| # | Name | Location | Type | Details | Index | Description |
|---|---|---|---|---|---|---|
| .001 | number | 11 | This is the internal file number of this entry. | |||
| .01 | name(+) | 0;1 | FREE TEXT | B | This is the full name/description of this entry. | |
| .02 | code | 0;2 | FREE TEXT | C | This identifies the code or number associated with this entry. | |
| .03 | abbreviation | 0;3 | FREE TEXT | D | This is the abbreviation (if any) of the name of this entry. | |
| .11 | occurrence code | 0;4 | BOOLEAN | 1:YES 0:NO | This indicates whether or not this entry is an Occurrence Code. | |
| .12 | bedsection | 0;5 | BOOLEAN | 1:YES 0:NO | This indicates whether or not this entry is a Bedsection. | |
| .13 | discharge status | 0;6 | BOOLEAN | 1:YES 0:NO | This indicates whether or not this entry is a Discharge Status. | |
| .14 | ib action type (copayment) | 0;7 | POINTER | 350.1 | AC | This field will only be used for those bedsections which are included in the billing of Means Test/Category C charges. The field is a pointer to the IB ACTION TYPE file. Once the bedsection is derived from the patient's treating specialty, the IB ACTION TYPE for the Category C Inpatient/NHC co-payment charge can be determined. |
| .15 | ib action type (per diem) | 0;8 | POINTER | 350.1 | This field will only be used for those bedsections which are included in the billing of Means Test/Category C charges. The field is a pointer to the IB ACTION TYPE file. Once the bedsection is derived from the patient's treating specialty, the IB ACTION TYPE for the Category C Inpatient/NHC per diem charge can be determined. | |
| .16 | occ related to | 0;9 | SET OF CODES | 1:EMPLOYMENT 2:AUTO ACCIDENT 3:OTHER ACCIDENT | Relates the Occurrence Codes to the 'Condition Related To' question on the CMS-1500, box 10. | |
| .17 | occurrence span | 0;10 | BOOLEAN | 1:YES 0:NO | A code and related dates that identify an event that relates to the payment of the claim. | |
| .18 | value code | 0;11 | BOOLEAN | 1:YES 0:NO | ||
| .19 | value code amount | 0;12 | BOOLEAN | 1:YES 0:NO | Enter Yes if the value amount associated with this value code should be right justified to the right of the delimiter, ie with cents printed. | |
| .2 | billable service | 0;13 | BOOLEAN | 1:YES 0:NO | These are the types of services a patient may receive that may be billable to a payer. | |
| .21 | billable event | 0;14 | BOOLEAN | 1:YES 0:NO | These are the types of events used to itemize on the bill the care provided to the patient and are billable for at least one payer rate. | |
| .22 | condition code | 0;15 | BOOLEAN | 1:YES 0:NO | This indicates whether or not this entry is a Condition Code. | |
| .23 | bill classification | 0;23 | BOOLEAN | 0:NO 1:YES | This indicates whether or not this entry is a bill classification code. | |
| .24 | valid location of care values | 0;24 | FREE TEXT | This is the list of valid location of care values that are consistent with the bill classification code. More than 1 value can be entered, separated by commas. | ||
| .25 | other care | 0;25 | POINTER | 399.1 | If this Bedsection is associated with an 'Other Type of Care', then this Billable Service will identify the Rate Schedules that apply. | |
| .26 | value code obsolete date | 0;26 | DATE-TIME | |||
| 1 | value code help text | 1;0 | WORD-PROCESSING |