5010 Health Care Claim Status Response [P0]


Loop Qualifiers
xx - Loop Iteration Prefix
xxyy - Outer Loop Iteration and Inner Loop Iteration
yy / yyy - Loop Value Qualifier
xxyy / xxyyy - Loop Iteration and Value Qualifier
Segment Modifiers:
X - Distinguishing Identifier Suffix
nn - Segment Iteration (only after first iterartion)
nn - Element Repeat Iteration (only after first iterartion)

GSHDR - GROUP HEADER
GSHDRGSFunctional Group Header
02GSHDR_GS02_APP_SNDR_CDStringApplication Senders Code
03GSHDR_GS03_APP_RCV_CDStringApplication Receivers Code
04GSHDR_GS04_D8Date/TimeDate
05GSHDR_GS05_TMTimeTime
06GSHDR_GS06_GCNIntegerGroup Control Number
STHDR - TRANSACTION SET HEADER
STHDRSTTransaction Set Header
02STHDR_ST02_TCNStringTransaction Set Control Number
03STHDR_ST03_VERS_REL_IND_IDStringVersion, Release, or Industry Identifier
STHDRBHTBeginning of Hierarchical Transaction
01STHDR_BHT01_HIER_STRUC_CDStringHierarchical Structure Code
03STHDR_BHT03_ORIG_APP_TRANS_IDStringOriginator Application Transaction Identifier
04STHDR_BHT04_TS_CRTN_D8Date/TimeTransaction Set Creation Date
05STHDR_BHT05_TS_CRTN_TMTimeTransaction Set Creation Time
L2000A - INFORMATION SOURCE LEVEL
L2000AHLInformation Source Level
01L2000A_HL01_HIER_ID_NRStringHierarchical ID Number
L2100A - PAYER NAME
L2100ANM1Payer Name
03L2100A_NM103_PYR_NMStringPayer Name
09L2100A_NM109_PAYR_IDStringPayor Identification
09L2100A_NM109_CMS_PLANIDStringCenters for Medicare and Medicaid Services PlanID
L2100APERPayer Contact Information
02L2100A_PER02_PYR_CON_NMStringPayer Contact Name
04L2100A_PER04_EDI_ACS_NRStringElectronic Data Interchange Access Number
04L2100A_PER04_EMAILStringElectronic Mail
04L2100A_PER04_FAXStringFacsimile
04L2100A_PER04_PHN_NRStringTelephone
06L2100A_PER06_EDI_ACS_NRStringElectronic Data Interchange Access Number
06L2100A_PER06_EMAILStringElectronic Mail
06L2100A_PER06_PHN_EXTStringTelephone Extension
06L2100A_PER06_FAXStringFacsimile
06L2100A_PER06_PHN_NRStringTelephone
08L2100A_PER08_EDI_ACS_NRStringElectronic Data Interchange Access Number
08L2100A_PER08_EMAILStringElectronic Mail
08L2100A_PER08_PHN_EXTStringTelephone Extension
08L2100A_PER08_FAXStringFacsimile
08L2100A_PER08_PHN_NRStringTelephone
L2000B - INFORMATION RECEIVER LEVEL
L2000BHLInformation Receiver Level
01L2000B_HL01_HIER_ID_NRStringHierarchical ID Number
02L2000B_HL02_HIER_PARNT_ID_NRStringHierarchical Parent ID Number
04L2000B_HL04_HL_CHLD_CDStringHierarchical Child Code
L2100B - INFORMATION RECEIVER NAME
L2100BNM1Information Receiver Name
02L2100B_NM102_ENT_TYP_QUALStringEntity Type Qualifier
03L2100B_NM103_NFO_RCV_NMStringInformation Receiver Last or Organization Name
04L2100B_NM104_NFO_REC_FNMStringInformation Receiver First Name
05L2100B_NM105_NFO_REC_MNMStringInformation Receiver Middle Name
09L2100B_NM109_NFO_REC_ID_NRStringInformation Receiver Identification Number
L2200B - INFORMATION RECEIVER TRACE IDENTIFIER
L2200BTRNInformation Receiver Trace Identifier
02L2200B_TRN02_CLM_TRNS_BAT_NRStringClaim Transaction Batch Number
L2200BX - INFORMATION RECEIVER TRACE IDENTIFIER - STC CUTOUT
L2200BXSTCInformation Receiver Status Information
