TS3 Transaction Statistics

To supply provider-level control information

Position
Element
Name
Type
Requirement
Min
Max
Repeat
TS3-01
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.
TS3-02
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.
TS3-03
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.
TS3-04
Quantity
Decimal number (R)
Mandatory
1
15
1
Numeric value of quantity
TS304 is the total number of claims.
TS3-05
Monetary Amount
Decimal number (R)
Mandatory
1
18
1
Monetary amount
TS305 is the total of reported charges.
TS3-06
Monetary Amount
Decimal number (R)
Optional
1
18
1
Monetary amount
TS306 is the total of covered charges.
TS3-07
Monetary Amount
Decimal number (R)
Optional
1
18
1
Monetary amount
TS307 is the total of noncovered charges.
TS3-08
Monetary Amount
Decimal number (R)
Optional
1
18
1
Monetary amount
TS308 is the total of denied charges.
TS3-09
Monetary Amount
Decimal number (R)
Optional
1
18
1
Monetary amount
TS309 is the total provider payment.
TS3-10
Monetary Amount
Decimal number (R)
Optional
1
18
1
Monetary amount
TS310 is the total amount of interest paid.
TS3-11
Monetary Amount
Decimal number (R)
Optional
1
18
1
Monetary amount
TS311 is the total contractual adjustment.
TS3-12
Monetary Amount
Decimal number (R)
Optional
1
18
1
Monetary amount
TS312 is the total Gramm-Rudman Reduction.
TS3-13
Monetary Amount
Decimal number (R)
Optional
1
18
1
Monetary amount
TS313 is the total Medicare Secondary Payer (MSP) primary payer amount.
TS3-14
Monetary Amount
Decimal number (R)
Optional
1
18
1
Monetary amount
TS314 is the total blood deductible amount in dollars.
TS3-15
Monetary Amount
Decimal number (R)
Optional
1
18
1
Monetary amount
TS315 is the summary of non-lab charges.
TS3-16
Monetary Amount
Decimal number (R)
Optional
1
18
1
Monetary amount
TS316 is the total coinsurance amount.
TS3-17
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.
TS3-18
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.
TS3-19
Monetary Amount
Decimal number (R)
Optional
1
18
1
Monetary amount
TS319 is the total deductible amount.
TS3-20
Monetary Amount
Decimal number (R)
Optional
1
18
1
Monetary amount
TS320 is the total professional component amount.
TS3-21
Monetary Amount
Decimal number (R)
Optional
1
18
1
Monetary amount
TS321 is the total Medicare Secondary Payer (MSP) patient liability met.
TS3-22
Monetary Amount
Decimal number (R)
Optional
1
18
1
Monetary amount
TS322 is the total patient reimbursement.
TS3-23
Quantity
Decimal number (R)
Optional
1
15
1
Numeric value of quantity
TS323 is the total periodic interim payment (PIP) number of claims.
TS3-24
Monetary Amount
Decimal number (R)
Optional
1
18
1
Monetary amount
TS324 is total periodic interim payment (PIP) adjustment.

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