Segment

in

X12 Release 005040# TS3 Transaction Statistics

To supply provider-level control information

Sequence

Element

Name

Type

Requirement

Min

Max

Repeat

Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier

TS301 is the provider number.

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.

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.

Numeric value of quantity

TS304 is the total number of claims.

Monetary amount

TS305 is the total of reported charges.

Monetary amount

TS306 is the total of covered charges.

Monetary amount

TS307 is the total of noncovered charges.

Monetary amount

TS308 is the total of denied charges.

Monetary amount

TS309 is the total provider payment.

Monetary amount

TS310 is the total amount of interest paid.

Monetary amount

TS311 is the total contractual adjustment.

Monetary amount

TS312 is the total Gramm-Rudman Reduction.

Monetary amount

TS313 is the total Medicare Secondary Payer (MSP) primary payer amount.

Monetary amount

TS314 is the total blood deductible amount in dollars.

Monetary amount

TS315 is the summary of non-lab charges.

Monetary amount

TS316 is the total coinsurance amount.

Monetary amount

TS317 is the Health Care Financing Administration Common Procedural Coding System (HCPCS) reported charges.

Monetary amount

TS318 is the total Health Care Financing Administration Common Procedural Coding System (HCPCS) payable amount.

Monetary amount

TS319 is the total deductible amount.

Monetary amount

TS320 is the total professional component amount.

Monetary amount

TS321 is the total Medicare Secondary Payer (MSP) patient liability met.

Monetary amount

TS322 is the total patient reimbursement.

Numeric value of quantity

TS323 is the total periodic interim payment (PIP) number of claims.

Monetary amount

TS324 is total periodic interim payment (PIP) adjustment.

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