DA1 Record Entry Field Locations
Payer Data 2
Number
Position
Field Name
Data Entry Screen
01
1-3
Record Type
(Auto Fill)
02
4-5
Sequence Number
Patient List > Insurance button > General tab > Priority
03
6-22
Patient ID
(See
CAO Record
Patient ID)
04
23-52
Payer Address 1
Setup > Lookup Lists > Carriers > [Change] > General Tab > Address 1
05
53-82
Payer Address 2
Setup > Lookup Lists > Carriers > [Change] > General tab > Address 2
06
83-102
Payer City
Setup > Lookup Lists > Carriers > [Change] > General tab > City
07
103-104
Payer State
Setup > Lookup Lists > Carriers > [Change] > General tab > State
08
105-113
Payer Zip Code
Setup > Lookup Lists > Carriers > [Change] > General tab > Zip Code
09
114-120
Cost Containment Amount
Setup > Lookup Lists > Carriers > [Change] > General tab > Plan Name
10
121-127
Other Disallowance Amount
(Not Supported)
11
128-134
Amount Allowed
(Not Supported)
12
135-141
Deductible Amount
(Not Supported)
13
142-147
Co-Insurance Amount
(Not Supported)
14
149-155
Payer Paid Amount
(Not Supported)
15
156
Zero Payment Indicator
(Not Supported)
16
157-158
Adjudication Indicator 1
Patient List >Transactions button > Service > Misc tab > Reasons Code
17
159-160
Adjudication Indicator 2
Patient List > Transactions button > Service > Misc tab > Reasons Code
18
161-162
Adjudication Indicator 3
Patient List > Transactions button > Service > Misc tab > Reasons Code
19
163
CHAMPUS Branch
Patient List > Insurance button > Elegibility tab > Military Branch
20
164
CHAMPUS Sponsor Grade
Patient List > Insurance button > Eligibility tab > Military Grade
21
165
CHAMPUS Sponsor Status
Patient List > Insurance button > Eleigibility tab > Sponsor Status
22
167-174
Insurance Card Effective Date
Patient List > Insurance button > Eligibility tab > Effective Date
23
175-182
Insurance Card Termination Date
Patient List > Insurance button > Eligibility tab > Termination Date
24
183-189
Balance Due Amount
(Auto fill)
25
190-197
EOMB Date 1
(Not Supported)
26
198-205
EOMB Date 2
(Not Supported)
27
206-213
EOMB Date 3
(Not Supported)
28
214-221
EOMB Date 4
(Not Supported)
29
222-229
Claim Receipt Date
(Not Supported)
30
230-239
Amount Paid To Beneficiary
(Not Supported)
31
239-253
Benefit Check/EFT Trace Number
(Not Supported)
32
254-261
Benefit Check/EFT Date
(Not Supported)
33
262-270
Amount Paid to Provider
(Not Supported)
34
271-285
Provider Check/EFT Trace Number
(Not Supported)
35
286-293
Provider Check Date
(Not Supported)
36
294-302
Interest Paid Amount
(Not Supported)
37
303-311
Approved Amount
(Not Supported)
38
312
Contractual Agreement Indicator
(Not Supported)
39
313-320
Filler National
(Not Supported)
Copyright © 1993
