L2100A | NM1 | Information Source Name |
| |
03 | | L2100A_yy_NM103_PERSN_LNM | String | Person Last Name |
03 | | L2100A_yy_NM103_NONPSNENT_NM | String | Non-Person Entity Name |
04 | | L2100A_yy_NM104_NFO_SRC_FNM | String | Information Source First Name |
05 | | L2100A_yy_NM105_NFO_SRC_MNM | String | Information Source Middle Name |
07 | | L2100A_yy_NM107_NFO_SRC_SFX | String | Information Source Name Suffix |
09 | | L2100A_yy_NM109_EMPLYR_ID | String | Employer?s Identification Number |
09 | | L2100A_yy_NM109_ETN_NR | String | Electronic Transmitter Identification Number (ETIN) |
09 | | L2100A_yy_NM109_TAX_ID | String | Federal Taxpayer?s Identification Number |
09 | | L2100A_yy_NM109_NAIC_ID | String | National Association of Insurance Commissioners (NAIC) Identification |
09 | | L2100A_yy_NM109_PAYR_ID | String | Payor Identification |
09 | | L2100A_yy_NM109_HCFA_PLAN_ID | String | Centers for Medicare and Medicaid Services PlanID |
09 | | L2100A_yy_NM109_NPI | String | Centers for Medicare and Medicaid Services National Provider Identifier |
L2100B - INFORMATION RECEIVER NAME (Value Qualified) |
Mapping Prefix: L2100B_1P - Provider |
Mapping Prefix: L2100B_2B - Third-Party Administrator |
Mapping Prefix: L2100B_36 - Employer |
Mapping Prefix: L2100B_80 - Hospital |
Mapping Prefix: L2100B_FA - Facility |
Mapping Prefix: L2100B_GP - Gateway Provider |
Mapping Prefix: L2100B_P5 - Plan Sponsor |
Mapping Prefix: L2100B_PR - Payer |
L2100B | NM1 | Information Receiver Name |
| |
03 | | L2100B_yy_NM103_PERSN_LNM | String | Person Last Name |
03 | | L2100B_yy_NM103_NONPSNENT_NM | String | Non-Person Entity Name |
04 | | L2100B_yy_NM104_NFO_REC_FNM | String | Information Receiver First Name |
05 | | L2100B_yy_NM105_NFO_REC_MNM | String | Information Receiver Middle Name |
07 | | L2100B_yy_NM107_NFO_RCV_SFX | String | Information Receiver Name Suffix |
09 | | L2100B_yy_NM109_EMPLYR_ID | String | Employer?s Identification Number |
09 | | L2100B_yy_NM109_SSN | String | Social Security Number |
09 | | L2100B_yy_NM109_TAX_ID | String | Federal Taxpayer?s Identification Number |
09 | | L2100B_yy_NM109_PAYR_ID | String | Payor Identification |
09 | | L2100B_yy_NM109_PHM_PRCSR_NR | String | Pharmacy Processor Number |
09 | | L2100B_yy_NM109_SVC_PROV_NR | String | Service Provider Number |
09 | | L2100B_yy_NM109_HCFA_PLAN_ID | String | Centers for Medicare and Medicaid Services PlanID |
09 | | L2100B_yy_NM109_NPI | String | Centers for Medicare and Medicaid Services |
L2100B | REF | Information Receiver Additional Identification |
| |
02 | | L2100B_yy_REF_DUN_BRDST | String | Dun and Brandstreet |
02 | | L2100B_yy_REF_DUN_BRDST_SFX | String | Duns Plus Suffix |
02 | | L2100B_yy_REF_HIN | String | Health Industry Number |
02 | | L2100B_yy_REF_CARR_ID | String | Carrier Identification Number as assigned by Health Care Financing Administration |
02 | | L2100B_yy_REF_HCFA_FIIN | String | Fiscal Intermediary Identification Number as assigned by Health Care Financing Administration |
02 | | L2100B_yy_REF_HCFA_ID | String | Medicare Provider and Supplier Identification Number as assigned by Health Care Financing Administration |
02 | | L2100B_yy_REF_TAX_ID | String | US Federal Tax Identification Number |
02 | | L2100B_yy_REF_NAIC_CD | String | National Association of Insurance Commissioners Company Code |
02 | | L2100B_yy_REF_MUTLY_DEF | String | Mutually Defined |
03 | | L2100B_yy_REF03_NFORCV_AD_ID | String | Information Receiver Additional Identifier State |
L2100B | N4 | Information Receiver City, State, ZIP Code |
| |
01 | | L2100B_yy_N401_NFO_RCV_CITY_NM | String | Information Receiver City Name |
02 | | L2100B_yy_N402_NFO_RCV_STAT | String | Information Receiver State Code |
03 | | L2100B_yy_N403_NFO_RCV_ZIP | String | Information Receiver Postal Zone or ZIP Code |
04 | | L2100B_yy_N404_CNTRY_CD | String | Country Code |
07 | | L2100B_yy_N407_CNTRY_SUBDV_CD | String | Country Subdivision Code |
