Confidential -

2004 Hyland Software, Inc.

List of all data that is scrubbed by ediscrubber:

EDI 835
Loop
Header
Header
Header
Header
L1000B
L1000B
L1000B
L1000B
L1000B
L1000B
L1000B
L1000B
L2100
L2100
L2100
L2100
L2100
L2100
L2100
L2100
L2100
L2100
L2100
L2100
L2100
L2100
L2100
L2100
L2100
L2100
L2100
L2100

Reference
BPR07
BPR09
BPR13
BPR15
N102
N104
N301
N302
N401
N402
N403
REF02
CLP01
CLP07
NM103
NM104
NM105
NM107
NM109
NM103
NM104
NM105
NM107
NM109
NM103
NM104
NM105
NM107
NM109
PER02
PER04/06
PER08

Description
Sender DFI Identification Number
Sender Bank Account Number
Receiver/Provider DFI Identification Number
Receiver/Provider Bank Account Number
Payee Name
Payee Identification Code
Payee Address Line 1
Payee Address Line 2
Payee City Name
Payee State/Province
Payee Postal Code
Payee Additional Identifier
Patient Control Number
Payer Claim Control Number
Patient Last Name
Patient First Name
Patient Middle Name
Patient Name Suffix
Patient Identifier
Subscriber Last Name
Subscriber First Name
Subscriber Middle Name
Subscriber Name Suffix
Subscriber Identifier
Corrected Patient/Subscriber Last Name
Corrected Patient/Subscriber First Name
Corrected Patient/Subscriber Middle Name
Corrected Patient/Subscriber Name Suffix
Corrected Patient/Subscriber Identifer
Claim Contact Name
Claim Contact Communications Number
Claim Contact Communications Number Extension

EDI 837
Loop

Reference Description

Confidential -

L2010AA
L2010AA
L2010AB
L2010BA
L2010BA
L2010BA
L2010BA
L2010BA
L2010BA
L2010BA
L2010BA
L2010BA
L2010BA
L2010BA
L2010BA
L2010BC
L2010BC
L2010BC
L2010BC
L2010BC
L2010BC
L2010BC
L2010BC
L2010BC
L2010BD
L2010BD
L2010BD
L2010BD
L2010BD
L2010BD
L2010CA
L2010CA
L2010CA
L2010CA
L2010CA
L2010CA
L2010CA
L2010CA
L2010CA
L2010CA
L2010CA
L2010CA

2004 Hyland Software, Inc.

REF02
REF02
REF02
NM103
NM104
NM105
NM107
NM109
N301
N302
N401
N402
N403
REF02
REF02
NM103
NM104
NM105
NM107
N301
N302
N401
N402
N403
NM103
NM104
NM105
NM107
NM109
REF02
NM103
NM104
NM105
NM107
NM109
N301
N302
N401
N402
N403
REF02
REF02

Billing Provider Additional Identifier

Billing Provider Credit Card Identifier
Pay-to-Provider Additional Identifier
Subcriber Last Name
Subscriber First Name
Subscriber Middle Name
Subscriber Name Suffix
Subscriber Identifier
Subscriber Address Line 1
Subscriber Address Line 2
Subscriber City Name
Subscriber State/Province
Subscriber Postal Code
Subscriber Supplemental Identifier
Property Casualty Claim Number
Responsible Party Last Name
Subscriber Party First Name
Responsible Party Middle Name
Responsible Party Name Suffix
Responsible Party Address Line 1
Responsible Party Address Line 2
Responsible Party City Name
Responsible Party State/Province
Responsible Party Postal Code
Credit/Debit Card Holder Last Name
Credit/Debit Card Holder First Name
Credit/Debit Card Holder Middle Name
Credit/Debit Card Holder Name Suffix
Credit/Debit Card Number
Credit/Debit Card Authorization Number
Patient Last Name
Patient First Name
Patient Middle Name
Patient Name Suffix
Patient Primary Identifier
Patient Address Line 1
Patient Address Line 2
Patient City Name
Patient State/Province
Patient Postal Code
Patient Supplemental Identifier
Property Casualty Claim Number

Confidential -

2004 Hyland Software, Inc.

L2300
L2300
L2300
L2300
L2300
L2300
L2300
L2300
L2300
L2300
L2300
L2300
L2300
L2310A
L2310B
L2310C
L2310D
L2310E
L2010BA
L2010BA
L2010BA
L2010BA
L2010BA
L2010BA
L2010BA
L2010BA
L2010BA
L2010BA
L2010BA
L2330B
L2330B
L2330C
L2330C
L2330C
L2330D
L2330E

CLM03
PWK06
CN104
REF02
REF02
REF02
REF02
REF02
REF02
REF02
REF02
REF02
REF02
REF02
REF02
REF02
REF02
REF02
NM103
NM104
NM105
NM107
NM109
N301
N302
N401
N402
N403
REF02
REF02
REF02
NM103
NM109
REF02
REF02
REF02

L2330F

REF02

L2330G

REF02

L2330H

REF02

Patient Account Number

Attachment Control Number
Contract Code
Mammography Certification Number
Prior Authorization or Referral Number
Claim Original Reference Number
Clinical Laboratory Improvement Amendment No.
Repriced Claim Number
Adjusted Repriced Claim Number
Investigational Device Exemption Identifier
Clearinghouse Trace Number
Ambulatory Patient Group Number
Medical Record Number
Referring Provider Secondary Identifier
Rendering Provider Secondary Identifier
Purchased Service Provider Secondary Identifier
Service Facility Location Secondary Identifier
Supervising Provider Secondary Identifier
Other Subcriber Last Name
Other Subscriber First Name
Other Subscriber Middle Name
Other Subscriber Name Suffix
Other Subscriber Identifier
Other Subscriber Address Line 1
Other Subscriber Address Line 2
Other Subscriber City Name
Other Subscriber State/Province
Other Subscriber Postal Code
Other Subscriber Supplemental Identifier
Other Payer Secondary Identifier
Other Payer Prior Authorization or Referral Number
Other Payer Patient Last Name
Other Payer Patient Primary Identifier
Other Payer Patient Secondary Identifier
Other Payer Referring Provider Secondary Identifier
Other Payer Rendering Provider Secondary
Identifier
Other Payer Purchased Service Provider Secondary
Identifier
Other Payer Service Facility Location Secondary
Identifier
Other Payer Supervising Provider Secondary
Identifier

Confidential -

L2400
L2400
L2400
L2400
L2400
L2400
L2400
L2400
L2400
L2420A
L2420B
L2420C
L2420D
L2420E
L2420F
L2420G

2004 Hyland Software, Inc.

CN104
REF02
REF02
REF02
REF02
REF02
REF02
REF02
REF02
REF02
REF02
REF02
REF02
REF02
REF02
REF02

Contract Code
Repriced Line Item Reference Number
Adjusted Repriced Line Item Reference Number
Prior Authorization or Referral Number
Mammography Certification Number
CLIA Number
Referring CLIA Number
Immunization Batch Number
Ambulatory Patient Number
Rendering Provider Secondary Identifier
Purchased Service Provider Secondary Identifier
Service Facility Location Secondary Identifier
Supervising Provider Secondary Identifier
Ordering Provider Secondary Identifier
Referring Provider Secondary Identifier
Other Payer Prior Authorization or Referral Number