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Database Parser

Model : C1D0U485
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Table of Contents

Section 1. - Overview of the X12 Database Parser
Section 2. - Features and Specifications
Section 3. - Using the Database Parser
Section 4. - Getting Started with the Database Parser
Section 5. - Database Drivers
Section 6. - Database Parser Options
Section 7. - SDDODBC SQL Database Driver
Section 8. - Parser Mapping
Section 9. - Parser Mapping Tool
Section 10. - Schema Generator
Section 11. - MSSQL
Section 12. - Microsoft Access Driver mdb accdb
Section 13. - MySQL
Section 14. - MySQL in the Cloud
Section 15. - DBF
Section 16. - Oracle
Section 17. - 837I Single Table Schema
Section 18. - 835 Single Table Schema
Section 19. - 837I Multi Table Schema
Section 20. - 837I and 835 Multi Table Schema
Section 21. - 838I Map Configuration
Section 22. - 835 Map Configuration
Section 23. - List of X12 Transactions
Section 24. - Order Database Parser

Updated:07/31/17



Section 1

Overview of the X12 Database Parser

[Table of Contents]

X12 Database Parser
Model C1D0U485 64 bit
Model C1D0N485 32 bit
Standard License

Copyright (c)1992-2014 Com1 Software Development
Com1 Software, Inc.
P.O. Box 482
Hudson, Ohio 44236
(330) 653-3771

Website: http://com1software.com
Email: information@com1software.com



IMPORTANT NOTICE
    This computer program is protected by copyright law and
    international treaties. Any unauthorized reproduction or
    distribution of this program or any portion of it may result
    in severe civil or criminal penalties, and will be prosecuted
    under the maximum extent possible under the law.

    This program and all support programs and documents are
    provided "AS IS" without warranty of any kind, either
    expressed or implied, including and not limited to the
    implied warranties of merchantability and fitness for a
    particular purpose.

    In no event shall Com1 Software, Inc. or Com1 Software
    Development be liable for any damages arising out of the
    use or inability to use this program, support programs or
    documentation. All prices and other information is subject
    to change without notice.

    This program and support documents are for trial and
    demonstration purposes. Any other use is strictly prohibited.




Section 2

Features and Specifications

[Table of Contents]

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

Using the Database Parser

[Table of Contents]

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.

There are sample schemas and and maps available that you can cut and
paste into the appropriate editors to help you get stated.

The Database Parser is based on the X12 Inline Paser and thus uses
it's 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 it's
X12 Inline Parase maps. 



USER INTERFACE SCREEN

The PARSE.LOG can be viewed to verify and troubleshot the results of the
process.

COMMAND LINE INTERFACE

To parse a file using the command line interface use the following 
syntax:

C1D0N485 schema,source
C1D0U485 schema,source




Section 4

Getting Started with the Database Parser

[Table of Contents]

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

Database Drivers

[Table of Contents]

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

Database Parser Options

[Table of Contents]

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

[Table of Contents]

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

Parser Mapping

[Table of Contents]

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

Parser Mapping Tool

[Table of Contents]

You can use the Parser Mapping Tool to create
and edit Inline Parser maps.




Section 10

Schema Generator

[Table of Contents]

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

MSSQL

[Table of Contents]

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:
Server/User: Displayed in SQL Server Management Studio



Section 12

Microsoft Access Driver mdb accdb

[Table of Contents]

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.  




Section 13

MySQL

[Table of Contents]

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=*****
    



Section 14

MySQL in the Cloud

[Table of Contents]

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

DBF

[Table of Contents]

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

Oracle

[Table of Contents]

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

837I Single Table Schema

[Table of Contents]

************************** 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

835 Single Table Schema

[Table of Contents]

************************** 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

837I Multi Table Schema

[Table of Contents]

************************** 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

837I and 835 Multi Table Schema

[Table of Contents]

--



Section 21

838I Map Configuration

[Table of Contents]

********** 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

835 Map Configuration

[Table of Contents]

--



Section 23

List of X12 Transactions

[Table of Contents]

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

Order Database Parser

[Table of Contents]

You can order the X12 Database Parse online at:
       
                       http://com1software.com


(c) 1992-2015 Com1 Software, Inc.