Segment Modifiers:
X - Distinguishing Identifier Suffix
nn - Segment Iteration (only after first iterartion)
nn - Element Repeat Iteration (only after first iterartion)

GSHDR - GROUP HEADER

GSHDR	GS	Functional Group Header
02		GSHDR_GS02_APP_SNDR_CD	String	Application Senders Code
03		GSHDR_GS03_APP_RCV_CD	String	Application Receivers Code
04		GSHDR_GS04_D8	Date/Time	Date
05		GSHDR_GS05_TM	Time	Time
06		GSHDR_GS06_GCN	Integer	Group Control Number

STHDR - TRANSACTION SET HEADER

STHDR	ST	Transaction Set Header
02		STHDR_ST02_TCN	String	Transaction Set Control Number
03		STHDR_ST03_IMP_GUID_VERS_NM	String	Implementation Guide Version Name

STHDR	BHT	Beginning of Hierarchical Transaction
01		STHDR_BHT01_HIER_STRUC_CD	String	Hierarchical Structure Code
03		STHDR_BHT03_SBM_TRANS_ID	String	Submitter Transaction Identifier
04		STHDR_BHT04_TS_CRTN_D8	Date/Time	Transaction Set Creation Date
05		STHDR_BHT05_TS_CRTN_TM	Time	Transaction Set Creation Time
06		STHDR_BHT06_TRANS_TYP_CD	String	Transaction Type Code

L2000A - UTILIZATION MANAGEMENT ORGANIZATION (UMO) LEVEL

L2000A	HL	Utilization Management Organization (UMO) Level
01		L2000A_HL01_HIER_ID_NR	String	Hierarchical ID Number
04		L2000A_HL04_HL_CHLD_CD	String	Hierarchical Child Code

L2000A	AAA	Request Validation	Iterated: [01-09]
01		L2000A_nnAAA01_VLDREQ_IND	String	Valid Request Indicator
03		L2000A_nnAAA03_REJ_RSN_CD	String	Reject Reason Code
04		L2000A_nnAAA04_FWUP_ACTCD	String	Follow-up Action Code

L2010A - UTILIZATION MANAGEMENT ORGANIZATION (UMO) NAME (Value Qualified)

Mapping Prefix: L2010A_2B - Third-Party Administrator

Mapping Prefix: L2010A_36 - Employer

Mapping Prefix: L2010A_PR - Payer

Mapping Prefix: L2010A_X3 - Utilization Management Organization

L2010A	NM1	Utilization Management Organization (UMO) Name
02		L2010A_yy_NM102_ENT_TYP_QUAL	String	Entity Type Qualifier
03		L2010A_yy_NM103_UMO_LNM	String	Utilization Management Organization (UMO) Name Last or Organization Name
04		L2010A_yy_NM104_UMO_FNM	String	Utilization Management Organization (UMO) Name First
05		L2010A_yy_NM105_UMO_MNM	String	Utilization Management Organization (UMO) Name Middle
07		L2010A_yy_NM107_UMO_SFX	String	Utilization Management Organization (UMO) Name Suffix
09		L2010A_yy_NM109_EMPLYR_ID	String	Employer?s Identification Number
09		L2010A_yy_NM109_SSN	String	Social Security Number
09		L2010A_yy_NM109_ETN_NR	String	Electronic Transmitter Identification Number (ETIN)
09		L2010A_yy_NM109_PAYR_ID	String	Payor Identification
09		L2010A_yy_NM109_HCFA_PLAN_ID	String	Centers for Medicare and Medicaid Services PlanID

L2010A	PER	Utilization Management Organization (UMO) Contact Information
02		L2010A_yy_PER02_UMO	String	Utilization Management Organization (UMO)
04		L2010A_yy_PER04_EMAIL	String	Electronic Mail
04		L2010A_yy_PER04_FAX	String	Facsimile
04		L2010A_yy_PER04_PHN_NR	String	Telephone
04		L2010A_yy_PER04_URL	String	Uniform Resource Locator (URL)
06		L2010A_yy_PER06_EMAIL	String	Electronic Mail
06		L2010A_yy_PER06_PHN_EXT	String	Telephone Extension
06		L2010A_yy_PER06_FAX	String	Facsimile
06		L2010A_yy_PER06_PHN_NR	String	Telephone
06		L2010A_yy_PER06_URL	String	Uniform Resource Locator (URL)
08		L2010A_yy_PER08_EMAIL	String	Electronic Mail
08		L2010A_yy_PER08_PHN_EXT	String	Telephone Extension
08		L2010A_yy_PER08_FAX	String	Facsimile
08		L2010A_yy_PER08_PHN_NR	String	Telephone
08		L2010A_yy_PER08_URL	String	Uniform Resource Locator (URL)

