5010 Institutional form configuration variables

The following variables are configured in the 5010_Inst.ini configuration file.

Table 1. General
Variable Default Description
ImpliedDecimalON TRUE When set to TRUE, this boolean variable normalizes all currency data values to have a two-digit value for cents such as 0.00. The variable then formats output for 837 requirements of no leading or trailing zeros.
PreFilter TRUE This boolean variable filters character output to EDI elements when set to TRUE. The only characters allowed are Comma, Hyphen, Period, 0-9, and A-Z. Lower case a-z characters are capitalized.
Table 2. Log
Variable Default Description
SegmentLog TRUE When set to TRUE, this boolean variable adds a single log entry to the RRS log when a segment is counted for adding to the EDI export stream.
SegmentReport FALSE When set to TRUE, this variable saves all segment logs added to the export stream and outputs the stream to the RRS log file as a summary after the EDI is created. This variable does not affect output.
Table 3. X12N
Variable Default Description
Segmentseparator * Segment Separator character which indicates the start/end of 837 segment elements.
SegmentTerminator ~ Segment Terminator character which indicates the end of a single 837 segment.
RepetitionSeparator ∧ Delimiter character used to separate repeated occurrences of a simple data element or composite data structure.
TerminatorPlusLineFeed FALSE When set to TRUE, this variable adds a line feed and carriage return to the end of each Segment Terminator character. Typically this option is disabled in a production environment, and is only used for debugging the output data.
Attention: The program will by default also create a file named EDI_OutputText.txt which performs the same debugging function. This file is generated using the output file to ensure data integrity, and cannot be disabled.
SuppressSVdateSpan FALSE When this variable is set to TRUE, there is no creation of a DTP RD8 date span in the service line even if Type of Bill is Inpatient type.
AllUpperCase FALSE When set to TRUE, all output characters are converted to uppercase.
Restriction: Use of the Prefilter option forces all characters to uppercase regardless of this option.
AppendToLastGSGE FALSE When merging individual claim EDI files, this option chooses whether the new claim is added as the first claim in a new GS/GE loop in the merged file. When this option is set to FALSE, each claim will be created in a new GS/GE and ST/SE loop in the merged file. When this option is set to TRUE, then each claim will be added to the existing GS/GE loop in the merged file. See the AppendToLastSTSE option for ST/SE information when added with this option set to TRUE.
AppendToLastSTSE FALSE When merging individual claim EDI files, this option chooses whether the new claim is added as the first claim in a new ST/SE loop in the merged file. When this option is set to FALSE, each claim will be created in a new ST/SE loop within the existing GS/GE loop in the merged file. When this option is set to TRUE, then each claim will be added to the existing GS/GE loop in a new ST/SE loop in the merged file.
Table 4. ISA_Header
Variable Default Description
AuthorizationInformation   Sets value for ISA02. Limited to ten characters, empty by default. A value placed here will automatically set ISA01 from 00 (default-No authorization info present) to 03 (Additional Data Identification).
SecurityInformation   Sets value for ISA04. Limited to ten characters, empty by default. A value placed here will automatically set ISA03 from 00 (default-No Security Info present) to 01 (Password).
InterchangeSenderQualifier ZZ Sets value for ISA05. Code indicating the type of Sender ID. Value codes are: 01, 14, 20, 27, 28, 29, 30, 33 or ZZ. Standard setting is ZZ.
InterchangeSenderID DATACAP Sets value for ISA06. Sender ID value, limited to 15 characters.
InterchangeReceiverQualifier ZZ Sets value for ISA07. Code indicating the type of Receiver ID. Value codes are: 01, 14, 20, 27, 28, 29, 30, 33 or ZZ. Standard setting is ZZ.
InterchangeReceiverID 00000 Sets value for ISA08. Receiver ID value, limited to 15 characters.
InterchangeControlNum BATCH Sets the value for ISA13. Valid values are BATCH or a fixed value. Use of BATCH will use the current batch ID - right-justified and minus decimal characters. Any other entry is treated as a fixed output value for this element. This value is limited to fifteen numeric characters.
Attention: By default, if the Batch ID is a split batch alphadecimal value, then the new value will be the 3 digit Julian Day, followed by the three digit daily batch number, and then concluded with the integer conversion of the alphadecimal split batch value. The maximum length of the split batch number is limited to 3 digits. Alternatively, the value for ISA(13) also supports smart parameters, so that entries can generate or create their own unique values and include it in the export.
AcknowedgmentRequested 0 Sets value for ISA14. Valid values are 0 (No Acknowledgement Default) or 1 (Interchange Acknowledgement Requested)
TestIndicator P Sets value for ISA15. Valid values are P (production) or T (test).
