SD and SF Reports Mapping
To access the SD or SF report in the ConnectCenter:
- Log in to ConnectCenter.
- Click Help >> API Documentation >> Responses and Reports >> Claims >> Reports >> Select SD or SF for mapping.
SD payer batch totals data file
The Payer Batch Totals Data File (SD) report presents payer batch information in a standard, delimited data file format.
The elements in the data file vary in length. Each element is delimited by a pipe (|) character and is given a reference number in the Element Number column. The elements in the data file will be populated only if returned by the payer on their reports. Each record ends with a carriage return/line feed. One data file will be created for each report. Elements highlighted in gray, 14 through 29, will not populate in the Payer Batch Totals Report (SB).
The SD and SF reports include the information in the following format:
| Element Number | Element Name | Maximum Element Size | Description |
|---|---|---|---|
NOTE
SD report naming convention: SDnnnnnn.xx, where, nnnnnn is the Optum assigned Submitter ID and xx is an incremented two-byte file extension.
For the Payer Batch Totals Data File (SD) report, repeat the following data, zero to many times depending on how many claims are tied to the batch. If the claim data cannot be tied back to the batch file, no detail records will be created.
| Element Number | Element Name | Maximum Element Size | Description |
|---|---|---|---|
| 1 | Record Code | 1 | D for detail information Populated by data extracted from Optum. |
| 2 | Patient Control Number | 30 | Populated by data extracted from Optum. |
| 3 | Patient Last Name | 35 | Populated by data extracted from Optum. |
| 4 | Patient First Name | 25 | Populated by data extracted from Optum. |
| 5 | Patient Middle Name | 25 | Populated by data extracted from Optum. |
| 6 | Claim From Date | 8 | Format: CCYYMMDD Populated by data extracted from Optum. |
| 7 | Claim To Date | 8 | Format: CCYYMMDD Populated by data extracted from Optum. |
| 8 | Claim Charge Amount | 21 | |
| Populated by data extracted from Optum. | |||
| 9 | Policy Number | 30 | Populated by data extracted from Optum. |
| 10 | Submitter Assign Claim ID | 30 | Claim identification number from client Populated by data extracted from Optum. |
| 11 | TSH Unique Claim ID | 13 | Transaction Solution Hub (TSH) is the Optum-assigned unique claim ID populated by data extracted from Optum. |
| 12 | Type of Bill | 3 | Populated by data extracted from Optum. |
| 13 | Group Number | 30 | Populated by data extracted from Optum. |
Sample payer batch totals data file
B|9999|123456|123456|CHI03|9999|20080617|222222|20080422|||1225557890|||||||||||||||||2074|ACCEPTED|000002||000002| 00000999.54|000000|||||
PAYOR REPORTH99RAR04 BATCH DETAIL CONTROL LISTING D|123456-99|SMITH|BRIAN||20061105|20061105|
00000000000000999.00|XXBB12345XX|1354578915651|0632599999999||
D|234567-99|SAY|ELIZABETH|M|20061015|20061015| 00000000000000999.00|FFF66666CCC|
5432154321245|0632514565656|| D|345678-99|HI|LONG|M|20061010|20061010| 00000000000000222.00|
3456789098|4444444445555|6767676767676||141414 D|456789-99|SMITH|RAYMOND||20061112|20061112|
00000000000000555.00|WWWLLLDDD23|4564545454545|0632578787878||68686868686868 D|
678902454545|SIMMONS|NANCY|B|20061109|20061109| 00000000000008989.00|187767676||0632545454545||
B|9999|123456|123456|CHI03|9999|20080617|676767|20020088|||1535656565|||||||||||||||||
3926|ACCEPTED|000022||000022| 00003333.88|000000|||||PAYOR REPORTH99RAR04 BATCH DETAIL CONTROL LISTING B|
9999|123456|123456|CHI03|9999|20080617|111815|20020088|||1700801966|||||||||||||||||5079|
ACCEPTED|000015||000015| 00003920.78|000000|||||IL MEDICARE H99RAR04 BATCH
DETAIL CONTROL LISTING D|123456-99|SMITH|BRIAN||20061105|20061105|
00000000000000999.00|XXBB12345XX|1354578915651|0632599999999||
D|234567-99|SAY|ELIZABETH|M|20061015|20061015| 00000000000000999.00|
FFF66666CCC|5432154321245|0632514565656||
SF payer report data file (normalized)
This Payer Report Data File (SF) report presents payer claim information in a standard, delimited data file format.
