Medical Billing - FB0 Record Fields 1 Through 7

By: Michael Russell
Submitted: 2007-01-17 15:33:56
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The FA0 record for medical billing was pretty long to say the least. Well, the F series records are not quite done. The FB0 record, even though it is separate from the FA0 record, is still considered line item detail for the claim and must be transmitted if it is required by the payer. In this installment we will begin our review of the FB0 record.

FB0 field 1, positions 1 - 3, is the record type. This must be filled with FB0. It should also be noted that the FB0 record must come right after the FA0 record for that particular line item. In other words, if there are say five FA0 records and five FB0 records, the sequence of records must be FA0, FB0, FA0, FB0 and so on. If the records are out of sequence, the claim will be denied.

FB0 field 2, positions 4 - 5, is the sequence number in the claim. Because there can be up to 99 F records in a claim file, each one must be given a sequence number, such as FB0-01, FB0-02 and so on. These sequence numbers cannot be out of sequence. If they are, the claim will be denied.

FB0 field 3, positions 6 - 22, is the patient ID. This is the same patient ID that was reported way back in record CA0. It should be noted that each patient's claims are reported separately. In other words, after the CA0 record comes the D, F and other records for THAT patient. Another CA0 record cannot be transmitted until all the line item detail for that patient has been transmitted. Out of sequence, CA0 and F records will cause denied claims.

FB0 field 4, positions 23 - 39, is the line item control number. This is a number assigned to each item in the claim for each patient. It should be noted that this number in the FB0 record must match this number in the FA0 record for that particular line item or the claim will be denied.

FB0 field 5, positions 40 - 46, is the purchase service charge amount. This is an additional service charge that is applied to that particular line item, if applicable. In most cases, this field is not used.

FB0 field 6, positions 47 - 53, is the allowed amount. This is the amount of the item billed that is actually allowed to be paid on. For example, if the charge is for $100 and the allowed amount is 80% of this, which is what it is in most cases, the allowed amount will be $80 and in almost all cases, this is what will be paid.

FB0 field 7, positions 54 - 60, is the deductible amount. Almost all policies have a deductible. This is an amount that the patient is responsible for paying before benefits actually kick in. This amount is only transmitted if the deductible has not yet been paid.

In our next installment on medical billing of FB0 records, we'll continue our review with field number 8.

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