ComponentElementSeparator < Sets value for ISA16 the sub-element separator value. Segment Elements have multiple values are required to separate the values with a predefined character. Recommended are : or <.
Table 5. GS_Header
Variable Default Description
SenderCode DATACAP EXPORT GS02 value limited to 15 characters.
ReceiverCode 00000 GS03 value limited to 15 characters, Defaults to 00000.
EDIstandard 005010X223A2 GS08 EDI version identifier code.
Table 6. Header
Variable Default Description
SubmitterName The Defaults NM103 setting. Sets the Loop 1000A NM1(03) value. Limited to 60 characters.
SubmitterPhone The Defaults PER04 setting. Sets the Loop 1000A PER(03) value.
SubmitterID The GS_Header SenderCode setting value. If SenderCode is blank this value defaults to the Defaults NM109 setting. Sets the Loop 1000A NM1(09) value. The standard setting is usually blank which fills this value with the GS_Header SenderCode value.
ReceiverName The Defaults NM103 setting. Sets the Loop 1000B NM1(03) value.
ReceiverID 00000
SequenceSerialNumber The value found in ST(02) Sets the BHT(03) Reference ID value. Limited to 50 characters.
TransactionSetControlSource The current Document ID value Sets ST(02) value to use a Batch parameter. Entry is the parameter name to use as the source for the ST(02) value.
PayerIDNumber 123456789 Sets Loop 2000B SBR(03) value if field 11 Plan and Policy are emtpy. See also the CheckJobID settings in this setting section. Also sets Loop 2010BB NM1(09) if field 11 Poicy number is empty. Note this value is overridden if the setting 2010BB_BC PrimaryPayerIDNumber has a value.
CheckJobID FALSE

When set to TRUE, this variable enables the ValueByJobID(Key) utility to retrieve values based on the JobID of the task. This allows the processing of claims for multiple entities, such as different payers.

For example, the following function looks in the Header section for the number of different JobID's for which to check:. 
[Header]   
CheckJobID=TRUE/FALSE
numJobID=2   
numJobID[1]=JobName1
numJobID[2]=JobName2
Use values for paramter 'Key' (PayerIDNumber in example) as follows: 
[JobName1]
PayerIDNumber=1111111
[JobName2]   
PayerIDNumber=2222222
The example shows ini entries numJobID, numJobID[n] and JobName[n] PayerIDNumber that must be created by the user.
Table 7. FileNameFormat
Variable Default Description
FileHeader 00501_ The default file name is the Page or Doc ID with decimals removed and spaces replaced with the underscore character. This is an option to place the specified text leading the default file name. For example if the Doc ID 2012004.03 is used and the FileHeader contains 00501_ then the file name becomes 00501_201200403. This can be used in conjuction with the FileTrailer option.
FileTrailer   The default file name is the Page or Doc ID with decimals removed and spaces replaced with the underscore character. This is an option to place the specified text trailing the default file name. For example if the Doc ID 2012004.03 is used and the FileTrailer contains _0500 then the file name becomes 201200403_0500. This can be used in conjunction with the FileHeader option.
MergeFileHeader 5010_ If no File name is specified when calling to merge the 5010 file, the default file name becomes the batch Id. This is an option to place the specified text leading the default file name.
MergeFileTrailer   If no File name is specified when calling to merge the 5010 file, the default file name becomes the batch Id. This is an option to place the specified text trailing the default file name. The default value is blank.
Table 8. Defaults
Variable Default Description
NM103   General default for NM1(03) segment element values. Loops 1000A, 1000B, 2010BA, 2010CA, 2310A, 2310B, 2310C, 2330A, 2330B, 2420A.
NM104   General default for NM1(04) segment element values. Loops 2010BA, 2010CA, 2310A, 2310B, 2310CDF, 2330A, 2420A.
NM109   General default for NM1(09) segment element values. Loops 1000A, 1000B, 2010BA, 2310A, 2310CDF, 2330A, 2330B.
N301   General default for N3(01) segment element values. All instances.
N401   General default for N4(01) segment element values. All instances.
N402   General default for N4(02) segment element values. All instances.
N403   General default for N4(03) segment element values. All instances.
PER04   General default for PER(04) segment element values. Loop 1000A, 2010AA
DMG02   General default for DMG(02) segment element values. Loop 2000CA, 2010BA.
CLM07   Value for setting Loop 2300 CLM(07). Default is blank.
CLM08   Value for setting Loop 2300 CLM(08) if field 53 is not N or Y. Default is blank.
CLM09   Value for setting Loop 2300 CLM(09) if field 52 is not I or Y. Default is blank.
HI_BK   Default principle diagnosis code if no diagnosis fields on the claim are filled. Default is blank. Loop 2300 HI BK.