L2010A	AAA	Utilization Management Organization (UMO) Request Validation	Iterated: [01-09]
03		L2010A_yy_nnAAA03_REJ_RSN_CD	String	Reject Reason Code
04		L2010A_yy_nnAAA04_FWUP_ACTCD	String	Follow-up Action Code

L2000B - REQUESTER LEVEL

L2000B	HL	Requester Level
01		L2000B_HL01_HIER_ID_NR	String	Hierarchical ID Number
02		L2000B_HL02_HIER_PARNT_ID_NR	String	Hierarchical Parent ID Number
04		L2000B_HL04_HL_CHLD_CD	String	Hierarchical Child Code

L2010B - REQUESTER NAME (Value Qualified)

Mapping Prefix: L2010B_1P - Provider

Mapping Prefix: L2010B_FA - Facility

L2010B	NM1	Requester Name
02		L2010B_yy_NM102_ENT_TYP_QUAL	String	Entity Type Qualifier
03		L2010B_yy_NM103_REQ_LNM	String	Requester Last or Organization Name
04		L2010B_yy_NM104_REQ_FNM	String	Requester First Name
05		L2010B_yy_NM105_REQ_MNM	String	Requester Middle Name
07		L2010B_yy_NM107_REQ_SFX	String	Requester Name Suffix
09		L2010B_yy_NM109_EMP_ID_NR	String	Employer?s Identification Number
09		L2010B_yy_NM109_SSN	String	Social Security Number
09		L2010B_yy_NM109_ETIN	String	Electronic Transmitter Identification Number (ETIN)
09		L2010B_yy_NM109_NPI	String	Centers for Medicare and Medicaid Services National Provider Identifier

L2010B	REF	Requester Supplemental Identification
02		L2010B_yy_REF_UPIN	String	Provider UPIN Number
02		L2010B_yy_REF_FAC_ID	String	Facility ID Number
02		L2010B_yy_REF_EMPLR_ID_NR	String	Employer?s Identification Number
02		L2010B_yy_REF_PVR_SIT_NR	String	Provider Site Number
02		L2010B_yy_REF_PRV_PLN_ID	String	Provider Plan Network Identification Number
02		L2010B_yy_REF_FAC_NET_ID	String	Facility Network Identification Number
02		L2010B_yy_REF_SSN	String	Social Security Number
02		L2010B_yy_REF_CRR_AS_REF_NR	String	Carrier Assigned Reference Number

L2010B	AAA	Requester Request Validation	Iterated: [01-09]
03		L2010B_yy_nnAAA03_REJ_RSN_CD	String	Reject Reason Code
04		L2010B_yy_nnAAA04_FWUP_ACTCD	String	Follow-up Action Code

L2010B	PRV	Requester Provider Information
01		L2010B_yy_PRV01_PVD_CD	String	Provider Code
03		L2010B_yy_PRV03_PVR_TAX_CD	String	Provider Taxonomy Code

L2000C - SUBSCRIBER LEVEL

L2000C	HL	Subscriber Level
01		L2000C_HL01_HIER_ID_NR	String	Hierarchical ID Number
02		L2000C_HL02_HIER_PARNT_ID_NR	String	Hierarchical Parent ID Number
04		L2000C_HL04_HL_CHLD_CD	String	Hierarchical Child Code

L2010C - SUBSCRIBER NAME

L2010C	NM1	Subscriber Name
03		L2010C_NM103_SBR_LNM	String	Subscriber Last Name
04		L2010C_NM104_SBR_FNM	String	Subscriber First Name
05		L2010C_NM105_SBR_MNM	String	Subscriber Middle Name or Initial
06		L2010C_NM106_SBR_PFX	String	Subscriber Name Prefix
07		L2010C_NM107_SBR_SFX	String	Subscriber Name Suffix
09		L2010C_NM109_UNQ_HLTH_ID	String	Standard Unique Health Identifier for each Individual in the United States
09		L2010C_NM109_MEM_ID_NR	String	Member Identification Number

