or Data Set Name DSN= --- DIRECTORY= --- DRIVE= --- SERVER= --- USER= --- PASSWORD= --- OPTIONS= ---
Section 6
ADD - Will always add a record to the table for each record parsed.
LOOKUP - Will search on the KEYFIELD. If record is found a one will
not be added. If a record is not found a record will be
added to the database table.
INDEX0 - Uses traditional SQL syntax for lookup.
This is the default and preferred index
methode for the SDDODBC.
INDEX1 - Uses an Xbase index system in memory in
the SDDODBC.
INDEXCDX - Uses Foxpro CDX indexes when the DRIVER=DBF is in use.
INDEXNTX - Uses xbase NTX indexes when the DRIVER=DBF is in use.
CONN0
Server=;Driver={};dsn=;user=;password=;database=;"
CONN1
driver={};DSN=;UID=;pwd=;
CONN2
DBQ=;Driver=;
Section 7
SDDODBC - SQL Database Driver Open Database Connectivity The SDDODBC is an interface that implements accessing an SQL query result via the Harbour RDD Replacable Database Driver interface. Every SQL server MySQL, PostgreSQL, etc. has a corresponding SDD. The SDD driver implements a specific part of data exchange between RDD SQLBASE and SQL server.
Section 8
Default mapping for the Inline Parser can be stored in a file
called c1map.cfg.
Maps for the Inline Parser can be generated using the Mapping Tool.
The mapping tool lets you generate a map based on the type of
X12 transaction that you wish to parse. Map file names are based
on the version and transaction specification and example of this
is the file 004010X098A1.cfg that is used when a file is detected
to be a 837 Professional Claims version 4010A1. X12 File determination
is done using the GS segment Element 8. If a map is not found for
that version the c1map.cfg will be used.
- - -
KEYHEADERFIELD
Syntax : KEYHEADERFIELD=segmet,element1,element2,element3,ect...
The KEYHEADERFIELD is mapped to a segment that is used to determine
the separation for header data within the batch.
- - -
KEYFIELD
Syntax : KEYFIELD=segmet,element1,element2,element3,ect...
The KEYFIELD is mapped to a segment that is used to determine
the separation for each transaction within the file.
- - -
KEYDOCFIELD
Syntax : KEYDOCFIELD=segmet,element1,element2,element3,ect...
The KEYDOCFIELD is mapped to a segment that is used to determine
the separation for each document within a transaction.
- - -
KEYLINEFIELD
Syntax : KEYLINEFIELD=segmet,element1,element2,element3,ect...
The KEYLINEFIELD is mapped to a segment that is used to determine
the separation for each service line with a transaction.
- - -
FIELD
Syntax FIELD=a,b,c,d,e,f,g,h,i,j,k,l,m,n,o,p,q,r,s
A =Field Name
Any Alpha/Numeric value. No duplicates.
B =Field Width
1 - 999
C = Segment Type
Based on the 1st Segment
D = Segment Qualifier
E = Qualifier Position
Position includes all segments.
F = Element Position
Position does not include 1st segment.
G = Sub Element Position
H = Conditional Field
The name of another field within the map
that must be populated for this field to
work.
I = Occurrence
The identified record in a repeating segment.
J = Level
Blank = Default
1 = Header
2 = Document
3 = Line
4 = Trailer
5 = Source File Name
6 = Destination File Name
K = Service Line Number
L = Field Description
M = Data Starting Position within theField
N = Length of data
O = Function
Name of file that contains functional script
P = Previous Segment
Checks an 8 segment buffer for a valid segment and
qualifier.
Q = Previous Segment Qualifier
R = Previous Segment Qualifier Position
S = Toggle Off Field
Turns off field population if this field is populated
The FIELD is used to map all data that is to be parsed.
- - -
SEGMENT
Syntax SEGMENT=a,b,c,d,e - z
A = Level
1 - Header
2 - Invoice / Claim
3 - Line
4 - Trailer
B = Segment
: - Qualifier Separator
Example : SEGMENT=2,HI:$OCCURRENCECODE01,%BH;$OCCURRENCECODE01;D8;$OCCURRENCEDATE01
Note : If $OCCURRENCECODE01 in HI:$OCCURRENCECODE01 is not populated the segment
will be dropped.
C - Z = Segment Data
$ - Returns data for $filedname
Example : $CLAIMID
& - Returns counter for internal counter &counter
Example : &HL1
% - Starts use for subvalue within an element.
Example : %BH;$OCCURRENCECODE01;D8;$OCCURRENCEDATE01
; - Subvalue separator
Examples:
SEGMENT=1,NM1,85,$BILLINGPROVIDERNAME
SEGMENT=2,HI:$OCCURRENCECODE01,%BH;$OCCURRENCECODE01;D8;$OCCURRENCEDATE01
SEGMENT=3,SV2,$IREVCODE,%HC;$IPROC,$IUNITS,UN,$IQTY
- - -
SCREEN
Syntax SCREEN=a,b,c,d,e,f
A =Screen Number
B =Type
- TITLE
C = Screen Type
1=Record Listing
2=Record Detail
3=Line Item Listing
4=Line Item Detail
- BUTTON
C = SCREEN TO Go TO
- FIELD
C = Field Name
D = Field Description
E = New Line Control
0=No New Line
1=Create New Line after the field
F = Field Type
1=Line Item
Section 9
You can use the Parser Mapping Tool to create and edit Inline Parser maps.
Section 10
Use the Mapping Tool to generate map configuration files for the x12 transactions that you want included in your schema. The generate function within the Mapping Tool will step you through what type of data fields should be included in your map. Once you have created a map configuration file you can now generate a schema using the Schema Generator. In the Schema Generator screen on the left side of the screen you will see a list of X12 transactions with an available checkbox. When you click on the checkbox for a given x12 transaction, you will be asked to select an x12 map configuration file that will be associated with the checked x12 transaction. After you have associated your map configuration files with your transactions you can now edit your schema. In the Schema Editor you can now add a table. In the Add Table screen on the left side you will see a checkbox list of the x12 transactions used for this table. You can deselect transactions that you do not want included in your table. A minimum of one transaction type is required. Beyond the table name you will be able to add the Database Driver, Data Set Name, Server, User, and Password. For more information on table settings as they pertain to your version of SQL, please see the document on SDDODBC SQL Database Driver. When you add fields to your table, you will be asked to select the transaction type. In the Add Field to Table screen select the individual fields that you wish to add to the table or select all. Once you have made your selection click on Add Fileds to add them to your table
Section 11
To use SDDODBC with MSSQL a starter database needs to be created using SQL Server Management Studio.
Open Microsoft SQL Server Management Studio
Connect to Server dialog box will display with Server name (SERVER) and User Name (USER).
In this case, PASSWORD is the password used to log into Windows.
Click Connect, Object Explorer will display.
Select Databases, right click mouse and select New Database.
A New Database dialog box will display.
Enter the Database name: testdata.
Click Ok.
From the product Main Menu
Select Functions
-Database Parser Examples
Click on Download List of Available Examples
A list of the Available Examples will display on the left side of screen.
Expand the 835 Remittance selection tree and for this example, select 835 Remittance Basic
Microsoft SQL.
A pop up box will ask Set up this example?
Click Yes and another pop up box will ask Create folder?
Click Yes to continue and it will download and setup the example on your local computer.
The example selected will display Your local X12 Examples.
Click on the tree item 835 Remittance Basic Microsoft SQL.
X12 Inline Database Parser will display.
Click on the Schema Generator button.
Schema Generator box will display.
Click on Text Edit button on right side of screen.
Notepad will load the schema file basicmssql.dbs
Note:
Four critical fields need to be modified -
SERVER, USER, PASSWORD and DSN
After the changes are applied to the schema, the X12 Inline Database Parser screen will display.
Click on Build Tables button
A table will be created. Click Begin.
The source.x12 file will be imported into the testdata databases.
A table called qadbt1 will be created in the testdata database.
Select Top 1000 Rows and your data will be displayed.
Note:
- The SDDODBC SQL Database Driver allows for a maximum of 726 columns.
- Server/User: Displayed in SQL Server Management Studio
Section 12
With Microsoft Access you will need to have the option CONN2 in the option string. DRIVER=Microsoft Access Driver (*.mdb, *.accdb) http://www.microsoft.com/en-us/download/details.aspx?id=13255 Example configuration: TABLE=accessqadbt1.mdb TRANSACTIONTYPE=835 DRIVER=Microsoft Access Driver (*.mdb, *.accdb) DIRECTORY=\qadb\qadbt1 DRIVE=c: KEYFIELD=CLAIMID OPTIONS=ADD,CONN2 Note: You will not need to setup a DSN in the ODBC. You will need to have the ODBC driver installed. Access will not allow you to create a database from scratch. To get around this issue you will need to use a dummy Access database file to start with. The Database Parser will rebuild your dummy file to match the schema you are using. To set up a DSN in windows: Start, Control Panel, Administrative Tools, Data Sources(ODBC) If you are are on a 64bit machine you will have a 32bit and 64bit ODBC Data Source Administrator. Note: - The SDDODBC SQL Database Driver allows for a maximum of 201 columns.
Section 13
To use SDDODBC with MySQL you do NOT need to set up a DSN in
the ODBC Data Source.
You will need to create a schema in MySQL Workbench that has
your DSN Data Set Name.
Driver : MySQL ODBC 5.2 ANSI Driver
Server : localhost
User : root
Note : DSN is created using MySQL Workbench create schema.
Example configuration:
TABLE=qadbt1
TRANSACTIONTYPE=835
DRIVER=MySQL ODBC 5.2 ANSI Driver
DSN=myssql
SERVER=localhost
USER=root
PASSWORD=*****
Note:
- The SDDODBC SQL Database Driver allows for a maximum of 726 columns.
Section 14
The Database Parser can be connected to the Cloud via ODBC and MySQL. On Your Server Web Hosting Site: Inside your web hosting service Using cpanel click on MySQL Databases. Create a database In our example we will use the name testdb. Create a user. Once you have created a user then add that user to the testdb database. When you Add a current user to the database you will go to a screen that will let you manage the user privileges. In our example we have set the user to have all privilages. From cPanel using the Remote MySQL add the ip address of the remote computer (Your local PC) that will accessing the database. On Your Local PC: Download and install the MySQL ODBC 5.1 Driver. http://dev.mysql.com/downloads/file.php?id=415029 If you are running a Database Parser Example on your local PC you will need to do the following steps. Form the X12 Inline Database Parser screen, select the Schema generator. Next select the Text Edit. Modify the DSN to match the name of the database you created on your MySQL web hosting service. Modify the SERVER to be the TCP/IP address of you MySQL web hosting service. Modify the USER and PASSWORD you set up on your MySQL web hosting service. After you save you schema with your changes Exit the Schema Generator to the X12 Inline Database Parser screen. Next click on Build Table. If everything is correct the Database Parser will display Building Tables Complete, the schema used and the number of tables created. To run the Database Parser click Begin. A progress bar will be displayed. You can run the example source file we have provided or you may select you own file or a folder that contains files you wish to parse to the database. You can view the table you created on your web hosting service using cpanel by clicking on phpMyAdmin. Trouble Shooting: You can use the ODBC Data Source Administrator add a User DSN. In our example our Data Source Name will be mysqlweb. We will make our Description the same name. Select and set the TCP/IP Server to the IP address of your web hosing service. Make sure to set the user and password. The database is set to testdb the name of the remote database. Click the Test button. At this point if you have everything correct your test results should with Connection Successful.
Section 15
The DBF format uses the INDEXNTX or INDEXCDX options. DBF files do not use ODBC they are created directly. Example configuration: TABLE=qadbt1 TRANSACTIONTYPE=835 DRIVER=DBF DIRECTORY=\qadb\qadbt1 DRIVE=c: KEYFIELD=CLAIMID OPTIONS=ADD,INDEXNTX Notes: Does not use ODBC.
Section 16
To use SDDODBC with Oracle you NOT need to set up a DSN in the ODBC Data Source. In the options the CONN1 is required. Driver : Oracle in XE Server : 127.0.0.1 User : SYSTEM Example configuration: TABLE=qadbt1 TRANSACTIONTYPE=835 DRIVER=Oracle in XE DSN=test3 SERVER=127.0.0.1 USER=SYSTEM PASSWORD=******* OPTIONS=CONN1 Note : DSN is created via the SDDODBC. CONN1 option is required.