0101L2200BX_STC0101_HTCRCLM_CAT_CDStringHealth Care Claim Status Category Code
0102L2200BX_STC0102_STATS_CDStringStatus Code
0103L2200BX_STC0103_ENTY_ID_CDStringEntity Identifier Code
02L2200BX_STC02_STMT_NFO_EFF_D8Date/TimeStatus Information Effective Date
1001L2200BX_STC1001_HTCRCLM_CAT_CDStringHealth Care Claim Status Category Code
1002L2200BX_STC1002_STATS_CDStringStatus Code
1003L2200BX_STC1003_ENTY_ID_CDStringEntity Identifier Code
1101L2200BX_STC1101_HTCRCLM_CAT_CDStringHealth Care Claim Status Category Code
1102L2200BX_STC1102_STATS_CDStringStatus Code
1103L2200BX_STC1103_ENTY_ID_CDStringEntity Identifier Code
L2000C - SERVICE PROVIDER LEVEL
L2000CHLService Provider Level
01L2000C_HL01_HIER_ID_NRStringHierarchical ID Number
02L2000C_HL02_HIER_PARNT_ID_NRStringHierarchical Parent ID Number
04L2000C_HL04_HL_CHLD_CDStringHierarchical Child Code
L2100C - PROVIDER NAME (Single Iteration)
L2100CNM1Provider Name
02L2100C_xx_NM102_ENT_TYP_QUALStringEntity Type Qualifier
03L2100C_xx_NM103_PVR_LNMStringProvider Last or Organization Name
04L2100C_xx_NM104_PVR_FNMStringProvider First Name
05L2100C_xx_NM105_PVR_MNMStringProvider Middle Name
07L2100C_xx_NM107_PVR_SFXStringProvider Name Suffix
09L2100C_xx_NM109_TAX_IDStringFederal Taxpayer?s Identification Number
09L2100C_xx_NM109_SVC_PROV_NRStringService Provider Number
09L2100C_xx_NM109_NPIStringCenters for Medicare and Medicaid Services National Provider Identifier
L2200C - PROVIDER OF SERVICE TRACE IDENTIFIER
L2200CTRNProvider of Service Trace Identifier
02L2200C_TRN02_PVR_SVCNFO_TRC_IDStringProvider of Service Information Trace Identifier
L2200CX - PROVIDER OF SERVICE TRACE IDENTIFIER - STC CUTOUT
L2200CXSTCProvider Status Information
0101L2200CX_STC0101_HTCRCLM_CAT_CDStringHealth Care Claim Status Category Code
0102L2200CX_STC0102_STATS_CDStringStatus Code
0103L2200CX_STC0103_ENTY_ID_CDStringEntity Identifier Code
02L2200CX_STC02_STMT_NFO_EFF_D8Date/TimeStatus Information Effective Date
1001L2200CX_STC1001_HTCRCLM_CAT_CDStringHealth Care Claim Status Category Code
1002L2200CX_STC1002_STATS_CDStringStatus Code
1003L2200CX_STC1003_ENTY_ID_CDStringEntity Identifier Code
1101L2200CX_STC1101_HTCRCLM_CAT_CDStringHealth Care Claim Status Category Code
1102L2200CX_STC1102_STATS_CDStringStatus Code
1103L2200CX_STC1103_ENTY_ID_CDStringEntity Identifier Code
L2000D - SUBSCRIBER LEVEL
L2000DHLSubscriber Level
01L2000D_HL01_HIER_ID_NRStringHierarchical ID Number
02L2000D_HL02_HIER_PARNT_ID_NRStringHierarchical Parent ID Number
04L2000D_HL04_HL_CHLD_CDStringHierarchical Child Code
L2100D - SUBSCRIBER NAME
L2100DNM1Subscriber Name
03L2100D_NM103_PERSN_LNMStringPerson Last Name
03L2100D_NM103_NONPSNENT_NMStringNon-Person Entity Name
04L2100D_NM104_SBR_FNMStringSubscriber First Name
05L2100D_NM105_SBR_MNMStringSubscriber Middle Name or Initial
07L2100D_NM107_SBR_SFXStringSubscriber Name Suffix
09L2100D_NM109_EMPLYR_IDStringEmployer?s Identification Number
09L2100D_NM109_UNQ_HLTH_IDStringStandard Unique Health Identifier for each Individual in the United States
09L2100D_NM109_MEM_ID_NRStringMember Identification Number
L2200D - CLAIM STATUS TRACKING NUMBER