L2010C	REF	Subscriber Supplemental Identification	Iterated: [01-09]
02		L2010C_nnREF_GRP_POLCY_NR	String	Group or Policy Number
02		L2010C_nnREF_BRNCH_ID	String	Branch Identifier
02		L2010C_nnREF_GRP_NR	String	Group Number
02		L2010C_nnREF_DEPT_NR	String	Department Number
02		L2010C_nnREF_PATNT_ACCT_NR	String	Patient Account Number
02		L2010C_nnREF_HIC_NR	String	Health Insurance Claim (HIC) Number
02		L2010C_nnREF_ID_CRD_NR	String	Identity Card Number
02		L2010C_nnREF_INS_PLCY_NR	String	Insurance Policy Number
02		L2010C_nnREF_PLN_NET_ID	String	Plan Network Identification Number
02		L2010C_nnREF_MDCD_ID_NR	String	Medicaid Recipient Identification Number
02		L2010C_nnREF_SSN	String	Social Security Number

L2010C	N3	Subscriber Mailing Address
01		L2010C_N301_SBR_ADDR	String	Subscriber Address Line
02		L2010C_N302_SBR_ADDR	String	Subscriber Address Line

L2010C	N4	Subscriber City, State, ZIP Code
01		L2010C_N401_SBR_CITY	String	Subscriber City Name
02		L2010C_N402_SBR_STAT	String	Subscriber State Code
03		L2010C_N403_SBR_ZIP	String	Subscriber Postal Zone or ZIP Code
04		L2010C_N404_CNTRY_CD	String	Country Code
07		L2010C_N407_CNTRY_SUBDV_CD	String	Country Subdivision Code

L2010C	AAA	Subscriber Request Validation	Iterated: [01-09]
03		L2010C_nnAAA03_REJ_RSN_CD	String	Reject Reason Code
04		L2010C_nnAAA04_FWUP_ACTCD	String	Follow-up Action Code

L2010C	DMG	Subscriber Demographic Information
02		L2010C_DMG02_SBR_DOB_D8	Date/Time	Subscriber Birth Date
03		L2010C_DMG03_SUB_GENDR_CD	String	Subscriber Gender Code

L2010C	INS	Subscriber Relationship
08		L2010C_INS08_EMPMT_STAT_CD	String	Employment Status Code

L2000D - DEPENDENT LEVEL

L2000D	HL	Dependent Level
01		L2000D_HL01_HIER_ID_NR	String	Hierarchical ID Number
02		L2000D_HL02_HIER_PARNT_ID_NR	String	Hierarchical Parent ID Number
04		L2000D_HL04_HL_CHLD_CD	String	Hierarchical Child Code

L2010D - DEPENDENT NAME

L2010D	NM1	Dependent Name
03		L2010D_NM103_DEP_LNM	String	Dependent Last Name
04		L2010D_NM104_DEP_FNM	String	Dependent First Name
05		L2010D_NM105_DEP_MNM	String	Dependent Middle Name
07		L2010D_NM107_DEP_SFX	String	Dependent Name Suffix
09		L2010D_NM109_UNQ_HLTH_ID	String	Standard Unique Health Identifier for each Individual
09		L2010D_NM109_MEM_ID_NR	String	Member Identification Number

L2010D	REF	Dependent Supplemental Identification	Iterated: [01-03]
02		L2010D_nnREF_PATNT_ACCT_NR	String	Patient Account Number
02		L2010D_nnREF_SSN	String	Social Security Number

L2010D	N3	Dependent Address
01		L2010D_N301_DEP_ADDR	String	Dependent Address Line
02		L2010D_N302_DEP_ADDR	String	Dependent Address Line

L2010D	N4	Dependent City, State, ZIP Code
01		L2010D_N401_DEP_CITY	String	Dependent City Name
02		L2010D_N402_DEP_STAT	String	Dependent State Code
03		L2010D_N403_DEP_POSTL_ZIP	String	Dependent Postal Zone or ZIP Code
04		L2010D_N404_CNTRY_CD	String	Country Code
07		L2010D_N407_CNTRY_SUBDV_CD	String	Country Subdivision Code

