FA0 Record Entry Field Locations
Service Line Detail
Number
Position
Field Name
Data Entry Screen
01
1-3
Record Type
(Auto Fill)
02
4-5
Sequence Number In Claim
(Auto Fill)
03
6-22
Patient ID
(See
CAO Record
Patient ID)
04
23-39
Line Item Control Number
(Auto Fill)
05
40-47
Service From Date
Patient List > Transactions button > [Change Service] > General tab > From Date
06
48-55
Service To Date
Patient List > Transactions button > [Change Service] > General tab > To Date
07
56-57
Place of Service Code
Patient List > Transactions button > [Change Service] > General tab > Place of Service
08
58-59
Type of Service Code
Patient List > Transactions button > [Change Service] > General tab > Type of Service
and
Setup > Lookup Lists >
09
60-64
Procedure Code
Setup > Lookup Lists > Carriers > [Change] > Claims tab > No Show Procedure Code/Cancellation Procedure Code
and
Setup > Lookup Codes > Procedure Codes > [Change] > Carrier tab > Substitute Code
and
Patient List > Transactions button > [Change Service] > General tab > Procedure Code
10
65-66
Procedure Modifier 1
Setup > Lookup Lists > Carriers > [Change] > Claims tab > NoShow Procedure Code/Cancellation Procedure Code
and
Patient List > Transactions button > [Change Service] > General tab > Modifier 1
11
67-68
Procedure Modifier 2
Setup > Lookup Lists > Carriers > [Change] > Claims tab > NoShow Procedure Code/Cancellation Procedure Code
and
Patient List > Transactions button > [Change Service] > General tab > Modifier 2
12
69-70
Procedure Modifier 3
Setup > Lookup Lists > Carriers > [Change] > Claims tab > NoShow Procedure Code/Cancellation Procedure Code
and
Patient List > Transactions button > [Change Service] > General tab > Modifier 3
13
71-77
Line Charge Amount
Billing > Electronic Claims Receivers > Generator Options button > Submission tab > Include Service Fees in Claims
14
78
Diagnosis Code Pointer 1
Patient List > Transactions button > [Change Service] > Diagnosis tab > Select Diagnosis
15
79
Diagnosis Code Pointer 2
Patient List > Transactions button > [Change Service] > Diagnosis tab > Select Diagnosis
16
80
Diagnosis Code Pointer 3
Patient List > Transactions button > [Change Service] > Diagnosis tab > Select Diagnosis
17
81
Diagnosis Code Pointer 4
Patient List > Transactions button > [Change Service] > Diagnosis tab > Select Diagnosis
18
82-85
Units of Service
Setup > Lookup Codes > Procedure Codes > [Change] > Units
and
Billing > Electronic Claims Receivers > Generator Options button > Sumission tab > Implied Decimals for Units
and
Patient List > Transactions button > [Change Service] > General tab > Units
19
86-89
Anethesia Minutes
20
90
Emergency Indicator
Patient List > Transactions button > [Change Service] > General tab > Emergency
21
91
COB Indicator
Patient List > Transactions button > [Change Service] > General tab > COB Code
22
92
HPSA Indicator
Setup > Preferences > Practice Preferences > General tab > HPSA Code
and
Seup > Lookup Lists > Facilities and Laboratories > [Change] > Identification tab > HPSA Indicator
23
93-107
Rendering Provider ID
Setup > Lookup Lists > Carriers > [Change] > Claims tab
24
108-122
Referring Provider ID
Setup > Lookup Lists > Outside Physicians > [Change] > General tab > NPI
or
Setup > Lookup Lists > Outside Physicians > [Change] > Carrier tab > [Insert] > [Select] > Physician ID
25
123-124
Referring Provider State
Setup > Lookup Lists > Outside Physicians > [Change] > General tab > State
26
125
Purchase Service Indicator
(Not Supported)
27
126-132
Disallowed Cost Containment Amount
(Not Supported)
28
133-139
Disallowed Other Amount
(Not Supported)
29
140
Review Code Indicator
Patient List > Transaction button > [Change Service] > Misc. tab > Review Indicator
30
141
Multiple Procedure Indicator
(Not Supported)
31
142-151
Mamography Certification Number
(Not Supported)
32
152-160
Class Findings
(Not Supported)
33
161-163
Podiatry Service Condition
(Not Supported)
34
164-178
CLIA ID Number
Setup > Lookup Lists > Facilities/Laboratories > [Change] > Identification tab > CLIA Number
35
179-185
Primary Insurance Amount Paid
36
186-187
Procedure Modifier 4
Patient List > Transactions button > [Change Service] > General tab > Modifier 4
37
188-190
Provider Specialty
Setup > Preferences > Provider Preferences > [Change] > General tab > Specialty Code
38
191
Podiatry Therapy Indicator
(Not Supported)
39
192
Podiatry Therapy Type
(Not Supported)
40
193
Hospice Provider
(Not Supported)
41
194-201
HGB/HCT Date
(Not Supported)
42
202-204
Hemoglobin Result
(Not Supported)
43
205-206
HCT Result
(Not Supported)
44
207-209
Patient Weight
45
210-212
Epotin Dosage
(Not Supported)
46
213-220
Serum Creatine Date
(Not Supported)
47
221-223
Creatine Result
(Not Supported)
48
224-230
Obligated to Accept Amount
Setup > Lookup Lists > Carriers > Carrier > [Change] > Codes tab > Code > Obligated to Accept
and
Setup > Lookup Codes > Procedure Codes > [Change] > Carrier tab > Obligated to Accept
49
231-237
Drug Discount Amount
(Not Supported)
50
238
Type of Units Indicator
(Not Supported)
51
239-245
Approved Amount
(Not Supported)
52
246-252
Paid Amount
(Not Supported)
53
253-259
Beneficiary Liability Amount
(Not Supported)
54
260-266
Balance Billing Limit Charge Amount
(Not Supported)
55
257-273
Limiting Charge Percent Amount
(Not Supported)
56
274-283
Performing Provider Phone
Setup > Preferences > Practice Preferences > General tab > Voice Phone (area code and phone number)
57
284
Performing Provider Tax Type
Setup > Lookup Lists > Carriers > [Change] > Claims tab > Tax ID Preference
58
285
Performing Provider Tax ID
Setup > Preferences > Practice Preferences > General tab > Employer ID or Social Security Number
59
294
Performing Provider Assignment Indicator
Setup > Lookup Lists > Carriers > [Change] > Contract tab > Accept Assignment Code
or overridden with
Setup > Lookup Lists > Carriers > [Change] > Provider Options button > [Change] > Override carrier's Accept Assignment setting and Assignment Code
60
295
Pre-Transplant Indicator
(Not Supported)
61
296-302
ICD-10-PCS
(Not Supported)
62
303-316
Universal Product Code Number
(Not Supported)
63
317
Diagnosis Code Pointer 5
Patient List > Transactions button > [Change Service] > Diagnosis tab > Select Diagnosis
64
318
Diagnosis Code Pointer 6
Patient List > Transactions button > [Change Service] > Diagnosis tab > Select Diagnosis
65
319
Diagnosis Code Pointer 7
Patient List > Transactions button > [Change Service] > Diagnosis tab > Select Diagnosis
66
320
Diagnosis Code Pointer 8
Patient List > Transactions button > [Change Service] > Diagnosis tab > Select Diagnosis
Copyright © 1993