L2200DTRNClaim Status Tracking Number
02L2200D_TRN02_REF_TRAN_TRAC_NRStringReferenced Transaction Trace Number
L2200DX - CLAIM STATUS TRACKING NUMBER - STC CUTOUT
L2200DXSTCClaim Level Status Information
0101L2200DX_STC0101_HTCRCLM_CAT_CDStringHealth Care Claim Status Category Code
0102L2200DX_STC0102_STATS_CDStringStatus Code
0103L2200DX_STC0103_ENTY_ID_CDStringEntity Identifier Code
0104L2200DX_STC0104_CD_LST_QL_CDStringCode List Qualifier Code
02L2200DX_STC02_STMT_NFO_EFF_D8Date/TimeStatus Information Effective Date
04L2200DX_STC04_TOT_CLM_CHG_AMTDecimalTotal Claim Charge Amount
05L2200DX_STC05_CLM_PMT_AMTDecimalClaim Payment Amount
06L2200DX_STC06_ADJ_FINAL_D8Date/TimeAdjudication Finalized Date
08L2200DX_STC08_REMTC_D8Date/TimeRemittance Date
09L2200DX_STC09_REMTC_TRAC_NRStringRemittance Trace Number
1001L2200DX_STC1001_HTCRCLM_CAT_CDStringHealth Care Claim Status Category Code
1002L2200DX_STC1002_STATS_CDStringStatus Code
1003L2200DX_STC1003_ENTY_ID_CDStringEntity Identifier Code
1004L2200DX_STC1004_CD_LST_QL_CDStringCode List Qualifier Code
1101L2200DX_STC1101_HTCRCLM_CAT_CDStringHealth Care Claim Status Category Code
1102L2200DX_STC1102_STATS_CDStringStatus Code
1103L2200DX_STC1103_ENTY_ID_CDStringEntity Identifier Code
1104L2200DX_STC1104_CD_LST_QL_CDStringCode List Qualifier Code

L2200DREFPayer Claim Control Number
02L2200D_REF_PYR_CLM_NRStringPayor?s Claim Number
L2200DREFInstitutional Bill Type Identification
02L2200D_REF_BILL_TYPStringBilling Type
L2200DREFPatient Control Number
02L2200D_REF_PATNT_ACCT_NRStringPatient Account Number
L2200DREFPharmacy Prescription Number
02L2200D_REF_PHRM_RX_NRStringPharmacy Prescription Number
L2200DREFVoucher Identifier
02L2200D_REF_VOUCHRStringVoucher
L2200DREFClaim Identification Number For Clearinghouses and Other Transmission Intermediaries
02L2200D_REF_CLM_NRStringClaim Number
L2200DDTPClaim Service Date
03L2200D_DTP_SVC_D8Start DateService (D8)
03L2200D_DTP_SVC_RD8_1Start DateService (D8)
03L2200D_DTP_SVC_RD8_2End DateService (D8)
L2220D - SERVICE LINE INFORMATION
L2220DSVCService Line Information
0102L2220D_SVC0102_ADA_CDStringAmerican Dental Association Codes
0102L2220D_SVC0102_JS_PRC_SPY_CDStringJurisdiction Specific Procedure and Supply Codes
0102L2220D_SVC0102_HCPCS_CDStringHealth Care Financing Administration Common Procedural Coding System (HCPCS) Codes
0102L2220D_SVC0102_HIPPA_SNF_RT_CDStringHealth Insurance Prospective Payment System (HIPPS) Skilled Nursing Facility Rate Code
0102L2220D_SVC0102_HIC_PRD_SVCCDStringHome Infusion EDI Coalition (HIEC) Product/Service
0102L2220D_SVC0102_NDC542StringNational Drug Code in 5-4-2 Format
0102L2220D_SVC0102_NUBC_UB92_CDStringNational Uniform Billing Committee (NUBC) UB92
0102L2220D_SVC0102_ABC_CDStringAdvanced Billing Concepts (ABC) Codes
0103L2220D_SVC0103_PROC_MODStringProcedure Modifier
0104L2220D_SVC0104_PROC_MODStringProcedure Modifier
0105L2220D_SVC0105_PROC_MODStringProcedure Modifier
0106L2220D_SVC0106_PROC_MODStringProcedure Modifier
02L2220D_SVC02_LIN_ITM_CHG_AMTDecimalLine Item Charge Amount
03L2220D_SVC03_LIN_ITM_PMT_AMTDecimalLine Item Payment Amount
04L2220D_SVC04_REV_CDStringRevenue Code
