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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.
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