FB0 Record Entry Field Locations
Medical Segment 1
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
40-46
Purchase Service Charge Amount
(Not Supported)
06
47-53
Amount Allowed
(Not Supported)
07
54-60
Deductible Amount
Patient List > Transaction button > Service > Money tab > Insurance tab > Apply to deductible
08
61-67
Co-Insurance Amount
(Not Supported)
09
68-82
Ordering Provider ID
Setup > Lookup Lists > Outside Physicians > [Change] > General tab > NPI
or
Setup > Lookup Lists > Outside Physicians > [Change] > Carrier tab > [Insert] > [Select] > Physician ID
and
Patient List > Transactions button > [Change Service] > Misc tab > Modify Service Links button > Physicians tab > Ordering
10
83-84
Ordering Provider State
Setup > Lookup Lists > Outside Physicians > [Change] > General tab > State
and
Patient List > Transactions button > [Change Service] > Misc tab > Modify Service Links button > Physicians tab > Ordering
11
85-99
Purchase Service Provider ID
Setup > Lookup Lists > Outside Physicians > [Change] > General tab > NPI
or
Setup > Lookup Lists > Outside Physicians > [Change] > Carrier tab > [Insert] > [Select] > Physician ID
and
Patient List > Transactions button > [Change Service] > Misc tab > Modify Service Links button > Physicians tab > Purchasing
12
100-101
Purchaser Service State
Setup > Lookup Lists > Outside Physicians > [Change] > General tab > State
and
Patient List > Transactions button > [Change Service] > Misc tab > Modify Service Links button > Physicians tab > Purchasing
13
102-105
Pen Grams of Protein
(Not Supported)
14
106-109
Pen Calories
(Not Supported)
15
110-120
National Drug Code
(Not Supported)
16
121-127
National Drug Units
(Not Supported)
17
128-142
Prescription Number
(Not Supported)
18
143-150
Prescription Date
(Not Supported)
19
151-152
Prescription Number of Months
(Not Supported)
20
153
Special Pricing Indicator
(Not Supported)
21
154
Co-pay Status Indicator
Patient List > Transactions button > Service > Misc tab > Copayment Status
22
155
EPSDT Indicator
Patient List > Transactions button > Service > General tab > EPSDT
23
156
Family Planning Indicator
Patient List > Transactions button > Service > General tab > Family Planning
24
157
DME Charge Indicator
(Not Supported)
25
158-172
HPSA Facility ID
Setup > Preferences > Practice Preferences > General tab > HPSA ID
and
Setup > Lookup Lists > Facilities/Laboratories > [Change] > Identification tab > HPSA ID
26
173-181
HPSA Facility Zip Code
Setup > Lookup Lists > Facilities/Laboratories > [Change] > General tab > Zip Code
27
182-214
Purchase Service Name
(Not Supported)
28
215-244
Purchase Service Address 1
(Not Supported)
29
245-274
Purchase Service Address 2
(Not Supported)
30
275-294
Purchase Service City
(Not Supported)
31
295-303
Purchase Service Zip Code
(Not Supported)
32
304-313
Purchase Service Phone
(Not Supported)
33
314-316
Number of Drug Days Supplied
(Not Supported)
34
317
Payment Indicator Type
(Not Supported)
35
318-320
Filler National
(Not Supported)
Copyright © 1993
