Medical Billing - DA0 Record Fields 17 - 32

By: Michael Russell

In this installment of our series on medical billing of claims electronically, using NSF 3.01 specifications, we're going to conclude our review of the DA0 record, which is the record that identifies the payer to whom the claim is being transmitted and whom will ultimately be paying this claim to the patient or insured. We'll begin with field number 17.

DA0 field 17, positions 155 - 156, is the patient relationship to insured code. This requires a brief explanation. In many cases, the patient and the insured are the same person. In some cases, however, the patient is covered under another person's insurance, such as a child being covered under a parent's insurance. It has to be stated here how the patient is related to the insured so the payer can check to see if the patient is actually covered under the insured's policy. If not, the claim will not be paid.

DA0 field 18, positions 157 - 181, is the patient's ID or Medicare number. Most electronic claims billed are usually to Medicare but in the cases where they are not an ID number still needs to be transmitted. Fortunately, the industry has been standardized so that the ID numbers are all the same length.

DA0 fields 19, 20 and 21, positions 182 - 214, are the insured's last name, first name and middle initial. It is important to note that this is the insured's name and NOT the patient's name because the patient may be insured under another policy.

DA0 field 22, positions 215 - 217, is the patient's generation. This is required if the patient has a name like Charles Johnson III.

DA0 field 23, position 218, is the patient's gender, which is a one character code. M if for male and F is for female.

DA0 field 24, positions 219 - 226, is the patient's date of birth. The format of this date will be determined by the rules of the carrier. Some are yyyymmdd and others are mmddyyyy. So please check the specs for that particular carrier.

DA0 field 25, position 227, is the employment status, which is a one character code, such as E for employed, U for unemployed, etc.

DA0 field 26, position 228, is the supplemental insurance indicator. This is an indicator that tells the payer if the insured has other insurance besides their primary carrier. This must be filled in so they know how much to pay.

DA0 field 27, positions 229 - 235, is the Title 19 Identifier. Explaining what Title 19 is, is beyond the scope of this article so check with your carrier on this.

DA0 field 28, positions 236 - 260, is the patient's Medicaid number. If the patient has Medicaid, this field must be filled in even if you are not billing Medicaid.

DA0 field 29, positions 261 - 285, is the patient's supplemental ID number. This is in case the patient has other insurance. That ID number must be filled in here.

DA0 field 30, position 286, is the assignment for 4081 claim indicator. The explanation of a 4081 claim is beyond the scope of this article. Please check with your carrier.

DA0 field 31, position 287, is the COB routing indicator. COB stands for Coordination Of Benefits and this indicator needs to be filled in if the patient has other insurance.

DA0 field 32, positions 288 - 320, is filler national and must be left blank.

This concludes our three part review of the DA0 record for medical billing of claims electronically using NSF 3.01 specifications.