07L2220D_SVC07_UN_SVC_CTDecimalUnits of Service Count
L2220DX - SERVICE LINE INFORMATION - STC CUTOUT
L2220DXSTCService Line Status Information
0101L2220DX_STC0101_HTCRCLM_CAT_CDStringHealth Care Claim Status Category Code
0102L2220DX_STC0102_STATS_CDStringStatus Code
0103L2220DX_STC0103_ENTY_ID_CDStringEntity Identifier Code
0104L2220DX_STC0104_CD_LST_QL_CDStringCode List Qualifier Code
02L2220DX_STC02_STMT_NFO_EFF_D8Date/TimeStatus Information Effective Date
1001L2220DX_STC1001_HTCRCLM_CAT_CDStringHealth Care Claim Status Category Code
1002L2220DX_STC1002_STATS_CDStringStatus Code
1003L2220DX_STC1003_ENTY_ID_CDStringEntity Identifier Code
1004L2220DX_STC1004_CD_LST_QL_CDStringCode List Qualifier Code
1101L2220DX_STC1101_HTCRCLM_CAT_CDStringHealth Care Claim Status Category Code
1102L2220DX_STC1102_STATS_CDStringStatus Code
1103L2220DX_STC1103_ENTY_ID_CDStringEntity Identifier Code
1104L2220DX_STC1104_CD_LST_QL_CDStringCode List Qualifier Code

L2220DREFService Line Item Identification
02L2220D_REF_LIN_ITMStringLine Item Control Number
L2220DDTPService Line Date
03L2220D_DTP_SVC_D8Start DateService (D8)
03L2220D_DTP_SVC_RD8_1Start DateService (D8)
03L2220D_DTP_SVC_RD8_2End DateService (D8)
L2000E - DEPENDENT LEVEL
L2000EHLDependent Level
01L2000E_HL01_HIER_ID_NRStringHierarchical ID Number
02L2000E_HL02_HIER_PARNT_ID_NRStringHierarchical Parent ID Number
L2100E - DEPENDENT NAME
L2100ENM1Dependent Name
03L2100E_NM103_PT_LNMStringPatient Last Name
04L2100E_NM104_PT_FNMStringPatient First Name
05L2100E_NM105_PT_MNMStringPatient Middle Name or Initial
07L2100E_NM107_PT_SFXStringPatient Name Suffix
L2200E - CLAIM STATUS TRACKING NUMBER
L2200ETRNClaim Status Tracking Number
02L2200E_TRN02_REF_TRAN_TRAC_NRStringReferenced Transaction Trace Number
L2200EX - CLAIM STATUS TRACKING NUMBER - STC CUTOUT
L2200EXSTCClaim Level Status Information
0101L2200EX_STC0101_HTCRCLM_CAT_CDStringHealth Care Claim Status Category Code
0102L2200EX_STC0102_STATS_CDStringStatus Code
0103L2200EX_STC0103_ENTY_ID_CDStringEntity Identifier Code
0104L2200EX_STC0104_CD_LST_QL_CDStringCode List Qualifier Code
02L2200EX_STC02_STMT_NFO_EFF_D8Date/TimeStatus Information Effective Date
04L2200EX_STC04_TOT_CLM_CHG_AMTDecimalTotal Claim Charge Amount
05L2200EX_STC05_CLM_PMT_AMTDecimalClaim Payment Amount
06L2200EX_STC06_ADJ_FINAL_D8Date/TimeAdjudication Finalized Date
08L2200EX_STC08_REMTC_D8Date/TimeRemittance Date
09L2200EX_STC09_REMTC_TRAC_NRStringRemittance Trace Number
1001L2200EX_STC1001_HTCRCLM_CAT_CDStringHealth Care Claim Status Category Code
1002L2200EX_STC1002_STATS_CDStringStatus Code
1003L2200EX_STC1003_ENTY_ID_CDStringEntity Identifier Code
1004L2200EX_STC1004_CD_LST_QL_CDStringCode List Qualifier Code
1101L2200EX_STC1101_HTCRCLM_CAT_CDStringHealth Care Claim Status Category Code
1102L2200EX_STC1102_STATS_CDStringStatus Code
1103L2200EX_STC1103_ENTY_ID_CDStringEntity Identifier Code
1104L2200EX_STC1104_CD_LST_QL_CDStringCode List Qualifier Code

L2200EREFPayer Claim Control Number
02L2200E_REF_PYR_CLM_NRStringPayor?s Claim Number
L2200EREFInstitutional Bill Type Identification
02L2200E_REF_BILL_TYPStringBilling Type
