Fields that Display by Default

Field on Transmission Page

Location of Data in EDI

Amount

n/a

Assigned

From My Tasks page

Document Date

BHT04

Time is not meaningful since the corresponding time element is not used by HIPAA

Number of Errors

Count of errors with a severity greater than 2

Original File Date

Date supplied by the -m Instream command line parameter

Original File Name

Name supplied by the -m Instream command line parameter

Receiver

Criteria set up by TI administrator

Sender

Criteria set up by TI administrator

Status

From My Tasks page

See List of Statuses

Submitter Identifier

2200E - TRN02 if available

Otherwise 2200D - TRN02

Fields that you can add with Choose Fields Link

Field on Transmission Page

Location of Data in EDI

Claim Service Date

2200E  - DTP03 if available

Otherwise 2200D - DTP03

Dependent Entity Id Code

2100E - NM101

Dependent Entity Type Qual

2100E - NM102

Dependent Id Code

2100E - NM109

Dependent Id Code Qual

2100E - NM108

Dependent Name First

2100E - NM104

Dependent Name Last

2100E - NM103

Dependent Name Middle

2100E - NM105

Dependent Name Prefix

2100E - NM106

Dependent Name Suffix

2100E - NM107

Payer Claim Id Num

2200E  - REF02 if available

/2200D - REF02

Payer Entity Id Code

2100A - NM101

Payer Entity Type Qual

2100A - NM102

Payer Id Code

2100A - NM109

Payer Id Code Qual

2100A - NM108

Payer Name Last

2100A - NM103

Provider Entity Id Code

2100C - NM101

Provider Entity Type Qual

2100C - NM102

Provider Id Code

2100C - NM109

Provider Id Code Qual

2100C - NM108

Provider Name First

2100C - NM104

Provider Name Last

2100C - NM103

Provider Name Middle

2100C - NM105

Provider Name Prefix

2100C - NM106

Provider Name Suffix

2100C - NM107

Subscriber Entity Id Code

2100D - NM101

Subscriber Entity Type Qual

2100D - NM102

Subscriber Id Code

2100D - NM109

Subscriber Id Code Qual

2100D - NM108

Subscriber Name First

2100D - NM104

Subscriber Name Last

2100D - NM103

Subscriber Name Middle

2100D - NM105

Subscriber Name Prefix

2100D - NM106

Subscriber Name Suffix

2100D - NM107