NextGen Knowledge Center

Creating a Claim Status Profile Library

The following table describes the claim status profile library fields.

Receiver Name [2100B Loop NM1 Segments]

OptionSetting
Entity Type Qualifier [NM102]You can select one of the following options: <none> Non-Person Entity [2] Person [1]
Last Name/Organization Name [NM103]You can enter the last name or the name of the organization.
First Name [NM104]You can enter the receiver first name.
Middle Name [NM105]You can enter the receiver middle name.
Identification Code Qualifier [NM108]You can select one of the following options: <none> Electronic Transmitter Identification Number [ETIN] [46]Employers Identification Number [24] Facility Identification [FA] Federal Taxpayers Identification Number [FI] Health Care Financing Administration National PlanID [XV] Health Care Financing Administration National Provider Identifier [XX] Member Identification Number [MI] National Association Of Insurance Commissioners [NAIC] IdentificationPayer Identification [PI] Pharmacy Processor Number [PP] Service Provider Number [SV] Social Security Number [34]
Identification Code [NM109]You can enter the identification code.

Provider Name [2100C Loop NM1 Segments]

OptionSetting
Service ProviderSpecifies the type of service provider:
  • Billing (B)
  • Rendering for 837P/D or Attending for 837I (R)
  • Rendering for 837P/D or Attending for 837I if populated else Billing (N)
Identification Code Qualifier [NM108]Specifies the identification code:
  • FI
  • XX
  • SV

Reference Identification [2200D Loop REF Segments]

OptionSetting
Payer Claim ID Number [1K]You can select this option to use the payer claim ID number.
Institutional Bill Type ID [BLT]You can select this option to use the institutional bill type.
Medical Record ID [EA]You can select this option to use the medical record ID.
Claim Submitted Charges (AMT)You can select this option to use the total claim charge amount.

Reference Identification [2200E Loop REF Segments]

OptionSetting
Payer Claim ID Number [1K]You can select this option to use the payer claim ID number.
Institutional Bill Type ID [BLT]You can select this option to use the institutional bill type.
Medical Record ID [EA]You can select this option to use the medical record ID.
Claim Submitted Charges (AMT)You can select this option to use the total claim charge amount.