SV201   Default Loop 2400 SV2(1) RevCode if captured value is blank or all zeros. Default is blank.
OccDt   Default Date Value. Loop 2300 DTP 434 & 345, also Loop 2300 default date if procedure date is not valid, and occurrence span dates, Loop 2400 DTP 472
Table 9. ImpliedDecimalON
Variable Default Description
BuildLog FALSE TRUE/FALSE value. Adds RRS logging when building EDI if the ImpliedDecimal setting is enabled. See the General settings.
Table 10. 2000B
Variable Default Description
SubscriberIsPatient FALSE TRUE/FALSE. Setting for forcing EDI to output Subscriber is the Patient. Default is false.
UseCurrentPayer See description Value is a Regular expression that is tested against the value in field 50. If a match is found this is the Payer for this claim. Otherwise default is the last payer a, b or c on the completed form. Example: If payer is always Medicaid. Use of regular expression MED[iI1lT]iIl1T]D will find the correct field 50 line to assign. Default is blank and uses last payer on form.
UsePreviousPayer See description Value is a Regular expression that is tested against the value in field 50. If a match is found the line before the match becomes the Payer info for this claim. Otherwise default is the last payer a, b or c on the completed form. Example: If payer is always listed before Medicaid. Use of regular expression MED[iI1lT]CA[iIl1T]D will find the prior field 50 line to assign. Default is blank and uses last payer on form.
Attention: Both UseCurrentPayer and UsePreviousPayer can be used simultainously. Use Previous takes priority if both expressions match.
Table 11. 2010BB_BC
Variable Default Description
PrimaryPayerName   Setting to use for all processed claims for Loop 2010BB NM1(03). Takes priority over capured value as well as default value set in Header PayerName section.
PrimaryPayerIDNumber   Setting to use for all processed claims for Loop 2010BB NM1(09). Takes priority over default value set in Header PayerIDNumber section.
PrimaryPayerAddress   Value to place in Loop 2010BB N3(01).
PrimaryPayerCity   Value to place in Loop 2010BB N4(01).
PrimaryPayerState   Value to place in Loop 2010BB N4(02).
PrimaryPayerZip   Value to place in Loop 2010BB N4(03).
Table 12. 2300
Variable Default Description
PatientReason   Default value for Patient Reason for for admission if field 69 is blank. Outpatient Claims only, default is blank.
DischargeStatus 01 Default value for Loop 2300 CL1(03) if field 17 is blank.
CalculatedTotal TRUE TRUE/FALSE. Option to calculate the lineitem total using service line data instead of the field 28 total charges field for Loop 2300 CLM(02).
Table 13. 2310A
Variable Default Description
CreateOutpatient FALSE TRUE/FALSE. Setting to optionally always export Loop 2310A even if Type of Bill is outpatient.
ExportSecondaryID FALSE TRUE/FALSE. Optionally export a REF 1G segment in this loop with the value from field 76.
Table 14. 2320
Variable Default Description
OI03 Y Value for Loop 2320 OI(03).
OI06 Y Value for Loop 2320 OI(06).
Table 15. 2330A
Variable Default Description
UsePatientAddress FALSE TRUE/FALSE. Option to use always use field 9 address values for Loop 2330A N4 segment if patient is not the subscriber.
SubscriberCity   Default value for Loop 2330A N4(01) if patient is not the subscriber and UsePatientAddress is not enabled.
SubscriberState   Default value for Loop 2330A N4(02) if patient is not the subscriber and UsePatientAddress is not enabled
SubscriberZip   Default value for Loop 2330A N4(03) if patient is not the subscriber and UsePatientAddress is not enabled
Table 16. 2330B
Variable Default Description
PayerCity   Value to place in Loop 2330B N4(01).
PayerState   Value to place in Loop 2330B N4(02).
PayerZip   Value to place in Loop 2330B N4(03).
PayerIDNumber   Value to place in loop 2330B NM1(09) if field 51 is blank.
Table 17. N3
Variable Default Description
BuildLog FALSE TRUE/FALSE value. Adds more detailed RRS logging when creating N3 segments.
KeepTrailingSeparators FALSE TRUE/FALSE value. Option to not remove blank trailing elements from N3 segments.
Table 18. N4
Variable Default Description
BuildLog FALSE TRUE/FALSE value. Adds more detailed RRS logging when creating N4 segments.
KeepTrailingSeparators FALSE TRUE/FALSE value. Option to not remove blank trailing elements from N4 segments.
Table 19. REF
Variable Default Description
BuildLog FALSE TRUE/FALSE value. Adds more detailed RRS logging when creating REF segments.
Parent topic: Medical Claims 5010 form configuration parameters