Report Templates

A report template is a text file that contains formatting information used by Response Generator to create a custom report.

Templates are made up of sections that contain variables.

Sections provide structure for the report by grouping types of information such as provider information, receiver information, and so forth.
Variables provide data by importing specific information into the report.

As shown here, template sections are preceded with a dot (.) (e.g, .PROVHEADER) and variables are preceded with a % sign (e.g., %ICUsage).

Templates also contain user-specified formatting options (.OPTIONS) and user-specified literal text (e.g., 270 Status Report).

Sample Templates

For sample templates, see the files that start with RGtemplate in Instream’s DemoData directory. They are used by scripts with file names containing textrpt (example: V_RG_837P_4010_textrpt_1).

See the Instream DemoData Directory section of Demo_Index.pdf for a list and description.

Template Sections

General information about template sections:

All template sections are optional.
You can use a header without its trailer and vice versa.

Example: You can have .PROVHEADER without .PROVTRAILER.

The template header and trailer lines are not case sensitive.
When a template section is encountered, its variables are cleared and reloaded.

Example: If you use a .SOURCEHEADER section, values that were set for the first provider are cleared when the second provider is encountered.

Values set in a higher section can be used in lower sections, but not vice versa.

Example: the variable %PayerName% gets set/reset at each 2000A/.SOURCEHEADER section. If you use it at the .HEADER section, it will be blank. You will only get output from %PayerName% at or below the .SOURCEHEADER section.

All Templates

All templates can have these sections:

OPTIONS Section

This section is optional and appears once at the beginning of the output file. It consists of one of these:

`.OPTIONS NoWrap`	Truncate information rather than wrap it to a new line.
`.OPTIONS RepeatText`	Repeats constant information on each error line.
`.OPTIONS NoWrap,RepeatText`

FILEHEADER and FILETRAILER Sections

In the output file, the FILEHEADER section appears once per ISA and begins with a line containing only:

.FILEHEADER

Put information here if you want it to appear once for each file.

The FILETRAILER section appears once per ISA and begins with a line containing only:

. FILETRAILER

Put information here if you want it to appear once for each file, after the file’s information has been processed.

GROUPHEADER and GROUPTRAILER Sections

In the output file, the GROUPHEADER section appears once per GS and begins with a line containing only:

. GROUPHEADER

Put information here if you want it to appear once for each group.

The GROUPTRAILER section appears once per GS and begins with a line containing only:

. GROUPTRAILER

Put information here if you want it to appear once for each group, after the group’s information has been processed.

HEADER and Trailer Sections

The Header appears once for each GS in the input file. If an OPTIONS section is included, the Header section follows it. It begins with a line containing only:

.HEADER

Put information here if you want it to appear once for each file. Examples include information from the ISA.

The TRAILER section is optional and appears once at the end of the output file, and begins with a line containing only:

.TRAILER

DETAIL Section

In the output file, the DETAIL section appears for each claim and begins with a line containing only:

.DETAIL

Put information here that you want to appear once for each claim. Examples include claim numbers and amounts.

ERRORHEADER and ERRORTRAILER Sections

In the output file, the ERRORHEADER section appears for each DETAIL section and begins with a line containing only:

.ERRORHEADER

The ERRORTRAILER section appears once for each DETAIL section and begins with a line containing only:

.ERRORTRAILER

ISATOTALHEADER and ISATOTALTRAILER Sections

Note: This section is not available for 277, 820, or 834 reports.

In the output file, the ISATOTALHEADER section appears once at the end of the output file, and begins with a line containing only:

. ISATOTALHEADER

Put information here to provide ISA summary information for the file. Examples include totals for data such as number of claims and dollar value.

The ISATOTALTRAILER section appears once at the end of the output file, and begins with a line containing only:

. ISATOTALTRAILER

Put information here if you want it to appear once to provide an end for ISA summary information for the file.

OVERRIDE Section

The OVERRIDE section is optional and can appear anywhere in the template. It allows you to override the default display information for a particular error (including its number and associated data) with information of your choosing. It consists of a line containing the following:

Where:

`errno`	The error number to be overridden. This field must be populated.
`\|`	Separator. This symbol must be used between line values.
`loop`	Alternate location information to be provided instead of the default (Loop ID).
`segelmdata`	Alternate segment/element error data to be provided instead of the default.
`error_ref`	User-defined field intended to provide additional reference information. There is no default text for this field.
`error_message`	Alternate error message text to be provided instead of the default.
`error_data`	Alternate error data to be provided instead of the default (%ErrData%).

All fields are required, although only errno must be populated. If a value is left empty, the default value is used. (This excludes errno, which can’t be left empty.)

Note that there is a difference between leaving a field empty and entering a blank (or space) in the field. An empty field will display the default system value. A field with a space will display "" (a blank).

You can use a custom report variable in any field except errno. However, if the variable's value is empty, the original value will be replaced with "" (a blank).

Examples:

For error 23456, override the default loop location information that would typically be displayed (such as “2000B”) and show the text “Provider” instead. Allow all other default information for the error to display:

.OVERRIDE 23456|Provider|||||

For error 60001, override the default loop location information and show the text “2010BA” instead. Use the default information for the segment/element error data. Use “NM109” as additional error reference information. Display the default error message text and, finally, display the contents of the variable %SubCustomRecord1% as additional error data:

.OVERRIDE 60001|2010BA||NM109||%SubCustomRecord1%

For error 60002, override the loop location information and show the text “2000B” instead. Display a blank for the segment/element error data. Use “SBR09” as additional error reference information. Display a blank instead of error message text and, finally, display the contents of the variable %SubCustomRecord0% as additional error data:

270, 276, and 277 Templates

270, 276, and 277 templates can have additional sections for source, provider, subscriber, and dependent:

Additionally, 276 and 277 templates can have sections for receiver information:

SOURCEHEADER and SOURCETRAILER Sections

In the output file, the SOURCEHEADER section appears once for each 2000A loop in 270, 276, and 277 transactions. It begins with a line containing only:

.SOURCEHEADER

Put information here if you want it to appear once for each information source.

The SOURCETRAILER section appears once for each information source in 270, 276, and 277 transactions. It begins with a line containing only:

.SOURCETRAILER

Put information here if you want it to appear once for each information receiver, after the source’s information has been processed.

RECEIVERHEADER and RECEIVERTRAILER Sections

In the output file, the RECEIVERHEADER section appears once for each 2000B loop in 276 and 277 transactions. It begins with a line containing only:

.RECEIVERHEADER

The RECEIVERTRAILER section appears once for each receiver in 276 and 277 transactions. It begins with a line containing only:

.RECEIVERTRAILER

Put information here if you want it to appear once for each information receiver after the receiver’s information has been processed.

PROVHEADER and PROVTRAILER Sections

In the output file, the PROVHEADER section appears once for each provider in 270, 276, and 277 transactions. It begins with a line containing only:

.PROVHEADER

Put information here if you want it to appear once for each provider. Examples include provider and patient information. Note that, for these transactions, “Provider” refers to information in the 2000C.

Put information here if you want it to appear once for each information receiver.

The PROVTRAILER section appears once for each provider in 270, 276, and 277 transactions. It begins with a line containing only:

.PROVTRAILER

Put information here if you want it to appear once for each provider, after the provider information has been processed. Examples include claim totals and counts by provider.

SUBSCRIBERHEADER and SUBSCRIBERTRAILER Sections

In the output file, the SUBSCRIBERHEADER section appears once for each subscriber in 270, 276, and 277 transactions. It begins with a line containing only:

.SUBSCRIBERHEADER

Put information here if you want it to appear once for each subscriber.

The SUBSCRIBERTRAILER section appears once for each subscriber in 270, 276, and 277 transactions. It begins with a line containing only:

.SUBSCRIBERTRAILER

Put information here if you want it to appear once for each subscriber, after the subscriber’s information has been processed.

