|
Name |
Type |
Discontinued? |
|
1 |
INVOICE_ID |
NUMERIC |
No |
|
|
|
|
2 |
LINE |
INTEGER |
No |
|
|
|
The line number for the information associated with this record. Multiple pieces of information can be associated with this record. |
|
|
3 |
EDIT_EOB_CVG_ID |
NUMERIC |
No |
|
|
|
The edited explanation of benefits coverage. |
|
|
4 |
EDIT_EOB_CLM_LN |
INTEGER |
No |
|
|
|
The edited explanation of benefits line. |
|
|
5 |
EDIT_EOB_GRP_LN_C_NAME |
VARCHAR |
No |
|
|
|
The edited explanation of benefits line group code. |
May contain organization-specific values: Yes |
Category Entries: |
Patient Responsibility |
Contractual Obligation |
Payor Initiated |
Correction and Reversal |
Other Adjustment |
|
|
6 |
EDIT_EOB_RMT_CD_LN |
VARCHAR |
No |
|
|
|
The edited explanation of benefits line remittance code. |
|
|
7 |
EDIT_EOB_AMT_LN |
NUMERIC |
No |
|
|
|
The edited explanation of benefits line level service adjustment. |
|
|
8 |
EDIT_EOB_QTY_LN |
INTEGER |
No |
|
|
|
The edited explanation of benefits line quantity. |
|
|