Top Management Story

Writen by Michael Russell

The EA0 record is very long and takes a while to get through it all. In this installment of our series on medical billing and the EA0 record for electronic claims submission, we're going to pick up our review of this record with field number 20.

EA0 field 20, positions 80 - 94, is the referring physician number. Every registered physician in the United States has a number for each state and each agency that they bill to. This field contains their number registered with the payer that the claim is being billed to.

EA0 field 21, positions 95 - 109, is the referring physician UPIN number. This is where things can really get confusing. A UPIN number is a number assigned to every physician in the United States who bills Medicare. This is only used for Medicare billing and not to be confused with the number in field 20, unless they happen to be the same number.

EA0 field 22, position 110, is the referring physician tax ID type. This is a one character code that tells the payer the tax status of the physician. Most are the same, unless there are physicians who work in special clinics that are tax exempt or have different tax laws.

EA0 field 23, positions 111 - 121, is the referring physicians tax ID number. This is the actual tax ID number, similar to a social security number that is assigned to the physician by the government.

EA0 fields 24 - 26, positions 122 - 152, is the referring physicians last, first and middle initial. This must be filled in with the doctor's legal name on his medical license issued by the state to which he is billing.

EA0 field 27, positions 153 - 154, is the referring physician's state. This is the two character abbreviation for the state to which the referring physician is billing this claim to.

EA0 field 28, positions 155 - 162, is the hospital admission date. This is the date when the patient was admitted into the hospital if such an admission took place. If not, then this field is left blank. It is called a conditional field. There are many of these in electronic billing.

EA0 field 29, positions 163 - 170 is the hospital discharge date. This is the date the patient was released from the hospital. If the patient has not yet been released or if the patient was never admitted to a hospital then this field is left blank.

EA0 field 30, position 171, Is the outside lab indicator. This field tells the payer being billed if the patient was given tests by an outside lab and not the referring physician. This is field in with either a Y or N.

EA0 field 31, positions 172 - 178, is the outside lab charges. If the patient was given tests by an outside lab, then any charges must be submitted in this field. These charges may or may not be covered depending on the patient's coverage.

In our next medical billing installment of the EA0 record, we'll continue our review with field number 32.