L2010D	AAA	Dependent Request Validation	Iterated: [01-09]
03		L2010D_nnAAA03_REJ_RSN_CD	String	Reject Reason Code
04		L2010D_nnAAA04_FWUP_ACTCD	String	Follow-up Action Code

L2010D	DMG	Dependent Demographic Information
02		L2010D_DMG02_DEP_DOB_D8	Date/Time	Dependent Birth Date
03		L2010D_DMG03_DEP_GNDR_CD	String	Dependent Gender Code

L2010D	INS	Dependent Relationship
02		L2010D_INS02_IND_RELAT_CD	String	Individual Relationship Code
17		L2010D_INS17_BRTH_SEQ_NR	String	Birth Sequence Number

L2000E - PATIENT EVENT LEVEL

L2000E	HL	Patient Event Level
01		L2000E_HL01_HIER_ID_NR	String	Hierarchical ID Number
02		L2000E_HL02_HIER_PARNT_ID_NR	String	Hierarchical Parent ID Number
04		L2000E_HL04_HL_CHLD_CD	String	Hierarchical Child Code

L2000E	TRN	Patient Event Tracking Number	Iterated: [01-03]
01		L2000E_nnTRN01_TRAC_TYP_CD	String	Trace Type Code
02		L2000E_nnTRN02_PTEVT_TRAC_NR	String	Patient Event Trace Number
03		L2000E_nnTRN03_TRAC_ASS_ID	String	Trace Assigning Entity Identifier
04		L2000E_nnTRN04_TRC_ASS_ADDL_ID	String	Trace Assigning Entity Additional Identifier

L2000E	AAA	Patient Event Request Validation	Iterated: [01-09]
03		L2000E_nnAAA03_REJ_RSN_CD	String	Reject Reason Code
04		L2000E_nnAAA04_FWUP_ACTCD	String	Follow-up Action Code

L2000E	UM	Health Care Services Review Information
01		L2000E_UM01_REQST_CAT_CD	String	Request Category Code
02		L2000E_UM02_CERT_TYP_CD	String	Certification Type Code
03		L2000E_UM03_SVC_TYP_CD	String	Service Type Code
04	01	L2000E_UM0401_FAC_TYP_CD	String	Facility Type Code
04	02	L2000E_UM0402_FAC_CD_QUAL	String	Facility Code Qualifier
06		L2000E_UM06_LVL_SVC_CD	String	Level of Service Code

L2000E	HCR	Health Care Services Review
01		L2000E_HCR01_ACTN_CD	String	Action Code
02		L2000E_HCR02_RVW_ID_NR	String	Review Identification Number
03		L2000E_HCR03_Enn_RVW_DEC_RSN_CD	String	Review Decision Reason Code
04		L2000E_HCR04_2ND_SURG_OPN_IND	String	Second Surgical Opinion Indicator

L2000E	REF	Administrative Reference Number
02		L2000E_REF_ADMIN_REF_NR	String	Administrator?s Reference Number

L2000E	REF	Previous Review Authorization Number
02		L2000E_REF_AUTH_NR	String	Authorization Number

L2000E	DTP	Accident Date
03		L2000E_DTP_ACCDNT_D8	Start Date	Accident (D8)

L2000E	DTP	Last Menstrual Period Date
03		L2000E_DTP_MENS_PERD_D8	Start Date	Last Menstrual Period (D8)

L2000E	DTP	Estimated Date of Birth
03		L2000E_DTP_EST_DOB_D8	Start Date	Estimated Date of Birth (D8)

L2000E	DTP	Onset of Current Symptoms or Illness Date
03		L2000E_DTP_ONST_CURR_SYMPTM_D8	Start Date	Onset of Current Symptoms or Illness (D8)

L2000E	DTP	Event Date
03		L2000E_DTP_EVNT_D8	Start Date	Event (D8)
03		L2000E_DTP_EVNT_RD8_1	Start Date	Event (D8)
03		L2000E_DTP_EVNT_RD8_2	End Date	Event (D8)

L2000E	DTP	Admission Date
03		L2000E_DTP_ADMSN_D8	Start Date	Admission (D8)
03		L2000E_DTP_ADMSN_RD8_1	Start Date	Admission (D8)
03		L2000E_DTP_ADMSN_RD8_2	End Date	Admission (D8)

