Lockbox Version G version 2 of the EOD Posting File is 835 v1.0 and works with all grouping methods. However, it needs to use different <Configurable Value> with Group by Merchant, or the groups will overwrite files because of the naming convention.
- File Name Standard: <Database/File Grouping> + “_” + <Configurable Value> + “_” + BusinessDate + “.835”
- Group by Outlet / MST / Display MID (one mid per ST)
Note: This version includes custom grouping and negative values in the CLP03, CLP04, BPR02 on refunds, also uses 5010 format 835.
Custom Grouping is:First Two Letters of Patient Account Number | Database/File Grouping |
---|---|
HK | BAR.AHH |
FV | BAR.FVH |
HN | BAR.HCH |
HH | BAR.HMH |
PL|PP|RC | BAR.LMCK |
DR|FL|GH|HD|HF|MA|MK|SS | BAR.MCK |
NM|RM | BAR.MCKORL |
MR | BAR.MRM |
OC | BAR.OCH |
PI | BAR.PCM |
SX | BAR.SCH |
SH | BAR.SHH |
SL|RL|XL|PB|B | BAR.SLH |
QP | BAR.QOP |
GT|SY | BAR.PIR |
Other | Default |
SEG | Field ID | Field Name | Format | Required? | Config? | Expected Value | Comments |
---|---|---|---|---|---|---|---|
BPR | Financial Information | ||||||
BPR01 | Transaction Handling Code | AN | Y | Y | "H" | ||
BPR02 | Payment Amount | DEC | Y | Amount | Configurable via Support Tool. Can be "H," "C," "D," "I," "P". Amount can be positive or negative value dependent on sale/refund. | ||
BPR03 | Credit/Debit Flag Code | AN | Y | "C" or "D" | Payment Transaction action - sale = C; refund = D. | ||
BPR04 | Payment Method Code | AN | Y | Y | "NON" | Configurable via Support Tool. Can be: "NON," "FWT," "CHK," "BOP," "ACH". | |
BPR05 | Payment Format Code | S | Not currently used. | ||||
BPR06 | (DFI) ID Number Qualifier | S | Not currently used. | ||||
BPR07 | (DFI) Identification Number | S | Not currently used. | ||||
BPR08 | Account Number Qualifier | S | Not currently used. | ||||
BPR09 | Account Number | S | Not currently used. | ||||
BPR10 | Originating Company Identifier | AN | S | Y | "1999999999" | Same as TRN 03. | |
BPR11 | Originating Company Supplemental Code | AN | S | Y | "credit card," "eCheck," "cash," "manual check" | Same as TRN 04. Transaction Type: Credit Card, eCheck, cash, manual check. | |
BPR12 | Depository Financial Institution | S | Not currently used. | ||||
BPR13 | Provider Bank ID Number | S | Not currently used. | ||||
BPR14 | Account Number Qualifier | S | Not currently used. | ||||
BPR15 | Provider Account Number | Y | Not currently used. | ||||
BPR16 | Check Issue or EFT Effective Date | DT | S | Business Date | |||
TRN | Reassociation Trace Number | ||||||
TRN01 | Trace Type Code | AN | Y | "1" | |||
TRN02 | Check or EFT Trace Number | AN | Y | Y | Authorization Number | Configurable via Support Tool. Maximum 30 characters in length. | |
TRN03 | Originating Company Identifier | AN | Y | Y | "1999999999" | Configurable via Support Tool. Maximum of 9 characters + "1" appended at the beginning. | |
TRN04 | Originating Company Supplemental Code | AN | S | Y | "credit card," "eCheck," "cash," "manual check" | Configurable via Support Tool. Maximum Length 30 characters. Defaults to Transaction Type. Transaction Type: Credit Card, eCheck, cash, manual check . | |
N1 | Payer Identification | ||||||
N101 | Entity Identifier Code | AN | Y | "PR" | |||
N102 | Name | AN | Y | Patient First Name + Patient Last Name | If not available, use "Patient," max 60 characters. | ||
N103 | Identification Code Qualifier | AN | Y | "XV" | |||
N104 | Payer Identifier | AN | Y | Y | Patient Account Number | Configurable via Support Tool. Maximum value of 30. Defaults to "9999". | |
N3 | Payer Address | ||||||
N301 | Payer Address Line | AN | Y | Y | Patient Address 1 | Configurable via Support Tool Maximum Length of 55 characters. | |
N302 | Payer Address Line | AN | S | Y | Patient Address 2 if available | Field ID is not used. | |
N4 | Payer City, State, ZIP Code | ||||||
N401 | Payer City Name | AN | Y | Y | Patient City | Configurable via Support Tool - 30 characters max length; defaults to "City". | |
N402 | State or Province Code | AN | Y | Y | Patient State | Configurable via Support Tool - 2 characters max length. Defaults to "CA". | |