Section 17
************************** Schema Sample 1 ************************** 837I to a single table ************************** Transaction List [transactions] 837I=C:\csx\837I.cfg ************************** Database 1 [database] TABLE=helloworld TRANSACTIONTYPE=837I DRIVER=SQL Server DSN=test SERVER=COM1SOFTWARE\SQLExpress USER=COM1SOFTWARE\User PASSWORD=******* KEYFIELD=SUBID OPTIONS=LOOKUP,INDEX0 FIELD=SUBID FIELD=BILLINGPROVIDERID FIELD=BILLINGPROVIDERNAME FIELD=BILLINGPROVIDERADDR1 FIELD=BILLINGPROVIDERADDR2 FIELD=BILLINGPROVIDERCITY FIELD=BILLINGPROVIDERST FIELD=BILLINGPROVIDERZIP FIELD=PAYTOPROVIDERID FIELD=PAYTOPROVIDERNAME FIELD=PAYTOPROVIDERADDR1 FIELD=PAYTOPROVIDERADDR2 FIELD=PAYTOPROVIDERCITY FIELD=PAYTOPROVIDERST FIELD=PAYTOPROVIDERZIP FIELD=PRIMARYCOV FIELD=SECONDARYCOV FIELD=TERTIARYCOV FIELD=SUBLNAME FIELD=SUBFNAME FIELD=SUBMI FIELD=SUBADDR1 FIELD=SUBADDR2 FIELD=SUBCITY FIELD=SUBST FIELD=SUBZIP FIELD=SUBSEX FIELD=SUBMSTATUS FIELD=SUBDOB FIELD=SUBREL FIELD=SUBORDER FIELD=PAYERID FIELD=PAYERNAME FIELD=PAYERADDR1 FIELD=PAYERADDR2 FIELD=PAYERCITY FIELD=PAYERST FIELD=PAYERZIP FIELD=PRIMARYSUBID FIELD=PRIMARYSUBLNAME FIELD=PRIMARYSUBFNAME FIELD=PRIMARYSUBMI FIELD=PRIMARYSUBADDR1 FIELD=PRIMARYSUBADDR2 FIELD=PRIMARYSUBCITY FIELD=PRIMARYSUBST FIELD=PRIMARYSUBZIP FIELD=PRIMARYSUBSEX FIELD=PRIMARYSUBMSTATUS FIELD=PRIMARYSUBDOB FIELD=PRIMARYSUBREL FIELD=PRIMARYGRPPOLNUM FIELD=PRIMARYGRPNAME FIELD=PRIMARYINSTYPE FIELD=PRIMARYCFI FIELD=PRIMARYPAYERID FIELD=PRIMARYPAYERNAME FIELD=PRIMARYPAYERADDR1 FIELD=PRIMARYPAYERADDR2 FIELD=PRIMARYPAYERCITY FIELD=PRIMARYPAYERST FIELD=PRIMARYPAYERZIP FIELD=SECONDARYSUBID FIELD=SECONDARYSUBLNAME FIELD=SECONDARYSUBFNAME FIELD=SECONDARYSUBMI FIELD=SECONDARYSUBADDR1 FIELD=SECONDARYSUBADDR2 FIELD=SECONDARYSUBCITY FIELD=SECONDARYSUBST FIELD=SECONDARYSUBZIP FIELD=SECONDARYSUBSEX FIELD=SECONDARYSUBMSTATUS FIELD=SECONDARYSUBDOB FIELD=SECONDARYSUBREL FIELD=SECONDARYGRPPOLNUM FIELD=SECONDARYGRPNAME FIELD=SECONDARYINSTYPE FIELD=SECONDARYCFI FIELD=SECONDARYPAYERID FIELD=SECONDARYPAYERNAME FIELD=SECONDARYPAYERADDR1 FIELD=SECONDARYPAYERADDR2 FIELD=SECONDARYPAYERCITY FIELD=SECONDARYPAYERST FIELD=SECONDARYPAYERZIP FIELD=TERTIARYSUBID FIELD=TERTIARYSUBLNAME FIELD=TERTIARYSUBFNAME FIELD=TERTIARYSUBMI FIELD=TERTIARYSUBADDR1 FIELD=TERTIARYSUBADDR2 FIELD=TERTIARYSUBCITY FIELD=TERTIARYSUBST FIELD=TERTIARYSUBZIP FIELD=TERTIARYSUBSEX FIELD=TERTIARYSUBMSTATUS FIELD=TERTIARYSUBDOB FIELD=TERTIARYSUBREL FIELD=TERTIARYGRPPOLNUM FIELD=TERTIARYGRPNAME FIELD=TERTIARYINSTYPE FIELD=TERTIARYCFI FIELD=TERTIARYPAYERID FIELD=TERTIARYPAYERNAME FIELD=TERTIARYPAYERADDR1 FIELD=TERTIARYPAYERADDR2 FIELD=TERTIARYPAYERCITY FIELD=TERTIARYPAYERST FIELD=TERTIARYPAYERZIP FIELD=PATID FIELD=PATLNAME FIELD=PATFNAME FIELD=PATMI FIELD=PATADDR1SUBADDR1 FIELD=PATADDR2SUBADDR2 FIELD=PATCITY FIELD=PATST FIELD=PATZIP FIELD=PATSEX FIELD=PATMSTAT FIELD=PATDOB FIELD=PATREL FIELD=CLAIMID FIELD=CLAIMAMT FIELD=ADMISSIONDATETIME FIELD=ADMISSIONTYPE FIELD=ADMISSIONSOURCE FIELD=PATIENTSTATUS FIELD=NURSINGHOMECODE FIELD=REPORTTYPECODE FIELD=REPORTTRANCODE FIELD=REPORTDESC FIELD=CLAIMNUMBER FIELD=DISCHARGEDATE FIELD=DISCHARGEHOUR FIELD=STATEMENTDATE FIELD=MEDICALRECORDNUMBER FIELD=FACILITYCODEVALUE FIELD=FACILITYCODEQUALIFIER FIELD=FREQUENCYTYPECODE FIELD=PRINCIPALDX FIELD=ADMITDX FIELD=PRIORAUTH FIELD=K3DATA FIELD=NOTECODE FIELD=NOTEDESC FIELD=SUPPLEMENTALINFOTYPE FIELD=SUPPLEMENTALINFOTRANS FIELD=SUPPLEMENTALINFODESC FIELD=NDCCODE FIELD=NDCUNITPRICE FIELD=NDCUNITS FIELD=ECODE FIELD=ATTENDINGID FIELD=ATTENDINGLNAME FIELD=ATTENDINGFNAME FIELD=ATTENDINGMNAME FIELD=ATTENDINGPREFIX FIELD=ATTENDINGSUFFIX FIELD=ATTENDINGIDCODE FIELD=ATTENDINGTYPE FIELD=ATTENDINGTAXONOMY FIELD=OPERATEINGID FIELD=OPERATEINGLNAME FIELD=OPERATEINGFNAME FIELD=OPERATINGMNAME FIELD=OPERATINGPREFIX FIELD=OPERATINGSUFFIX FIELD=OPERATINGIDCODE FIELD=OPERATINGTYPE FIELD=OPERATINGTAXONOMY FIELD=REFERRINGID FIELD=REFERRINGLNAME FIELD=REFERRINGFNAME FIELD=REFERRINGMNAME FIELD=REFERRINGPREFIX FIELD=REFERRINGSUFFIX FIELD=REFERRINGIDCODE FIELD=REFERRINGTYPE FIELD=REFERRINGTAXONOMY FIELD=RENDERINGID FIELD=RENDERINGLNAME FIELD=RENDERINGFNAME FIELD=RENDERINGMNAME FIELD=RENDERINGPREFIX FIELD=RENDERINGSUFFIX FIELD=RENDERINGIDCODE FIELD=RENDERINGTYPE FIELD=RENDERINGTAXONOMY FIELD=SERVICEFACILITYNAME FIELD=SERVICEFACILIYID FIELD=OTHERDX01 FIELD=OTHERDX02 FIELD=OTHERDX03 FIELD=OTHERDX04 FIELD=OTHERDX05 FIELD=OTHERDX06 FIELD=OTHERDX07 FIELD=OTHERDX08 FIELD=OTHERDX09 FIELD=OTHERDX10 FIELD=OTHERDX11 FIELD=OTHERDX12 FIELD=PRINCIPLEPROCICD9 FIELD=PRINCIPLEPROCDATE FIELD=PRINCIPLEPROCHCFA FIELD=OTHERPROC01 FIELD=OTHERPROC02 FIELD=OTHERPROC03 FIELD=OTHERPROC04 FIELD=OTHERPROC05 FIELD=OTHERPROC06 FIELD=OTHERPROC07 FIELD=OTHERPROC08 FIELD=OTHERPROC09 FIELD=OTHERPROC10 FIELD=OTHERPROC11 FIELD=OTHERPROC12 FIELD=OCCURRENCESPAN01 FIELD=OCCURRENCESPAN02 FIELD=OCCURRENCESPAN03 FIELD=OCCURRENCESPAN04 FIELD=OCCURRENCESPAN05 FIELD=OCCURRENCESPAN06 FIELD=OCCURRENCESPAN07 FIELD=OCCURRENCESPAN08 FIELD=OCCURRENCESPAN09 FIELD=OCCURRENCESPAN10 FIELD=OCCURRENCESPAN11 FIELD=OCCURRENCESPAN12 FIELD=OCCURRENCECODE01 FIELD=OCCURRENCEDATE01 FIELD=OCCURRENCECODE02 FIELD=OCCURRENCEDATE02 FIELD=OCCURRENCECODE03 FIELD=OCCURRENCEDATE03 FIELD=OCCURRENCECODE04 FIELD=OCCURRENCEDATE04 FIELD=OCCURRENCECODE05 FIELD=OCCURRENCEDATE05 FIELD=OCCURRENCECODE06 FIELD=OCCURRENCEDATE06 FIELD=OCCURRENCECODE07 FIELD=OCCURRENCEDATE07 FIELD=OCCURRENCECODE08 FIELD=OCCURRENCEDATE08 FIELD=OCCURRENCECODE09 FIELD=OCCURRENCEDATE09 FIELD=OCCURRENCECODE10 FIELD=OCCURRENCEDATE10 FIELD=OCCURRENCECODE11 FIELD=OCCURRENCEDATE11 FIELD=OCCURRENCECODE12 FIELD=OCCURRENCEDATE12 FIELD=VALUECODE01 FIELD=VALUEAMOUNT01 FIELD=VALUEQTY01 FIELD=VALUECODE02 FIELD=VALUEAMOUNT02 FIELD=VALUEQTY02 FIELD=VALUECODE03 FIELD=VALUEAMOUNT03 FIELD=VALUEQTY03 FIELD=VALUECODE04 FIELD=VALUEAMOUNT04 FIELD=VALUEQTY04 FIELD=VALUECODE05 FIELD=VALUEAMOUNT05 FIELD=VALUEQTY05 FIELD=VALUECODE06 FIELD=VALUEAMOUNT06 FIELD=VALUEQTY06 FIELD=VALUECODE07 FIELD=VALUEAMOUNT07 FIELD=VALUEQTY07 FIELD=VALUECODE08 FIELD=VALUEAMOUNT08 FIELD=VALUEQTY08 FIELD=VALUECODE09 FIELD=VALUEAMOUNT09 FIELD=VALUEQTY09 FIELD=VALUECODE10 FIELD=VALUEAMOUNT10 FIELD=VALUEQTY10 FIELD=CONDITIONCODE01 FIELD=CONDITIONCODE02 FIELD=CONDITIONCODE03 FIELD=CONDITIONCODE04 FIELD=CONDITIONCODE05 FIELD=CONDITIONCODE06 FIELD=CONDITIONCODE07 FIELD=CONDITIONCODE08 FIELD=CONDITIONCODE09 FIELD=CONDITIONCODE10 FIELD=CONDITIONCODE11 FIELD=CONDITIONCODE12 FIELD=TREATMENTCODE01 FIELD=TREATMENTCODE02 FIELD=TREATMENTCODE03 FIELD=TREATMENTCODE04 FIELD=TREATMENTCODE05 FIELD=TREATMENTCODE06 FIELD=TREATMENTCODE07 FIELD=TREATMENTCODE08 FIELD=TREATMENTCODE09 FIELD=TREATMENTCODE10 FIELD=TREATMENTCODE11 FIELD=TREATMENTCODE12 FIELD=ADMITTINGDX01 FIELD=ADMITTINGDX02 FIELD=ADMITTINGDX03 FIELD=ADMITTINGDX04 FIELD=ADMITTINGDX05 FIELD=ADMITTINGDX06 FIELD=ADMITTINGDX07 FIELD=ADMITTINGDX08 FIELD=ADMITTINGDX09 FIELD=ADMITTINGDX10 FIELD=ADMITTINGDX11 FIELD=ADMITTINGDX12 FIELD=VISITREASONDX01 FIELD=VISITREASONDX02 FIELD=VISITREASONDX03 FIELD=VISITREASONDX04 FIELD=VISITREASONDX05 FIELD=VISITREASONDX06 FIELD=VISITREASONDX07 FIELD=VISITREASONDX08 FIELD=VISITREASONDX09 FIELD=VISITREASONDX10 FIELD=VISITREASONDX11 FIELD=VISITREASONDX12 FIELD=DRG FIELD=DRGAMT FIELD=IREVCODE1 FIELD=IPROC1 FIELD=IPROCQUAL1 FIELD=IMODA1 FIELD=IMODB1 FIELD=IMODC1 FIELD=IMODD1 FIELD=IAMT1 FIELD=IUNITS1 FIELD=IQTY1 FIELD=IRATE1 FIELD=IAMTNCC1 FIELD=IDOS1 FIELD=IADJGRPCODE1 FIELD=IADJREASONCODE1 FIELD=IADJAMOUNT1 FIELD=IADJQTY1 FIELD=IREVCODE2 FIELD=IPROC2 FIELD=IPROCQUAL2 FIELD=IMODA2 FIELD=IMODB2 FIELD=IMODC2 FIELD=IMODD2 FIELD=IAMT2 FIELD=IUNITS2 FIELD=IQTY2 FIELD=IRATE2 FIELD=IAMTNCC2 FIELD=IDOS2 FIELD=IADJGRPCODE2 FIELD=IADJREASONCODE2 FIELD=IADJAMOUNT2 FIELD=IADJQTY2 FIELD=IREVCODE3 FIELD=IPROC3 FIELD=IPROCQUAL3 FIELD=IMODA3 FIELD=IMODB3 FIELD=IMODC3 FIELD=IMODD3 FIELD=IAMT3 FIELD=IUNITS3 FIELD=IQTY3 FIELD=IRATE3 FIELD=IAMTNCC3 FIELD=IDOS3 FIELD=IADJGRPCODE3 FIELD=IADJREASONCODE3 FIELD=IADJAMOUNT3 FIELD=IADJQTY3 FIELD=IREVCODE4 FIELD=IPROC4 FIELD=IPROCQUAL4 FIELD=IMODA4 FIELD=IMODB4 FIELD=IMODC4 FIELD=IMODD4 FIELD=IAMT4 FIELD=IUNITS4 FIELD=IQTY4 FIELD=IRATE4 FIELD=IAMTNCC4 FIELD=IDOS4 FIELD=IADJGRPCODE4 FIELD=IADJREASONCODE4 FIELD=IADJAMOUNT4 FIELD=IADJQTY4 FIELD=IREVCODE5 FIELD=IPROC5 FIELD=IPROCQUAL5 FIELD=IMODA5 FIELD=IMODB5 FIELD=IMODC5 FIELD=IMODD5 FIELD=IAMT5 FIELD=IUNITS5 FIELD=IQTY5 FIELD=IRATE5 FIELD=IAMTNCC5 FIELD=IDOS5 FIELD=IADJGRPCODE5 FIELD=IADJREASONCODE5 FIELD=IADJAMOUNT5 FIELD=IADJQTY5 FIELD=IREVCODE6 FIELD=IPROC6 FIELD=IPROCQUAL6 FIELD=IMODA6 FIELD=IMODB6 FIELD=IMODC6 FIELD=IMODD6 FIELD=IAMT6 FIELD=IUNITS6 FIELD=IQTY6 FIELD=IRATE6 FIELD=IAMTNCC6 FIELD=IDOS6 FIELD=IADJGRPCODE6 FIELD=IADJREASONCODE6 FIELD=IADJAMOUNT6 FIELD=IADJQTY6 FIELD=IREVCODE7 FIELD=IPROC7 FIELD=IPROCQUAL7 FIELD=IMODA7 FIELD=IMODB7 FIELD=IMODC7 FIELD=IMODD7 FIELD=IAMT7 FIELD=IUNITS7 FIELD=IQTY7 FIELD=IRATE7 FIELD=IAMTNCC7 FIELD=IDOS7 FIELD=IADJGRPCODE7 FIELD=IADJREASONCODE7 FIELD=IADJAMOUNT7 FIELD=IADJQTY7 FIELD=IREVCODE8 FIELD=IPROC8 FIELD=IPROCQUAL8 FIELD=IMODA8 FIELD=IMODB8 FIELD=IMODC8 FIELD=IMODD8 FIELD=IAMT8 FIELD=IUNITS8 FIELD=IQTY8 FIELD=IRATE8 FIELD=IAMTNCC8 FIELD=IDOS8 FIELD=IADJGRPCODE8 FIELD=IADJREASONCODE8 FIELD=IADJAMOUNT8 FIELD=IADJQTY8 FIELD=IREVCODE9 FIELD=IPROC9 FIELD=IPROCQUAL9 FIELD=IMODA9 FIELD=IMODB9 FIELD=IMODC9 FIELD=IMODD9 FIELD=IAMT9 FIELD=IUNITS9 FIELD=IQTY9 FIELD=IRATE9 FIELD=IAMTNCC9 FIELD=IDOS9 FIELD=IADJGRPCODE9 FIELD=IADJREASONCODE9 FIELD=IADJAMOUNT9 FIELD=IADJQTY9 FIELD=IREVCODE10 FIELD=IPROC10 FIELD=IPROCQUAL10 FIELD=IMODA10 FIELD=IMODB10 FIELD=IMODC10 FIELD=IMODD10 FIELD=IAMT10 FIELD=IUNITS10 FIELD=IQTY10 FIELD=IRATE10 FIELD=IAMTNCC10 FIELD=IDOS10 FIELD=IADJGRPCODE10 FIELD=IADJREASONCODE10 FIELD=IADJAMOUNT10 FIELD=IADJQTY10 FIELD=PAYTOPLAID FIELD=PAYTOPLANAME FIELD=PAYTOPLAADDR1 FIELD=PAYTOPLAADDR2 FIELD=PAYTOPLACITY FIELD=PAYTOPLAST FIELD=PAYTOPLAZIP FIELD=SUBMITTERID FIELD=SUBMITTERNAME FIELD=SUBMITTERADDR1 FIELD=SUBMITTERADDR2 FIELD=SUBMITTERCITY FIELD=SUBMITTERST FIELD=SUBMITTERZIP FIELD=TRANSACTIONSETCODE FIELD=TRANSACTIONID FIELD=TRANSACTIONDATE FIELD=TRANSACTIONTIME FIELD=TRANSACTIONTYPE FIELD=SOURCEFILE FIELD=DESTINATIONFILE
Section 18
