CONTROL SEGMENT # Field Name Value Value Description Status 1 Segment ID CTL HC Segment Identifier 2 Source System FMS HC Source system identification 3 Destination System ARS HC Destination system identification 4 Submitting Station 3A VAR IFCAP Station 5 Transaction Class OBR HC Outstanding Bill Reconciliation Statement 6 Transaction Code Null HC 7 Sec1 Code Null HC 8 Batch Number Null HC 9 Transaction Number 11A VAR Station(3) + Fiscal Year(1) + K + Sequential(5) + 0 10 Transaction Date 8N VAR Calendar date document created (YYYYMMDD) 11 Transaction Time 6N VAR Time document created (HHMMSS) 12 Sequence Number 3N VAR Transaction part Sequence Number of Sequence Total 13 Sequence Total 3N VAR Total number of transaction parts 14 Version 3A VAR IFCAP-FMS Interface Version LINE SEGMENT # Field Name Value Value Description Status 1 Segment ID OBR HC Segment Identifier 2 Station 3A HC Station # 6 Transaction Code 2A VAR Transaction code 9 Transaction Number 11A VAR Station(3) + Fiscal Year(1) + K + Sequential(5) + 0 13 Line No 3N VAR 001-999 14 Line Amount 17N VAR Outstanding dollar amount for the line MDA Medicare Deductible Alert [SEQ 1] – Maximum Piece Description Comments Length/Type 1 RECORD ID = ‘MDA ’ 4 ALPHA None. 2 Medicare Type 1 Alpha Always equal to “A” for Part A Medicare assigned member ID 3 HICN 19 ALPHANUM number. Year the claim deductible is applied 4 Claim year 4 NUM against Claim tracking number assigned by 5 Patient account number 11 ALPHANUM the VA 6 DCN 25 ALPHANUM Document Control Number for VA
CONTROL SEGMENT # Field Name Value Value Status Description 1 Segment ID CTL HC Segment Identifier 2 Source System FMS HC Source system identification 3 Destination System ARS HC Destination system identification 4 Submitting Station 3A VAR IFCAP Station 5 Transaction Class OBR HC Outstanding Bill Reconciliation Statement 6 Transaction Code Null HC 7 Sec1 Code Null HC 8 Batch Number Null HC 9 Transaction Number 11A VAR Station(3) + Fiscal Year(1) + K + Sequential(5) + 0 10 Transaction Date 8N VAR Calendar date document created (YYYYMMDD) 11 Transaction Time 6N VAR Time document created (HHMMSS) 12 Sequence Number 3N VAR Transaction part Sequence Number of Sequence Total 13 Sequence Total 3N VAR Total number of transaction parts 14 Version 3A VAR IFCAP-FMS Interface Version LINE SEGMENT # Field Name Value Value Status Description 1 Segment ID OBR HC Segment Identifier 2 Station 3A HC Station # 6 Transaction Code 2A VAR Transaction code 9 Transaction Number 11A VAR Station(3) + Fiscal Year(1) + K + Sequential(5) + 0 13 Line No 3N VAR 001-999 14 Line Amount 17N VAR Outstanding dollar amount for the line MDA – Medicare Deductible Alert [SEQ 1] Piece Description Maximum Length/Type Comments 1 RECORD ID = ‘MDA ’ 4 ALPHA None. 2 Medicare Type 1 Alpha Always equal to “A” for Part A 3 HICN 19 ALPHANUM Medicare assigned member ID number. 4 Claim year 4 NUM Year the claim deductible is applied against 5 Patient account number 11 ALPHANUM Claim tracking number assigned by the VA 6 DCN 25 ALPHANUM Document Control Number for VA