Just when you thought you were done with claim data information with the end of the EA0 record review, we have more claim data to send with the EA1 record when doing medical billing of claims via electronic means using NSF 3.01 specifications. We're going to begin our review of the required fields for the EA1 record in this article.
EA1 field 1, positions 1 - 3, is the record type and must be filled with EA1. If it is not, the claim will be denied. Also, this record must come immediately after the EA0 record. If it comes before it or with other records in between, the claim will also be denied.
EA1 field 2, positions 4 - 5, is reserved for future use. This is another one of the many fields that are reserved for future use that will probably never get used.
EA1 field 3, positions 6 - 22, is the patient ID number. This is the same number that gets transmitted in the CA0, DA0 and every other record that gets sent with patient information. This is done so the payer can cross-reference the records to make sure that everything is in order.
EA1 field 4, positions 23 - 37, is the alternate facility ID. The EA1 record is really more of what is referred to as a facility record even though it is considered claim data. Most additional facility information is included in this record. This field sends the ID number of the alternate facility where the patient was treated. The meaning of alternate facility is beyond the scope of this article so consult with your supervisor for an explanation.
EA1 field 5, positions 38 - 52, is reserved for future use. The proposed data for this field is supposed to be some kind of other identification number, thus the 15 characters similar to the facility ID in field 4. We're still waiting on this one.
EA1 fields 6 - 10, positions 53 - 143, is the facility address, which includes street address (2 fields), city, state and zip code. All fields are required except for street address 2, which in many cases does not exist.
EA1 field 11, positions 144 - 160, is the medical record number. Each patient has a medical record, or file and that file is given a case number. This is the number that is transmitted here.
EA1 field 12, positions 161 - 168, is the return to work date. This is the date when the patient was able or will be able to return to work, in the cases of temporary disability. If the patient is unemployed or retired, or permanently disabled, then this field is left blank.
EA1 field 13, positions 169 - 176, is the date of initial consultation. This is the date when the patient initially went to see the physician about the problem being billed, not when he first saw the physician for any other condition such as first time check up.
In our next installment of medical billing electronic claims, we'll continue with EA1 record field number 14.
Michael Russell Your Independent guide to Medical Billing |
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