NOTE
SF report naming convention: SFnnnnnn.xx, where nnnnnn is the Optum-assigned Submitter ID and xx is an incremented two byte file extension.
The elements in the data file vary in length. Each element is delimited by a pipe (|) character and given a reference number in the Element Number column. Most of the elements in the data file will be populated only if returned by the payer on their reports. Elements 44 through 54 will be populated from the originally submitted claim data when the claim can be uniquely identified by Optum. Each record ends with a carriage return/line feed. Elements highlighted in gray, will not populate in the Payer Claim Data Report (SR) except when the SR Patient Control Number is preceded by an asterisk (*).
Sample payer report data file
9999|209999|079999|CHI01|3429|20090324|064500|9999A 260|GREEN|LUIS|A|20081203|20081203| 000000000000210.10|20090324|WHITE HOBDY||1851349999||||||||922379999|0907911308515079999|A1:19:PR:65|M - INFORMATIONAL|||||||||090791130PPPP|090791130PPPP|A1:19:PR:65| ACK,RECPT- CLM,ENCOUNTER RECEIVED. DOES NOT MEAN THAT CLM HAS BEEN ACCEPTD FOR ADJUDICATION.:ENTITY ACKNOWLEDGES RECEIPT OF CLAIM, ENCOUNTER.||277 DATA FILE||660689999|0001|9999A 260|GREEN|LUIS|A|20089999|20089999| 000000000000210.10|922379999|1851349999||||
9999|209999|079999|CHI01|3429|20090324|064500|9999A 260|GREEN|LUIS|A|20081210|20089999| 000000000000210.10|20099999|WHITE HOBDY||1851349999||||||||922379999|0907911308516079999|A1:19:PR:65|M - INFORMATIONAL|||||||||0907911309999|0907911309999|A1:19:PR:65| ACK,RECPT- CLM,ENCOUNTER RECEIVED. DOES NOT MEAN THAT CLM HAS BEEN ACCEPTD FOR ADJUDICATION.:ENTITY ACKNOWLEDGES RECEIPT OF CLAIM, ENCOUNTER.||277 DATA FILE||660689999|0001|9999A 260|GREEN|LUIS|A|20081210|20081210| 000000000000210.10|922379999|1851349999||||
Field Description
- Payer ID — You will recognize this as the four-digit CPID of the payer as found on payer list.
- Billing ID — An internal number set up with our accounting department that is used for invoicing.
- Submitter ID — Your six-digit submitter number. It is set up when we send out production credentials.
- System ID — An internal number associated with the clearinghouse.
- TSH Unique Claim ID — A product name for our back-end solution. In regard to the claim ID, it is the 13-digit number you find on your claim that is assigned by Optum (level III editing).
- Type of Bill — Is sent on a claim by the provider and can be returned by the payer. It basically indicates where services were rendered. The Type of Bill Code structure is a four-digit alphanumeric code providing three specific pieces of information after the leading zero. CMS ignores the leading zero.
