FB2 Record Entry Field Locations

Medical Segment 3

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	40-41	Provider "A" Type Indicator	(Auto Fill)
06	42-71	Provider "A" Address 1	(See Note 1)
07	72-101	Provider "A" Address 2	(See Note 1)
08	102-121	Provider "A" City	(See Note 1)
09	122-123	Provider "A" State	(See Note 1)
10	124-132	Provider "A" Zip Code	(See Note 1)
11	133-134	Provider "B" Type Indicator	(Auto Fill)
12	135-164	Provider "B" Address 1	(See Note 1)
13	165-194	Provider "B" Address 2	(See Note 1)
14	195-214	Provider "B" City	(See Note 1)
15	215-216	Provider "B" State Code	(See Note 1)
16	217-225	Provider "B" Zip Code	(See Note 1)
17	226-227	Provider "C" Type Indicator	(Auto Fill)
18	228-257	Provider "C" Address 1	(See Note 1)
19	258-287	Provider "C" Address 2	(See Note 1)
20	288-307	Provider "C" City	(See Note 1)
21	308-309	Provider "C" State Code	(See Note 1)
22	310-318	Provider "C" Zip Code	(See Note 1)
23	319-320	Filler National	(Not Supported)

Note 1: Providers A, B, and C can be filled from either the Outside Physicians list (Setup > Lookup Lists > Outside Physicians > [Change] > General tab) when there is a referring or ordering physician or the Providers list (Setup > Preferences> Provider Preferences> [Change] > General tab) when there is a supervising provider.

They are filled in the following order:

1. Ordering Physician (OD)
2. Referring Physician (RF)
3. Supervising Provider (SP)

The value of the auto filled type fields are filled with the value in parenthesis above for the physician type being filled.