EA0 Record Entry Field Locations

Medical Segment 1

Number Position Field Name Data Entry Screen
01 1-3 Record Type (Auto Fill)
02 4-5 Reserved (Not Supported)
03 6-22 Patient ID

(See CAO Record Patient ID)
04 23 Condition Employment Related Patient List > Case/Diagnosis button > Case Information button > Condition tab > Employment Related
05 24 Condition Accident Related Patiennt List > Case/Diagnosis button > Case Information > Misc tab > Accident
06 25 Symptom Indicator Patient List > Case/Diagnosis button > Case Information button > General tab > Symptom Indicator
07 26-33 Accident/Symptom Date Patient List > Case/Diagnosis button > Case Information button > General tab > Onset/Symptom Date or LPM Date
  or
Patient List > Case/Diagnosis button > Case Information button > Misc tab > Accident Date
08 34-38 External Cause of Accident Patient List > Case/Diagnosis button > Case Information button > Misc tab > External Cause
09 39 Responsibility Indicator Patient List > Case/Diagnosis button > Case Information button > Accident was caused by third party
10 40-41 Accident State Patient List > Case/Diagnosis button > Case Information button > Misc tab > Accident Location
11 42-43 Accident Hour Patient List > Case/Diagnosis button > Case Information button > Misc tab > Accident Time
12 44 Abuse Indicator Patient List > Case/Diagnosis button > Case Information button > Condition tab > Condition was caused by or related to abuse
13 45 Release of Information Indicator Patient List > Highlight Patient > Demographics button > Claims tab > Release of Information
14 46-53 Release of Information Date Patient List > Highlight Patient > Demographics button > Claims tab > Signature Date
15 54 Same or Similar Symptom Indicator Patient List > Case/Diagnosis button > Case Information button > Condition tab > Patient previously had the same or similar illness
16 55-62 Same or Similar Symptom Date Patient List > Case/Diagnosis button > Case Information button > Condition tab > Date
17 63 Disability - Total, Partial Patient List > Case/Diagnosis button > Case Information button > Condition tab > Disability
18 64-71 Disability Date Patient List > Case/Diagnosis button > Case Information button > Condition tab > Disability From Date
19 72-79 Disability To Date Patient List > Case/Diagnosis button > Case Information button > Condition tab > Disability To Date
20 80-94 Referring Physician Number Setup > Lookup Lists > Outside Physicians > Physician > Change button > General tab > NPI
  and
Patient List > Case/Diagnosis button > Case Information button > Links tab > Referring Physician
21 95-109 Referring Provider's UPIN Setup > Lookup Lists > Outside Physicians > Physician > Change button > General tab > UPIN
  and
Patient List > Case/Diagnosis button > Case Information button > Links tab > Referring Physician
22 110 Referring Provider's Tax ID Type Setup > Lookup Lists > Outside Physicians > Physician > Change button > General tab > Social Security Number
  and
Patient List > Case/Diagnosis button > Case Information button > Links tab > Referring Physician
23 111-121 Referring Provider's Tax ID Setup > Lookup Lists > Outside Physicians > Physician > Change button > General tab > Tax
  and
Patient List > Case Diagnosis button > Case Information button > Links tab > Referring Physician
24 120-139 Referral Last Name Setup > Lookup Lists > Outside Physicians > Physician > Change button > General tab > Last
  and
Patient List > Case/Diagnosis button > Case Information button > Links tab > Referring Physician
25 140-151 Referral First Name Setup > Lookup Lists > Outside Physicians > Physician > Change button > General tab > First Name
  and
Patient List > Case/Diagnosis button > Case Information button > Links tab > Referring Physician
26 152 Referral Middle Initial Setup > Lookup Lists > Outside Physciains > Physician > Change button > General tab > MI
  and
Patient List > Case/Diagnosis button > Case Information button > Links tab > Referring Physician
27 153-154 Referral State Setup > Lookup Lists > Outside Physician > Physician > Change button > General tab > State
  and
Patient List > Case/Diagnosis button > Case Information button > Links tab > Referring Physician