L2100C | REF | Subscriber Additional Identification |
Iterated: [01-09]
| |
02 | | L2100C_nnREF_PLAN_NR | String | Plan Number |
02 | | L2100C_nnREF_GRP_POLCY_NR | String | Group or Policy Number |
02 | | L2100C_nnREF_MEM_ID | String | Member Identification Number |
02 | | L2100C_nnREF_CASE_NR | String | Case Number |
02 | | L2100C_nnREF_GRP_NR | String | Group Number |
02 | | L2100C_nnREF_CNTRCT_NR | String | Contract Number |
02 | | L2100C_nnREF_MED_REC_ID | String | Medical Record Identification Number |
02 | | L2100C_nnREF_PATNT_ACCT_NR | String | Patient Account Number |
02 | | L2100C_nnREF_HIC_NR | String | Health Insurance Claim (HIC) Number |
02 | | L2100C_nnREF_ID_SERL_NR | String | Identification Card Serial Number |
02 | | L2100C_nnREF_ID_CRD_NR | String | Identity Card Number |
02 | | L2100C_nnREF_INS_PLCY_NR | String | Insurance Policy Number |
02 | | L2100C_nnREF_PLN_NET_ID | String | Plan Network Identification Number |
02 | | L2100C_nnREF_MDCD_ID_NR | String | Medicaid Recipient Identification Number |
02 | | L2100C_nnREF_SSN | String | Social Security Number |
02 | | L2100C_nnREF_AGNCY_CLM_NR | String | Agency Claim Number |
L2100C | HI | Subscriber Health Care Diagnosis Code |
| |
01 | 02 | L2100C_HI0102_ICD10_PRIN_DIAG | String | International Classification of Diseases Clinical Modification (ICD-10-CM) Principal Diagnosis |
01 | 02 | L2100C_HI0102_ICD9_PRIN_DIAG | String | International Classification of Diseases Clinical Modification (ICD-9-CM) Principal Diagnosis |
02 | 02 | L2100C_HI0202_ICD10_DIAG | String | International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis |
02 | 02 | L2100C_HI0202_ICD9_DIAG | String | International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis |
03 | 02 | L2100C_HI0302_ICD10_DIAG | String | International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis |
03 | 02 | L2100C_HI0302_ICD9_DIAG | String | International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis |
04 | 02 | L2100C_HI0402_ICD10_DIAG | String | International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis |
04 | 02 | L2100C_HI0402_ICD9_DIAG | String | International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis |
05 | 02 | L2100C_HI0502_ICD10_DIAG | String | International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis |
05 | 02 | L2100C_HI0502_ICD9_DIAG | String | International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis |
06 | 02 | L2100C_HI0602_ICD10_DIAG | String | International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis |
06 | 02 | L2100C_HI0602_ICD9_DIAG | String | International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis |
07 | 02 | L2100C_HI0702_ICD10_DIAG | String | International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis |
07 | 02 | L2100C_HI0702_ICD9_DIAG | String | International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis |
08 | 02 | L2100C_HI0802_ICD10_DIAG | String | International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis |
08 | 02 | L2100C_HI0802_ICD9_DIAG | String | International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis |
L2110C | EQ | Subscriber Eligibility or Benefit Inquiry |
| |
01 | | L2110C_EQ01_Enn_SVC_TYP_CD | String | Service Type Code |
02 | 02 | L2110C_EQ0202_ADA_CD | String | American Dental Association Codes |
02 | 02 | L2110C_EQ0202_CPT_CD | String | Current Procedural Terminology (CPT) Codes |
02 | 02 | L2110C_EQ0202_HCPCS_CD | String | Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes |
02 | 02 | L2110C_EQ0202_ICD9_PROC | String | International Classification of Diseases Clinical Modification (ICD-9-CM) - Procedure |
02 | 02 | L2110C_EQ0202_HIC_PRD_SVCCD | String | Home Infusion EDI Coalition (HIEC) Product/Service Code |
02 | 02 | L2110C_EQ0202_NDC542 | String | National Drug Code in 5-4-2 Format |
02 | 02 | L2110C_EQ0202_MUTLY_DEF | String | Mutually Defined |
