# | Name | Location | Type | Details | Index | Description |
---|---|---|---|---|---|---|
.01 | sequence #(+) | 0;1 | NUMERIC | B | This is a sequence # used internally to identify this ERA detail record. | |
.02 | eob detail | 0;2 | POINTER | 361.1 | AC | The detail EOB records that comprise the 835 transaction. |
.03 | amount paid | 0;3 | NUMERIC | This is the specific amount the payer has paid on this bill. | ||
.04 | insurance company on bill | 0;4 | POINTER | 36 | This is the insurance company that supplied this EOB data | |
.05 | invalid bill number | 0;5 | FREE TEXT | AD | This is the bill # received on the EOB, but it doesn't exist in VistA. | |
.07 | error category | 0;7 | SET OF CODES | 1:VALID BILL NOT FOUND 2:EOB DETAIL NOT IN IB 99:OTHER | AEXC | This field is used to categorize the specific errors associated with EOB detail records. This is the coded error for special exception processing. |
.08 | unspecific error | 0;8 | FREE TEXT | This is the text to describe the error associated with EOB detail records when the ERROR CATEGORY field is OTHER. | ||
.09 | transferred out msg # | 0;9 | FREE TEXT | This field will hold the last mail message number used to transmit a detail record for an EOB received for a bill belonging to another site. | ||
.1 | transfer status | 0;10 | SET OF CODES | 0:NOT ACCEPTED 1:ACCEPTED | This field indicates whether or not an EOB transfer has been accepted by a site to whom this EOB detail record was sent. | |
.11 | transferred to site | 0;11 | POINTER | 4 | This is the name of the site where the EOB detail record will be sent. | |
.12 | transferred date | 0;12 | DATE-TIME | ATOUT | This is the latest date/time when the transfer of the EOB detail record took place. | |
.13 | error status | 0;13 | SET OF CODES | 0:UNRESOLVED 1:RESOLVED | This indicates if the error associated with this EOB detail record was resolved or not. If resolved, it will not appear on any more EOB detail exception lists. | |
.14 | reversal | 0;14 | BOOLEAN | 0:NO 1:YES | ATB | This is the flag that indicates the bill was not paid, but was reversed. |
.15 | free text patient name | 0;15 | FREE TEXT | This is the name of the patient as returned by the payer. Used only if the bill cannot be found at the site. | ||
.16 | transfer received other site | 0;16 | BOOLEAN | 0:NO 1:YES | This indicates whether or not the other site has received the transferred EOB record. | |
.17 | bill number from payer | 0;17 | FREE TEXT | If a bill number must be edited because it could not be found in the site's A/R file, this is the original bill # that the payer sent. | ||
.18 | billing provider npi | 3;1 | FREE TEXT | This field contains the NPI for the Billing Provider that is found in piece 16 of the line type 10 of the 835ERA sent from Austin Information Technology Center. | ||
.19 | rendering/servicing prov npi | 3;2 | FREE TEXT | This field contains the NPI for the Rendering/Servicing Provider that is found in piece 16 of the line type 10 of the 835ERA sent from the Austin Information Technology Center. This field is named Rendering NPI on the 835ERA and can contain the NPI for the Rendering (individual) or the Servicing (non-individual) provider. | ||
.2 | entity type qualifier | 3;3 | SET OF CODES | 1:INDIVIDUAL 2:NON-INDIVIDUAL | This field reflects the type of NPI that is being returned in the NM1 segment of the X12N 835. If it is a 1 then the NPI is for an individual provider. If it is a 2 then it is a non-individual (organizational) NPI. This data is found in piece 17 of line type 10 in the 835ERA message transmitted from the Austin Information Technology Center. | |
.21 | rendering/servicing prov name | 3;4 | FREE TEXT | This field holds the value of the "Rendering Provider Name" field from the NM1 segment of the X12N 835. It is last name (or servicing organization name) concatenated with a comma (if there is a first name) concatenated with the first name. The last name is piece 18 of a line type of 10 in the 835ERA message and the first name is piece 19 of a line type of 10 in the 835ERA message transmitted from the Austin Information Technology Center. | ||
.22 | billing prov comment | 3;5 | FREE TEXT | This comment is about the Billing Provider NPI. This field is filled in only if the NPI is not in proper format. | ||
.23 | ren prov comment | 4;1 | FREE TEXT | This field is filled in with a comment if the Rendering/Servicing Provider NPI is not in correct format. | ||
.24 | ecme # | 4;2 | FREE TEXT | ECME | The ELECTRONIC CLAIMS MANAGEMENT ENGINE NUMBER is used to track an ERA for matching, posting, and reporting claims. | |
.25 | receipt | 4;3 | POINTER | 344 | RECEIPT | This is the AR BATCH PAYMENT entry that has the associated Receipt Number. |
1 | raw data | 1;0 | WORD-PROCESSING | This field stores the raw data as it was received for the individual EOB if its detail could not be stored in IB. | ||
1.1 | formatted message data | COMPUTED | ||||
2 | resolution log | 2;0 | WORD-PROCESSING | This field contains comments to detail the attempts made to remove the exception condition associated with this individual EOB. | ||
5 | auto-post rejection reason | 5;1 | SET OF CODES | 1:FIELD VERIFICATION FAILED 2:CLAIM ALREADY COMPLETED/CLOSED 3:PAYMENT EXCEEDS CLAIM BALANCE 4:REFERRED TO GENERAL COUNCIL 5:REJECTED (COMPLETED/CLOSED) 6:PAYMENT AMOUNT IS NEGATIVE 7:REJECTED (GENERAL COUNCIL) | This field describes the reason that caused the ERA detail line to be rejected by the ERA auto-posting process in the AR nightly job. | |
6 | mark for auto-post | 5;2 | BOOLEAN | 0:NO 1:YES | AP | This flag identifies if the EEOB line item in the ERA is marked for automatic posting to a receipt during the nightly job process. |
7 | auto-decrease indicator | 5;3 | BOOLEAN | 1:YES | This field indicates that the claim on this ERA DETAIL line has been reviewed by the nightly decrease adjustment process. | |
8 | auto-decrease amount | 5;4 | NUMERIC | This is the dollar amount of the decrease adjustment applied to the claim on this ERA DETAIL line by the nightly automatic decrease adjustment process. | ||
9 | auto-post date | 5;5 | DATE-TIME | F | This is the date on which the claim line was auto-posted by the AR Nightly process. | |
9.01 | pharmacy claim comment | 9;1 | FREE TEXT | This field is informational and is to aid users in the processing of pharmacy claims. | ||
10 | auto-decrease date | 5;6 | DATE-TIME | G | This is the date on which the claim line was auto-decreased by the AR Nightly process. | |
99 | bill reference number | COMPUTED |
Error: Invalid Global File Type: 344.41