Lockbox Version G of the EOD Posting File is 835 v1.0 and works with all grouping methods. However, it needs to use different <Configurable Value> with Group by Merchant, or the groups will overwrite files because of the naming convention.
File Name Standard: <Database/File Grouping> + “_” + <Configurable Value> + “_” + BusinessDate + “.835”
Note: This version includes custom grouping and negative values in the CLP03, CLP04, BPR02 on refunds, also uses 4010 format 835.
Custom Grouping is:| First Two Letters of Patient Account Number | Database/File Grouping |
|---|---|
| HK | BAR.AHH |
| FV | BAR.FVH |
| HN | BAR.HCH |
| HH | BAR.HMH |
| PL|PP|RC | BAR.LMCK |
| DR|FL|GH|HD|HF|MA|MK|SS | BAR.MCK |
| NM|RM | BAR.MCKORL |
| MR | BAR.MRM |
| OC | BAR.OCH |
| PI | BAR.PCM |
| SX | BAR.SCH |
| SH | BAR.SHH |
| SL|RL|XL|PB|B | BAR.SLH |
| QP | BAR.QOP |
| GT|SY | BAR.PIR |
| Other | Default |
| SEG | Field ID | Field Name | Format | Required? | Config? | Expected Value | Comments |
|---|---|---|---|---|---|---|---|
| BPR | Financial Information | ||||||
| BPR01 | Transaction Handling Code | AN | Y | Y | "H" | ||
| BPR02 | Payment Amount | DEC | Y | Amount | Configurable via Support Tool. Can be "H," "C," "D," "I," "P". Amount can be positive or negative value dependent on sale/refund. | ||
| BPR03 | Credit/Debit Flag Code | AN | Y | "C" or "D" | Payment Transaction action - sale = C; refund = D. | ||
| BPR04 | Payment Method Code | AN | Y | Y | "NON" | Configurable via Support Tool. Can be: "NON," "FWT," "CHK," "BOP," "ACH". | |
| BPR05 | Payment Format Code | S | Not currently used. | ||||
| BPR06 | (DFI) ID Number Qualifier | S | Not currently used. | ||||
| BPR07 | (DFI) Identification Number | S | Not currently used. | ||||
| BPR08 | Account Number Qualifier | S | Not currently used. | ||||
| BPR09 | Account Number | S | Not currently used. | ||||
| BPR10 | Originating Company Identifier | AN | S | Y | "1999999999" | Same as TRN 03. | |
| BPR11 | Originating Company Supplemental Code | AN | S | Y | "credit card," "eCheck," "cash," "manual check" | Same as TRN 04. Transaction Type: Credit Card, eCheck, cash, manual check. | |
| BPR12 | Depository Financial Institution | S | Not currently used. | ||||
| BPR13 | Provider Bank ID Number | S | Not currently used. | ||||
| BPR14 | Account Number Qualifier | S | Not currently used. | ||||
| BPR15 | Provider Account Number | Y | Not currently used. | ||||
| BPR16 | Check Issue or EFT Effective Date | DT | S | Business Date | |||
| TRN | Reassociation Trace Number | ||||||
| TRN01 | Trace Type Code | AN | Y | "1" | |||
| TRN02 | Check or EFT Trace Number | AN | Y | Y | Authorization Number | Configurable via Support Tool. Maximum 30 characters in length. | |
| TRN03 | Originating Company Identifier | AN | Y | Y | "1999999999" | Configurable via Support Tool. Maximum of 9 characters + "1" appended at the beginning. | |
| TRN04 | Originating Company Supplemental Code | AN | S | Y | "credit card," "eCheck," "cash," "manual check" | Configurable via Support Tool. Maximum Length 30 characters. Defaults to Transaction Type. Transaction Type: Credit Card, eCheck, cash, manual check . | |
| N1 | Payer Identification | ||||||
| N101 | Entity Identifier Code | AN | Y | "PR" | |||
| N102 | Name | AN | Y | Patient First Name + Patient Last Name | If not available, use "Patient," max 60 characters. | ||
| N103 | Identification Code Qualifier | AN | Y | "XV" | |||
| N104 | Payer Identifier | AN | Y | Y | Patient Account Number | Configurable via Support Tool. Maximum value of 30. Defaults to "9999". | |
| N3 | Payer Address | ||||||
| N301 | Payer Address Line | AN | Y | Y | Patient Address 1 | Configurable via Support Tool Maximum Length of 55 characters. | |
| N302 | Payer Address Line | AN | S | Y | Patient Address 2 if available | Field ID is not used. | |
| N4 | Payer City, State, ZIP Code | ||||||
| N401 | Payer City Name | AN | Y | Y | Patient City | Configurable via Support Tool - 30 characters max length; defaults to "City". | |
| N402 | State or Province Code | AN | Y | Y | Patient State | Configurable via Support Tool - 2 characters max length. Defaults to "CA". | |
