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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