|
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 |
EOB_CLM_CVG_ID |
NUMERIC |
No |
|
|
|
This item holds the coverage ID associated with American National Standards Institute secondary information that has been edited. |
|
|
4 |
EOB_CLM_PAID |
NUMERIC |
No |
|
|
|
|
5 |
EOB_CLM_CONTRACT |
NUMERIC |
No |
|
|
|
|
6 |
EOB_CLM_PAT_REMAIN |
NUMERIC |
No |
|
|
|
The remaining patient liability amount. |
|
|
7 |
EOB_CLM_NONCOVERED |
NUMERIC |
No |
|
|
|
|
8 |
EOB_CLM_MIA_01 |
INTEGER |
No |
|
|
|
This item holds the value for the covered days. |
|
|
9 |
EOB_CLM_MIA_02 |
NUMERIC |
No |
|
|
|
The Monetary amount from the adjudication of the claim. |
|
|
10 |
EOB_CLM_MIA_03 |
INTEGER |
No |
|
|
|
This item holds the value for the lifetime reserve days. |
|
|
11 |
EOB_CLM_MIA_04 |
NUMERIC |
No |
|
|
|
This is the diagnosis related group adjudication amount for the claim. |
|
|
12 |
EOB_CLM_MIA_05 |
VARCHAR |
No |
|
|
|
This is the claim payment remark code. |
|
|
13 |
EOB_CLM_MIA_06 |
NUMERIC |
No |
|
|
|
This is the disproportionate share amount. |
|
|
14 |
EOB_CLM_MIA_07 |
NUMERIC |
No |
|
|
|
This is the Medicare Secondary Payer pass-through amount. |
|
|
15 |
EOB_CLM_MIA_08 |
NUMERIC |
No |
|
|
|
This is the Prospective Payment System capital amount. |
|
|
16 |
EOB_CLM_MIA_09 |
NUMERIC |
No |
|
|
|
This is the Prospective Payment System capital, federal specific portion, Diagnosis Related Group amount. |
|
|
17 |
EOB_CLM_MIA_10 |
NUMERIC |
No |
|
|
|
This is the Prospective Payment System capital, hospital specific portion, Diagnosis Related Group amount. |
|
|
18 |
EOB_CLM_MIA_11 |
NUMERIC |
No |
|
|
|
This is the Prospective Payment System capital, disproportionate share, hospital Diagnosis Related Group amount. |
|
|
19 |
EOB_CLM_MIA_12 |
NUMERIC |
No |
|
|
|
This is the old capital amount |
|
|
20 |
EOB_CLM_MIA_13 |
NUMERIC |
No |
|
|
|
This is the Prospective Payment System capital indirect medical education claim amount. |
|
|
21 |
EOB_CLM_MIA_14 |
NUMERIC |
No |
|
|
|
This is the hospital specific Diagnosis Related Group amount. |
|
|
22 |
EOB_CLM_MIA_15 |
INTEGER |
No |
|
|
|
This is the cost report days for the claim. |
|
|
23 |
EOB_CLM_MIA_16 |
NUMERIC |
No |
|
|
|
This is the federal specific Diagnosis Related Group amount. |
|
|
24 |
EOB_CLM_MIA_17 |
NUMERIC |
No |
|
|
|
This is the Prospective Payment System Capital Outlier amount. |
|
|
25 |
EOB_CLM_MIA_18 |
NUMERIC |
No |
|
|
|
This is the indirect teaching amount. |
|
|
26 |
EOB_CLM_MIA_19 |
NUMERIC |
No |
|
|
|
This is the professional component amount billed but not payable. |
|
|
27 |
EOB_CLM_MIA_20 |
VARCHAR |
No |
|
|
|
This is the Claim Payment Remark Code. |
|
|
28 |
EOB_CLM_MIA_21 |
VARCHAR |
No |
|
|
|
This is the Claim Payment Remark Code. |
|
|
29 |
EOB_CLM_MIA_22 |
VARCHAR |
No |
|
|
|
This is the Claim Payment Remark Code. |
|
|
30 |
EOB_CLM_MIA_23 |
VARCHAR |
No |
|
|
|
This is the Claim Payment Remark Code. |
|
|
31 |
EOB_CLM_MIA_24 |
NUMERIC |
No |
|
|
|
This is the capital exception amount. |
|
|
32 |
EOB_CLM_MOA_01 |
NUMERIC |
No |
|
|
|
This is the reimbursement rate. |
|
|
33 |
EOB_CLM_MOA_02 |
NUMERIC |
No |
|
|
|
This is the claim Health Care Financing Common Procedural Coding System payable amount. |
|
|
34 |
EOB_CLM_MOA_03 |
VARCHAR |
No |
|
|
|
This is the Claim Payment Remark Code. |
|
|
35 |
EOB_CLM_MOA_04 |
VARCHAR |
No |
|
|
|
This is the Claim Payment Remark Code. |
|
|
36 |
EOB_CLM_MOA_05 |
VARCHAR |
No |
|
|
|
This is the Claim Payment Remark Code. |
|
|
37 |
EOB_CLM_MOA_06 |
VARCHAR |
No |
|
|
|
This is the Claim Payment Remark Code. |
|
|
38 |
EOB_CLM_MOA_07 |
VARCHAR |
No |
|
|
|
This is the Claim Payment Remark Code. |
|
|
39 |
EOB_CLM_MOA_08 |
NUMERIC |
No |
|
|
|
This is the End Stage Renal Disease payment amount. |
|
|
40 |
EOB_CLM_MOA_09 |
NUMERIC |
No |
|
|
|
This is the professional component amount billed but not payable. |
|
|
41 |
EOB_CLM_DATE |
DATETIME |
No |
|
|
|
|
42 |
EOB_CLM_AMT_D8 |
NUMERIC |
No |
|
|
|
|
43 |
EOB_CLM_AMT_DY |
NUMERIC |
No |
|
|
|
|
44 |
EOB_CLM_AMT_F5 |
NUMERIC |
No |
|
|
|
|
45 |
CLM_EOB_AMT_T |
NUMERIC |
No |
|
|
|
|
46 |
EOB_CLM_AMT_T2 |
NUMERIC |
No |
|
|
|
The total amount before taxes. |
|
|
47 |
EOB_COINS_DAYS |
INTEGER |
No |
|
|
|
|