DEPENDENTHEADER and DEPENDENTTRAILER Sections

In the output file, the DEPENDENTHEADER section appears once for each dependent in 270, 276, and 277 transactions. It begins with a line containing only:

.DEPENDENTHEADER

Put information here if you want it to appear once for each dependent.

The DEPENDENTTRAILER section appears once for each dependent in 270, 276, and 277 transactions. It begins with a line containing only:

. DEPENDENTTRAILER

Put information here if you want it to appear once for each subscriber after the dependent’s information has been processed.

278 Templates

278 templates can have additional sections for interchange and utilization management organization information:

ISAHEADER and ISATRAILER Sections

In the output file, the ISAHEADER section appears once for each ISA Level loop in 278 transactions. It begins with a line containing only:

.ISAHEADER

Put information here if you want it to appear once for each information source.

The ISATRAILER section appears once for each ISA Level loop in 278 transactions. It begins with a line containing only:

.ISATRAILER

Put information here if you want it to appear once for each information receiver after the receiver’s information has been processed.

UMOHEADER and UMOTRAILER Sections

In the output file, the UMOHEADER section appears once for each 2000A UMO level loop in 278 transactions. It begins with a line containing only:

.UMOHEADER

Put information here if you want it to appear once for each information source.

The UMOTRAILER section appears once for each 2000A UMO level loop in 278 transactions. It begins with a line containing only:

.UMOTRAILER

Put information here if you want it to appear once for each information receiver after the receiver’s information has been processed.

820 Templates

820 templates can have additional sections for payers, including information about remittance:

PAYERHEADER and PAYERTRAILER Sections

In the output file, the PAYERHEADER section appears once per transaction set. It begins with a line containing only:

.PAYERHEADER

Put information here if you want it to appear once for each transaction set. Examples include provider reference ID, fiscal period date, and adjustment reason codes.

The PAYERTRAIL section appears once per transaction set. It begins with a line containing only:

. PAYERTRAIL

Put information here if you want it to appear once per transaction set, after the provider level adjustment information has been processed.

ORGREMHEADER and ORGREMTRAILER Sections

In the output file, the ORGREMHEADER section appears once per transaction set, and begins with a line containing only:

. ORGREMHEADER

Put information here to provide information about organization remittance.

The ORGREMTRAILER section appears once per transaction set, and begins with a line containing only:

. ORGREMTRAILER

Put information here if you want it to appear once per transaction set, after the organization remittance information has been processed.

ORGREMDTLHEADER and ORGREMDTLTRAILER Sections

In the output file, the ORGREMDTLHEADER section appears once per transaction set, and begins with a line containing only:

.ORGREMDTLHEADER

Put information here to provide information about organization remittance details.

The ORGREMDTLTRAILER section appears once per transaction set, and begins with a line containing only:

. ORGREMDTLTRAILER

Put information here if you want it to appear once per transaction set, after the organization remittance detail information has been processed.

ORGREMDETAIL Section

In the output file, the ORGREMDETAIL section appears once per transaction set, and begins with a line containing only:

. ORGREMDETAIL

This section provides the organization remittance detail.

ORGREMADJHEADER and ORGREMADJTRAILER Sections

In the output file, the ORGREMADJHEADER section appears once per transaction set, and begins with a line containing only:

. ORGREMADJHEADER

Put information here to provide information about organization remittance adjustments.

The ORGREMADJTRAILER section appears once per transaction set, and begins with a line containing only:

. ORGREMADJTRAILER

Put information here if you want it to appear once per transaction set, after the organization's remittance adjustment information has been processed.

INDREMHEADER and INDREMTRAILER Sections

In the output file, the INDREMHEADER section appears once per transaction set, and begins with a line containing only:

. INDREMHEADER

Put information here to provide information about individual remittance.

The INDREMTRAILER section appears once per transaction set, and begins with a line containing only:

. INDREMTRAILER

Put information here if you want it to appear once per transaction set, after the individual remittance information has been processed.

INDREM Section

In the output file, the INDREM section appears once per transaction set, and begins with a line containing only:

. INDREM

Put information here to provide information individual remittance.

INDREMDTLHEADER and INDREMDTLTRAILER Sections

In the output file, the INDREMDTLHEADER section appears once per transaction set, and begins with a line containing only:

. INDREMDTLHEADER

Put information here to provide information about individual remittance details.

The INDREMDTLTRAILER section appears once per transaction set, and begins with a line containing only:

. INDREMDTLTRAILER

Put information here if you want it to appear once per transaction set, after the individual remittance detail information has been processed.

INDREMDETAIL Section

In the output file, the INDREMDETAIL section appears once per transaction set, and begins with a line containing only:

. INDREMDETAIL

Put information here to provide information about individual remittance detail.

INDREMADJHEADER and INDREMADJTRAILER Section

In the output file, the INDREMADJHEADER section appears once per transaction set, and begins with a line containing only:

. INDREMADJHEADER

Put information here if you want it to appear once per transaction set, to provide information about individual remittance adjustments.

The INDREMADJTRAILER section appears once per transaction set, and begins with a line containing only:

. INDREMADJTRAILER

Put information here if you want it to appear once per transaction set, after the individual remittance adjustment information has been processed.

835 Templates

835 templates can have additional sections about provider level adjustments and errors affecting them.

PLBHEADER and PLBTRAILER Sections

In the output file, the PLBHEADER section appears once per transaction set. It begins with a line containing only:

. PLBHEADER

Put information here if you want it to appear once for each transaction set to provide information about provider level adjustments.

The PLBTRAILER section appears once per transaction set. It begins with a line containing only:

. PLBTRAILER

Put information here if you want it to appear once per transaction set, after the provider level adjustment information has been processed.

PLBERRORHEADER and PLBERRORTRAILER Sections

In the output file, the PLBERRORHEADER section appears once per transaction set, and begins with a line containing only:

. PLBERRORHEADER

Put information here to provide information about all errors at the ST level and above affecting provider level adjustments.

The PLBERRORTRAILER section appears once per transaction set, and begins with a line containing only:

. PLBERRORTRAILER

Put information here if you want it to appear once per transaction set, after the provider level adjustment error information has been processed.

837 Templates

837 templates can have additional sections for provider and interchange total information.

PROVHEADER and PROVTRAILER Sections

In the output file, the PROVHEADER section appears once for each provider in 837 transactions. It begins with a line containing only:

.PROVHEADER

Put information here if you want it to appear once for each provider. Examples include provider and patient information. Note that, for this transaction, “Provider” refers to information in the 2000A and above.

The PROVTRAILER section appears once for each provider in 837 transactions. It begins with a line containing only:

.PROVTRAILER

Put information here if you want it to appear once for each provider, after the provider information has been processed. Examples include claim totals and counts by provider.

Literals and Variables

The template has both literal text and variables. In the example above, everything not surrounded by % is a literal. Everything surrounded by % is a variable that will be replaced when the custom report is generated. For example:

ClaimNumber: %CLAIMID%

TotalAmt: %CLAIMAMT%

In the report, these lines might generate something like this for each claim:

ClaimNumber: 10

TotalAmt: $1000.00

If you have tables in your HTML template, put entire <TR>...</TR> onto one line of the template file. Add the statement '.OPTIONS RepeatText' at the beginning of the template file, as shown in the template file RGtemplate837I_h.txt in Instream’s DemoData directory.

Variables are pre-defined by Response Generator (see page Template Variables) and are not case sensitive: CLAIMAMT is the same as ClaimAmt.

In the template, variables may be accompanied by column width and justification information - especially important when producing a column report.

Format	Result in Report	Example
%varname%	varname is the name of the variable to be output (see page Template Variables). The report displays the value, taking up as many spaces as needed.	% PatName% displays the patient last, first, and middle names.
(note colon) %varname:w%	w is the field width.	%PatName:25% displays the patient last, first, and middle names in a column that is 25 characters wide.. If the name has less than 25 characters, blanks are added. If the name has more than 25 characters, it wraps. Note the colon that separates the variable name from the width.
%varname:jw%	j is an optional field justification of either L or R. You must use a width if you use justification.	%PatName:R25% right-justifies up to 25 characters of the patient last, first, and middle names. For numeric fields, you can right-justify and fill with leading zeros. To do this, put a 0 right after the R. Example: R010 defines a right-justified field of 10 characters, with leading zeros. If the value is 23, then this field will show 0000000023 in the custom report. Default is left justification. The justification can come before or after the width: R25 and 25R have the same result.