************************** Transaction List [transactions] 835=C:\qa\qat1\qat1a.cfg ************************** Database 1 [database] TABLE=qat1 TRANSACTIONTYPE=835 DRIVER=DBF DIRECTORY=\qa\db DRIVE=c: KEYFIELD=CLAIMID OPTIONS=ADD,INDEXNTX FIELD=CLAIMID FIELD=SUBID FIELD=SUBLNAME FIELD=SUBFNAME FIELD=SUBMI FIELD=SUBADDR1 FIELD=SUBADDR2 FIELD=SUBCITY FIELD=SUBST FIELD=SUBZIP FIELD=SUBSEX FIELD=SUBMSTATUS FIELD=SUBDOB FIELD=SUBREL FIELD=SUBORDER FIELD=PATID FIELD=PATLNAME FIELD=PATFNAME FIELD=PATMI FIELD=PATADDR1 FIELD=PATADDR2 FIELD=PATCITY FIELD=PATST FIELD=PATZIP FIELD=PATSEX FIELD=PATMSTATUS FIELD=PATDOB FIELD=PATREL FIELD=PATORDER FIELD=SPROVID FIELD=SPROVLNAME FIELD=SPROVFNAME FIELD=SPROVMI FIELD=SPROVADDR1 FIELD=SPROVADDR2 FIELD=SPROVCITY FIELD=SPROVST FIELD=SPROVZIP FIELD=CLAIMTOTALCHARGE FIELD=CLAIMTOTALPAID FIELD=PATIENTRESPONSIBILITY FIELD=FILINGINDICATO FIELD=PAYERCLAIMCODE FIELD=CLAIMFREQ FIELD=CLMADJCODE1CO FIELD=CLMADJAMT1CO FIELD=CLMADJQTY1CO FIELD=CLMADJCODE2CO FIELD=CLMADJAMT2CO FIELD=CLMADJQTY2CO FIELD=CLMADJCODE3CO FIELD=CLMADJAMT3CO FIELD=CLMADJQTY3CO FIELD=CLMADJCODE4CO FIELD=CLMADJAMT4CO FIELD=CLMADJQTY4CO FIELD=CLMADJCODE5CO FIELD=CLMADJAMT5CO FIELD=CLMADJQTY5CO FIELD=CLMADJCODE6CO FIELD=CLMADJAMT6CO FIELD=CLMADJQTY6CO FIELD=CLMADJCODE1PR FIELD=CLMADJAMT1PR FIELD=CLMADJQTY1PR FIELD=CLMADJCODE2PR FIELD=CLMADJAMT2PR FIELD=CLMADJQTY2PR FIELD=CLMADJCODE3PR FIELD=CLMADJAMT3PR FIELD=CLMADJQTY3PR FIELD=CLMADJCODE4PR FIELD=CLMADJAMT4PR FIELD=CLMADJQTY4PR FIELD=CLMADJCODE5PR FIELD=CLMADJAMT5PR FIELD=CLMADJQTY5PR FIELD=CLMADJCODE6PR FIELD=CLMADJAMT6PR FIELD=CLMADJQTY6PR FIELD=CLMDATEREC FIELD=CLMEXPDATE FIELD=CLMSTATESTART FIELD=CLMSTATEEND FIELD=XOVERCARRIER FIELD=PAYERNAME FIELD=PAYERADDRESS1 FIELD=PAYERADDRESS2 FIELD=PAYERCITY FIELD=PAYERSTATE FIELD=PAYERZIP FIELD=PAYEEID FIELD=PAYEEADIDQUAL FIELD=PAYEENAME FIELD=SERVICEPROVIDER FIELD=SERVICEPROVIDERID FIELD=MEDICALRECORDIDNUMBER FIELD=GROUPPOLICYNUMBER FIELD=MEMBERIDNUMBER FIELD=REPRICECLAIMREFNUMBER FIELD=ADJREPRICECLAIMREFNUMBER FIELD=EMPLOYEEIDNUMBER FIELD=AUTHORIZATIONNUMBER FIELD=CLASSCONTRACTCODE FIELD=ORIGINALREFNUMBER FIELD=PRIORAUTHORIZATIONMUMBER FIELD=BENEFITIDNUMBER FIELD=INSURANCEPOLICYNUMBER FIELD=SSN FIELD=MOAPERCENT FIELD=MOAMOUNTPAYABLE FIELD=MOAREMARK1 FIELD=MOAREMARK2 FIELD=MOAREMARK3 FIELD=MOAREMARK4 FIELD=MOAREMARK5 FIELD=MOAPAYMENT FIELD=MOANONPAYABLE FIELD=MIACOVDVC FIELD=MIAOPOUTAMT FIELD=MIALIFPSYDAYS FIELD=MIADRGAMT FIELD=MIAREMARK1 FIELD=MIASHAREAMT FIELD=MIAMSPPASSAMT FIELD=MIAPPSCAPAMT FIELD=MIAFSPDRGAMT FIELD=MIAHSPDRGAMT FIELD=MIADHSDRGAMT FIELD=MIAOLDCAPAMT FIELD=MIAIMEAMT FIELD=MIAOHSDRG FIELD=MIACOSTRPTDATCNT FIELD=MIAOFSDRG FIELD=MIAPPSCAPOUTAMT FIELD=MIAINDTEACHAMT FIELD=MIANONPAYPROAMT FIELD=MIAREMARK2 FIELD=MIAREMARK3 FIELD=MIAREMARK4 FIELD=MIACAPEXCPAMT FIELD=RENPROVBLUECROSSID FIELD=RENPROVBLUESHIELDID FIELD=RENPROVMEDICAREID FIELD=RENPROVMEDICAIDID FIELD=RENPROVUPINID FIELD=RENPROVCHAMUSID FIELD=RENPROVFACILITYID FIELD=RENPROVNPIID FIELD=RENPROVTAXID FIELD=CLAIMSUPPLEMENTALCA FIELD=CLAIMSUPPLEMENTALCD FIELD=CLAIMSUPPLEMENTALLA FIELD=CLAIMSUPPLEMENTALLE FIELD=CLAIMSUPPLEMENTALNA FIELD=CLAIMSUPPLEMENTALNE FIELD=CLAIMSUPPLEMENTALNR FIELD=CLAIMSUPPLEMENTALOU FIELD=CLAIMSUPPLEMENTALPS FIELD=CLAIMSUPPLEMENTALVS FIELD=CLAIMSUPPLEMENTALZK FIELD=CLAIMSUPPLEMENTALZL FIELD=CLAIMSUPPLEMENTALZM FIELD=CLAIMSUPPLEMENTALZN FIELD=CLAIMSUPPLEMENTALZO FIELD=PROCEDURE1 FIELD=PROCEDUREMODA1 FIELD=PROCEDUREMODB1 FIELD=PROCEDUREMODC1 FIELD=PROCBILLEDAMT1 FIELD=PROCPAYAMT1 FIELD=PROCREVENUECODE1 FIELD=DATEOFSERVICE1 FIELD=PROCUNITSPAID1 FIELD=PROCUNITS1 FIELD=PROCALLOWEDAMT1 FIELD=PROCPERDAYLIMITAMT1 FIELD=PROCDEDUCTIONAMT1 FIELD=PROCNETBILLEDAMT1 FIELD=PROCTAXAMT1 FIELD=PROCTOTALBEFORETAXESAMT1 FIELD=PROCPAYADJAMT1 FIELD=PROCDEDUCTAMT1 FIELD=PROCCOINSAMT1 FIELD=PROCCOADJAMT1 FIELD=PROCPROTHERAM1 FIELD=PROCCOPAYAMT1 FIELD=SERVICEDATEFROM1 FIELD=SERVICEDATETO1 FIELD=PROCPRIORAUTHNUMBER1 FIELD=PROCCTLNUMBER1 FIELD=PROCREMARKCODE1 FIELD=PROCREMARK1 FIELD=PROCEDURE2 FIELD=PROCEDUREMODA2 FIELD=PROCEDUREMODB2 FIELD=PROCEDUREMODC2 FIELD=PROCBILLEDAMT2 FIELD=PROCPAYAMT2 FIELD=PROCREVENUECODE2 FIELD=DATEOFSERVICE2 FIELD=PROCUNITSPAID2 FIELD=PROCUNITS2 FIELD=PROCALLOWEDAMT2 FIELD=PROCPERDAYLIMITAMT2 FIELD=PROCDEDUCTIONAMT2 FIELD=PROCNETBILLEDAMT2 FIELD=PROCTAXAMT2 FIELD=PROCTOTALBEFORETAXESAMT2 FIELD=PROCPAYADJAMT2 FIELD=PROCDEDUCTAMT2 FIELD=PROCCOINSAMT2 FIELD=PROCCOADJAMT2 FIELD=PROCPROTHERAM2 FIELD=PROCCOPAYAMT2 FIELD=SERVICEDATEFROM2 FIELD=SERVICEDATETO2 FIELD=PROCPRIORAUTHNUMBER2 FIELD=PROCCTLNUMBER2 FIELD=PROCREMARKCODE2 FIELD=PROCREMARK2 FIELD=PROCEDURE3 FIELD=PROCEDUREMODA3 FIELD=PROCEDUREMODB3 FIELD=PROCEDUREMODC3 FIELD=PROCBILLEDAMT3 FIELD=PROCPAYAMT3 FIELD=PROCREVENUECODE3 FIELD=DATEOFSERVICE3 FIELD=PROCUNITSPAID3 FIELD=PROCUNITS3 FIELD=PROCALLOWEDAMT3 FIELD=PROCPERDAYLIMITAMT3 FIELD=PROCDEDUCTIONAMT3 FIELD=PROCNETBILLEDAMT3 FIELD=PROCTAXAMT3 FIELD=PROCTOTALBEFORETAXESAMT3 FIELD=PROCPAYADJAMT3 FIELD=PROCDEDUCTAMT3 FIELD=PROCCOINSAMT3 FIELD=PROCCOADJAMT3 FIELD=PROCPROTHERAM3 FIELD=PROCCOPAYAMT3 FIELD=SERVICEDATEFROM3 FIELD=SERVICEDATETO3 FIELD=PROCPRIORAUTHNUMBER3 FIELD=PROCCTLNUMBER3 FIELD=PROCREMARKCODE3 FIELD=PROCREMARK3 FIELD=PROCEDURE4 FIELD=PROCEDUREMODA4 FIELD=PROCEDUREMODB4 FIELD=PROCEDUREMODC4 FIELD=PROCBILLEDAMT4 FIELD=PROCPAYAMT4 FIELD=PROCREVENUECODE4 FIELD=DATEOFSERVICE4 FIELD=PROCUNITSPAID4 FIELD=PROCUNITS4 FIELD=PROCALLOWEDAMT4 FIELD=PROCPERDAYLIMITAMT4 FIELD=PROCDEDUCTIONAMT4 FIELD=PROCNETBILLEDAMT4 FIELD=PROCTAXAMT4 FIELD=PROCTOTALBEFORETAXESAMT4 FIELD=PROCPAYADJAMT4 FIELD=PROCDEDUCTAMT4 FIELD=PROCCOINSAMT4 FIELD=PROCCOADJAMT4 FIELD=PROCPROTHERAM4 FIELD=PROCCOPAYAMT4 FIELD=SERVICEDATEFROM4 FIELD=SERVICEDATETO4 FIELD=PROCPRIORAUTHNUMBER4 FIELD=PROCCTLNUMBER4 FIELD=PROCREMARKCODE4 FIELD=PROCREMARK4 FIELD=PROCEDURE5 FIELD=PROCEDUREMODA5 FIELD=PROCEDUREMODB5 FIELD=PROCEDUREMODC5 FIELD=PROCBILLEDAMT5 FIELD=PROCPAYAMT5 FIELD=PROCREVENUECODE5 FIELD=DATEOFSERVICE5 FIELD=PROCUNITSPAID5 FIELD=PROCUNITS5 FIELD=PROCALLOWEDAMT5 FIELD=PROCPERDAYLIMITAMT5 FIELD=PROCDEDUCTIONAMT5 FIELD=PROCNETBILLEDAMT5 FIELD=PROCTAXAMT5 FIELD=PROCTOTALBEFORETAXESAMT5 FIELD=PROCPAYADJAMT5 FIELD=PROCDEDUCTAMT5 FIELD=PROCCOINSAMT5 FIELD=PROCCOADJAMT5 FIELD=PROCPROTHERAM5 FIELD=PROCCOPAYAMT5 FIELD=SERVICEDATEFROM5 FIELD=SERVICEDATETO5 FIELD=PROCPRIORAUTHNUMBER5 FIELD=PROCCTLNUMBER5 FIELD=PROCREMARKCODE5 FIELD=PROCREMARK5 FIELD=PROCEDURE6 FIELD=PROCEDUREMODA6 FIELD=PROCEDUREMODB6 FIELD=PROCEDUREMODC6 FIELD=PROCBILLEDAMT6 FIELD=PROCPAYAMT6 FIELD=PROCREVENUECODE6 FIELD=DATEOFSERVICE6 FIELD=PROCUNITSPAID6 FIELD=PROCUNITS6 FIELD=PROCALLOWEDAMT6 FIELD=PROCPERDAYLIMITAMT6 FIELD=PROCDEDUCTIONAMT6 FIELD=PROCNETBILLEDAMT6 FIELD=PROCTAXAMT6 FIELD=PROCTOTALBEFORETAXESAMT6 FIELD=PROCPAYADJAMT6 FIELD=PROCDEDUCTAMT6 FIELD=PROCCOINSAMT6 FIELD=PROCCOADJAMT6 FIELD=PROCPROTHERAM6 FIELD=PROCCOPAYAMT6 FIELD=SERVICEDATEFROM6 FIELD=SERVICEDATETO6 FIELD=PROCPRIORAUTHNUMBER6 FIELD=PROCCTLNUMBER6 FIELD=PROCREMARKCODE6 FIELD=PROCREMARK6 FIELD=PROCEDURE7 FIELD=PROCEDUREMODA7 FIELD=PROCEDUREMODB7 FIELD=PROCEDUREMODC7 FIELD=PROCBILLEDAMT7 FIELD=PROCPAYAMT7 FIELD=PROCREVENUECODE7 FIELD=DATEOFSERVICE7 FIELD=PROCUNITSPAID7 FIELD=PROCUNITS7 FIELD=PROCALLOWEDAMT7 FIELD=PROCPERDAYLIMITAMT7 FIELD=PROCDEDUCTIONAMT7 FIELD=PROCNETBILLEDAMT7 FIELD=PROCTAXAMT7 FIELD=PROCTOTALBEFORETAXESAMT7 FIELD=PROCPAYADJAMT7 FIELD=PROCDEDUCTAMT7 FIELD=PROCCOINSAMT7 FIELD=PROCCOADJAMT7 FIELD=PROCPROTHERAM7 FIELD=PROCCOPAYAMT7 FIELD=SERVICEDATEFROM7 FIELD=SERVICEDATETO7 FIELD=PROCPRIORAUTHNUMBER7 FIELD=PROCCTLNUMBER7 FIELD=PROCREMARKCODE7 FIELD=PROCREMARK7 FIELD=PROCEDURE8 FIELD=PROCEDUREMODA8 FIELD=PROCEDUREMODB8 FIELD=PROCEDUREMODC8 FIELD=PROCBILLEDAMT8 FIELD=PROCPAYAMT8 FIELD=PROCREVENUECODE8 FIELD=DATEOFSERVICE8 FIELD=PROCUNITSPAID8 FIELD=PROCUNITS8 FIELD=PROCALLOWEDAMT8 FIELD=PROCPERDAYLIMITAMT8 FIELD=PROCDEDUCTIONAMT8 FIELD=PROCNETBILLEDAMT8 FIELD=PROCTAXAMT8 FIELD=PROCTOTALBEFORETAXESAMT8 FIELD=PROCPAYADJAMT8 FIELD=PROCDEDUCTAMT8 FIELD=PROCCOINSAMT8 FIELD=PROCCOADJAMT8 FIELD=PROCPROTHERAM8 FIELD=PROCCOPAYAMT8 FIELD=SERVICEDATEFROM8 FIELD=SERVICEDATETO8 FIELD=PROCPRIORAUTHNUMBER8 FIELD=PROCCTLNUMBER8 FIELD=PROCREMARKCODE8 FIELD=PROCREMARK8 FIELD=PROCEDURE9 FIELD=PROCEDUREMODA9 FIELD=PROCEDUREMODB9 FIELD=PROCEDUREMODC9 FIELD=PROCBILLEDAMT9 FIELD=PROCPAYAMT9 FIELD=PROCREVENUECODE9 FIELD=DATEOFSERVICE9 FIELD=PROCUNITSPAID9 FIELD=PROCUNITS9 FIELD=PROCALLOWEDAMT9 FIELD=PROCPERDAYLIMITAMT9 FIELD=PROCDEDUCTIONAMT9 FIELD=PROCNETBILLEDAMT9 FIELD=PROCTAXAMT9 FIELD=PROCTOTALBEFORETAXESAMT9 FIELD=PROCPAYADJAMT9 FIELD=PROCDEDUCTAMT9 FIELD=PROCCOINSAMT9 FIELD=PROCCOADJAMT9 FIELD=PROCPROTHERAM9 FIELD=PROCCOPAYAMT9 FIELD=SERVICEDATEFROM9 FIELD=SERVICEDATETO9 FIELD=PROCPRIORAUTHNUMBER9 FIELD=PROCCTLNUMBER9 FIELD=PROCREMARKCODE9 FIELD=PROCREMARK9 FIELD=PROCEDURE10 FIELD=PROCEDUREMODA10 FIELD=PROCEDUREMODB10 FIELD=PROCEDUREMODC10 FIELD=PROCBILLEDAMT10 FIELD=PROCPAYAMT10 FIELD=PROCREVENUECODE10 FIELD=DATEOFSERVICE10 FIELD=PROCUNITSPAID10 FIELD=PROCUNITS10 FIELD=PROCALLOWEDAMT10 FIELD=PROCPERDAYLIMITAMT10 FIELD=PROCDEDUCTIONAMT10 FIELD=PROCNETBILLEDAMT10 FIELD=PROCTAXAMT10 FIELD=PROCTOTALBEFORETAXESAMT10 FIELD=PROCPAYADJAMT10 FIELD=PROCDEDUCTAMT10 FIELD=PROCCOINSAMT10 FIELD=PROCCOADJAMT10 FIELD=PROCPROTHERAM10 FIELD=PROCCOPAYAMT10 FIELD=SERVICEDATEFROM10 FIELD=SERVICEDATETO10 FIELD=PROCPRIORAUTHNUMBER10 FIELD=PROCCTLNUMBER10 FIELD=PROCREMARKCODE10 FIELD=PROCREMARK10 FIELD=PROVADJREFID1 FIELD=PROVADJPERIOD1 FIELD=PROVADJREASONCODEA1 FIELD=PROVADJREASONIDA1 FIELD=PROVADJAMTA1 FIELD=PROVADJREASONCODEB1 FIELD=PROVADJREASONIDB1 FIELD=PROVADJAMTB1 FIELD=PROVADJREASONCODEC1 FIELD=PROVADJREASONIDC1 FIELD=PROVADJAMTC1 FIELD=PROVADJREASONCODED1 FIELD=PROVADJREASONIDD1 FIELD=PROVADJAMTD1 FIELD=PROVADJREASONCODEE1 FIELD=PROVADJREASONIDE1 FIELD=PROVADJAMTE1 FIELD=PROVADJREASONCODEF1 FIELD=PROVADJREASONIDF1 FIELD=PROVADJAMTF1 FIELD=TRANSACTIONHANDLINGCODE FIELD=TRANSACTIONAMOUNT FIELD=TRANSACTIONDC FIELD=TRANSACTIONPAYMENTMETHOD FIELD=TRANSACTIONPAYMENTFORMAT FIELD=TRANSACTIONIDNQ FIELD=TRANSACTIONIDN FIELD=TRANSACTIONACCOUNTNQ FIELD=TRANSACTIONACCOUNTNUM FIELD=TRANSACTIONORIGINATINGCID FIELD=TRANSACTIONORIGINATINGSCID FIELD=TRANSACTIONDFIQ FIELD=TRANSACTIONDFINUM FIELD=TRANSACTIONDEPOSITACCOUNTQ FIELD=TRANSACTIONDEPOSITACCOUNTNUM FIELD=TRANSACTIONDATE FIELD=TRACETYPE FIELD=TRACEREFID FIELD=TRACEOCID FIELD=TRACESUPOCID FIELD=PRODDATE FIELD=RECEIVERID
Section 19
