XA0 Record Entry Field Locations
Claim Trailer
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
23-24
CXX Record Count
(Auto Fill)
05
25-26
DXX Record Count
(Auto Fill)
06
27-28
EXX Record Count
(Auto Fill)
07
29-30
FXX Record Count
(Auto Fill)
08
31-32
GXX Record Count
(Auto Fill)
09
33-34
HXX Record Count
(Auto Fill)
10
35-37
Claim Total Record Count
(Auto Fill)
11
38-77
Reserved
(Not Supported)
12
78-84
Total Claim Charges
(Auto Fill)
13
85-91
Total Disallowed Cost Containment
(Not Supported)
14
92-98
Total Disallowed Other
(Not Supported)
15
99-105
Total Amount Allowed
(Not Supported)
16
106-112
Total Deductible Amount
(Auto Fill)
17
113-119
Total Coinsurance Amount
(Not Supported)
18
120-126
Total Payer Paid Amount
(Auto Fill)
19
127-133
Total Patient Paid Amount
(Auto Fill)
20
134-140
Total Purchased Service Charge
(Not Supported)
21
141-156
Provider Discount Information
(Not Supported)
22
157-259
Claim Remarks
Patient List > Case/Diagnosis button > Case Information button > Notes tab > Claim Remarks
23
260-320
Filler National
(Not Supported)
Copyright © 1993