Format

Result in Report

Example

%varname%

varname is the name of the variable to be output (see page Template Variables). The report displays the value, taking up as many spaces as needed.

% PatName% displays the patient last, first, and middle names.

(note colon)

%varname:w%

w is the field width.

%PatName:25% displays the patient last, first, and middle names in a column that is 25 characters wide..

If the name has less than 25 characters, blanks are added.

If the name has more than 25 characters, it wraps.

Note the colon that separates the variable name from the width.

%varname:jw%

j is an optional field justification of either L or R. You must use a width if you use justification.

%PatName:R25% right-justifies up to 25 characters of the patient last, first, and middle names.

For numeric fields, you can right-justify and fill with leading zeros. To do this, put a 0 right after the R. Example: R010 defines a right-justified field of 10 characters, with leading zeros. If the value is 23, then this field will show 0000000023 in the custom report.

Default is left justification.

The justification can come before or after the width: R25 and 25R have the same result.

Template Variables

Template variables are not case-sensitive.

General Template Variables

These variables can be used in any template.

ClaimCnt_byGS	Number of claims encountered so far in this functional group set. Resets at the beginning of each functional group set.
ClaimCntGood_byGS	Number of good claims encountered so far in this functional group set. Resets at the beginning of each functional group set.
ClaimCntBad_byGS	Number of bad claims encountered so far in this functional group set. Resets at the beginning of each functional group set.
ClaimCustomRecord [0-9]	Claim Custom Record as determined by the corresponding ZREC at the specified level. This variable can be used multiple times using 0-9 (for example, ClaimCustomRecord0, ClaimCustomRecord1). This variable corresponds to ZZCRx, where x is also 0-9 and is a 1:1 match. See TIB_fsp-instream_<n.n>_usersguide.pdf, the section “Z Custom Data Record”. Example: ZZCR2 at the 2300 loop level corresponds to %ClaimCustomRecord2%.
ClaimPercentGood_byGS	Percent of claims that are good in this functional group set; includes one decimal place. Example: 60.0.
ClaimPercentBad_byGS	Percent of claims that are bad in this functional group set; includes one decimal place. Example: 40.0.
ContactPhone	Contact phone number as passed through a ZZWPC custom record.
Date	Current date in format MM/DD/YYYY.
Date_YYMMDD	Current date in format YYMMDD.
Date_MMDDYYYY	Current date in format MM-DD-YYYY.
DATE_YYYY_MM_DD	Current date in format YYYY-MM-DD.
DepCustomRecord[0-9]	Dependent Custom Record as determined by the corresponding ZREC at the specified level. This variable can be used multiple times using 0-9 (for example, DepCustomRecord0, DepCustomRecord1). This variable corresponds to ZZCRx, where x is also 0-9 where x is also 0-9 and is a 1:1 match. See TIB_fsp-instream_<n.n.n >_UsersGuide.pdf the section "Z Custom Data Record". Example: ZZCR2 at the 2300 loop level corresponds to %DepCustomRecord2%.
EdiFileName	Name of the EDI file. STRT record must be in the results file. Example output: 837P_098Dep_11.txt
EdiFilePath	Path to the EDI file. STRT record must be in the results file. Example output: C:\Systest\Data\
EDILine	Line number in EDI file.
Filler:n	Insert n spaces. Example: Filler:5
LineCount	Number of lines so far in the report.
MostFrequentError[0-10]	For the top ten errors, displays the most to least frequently occurring error. Examples: MostFrequentError1displays the most frequent error. MostFrequentError3 displays the third most frequent error.
MostFrequentErrorCount[0-10]	Count for the [first through tenth] most frequent error. Examples: MostFrequentErrorCount1is the percentage of the most frequent error. MostFrequentErrorCount3 is the percentage of the third most frequent error.
MostFrequentErrorPercent[0-10]	Percentage of the [first through tenth] most frequently occurring error. Examples: MostFrequentErrorPercent1is the percentage of the most frequent error. MostFrequentErrorPercent3 is the percentage of the third most frequent error.
NEWLINE	Line break.
OriginalFname	Original Filename as passed through a ZZWRO custom record.
PayerCustomRecord[0-9]	Payer Custom Record as determined by the corresponding ZREC at the specified level. This variable can be used multiple times using 0-9 (for example, PayerCustomRecord0, PayerCustomRecord1). This variable corresponds to ZZCRx, where x is also 0-9 where x is also 0-9 and is a 1:1 match. See TIB_fsp-instream_<n.n.n >_UsersGuide.pdf the section “Z Custom Data Record”. Example: ZZCR2 at the 2300 loop level corresponds to %PayerCustomRecord2%.
PayerLineCount	Placed in one of the types of trailer records, this shows the number of lines displayed for the current payer up to this point.
ProvCustomRecord[0-9]	Provider Custom Record as determined by the corresponding ZREC at the specified level. This variable can be used multiple times using 0-9 (for example, ProvCustomRecord0, ProvCustomRecord1). This variable corresponds to ZZCRx, where x is also 0-9 where x is also 0-9 and is a 1:1 match. See TIB_fsp-instream_<n.n.n >_UsersGuide.pdf, the section “Z Custom Data Record”. Example: ZZCR2 at the 2300 loop level corresponds to %ProvCustomRecord2%.
SubCustomRecord[0-9]	Submitter Custom Record as determined by the corresponding ZREC at the specified level. This variable can be used multiple times using 0-9 (for example, SubCustomRecord0, SubCustomRecord1). This variable corresponds to ZZCRx, where x is also 0-9 where x is also 0-9 and is a 1:1 match. See TIB_fsp-instream_<n.n.n >_UsersGuide.pdf, the section “Z Custom Data Record”. Example: ZZCR2 at the 2300 loop level corresponds to %SubCustomRecord2%.
Time	Current Time in 24hr format HH:MM.
TPCustomRecord[0-9]	Trading Partner Custom Record as determined by the corresponding ZREC at the specified level. This variable can be used multiple times using 0-9 (for example, TPCustomRecord0, TPCustomRecord1). This variable corresponds to ZZCRx, where x is also 0-9 where x is also 0-9 and is a 1:1 match. See TIB_fsp-instream_<n.n.n >_UsersGuide.pdf, the section “Z Custom Data Record”. Example: ZZCR2 at the 2300 loop level corresponds to %TPCustomRecord2%.
UserGSControlNum	User-specified GS Control Number, as set via the -dcg command.
WrappedText	Display the text that was truncated from the end of a variable that was specified with a fixed width. For example, using %WrappedText% after the variable %ErrMsg:128% results in the display of all text from positions 129 on.

Error/Message Template Variables

Error variables really represent lists of values, since a claim may have more than one. If so, subsequent occurrences appear on another line.

These variables can be used in any template.

ErrData	Data causing error.
ErrElmPos	Position of the erroneous element with the segment.
ErrID	Error number.
ErrLoop	ID of the loop with the error.
ErrMsg	Error text – TIBCO Foresight flavor.
ErrMsg_ADA	Error text – ADA flavor.
ErrMsg_COBA	Error text – COBA flavor. For errors not defined in ErrMsgTrans.txt, the report will have an error number of 009999. This will generally happen with your custom error messages that you set up with your own business rules.
ErrMsg_Foresight	Error text – TIBCO Foresight flavor.
ErrMsg_HCFA	Error text – HCFA flavor.
ErrMsg_NonTech	Error text – Non-technical flavor if an ELOC record is associated with the DTL record for an error in the 10000-29999 range. For a demo, see V_RG_837P_4010_textrpt_ELOC in Instream’s Scripts directory.
ErrMsg_NSF	Error text – NSF flavor.
ErrMsg_UB92	Error text – UB92 flavor.
ErrRefDes	ErrSegData+ErrElemPos+ErrSubElmPos.
ErrSeg	ID of the segment with the error.
ErrSegData	Entire segment causing or containing the error (if present in data).
ErrSev	Error severity number.
ErrSubElmPos	Position of the subelement within the composite.
ErrType	Error type number.

