Field | Format | Required? | Min | Max | Comments |
---|---|---|---|---|---|
ServiceData | See Estimator Request Service Data v1.0 | Y | |||
EstimatedMinAllowed | DEC | C | 1 | 15 | |
EstimatedMaxAllowed | DEC | C | 1 | 15 | |
EstimatedAllowed | DEC | Y | 1 | 15 | |
TotalCopay | DEC | N | 1 | 15 | |
ScheduleName | AN | N | 1 | 50 | |
PatientResponsibility | DEC | N | 1 | 10 | |
PayerResponsibility | DEC | N | 1 | 10 | |
AdjustmentReasons | See Estimator Response Adjustment Reason Data v1.0 | N |