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Segment
in
X12 Release 003030

TS3 Transaction Statistics

To supply provider level summary of control information by provider fiscal year and bill type
Sequence
Element
Name
Type
Requirement
Min
Max
Repeat
01
127
Reference Number
String (AN)
Mandatory
1
30
-
Reference number or identification number as defined for a particular Transaction Set, or as specified by the Reference Number Qualifier.
TS301 is the provider number.
02
Facility Code
Identifier (ID)
Mandatory
1
2
-
Code identifying the type of facility where services were performed; the first position of the uniform bill type or place of service from health care financing administration claim form or place of treatment from the dental claim form
03
Date
Date (DT)
Mandatory
6
6
-
Date (YYMMDD).
TS303 is the last day of the provider's fiscal year.
04
Quantity
Decimal number (R)
Mandatory
1
15
-
Numeric value of quantity.
TS304 is the total number of claims.
05
Monetary Amount
Decimal number (R)
Mandatory
1
15
-
Monetary amount.
TS305 is the total of reported charges.
06
Monetary Amount
Decimal number (R)
Optional
1
15
-
Monetary amount.
TS306 is the total of covered charges.
07
Monetary Amount
Decimal number (R)
Optional
1
15
-
Monetary amount.
TS307 is the totl of non-covered charges.
08
Monetary Amount
Decimal number (R)
Optional
1
15
-
Monetary amount.
TS308 is the total of denied charges.
09
Monetary Amount
Decimal number (R)
Optional
1
15
-
Monetary amount.
TS309 is the total provider payment.
10
Monetary Amount
Decimal number (R)
Optional
1
15
-
Monetary amount.
TS310 is the total amount of interest paid.
11
Monetary Amount
Decimal number (R)
Optional
1
15
-
Monetary amount.
TS311 is the total contractual adjustment.
12
Monetary Amount
Decimal number (R)
Optional
1
15
-
Monetary amount.
TS312 is the total Gramm-Rudman Reduction.
13
Monetary Amount
Decimal number (R)
Optional
1
15
-
Monetary amount.
TS313 is the total Medicare Secondary Payer (MSP) primary payer amount.
14
Monetary Amount
Decimal number (R)
Optional
1
15
-
Monetary amount.
TS314 is the total blood deductible amount in dollars.
15
Monetary Amount
Decimal number (R)
Optional
1
15
-
Monetary amount.
TS315 is the summary of non-lab charges.
16
Monetary Amount
Decimal number (R)
Optional
1
15
-
Monetary amount.
TS316 is the total coinsurance amount.
17
Monetary Amount
Decimal number (R)
Optional
1
15
-
Monetary amount.
TS317 is the Health Care Financing Administration Common Procedural Coding System (HCPCS) reported charges.
18
Monetary Amount
Decimal number (R)
Optional
1
15
-
Monetary amount.
TS318 is the total Health Care Financing Administration Common Procedural Coding System (HCPCS) payable amount.
19
Monetary Amount
Decimal number (R)
Optional
1
15
-
Monetary amount.
TS319 is the total deductible amount.
20
Monetary Amount
Decimal number (R)
Optional
1
15
-
Monetary amount.
TS320 is the total professional component amount.
21
Monetary Amount
Decimal number (R)
Optional
1
15
-
Monetary amount.
TS321 is the total Medicare Secondary Payer (MSP) patient liability met.
22
Monetary Amount
Decimal number (R)
Optional
1
15
-
Monetary amount.
TS322 is the total patient reimbursment.
23
Quantity
Decimal number (R)
Optional
1
15
-
Numeric value of quantity.
TS323 is the total Periodic Interim Payment (PIP) number of claims.
24
Monetary Amount
Decimal number (R)
Optional
1
15
-
Monetary amount.
TS324 is total Periodic Interim Payment (PIP) adjustment.
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Stedi is a registered trademark of Stedi, Inc. Stedi's EDI Reference and Mapping Guides are provided for marketing purposes and are free of charge. All names, logos, and brands of third parties listed on our site are trademarks of their respective owners (including “X12”, which is a trademark of X12 Incorporated). Stedi, Inc. and its products and services are not endorsed by, sponsored by, or affiliated with these third parties. Our use of these names, logos, and brands is for identification purposes only, and does not imply any such endorsement, sponsorship, or affiliation.