# | Name | Location | Type | Details | Index | Description |
---|---|---|---|---|---|---|
.01 | insurance company(+) | 0;1 | POINTER | 36 | B | This is the insurance company that is providing the facility id. |
.03 | care units | 0;3 | POINTER | 355.95 | AC | This is the care unit for which this ID is being defined. Care Units are only used for Billing Provider Secondary ID #2 . |
.04 | form type applied to(+) | 0;4 | SET OF CODES | 0:BOTH UB-04 AND CMS-1500 FORMS 1:UB-04 FORMS ONLY 2:CMS-1500 ONLY 3:PRESCRIPTION ONLY | This designates whether the id number is to be used for just UB-04 form types, just CMS-1500 form types or both form types. | |
.05 | division | 0;5 | POINTER | 40.8 | This designates which division this id number should be used for. | |
.06 | provider id type(+) | 0;6 | POINTER | 355.97 | This is the indicator of what type of id is being recorded. | |
.07 | provider id(+) | 0;7 | FREE TEXT | This is the facility ID that will be reported for the provider id type for the insurance co. | ||
.08 | id type flag | 0;8 | SET OF CODES | E:ELECTRONIC PLAN TYPE A:ADDITIONAL IDS LF:VA LAB/FACILITY ID | This is the flag that enables the code to tell the 3 types of IDs in this file apart. | |
.1 | index value care unit | 0;10 | FREE TEXT | This field contains the value for the care unit or '*N/A*' if no care unit is selected. This is to assure uniqueness in the records in the file even if the care unit is blank. | ||
.11 | index value division | 0;11 | FREE TEXT | This field contains the value for the division or '*N/A*' if no division is selected. This is to assure uniqueness in the records in the file even if the division is blank. |
Not Referenced