************************** Schema Sample 2 ************************** 837I Transaction to a ************************** Multiple Table ************************** Relational Database ************************************************* [transactions] 837I=C:\csx\837I.cfg ************************** Database 1 [database] TABLE=SUBSCRIBER TRANSACTIONTYPE=837I DRIVER=SQL Server DSN=test SERVER=COM1SOFTWARE\SQLExpress USER=COM1SOFTWARE\User PASSWORD=******* KEYFIELD=SUBID OPTIONS=LOOKUP,INDEX0 FIELD=SUBID FIELD=PRIMARYCOV FIELD=SECONDARYCOV FIELD=TERTIARYCOV FIELD=SUBLNAME FIELD=SUBFNAME FIELD=SUBMI FIELD=SUBADDR1 FIELD=SUBADDR2 FIELD=SUBCITY FIELD=SUBST FIELD=SUBZIP FIELD=SUBSEX FIELD=SUBMSTATUS FIELD=SUBDOB FIELD=SUBREL FIELD=SUBORDER FIELD=PAYERID FIELD=PAYERNAME FIELD=PAYERADDR1 FIELD=PAYERADDR2 FIELD=PAYERCITY FIELD=PAYERST FIELD=PAYERZIP FIELD=PRIMARYSUBID FIELD=PRIMARYSUBLNAME FIELD=PRIMARYSUBFNAME FIELD=PRIMARYSUBMI FIELD=PRIMARYSUBADDR1 FIELD=PRIMARYSUBADDR2 FIELD=PRIMARYSUBCITY FIELD=PRIMARYSUBST FIELD=PRIMARYSUBZIP FIELD=PRIMARYSUBSEX FIELD=PRIMARYSUBMSTATUS FIELD=PRIMARYSUBDOB FIELD=PRIMARYSUBREL FIELD=PRIMARYGRPPOLNUM FIELD=PRIMARYGRPNAME FIELD=PRIMARYINSTYPE FIELD=PRIMARYCFI FIELD=PRIMARYPAYERID FIELD=PRIMARYPAYERNAME FIELD=PRIMARYPAYERADDR1 FIELD=PRIMARYPAYERADDR2 FIELD=PRIMARYPAYERCITY FIELD=PRIMARYPAYERST FIELD=PRIMARYPAYERZIP FIELD=SECONDARYSUBID FIELD=SECONDARYSUBLNAME FIELD=SECONDARYSUBFNAME FIELD=SECONDARYSUBMI FIELD=SECONDARYSUBADDR1 FIELD=SECONDARYSUBADDR2 FIELD=SECONDARYSUBCITY FIELD=SECONDARYSUBST FIELD=SECONDARYSUBZIP FIELD=SECONDARYSUBSEX FIELD=SECONDARYSUBMSTATUS FIELD=SECONDARYSUBDOB FIELD=SECONDARYSUBREL FIELD=SECONDARYGRPPOLNUM FIELD=SECONDARYGRPNAME FIELD=SECONDARYINSTYPE FIELD=SECONDARYCFI FIELD=SECONDARYPAYERID FIELD=SECONDARYPAYERNAME FIELD=SECONDARYPAYERADDR1 FIELD=SECONDARYPAYERADDR2 FIELD=SECONDARYPAYERCITY FIELD=SECONDARYPAYERST FIELD=SECONDARYPAYERZIP FIELD=TERTIARYSUBID FIELD=TERTIARYSUBLNAME FIELD=TERTIARYSUBFNAME FIELD=TERTIARYSUBMI FIELD=TERTIARYSUBADDR1 FIELD=TERTIARYSUBADDR2 FIELD=TERTIARYSUBCITY FIELD=TERTIARYSUBST FIELD=TERTIARYSUBZIP FIELD=TERTIARYSUBSEX FIELD=TERTIARYSUBMSTATUS FIELD=TERTIARYSUBDOB FIELD=TERTIARYSUBREL FIELD=TERTIARYGRPPOLNUM FIELD=TERTIARYGRPNAME FIELD=TERTIARYINSTYPE FIELD=TERTIARYCFI FIELD=TERTIARYPAYERID FIELD=TERTIARYPAYERNAME FIELD=TERTIARYPAYERADDR1 FIELD=TERTIARYPAYERADDR2 FIELD=TERTIARYPAYERCITY FIELD=TERTIARYPAYERST FIELD=TERTIARYPAYERZIP FIELD=PATID FIELD=PATLNAME FIELD=PATFNAME FIELD=PATMI FIELD=PATADDR1SUBADDR1 FIELD=PATADDR2SUBADDR2 FIELD=PATCITY FIELD=PATST FIELD=PATZIP FIELD=PATSEX FIELD=PATMSTAT FIELD=PATDOB FIELD=PATREL ************************** Database 2 [database] TABLE=CLAIMS TRANSACTIONTYPE=837I DRIVER=SQL Server DSN=test SERVER=COM1SOFTWARE\SQLExpress USER=COM1SOFTWARE\User PASSWORD=******* KEYFIELD=SUBID,CLAIMID OPTIONS=LOOKUP,INDEX0 FIELD=SUBID FIELD=CLAIMID FIELD=CLAIMAMT FIELD=ADMISSIONDATETIME FIELD=ADMISSIONTYPE FIELD=ADMISSIONSOURCE FIELD=PATIENTSTATUS FIELD=NURSINGHOMECODE FIELD=REPORTTYPECODE FIELD=REPORTTRANCODE FIELD=REPORTDESC FIELD=CLAIMNUMBER FIELD=DISCHARGEDATE FIELD=DISCHARGEHOUR FIELD=STATEMENTDATE FIELD=MEDICALRECORDNUMBER FIELD=FACILITYCODEVALUE FIELD=FACILITYCODEQUALIFIER FIELD=FREQUENCYTYPECODE FIELD=PRINCIPALDX FIELD=ADMITDX FIELD=PRIORAUTH FIELD=K3DATA FIELD=NOTECODE FIELD=NOTEDESC FIELD=SUPPLEMENTALINFOTYPE FIELD=SUPPLEMENTALINFOTRANS FIELD=SUPPLEMENTALINFODESC FIELD=NDCCODE FIELD=NDCUNITPRICE FIELD=NDCUNITS FIELD=ECODE FIELD=ATTENDINGID FIELD=ATTENDINGLNAME FIELD=ATTENDINGFNAME FIELD=ATTENDINGMNAME FIELD=ATTENDINGPREFIX FIELD=ATTENDINGSUFFIX FIELD=ATTENDINGIDCODE FIELD=ATTENDINGTYPE FIELD=ATTENDINGTAXONOMY FIELD=OPERATEINGID FIELD=OPERATEINGLNAME FIELD=OPERATEINGFNAME FIELD=OPERATINGMNAME FIELD=OPERATINGPREFIX FIELD=OPERATINGSUFFIX FIELD=OPERATINGIDCODE FIELD=OPERATINGTYPE FIELD=OPERATINGTAXONOMY FIELD=REFERRINGID FIELD=REFERRINGLNAME FIELD=REFERRINGFNAME FIELD=REFERRINGMNAME FIELD=REFERRINGPREFIX FIELD=REFERRINGSUFFIX FIELD=REFERRINGIDCODE FIELD=REFERRINGTYPE FIELD=REFERRINGTAXONOMY FIELD=RENDERINGID FIELD=RENDERINGLNAME FIELD=RENDERINGFNAME FIELD=RENDERINGMNAME FIELD=RENDERINGPREFIX FIELD=RENDERINGSUFFIX FIELD=RENDERINGIDCODE FIELD=RENDERINGTYPE FIELD=RENDERINGTAXONOMY FIELD=SERVICEFACILITYNAME FIELD=SERVICEFACILIYID FIELD=OTHERDX01 FIELD=OTHERDX02 FIELD=OTHERDX03 FIELD=OTHERDX04 FIELD=OTHERDX05 FIELD=OTHERDX06 FIELD=OTHERDX07 FIELD=OTHERDX08 FIELD=OTHERDX09 FIELD=OTHERDX10 FIELD=OTHERDX11 FIELD=OTHERDX12 FIELD=PRINCIPLEPROCICD9 FIELD=PRINCIPLEPROCDATE FIELD=PRINCIPLEPROCHCFA FIELD=OTHERPROC01 FIELD=OTHERPROC02 FIELD=OTHERPROC03 FIELD=OTHERPROC04 FIELD=OTHERPROC05 FIELD=OTHERPROC06 FIELD=OTHERPROC07 FIELD=OTHERPROC08 FIELD=OTHERPROC09 FIELD=OTHERPROC10 FIELD=OTHERPROC11 FIELD=OTHERPROC12 FIELD=OCCURRENCESPAN01 FIELD=OCCURRENCESPAN02 FIELD=OCCURRENCESPAN03 FIELD=OCCURRENCESPAN04 FIELD=OCCURRENCESPAN05 FIELD=OCCURRENCESPAN06 FIELD=OCCURRENCESPAN07 FIELD=OCCURRENCESPAN08 FIELD=OCCURRENCESPAN09 FIELD=OCCURRENCESPAN10 FIELD=OCCURRENCESPAN11 FIELD=OCCURRENCESPAN12 FIELD=OCCURRENCECODE01 FIELD=OCCURRENCEDATE01 FIELD=OCCURRENCECODE02 FIELD=OCCURRENCEDATE02 FIELD=OCCURRENCECODE03 FIELD=OCCURRENCEDATE03 FIELD=OCCURRENCECODE04 FIELD=OCCURRENCEDATE04 FIELD=OCCURRENCECODE05 FIELD=OCCURRENCEDATE05 FIELD=OCCURRENCECODE06 FIELD=OCCURRENCEDATE06 FIELD=OCCURRENCECODE07 FIELD=OCCURRENCEDATE07 FIELD=OCCURRENCECODE08 FIELD=OCCURRENCEDATE08 FIELD=OCCURRENCECODE09 FIELD=OCCURRENCEDATE09 FIELD=OCCURRENCECODE10 FIELD=OCCURRENCEDATE10 FIELD=OCCURRENCECODE11 FIELD=OCCURRENCEDATE11 FIELD=OCCURRENCECODE12 FIELD=OCCURRENCEDATE12 FIELD=VALUECODE01 FIELD=VALUEAMOUNT01 FIELD=VALUEQTY01 FIELD=VALUECODE02 FIELD=VALUEAMOUNT02 FIELD=VALUEQTY02 FIELD=VALUECODE03 FIELD=VALUEAMOUNT03 FIELD=VALUEQTY03 FIELD=VALUECODE04 FIELD=VALUEAMOUNT04 FIELD=VALUEQTY04 FIELD=VALUECODE05 FIELD=VALUEAMOUNT05 FIELD=VALUEQTY05 FIELD=VALUECODE06 FIELD=VALUEAMOUNT06 FIELD=VALUEQTY06 FIELD=VALUECODE07 FIELD=VALUEAMOUNT07 FIELD=VALUEQTY07 FIELD=VALUECODE08 FIELD=VALUEAMOUNT08 FIELD=VALUEQTY08 FIELD=VALUECODE09 FIELD=VALUEAMOUNT09 FIELD=VALUEQTY09 FIELD=VALUECODE10 FIELD=VALUEAMOUNT10 FIELD=VALUEQTY10 FIELD=CONDITIONCODE01 FIELD=CONDITIONCODE02 FIELD=CONDITIONCODE03 FIELD=CONDITIONCODE04 FIELD=CONDITIONCODE05 FIELD=CONDITIONCODE06 FIELD=CONDITIONCODE07 FIELD=CONDITIONCODE08 FIELD=CONDITIONCODE09 FIELD=CONDITIONCODE10 FIELD=CONDITIONCODE11 FIELD=CONDITIONCODE12 FIELD=TREATMENTCODE01 FIELD=TREATMENTCODE02 FIELD=TREATMENTCODE03 FIELD=TREATMENTCODE04 FIELD=TREATMENTCODE05 FIELD=TREATMENTCODE06 FIELD=TREATMENTCODE07 FIELD=TREATMENTCODE08 FIELD=TREATMENTCODE09 FIELD=TREATMENTCODE10 FIELD=TREATMENTCODE11 FIELD=TREATMENTCODE12 FIELD=ADMITTINGDX01 FIELD=ADMITTINGDX02 FIELD=ADMITTINGDX03 FIELD=ADMITTINGDX04 FIELD=ADMITTINGDX05 FIELD=ADMITTINGDX06 FIELD=ADMITTINGDX07 FIELD=ADMITTINGDX08 FIELD=ADMITTINGDX09 FIELD=ADMITTINGDX10 FIELD=ADMITTINGDX11 FIELD=ADMITTINGDX12 FIELD=VISITREASONDX01 FIELD=VISITREASONDX02 FIELD=VISITREASONDX03 FIELD=VISITREASONDX04 FIELD=VISITREASONDX05 FIELD=VISITREASONDX06 FIELD=VISITREASONDX07 FIELD=VISITREASONDX08 FIELD=VISITREASONDX09 FIELD=VISITREASONDX10 FIELD=VISITREASONDX11 FIELD=VISITREASONDX12 FIELD=DRG FIELD=DRGAMT ************************** Database 3 ************************** Service Line Data [database] TABLE=SERVICES TRANSACTIONTYPE=837I DRIVER=SQL Server DSN=test SERVER=COM1SOFTWARE\SQLExpress USER=COM1SOFTWARE\User PASSWORD=******* KEYFIELD=SUBID,CLAIMID OPTIONS=LOOKUP,INDEX0,ML FIELD=SUBID FIELD=CLAIMID FIELD=IREVCODE1 FIELD=IPROC1 FIELD=IPROCQUAL1 FIELD=IMODA1 FIELD=IMODB1 FIELD=IMODC1 FIELD=IMODD1 FIELD=IAMT1 FIELD=IUNITS1 FIELD=IQTY1 FIELD=IRATE1 FIELD=IAMTNCC1 FIELD=IDOS1 FIELD=IADJGRPCODE1 FIELD=IADJREASONCODE1 FIELD=IADJAMOUNT1 FIELD=IADJQTY1
Section 20
--
Section 21