02 | 03 | L2110C_EQ0203_PROC_MOD | String | Procedure Modifier |
02 | 04 | L2110C_EQ0204_PROC_MOD | String | Procedure Modifier |
02 | 05 | L2110C_EQ0205_PROC_MOD | String | Procedure Modifier |
02 | 06 | L2110C_EQ0206_PROC_MOD | String | Procedure Modifier |
03 | | L2110C_EQ03_COVG_LVL_CD | String | Coverage Level Code |
05 | 01 | L2110C_EQ0501_DIAG_CD_PTR | Integer | Diagnosis Code Pointer |
05 | 02 | L2110C_EQ0502_DIAG_CD_PTR | Integer | Diagnosis Code Pointer |
05 | 03 | L2110C_EQ0503_DIAG_CD_PTR | Integer | Diagnosis Code Pointer |
05 | 04 | L2110C_EQ0504_DIAG_CD_PTR | Integer | Diagnosis Code Pointer |
L2100D | HI | Dependent Health Care Diagnosis Code |
| |
01 | 02 | L2100D_HI0102_ICD10_PRIN_DIAG | String | International Classification of Diseases Clinical Modification (ICD-10-CM) Principal Diagnosis |
01 | 02 | L2100D_HI0102_ICD9_PRIN_DIAG | String | International Classification of Diseases Clinical Modification (ICD-9-CM) Principal Diagnosis |
02 | 02 | L2100D_HI0202_ICD10_DIAG | String | International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis |
02 | 02 | L2100D_HI0202_ICD9_DIAG | String | International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis |
03 | 02 | L2100D_HI0302_ICD10_DIAG | String | International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis |
03 | 02 | L2100D_HI0302_ICD9_DIAG | String | International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis |
04 | 02 | L2100D_HI0402_ICD10_DIAG | String | International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis |
04 | 02 | L2100D_HI0402_ICD9_DIAG | String | International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis |
05 | 02 | L2100D_HI0502_ICD10_DIAG | String | International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis |
05 | 02 | L2100D_HI0502_ICD9_DIAG | String | International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis |
06 | 02 | L2100D_HI0602_ICD10_DIAG | String | International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis |
06 | 02 | L2100D_HI0602_ICD9_DIAG | String | International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis |
07 | 02 | L2100D_HI0702_ICD10_DIAG | String | International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis |
07 | 02 | L2100D_HI0702_ICD9_DIAG | String | International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis |
08 | 02 | L2100D_HI0802_ICD10_DIAG | String | International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis |
08 | 02 | L2100D_HI0802_ICD9_DIAG | String | International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis |
L2110D | EQ | Dependent Eligibility or Benefit Inquiry |
| |
01 | | L2110D_EQ01_Enn_SVC_TYP_CD | String | Service Type Code |
02 | 02 | L2110D_EQ0202_ADA_CD | String | American Dental Association Codes |
02 | 02 | L2110D_EQ0202_CPT_CD | String | Current Procedural Terminology (CPT) Codes |
02 | 02 | L2110D_EQ0202_HCPCS_CD | String | Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes |
02 | 02 | L2110D_EQ0202_ICD9_PROC | String | International Classification of Diseases Clinical Modification (ICD-9-CM) - Procedure |
02 | 02 | L2110D_EQ0202_HIC_PRD_SVCCD | String | Home Infusion EDI Coalition (HIEC) Product/Service Code |
02 | 02 | L2110D_EQ0202_NDC542 | String | National Drug Code in 5-4-2 Format |
02 | 02 | L2110D_EQ0202_MUTLY_DEF | String | Mutually Defined |
02 | 03 | L2110D_EQ0203_PROC_MOD | String | Procedure Modifier |
02 | 04 | L2110D_EQ0204_PROC_MOD | String | Procedure Modifier |
02 | 05 | L2110D_EQ0205_PROC_MOD | String | Procedure Modifier |
02 | 06 | L2110D_EQ0206_PROC_MOD | String | Procedure Modifier |
05 | 01 | L2110D_EQ0501_DIAG_CD_PTR | Integer | Diagnosis Code Pointer |
05 | 02 | L2110D_EQ0502_DIAG_CD_PTR | Integer | Diagnosis Code Pointer |
05 | 03 | L2110D_EQ0503_DIAG_CD_PTR | Integer | Diagnosis Code Pointer |
05 | 04 | L2110D_EQ0504_DIAG_CD_PTR | Integer | Diagnosis Code Pointer |