Date of Service Matching Accounts File Field Specification (CSV)

File name: accounts_in.csv
Response file name: accounts_in.csv.resp

File format is standard CSV (http://www.ietf.org/rfc/rfc4180.txt).

Patient Visit

Field Index	Description	Format	Required	Max Len
1	Date of Service	mm/dd/yyyy	No	10
2	Encounter ID		No	50
3	Balance Due	99999999.99	No	12

Patient Information

Field Index	Description	Format	Required	Max Len
4	Patient ID		Yes	50
5	Prefix		No	10
6	First Name		Yes	50
7	Last Name		Yes	50
8	Suffix		No	20
9	Gender	M = Male, F = Female	No	1
10	Date of Birth	mm/dd/yyyy	No	10
11	Address Line 1		No	50
12	Address Line 2		No	50
13	City		No	50
14	State		No	2
15	ZIP Code	999999999	No	9
16	Primary Phone Number	9999999999	No	10
17	Mobile Phone Number	9999999999	No	10
18	Fax Number	9999999999	No	10
19	Email Address		No	128

Subscriber Information

Field Index	Description	Format	Required	Max Len
20	Prefix		No	10
21	First Name		Yes¹	50
22	Last Name		Yes¹	50
23	Suffix		No	20
24	Address Line 1		No	50
25	Address Line 2		No	50
26	City		No	50
27	State		No	2
28	ZIP Code	999999999	No	9
29	Primary Phone Number	9999999999	No	10
30	Mobile Phone Number	9999999999	No	10
31	Date of Birth	mm/dd/yyyy	No	10
32	Email Address		No	128
33	Relationship	PA = Parent, SP = Spouse, OT = Other	Yes¹	2

¹ Subscriber information only required when the patient is not the subscriber.

Primary Carrier

Field Index	Description	Required	Max Len
34	Plan ID	No	50
35	Plan Name	No	50
36	Member ID	No	50
37	Group ID	No	50

Secondary Carrier

Field Index	Description	Required	Max Len
38	Plan ID	No	50
39	Plan Name	No	50
40	Member ID	No	50
41	Group ID	No	50

Alternate Contact

Field Index	Description	Format	Required	Max Len
42	First Name		Yes	50
43	Last Name		Yes	50
44	Suffix		No	20
45	Address Line 1		No	50
46	Address Line 2		No	50
47	City		No	50
48	State		No	2
49	ZIP Code	999999999	No	9
50	Primary Phone Number	9999999999	No	10
51	Mobile Phone Number	9999999999	No	10
52	Fax Number	9999999999	No	10
53	Email Address		No	128
54	Contact Type	FM = Family, EM = Employer, GA = Guarantor, OT = Other	No	50

Additional Info

Field Index	Description	Format	Required	Max Len
55	Client ID		No	8
56	SSN		No	50

Example record

"05/03/2011","CLG.11224*66","107.16","CLG.11224",,"SMITH","JOHN",,"M","11/28/1971","1400 BIRCH ST","","HINESVILLE","GA",
"31313","9123211234","9123211235",,,,"SMITH","JANE",,,"1400 BIRCH ST",,"HINESVILLE","GA","31313","9123211234",,,,,"SP","2222",
"UNITED HEALTHCARE","932000000","700000",,,,,,,,,,,,,,,,

Response File

A response file will be generated during the import of the receivables file. There will be a row in the response file for each record processed. The row will contain the line number in the receivables file being processed, the Patient ID, and the Encounter ID. If an exception occurs during the processing of a record, the details of the exception will be included at the end of the row.

Example response file

"1","CLG.11224","CLG.11224*66"
"2","CLG.11233","CLG.11233*170","Data too long for field ZIP Code"

ClearGage, Inc.