N403 | Payer Postal Zone | AN | Y | Y | Patient Zip Code | Configurable via Support Tool - 15 characters max, defaults to "99999". | |
N1 | Payee Identification | ||||||
N101 | Entity Identifier Code | AN | Y | "PE" | |||
N102 | Payee Name | AN | S | Merchant Name | Patient Name (First + Middle + Last) defaults to "Patient" if not present. | ||
N103 | Identification Code Qualifier | AN | Y | "FI" | |||
N104 | Payee Identification Code | AN | Y | Merchant ID | The unique ID associated with your merchant processing account, which will be given by your Implementations Manager. | ||
REF | Payee Additional Identification | ||||||
REF01 | Reference Identification Qualifier | AN | Y | "PQ" | |||
REF02 | Additional Payee Identifier | AN | Y | Merchant|Store|Terminal ID | The unique ID associated with your merchant processing account, which will be given by your Implementations Manager. | ||
CLP | Claim Payment Information | ||||||
CLP01 | Claim Submitter's Identifier | AN | Y | Y | Patient Account Number | Configurable via Support Tool. Max length 38 characters. If not available, use "9999". | |
CLP02 | Claim Status Code | AN | Y | "0" OR "1" OR "22" | Sale = 1; Refund = 22; Default = 0. | ||
CLP03 | Total Claim Charge Amount | DEC | Y | Amount | Negative or positive based on refund or sale, respectively. | ||
CLP04 | Claim Payment Amount | DEC | Y | Amount | Negative or positive based on refund or sale, respectively. | ||
CLP05 | Patient Responsibility Amount | DEC | S | "0" | |||
CLP06 | Claim Filing Indicator Code | AN | Y | Y | "13" | Configurable via Support Tool Can be, "12," "13," "14," "15," "16," "AM," "CH," "DS," "HM," "LM," "MA," "MB," "MC," "OF," "TV," "VA," "WC". | |
CLP07 | Payer Claim Control Number | AN | S | Y | Transaction ID | Configurable via Support Tool Max Length 30 characters. | |
CLP08 | Facility Code Value | S | Not currently used. | ||||
CLP09 | Claim Frequency Code | S | Not currently used. | ||||
CLP10 | Patient Status Code | S | Not currently used. | ||||
CLP11 | Diagnosis Related Group (DRG) Code | S | Not currently used. | ||||
CLP12 | Diagnosis Related Group (DRG) Weight | S | Not currently used. | ||||
CLP13 | Discharge Fraction | S | Not currently used. | ||||
NM1 | Patient Name | ||||||
NM101 | Entity Identifier Code | AN | Y | "QC" | |||
NM102 | Entity Type Qualifier | AN | Y | "1" | |||
NM103 | Patient Last Name | AN | Y | Patient Last Name | If not available, use "Patient Last". | ||
NM104 | Patient First Name | AN | S | Patient First Name | If not available, use "Patient First". | ||
NM105 | Patient Middle Name | AN | S | Patient Middle Name | Not currently used. If not available, use "Patient Middle". | ||
NM106 | Name Prefix | S | Not currently used. | ||||
NM107 | Name Suffix | S | Not currently used. | ||||
NM108 | Identification Code Qualifier | AN | Y | "MI" | |||
NM109 | Patient Identifier | AN | Y | Y | Patient Account Number | Configurable via Support Tool. Maximum length of 80 characters Defaults to "9999". | |
REF | Other Claim Related Identification | ||||||
REF01 | Qualifier | AN | Y | "BB" OR "EA" | Not currently used. BB = Auth Code; EA = Med Rec#. | ||
REF02 | Identifier | AN | Y | Authorization Number/Medical Record # | Not currently used. | ||
DTM | Claim Date | ||||||
DTM01 | Qualifier | AN | Y | 232/233 to convey service start and end date | Not currently used. If not available, use transaction date. | ||
DTM02 | Date | DT | Y | Service start and end date | Not currently used. | ||
PER | Claim Contact Information | ||||||
PER01 | Contact Function Code | AN | Y | CX - Payers Claim Office | |||
PER02 | Claim Contact Name | AN | S | User ID | Not currently used. | ||
PER03 | Communication Number Qualifier | S | Not currently used. | ||||
PER04 | Claim Contact Communications Number | S | Not currently used. | ||||
PER05 | Communication Number Qualifier | S | Not currently used. | ||||
PER06 | Claim Contact Communications Number | S | Not currently used. | ||||
PER07 | Telephone Extension | S | Not currently used. | ||||
PER08 | Communication Number | S | Not currently used. |