Envelope Template Variables

These variables can be used in any template.

Interchange

ICSendID	Sender ID (ISA-06).
ICSendIDQual	Sender ID qualifier (ISA-05).
ICRecID	Receiver ID (ISA-08).
ICRecIDQual	Received ID qualifier (ISA-07).
ICCtlNoStart	Control number passed with the Response Generator command line parameter -dic.
ICDate	Date (ISA-09) in format MM/DD/YYYY.
ICDate_MMDDYYYY	Date (ISA09) in format MM-DD-YYYY.
ICDate_YYMMDD	Date (ISA-09) in format YYMMDD.
ICDATE_YYYY_MM_DD	Date (ISA-09) in format YYYY-MM-DD.
ICTime	Time (ISA-10) in format HH:MM.
ICCtlNo	Interchange control number (ISA-13).
ICDate_YYYYMMDD	ISA date in YYYYMMDD format.
ICUsage	Usage (ISA-15)

Functional Group

FGSendID	Sender ID (GS-02).
FGRecID	Receiver ID (GS-03).
FGDate	Date (GS-04) in format MM/DD/YYYY.
FGDate_YYMMDD	Date (GS-04) in format YYMMDD.
FGDate_MMDDYYYY	Date (GS-04) in format in MM-DD-YYYY.
FGTime	Time (GS-05) in format HH:MM.
FGCtlNo	Control number (GS-06).
FGVerRel	Version/Release/Industry Identifier Code (GS-08).
FGType	HIPAA type of the source document (Example: 837 D 5010).
COBA_837Type	Returns “Part A” or “Part B”.

Transaction Set

SetCtlNo

Set control number (ST-02).

ISATOTAL Summary Variables

These variables can be used in any template except 277, 820, and 834.

FileClaimCntTotals	Total number of claims in that ISA.
FileClaimCntGoodTotals	Total number of good claims in that ISA.
FileClaimCntBadTotals	Total number of good claims in that ISA.
FileClaimAmtTotals	Total dollar value of claims in that ISA.
FileClaimAmtGoodTotals	Total dollar value of good claims in that ISA.
FileClaimAmtBadTotals	Total dollar value of bad claims in that ISA.
FileClaimTotalIndex	The claim being reported on.

270-Specific Report Variables

These variables can be used only for a 270 custom report template.

Note: Payer and Provider are the generic values. If not listed, use the generic Subscriber and Dependent codes.

Detail Section
TSRefID	Transaction set reference ID (BHT03).
TSTypeCpde	Transaction type code (BHT06).
2000C
SubTraceTypeCode	Type of transaction being referenced (TRN01).
SubTraceID	Transaction trace number (TRN02).
SubOrigTraceID	Originating company identifier (TRN03).
SubOrigTraceSuppID	Originating company supplemental identifier (TRN04).
2110C
SubServiceTypeCode	Service type classification code (EQ01).
SubServiceIDQual	Service Id qualifier (EQ0201).
SubServiceID	Service Id (EQ0202).
SubProcedureMod1	Service/procedure modifier code #1 (EQ0203).
SubProcedureMod1	Service/procedure modifier code #2 (EQ0204).
SubProcedureMod1	Service/procedure modifier code #3 (EQ0205).
SubProcedureMod1	Service/procedure modifier code #4 (EQ0206).
SubCoverageLevelCode	Coverage level provided (EQ03).
2000D
DepTraceTypeCode	Type of transaction being referenced (TRN01).
DepTraceID	Transaction trace number (TRN02).
DepOrigTraceID	Originating company identifier (TRN03).
DepOrigTraceSuppID	Originating company supplemental identifier (TRN04).
2110D
DepServiceTypeCode	Service type classification code (EQ01).
DepServiceIDQual	Service Id qualifier (EQ0201).
DepServiceID	Service Id (EQ0202).
DepProcedureMod1	Service/procedure modifier code #1 (EQ0203).
DepProcedureMod1	Service/procedure modifier code #2 (EQ0204).
DepProcedureMod1	Service/procedure modifier code #3 (EQ0205).
DepProcedureMod1	Service/procedure modifier code #4 (EQ0206).
DepCoverageLevelCode	Coverage level provided (2110 EQ03).

276-Specific Report Variables

These variables can be used only for a 276 custom report template

Detail Section

2200D
SubPayerClaimControlNumber	Payer Claim Control Number (REF*1K).
SubSVCDate	Service date (DTP03).
2200E
DepPayerClaimControlNumber	Payer Claim Control Number (REF*1K).
DepSVCDate	Service date (DTP03).
2210D/E
SVCMonAmt	SVC monetary amount (SVC02).
SVCNUBCID	SVC NUBC Id (SVC04).

277CA, 277U, and 277X228-Specific Report Variables

These variables can be used only for a 277CA, 277U, or 277X228 custom report template

Note: The 277U custom report is available for 4010 only.

HEADER Section
ProcessAllFor277	If the input file contained multiple errors or service lines per claim, only the last error or service line information appears in the custom report. ProcessAllFor277 causes all errors and service line information to appear:
SOURCEHEADER Section
2100A
PayerName	Payer last name (NM103).
PayerIDQual	Payer ID qualifier (NM108).
PayerID	Payer ID (NM109).
RECEIVERHEADER Section
2100B
ReceiverLName	Information receiver last name (NM103).
ReceiverFName	Information receiver first name (NM104).
ReceiverMName	Information receiver middle name (NM105).
ReceiverName	Information receiver full name (NM103, NM104, NM105).
ReceiverIDQual	Information receiver ID qualifier (NM108).
ReceiverID	Information receiver ID (NM109).
PROVHEADER Section
2100C
ProvIDCode	Provider entity code (NM101).
ProvLName	Provider last name (NM103).
ProvFName	Provider first name (NM104).
ProvMName	Provider middle name (NM105).
ProvName	Provider full name (NM103, NM104, NM105).
ProvIDQual	Provider ID qualifier (NM108).
ProvID	Provider entity code (NM109).
SUBSCRIBERHEADER Section
2000D
SubBirthDate	Subscriber birth date (DMG02).
SubGender	Subscriber gender (DMG03).
2100D
PatLName	Patient last name (NM103 (NM101=QC)).
PatFName	Patient first name (NM104 (NM101=QC)).
PatMName	Patient middle name (NM105 (NM101=QC)).
PatName	(NM103, NM104, NM105 (NM101=QC)).
PatIDQual	Patient ID code qualifier (NM108 (NM101=QC)).
PatID	Patient ID (NM109 (NM101=QC)).
SubIDCode	Subscriber qualifier (NM101 (NM101=IL)).
SubLName	Subscriber last name (NM103 (NM101=IL)).
SubFName	Subscriber first name (NM104 (NM101=IL)).
SubMName	Subscriber middle name (NM105 (NM101=IL)).
SubName	Subscriber full name (NM103, NM104, NM105 (NM101=IL)).
SubIDQual	Subscriber ID code qualifier (NM108 (NM101=IL)).
SubID	Subscriber ID (NM109 (NM101=IL)).
DEPENDENTHEADER Section
2000E
PatBirthDate	Patient birth date (DMG02).
PatGender	Patient gender (DMG03).
2100E
PatLName	Patient last name (NM103).
PatFName	Patient first name (NM104).
PatMName	Patient middle name (NM105).
PatName	Patient full name (NM103, NM104, NM105).
PatIDQual	Patient ID code qualifier (NM108).
PatID	Patient ID (NM109).
DETAIL Section
2200D
BillTypeQual	Bill type qualifier (REF01 (REF01=BLT)).
BillTypeID	Bill type ID (REF02 (REF01=BLT)).
ClaimID	Claim submitter trace number (TRN02).
DateOfService	Claim service period (DTP03).
PayerClaimQual	Payer claim ID qualifier (REF01 (REF01=1K)).
PayerClaimID	Payer claim control number (REF02 (REF01=1K)).
ClaimCategoryCode	Claim level status category code (STC01.01).
ClaimStatusCode	Claim level status code (STC01.02).
PlaceOfService	Place of service code (STC01.03).
PmtAmt	Original submitted charges (STC04).
PmtMethod	Claim payment method code (STC07).
PmtDate	Payment issue date (STC08).
CheckNum	Check number (STC09).
2220D
SvcIDQual	Medical procedure ID qualifier (SVC01.01).
SvcID	Medical procedure ID (SVC01.02).
SvcMod1	Medical procedure modifier code (SVC01.03).
SvcMod2	Medical procedure modifier code (SVC01.04).
SvcMod3	Medical procedure modifier code (SVC01.05).
SvcMod4	Medical procedure modifier code (SVC01.06).
SvcChgAmt	Submitted service charge (SVC02).
SvcQty	Original submitted units of service (SVC07).
2200E
BillTypeQual	Bill type ID qualifier (REF01 (REF01=BLT)).
BillTypeID	Bill type ID (REF02 (REF01=BLT)).
DateOfService	Claim service date (DTP03).
PayerClaimID	Payer claim ID qualifier (REF01 (REF01=1K)).
PayerClaimQual	Payer claim control number (REF02 (REF01=1K)).
ClaimID	Claim submitter trace number (TRN02).
ClaimCategoryCode	Claim industry category (STC01.01).
ClaimStatusCode	Claim status code (STC01.02).
PlaceOfService	Service entity (STC01.03).
PmtAmt	Amount of originally submitted charges (STC04).
PmtMethod	Payment method (STC07).
PmtDate	Check issue date (STC08).
CheckNum	Check identification number (STC09).
2220E
SvcIDQual	Procedure code qualifier (SVC01.01).
SvcID	Procedure code (SVC01.02).
SvcMod1	Procedure modifier (SVC01.03).
SvcMod2	Procedure modifier (SVC01.04).
SvcMod3	Procedure modifier (SVC01.05).
SvcMod4	Procedure modifier (SVC01.06).
SvcChgAmt	Submitter service charge (SVC02).
SvcQty	Original submitted units of service (SVC07).