L2200EREFPatient Control Number
02L2200E_REF_PATNT_ACCT_NRStringPatient Account Number
L2200EREFPharmacy Prescription Number
02L2200E_REF_PHRM_RX_NRStringPharmacy Prescription Number
L2200EREFVoucher Identifier
02L2200E_REF_VOUCHRStringVoucher
L2200EREFClaim Identification Number For Clearinghouses and Other Transmission Intermediaries
02L2200E_REF_CLM_NRStringClaim Number
L2200EDTPClaim Service Date
03L2200E_DTP_SVC_D8Start DateService (D8)
03L2200E_DTP_SVC_RD8_1Start DateService (D8)
03L2200E_DTP_SVC_RD8_2End DateService (D8)
L2220E - SERVICE LINE INFORMATION
L2220ESVCService Line Information
0102L2220E_SVC0102_ADA_CDStringAmerican Dental Association Codes
0102L2220E_SVC0102_JS_PRC_SPY_CDStringJurisdiction Specific Procedure and Supply Codes
0102L2220E_SVC0102_HCPCS_CDStringHealth Care Financing Administration Common
0102L2220E_SVC0102_HIPPA_SNF_RT_CDStringHealth Insurance Prospective Payment System (HIPPS) Skilled Nursing Facility Rate Code
0102L2220E_SVC0102_HIC_PRD_SVCCDStringHome Infusion EDI Coalition (HIEC) Product/Service Code
0102L2220E_SVC0102_NDC542StringNational Drug Code in 5-4-2 Format
0102L2220E_SVC0102_NUBC_UB92_CDStringNational Uniform Billing Committee (NUBC) UB92 Codes
0102L2220E_SVC0102_ABC_CDStringAdvanced Billing Concepts (ABC) Codes
0103L2220E_SVC0103_PROC_MODStringProcedure Modifier
0104L2220E_SVC0104_PROC_MODStringProcedure Modifier
0105L2220E_SVC0105_PROC_MODStringProcedure Modifier
0106L2220E_SVC0106_PROC_MODStringProcedure Modifier
02L2220E_SVC02_LIN_ITM_CHG_AMTDecimalLine Item Charge Amount
03L2220E_SVC03_LIN_ITM_PMT_AMTDecimalLine Item Payment Amount
04L2220E_SVC04_REV_CDStringRevenue Code
07L2220E_SVC07_UN_SVC_CTDecimalUnits of Service Count
L2220EX - SERVICE LINE INFORMATION - STC CUTOUT
L2220EXSTCService Line Status Information
0101L2220EX_STC0101_HTCRCLM_CAT_CDStringHealth Care Claim Status Category Code
0102L2220EX_STC0102_STATS_CDStringStatus Code
0103L2220EX_STC0103_ENTY_ID_CDStringEntity Identifier Code
0104L2220EX_STC0104_CD_LST_QL_CDStringCode List Qualifier Code
02L2220EX_STC02_STMT_NFO_EFF_D8Date/TimeStatus Information Effective Date
1001L2220EX_STC1001_HTCRCLM_CAT_CDStringHealth Care Claim Status Category Code
1002L2220EX_STC1002_STATS_CDStringStatus Code
1003L2220EX_STC1003_ENTY_ID_CDStringEntity Identifier Code
1004L2220EX_STC1004_CD_LST_QL_CDStringCode List Qualifier Code
1101L2220EX_STC1101_HTCRCLM_CAT_CDStringHealth Care Claim Status Category Code
1102L2220EX_STC1102_STATS_CDStringStatus Code
1103L2220EX_STC1103_ENTY_ID_CDStringEntity Identifier Code
1104L2220EX_STC1104_CD_LST_QL_CDStringCode List Qualifier Code

L2220EREFService Line Item Identification
02L2220E_REF_LIN_ITMStringLine Item Control Number
L2220EDTPService Line Date
03L2220E_DTP_SVC_D8Start DateService (D8)
03L2220E_DTP_SVC_RD8_1Start DateService (D8)
03L2220E_DTP_SVC_RD8_2End DateService (D8)

STHDRSETransaction Set Trailer
01STHDR_SE01_TS_SEG_CTIntegerTransaction Segment Count
02STHDR_SE02_TCNStringTransaction Set Control Number

GSHDRGEFunctional Group Trailer
01GSHDR_GE01_NR_TS_INCLUDEDIntegerNumber of Transaction Sets Included
02GSHDR_GE02_GCNIntegerGroup Control Number