PatientLastName | AN | N | 1 | 35 | |
PatientFirstName | AN | N | 1 | 25 | |
PatientMiddleName | AN | N | 1 | 25 | |
PatientAccountNumber | AN | N | 1 | 80 | |
SubscriberLastName | AN | N | 1 | 35 | |
SubscriberFirstName | AN | N | 1 | 25 | |
SubscriberMiddleName | AN | N | 1 | 25 | |
PolicyNumber | AN | N | 1 | 80 | |
EstimatedAllowedLow | DEC | C | 1 | 15 | |
EstimatedAllowedHigh | DEC | C | 1 | 15 | |
EstimatedAllowed | DEC | Y | 1 | 15 | |
EstimatedPatientResponsibilityLow | DEC | C | 1 | 15 | |
EstimatedPatientResponsibilityHigh | DEC | C | 1 | 15 | |
EstimatedPatientResponsibility | DEC | Y | 1 | 15 | |
EstimatedPayerResponsibility | DEC | Y | 1 | 15 | |
EstimatedPatientResponsibilityCoInsAmount | DEC | C | 11oo | 15 | |
EstimatedPatientResponsibilityDeductibleAmonut | DEC | C | 1 | 15 | |
DRGEstimatedAllowedLow | See Estimator Response Service Data v1.0 | C | | | |
DRGEstimatedAllowed | AN | N | 1 | 80 | |
DRGEstimatedAllowedHigh | AN | C | 1 | 4 | |
DRGTotalCharge | AN | C | 1 | 80 | |
TotalCharge | DEC | Y | 1 | 15 | |
CoPay | DEC | C | 1 | 15 | |
FeeScheduleName | AN | N | 1 | 35 | |
EstimatedServices | See Estimator Response Service Data v1.0 | C | | | |
EstimateID | AN | Y | 1 | 32 | |
PatientEstimatedResponsibilityAvailable | | | | | Not currently used |
TraceNumber | AN | C | 1 | 30 | |
EffectiveBenefitInfo | See Estimator Request Effective Benefit Information v1.0 | C | | | |