278-Specific Report Variables

(Including 278x215 and 278x216 transactions)

These variables can be used only for a 278 custom report template. This includes

2000A

PayerName	Last name or organization name (NM103).
PayerIDQual	Identification code qualifier (NM108).
PayerID	Identification code (NM109).

2000B

ReceiverNameL	Last name or organization name (NM103).
ReceiverNameF	First name (NM104).
ReceiverNameF	Middle name (NM105).
ReceiverName	Combined first name, last name, and middle initial.

2000C

SubNameL	Last name or organization name (NM103).
SubNameF	First name (NM104).
SubNameF	Middle name (NM105).
SubName	Combined first name, last name, and middle initial.
SubTraceTypeCode	Trace number type (TRN01).
SubTrace	Trace number (TRN02).

2000D

DepNameL	Last name or organization name (NM103).
DepNameF	First name (NM104).
DepNameF	Middle name (NM105).
DepName	Combined first name, last name, and middle initial
DepTraceTypeCode	Trace number type (TRN01).
DepTrace	Trace number (TRN02).

2000E

PatientName	Last name (If 2000D exists, 2000D NM103 is used, otherwise 2000C NM103 is used.)
PatientTraceTypeCode	Trace number type (If 2100D exists, 2100D NM108 is used, otherwise 2100C NM108 is used.)
PatientTrace	Trace number (If 2100D exists, 2100D NM109 is used, otherwise 2100C NM109 is used.)
EventTraceTypeCode	Trace number type (TRN01).
EventTrace	Trace number (TRN02).
EventDate	2000E Event Date - DTP*AAH DTP03 (YYYYMMDD).

820x218-Specific Report Variables

These variables can be used only for an 820 custom report template.

HEADER Section

TransCode	Transaction Handling Code (BPR01)
MonetaryAmt	Monetary Amount (BPR02)
PayMethod	Payment Method Code (BPR04)
PaymentDate	Date (BPR16)
ReassociationKey	Reassociation Key (TRN02)

1000A

ReceiverName	Premium Receiver Name (1000A, N102)
ReceiverID	Premium Receiver ID (1000A, N104)

1000B

PayersName	Premium Payer’s Name (1000B, N102)
PayersID	Premium Payer’s ID (1000B, N104)

2000B

OrgAssignedNumber	Organization Summary Remittance (2000A, ENT01)
OrganizationID	Organization ID (2000A, ENT04)

2300A

OrgRMRID	RMR Organization Reference ID (2300A, RMR02)
OrgRMRAmt	RMR Organization Monetary Amount (2300A, RMR04)

2320A

OrgADXAmt	Organization Monetary Amount (2320A, ADX01)
OrgADXAdjCode	Organization Adjustment Reason Code (2320A, ADX02)

2000B

IndAssignedNumber	Individual Summary Remittance (2000B, ENT01)
IndividualID	Individual ID (2000B, ENT04)

2100B

IndName	Individual Name (2100B, NM103)
IndID	Individual ID (2100B, NM109)

2300B

IndRMRID	RMR Individual Reference ID (2300B, RMR02)
IndRMRAmt	RMR Individual Monetary Amount (2300B, RMR04)

2320B

IndADXAmt	Individual Monetary Amount (2320B, ADX01)
IndADXAdjCode	Individual Adjustment Reason Code (2320B, ADX02)

820x306-Specific Report Variables

These variables can be used only for an 820 custom report template.

HEADER Section

TransCode	Transaction Handling Code (BPR01)
MonetaryAmt	Monetary Amount (BPR02)
PayMethod	Payment Method Code (BPR04)
PaymentDate	Date (BPR16)
ReassociationKey	Reassociation Key (TRN02)

1000A

PayeeName	Payee Name (1000A, N102)
PayeeID	Payee ID (1000A, N104)

1000B

PayersName	Premium Payer’s Name (1000B, N102)
PayersID	Premium Payer’s ID (1000B, N104)

2000

RemittanceInfo

Remittance Information (2000, ENT01)

2100

IndName	Individual Name (2100, NM103)
IndID	Individual ID (2100, NM109)

2300

IndRMRID	RMR Reference ID (2300, RMR02)
IndRMRAmt	RMR Monetary Amount (2300, RMR04)

834-Specific Variables

These variables can be used only for an 834 custom report template

HEADER Section

TSPurposeCode	Transaction set purpose code (BGN-01).
ReferenceID	ReferenceID (BGN-02).
CreationDate	Transaction set creation date (BGN-03).
ActionCode	Action code (BGN-08).

1000A

SponsorName	Plan sponsor name (N1-02).
SponsorIDQual	Sponsor identification code qualifier (N1-03).
SponsorID	Sponsor identifier (N1-04).

1000B

PayerName	Payer (insurer) name (N1-02).
PayerIDQual	Payer (insurer) identification code qualifier (N1-03).
PayerID	Payer (insurer) identification code (N1-04).

1000C

TPAName	TPA or broker name (N1-02).
TPAQual	TPA or broker identification code qualifier (N1-03).
TPAID	TPA or broker identification code (N1-04).

SUBSCRIBERHEADER Section

2000

SubDepIndicator	Subscriber or insured indicator (INS-01).
MbrRelCode	Individual relationship code (INS-02).
MbrMaintTypeCode	Maintenance type code (INS-03).
MbrMaintTypeCodeText	Description of the 834 Member MTC (Example: "Change" - Code 001).
MbrBenefitStatus	Benefit status code (INS-05).
SubID	Subscriber identifier (where REF-01 = OF/REF-02).
MbrPolicyNum	Insured group or policy number (where REF01 = 1L/REF-02).
MbrLevelQual	Applicable dates qualifier (DTP-01).
MbrLevelDate	Status information effective date (DTP-03).

