Field Description for provider EOBs. Please see definitions below.
1. PIN: the name and unique provider ID number assigned by Aetna.
2. MAILING ADDRESS: The name and mailing address for the servicing physician/hospital or other practitioner.
3. TAX ID #: The federal tax ID number for the physician/hospital or other practitioner.
4. CHECK NUMBER: The bank ID and check number being issued.
5. CHECK AMOUNT: The amount of the check being issued.
6. NOTES: Informational Message Display Area
7. PATIENT NAME: The full first and last name of the patient with middle initial.
8. PATIENT ACCOUNT: A unique number supplied and used by the physician/hospital or other practitioner.
9. PATIENT ID: The social security number for the member
10. MEMBER ID: Aetna's unique customer member ID for the member
11. RELATION: Relationship to member
12. MEMBER: The full first and last name of the member
13. LEGAL ENTITY NAME: Name of entity that underwrites or administers this plan.
14. GROUP NUMBER: The group (control) number for the plan sponsor
15. DIAG: Diagnosis code associated with the services.
16. GROUP NAME: The member's plan sponsor.
17. PRODUCT: The member's plan name.
18. APC/DRG: The APC (Ambulatory Procedure Category) for outpatient hospital services or the DRG (Diagnostic Related Group) for inpatient hospital services. Only one of the two displays.
19. CLAIM ID/RECD. Claim ID number used internally by Aetna, followed by date the claim was received.
20. NETWORK ID: Identifying number and name for the network.
21. SERVICE DATES: Month/day/year service was provided.
22. PL (PLACE): Industry standard code that identifies the location where services were provided.
23. SERVICE CODE: The procedure code that identifies the service being performed.
24. NUM SVCS: The number of services, procedures, days, units etc.
25. SUBMITTED CHARGES: The amount billed for this service.
26. NEGOTIATED OR ALLOWED AMOUNT: When the physician/hospital or other practitioner is participating (in network), the rate that has been negotiated for the service. Otherwise, the amount recognized under the members plan.
27. COPAY AMOUNT: The co-payment owed by the patient for this service.
28. PENDING OR NOT PAYABLE: The amount being pended or denied. The next field (29) points to reason.
29. SEE REMARKS: Corresponds to the remark with this number in field 36.
30. DEDUCTIBLE: Patient deductible applied to either Field 25 or 26, depending on physician/hospital/practitioner network status and the plan.
31. COINSURANCE: The portion of the charge, in addition to any co-pay or deductible, for which the patient is responsible.
32. PATIENT RESP: Amount for which the patient is responsible, including co-pay, deductible, coinsurance and any amount not covered. This can be adjusted by dollars in Field 34, in which case final patient responsibility is in Field 38.
33. PAYABLE AMOUNT: Amount the plan pays for this service in absence of any amount identified in Field 34.
34. CLAIM ADJUSTMENTS: An adjustment that may impact the amount the plan will pay. Examples: amount paid by other carrier, or amount previously paid on same claim.
35. ISSUED AMOUNT: The plan benefit for these services after any adjustments made in Field 34.
36. REMARKS: Explanation of denied or pended charges, or any additional information. Corresponds to expense line above with the same number in Field 29, or the entire claim if no number is present.
The following (37-41) appear after each patient invoice. If a patient has more than one claim, the Total Payment Box appears at the end of the last claim.
37. FOR QUESTIONS REGARDING THIS CLAIM: The address/telephone number that should be used for any questions.
38. TOTAL PATIENT RESPONSIBILITY: The total amount for which the patient is responsible, after any adjustments in Field 34.
39. CLAIM PAYMENT: The total amount payable for this patient.
40. PAYMENT LEVEL ADJUSTMENT: Withhold amount, if appropriate (for single/physician/hospital/practitioner EOB only).
41. TOTAL PAYMENT TO: The final payment after any adjustments in Field 40.
42. PRIVACY MESSAGE: Message regarding ID numbers. | 