| N403 | Payer Postal Zone | AN | Y | Y | Patient Zip Code | Configurable via Support Tool - 15 characters max, defaults to "99999". | |
| N1 | Payee Identification | ||||||
| N101 | Entity Identifier Code | AN | Y | "PE" | |||
| N102 | Payee Name | AN | S | Merchant Name | Patient Name (First + Middle + Last) defaults to "Patient" if not present. | ||
| N103 | Identification Code Qualifier | AN | Y | "FI" | |||
| N104 | Payee Identification Code | AN | Y | Merchant ID | The unique ID associated with your merchant processing account, which will be given by your Implementations Manager. | ||
| REF | Payee Additional Identification | ||||||
| REF01 | Reference Identification Qualifier | AN | Y | "PQ" | |||
| REF02 | Additional Payee Identifier | AN | Y | Merchant|Store|Terminal ID | The unique ID associated with your merchant processing account, which will be given by your Implementations Manager. | ||
| CLP | Claim Payment Information | ||||||
| CLP01 | Claim Submitter's Identifier | AN | Y | Y | Patient Account Number | Configurable via Support Tool. Max length 38 characters. If not available, use "9999". | |
| CLP02 | Claim Status Code | AN | Y | "0" OR "1" OR "22" | Sale = 1; Refund = 22; Default = 0. | ||
| CLP03 | Total Claim Charge Amount | DEC | Y | Amount | Negative or positive based on refund or sale, respectively. | ||
| CLP04 | Claim Payment Amount | DEC | Y | Amount | Negative or positive based on refund or sale, respectively. | ||
| CLP05 | Patient Responsibility Amount | DEC | S | "0" | |||
| CLP06 | Claim Filing Indicator Code | AN | Y | Y | "13" | Configurable via Support Tool Can be, "12," "13," "14," "15," "16," "AM," "CH," "DS," "HM," "LM," "MA," "MB," "MC," "OF," "TV," "VA," "WC". | |
| CLP07 | Payer Claim Control Number | AN | S | Y | Transaction ID | Configurable via Support Tool Max Length 30 characters. | |
| CLP08 | Facility Code Value | S | Not currently used. | ||||
| CLP09 | Claim Frequency Code | S | Not currently used. | ||||
| CLP10 | Patient Status Code | S | Not currently used. | ||||
| CLP11 | Diagnosis Related Group (DRG) Code | S | Not currently used. | ||||
| CLP12 | Diagnosis Related Group (DRG) Weight | S | Not currently used. | ||||
| CLP13 | Discharge Fraction | S | Not currently used. | ||||
| NM1 | Patient Name | ||||||
| NM101 | Entity Identifier Code | AN | Y | "QC" | |||
| NM102 | Entity Type Qualifier | AN | Y | "1" | |||
| NM103 | Patient Last Name | AN | Y | Patient Last Name | If not available, use "Patient Last". | ||
| NM104 | Patient First Name | AN | S | Patient First Name | If not available, use "Patient First". | ||
| NM105 | Patient Middle Name | AN | S | Patient Middle Name | Not currently used. If not available, use "Patient Middle". | ||
| NM106 | Name Prefix | S | Not currently used. | ||||
| NM107 | Name Suffix | S | Not currently used. | ||||
| NM108 | Identification Code Qualifier | AN | Y | "MI" | |||
| NM109 | Patient Identifier | AN | Y | Y | Patient Account Number | Configurable via Support Tool. Maximum length of 80 characters Defaults to "9999". | |
| REF | Other Claim Related Identification | ||||||
| REF01 | Qualifier | AN | Y | "BB" OR "EA" | Not currently used. BB = Auth Code; EA = Med Rec#. | ||
| REF02 | Identifier | AN | Y | Authorization Number/Medical Record # | Not currently used. | ||
| DTM | Claim Date | ||||||
| DTM01 | Qualifier | AN | Y | 232/233 to convey service start and end date | Not currently used. If not available, use transaction date. | ||
| DTM02 | Date | DT | Y | Service start and end date | Not currently used. | ||
| PER | Claim Contact Information | ||||||
| PER01 | Contact Function Code | AN | Y | CX - Payers Claim Office | |||
| PER02 | Claim Contact Name | AN | S | User ID | Not currently used. | ||
| PER03 | Communication Number Qualifier | S | Not currently used. | ||||
| PER04 | Claim Contact Communications Number | S | Not currently used. | ||||
| PER05 | Communication Number Qualifier | S | Not currently used. | ||||
| PER06 | Claim Contact Communications Number | S | Not currently used. | ||||
| PER07 | Telephone Extension | S | Not currently used. | ||||
| PER08 | Communication Number | S | Not currently used. | ||||