2100A

MbrIDCode	Entity identifier code (NM1-01).
MbrLName	Subscriber last name (NM1-03).
MbrFName	Subscriber first name (NM1-04).
MbrMName	Subscriber middle name (NM1-05).
MbrName (Last, First Middle)	MbrLName, MbrFName MbrMName (Example: JOHNSON, BARBARA T).
MbrIDQual	Identification code qualifier (NM1-08).
MbrID	Subscriber identifier (NM1-09).
MbrBirthDate	Member birth date (DMG-02).
MbrGenderCode	Gender code (DMG-03).

DETAIL Section

2300

CvrgMaintCode	Maintenance type code (HD-01).
CvrgInsurCode	Insurance line code (HD-03).
CvrgLevelQual	Maintenance date/time qualifier (DTP-01).
CvrgLevelDate	Coverage period (DTP-03).
CvrgPolicyNumQual	Coverage policy reference identification qualifier (REF-01).
CvrgPolicyNum	Insured group or policy number (REF-02).

2310

ProvIDCode	Provider entity identifier code (NM1-01).
ProvLName	Provider last name or organization name (NM1-03).
ProvFName	Provider (individual) first name (NM1-04).
ProvMName	Provider (individual) middle name or initial (NM1-05).
ProvName	(Last, First Middle) ProvLName, ProvFName ProvMName (Example: JOHNSON, BARBARA T).
ProvIDQual	Provider identification code qualifier (NM1-08).
ProvID	Provider identifier (NM1-09).

2320

COBResponsibility	Payer responsibility sequence number code (COB-01).
COBPolicyNum	Insured group or policy number (COB-02).
COBBenefitCode	Coordination of benefits code (COB-03).
COBName	Insurer name (N1-02).
COBID	Provider organizational ID (N1-04).
COBLevelQual	Coordination of benefits date/time qualifier (DTP-01).
COBPolicyDate	Coordination of benefits date (DTP-03).

835-Specific Report Variables

These variables can be used only for an 835 custom report template.

HEADER Section

TransHandleCode	Transaction Handling Code (BPR-01).
TotalPmtAmt	Total Payment Amount (BPR-02).
CreditDebitFlag	Credit/Debit Flag Code (BPR-03).
PmtMethod	Payment Method Code (BPR-04).
PmtFormat	Payment Format Code (BPR-05).
OrigDFIQual	Originating DFI Qualifier (BPR-06).
OrigDFIID	Originating DFI ID Number (BPR-07).
OrigAcctQual	Originating Acct Qualifier (BPR-08).
OrigAcctID	Originating Acct Number (BPR-09).
OrigCoID	Originating Company ID (BPR-10).
OrigCoSupplID	Originating Company Suppl Code (BPR-11).
RecvDFIQual	Receiving DFI Qualifier (BPR-12).
RecvDFIID	Receiving DFI ID Number (BPR-13).
RecvAcctQual	Receiving Acct Qualifier (BPR-14).
RecvAcctID	Receiving Acct Number (BPR-15).
PmtDate	Payment Date (BPR-16).
TraceType	Trace Type Code (TRN-01).
TraceID	Ref ID (TRN-02).
OrigCoIDTrn	Originating Company ID (TRN-03).
OrigCoSupplIDTrn	Originating Company Suppl Code (TRN-04).
RecvRefQual	Receiver Reference ID Qual (REF-01).
RecvRefID	Receiver Reference ID (REF-02).

1000A

PayerName	Payer Name (N1-02).
PayerID	Payer ID (N1-04).

1000B

PayeeName	Payee Name (N1-02).
PayeeID	Payee ID (N1-04).
PayeeAddlRefQual	Payee Additional Ref ID Qual (REF-01).
PayeeAddlRefID	Payee Additional Ref ID (REF-02).

1000B (Receiver Name)

ReceiverName	Receiver Name (1000B/NM103)
ReceiverID	Receiver ID (1000B/NM109)
ReceiverIDQual	Receiver ID Qualifier (1000B/NM108)

2000

PmtProvID	Provider ID (TS3-01).
FacType	Facility Type Code (TS3-02).
FiscalEndDate	Fiscal Period End Date (TS3-03).
TotalDRGAmt	Total Diagnosis Related Group (DRG) Amount (TS2-01).
TotalFedAmt	Total Federal Specific Amount (TS2-02).
TotalHospAmt	Total Hospital-specific Amount (TS2-03).
TotalDispAmt	Total Disproportionate Amount (TS2-04).
TotalCapAmt	Total Capital Amount (TS2-05).
TotalEduAmt	Total Indirect Medical Education Amount (TS2-06).
TotalOutlAmt	Total Day Outlier Amount (TS2-08).
TotalDayCount	Total Cost Report Day Count (TS2-12).
TotalMSPPassAmt	Total MSP Pass Through Amount (TS2-15).
TotalPPSFedDRGAmt	Total PPS Capital, Federal-specific portion DRG Amount (TS2-17).
TotalPPSHospDRGAmt	Total PPS Capital, Hospital-specific portion DRG Amount (TS2-18).
TotalPPSDispHospDRGAmt	Total PPS Disproportionate Share, Hospital DRG Amount (TS2-19).

2010BB (Payer Name)

PayerName2010BB	Payer Name (2010BB/NM103)
PayerNameID	PayerNameID (2010BB/NM109)
PayerNameSecondaryIDQual	Payer Name Secondary ID Qualifier (2010BB/REF02, where REF01=2U, EI, FY, or NF)

2100

PatientControlID	Patient Control Number (CLP-01).
ClaimStatusCode	Claim Status Code (CLP-02).
ClaimChgAmt	Total Claim Charge Amount (CLP-03).
ClaimPmtAmt	Claim Payment Amount (CLP-04).
ClaimPatRespAmt	Patient Responsibility Amount (CLP-05).
ClaimFilingCode	Claim Filing Indicator Code (CLP-06).
ClaimControlID	Payer Claim Control Number (CLP-07).
ClaimFacType	Facility Type Code (CLP-08).
ClaimFreq	Claim Frequency Code (CLP-09).
ClaimDRGCode	Diagnosis Related Group (DRG) Code (CLP-11).
ClaimDRGWt	Diagnosis Related Group (DRG) Weight (CLP-12).
ClaimDischFrac	Discharge Fraction (CLP-13).

2100 CAS

ClaimAdjTotalAmt	Sum of Adjustment Amounts (CAS-03+CAS-06+CAS-09+CAS-12+CAS-15+CAS-18).
ClaimLifeResDays	Lifetime Reserve Days (MIA-02).
ClaimDRGAmt	Diagnosis Related Group (DRG) Amount (MIA-04).
ClaimDispAmt	Disproportionate Share Amount (MIA-06).
ClaimMSPPassAmt	Medicare Secondary Payer (MSP) Pass-through Amount (MIA-07).
ClaimPPSCapAmt	Total Prospective Payment System (PPS) Capital Amount (MIA-08).
ClaimPPSFedDRGAmt	Prospective Payment System (PPS) Federal DRG Amount (MIA-09).
ClaimPPSHospDRGAmt	Prospective Payment System (PPS) Hospital DRG Amount (MIA-10).
ClaimPPSDispHospDRGAmt	Prospective Payment System (PPS) Hospital Disproportionate Share DRG Amount (MIA-11).
ClaimDayCount	Cost Report Days (MIA-15).
ClaimFedDRGAmt	Federal DRG Amount (MIA-16).
ClaimIndTeachAmt	Indirect Teaching Amount (MIA-18).

2110

SvcProcCode	Procedure Code (SVC-0102).
SvcChgAmt	Line Item Charge Amount (SVC-02).
SvcPmtAmt	Line Item Paid Amount (SVC-03).

2110 CAS

SvcAdjTotalAmt

Sum of Adjustment Amounts (CAS-03, 06, 09, 12, 15, 18).

