<< Previous Data Element X12-837 Input Table of Contents Next Data Element >>
Data Element Name:  Accommodations Total Non-Covered Charges
Format-Length:  N - 10 Required For:  IP
Effective Date:  1/1/94 Revision Date:  June 1998
National Standard Mapping:

Electronic - 837I
X12 Loop
Ref. Des.
Data Element
Code
Description
Version 4050R 2400 SV207 782 Accommodations Total Non-Covered Charges
Paper Form Locator Code Qualifier
Institutional - UB-04 48 N/A

Definition:

The charges which are not reimbursable by the primary payer.

Codes and Values:

  1. The amount must be entered in dollars and cents.

    Example:  $125.24 would be entered as: 125.24

Edit Applications:

  1. Accommodations Total Non-Covered Charges must be less than or equal to Accommodations Total Charges.

  2. If Accommodations Non-Covered Charges is entered, then Accommodations Code, Accommodations Days, Accommodations Total Charges, and Accommodations Rate must also be reported.

  3. SPARCS allows a maximum of 50 Accommodations.
<< Previous Data Element X12-837 Input Table of Contents Next Data Element >>