L2000E	DTP	Discharge Date
03		L2000E_DTP_DISCHG_D8	Start Date	Discharge (D8)

L2000E	DTP	Certification Issue Date
03		L2000E_DTP_ISSU_D8	Start Date	Issue (D8)

L2000E	DTP	Certification Expiration Date
03		L2000E_DTP_EXP_D8	Start Date	Expiration (D8)

L2000E	DTP	Certification Effective Date
03		L2000E_DTP_EFF_D8	Start Date	Effective (D8)
03		L2000E_DTP_EFF_RD8_1	Start Date	Effective (D8)
03		L2000E_DTP_EFF_RD8_2	End Date	Effective (D8)

L2000E	HI	Patient Diagnosis
01	02	L2000E_HI0102_ICD10_DIAG	String	International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis
01	02	L2000E_HI0102_ICD10_ADMTG_DIAG	String	International Classification of Diseases Clinical Modification (ICD-10-CM) Admitting Diagnosis
01	02	L2000E_HI0102_ICD10_PRIN_DIAG	String	International Classification of Diseases Clinical Modification (ICD-10-CM) Principal Diagnosis
01	02	L2000E_HI0102_ICD10_RSN_VISIT	String	International Classification of Diseases Clinical Modification (ICD-10-CM) Patient?s Reason for Visit
01	02	L2000E_HI0102_ICD9_DIAG	String	International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis
01	02	L2000E_HI0102_ICD9_ADMTG_DIAG	String	International Classification of Diseases Clinical Modification (ICD-9-CM) Admitting Diagnosis
01	02	L2000E_HI0102_ICD9_PRIN_DIAG	String	International Classification of Diseases Clinical Modification (ICD-9-CM) Principal Diagnosis
01	02	L2000E_HI0102_DRG	String	Diagnosis Related Group (DRG)
01	02	L2000E_HI0102_LOINC	String	Logical Observation Identifier Names and Codes (LOINC) Codes
01	02	L2000E_HI0102_ICD9_RSN_VISIT	String	International Classification of Diseases Clinical Modification (ICD-9-CM) Patient?s Reason for Visit
01	04	L2000E_HI0104_D8_D8	Date/Time	Date Expressed in Format CCYYMMDD
02	02	L2000E_HI0202_ICD10_DIAG	String	International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis
02	02	L2000E_HI0202_ICD10_ADMTG_DIAG	String	International Classification of Diseases Clinical Modification (ICD-10-CM) Admitting Diagnosis
02	02	L2000E_HI0202_ICD10_RSN_VISIT	String	International Classification of Diseases Clinical Modification (ICD-10-CM) Patient?s Reason for Visit
02	02	L2000E_HI0202_ICD9_DIAG	String	International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis
02	02	L2000E_HI0202_ICD9_ADMTG_DIAG	String	International Classification of Diseases Clinical Modification (ICD-9-CM) Admitting Diagnosis
02	02	L2000E_HI0202_DRG	String	Diagnosis Related Group (DRG)
02	02	L2000E_HI0202_LOINC	String	Logical Observation Identifier Names and Codes (LOINC) Codes
02	02	L2000E_HI0202_ICD9_RSN_VISIT	String	International Classification of Diseases Clinical Modification (ICD-9-CM) Patient?s Reason for Visit
02	04	L2000E_HI0204_D8_D8	Date/Time	Date Expressed in Format CCYYMMDD
03	02	L2000E_HI0302_ICD10_DIAG	String	International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis
03	02	L2000E_HI0302_ICD10_RSN_VISIT	String	International Classification of Diseases Clinical Modification (ICD-10-CM) Patient?s Reason for Visit
03	02	L2000E_HI0302_ICD9_DIAG	String	International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis
03	02	L2000E_HI0302_DRG	String	Diagnosis Related Group (DRG)
03	02	L2000E_HI0302_LOINC	String	Logical Observation Identifier Names and Codes (LOINC) Codes
03	02	L2000E_HI0302_ICD9_RSN_VISIT	String	International Classification of Diseases Clinical Modification (ICD-9-CM) Patient?s Reason for Visit