PLB

Note: The PLB section follows the current 835 Custom Report Claim (CLP) and Error sections. To display the PLB segment information and the errors affecting it, you must use, at minimum, the .PLBDETAIL and .PLBERRORDETAIL layout directives. If these layout directives are not used, the PLB variables are left blank.

TotalNonClaimAdj	Non-Claim Adjustment Total (Sum PLB-04, 06, 08, 10, 12, 14).
PLBReferenceID	Provider reference ID.
PLBDate	Fiscal period date, in CCYYMMDD.
PLBAdjustmentCode1	Adjustment reason code 1.
PLBAdjustmentRefID1	Adjustment reference ID 1.
PLBMonetaryAmount1	Amount of adjustment 1.
PLBAdjustmentCode2	Adjustment reason code 2.
PLBAdjustmentRefID2	Adjustment reference ID 2.
PLBMonetaryAmount2	Amount of adjustment 2.
PLBAdjustmentCode3	Adjustment reason code 3.
PLBAdjustmentRefID3	Adjustment reference ID 3.
PLBMonetaryAmount3	Amount of adjustment 3.
PLBAdjustmentCode4	Adjustment reason code 4.
PLBAdjustmentRefID4	Adjustment reference ID 4.
PLBMonetaryAmount4	Amount of adjustment 4.
PLBAdjustmentCode5	Adjustment reason code 5.
PLBAdjustmentRefID5	Adjustment reference ID 5.
PLBMonetaryAmount5	Amount of adjustment 5.
PLBAdjustmentCode6	Adjustment reason code 6.
PLBAdjustmentRefID6	Adjustment reference ID 6.
PLBMonetaryAmount6	Amount of adjustment 6.

837-Specific Report Variables

These variables can be used only for an 837 custom report template

HEADER Section

TransTypeIDQ	Transmission type ID qualifier (REF-01 in Table 1, position 015).
TransTypeID	Transmission type ID (REF-02 in Table 1, position 015).
BusAppId	Contents of the BHT-03.
BusAppDate	Contents of the BHT-04 in MM-DD-YYYY format.
BusAppTime	Contents of the BHT-05 in HH:MM format.

DETAIL or TRAILER Section

BCBSClaimID	BCBS Claim ID (REF02 when REF01 = "D9").
ClaimCnt_byTS	Number of claims encountered so far in this transaction set. Resets at the beginning of each transaction set.
ClaimCntGood_byTS	Number of good claims encountered so far in this transaction set. Resets at the beginning of each transaction set.
ClaimCntBad_byTS	Number of bad claims encountered so far in this transaction set. Resets at the beginning of each transaction set.
ClaimAmt_byTS	Total claim amount (CLM-02) in dollars and cents so far in this transaction set. Resets at the beginning of each transaction set.
ClaimAmtGood_byTS	Total good claim amount (CLM-02) in dollars and cents so far in this transaction set. Resets at the beginning of each transaction set.
ClaimAmtBad_byTS	Total bad claim amount (CLM-02) in dollars and cents so far in this transaction set. Resets at the beginning of each transaction set.
ClaimPercentGood_byTS	Percent of claims that are good in this transaction set; includes one decimal place. Example: 60.0.
ClaimPercentBad_byTS	Percent of claims that are bad in this transaction set; includes one decimal place. Example: 40.0.
ClaimBillType	Concatenated CLM0501 and CLM0503. This is a customized bill type code.
BCBSClaimID	BCBS Claim ID (REF02 when REF01 = "D9").
NonBCBSClaimID	Non-BCBS Claim ID (REF03 when REF01 = "D9").

1000B (Payer)

PayerName	Name (1000B/NM1-03).
PayerID	ID (1000B/NM1-09).
PayerIDQual	ID qualifier (1000B/NM1-08).

1000B (Receiver Name)

ReceiverName	Receiver Name (1000B/NM103)
ReceiverID	Receiver ID (1000B/NM109)
ReceiverIDQual	Receiver ID Qualifier (1000B/NM108)

Secondary Payer

SecPayerName	Secondary Payer name.
SecPayerID	Secondary Payer ID.
SecPayerIDQual	Secondary Payer ID Qualifier.

2010BB (Payer Name)

PayerName2010BB	Payer Name (2010BB/NM103)
PayerNameID	PayerNameID (2010BB/NM109)
PayerNameSecondaryIDQual	Payer Name Secondary ID Qualifier (2010BB/REF02, where REF01=2U, EI, FY, or NF)

Secondary Payer

SecPayerID	Secondary Payer ID (2010BB/REF01)
SecPayerIDQual	Secondary Payer ID Qualifier (2010BB/NM108)

Payer Routing Indicator

PayerRI

Payer Routing Indicator.

1000A (Trading Partner)

TPName	Name (1000A/NM1-03).
TPID	ID (1000A/NM1-09).
TPIDQual	ID qualifier (1000A/NM1-08).

2000A (Provider)

Provider identification information (variables starting with PROV) comes from the Pay-to Provider loop (2010AB) if the 2010AB NM109 contains an ID. Otherwise, it comes from the 2010AA loop.

ProvLName	Last name (2010AB or 2010AA/NM1-03).
ProvFName	First name (2010AB or 2010AA/NM1-04).
ProvMName	Middle name (2010AB or 2010AA/NM1-05).
ProvName	Provider name in ‘Last, First Middle’ format.
ProvID	ID (2010AB or 2010AA/NM1-09).
ProvIDQual	ID qualifier (2010AB or 2010AA/NM1-08).
ProvSecID	Secondary ID (2010AB or 2010AA/REF-02).
ProvSecIDQual	Secondary ID qualifier (2010AB or 2010AA/ REF-01).
ClaimAmt_byProv	Total in CLM-02 for all claims in this 2000A loop. Put this in the PROVTRAILER section, before the TRAILER section.
ClaimAmtBad_byProv	Total in CLM-02 for bad claims in this 2000A loop. Put this before the PROVTRAILER section.
ClaimAmtGood_byProv	Total in CLM-02 for good claims in this 2000A loop. Put this before the PROVTRAILER section.
ClaimCnt_byProv	Number of claims in this 2000A loop. Put this in the PROVTRAILER section.
ClaimCntGood_byProv	Number of good claims in this 2000A loop. Put this in the PROVTRAILER section.
ClaimCntBad_byProv	Number of bad claims in this 2000A loop. Put this in the PROVTRAILER section.
ClaimPercentGood_byProv	Percent of claims that are good in this 2000A loop. Put this in the PROVTRAILER section.
ClaimPercentBad_byProv	Percent of claims that are bad in this 2000A loop. Put this in the PROVTRAILER section.

2010AA (Billing Provider)

BillProvLName	Last name (2010AA/NM1-03).
BillProvFName	First name (2010AA/NM1-04).
BillProvMName	Middle name (2010AA/NM1-05).
BillProvName	Billing Provider name in ‘Last, First Middle’ format.
BillProvID	ID (2010AA/NM1-09).
BillProvIDQual	ID qualifier (2010AA/NM1-08).
BillProvSecID	Secondary ID (2010AA/REF-02).
BillProvSecIDQual	Secondary ID qualifier (2010AA/REF-01).

2010AB (Pay-To Provider)

PayProvLName	Last name (2010AB/NM1-03).
PayProvFName	First name (2010AB/NM1-04).
PayProvMName	Middle name (2010AB/NM1-05).
PayProvName	Pay-To Provider name in ‘Last, First Middle’ format.
PayProvID	ID (2010AB/NM1-09).
PayProvIDQual	ID qualifier (2010AB/NM1-08).
PayProvSecID	Secondary ID (2010AB/REF-02).
PayProvSecIDQual	Secondary ID qualifier (2010AB/REF-01).