********** Com1 Software Parser Map ********** Generated :08/08/14 16:20:06 ********** (c) 1992-2011 COM1 SOFTWARE DEVELOPMENT ************************************************** ********* File Name : 837I.cfg ********* 837I Claim Submission Configuration ************************************************** X12TRANSACTIONTYPE=837I KEYHEADERFIELD=HL,,,20 KEYFIELD=HL,,,22 KEYDOCFIELD=CLM KEYLINEFIELD=SV2 FIELD=SUBID,16,NM1,IL,2,9 FIELD=BILLINGPROVIDERID,16,NM1,85,2,9,,,,2 FIELD=BILLINGPROVIDERNAME,32,NM1,85,2,3,,,,2 FIELD=BILLINGPROVIDERADDR1,30,N3,,,1,,BILLINGPROVIDERNAME,,2 FIELD=BILLINGPROVIDERADDR2,30,N3,,,2,,BILLINGPROVIDERNAME,,2 FIELD=BILLINGPROVIDERCITY,30,N4,,,1,,BILLINGPROVIDERNAME,,2 FIELD=BILLINGPROVIDERST,2,N4,,,2,,BILLINGPROVIDERNAME,,2 FIELD=BILLINGPROVIDERZIP,10,N4,,,3,,BILLINGPROVIDERNAME,,2 FIELD=PAYTOPROVIDERID,16,NM1,87,2,9,,,,2 FIELD=PAYTOPROVIDERNAME,32,NM1,87,2,3,,,,2 FIELD=PAYTOPROVIDERADDR1,30,N3,,,1,,PAYTOPROVIDERNAME,,2 FIELD=PAYTOPROVIDERADDR2,30,N3,,,2,,PAYTOPROVIDERNAME,,2 FIELD=PAYTOPROVIDERCITY,30,N4,,,1,,PAYTOPROVIDERNAME,,2 FIELD=PAYTOPROVIDERST,2,N4,,,2,,PAYTOPROVIDERNAME,,2 FIELD=PAYTOPROVIDERZIP,10,N4,,,3,,PAYTOPROVIDERNAME,,2 FIELD=PRIMARYCOV,1,SBR,P,2,1 FIELD=SECONDARYCOV,1,SBR,S,2,1 FIELD=TERTIARYCOV,1,SBR,T,2,1 FIELD=SUBLNAME,32,NM1,IL,2,3,,SUBID FIELD=SUBFNAME,32,NM1,IL,2,4,,SUBID FIELD=SUBMI,1,NM1,IL,2,5,,SUBID FIELD=SUBADDR1,30,N3,,,1,,SUBID,,,,,,,,NM1,IL,2,PAYERID FIELD=SUBADDR2,30,N3,,,2,,SUBID,,,,,,,,NM1,IL,2,PAYERID FIELD=SUBCITY,30,N4,,,1,,SUBID,,,,,,,,NM1,IL,2,PAYERID FIELD=SUBST,2,N4,,,2,,SUBID,,,,,,,,NM1,IL,2,PAYERID FIELD=SUBZIP,10,N4,,,3,,SUBID,,,,,,,,NM1,IL,2,PAYERID FIELD=SUBSEX,1,DMG,,,3,,SUBID,,,,,,,,NM1,IL,2,PAYERID FIELD=SUBMSTATUS,1,DMG,,,4,,SUBID,,,,,,,,NM1,IL,2,PAYERID FIELD=SUBDOB,10,DMG,,,2,,SUBID,,,,,,,,NM1,IL,2,PAYERID FIELD=SUBREL,3,SBR,,,2,,SUBID FIELD=SUBORDER,3,SBR,,,1,,SUBID FIELD=PAYERID,16,NM1,PR,2,9,,SUBID FIELD=PAYERNAME,32,NM1,PR,2,3,,PAYERID FIELD=PAYERADDR1,30,N3,,,1,,PAYERID FIELD=PAYERADDR2,30,N3,,,2,,PAYERID FIELD=PAYERCITY,30,N4,,,1,,PAYERID FIELD=PAYERST,2,N4,,,2,,PAYERID FIELD=PAYERZIP,10,N4,,,3,,PAYERID FIELD=PRIMARYSUBID,16,NM1,IL,2,9,,PRIMARYCOV,,,,,,,,SBR,P,2,PRIMARYPAYERID FIELD=PRIMARYSUBLNAME,32,NM1,IL,2,3,,PRIMARYCOV,,,,,,,,SBR,P,2,PRIMARYPAYERID FIELD=PRIMARYSUBFNAME,32,NM1,IL,2,4,,PRIMARYCOV,,,,,,,,SBR,P,2,PRIMARYPAYERID FIELD=PRIMARYSUBMI,1,NM1,IL,2,5,,PRIMARYCOV,,,,,,,,SBR,P,2,PRIMARYPAYERID FIELD=PRIMARYSUBADDR1,30,N3,,,1,,PRIMARYCOV,,,,,,,,SBR,P,2,PRIMARYPAYERID FIELD=PRIMARYSUBADDR2,30,N3,,,2,,PRIMARYCOV,,,,,,,,SBR,P,2,PRIMARYPAYERID FIELD=PRIMARYSUBCITY,30,N4,,,1,,PRIMARYCOV,,,,,,,,SBR,P,2,PRIMARYPAYERID FIELD=PRIMARYSUBST,2,N4,,,2,,PRIMARYCOV,,,,,,,,SBR,P,2,PRIMARYPAYERID FIELD=PRIMARYSUBZIP,10,N4,,,3,,PRIMARYCOV,,,,,,,,SBR,P,2,PRIMARYPAYERID FIELD=PRIMARYSUBSEX,1,DMG,,,3,,PRIMARYCOV,,,,,,,,SBR,P,2,PRIMARYPAYERID FIELD=PRIMARYSUBMSTATUS,1,DMG,,,4,,PRIMARYCOV,,,,,,,,SBR,P,2,PRIMARYPAYERID FIELD=PRIMARYSUBDOB,10,DMG,,,2,,PRIMARYCOV,,,,,,,,SBR,P,2,PRIMARYPAYERID FIELD=PRIMARYSUBREL,3,SBR,,,2,,PRIMARYCOV,,,,,,,,SBR,P,2,PRIMARYPAYERID FIELD=PRIMARYGRPPOLNUM,24,SBR,,,3,,PRIMARYCOV,,,,,,,,SBR,P,2,PRIMARYPAYERID FIELD=PRIMARYGRPNAME,32,SBR,,,4,,PRIMARYCOV,,,,,,,,SBR,P,2,PRIMARYPAYERID FIELD=PRIMARYINSTYPE,4,SBR,,,5,,PRIMARYCOV,,,,,,,,SBR,P,2,PRIMARYPAYERID FIELD=PRIMARYCFI,24,SBR,,,9,,PRIMARYCOV,,,,,,,,SBR,P,2,PRIMARYPAYERID FIELD=PRIMARYPAYERID,16,NM1,PR,2,9,,PRIMARYCOV FIELD=PRIMARYPAYERNAME,32,NM1,PR,2,3,,PRIMARYCOV FIELD=PRIMARYPAYERADDR1,30,N3,,,1,,PRIMARYCOV FIELD=PRIMARYPAYERADDR2,30,N3,,,2,,PRIMARYCOV FIELD=PRIMARYPAYERCITY,30,N4,,,1,,PRIMARYCOV FIELD=PRIMARYPAYERST,2,N4,,,2,,PRIMARYCOV FIELD=PRIMARYPAYERZIP,10,N4,,,3,,PRIMARYCOV FIELD=SECONDARYSUBID,16,NM1,IL,2,9,,SECONDARYCOV,,,,,,,,SBR,S,2,SECONDARYPAYERID FIELD=SECONDARYSUBLNAME,32,NM1,IL,2,3,,SECONDARYCOV,,,,,,,,SBR,S,2,SECONDARYPAYERID FIELD=SECONDARYSUBFNAME,32,NM1,IL,2,4,,SECONDARYCOV,,,,,,,,SBR,S,2,SECONDARYPAYERID FIELD=SECONDARYSUBMI,1,NM1,IL,2,5,,SECONDARYCOV,,,,,,,,SBR,S,2,SECONDARYPAYERID FIELD=SECONDARYSUBADDR1,30,N3,,,1,,SECONDARYCOV,,,,,,,,SBR,S,2,SECONDARYPAYERID FIELD=SECONDARYSUBADDR2,30,N3,,,2,,SECONDARYCOV,,,,,,,,SBR,S,2,SECONDARYPAYERID FIELD=SECONDARYSUBCITY,30,N4,,,1,,SECONDARYCOV,,,,,,,,SBR,S,2,SECONDARYPAYERID FIELD=SECONDARYSUBST,2,N4,,,2,,SECONDARYCOV,,,,,,,,SBR,S,2,SECONDARYPAYERID FIELD=SECONDARYSUBZIP,10,N4,,,3,,SECONDARYCOV,,,,,,,,SBR,S,2,SECONDARYPAYERID FIELD=SECONDARYSUBSEX,1,DMG,,,3,,SECONDARYCOV,,,,,,,,SBR,S,2,SECONDARYPAYERID FIELD=SECONDARYSUBMSTATUS,1,DMG,,,4,,SECONDARYCOV,,,,,,,,SBR,S,2,SECONDARYPAYERID FIELD=SECONDARYSUBDOB,10,DMG,,,2,,SECONDARYCOV,,,,,,,,SBR,S,2,SECONDARYPAYERID FIELD=SECONDARYSUBREL,3,SBR,,,2,,SECONDARYCOV,,,,,,,,SBR,S,2,SECONDARYPAYERID FIELD=SECONDARYGRPPOLNUM,24,SBR,,,3,,SECONDARYCOV,,,,,,,,SBR,P,2,SECONDARYPAYERID FIELD=SECONDARYGRPNAME,32,SBR,,,4,,SECONDARYCOV,,,,,,,,SBR,P,2,SECONDARYPAYERID FIELD=SECONDARYINSTYPE,4,SBR,,,5,,SECONDARYCOV,,,,,,,,SBR,P,2,SECONDARYPAYERID FIELD=SECONDARYCFI,24,SBR,,,9,,SECONDARYCOV,,,,,,,,SBR,P,2,SECONDARYPAYERID FIELD=SECONDARYPAYERID,16,NM1,PR,2,9,,SECONDARYCOV FIELD=SECONDARYPAYERNAME,32,NM1,PR,2,3,,SECONDARYCOV FIELD=SECONDARYPAYERADDR1,30,N3,,,1,,SECONDARYCOV FIELD=SECONDARYPAYERADDR2,30,N3,,,2,,SECONDARYCOV FIELD=SECONDARYPAYERCITY,30,N4,,,1,,SECONDARYCOV FIELD=SECONDARYPAYERST,2,N4,,,2,,SECONDARYCOV FIELD=SECONDARYPAYERZIP,10,N4,,,3,,SECONDARYCOV FIELD=TERTIARYSUBID,16,NM1,IL,2,9,,TERTIARYCOV,,,,,,,,SBR,T,2,TERTIARYPAYERID FIELD=TERTIARYSUBLNAME,32,NM1,IL,2,3,,TERTIARYCOV,,,,,,,,SBR,T,2,TERTIARYPAYERID FIELD=TERTIARYSUBFNAME,32,NM1,IL,2,4,,TERTIARYCOV,,,,,,,,SBR,T,2,TERTIARYPAYERID FIELD=TERTIARYSUBMI,1,NM1,IL,2,5,,TERTIARYCOV,,,,,,,,SBR,T,2,TERTIARYPAYERID FIELD=TERTIARYSUBADDR1,30,N3,,,1,,TERTIARYCOV,,,,,,,,SBR,T,2,TERTIARYPAYERID FIELD=TERTIARYSUBADDR2,30,N3,,,2,,TERTIARYCOV,,,,,,,,SBR,T,2,TERTIARYPAYERID FIELD=TERTIARYSUBCITY,30,N4,,,1,,TERTIARYCOV,,,,,,,,SBR,T,2,TERTIARYPAYERID FIELD=TERTIARYSUBST,2,N4,,,2,,TERTIARYCOV,,,,,,,,SBR,T,2,TERTIARYPAYERID FIELD=TERTIARYSUBZIP,10,N4,,,3,,TERTIARYCOV,,,,,,,,SBR,T,2,TERTIARYPAYERID FIELD=TERTIARYSUBSEX,1,DMG,,,3,,TERTIARYCOV,,,,,,,,SBR,T,2,TERTIARYPAYERID FIELD=TERTIARYSUBMSTATUS,1,DMG,,,4,,TERTIARYCOV,,,,,,,,SBR,T,2,TERTIARYPAYERID FIELD=TERTIARYSUBDOB,10,DMG,,,2,,TERTIARYCOV,,,,,,,,SBR,T,2,TERTIARYPAYERID FIELD=TERTIARYSUBREL,3,SBR,,,2,,TERTIARYCOV,,,,,,,,SBR,T,2,TERTIARYPAYERID FIELD=TERTIARYGRPPOLNUM,24,SBR,,,3,,TERTIARYCOV,,,,,,,,SBR,P,2,TERTIARYPAYERID FIELD=TERTIARYGRPNAME,32,SBR,,,4,,TERTIARYCOV,,,,,,,,SBR,P,2,TERTIARYPAYERID FIELD=TERTIARYINSTYPE,4,SBR,,,5,,TERTIARYCOV,,,,,,,,SBR,P,2,TERTIARYPAYERID FIELD=TERTIARYCFI,24,SBR,,,9,,TERTIARYCOV,,,,,,,,SBR,P,2,TERTIARYPAYERID FIELD=TERTIARYPAYERID,16,NM1,PR,2,9,,TERTIARYCOV FIELD=TERTIARYPAYERNAME,32,NM1,PR,2,3,,TERTIARYCOV FIELD=TERTIARYPAYERADDR1,30,N3,,,1,,TERTIARYCOV FIELD=TERTIARYPAYERADDR2,30,N3,,,2,,TERTIARYCOV FIELD=TERTIARYPAYERCITY,30,N4,,,1,,TERTIARYCOV FIELD=TERTIARYPAYERST,2,N4,,,2,,TERTIARYCOV FIELD=TERTIARYPAYERZIP,10,N4,,,3,,TERTIARYCOV FIELD=PATID,16,NM1,QC,2,9 FIELD=PATLNAME,32,NM1,QC,2,3 FIELD=PATFNAME,32,NM1,QC,2,4 FIELD=PATMI,1,NM1,QC,2,5 FIELD=PATADDR1SUBADDR1,30,N3,,,1,,PATLNAME FIELD=PATADDR2SUBADDR2,30,N3,,,2,,PATLNAME FIELD=PATCITY,30,N4,,,1,,PATLNAME FIELD=PATST,2,N4,,,2,,PATLNAME FIELD=PATZIP,10,N4,,,3,,PATLNAME FIELD=PATSEX,1,DMG,,,3,,PATLNAME FIELD=PATMSTAT,1,DMG,,,4,,PATLNAME FIELD=PATDOB,10,DMG,,,2,,PATLNAME FIELD=PATREL,1,PAT,,,2,,PATLNAME FIELD=CLAIMID,20,CLM,,,1,,SUBID FIELD=CLAIMAMT,20,CLM,,,2,,SUBID FIELD=ADMISSIONDATETIME,16,DTP,435,2,3,,SUBID FIELD=ADMISSIONTYPE,3,CL1,,,1,,SUBID FIELD=ADMISSIONSOURCE,3,CL1,,,2,,SUBID FIELD=PATIENTSTATUS,3,CL1,,,3,,SUBID FIELD=NURSINGHOMECODE,3,CL1,,,4,,SUBID FIELD=REPORTTYPECODE,20,PWK,,,1,,SUBID FIELD=REPORTTRANCODE,20,PWK,,,2,,SUBID FIELD=REPORTDESC,20,PWK,,,6,,SUBID FIELD=CLAIMNUMBER,20,REF,D9,2,2,,SUBID FIELD=DISCHARGEDATE,10,CR6,,,5,,SUBID FIELD=DISCHARGEHOUR,10,DTP,096,2,3,,SUBID FIELD=STATEMENTDATE,20,DTP,434,2,3,,SUBID FIELD=MEDICALRECORDNUMBER,10,REF,EA,2,2,,SUBID FIELD=FACILITYCODEVALUE,3,CLM,,,5,1,SUBID FIELD=FACILITYCODEQUALIFIER,3,CLM,,,5,2,SUBID FIELD=FREQUENCYTYPECODE,3,CLM,,,5,3,SUBID FIELD=PRINCIPALDX,7,HI,BK,2,1,2,SUBID FIELD=ADMITDX,7,HI,BK,2,2,2,SUBID FIELD=PRIORAUTH,10,REF,G1,2,2,,SUBID FIELD=K3DATA,20,K3,,,1,,SUBID FIELD=NOTECODE,4,NTE,,,1,,SUBID FIELD=NOTEDESC,4,NTE,,,2,,SUBID FIELD=SUPPLEMENTALINFOTYPE,4,PWK,,,1,,SUBID FIELD=SUPPLEMENTALINFOTRANS,4,PWK,,,2,,SUBID FIELD=SUPPLEMENTALINFODESC,4,PWK,,,6,,SUBID FIELD=NDCCODE,16,LIN,N4,2,3,,SUBID FIELD=NDCUNITPRICE,16,CTP,,,3,,SUBID FIELD=NDCUNITS,16,CTP,,,4,,SUBID FIELD=ECODE,7,HI,BN,4,3,2,SUBID FIELD=ATTENDINGID,16,NM1,71,2,9,,SUBID FIELD=ATTENDINGLNAME,32,NM1,71,2,3,,SUBID FIELD=ATTENDINGFNAME,32,NM1,71,2,4,,SUBID FIELD=ATTENDINGMNAME,32,NM1,71,2,5,,SUBID FIELD=ATTENDINGPREFIX,32,NM1,71,2,6,,SUBID FIELD=ATTENDINGSUFFIX,32,NM1,71,2,7,,SUBID FIELD=ATTENDINGIDCODE,4,NM1,71,2,8,,SUBID FIELD=ATTENDINGTYPE,2,NM1,71,2,1,,SUBID FIELD=ATTENDINGTAXONOMY,2,PRV,AT,2,3,,ATTENDINGID FIELD=OPERATEINGID,16,NM1,72,2,9,,SUBID FIELD=OPERATEINGLNAME,32,NM1,72,2,3,,SUBID FIELD=OPERATEINGFNAME,32,NM1,72,2,4,,SUBID FIELD=OPERATINGMNAME,32,NM1,72,2,5,,SUBID FIELD=OPERATINGPREFIX,32,NM1,72,2,6,,SUBID FIELD=OPERATINGSUFFIX,32,NM1,72,2,7,,SUBID FIELD=OPERATINGIDCODE,4,NM1,72,2,8,,SUBID FIELD=OPERATINGTYPE,2,NM1,72,2,1,,SUBID FIELD=OPERATINGTAXONOMY,2,PRV,AT,2,3,,OPERATINGID FIELD=REFERRINGID,16,NM1,DN,2,9,,SUBID FIELD=REFERRINGLNAME,32,NM1,82,2,3,,SUBID FIELD=REFERRINGFNAME,32,NM1,82,2,4,,SUBID FIELD=REFERRINGMNAME,32,NM1,82,2,5,,SUBID FIELD=REFERRINGPREFIX,32,NM1,82,2,6,,SUBID FIELD=REFERRINGSUFFIX,32,NM1,82,2,7,,SUBID FIELD=REFERRINGIDCODE,4,NM1,82,2,8,,SUBID FIELD=REFERRINGTYPE,2,NM1,82,2,1,,SUBID FIELD=REFERRINGTAXONOMY,2,PRV,AT,2,3,,REFERRINGID FIELD=RENDERINGID,16,NM1,82,2,9,,SUBID FIELD=RENDERINGLNAME,32,NM1,82,2,3,,SUBID FIELD=RENDERINGFNAME,32,NM1,82,2,4,,SUBID FIELD=RENDERINGMNAME,32,NM1,82,2,5,,SUBID FIELD=RENDERINGPREFIX,32,NM1,82,2,6,,SUBID FIELD=RENDERINGSUFFIX,32,NM1,82,2,7,,SUBID FIELD=RENDERINGIDCODE,4,NM1,82,2,8,,SUBID FIELD=RENDERINGTYPE,2,NM1,82,2,1,,SUBID FIELD=RENDERINGTAXONOMY,2,PRV,AT,2,3,,RENDERINGID FIELD=SERVICEFACILITYNAME,32,NM1,77,2,3,,SUBID FIELD=SERVICEFACILIYID,16,NM1,77,2,9,,SUBID FIELD=OTHERDX01,7,HI,BF,2,1,2,SUBID FIELD=OTHERDX02,7,HI,BF,2,2,2,SUBID