03	04	L2000E_HI0304_D8_D8	Date/Time	Date Expressed in Format CCYYMMDD
04	02	L2000E_HI0402_ICD10_DIAG	String	International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis
04	02	L2000E_HI0402_ICD10_RSN_VISIT	String	International Classification of Diseases Clinical Modification (ICD-10-CM) Patient?s Reason for Visit
04	02	L2000E_HI0402_ICD9_DIAG	String	International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis
04	02	L2000E_HI0402_DRG	String	Diagnosis Related Group (DRG)
04	02	L2000E_HI0402_LOINC	String	Logical Observation Identifier Names and Codes (LOINC) Codes
04	02	L2000E_HI0402_ICD9_RSN_VISIT	String	International Classification of Diseases Clinical Modification (ICD-9-CM) Patient?s Reason for Visit
04	04	L2000E_HI0404_D8_D8	Date/Time	Date Expressed in Format CCYYMMDD
05	02	L2000E_HI0502_ICD10_DIAG	String	International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis
05	02	L2000E_HI0502_ICD10_RSN_VISIT	String	International Classification of Diseases Clinical Modification (ICD-10-CM) Patient?s Reason for Visit
05	02	L2000E_HI0502_ICD9_DIAG	String	International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis
05	02	L2000E_HI0502_DRG	String	Diagnosis Related Group (DRG)
05	02	L2000E_HI0502_LOINC	String	Logical Observation Identifier Names and Codes (LOINC) Codes
05	02	L2000E_HI0502_ICD9_RSN_VISIT	String	International Classification of Diseases Clinical Modification (ICD-9-CM) Patient?s Reason for Visit
05	04	L2000E_HI0504_D8_D8	Date/Time	Date Expressed in Format CCYYMMDD
06	02	L2000E_HI0602_ICD10_DIAG	String	International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis
06	02	L2000E_HI0602_ICD10_RSN_VISIT	String	International Classification of Diseases Clinical Modification (ICD-10-CM) Patient?s Reason for Visit
06	02	L2000E_HI0602_ICD9_DIAG	String	International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis
06	02	L2000E_HI0602_DRG	String	Diagnosis Related Group (DRG)
06	02	L2000E_HI0602_LOINC	String	Logical Observation Identifier Names and Codes (LOINC) Codes
06	02	L2000E_HI0602_ICD9_RSN_VISIT	String	International Classification of Diseases Clinical Modification (ICD-9-CM) Patient?s Reason for Visit
06	04	L2000E_HI0604_D8_D8	Date/Time	Date Expressed in Format CCYYMMDD
07	02	L2000E_HI0702_ICD10_DIAG	String	International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis
07	02	L2000E_HI0702_ICD10_RSN_VISIT	String	International Classification of Diseases Clinical Modification (ICD-10-CM) Patient?s Reason for Visit
07	02	L2000E_HI0702_ICD9_DIAG	String	International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis
07	02	L2000E_HI0702_DRG	String	Diagnosis Related Group (DRG)
07	02	L2000E_HI0702_LOINC	String	Logical Observation Identifier Names and Codes (LOINC) Codes
07	02	L2000E_HI0702_ICD9_RSN_VISIT	String	International Classification of Diseases Clinical Modification (ICD-9-CM) Patient?s Reason for Visit
07	04	L2000E_HI0704_D8_D8	Date/Time	Date Expressed in Format CCYYMMDD
08	02	L2000E_HI0802_ICD10_DIAG	String	International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis
08	02	L2000E_HI0802_ICD10_RSN_VISIT	String	International Classification of Diseases Clinical Modification (ICD-10-CM) Patient?s Reason for Visit
