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 Change Healthcare assigned Submitter ID and xx is an incremented two-byte file extension.
For the Payer Batch Totals Data File (SD) report, you can 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, 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 Change Healthcare. |
| 2 | Patient Control Number | 30 | Populated by data extracted from Change Healthcare. |
| 3 | Patient Last Name | 35 | Populated by data extracted from Change Healthcare. |
| 4 | Patient First Name | 25 | Populated by data extracted from Change Healthcare. |
| 5 | Patient Middle Name | 25 | Populated by data extracted from Change Healthcare. |
| 6 | Claim From Date | 8 | Format: CCYYMMDD Populated by data extracted from Change Healthcare. |
| 7 | Claim To Date | 8 | Format: CCYYMMDD Populated by data extracted from Change Healthcare. |
| 8 | Claim Charge Amount | 21 | Includes: Populated by data extracted from Change Healthcare. |
| 9 | Policy Number | 30 | Populated by data extracted from Change Healthcare. |
| 10 | Submitter Assign Claim ID | 30 | Claim identification number from client Populated by data extracted from Change Healthcare. |
| 11 | TSH Unique Claim ID | 13 | The Change Healthcare-assigned unique claim ID Populated by data extracted from Change Healthcare. |
| 12 | Type fo Bill | 3 | Populated by data extracted from Change Healthcare. |
| 13 | Group Number | 30 | Populated by data extracted from Change Healthcare. |
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 Change Healthcare 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 Change Healthcare. 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||||
Updated 8 months ago