FIELD=OTHERDX03,7,HI,BF,2,3,2,SUBID FIELD=OTHERDX04,7,HI,BF,2,4,2,SUBID FIELD=OTHERDX05,7,HI,BF,2,5,2,SUBID FIELD=OTHERDX06,7,HI,BF,2,6,2,SUBID FIELD=OTHERDX07,7,HI,BF,2,7,2,SUBID FIELD=OTHERDX08,7,HI,BF,2,8,2,SUBID FIELD=OTHERDX09,7,HI,BF,2,9,2,SUBID FIELD=OTHERDX10,7,HI,BF,2,10,2,SUBID FIELD=OTHERDX11,7,HI,BF,2,11,2,SUBID FIELD=OTHERDX12,7,HI,BF,2,12,2,SUBID FIELD=PRINCIPLEPROCICD9,7,HI,BR,2,1,2,SUBID FIELD=PRINCIPLEPROCDATE,7,HI,BP,2,1,4,SUBID FIELD=PRINCIPLEPROCHCFA,7,HI,BP,2,1,2,SUBID FIELD=OTHERPROC01,7,HI,BO:BQ,2,1,2,SUBID FIELD=OTHERPROC02,7,HI,BO:BQ,2,2,2,SUBID FIELD=OTHERPROC03,7,HI,BO:BQ,2,3,2,SUBID FIELD=OTHERPROC04,7,HI,BO:BQ,2,4,2,SUBID FIELD=OTHERPROC05,7,HI,BO:BQ,2,5,2,SUBID FIELD=OTHERPROC06,7,HI,BO:BQ,2,6,2,SUBID FIELD=OTHERPROC07,7,HI,BO:BQ,2,7,2,SUBID FIELD=OTHERPROC08,7,HI,BO:BQ,2,8,2,SUBID FIELD=OTHERPROC09,7,HI,BO:BQ,2,9,2,SUBID FIELD=OTHERPROC10,7,HI,BO:BQ,2,10,2,SUBID FIELD=OTHERPROC11,7,HI,BO:BQ,2,11,2,SUBID FIELD=OTHERPROC12,7,HI,BO:BQ,2,12,2,SUBID FIELD=OCCURRENCESPAN01,12,HI,BI,2,1,2,SUBID FIELD=OCCURRENCESPAN02,12,HI,BI,2,2,2,SUBID FIELD=OCCURRENCESPAN03,12,HI,BI,2,3,2,SUBID FIELD=OCCURRENCESPAN04,12,HI,BI,2,4,2,SUBID FIELD=OCCURRENCESPAN05,12,HI,BI,2,5,2,SUBID FIELD=OCCURRENCESPAN06,12,HI,BI,2,6,2,SUBID FIELD=OCCURRENCESPAN07,12,HI,BI,2,7,2,SUBID FIELD=OCCURRENCESPAN08,12,HI,BI,2,8,2,SUBID FIELD=OCCURRENCESPAN09,12,HI,BI,2,9,2,SUBID FIELD=OCCURRENCESPAN10,12,HI,BI,2,10,2,SUBID FIELD=OCCURRENCESPAN11,12,HI,BI,2,11,2,SUBID FIELD=OCCURRENCESPAN12,12,HI,BI,2,12,2,SUBID FIELD=OCCURRENCECODE01,12,HI,BH,2,1,2,SUBID FIELD=OCCURRENCEDATE01,12,HI,BH,2,1,4,SUBID FIELD=OCCURRENCECODE02,12,HI,BH,2,2,2,SUBID FIELD=OCCURRENCEDATE02,12,HI,BH,2,2,4,SUBID FIELD=OCCURRENCECODE03,12,HI,BH,2,3,2,SUBID FIELD=OCCURRENCEDATE03,12,HI,BH,2,3,4,SUBID FIELD=OCCURRENCECODE04,12,HI,BH,2,4,2,SUBID FIELD=OCCURRENCEDATE04,12,HI,BH,2,4,4,SUBID FIELD=OCCURRENCECODE05,12,HI,BH,2,5,2,SUBID FIELD=OCCURRENCEDATE05,12,HI,BH,2,5,4,SUBID FIELD=OCCURRENCECODE06,12,HI,BH,2,6,2,SUBID FIELD=OCCURRENCEDATE06,12,HI,BH,2,6,4,SUBID FIELD=OCCURRENCECODE07,12,HI,BH,2,7,2,SUBID FIELD=OCCURRENCEDATE07,12,HI,BH,2,7,4,SUBID FIELD=OCCURRENCECODE08,12,HI,BH,2,8,2,SUBID FIELD=OCCURRENCEDATE08,12,HI,BH,2,8,4,SUBID FIELD=OCCURRENCECODE09,12,HI,BH,2,9,2,SUBID FIELD=OCCURRENCEDATE09,12,HI,BH,2,9,4,SUBID FIELD=OCCURRENCECODE10,12,HI,BH,2,10,2,SUBID FIELD=OCCURRENCEDATE10,12,HI,BH,2,10,4,SUBID FIELD=OCCURRENCECODE11,12,HI,BH,2,11,2,SUBID FIELD=OCCURRENCEDATE11,12,HI,BH,2,11,4,SUBID FIELD=OCCURRENCECODE12,12,HI,BH,2,12,2,SUBID FIELD=OCCURRENCEDATE12,12,HI,BH,2,12,4,SUBID FIELD=VALUECODE01,12,HI,BE,2,1,2,SUBID FIELD=VALUEAMOUNT01,12,HI,BE,2,1,5,SUBID FIELD=VALUEQTY01,12,HI,BE,2,1,6,SUBID FIELD=VALUECODE02,12,HI,BE,2,2,2,SUBID FIELD=VALUEAMOUNT02,12,HI,BE,2,2,5,SUBID FIELD=VALUEQTY02,12,HI,BE,2,2,6,SUBID FIELD=VALUECODE03,12,HI,BE,2,3,2,SUBID FIELD=VALUEAMOUNT03,12,HI,BE,2,3,5,SUBID FIELD=VALUEQTY03,12,HI,BE,2,3,6,SUBID FIELD=VALUECODE04,12,HI,BE,2,4,2,SUBID FIELD=VALUEAMOUNT04,12,HI,BE,2,4,5,SUBID FIELD=VALUEQTY04,12,HI,BE,2,4,6,SUBID FIELD=VALUECODE05,12,HI,BE,2,5,2,SUBID FIELD=VALUEAMOUNT05,12,HI,BE,2,5,5,SUBID FIELD=VALUEQTY05,12,HI,BE,2,5,6,SUBID FIELD=VALUECODE06,12,HI,BE,2,6,2,SUBID FIELD=VALUEAMOUNT06,12,HI,BE,2,6,5,SUBID FIELD=VALUEQTY06,12,HI,BE,2,6,6,SUBID FIELD=VALUECODE07,12,HI,BE,2,7,2,SUBID FIELD=VALUEAMOUNT07,12,HI,BE,2,7,5,SUBID FIELD=VALUEQTY07,12,HI,BE,2,7,6,SUBID FIELD=VALUECODE08,12,HI,BE,2,8,2,SUBID FIELD=VALUEAMOUNT08,12,HI,BE,2,8,5,SUBID FIELD=VALUEQTY08,12,HI,BE,2,8,6,SUBID FIELD=VALUECODE09,12,HI,BE,2,9,2,SUBID FIELD=VALUEAMOUNT09,12,HI,BE,2,9,5,SUBID FIELD=VALUEQTY09,12,HI,BE,2,9,6,SUBID FIELD=VALUECODE10,12,HI,BE,2,10,2,SUBID FIELD=VALUEAMOUNT10,12,HI,BE,2,10,5,SUBID FIELD=VALUEQTY10,12,HI,BE,2,10,6,SUBID FIELD=CONDITIONCODE01,12,HI,BG,2,1,2,SUBID FIELD=CONDITIONCODE02,12,HI,BG,2,2,2,SUBID FIELD=CONDITIONCODE03,12,HI,BG,2,3,2,SUBID FIELD=CONDITIONCODE04,12,HI,BG,2,4,2,SUBID FIELD=CONDITIONCODE05,12,HI,BG,2,5,2,SUBID FIELD=CONDITIONCODE06,12,HI,BG,2,6,2,SUBID FIELD=CONDITIONCODE07,12,HI,BG,2,7,2,SUBID FIELD=CONDITIONCODE08,12,HI,BG,2,8,2,SUBID FIELD=CONDITIONCODE09,12,HI,BG,2,9,2,SUBID FIELD=CONDITIONCODE10,12,HI,BG,2,10,2,SUBID FIELD=CONDITIONCODE11,12,HI,BG,2,11,2,SUBID FIELD=CONDITIONCODE12,12,HI,BG,2,12,2,SUBID FIELD=TREATMENTCODE01,12,HI,TC,2,1,2,SUBID FIELD=TREATMENTCODE02,12,HI,TC,2,2,2,SUBID FIELD=TREATMENTCODE03,12,HI,TC,2,3,2,SUBID FIELD=TREATMENTCODE04,12,HI,TC,2,4,2,SUBID FIELD=TREATMENTCODE05,12,HI,TC,2,5,2,SUBID FIELD=TREATMENTCODE06,12,HI,TC,2,6,2,SUBID FIELD=TREATMENTCODE07,12,HI,TC,2,7,2,SUBID FIELD=TREATMENTCODE08,12,HI,TC,2,8,2,SUBID FIELD=TREATMENTCODE09,12,HI,TC,2,9,2,SUBID FIELD=TREATMENTCODE10,12,HI,TC,2,10,2,SUBID FIELD=TREATMENTCODE11,12,HI,TC,2,11,2,SUBID FIELD=TREATMENTCODE12,12,HI,TC,2,12,2,SUBID FIELD=ADMITTINGDX01,7,HI,BJ,2,1,2,SUBID FIELD=ADMITTINGDX02,7,HI,BJ,2,2,2,SUBID FIELD=ADMITTINGDX03,7,HI,BJ,2,3,2,SUBID FIELD=ADMITTINGDX04,7,HI,BJ,2,4,2,SUBID FIELD=ADMITTINGDX05,7,HI,BJ,2,5,2,SUBID FIELD=ADMITTINGDX06,7,HI,BJ,2,6,2,SUBID FIELD=ADMITTINGDX07,7,HI,BJ,2,7,2,SUBID FIELD=ADMITTINGDX08,7,HI,BJ,2,8,2,SUBID FIELD=ADMITTINGDX09,7,HI,BJ,2,9,2,SUBID FIELD=ADMITTINGDX10,7,HI,BJ,2,10,2,SUBID FIELD=ADMITTINGDX11,7,HI,BJ,2,11,2,SUBID FIELD=ADMITTINGDX12,7,HI,BJ,2,12,2,SUBID FIELD=VISITREASONDX01,7,HI,PR,2,1,2,SUBID FIELD=VISITREASONDX02,7,HI,PR,2,2,2,SUBID FIELD=VISITREASONDX03,7,HI,PR,2,3,2,SUBID FIELD=VISITREASONDX04,7,HI,PR,2,4,2,SUBID FIELD=VISITREASONDX05,7,HI,PR,2,5,2,SUBID FIELD=VISITREASONDX06,7,HI,PR,2,6,2,SUBID FIELD=VISITREASONDX07,7,HI,PR,2,7,2,SUBID FIELD=VISITREASONDX08,7,HI,PR,2,8,2,SUBID FIELD=VISITREASONDX09,7,HI,PR,2,9,2,SUBID FIELD=VISITREASONDX10,7,HI,PR,2,10,2,SUBID FIELD=VISITREASONDX11,7,HI,PR,2,11,2,SUBID FIELD=VISITREASONDX12,7,HI,PR,2,12,2,SUBID FIELD=DRG,16,HI,DR,2,1,2,SUBID FIELD=DRGAMT,16,AMT,ZZ,2,2,,SUBID FIELD=IREVCODE1,10,SV2,,,1,,SUBID,,,1 FIELD=IPROC1,10,SV2,,,2,2,SUBID,,,1 FIELD=IPROCQUAL1,10,SV2,,,2,1,SUBID,,,1 FIELD=IMODA1,3,SV2,,,2,3,SUBID,,,1 FIELD=IMODB1,3,SV2,,,2,4,SUBID,,,1 FIELD=IMODC1,3,SV2,,,2,5,SUBID,,,1 FIELD=IMODD1,3,SV2,,,2,6,SUBID,,,1 FIELD=IAMT1,10,SV2,,,3,,SUBID,,,1 FIELD=IUNITS1,10,SV2,,,5,,SUBID,,,1 FIELD=IQTY1,10,SV2,,,6,,SUBID,,,1 FIELD=IRATE1,10,SV2,,,7,,SUBID,,,1 FIELD=IAMTNCC1,10,SV2,,,8,,SUBID,,,1 FIELD=IDOS1,10,DTP,472,2,3,,SUBID,,,1 FIELD=IADJGRPCODE1,10,CAS,,,1,,SUBID,,,1 FIELD=IADJREASONCODE1,10,CAS,,,2,,SUBID,,,1 FIELD=IADJAMOUNT1,10,CAS,,,3,,SUBID,,,1 FIELD=IADJQTY1,10,CAS,,,4,,SUBID,,,1 FIELD=IREVCODE2,10,SV2,,,1,,SUBID,,,2 FIELD=IPROC2,10,SV2,,,2,2,SUBID,,,2 FIELD=IPROCQUAL2,10,SV2,,,2,1,SUBID,,,2 FIELD=IMODA2,3,SV2,,,2,3,SUBID,,,2 FIELD=IMODB2,3,SV2,,,2,4,SUBID,,,2 FIELD=IMODC2,3,SV2,,,2,5,SUBID,,,2 FIELD=IMODD2,3,SV2,,,2,6,SUBID,,,2 FIELD=IAMT2,10,SV2,,,3,,SUBID,,,2 FIELD=IUNITS2,10,SV2,,,5,,SUBID,,,2 FIELD=IQTY2,10,SV2,,,6,,SUBID,,,2 FIELD=IRATE2,10,SV2,,,7,,SUBID,,,2 FIELD=IAMTNCC2,10,SV2,,,8,,SUBID,,,2 FIELD=IDOS2,10,DTP,472,2,3,,SUBID,,,2 FIELD=IADJGRPCODE2,10,CAS,,,1,,SUBID,,,2 FIELD=IADJREASONCODE2,10,CAS,,,2,,SUBID,,,2 FIELD=IADJAMOUNT2,10,CAS,,,3,,SUBID,,,2 FIELD=IADJQTY2,10,CAS,,,4,,SUBID,,,2 FIELD=IREVCODE3,10,SV2,,,1,,SUBID,,,3 FIELD=IPROC3,10,SV2,,,2,2,SUBID,,,3 FIELD=IPROCQUAL3,10,SV2,,,2,1,SUBID,,,3 FIELD=IMODA3,3,SV2,,,2,3,SUBID,,,3 FIELD=IMODB3,3,SV2,,,2,4,SUBID,,,3 FIELD=IMODC3,3,SV2,,,2,5,SUBID,,,3 FIELD=IMODD3,3,SV2,,,2,6,SUBID,,,3 FIELD=IAMT3,10,SV2,,,3,,SUBID,,,3 FIELD=IUNITS3,10,SV2,,,5,,SUBID,,,3 FIELD=IQTY3,10,SV2,,,6,,SUBID,,,3 FIELD=IRATE3,10,SV2,,,7,,SUBID,,,3 FIELD=IAMTNCC3,10,SV2,,,8,,SUBID,,,3 FIELD=IDOS3,10,DTP,472,2,3,,SUBID,,,3 FIELD=IADJGRPCODE3,10,CAS,,,1,,SUBID,,,3 FIELD=IADJREASONCODE3,10,CAS,,,2,,SUBID,,,3 FIELD=IADJAMOUNT3,10,CAS,,,3,,SUBID,,,3 FIELD=IADJQTY3,10,CAS,,,4,,SUBID,,,3 FIELD=IREVCODE4,10,SV2,,,1,,SUBID,,,4 FIELD=IPROC4,10,SV2,,,2,2,SUBID,,,4 FIELD=IPROCQUAL4,10,SV2,,,2,1,SUBID,,,4 FIELD=IMODA4,3,SV2,,,2,3,SUBID,,,4 FIELD=IMODB4,3,SV2,,,2,4,SUBID,,,4 FIELD=IMODC4,3,SV2,,,2,5,SUBID,,,4 FIELD=IMODD4,3,SV2,,,2,6,SUBID,,,4 FIELD=IAMT4,10,SV2,,,3,,SUBID,,,4 FIELD=IUNITS4,10,SV2,,,5,,SUBID,,,4 FIELD=IQTY4,10,SV2,,,6,,SUBID,,,4 FIELD=IRATE4,10,SV2,,,7,,SUBID,,,4 FIELD=IAMTNCC4,10,SV2,,,8,,SUBID,,,4 FIELD=IDOS4,10,DTP,472,2,3,,SUBID,,,4 FIELD=IADJGRPCODE4,10,CAS,,,1,,SUBID,,,4 FIELD=IADJREASONCODE4,10,CAS,,,2,,SUBID,,,4 FIELD=IADJAMOUNT4,10,CAS,,,3,,SUBID,,,4 FIELD=IADJQTY4,10,CAS,,,4,,SUBID,,,4 FIELD=IREVCODE5,10,SV2,,,1,,SUBID,,,5 FIELD=IPROC5,10,SV2,,,2,2,SUBID,,,5 FIELD=IPROCQUAL5,10,SV2,,,2,1,SUBID,,,5 FIELD=IMODA5,3,SV2,,,2,3,SUBID,,,5 FIELD=IMODB5,3,SV2,,,2,4,SUBID,,,5 FIELD=IMODC5,3,SV2,,,2,5,SUBID,,,5 FIELD=IMODD5,3,SV2,,,2,6,SUBID,,,5 FIELD=IAMT5,10,SV2,,,3,,SUBID,,,5 FIELD=IUNITS5,10,SV2,,,5,,SUBID,,,5 FIELD=IQTY5,10,SV2,,,6,,SUBID,,,5 FIELD=IRATE5,10,SV2,,,7,,SUBID,,,5 FIELD=IAMTNCC5,10,SV2,,,8,,SUBID,,,5 FIELD=IDOS5,10,DTP,472,2,3,,SUBID,,,5 FIELD=IADJGRPCODE5,10,CAS,,,1,,SUBID,,,5 FIELD=IADJREASONCODE5,10,CAS,,,2,,SUBID,,,5 FIELD=IADJAMOUNT5,10,CAS,,,3,,SUBID,,,5 FIELD=IADJQTY5,10,CAS,,,4,,SUBID,,,5 FIELD=IREVCODE6,10,SV2,,,1,,SUBID,,,6 FIELD=IPROC6,10,SV2,,,2,2,SUBID,,,6 FIELD=IPROCQUAL6,10,SV2,,,2,1,SUBID,,,6 FIELD=IMODA6,3,SV2,,,2,3,SUBID,,,6 FIELD=IMODB6,3,SV2,,,2,4,SUBID,,,6 FIELD=IMODC6,3,SV2,,,2,5,SUBID,,,6 FIELD=IMODD6,3,SV2,,,2,6,SUBID,,,6 FIELD=IAMT6,10,SV2,,,3,,SUBID,,,6 FIELD=IUNITS6,10,SV2,,,5,,SUBID,,,6 FIELD=IQTY6,10,SV2,,,6,,SUBID,,,6 FIELD=IRATE6,10,SV2,,,7,,SUBID,,,6 FIELD=IAMTNCC6,10,SV2,,,8,,SUBID,,,6 FIELD=IDOS6,10,DTP,472,2,3,,SUBID,,,6 FIELD=IADJGRPCODE6,10,CAS,,,1,,SUBID,,,6 FIELD=IADJREASONCODE6,10,CAS,,,2,,SUBID,,,6 FIELD=IADJAMOUNT6,10,CAS,,,3,,SUBID,,,6 FIELD=IADJQTY6,10,CAS,,,4,,SUBID,,,6 FIELD=IREVCODE7,10,SV2,,,1,,SUBID,,,7 