08	02	L2000E_HI0802_ICD9_DIAG	String	International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis
08	02	L2000E_HI0802_DRG	String	Diagnosis Related Group (DRG)
08	02	L2000E_HI0802_LOINC	String	Logical Observation Identifier Names and Codes
08	02	L2000E_HI0802_ICD9_RSN_VISIT	String	International Classification of Diseases Clinical Modification (ICD-9-CM) Patient?s Reason for Visit
08	04	L2000E_HI0804_D8_D8	Date/Time	Date Expressed in Format CCYYMMDD
09	02	L2000E_HI0902_ICD10_DIAG	String	International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis
09	02	L2000E_HI0902_ICD10_RSN_VISIT	String	International Classification of Diseases Clinical Modification (ICD-10-CM) Patient?s Reason for Visit
09	02	L2000E_HI0902_ICD9_DIAG	String	International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis
09	02	L2000E_HI0902_DRG	String	Diagnosis Related Group (DRG)
09	02	L2000E_HI0902_LOINC	String	Logical Observation Identifier Names and Codes (LOINC) Codes
09	02	L2000E_HI0902_ICD9_RSN_VISIT	String	International Classification of Diseases Clinical Modification (ICD-9-CM) Patient?s Reason for Visit
09	04	L2000E_HI0904_D8_D8	Date/Time	Date Expressed in Format CCYYMMDD
10	02	L2000E_HI1002_ICD10_DIAG	String	International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis
10	02	L2000E_HI1002_ICD10_RSN_VISIT	String	International Classification of Diseases Clinical Modification (ICD-10-CM) Patient?s Reason for Visit
10	02	L2000E_HI1002_ICD9_DIAG	String	International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis
10	02	L2000E_HI1002_DRG	String	Diagnosis Related Group (DRG)
10	02	L2000E_HI1002_LOINC	String	Logical Observation Identifier Names and Codes (LOINC) Codes
10	02	L2000E_HI1002_ICD9_RSN_VISIT	String	International Classification of Diseases Clinical Modification (ICD-9-CM) Patient?s Reason for Visit
10	04	L2000E_HI1004_D8_D8	Date/Time	Date Expressed in Format CCYYMMDD
11	02	L2000E_HI1102_ICD10_DIAG	String	International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis
11	02	L2000E_HI1102_ICD10_RSN_VISIT	String	International Classification of Diseases Clinical Modification (ICD-10-CM) Patient?s Reason for Visit
11	02	L2000E_HI1102_ICD9_DIAG	String	International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis
11	02	L2000E_HI1102_DRG	String	Diagnosis Related Group (DRG)
11	02	L2000E_HI1102_LOINC	String	Logical Observation Identifier Names and Codes (LOINC) Codes
11	02	L2000E_HI1102_ICD9_RSN_VISIT	String	International Classification of Diseases Clinical Modification (ICD-9-CM) Patient?s Reason for Visit
11	04	L2000E_HI1104_D8_D8	Date/Time	Date Expressed in Format CCYYMMDD
12	02	L2000E_HI1202_ICD10_DIAG	String	International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis
12	02	L2000E_HI1202_ICD10_RSN_VISIT	String	International Classification of Diseases Clinical Modification (ICD-10-CM) Patient?s Reason for Visit
12	02	L2000E_HI1202_ICD9_DIAG	String	International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis
12	02	L2000E_HI1202_DRG	String	Diagnosis Related Group (DRG)
12	02	L2000E_HI1202_LOINC	String	Logical Observation Identifier Names and Codes (LOINC) Codes
12	02	L2000E_HI1202_ICD9_RSN_VISIT	String	International Classification of Diseases Clinical Modification (ICD-9-CM) Patient?s Reason for Visit
12	04	L2000E_HI1204_D8_D8	Date/Time	Date Expressed in Format CCYYMMDD

