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 Document Control Number for VA 6 DCN 25 ALPHANUM claim 7 Cash deductible submitted 6 NUM 8 Cash deductible available 6 NUM 9 Service start date 8 NUM CCYYMMDD 10 Service end date 8 NUM CCYYMMDD 11 Report date 8 NUM Date report created by Medicare Glossary Account Records established for an individual debtor in the AR Debtor file. One account can have any number of bills, just as a VISA or Master Card account can be used for multiple purchases.
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 claim 7 Cash deductible submitted 6 NUM 8 Cash deductible available 6 NUM 9 Service start date 8 NUM CCYYMMDD 10 Service end date 8 NUM CCYYMMDD 11 Report date 8 NUM Date report created by Medicare Glossary Account Records established for an individual debtor in the AR Debtor file. One account can have any number of bills, just as a VISA or Master Card account can be used for multiple purchases.
prca_4_5_p315_tm.docx