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Segment
in
X12 Release 005040

TS3 Transaction Statistics

To supply provider-level control information
Sequence
Element
Name
Type
Requirement
Min
Max
Repeat
01
127
Reference Identification
String (AN)
Mandatory
1
80
1
Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier
TS301 is the provider number.
02
Facility Code Value
String (AN)
Mandatory
1
3
1
Code identifying where services were, or may be, performed; the National Uniform Billing Committee (NUBC) Facility Type Code for Institutional Services or the Place of Service Codes for Professional or Dental Services.
03
Date
Date (DT)
Mandatory
8
8
1
Date expressed as CCYYMMDD where CC represents the first two digits of the calendar year
TS303 is the last day of the provider's fiscal year.
04
Quantity
Decimal number (R)
Mandatory
1
15
1
Numeric value of quantity
TS304 is the total number of claims.
05
Monetary Amount
Decimal number (R)
Mandatory
1
18
1
Monetary amount
TS305 is the total of reported charges.
06
Monetary Amount
Decimal number (R)
Optional
1
18
1
Monetary amount
TS306 is the total of covered charges.
07
Monetary Amount
Decimal number (R)
Optional
1
18
1
Monetary amount
TS307 is the total of noncovered charges.
08
Monetary Amount
Decimal number (R)
Optional
1
18
1
Monetary amount
TS308 is the total of denied charges.
09
Monetary Amount
Decimal number (R)
Optional
1
18
1
Monetary amount
TS309 is the total provider payment.
10
Monetary Amount
Decimal number (R)
Optional
1
18
1
Monetary amount
TS310 is the total amount of interest paid.
11
Monetary Amount
Decimal number (R)
Optional
1
18
1
Monetary amount
TS311 is the total contractual adjustment.
12
Monetary Amount
Decimal number (R)
Optional
1
18
1
Monetary amount
TS312 is the total Gramm-Rudman Reduction.
13
Monetary Amount
Decimal number (R)
Optional
1
18
1
Monetary amount
TS313 is the total Medicare Secondary Payer (MSP) primary payer amount.
14
Monetary Amount
Decimal number (R)
Optional
1
18
1
Monetary amount
TS314 is the total blood deductible amount in dollars.
15
Monetary Amount
Decimal number (R)
Optional
1
18
1
Monetary amount
TS315 is the summary of non-lab charges.
16
Monetary Amount
Decimal number (R)
Optional
1
18
1
Monetary amount
TS316 is the total coinsurance amount.
17
Monetary Amount
Decimal number (R)
Optional
1
18
1
Monetary amount
TS317 is the Health Care Financing Administration Common Procedural Coding System (HCPCS) reported charges.
18
Monetary Amount
Decimal number (R)
Optional
1
18
1
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
18
1
Monetary amount
TS319 is the total deductible amount.
20
Monetary Amount
Decimal number (R)
Optional
1
18
1
Monetary amount
TS320 is the total professional component amount.
21
Monetary Amount
Decimal number (R)
Optional
1
18
1
Monetary amount
TS321 is the total Medicare Secondary Payer (MSP) patient liability met.
22
Monetary Amount
Decimal number (R)
Optional
1
18
1
Monetary amount
TS322 is the total patient reimbursement.
23
Quantity
Decimal number (R)
Optional
1
15
1
Numeric value of quantity
TS323 is the total periodic interim payment (PIP) number of claims.
24
Monetary Amount
Decimal number (R)
Optional
1
18
1
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.