FIELD=IPROC7,10,SV2,,,2,2,SUBID,,,7 FIELD=IPROCQUAL7,10,SV2,,,2,1,SUBID,,,7 FIELD=IMODA7,3,SV2,,,2,3,SUBID,,,7 FIELD=IMODB7,3,SV2,,,2,4,SUBID,,,7 FIELD=IMODC7,3,SV2,,,2,5,SUBID,,,7 FIELD=IMODD7,3,SV2,,,2,6,SUBID,,,7 FIELD=IAMT7,10,SV2,,,3,,SUBID,,,7 FIELD=IUNITS7,10,SV2,,,5,,SUBID,,,7 FIELD=IQTY7,10,SV2,,,6,,SUBID,,,7 FIELD=IRATE7,10,SV2,,,7,,SUBID,,,7 FIELD=IAMTNCC7,10,SV2,,,8,,SUBID,,,7 FIELD=IDOS7,10,DTP,472,2,3,,SUBID,,,7 FIELD=IADJGRPCODE7,10,CAS,,,1,,SUBID,,,7 FIELD=IADJREASONCODE7,10,CAS,,,2,,SUBID,,,7 FIELD=IADJAMOUNT7,10,CAS,,,3,,SUBID,,,7 FIELD=IADJQTY7,10,CAS,,,4,,SUBID,,,7 FIELD=IREVCODE8,10,SV2,,,1,,SUBID,,,8 FIELD=IPROC8,10,SV2,,,2,2,SUBID,,,8 FIELD=IPROCQUAL8,10,SV2,,,2,1,SUBID,,,8 FIELD=IMODA8,3,SV2,,,2,3,SUBID,,,8 FIELD=IMODB8,3,SV2,,,2,4,SUBID,,,8 FIELD=IMODC8,3,SV2,,,2,5,SUBID,,,8 FIELD=IMODD8,3,SV2,,,2,6,SUBID,,,8 FIELD=IAMT8,10,SV2,,,3,,SUBID,,,8 FIELD=IUNITS8,10,SV2,,,5,,SUBID,,,8 FIELD=IQTY8,10,SV2,,,6,,SUBID,,,8 FIELD=IRATE8,10,SV2,,,7,,SUBID,,,8 FIELD=IAMTNCC8,10,SV2,,,8,,SUBID,,,8 FIELD=IDOS8,10,DTP,472,2,3,,SUBID,,,8 FIELD=IADJGRPCODE8,10,CAS,,,1,,SUBID,,,8 FIELD=IADJREASONCODE8,10,CAS,,,2,,SUBID,,,8 FIELD=IADJAMOUNT8,10,CAS,,,3,,SUBID,,,8 FIELD=IADJQTY8,10,CAS,,,4,,SUBID,,,8 FIELD=IREVCODE9,10,SV2,,,1,,SUBID,,,9 FIELD=IPROC9,10,SV2,,,2,2,SUBID,,,9 FIELD=IPROCQUAL9,10,SV2,,,2,1,SUBID,,,9 FIELD=IMODA9,3,SV2,,,2,3,SUBID,,,9 FIELD=IMODB9,3,SV2,,,2,4,SUBID,,,9 FIELD=IMODC9,3,SV2,,,2,5,SUBID,,,9 FIELD=IMODD9,3,SV2,,,2,6,SUBID,,,9 FIELD=IAMT9,10,SV2,,,3,,SUBID,,,9 FIELD=IUNITS9,10,SV2,,,5,,SUBID,,,9 FIELD=IQTY9,10,SV2,,,6,,SUBID,,,9 FIELD=IRATE9,10,SV2,,,7,,SUBID,,,9 FIELD=IAMTNCC9,10,SV2,,,8,,SUBID,,,9 FIELD=IDOS9,10,DTP,472,2,3,,SUBID,,,9 FIELD=IADJGRPCODE9,10,CAS,,,1,,SUBID,,,9 FIELD=IADJREASONCODE9,10,CAS,,,2,,SUBID,,,9 FIELD=IADJAMOUNT9,10,CAS,,,3,,SUBID,,,9 FIELD=IADJQTY9,10,CAS,,,4,,SUBID,,,9 FIELD=IREVCODE10,10,SV2,,,1,,SUBID,,,10 FIELD=IPROC10,10,SV2,,,2,2,SUBID,,,10 FIELD=IPROCQUAL10,10,SV2,,,2,1,SUBID,,,10 FIELD=IMODA10,3,SV2,,,2,3,SUBID,,,10 FIELD=IMODB10,3,SV2,,,2,4,SUBID,,,10 FIELD=IMODC10,3,SV2,,,2,5,SUBID,,,10 FIELD=IMODD10,3,SV2,,,2,6,SUBID,,,10 FIELD=IAMT10,10,SV2,,,3,,SUBID,,,10 FIELD=IUNITS10,10,SV2,,,5,,SUBID,,,10 FIELD=IQTY10,10,SV2,,,6,,SUBID,,,10 FIELD=IRATE10,10,SV2,,,7,,SUBID,,,10 FIELD=IAMTNCC10,10,SV2,,,8,,SUBID,,,10 FIELD=IDOS10,10,DTP,472,2,3,,SUBID,,,10 FIELD=IADJGRPCODE10,10,CAS,,,1,,SUBID,,,10 FIELD=IADJREASONCODE10,10,CAS,,,2,,SUBID,,,10 FIELD=IADJAMOUNT10,10,CAS,,,3,,SUBID,,,10 FIELD=IADJQTY10,10,CAS,,,4,,SUBID,,,10 FIELD=PAYTOPLAID,16,NM1,PE,2,9,,SUBID FIELD=PAYTOPLANAME,32,NM1,PE,2,3,,SUBID FIELD=PAYTOPLAADDR1,30,N3,,,1,,PAYTOPLANAME FIELD=PAYTOPLAADDR2,30,N3,,,2,,PAYTOPLANAME FIELD=PAYTOPLACITY,30,N4,,,1,,PAYTOPLANAME FIELD=PAYTOPLAST,2,N4,,,2,,PAYTOPLANAME FIELD=PAYTOPLAZIP,10,N4,,,3,,PAYTOPLANAME FIELD=SUBMITTERID,16,NM1,41,2,9,,,,1 FIELD=SUBMITTERNAME,32,NM1,41,2,3,,SUBMITTERID,,1 FIELD=SUBMITTERADDR1,30,N3,,,1,,SUBMITTERNAME,,1 FIELD=SUBMITTERADDR2,30,N3,,,2,,SUBMITTERNAME,,1 FIELD=SUBMITTERCITY,30,N4,,,1,,SUBMITTERNAME,,1 FIELD=SUBMITTERST,2,N4,,,2,,SUBMITTERNAME,,1 FIELD=SUBMITTERZIP,10,N4,,,3,,SUBMITTERNAME,,1 FIELD=TRANSACTIONSETCODE,10,BHT,,,2,,,,1 FIELD=TRANSACTIONID,20,BHT,,,3,,,,1 FIELD=TRANSACTIONDATE,10,BHT,,,4,,,,1 FIELD=TRANSACTIONTIME,10,BHT,,,5,,,,1 FIELD=TRANSACTIONTYPE,10,BHT,,,6,,,,1 FIELD=SOURCEFILE,64,,,,,,,,5 FIELD=DESTINATIONFILE,64,,,,,,,,6 SEGMENT=1,BHT,0019,$TRANSACTIONSETCODE,$TRANSACTIONID,$TRANSACTIONDATESEGMENT=1,REF,87,004010X98SEGMENT=1,NM1,41,$SUBMITTERNAME SEGMENT=1,N3,$SUBMITTERADDRESS1,$SUBMITTERADDRESS2 SEGMENT=1,N4,$SUBMITTERCITY,$SUBMITTERERST,$SUBMITTERZIP SEGMENT=1,NM1,85,$BILLINGPROVIDERNAME SEGMENT=1,N3,$BILLINGPROVIDERADDRESS1,$BILLINGPROVIDERADDRESS2 SEGMENT=1,N4,$BILLINGPROVIDERCITY,$BILLINGPROVIDERERST,$BILLINGPROVIDERZIP SEGMENT=1,NM1,87,$PAYTOPROVIDERNAME SEGMENT=1,N3,$PAYTOPROVIDERADDRESS1,$PAYTOPROVIDERADDRESS2 SEGMENT=1,N4,$PAYTOPROVIDERCITY,$PAYTOPROVIDERERST,$PAYTOPROVIDERZIP SEGMENT=2,SBR,P,18 SEGMENT=2,NM1,IL,1,$SUBLNAME,$SUBFNAME,$SUBMI,,,XX,$SUBID SEGMENT=1,N3,$SUBADDRESS1,$SUBADDRESS2 SEGMENT=1,N4,$SUBCITY,$SUBERST,$SUBZIP SEGMENT=2,CLM,$CLAIMID,$CLAIMAMT,,,Y,A,Y,Y,C SEGMENT=2,HI,BK,$DX1 SEGMENT=3,SV2,HC,$IPROC,$IUNITS,$IQTY SEGMENT=3,DTM,472,D8,$DOS SCREEN=0,BUTTON1,View Claims,1 SCREEN=1,TITLE,Claim Selection Screen,1 SCREEN=1,FIELD,CLAIMNUMBER,Claim Number,0 SCREEN=1,FIELD,SUBLNAME,,0 SCREEN=1,FIELD,SUBFNAME,,0 SCREEN=1,FIELD,SUBMI,,0 SCREEN=1,BUTTON1,Select Claim,2 SCREEN=2,TITLE,Claim Detail Screen,2 SCREEN=2,FIELD,,Subscriber,1 SCREEN=2,FIELD,SUBFNAME,,0 SCREEN=2,FIELD,SUBMI,,0 SCREEN=2,FIELD,SUBLNAME,,0 SCREEN=2,FIELD,SUBID,ID,1 SCREEN=2,FIELD,SUBADDR1,,1 SCREEN=2,FIELD,SUBADDR2,,1 SCREEN=2,FIELD,SUBCITY,,0 SCREEN=2,FIELD,SUBST,,0 SCREEN=2,FIELD,SUBZIP,,1 SCREEN=2,FIELD,SUBDOB,Date of Birth,0 SCREEN=2,FIELD,SUBSEX,Gender,1 SCREEN=2,FIELD,,Patient,1 SCREEN=2,FIELD,PATFNAME,,0 SCREEN=2,FIELD,PATMI,,0 SCREEN=2,FIELD,PATLNAME,,0 SCREEN=2,FIELD,PATID,ID,1 SCREEN=2,FIELD,PATADDR1,,1 SCREEN=2,FIELD,PATADDR2,,1 SCREEN=2,FIELD,PATCITY,,0 SCREEN=2,FIELD,PATST,,0 SCREEN=2,FIELD,PATZIP,,0 SCREEN=2,FIELD,PATCITY,,1 SCREEN=2,FIELD,PATDOB,Date of Birth,0 SCREEN=2,FIELD,PATSEX,Gender,1 SCREEN=2,FIELD,PATREL,Relation to Subscriber,1 SCREEN=2,FIELD,CLAIMID,Claim ID,0 SCREEN=2,FIELD,CLAIMAMT,Amount,1 SCREEN=2,FIELD,CLAIMNUMBER,Claim Number,1 SCREEN=2,FIELD,ADMISSIONDATETIME,Admission Date,1 SCREEN=2,FIELD,DISCHARGEDATE,,1 SCREEN=2,FIELD,DISCHARGEHOUR,,1 SCREEN=2,FIELD,STATEMENTDATE,,1 SCREEN=2,FIELD,MEDICALRECORDNUMBER,,1 SCREEN=2,FIELD,FACILITYCODEVALUE,,1 SCREEN=2,FIELD,FACILITYCODEQUALIFIER,,1 SCREEN=2,FIELD,FREQUENCYTYPECODE,,1 SCREEN=2,FIELD,PRINCIPALDX,,1 SCREEN=2,FIELD,ADMITDX,,1 SCREEN=2,FIELD,PRIORAUTH,,1 SCREEN=2,FIELD,K3DATA,,1 SCREEN=2,FIELD,NOTECODE,,1 SCREEN=2,FIELD,NOTEDESC,,1 SCREEN=2,FIELD,SUPPLEMENTALINFOTYPE,,1 SCREEN=2,FIELD,SUPPLEMENTALINFOTRANS,,1 SCREEN=2,FIELD,SUPPLEMENTALINFODESC,,1 SCREEN=2,FIELD,NDCCODE,,1 SCREEN=2,FIELD,NDCUNITPRICE,,1 SCREEN=2,FIELD,NDCUNITS,,1 SCREEN=2,FIELD,ECODE,,1 SCREEN=2,FIELD,ATTENDINGID,,1 SCREEN=2,FIELD,ATTENDINGLNAME,,1 SCREEN=2,FIELD,ATTENDINGFNAME,,1 SCREEN=2,FIELD,ATTENDINGMNAME,,1 SCREEN=2,FIELD,ATTENDINGIDCODE,,1 SCREEN=2,FIELD,ATTENDINGTAXONOMY,,1 SCREEN=2,FIELD,OPERATEINGID,,1 SCREEN=2,FIELD,OPERATEINGLNAME,,1 SCREEN=2,FIELD,OPERATEINGFNAME,,1 SCREEN=2,FIELD,OPERATINGMNAME,,1 SCREEN=2,FIELD,OPERATINGIDCODE,,1 SCREEN=2,FIELD,OPERATINGTAXONOMY,,1 SCREEN=2,FIELD,RENDERINGID,,1 SCREEN=2,FIELD,RENDERINGLNAME,,1 SCREEN=2,FIELD,RENDERINGFNAME,,1 SCREEN=2,FIELD,RENDERINGMNAME,,1 SCREEN=2,FIELD,RENDERINGIDCODE,,1 SCREEN=2,FIELD,RENDERINGTAXONOMY,,1 SCREEN=2,FIELD,SERVICEFACILITYNAME,,1 SCREEN=2,FIELD,SERVICEFACILIYID,,1 SCREEN=2,FIELD,SERVICEFACILITYNAME,,1 SCREEN=2,FIELD,SERVICEFACILIYID,,1 SCREEN=2,BUTTON1,Revenue Codes,3 SCREEN=2,BUTTON2,Diagnosis Codes,3 SCREEN=2,BUTTON3,Procedure Codes,3 SCREEN=2,BUTTON4,Value Codes,3 SCREEN=3,TITLE,Revenue Codes,3,IREVCODE SCREEN=3,FIELD,IREVCODE,,0,1 SCREEN=3,FIELD,IPROC,,0,1 SCREEN=3,FIELD,IPROCQUAL,,0,1 SCREEN=3,FIELD,IANT,,0,1 SCREEN=3,FIELD,IUNITS,,0,1 SCREEN=3,BUTTON1,Detail,4 SCREEN=4,TITLE,Revenue Code Detail,4 SCREEN=4,FIELD,IREVCODE,,0,1 SCREEN=4,FIELD,IPROC,,0,1 SCREEN=4,FIELD,IPROCQUAL,,0,1 SCREEN=4,FIELD,IANT,,0,1 SCREEN=4,FIELD,IUNITS,,0,1
Section 22
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Section 23
X12C Communications & Controls -------------------------------- 102 Associated Data 242 Data Status Tracking 815 Cryptographic Service Message 864 Text Message 868 Electronic Form Structure 993 Secured Receipt or Acknowledgment 997 Functional Acknowledgment 999 Implementation Acknowledgment ================================== X12F Finance ---------------------------------- 130 Student Educational Record (Transcript) 131 Student Educational Record (Transcript) Acknowledgment 132 Human Resource Information 133 Educational Institution Record 135 Student Aid Origination Record 138 Education Testing and Prospect Request and Report 139 Student Loan Guarantee Result 144 Student Loan Transfer and Status Verification 146 Request for Student Educational Record (Transcript) 147 Response to Request for Student Educational Record (Transcript) 155 Business Credit Report 188 Educational Course Inventory 189 Application for Admission to Educational Institutions 190 Student Enrollment Verifi cation 191 Student Loan Pre-Claims and Claims 197 Real Estate Title Evidence 198 Loan Verifi cation Information 199 Real Estate Settlement Information 200 Mortgage Credit Report 201 Residential Loan Application 202 Secondary Mortgage Market Loan Delivery 203 Secondary Mortgage Market Investor Report 205 Mortgage Note 206 Real Estate Inspection 245 Real Estate Tax Service Response 248 Account Assignment/Inquiry and Service/Status 259 Residential Mortgage Insurance Explanation of Benefi ts 260 Application for Mortgage Insurance Benefi ts 261 Real Estate Information Request 262 Real Estate Information Report 263 Residential Mortgage Insurance Application Response 264 Mortgage Loan Default Status 265 Real Estate Title Insurance Services Order 266 Mortgage or Property Record Change Notification 810 Invoice 811 Consolidated Service Invoice/Statement 812 Credit/Debit Adjustment 814 General Request, Response or Confirmation 819 Joint Interest Billing and Operating Expense Statement 820 Payment Order/Remittance Advice 821 Financial Information Reporting 822 Account Analysis 823 Lockbox 824 Application Advice 827 Financial Return Notice 828 Debit Authorization 829 Payment Cancellation Request 831 Application Control Totals 833 Mortgage Credit Report Order 844 Product Transfer Account Adjustment 849 Response to Product