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| Data Element Name: Source of Payment Information Group Definition | |||
| SPARCS Data Element Number: 29 - 34 | |||
| Record Positions: 214 - 609 | Format-Length: A/N - 396 | ||
| Effective Date: 1/1/2003 | Revision Date: January 2003 | ||
Definition:
The following block of data represents information about the payers involved in adjudicating the claim for each patient stay. For claims that involve multiple payers, multiple sequences of payer data are submitted.
The maximum number of sequences that could have been reported for payer-related data was six (6).
| Data Element Number |
Data Element Name |
Occurrence |
Record Positions |
| 29 | Source of Payment Code | 1 | 214 - 214 |
| 2 | 280 - 280 | ||
| 3 | 346 - 346 | ||
| 4 | 412 - 412 | ||
| 5 | 478 - 478 | ||
| 6 | 544 - 544 |
||
| 30 | Filler | 1 | 215 - 233 |
| 2 | 281 - 299 | ||
| 3 | 347 - 365 | ||
| 4 | 413 - 431 | ||
| 5 | 479 - 497 | ||
| 6 | 545 - 563 |
||
| 31 | Payer Identification | 1 | 234 - 238 |
| 2 | 300 - 304 | ||
| 3 | 366 - 370 | ||
| 4 | 432 - 436 | ||
| 5 | 498 - 502 | ||
| 6 | 564 - 568 |
||
| 32 | Filler | 1 | 239 - 258 |
| 2 | 305 - 324 | ||
| 3 | 371 - 390 | ||
| 4 | 437 - 456 | ||
| 5 | 503 - 522 | ||
| 6 | 569 - 588 |
||
| 33 | Provider Identification Number | 1 | 259 - 271 |
| 2 | 325 - 337 | ||
| 3 | 391 - 403 | ||
| 4 | 457 - 469 | ||
| 5 | 523 - 535 | ||
| 6 | 589 - 601 |
||
| 34 | Filler | 1 | 272 - 279 |
| 2 | 338 - 345 | ||
| 3 | 404 - 411 | ||
| 4 | 470 - 477 | ||
| 5 | 536 - 543 | ||
| 6 | 602 - 609 | ||
