| # | Name | Location | Type | Details | Index | Description |
|---|---|---|---|---|---|---|
| .01 | patient(+) | 0;1 | POINTER | 340 | ||
| .02 | ssn(+) | 0;2 | FREE TEXT | This is the SSN for the patient. | ||
| .03 | patient name(+) | 0;3 | FREE TEXT | This is the patient name as it appears on the statement. | ||
| .04 | amount due | 0;4 | NUMERIC | This is the total amount due for that statement period. | ||
| .05 | prev bal | 0;5 | NUMERIC | This is the amount of the previous balance on the previous statement. | ||
| .06 | total charges | 0;6 | NUMERIC | This is the total amount of charges for this statement. | ||
| .07 | total credits | 0;7 | NUMERIC | This is the total amount of charges for this patient statement. | ||
| .08 | new balance | 0;8 | NUMERIC | This is the total credits to the patient account for this statement period. | ||
| .09 | process# | 0;9 | NUMERIC | This is the process number for that patient statement. | ||
| .1 | process end time | 0;10 | DATE-TIME | This is the time that the process that sets the entries ended. | ||
| .11 | ps segment | 0;11 | POINTER | 349 | This is the PS SEGMENT that contains this PH segment. | |
| .12 | invalid statement error | 0;12 | POINTER | 349.7 | This is the error code for the record that was not accepted by CCPC. | |
| .13 | principal | 0;13 | NUMERIC | This is the principal amount recorded as the balance of the last statement. | ||
| .14 | interest | 0;14 | NUMERIC | This is the interest amount recorded as the balance of the last statement. | ||
| .15 | admin | 0;15 | NUMERIC | This is the administrative charges total as recorded with the last statement. | ||
| .16 | marshal fees | 0;16 | NUMERIC | This is the administrative fees total as recorded with the last statement. | ||
| .17 | court costs | 0;17 | NUMERIC | This is the total of marshal fees recorded as of the last statement. | ||
| .18 | ccpc file built | 0;18 | SET OF CODES | 0:NOT BUILT 1:BUILT | This field will store a marker that the CCPC PATIENT STATEMENTS file (349.2) is a complete file for that statement day. | |
| 11 | address 1 | 1;1 | FREE TEXT | This is the first address line for the patient. | ||
| 12 | address 2 | 1;2 | FREE TEXT | This is the second address line for the patient. | ||
| 13 | address 3 | 1;3 | FREE TEXT | This is the street address line 3 for the patient. | ||
| 14 | city | 1;4 | FREE TEXT | This is the city name for the patient address. | ||
| 15 | state | 1;5 | FREE TEXT | This is the state name abbreviation for the patient address. | ||
| 16 | zip code | 1;6 | FREE TEXT | This is the zip code for the patient address. | ||
| 17 | foreign country | 1;7 | FREE TEXT | This is the country code field for the patient address. | ||
| 20 | pd line | 2;0 | MULTIPLE | 349.21 | This is the PD segment level of the individual patient statement. | |
| 30 | special notices | 3;1 | FREE TEXT | This is the special notice information that prints on the patient statement. | ||
| 40 | paragraph codes | 4;1 | FREE TEXT | This is the paragraph codes indicating what paragraphs will print on the patient statement. | ||
| 51 | error code(s) | 5;1 | FREE TEXT | These are the error codes sent back by CCPC when a statement cannot be printed. | ||
| 61 | ccpc printed | 6;1 | BOOLEAN | 1:Y 0:N | This field indicates whether the patient statement for this patient printed at the CCPC or not. | |
| 62 | large print needed on stmt | 7;1 | BOOLEAN | 1:YES 0:NO | This field will identify 1st party debtors requiring statements with large print. This is the same field in file 340 field 111. |
Not Referenced