2010BA (Subscriber)

SubLName	Last name (2010BA/NM1-03).
SubFName	First name (2010BA/NM1-04).
SubMName	Middle name (2010BA/NM1-05).
SubName	Subscriber name in ‘Last, First Middle’ format.
SubID	ID (2010BA/NM1-09).
SubIDQual	ID qualifier (2010BA/NM1-08).
SubPropProvID	Proprietary Provider ID (2010BB REF for Billing Provider Secondary Identification)

2010CA (Dependent)

DepLName	Last name (2010CA/NM1-03).
DepFName	First name (2010CA/NM1-04).
DepMName	Middle name (2010CA/NM1-05).
DepName	Dependent name in ‘Last, First Middle’ format.
DepID	ID (2010CA/NM1-09).
DepIDQual	ID qualifier (2010CA/NM1-08).

Patient

The patient is the subscriber or the dependent, depending on where the claim occurred

PatLName	Last name (2010xA/NM1-03).
PatFName	First name (2010xA/NM1-04).
PatMName	Middle name (2010xA/NM1-05).
PatName	Patient name in ‘Last, First Middle’ format.
PatID	ID (2010xA/NM1-09).
PatIDQual	ID qualifier (2010xA/NM1-08).
PatBday	Patient Birth Day (2010xA/DMG-02).
PatGender	Patient Gender (2010xA/DMG-03).
PatRelship	Patient Relationship (SBR-02).

2300

ClaimID	Claim number (CLM-01).
ClaimAmt	Total Amount (CLM-02).
ClaimFacCode	Facility Code Value (CLM5-01).
ClaimCHID	Claim Identification Number for Clearing Houses and Other Transmission Intermediaries (REF-02 when REF-01=D9).
ClaimICDN	ICDN (REF-02 when REF-01 = F8).
ClaimMRN	Medical Record number (REF-02 when REF-01 = EA).
ClaimDate	Claim date.
ClaimStatus	Claim contains one of these: Good no errors or warnings Error contains at least one error Warning contains at least one warning, but no errors See on page for definitions of errors and warnings.

2310A (For 837P and 837D, this is Referring Provider. For 837I, this is Attending Physician. The following variables work for all three types of 837)

ReferProvName	Referring/attending name in ‘Last, First Middle’ format.
ReferProvLName	Last name (2310A/NM1-03).
ReferProvFName	First name (2310A/NM1-04).
ReferProvMName	Middle name (2310A/NM1-05).
ReferProvID	ID (2310A/NM1-09).
ReferProvIDQual	ID qualifier (2310A/NM1-08).
ReferProvSecID	Secondary ID qualifier (2310A/REF-01).
ReferProvSecIDQual	Secondary ID (2310A/REF-02).

2330A

ClaimOtherNameID	NM1-09 in loop 2330A Other Subscriber Name.
OtherSubNameID	Other Subscriber Name ID (2330A/NM109).

2330B

ClaimOtherPayerSecId	REF-02 in loop 2330B Other Payer Name. See also CobaClaimOtherPayerSecId.
CobaClaimOtherPayerSecId	REF-02 in loop 2330B Other Payer Secondary Identifier- only if REF-01=F8.
OtherPayerControlNumber	Other Payer Control Number (2330B/REF02, where REF01=F8)
OtherPayerNameSecID	Other Payer Name (2330B/REF02, where REF01= 2U, EI, FY or NF) OtherPayerControlNumber (2330B/REF02, where REF01=F8)

2400

SVCDiagPointer1	Primary diagnosis code (SV107-01)
SVCDiagPointer2	Second diagnosis code (SV107-02)
SVCDiagPointer3	Third diagnosis code (SV107-03)
SVCDiagPointer4	Fourth diagnosis code (SV107-04)

Service

Service variables really represent lists of values, since a claim may have more than one. If so, subsequent occurrences appear on another line.

SvcID	Service ID (2400/SV1-01.02 (P), 2400/SV2-01 (I), 2400/SV3-01.02 (D)).
SvcIDQual	ID qualifier.
SvcLine	Service Line number.
SvcChgAmt	Line Charge Amount.
SvcQty	Quantity.
SvcMod1	Modifier 1.
SvcMod2	Modifier 2.
SvcMod3	Modifier 3.
SvcMod4	Modifier 4.
SvcDateQual	Service date qualifier.
SvcDate	Service date.
ClaimFirstSrvDate	The earliest data in a service line for this claim (2400/DTP-03).
ClaimLastSrvDate	The latest data in a service line for this claim (2400/DTP-03).

ISATRAILER Section

These values can be used in the .ISATRAILER section. Values may be uninitialized if used in other report sections. Multiple values are presented in table format.

Note: Routing ID (RI) refers to the specific custom record ZZRI. The custom report can identify this value for the 837 payer or subscriber and then provide data for Routing ID totals.

ClaimAmt_ByISARI	Total amount for all claims, per unique Routing ID.
ClaimAmtBad_ByISARI	Claim amount totals for all bad claims, collated by unique Routing ID.
ClaimAmtGood_ByISARI	Claim amount totals for all good claims, collated by unique Routing ID.
ClaimCnt_ByISARI	Total count of all claims, per unique Routing ID.
ClaimCntBad_ByISARI	Number of bad claims per unique Routing ID.
ClaimCntGood_ByISARI	Number of good claims per unique Routing ID.
ClaimPctBad_ByISARI	Percent of bad claims vs. total claims, per unique Routing ID.
ClaimPctGood_ByISARI	Percent of good claims vs. total claims, per unique Routing ID.
ISARI	List of all Routing ID seen within the ISA.

GROUPTRAILER section

Group values

These group values can be used in the 837 .GROUPTRAILER section. Values may be uninitialized if used in other report sections. Multiple values are presented in table format.

Note: Routing ID (RI) refers to the specific custom record ZZRI. The custom report can identify this value for the 837 payer or subscriber and then provide data for Routing ID totals.

ClaimAmt_ByGroupRI Total amount for all claims, per unique Routing ID.

ClaimAmtBad_ByGroupRI
Claim amount totals for all bad claims, collated by unique Routing ID.

ClaimAmtGood_ByGroupRI
Claim amount totals for all good claims, collated by unique Routing ID.

ClaimCnt_ByGroupRI Total count of all claims, per unique Routing ID.

ClaimCntBad_ByGroupRI
Number of bad claims per unique Routing ID.

ClaimCntGood_ByGroupRI
Number of good claims per unique Routing ID.

ClaimPctGood_ByGroupRI
Percent of good claims vs. total claims, per unique Routing ID.

ClaimPctBad_ByGroupRI
Percent of bad claims vs. total claims, per unique Routing ID.

GroupRI List of all Routing Indicators seen within the ISA.

TRAILER section

Transaction Set values

These Transaction Set values can be used in the 837 .TRAILER section. Values may be uninitialized if used in other report sections. Multiple values are presented in table format.

Note: Routing ID (RI) refers to the specific custom record ZZRI. The custom report can identify this value for the 837 payer or subscriber and then provide data for Routing ID totals.

BCBSClaimID	BCBS Claim ID (REF02 when REF01 = "D9").
ClaimAmt_BySetRI	Total amount for all claims, per unique Routing ID.
ClaimAmtBad_BySetRI	Claim amount totals for all bad claims, collated by unique Routing ID.
ClaimAmtGood_BySetRI	Claim amount totals for all good claims, collated by unique Routing ID.
ClaimCnt_BySetRI	Total count of all claims, per unique Routing ID.
ClaimCntBad_BySetRI	Number of bad claims per unique Routing ID.
ClaimCntGood_BySetRI	Number of good claims per unique Routing ID.
ClaimPctBad_BySetRI	Percent of bad claims vs. total claims, per unique Routing ID.
ClaimPctGood_BySetRI	Percent of good claims vs. total claims, per unique Routing ID.
NonBCBSClaimID	Non-BCBS Claim ID (REF03 when REF01 = "D9").
SetRI	List of all Routing ID’s seen within the ISA.

Troubleshooting Custom Reports

The most common causes for custom report failures:

Symptom:	No custom report is generated
Probable cause:	The guideline used for validation was not a GuidelinePlus and did not create the necessary SVALU records. See ForesightHIPAAguidelinelist.pdf.
Symptom:	No data for a variable
Probable cause:	The template variable was used before it was encountered. Move the affected variables down into the proper section. For details, refer Template Variables