Ref	Id	Element Name	Req	Type	Min/Max	Usage
TS301	127	Reference Identification Description: Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier Industry: Provider Identifier Use this number for the provider number.	M	AN	1/30	Required
TS302	1331	Facility Code Value Description: Code identifying the type of facility where services were performed; the first and second positions of the Uniform Bill Type code or the Place of Service code from the Electronic Media Claims National Standard Format Industry: Facility Type Code	M	AN	1/2	Required
TS303	373	Date Description: Date expressed as CCYYMMDD Industry: Fiscal Period Date Use this date for the last day of the provider’s fiscal year. If the end of the provider’s fiscal year is not known, use December 31st of the current year.	M	DT	8/8	Required
TS304	380	Quantity Description: Numeric value of quantity Industry: Total Claim Count Use this number for the total number of claims.	M	R	1/15	Required
TS305	782	Monetary Amount Description: Monetary amount Industry: Total Claim Charge Amount Use this monetary amount for the total reported charges for all claims.	M	R	1/18	Required
TS306	782	Monetary Amount Description: Monetary amount Industry: Total Covered Charge Amount Use this monetary amount for the total covered charges. This is submitted charges less the non-covered charges.	O	R	1/18	Situational
TS307	782	Monetary Amount Description: Monetary amount Industry: Total Noncovered Charge Amount Use this monetary amount for the total of non-covered charges.	O	R	1/18	Situational
TS308	782	Monetary Amount Description: Monetary amount Industry: Total Denied Charge Amount Use this monetary amount for the total of denied charges.	O	R	1/18	Situational
TS309	782	Monetary Amount Description: Monetary amount Industry: Total Provider Payment Amount Use this monetary amount for the total provider payment. The total provider payment amount includes the total of all interest paid. The amount can be less than zero.	O	R	1/18	Situational
TS310	782	Monetary Amount Description: Monetary amount Industry: Total Interest Amount Use this monetary amount for the total amount of interest paid.	O	R	1/18	Situational
TS311	782	Monetary Amount Description: Monetary amount Industry: Total Contractual Adjustment Amount Use this monetary amount for the total contractual adjustment.	O	R	1/18	Situational
TS312	782	Monetary Amount Description: Monetary amount Industry: Total Gramm-Rudman Reduction Amount Use this monetary amount for the total Gramm-Rudman adjustment.	O	R	1/18	Situational
TS313	782	Monetary Amount Description: Monetary amount Industry: Total MSP Payer Amount Use this monetary amount for the total MSP primary payer amount.	O	R	1/18	Situational
TS314	782	Monetary Amount Description: Monetary amount Industry: Total Blood Deductible Amount Use this monetary amount for the total blood deductible amount in dollars.	O	R	1/18	Situational
TS315	782	Monetary Amount Description: Monetary amount Industry: Total Non-Lab Charge Amount Use this monetary amount for the sum of non-lab charges.	O	R	1/18	Situational
TS316	782	Monetary Amount Description: Monetary amount Industry: Total Coinsurance Amount Use this monetary amount for the total co-insurance amount.	O	R	1/18	Situational
TS317	782	Monetary Amount Description: Monetary amount Industry: Total HCPCS Reported Charge Amount Use this monetary amount for the total of HCPCS reported charges.	O	R	1/18	Situational
TS318	782	Monetary Amount Description: Monetary amount Industry: Total HCPCS Payable Amount Use this monetary amount for the total HCPCS payable amount.	O	R	1/18	Situational
TS319	782	Monetary Amount Description: Monetary amount Industry: Total Deductible Amount Use this monetary amount for the total cash deductible.	O	R	1/18	Situational
TS320	782	Monetary Amount Description: Monetary amount Industry: Total Professional Component Amount Use this monetary amount for the total professional component amount. The professional component amount must also be reported in the CAS segment with a Claim Adjustment Reason Code value of 89.	O	R	1/18	Situational
TS321	782	Monetary Amount Description: Monetary amount Industry: Total MSP Patient Liability Met Amount Use this monetary amount for the total MSP patient liability met amount.	O	R	1/18	Situational
TS322	782	Monetary Amount Description: Monetary amount Industry: Total Patient Reimbursement Amount Use this monetary amount for the total patient reimbursement.	O	R	1/18	Situational
TS323	380	Quantity Description: Numeric value of quantity Industry: Total PIP Claim Count Use this number for the total PIP number of claims.	O	R	1/15	Situational
TS324	782	Monetary Amount Description: Monetary amount Industry: Total PIP Adjustment Amount Use the monetary amount for the payment amount for PIP claims.	O	R	1/18	Situational

1.	TS301 is the provider number.
2.	TS303 is the last day of the provider's fiscal year.
3.	TS304 is the total number of claims.
4.	TS305 is the total of reported charges.
5.	TS306 is the total of covered charges.
6.	TS307 is the total of noncovered charges.
7.	TS308 is the total of denied charges.
8.	TS309 is the total provider payment.
9.	TS310 is the total amount of interest paid.
10.	TS311 is the total contractual adjustment.
11.	TS312 is the total Gramm-Rudman Reduction.
12.	TS313 is the total Medicare Secondary Payer (MSP) primary payer amount.
13.	TS314 is the total blood deductible amount in dollars.
14.	TS315 is the summary of non-lab charges.
15.	TS316 is the total coinsurance amount.
16.	TS317 is the Health Care Financing Administration Common Procedural Coding System (HCPCS) reported charges.
17.	TS318 is the total Health Care Financing Administration Common Procedural Coding System (HCPCS) payable amount.
18.	TS319 is the total deductible amount.
19.	TS320 is the total professional component amount.
20.	TS321 is the total Medicare Secondary Payer (MSP) patient liability met.
21.	TS322 is the total patient reimbursement.
22.	TS323 is the total periodic interim payment (PIP) number of claims.
23.	TS324 is total periodic interim payment (PIP) adjustment.