28 155-162 Hospital Admission Date Patient List > Case/Diagnosis button > Case Information button > Inpatient tab > Admission Date
29 163 Hospital Discharge Date Patient List > Case/Diagnosis button > Case Information button > Inpatient tab > Discharge Date
30 171 Outside Lab Indicator Y/N Patient List > Case/Diagnosis button > Case Information button > Misc tab > Outside Lab
31 172-178 Outside Lab Charge Amount Patient List > Case/Diagnosis button > Case Information button > Misc tab > Charges
32 179-183 Diagnosis Code 1 Patient List > Case/Diagnosis button > Diagnosis button > Diagnosis > Change > Axis 1 tab > Axis 1 Code 1
  and
Patient List > Highlight Patient > Transactions button > Service > Diagnosis tab > Diagnosis Code Checked (line 1 - top line)
33 184-188 Diagnosis Code 2 Patient List > Case/Diagnosis button > Diagnosis button > Diagnosis > Change > Axis 1 tab > Axis 1 Code 1
  and
Patient List > Highlight Patient > Transactions button > Service > Diagnosis tab > Diagnosis Code Checked (line 2)
34 189-193 Diagnosis Code 3 Patient List > Case/Diagnosis button > Diagnosis button > Diagnosis > Change > Axis 1 tab > Axis 1 Code 1
  and
Patient List > Highlight Patient > Transactions button > Service > Diagnosis tab > Diagnosis Code Checked (line 3)
35 194-198 Diagnosis Code 4 Patient List > Case/Diagnosis button > Diagnosis button > Diagnosis > Change > Axis 1 tab > Axis 1 Code 1
  and
Patient List > Highlight Patient > Transactions button > Service > Diagnosis tab > Diagnosis Code Checked (line 4)
36 199 Assignment Indicator Setup > Preferences > Provider Preferences > Highlight Provider > Change button > Misc tab > Provider Options Button > Assignment Code
  and
Setup > Lookup Codes > Carriers > Carrier > Change > Contract tab > Accept Assignment Code
37 200 Provider Signature Indicator Setup > Preferences > Provider Preferences > Highlight Provider > Change button > Claims tab > Provider's signature on file
38 201-208 Provider Signature Date Setup > Preferences > Provider Preferences > Highlight Provider > Change button > Claims tab > Signature Date
39 209-241 Facility/Laboratory Name Setup > Lookup Lists > Facilities/Laboratories > Facility > Change button > Name
  and
Patient List > Case/Diagnosis button > Case Information button > Inpatient tab > Facility Name
40 242 Documentation Indicator Patient List > Case/Diagnosis button > Case Information button > Misc tab > Documentation Indicator Code
41 243 Documentation Type Patient List > Case/Diagnosis button > Case Information button > Misc tab > Documentation Indicator Code
42 244-245 Function Status Code Patient List > Case/Diagnosis button > Case Information button > Condition tab > Functional Status Code
43 246-247 CHAMPUS Special Program Indicator Patient List > Case/Diagnosis button > Case Information button > Misc. tab > Special Program Indicator
44 248 CHAMPUS Non-Availability Indicator Patient List > Highlight Patient > Insurance button > Highlight Insurance Company > Change button > Eligibility tab > Non-Availability Statement
45 249 Supervising Provider Indicator Setup > Preferences > Provider Preferences > Highlight Provider > Change button > General tab > Supervisor
  and
Patient List > Case/Diagnosis Button > Case Information button > Links tab > Treatment Supervisor
46 250-251 Resubmission Number Patient List > Case/Diagnosis button > Case Information button > Misc tab > Resubmission Code
47 252-266 Resubmission Reference Number Patient List > Case/Diagnosis button > Case Information button > Misc. tab > Original Reference Number
48 267-274 Date Last Seen Patient List > Case/Diagnosis button > Case Information button > General tab > Last seen by referring Dr.
49 275-282 Date Documentation Sent
50 283 Homebound Indicator Patient List > Case/Diagnosis button > Case Information button > Misc tab > Homebound Indicator
51 284-286 Number of Blood Units Paid (Not Supported)
52 287-289 Number of Blood Units Remaining (Not Supported)
53 290-295 Care Plan Oversight Provider Number (Not Supported)
54 296-310 Investigational Device Exemption Number (Not Supported)
55 311-320 Filler National (Not Supported)
Copyright © 1993