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277 Transmission Page Map | ||
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Fields that Display by Default | ||
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Field on Transmission Page |
Location of Data in EDI | |
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Amount |
2200E - STC04 - Line Item Charge Amount (Dependent) 2200D - STC04 - Line Item Charge Amount (Subscriber) | |
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Assigned |
From My Tasks page | |
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Document Date |
BHT04 Time is not meaningful since the corresponding time element is not used by HIPAA | |
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Number of Errors |
Count of errors with a severity greater than 2 | |
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Original File Date |
Date supplied by the -m Instream command line parameter | |
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Original File Name |
Name supplied by the -m Instream command line parameter | |
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Receiver |
Criteria set up by TI administrator | |
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Sender |
Criteria set up by TI administrator | |
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Status |
From My Tasks page | |
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Submitter Identifier |
2200E - TRN02 if available Otherwise 2200D - TRN02 | |
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277 fields that you can add with Choose Fields Link |
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Field on Transmission Page |
Location of Data in EDI |
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Claim Service Date |
2200E - DTP03 if available Otherwise 2200D - DTP03 |
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Dependent Entity Id Code |
2100E - NM101 |
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Dependent Entity Type Qual |
2100E - NM102 |
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Dependent Id Code |
2100E - NM109 |
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Dependent Id Code Qual |
2100E - NM108 |
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Dependent Name First |
2100E - NM104 |
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Dependent Name Last |
2100E - NM103 |
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Dependent Name Middle |
2100E - NM105 |
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Dependent Name Prefix |
2100E - NM106 |
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Dependent Name Suffix |
2100E - NM107 |
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Payer Claim Id Num |
2200E - REF02 if available Otherwise 2200D - REF02 |
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Payer Entity Id Code |
2100A - NM101 |
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Payer Entity Type Qual |
2100A - NM102 |
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Payer Id Code |
2100A - NM109 |
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Payer Id Code Qual |
2100A - NM108 |
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Payer Name Last |
2100A - NM103 |
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Provider Entity Id Code |
2100C - NM101 |
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Provider Entity Type Qual |
2100C - NM102 |
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Provider Id Code |
2100C - NM109 |
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Provider Id Code Qual |
2100C - NM108 |
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Provider Name First |
2100C - NM104 |
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Provider Name Last |
2100C - NM103 |
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Provider Name Middle |
2100C - NM105 |
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Provider Name Prefix |
2100C - NM106 |
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Provider Name Suffix |
2100C - NM107 |
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Subscriber Entity Id Code |
2100D - NM101 |
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Subscriber Entity Type Qual |
2100D - NM102 |
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Subscriber Id Code |
2100D - NM109 |
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Subscriber Id Code Qual |
2100D - NM108 |
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Subscriber Name First |
2100D - NM104 |
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Subscriber Name Last |
2100D - NM103 |
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Subscriber Name Middle |
2100D - NM105 |
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Subscriber Name Prefix |
2100D - NM106 |
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Subscriber Name Suffix |
2100D - NM107 |
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