- First Digit – Leading zero. Ignored by CMS (not included on claim)
- Second Digit – Type of facility
- Third Digit – Type of care
- Fourth Digit – Sequence of this bill in this episode of care. Referred to as a "frequency code"
Type of Facility
First Code
| Code | Description |
|---|---|
| 1 | Hospital |
| 2 | Skilled Nursing Facility (SNF) |
| 3 | Home Health |
| 4 | Religious Nonmedical (Hospital) |
| 5 | Religious Nonmedical (Extended Care) discontinued 10/1/05 |
| 6 | Intermediate Care |
| 7 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) |
| 8 | Special facility or hospital (Critical Access Hospital ((CAH) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) |
| 9 | Reserved for National Assignment |
Type of Care
| # | Care |
|---|---|
| 1 | Except Clinics & Special Facilities – Inpatient Part A Clinics Only – Rural Health Center (RHC) Special Facilities Only – Hospice (non-hospital based) |
| 2 | Except Clinics & Special Facilities – Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment) Clinics Only – Hospital based or Independent Renal Dialysis Center Special Facilities Only – Hospice (hospital based) |
| 3 | Except Clinics & Special Facilities – Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment) Special Facilities Only – ASC Services to Hospital Outpatients |
| 4 | Except Clinics & Special Facilities – Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services) Clinics Only – Other Rehabilitation Facility (ORF) Special Facilities Only – Free Standing Birthing Center |
| 5 | Except Clinics & Special Facilities – Intermediate Care – Level I Clinics Only – Comprehensive Outpatient Rehabilitation Facility (CORF) Special Facilities Only – CAH |
| 6 | Except Clinics & Special Facilities – Intermediate Care - Level II Clinics Only – Community Mental Health Center (CMHC) Special Facilities Only – Residential Facility (not used for Medicare) |
| 7 | Except Clinics & Special Facilities – Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement) Clinics Only – Free-standing Provider-based Federally Qualified Health Center (FQHC) Special Facilities Only – Reserved for National Assignment |
| 8 | Except Clinics & Special Facilities – NA Clinics Only – Reserved for National Assignment Special Facilities Only – Reserved for National Assignment |
| 9 | Except Clinics & Special Facilities – Reserved for National Assignment Clinics Only – Other Special Facilities Only – Other |
Frequency
| Fourth Digit | Description |
|---|---|
| 0 | Non-payment/Zero Claim – Use when it does not anticipate payment from payer for the bill, but is informing the payer about a period of non- payable confinement or termination of care. "Through" date of this bill (FL 6) is discharge date for this confinement, or termination of plan of care. |
| 1 | Admit Through Discharge – Use for a bill encompassing an entire inpatient confinement or course of outpatient treatment for which it expects payment from payer or which will update deductible for inpatient or Part B claims when Medicare is secondary to an Employer Group Health Plan (EGHP). |
| 2 | Interim – First Claim – Use for first of an expected series of bills for which utilization is chargeable or which will update inpatient deductible for same confinement of course of treatment. For HHAs, used for submission of original or replacement RAPs. |
| 3 | Interim-Continuing Claims (Not valid for Prospective Payment System (PPS) Bills) – Use when a bill for which utilization is chargeable for same confinement or course of treatment had already been submitted and further bills are expected to be submitted later. |
| 4 | Interim – Last Claim (Not valid for PPS Bills) – Use for a bill for which utilization is chargeable, and which is last of a series for this confinement or course of treatment. |
| 5 | Late Charge Only - These bills contain only additional charges; however, if late charge is for: - Services on same day as outpatient surgery subject to ASC limit; - Services on same day as services subject to Outpatient PPS (OPPS); - ESRD services paid under composite rate; - Inpatient accommodation charges; - Services paid under HH PPS; and - Inpatient hospital or SNF PPS ancillaries. It must be submitted as an adjustment request (xx7). |
| 6 | Replacement of Prior Claim (see adjustment third digit) – Use to correct a previously submitted bill. Provider applies this code to corrected or "new" bill. |
| 7 | Void/Cancel of Prior Claim (see adjustment third digit) – Use to indicate this bill is an exact duplicate of an incorrect bill previously submitted. A code "7" (replacement of Prior Claim) is being submitted showing corrected information. |
Updated 6 days ago