Transfer Account Adjustment 872 Residential Mortgage Insurance Application 880 Grocery Products Invoice ======================================================= X12G Government ------------------------------- 103 Abandoned Property Filings 105 Business Entity Filings 113 Election Campaign & Lobbyist Reporting 149 Notice of Tax Adjustment or Assessment 150 Tax Rate Notifi cation 151 Electronic Filing of Tax Return Data Acknowledgment 152 Statistical Government Information 153 Unemployment Insurance Tax Claim or Charge Information 154 Secured Interest Filing 157 Notice of Power of Attorney 158 Tax Jurisdiction Sourcing 175 Court and Law Enforcement Notice 176 Court Submission 179 Environmental Compliance Reporting 185 Royalty Regulatory Report 194 Grant or Assistance Application 195 Federal Communications Commission (FCC) License Application 196 Contractor Cost Data Reporting 249 Animal Toxicological Data 251 Pricing Support 280 Voter Registration Information 283 Tax or Fee Exemption Certifi cation 284 Commercial Vehicle Safety Reports 285 Commercial Vehicle Safety and Credentials Information Exchange 286 Commercial Vehicle Credentials 288 Wage Determination 500 Medical Event Reporting 501 Vendor Performance Review 511 Requisition 517 Material Obligation Validation 521 Income or Asset Offset 527 Material Due-In and Receipt 536 Logistics Reassignment 540 Notice of Employment Status 561 Contract Abstract 567 Contract Completion Status 568 Contract Payment Management Report 650 Maintenance Service Order 805 Contract Pricing Proposal 806 Project Schedule Reporting 813 Electronic Filing of Tax Return Data 826 Tax Information Exchange 836 Procurement Notices 838 Trading Partner Profi le 839 Project Cost Reporting 996 File Transfer ================================================= X12I Transportation ------------------------------ 104 Air Shipment Information 106 Motor Carrier Rate Proposal 107 Request for Motor Carrier Rate Proposal 108 Response to a Motor Carrier Rate Proposal 109 Vessel Content Details 110 Air Freight Details and Invoice 120 Vehicle Shipping Order 121 Vehicle Service 125 Multilevel Railcar Load Details 126 Vehicle Application Advice 127 Vehicle Baying Order 128 Dealer Information 129 Vehicle Carrier Rate Update 160 Transportation Automatic Equipment Identifi cation 161 Train Sheet 163 Transportation Appointment Schedule Information 204 Motor Carrier Load Tender 210 Motor Carrier Freight Details and Invoice 211 Motor Carrier Bill of Lading 212 Motor Carrier Delivery Trailer Manifest 213 Motor Carrier Shipment Status Inquiry 214 Transportation Carrier Ship. Status Message 215 Motor Carrier Pick-up Manifest 216 Motor Carrier Shipment Pick-up Notifi cation 217 Motor Carrier Loading and Route Guide 219 Logistics Service Request 220 Logistics Service Response 222 Cartage Work Assignment 223 Consolidators Freight Bill and Invoice 224 Motor Carrier Summary Freight Bill Manifest 225 Response to a Cartage Work Assignment 227 Trailer Usage Report 228 Equipment Inspection Report 240 Motor Carrier Package Status 250 Purchase Order Shipment Management Document 300 Reservation (Booking Request) (Ocean) 301 Confirmation (Ocean) 303 Booking Cancellation (Ocean) 304 Shipping Instructions 309 Customs Manifest 310 Freight Receipt and Invoice (Ocean) 311 Canada Customs Information 312 Arrival Notice (Ocean) 313 Shipment Status Inquiry (Ocean) 315 Status Details (Ocean) 317 Delivery/Pickup Order 319 Terminal Information 322 Terminal Operations and Intermodal Ramp Activity 323 Vessel Schedule and Itinerary (Ocean) 324 Vessel Stow Plan (Ocean) 325 Consolidation of Goods in Container 326 Consignment Summary List 350 Customs Status Information 352 U.S. Customs Carrier General Order Status 353 Customs Events Advisory Details 354 U.S. Customs Auto. Manifest Archive Status 355 U.S. Customs Acceptance/Rejection 356 U.S. Customs Permit to Transfer Request 357 U.S. Customs In-Bond Information 358 Customs Consist Information 359 Customs Customer Profile Management 361 Carrier Interchange Agreement (Ocean) 404 Rail Carrier Shipment Information 410 Rail Carrier Freight Details and Invoice 412 Trailer or Container Repair Billing 414 Rail Carhire Settlements 417 Rail Carrier Waybill Interchange 418 Rail Advance Interchange Consist 419 Advance Car Disposition 420 Car Handling Information 421 Estimated Time of Arrival Car Scheduling 422 Equipment Order 423 Rail Industrial Switch List 424 Rail Carrier Services Settlement 425 Rail Waybill Request 426 Rail Revenue Waybill 429 Railroad Retirement Activity 431 Railroad Station Master File 432 Rail Deprescription 433 Railroad Reciprocal Switch File 434 Railroad Mark Register Update Activity 435 Standard Transportation Commodity Code Master 436 Locomotive Information 437 Railroad Junctions & Interchanges Activity 440 Shipment Weights 451 Railroad Event Report 452 Railroad Problem Log Inquiry or Advice 453 Railroad Service Commitment Advice 455 Railroad Parameter Trace Registration 456 Railroad Equipment Inquiry or Advice 460 Railroad Price Distribution Request or Response 463 Rail Rate Reply 466 Rate Request 468 Rate Docket Journal Log 470 Railroad Clearance 475 Rail Route File Maintenance 485 Ratemaking Action 486 Rate Docket Expiration 490 Rate Group Definition 492 Miscellaneous Rates 494 Rail Scale Rates 601 U.S. Customs Export Shipment Information 603 Transportation Equipment Registration 715 Intermodal Group Loading Plan 854 Shipment Delivery Discrepancy Info. 858 Shipment Information 859 Freight Invoice 920 Loss or Damage Claim - Gen. Commodities 924 Loss or Damage Claim - Motor Vehicle 925 Claim Tracer 926 Claim Status Report and Tracer Reply 928 Automotive Inspection Detail 980 Functional Group Totals 990 Response to a Load Tender 998 Set Cancellation ============================================================ X12M Supply Chain ------------------------------- 101 Name and Address Lists 140 Product Registration 141 Product Service Claim Response 142 Product Service Claim 143 Product Service Notification 159 Motion Picture Booking Confirmation 170 Revenue Receipts Statement 180 Return Merchandise Authorization & Notification 244 Product Source Information 290 Cooperative Advertising Agreements 503 Pricing History 504 Clauses and Provisions 620 Excavation Communication 625 Well Information 753 Request For Routing Instructions 754 Routing Instructions 816 Organizational Relationships 818 Commission Sales Report 830 Planning Schedule w/ Release Capability 832 Price/Sales Catalog 840 Request for Quotation 841 Specifications/Technical Information 842 Nonconformance Report 843 Response to Request for Quotation 845 Price Authorization Acknowledgment/Status 846 Inventory Inquiry/Advice 847 Material Claim 848 Material Safety Data Sheet 850 Purchase Order 851 Asset Schedule 852 Product Activity Data 853 Routing and Carrier Instruction 855 Purchase Order Acknowledgment 856 Ship Notice/Manifest 857 Shipment and Billing Notice 860 Purchase Order Change Request - Buyer Initiated 861 Receiving Advice/Acceptance Certificate 862 Shipping Schedule 863 Report of Test Results 865 Purchase Order Change Acknowledgment/Request - Seller Initiated 866 Production Sequence 867 Product Transfer and Resale Report 869 Order Status Inquiry 870 Order Status Report 873 Commodity Movement Services 874 Commodity Movement Services Response 875 Grocery Products Purchase Order 876 Grocery Products Purchase Order Change 877 Manufacturer Coupon Family Code Structure 878 Product Authorization/De-authorization 879 Price Information 881 Manufacturer Coupon Redemption Detail 882 Direct Store Delivery Summary Information 883 Market Development Fund Allocation 884 Market Development Fund Settlement 885 Retail Account Characteristics 886 Customer Call Reporting 887 Coupon Notification 888 Item Maintenance 889 Promotion Announcement 890 Contract & Rebate Management 891 Deduction Research Report 893 Item Information Request 894 Delivery/Return Base Record 895 Delivery/Return Acknowledgment or Adjustment 896 Product Dimension Maintenance 940 Warehouse Shipping Order 943 Warehouse Stock Transfer Shipment Advice 944 Warehouse Stock Transfer Receipt Advice 945 Warehouse Shipping Advice 947 Warehouse Inventory Adjustment Advice ================================================================= X12N Insurance ------------------------------------------- 100 Insurance Plan Description 111 Individual Insurance Policy & Client Info. 112 Property Damage Report 124 Vehicle Damage 148 Report of Injury, Illness, or Incident 186 Insurance Underwriting Requirements Reporting 187 Premium Audit Request and Return 252 Insurance Producer Administration 255 Underwriting Information Services 256 Periodic Compensation 267 Individual Life Annuity & Disability Application 268 Annuity Activity 269 Health Care Benefit Coordination Verification 270 Eligibility, Coverage or Benefit Inquiry 271 Eligibility, Coverage or Benefit Information 272 Property and Casualty Loss Notification 273 Insurance/Annuity Application Status 274 Health Care Provider Information 275 Patient Information 276 Health Care Claim Status Request 277 Health Care Information Status Notification 278 Health Care Services Review Information 362 Cargo Insurance Advice of Shipment 834 Benefit Enrollment and Maintenance 835 Health Care Claim Payment/Advice 837 Health Care Clai 924 Loss or Damage Claim - Motor Vehicle 925 Claim Tracer 926 Claim Status Report and Tracer Reply 928 Automotive Inspection Detail 997 Functional Acknowledgment 999 Functional Acknowledgment ===============================================================
Section 24
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