L2000E	HSD	Health Care Services Delivery
02		L2000E_HSD02_DAYS	Decimal	Days
02		L2000E_HSD02_UN	Decimal	Units
02		L2000E_HSD02_HR	Decimal	Hours
02		L2000E_HSD02_MO	Decimal	Month
02		L2000E_HSD02_VIST	Decimal	Visits
04		L2000E_HSD04_DAYS	Decimal	Days
04		L2000E_HSD04_MOS	Decimal	Months
04		L2000E_HSD04_WK	Decimal	Week
06		L2000E_HSD06_HR	Integer	Hour
06		L2000E_HSD06_DAY	Integer	Day
06		L2000E_HSD06_YEARS	Integer	Years
06		L2000E_HSD06_EPISD	Integer	Episode
06		L2000E_HSD06_VIST	Integer	Visit
06		L2000E_HSD06_MO	Integer	Month
06		L2000E_HSD06_WK	Integer	Week
07		L2000E_HSD07_DLVY_FREQ_CD	String	Delivery Frequency Code
08		L2000E_HSD08_DVY_PT_TM_CD	String	Delivery Pattern Time Code

L2000E	CL1	Institutional Claim Code
01		L2000E_CL101_ADMSN_TYP_CD	String	Admission Type Code
02		L2000E_CL102_ADMSN_SRC_CD	String	Admission Source Code
03		L2000E_CL103_PT_STATS_CD	String	Patient Status Code

L2000E	CR1	Ambulance Transport Information
03		L2000E_CR103_AMB_TRANS_CD	String	Ambulance Transport Code
06		L2000E_CR106_MILES	Decimal	Miles
06		L2000E_CR106_KM	Decimal	Kilometers

L2000E	CR2	Spinal Manipulation Service Information
01		L2000E_CR201_TMT_SERS_NR	Integer	Treatment Series Number
02		L2000E_CR202_TMT_CT	Decimal	Treatment Count
03		L2000E_CR203_SUBLUX_LVL_CD	String	Subluxation Level Code
04		L2000E_CR204_SUBLUX_LVL_CD	String	Subluxation Level Code

L2000E	CR5	Home Oxygen Therapy Information
03		L2000E_CR503_OXY_EQP_TYP_CD	String	Oxygen Equipment Type Code
04		L2000E_CR504_OXY_EQP_TYP_CD	String	Oxygen Equipment Type Code
06		L2000E_CR506_OXYGN_FLOW_RT	Decimal	Oxygen Flow Rate
07		L2000E_CR507_DLY_OXY_USE_CT	Decimal	Daily Oxygen Use Count
08		L2000E_CR508_OXY_USE_HOUR_CT	Decimal	Oxygen Use Period Hour Count
09		L2000E_CR509_RSP_THRP_ORD_TXT	String	Respiratory Therapist Order Text
16		L2000E_CR516_PORT_OXY_FLOW_RT	Decimal	Portable Oxygen System Flow Rate
17		L2000E_CR517_OXY_DEL_SYS_CD	String	Oxygen Delivery System Code
18		L2000E_CR518_OXY_EQP_TYP_CD	String	Oxygen Equipment Type Code

L2000E	CR6	Home Health Care Information
01		L2000E_CR601_PROGNS_CD	String	Prognosis Code
02		L2000E_CR602_HOMHLTH_START_D8	Date/Time	Home Health Start Date
04		L2000E_CR604_HOMHLTH_CERT_PRD	String	Home Health Certification Period
08		L2000E_CR608_CERT_TYP_CD	String	Certification Type Code

L2000E	PWK	Additional Patient Information	Iterated: [01-10]
01		L2000E_nnPWK01_ATT_REP_TYP_CD	String	Attachment Report Type Code
02		L2000E_nnPWK02_REPT_TRNS_CD	String	Report Transmission Code
06		L2000E_nnPWK06_ATTACH_CTL_NR	String	Attachment Control Number
07		L2000E_nnPWK07_ATTCH_DESCR	String	Attachment Description

L2000E	MSG	Message Text
01		L2000E_MSG01_FRFM_MSG_TXT	String	Free Form Message Text

L2010EA - PATIENT EVENT PROVIDER NAME (Value Qualified)

Mapping Prefix: L2010EA_71 - Attending Physician

Mapping Prefix: L2010EA_72 - Operating Physician

Mapping Prefix: L2010EA_73 - Other Physician

Mapping Prefix: L2010EA_77 - Service Location

Mapping Prefix: L2010EA_AAJ - Admitting Services

Mapping Prefix: L2010EA_DD - Assistant Surgeon

Mapping Prefix: L2010EA_DK - Ordering Physician

Mapping Prefix: L2010EA_DN - Referring Provider

Mapping Prefix: L2010EA_FA - Facility

Mapping Prefix: L2010EA_G3 - Clinic

Mapping Prefix: L2010EA_P3 - Primary Care Provider

Mapping Prefix: L2010EA_QB - Purchase Service Provider

Mapping Prefix: L2010EA_QV - Group Practice

Mapping Prefix: L2010EA_SJ - Service Provider

L2010EA	NM1	Patient Event Provider Name
02		L2010EA_yy_NM102_ENT_TYP_QUAL	String	Entity Type Qualifier
03		L2010EA_yy_NM103_PTEVT_PVR_LNM	String	Patient Event Provider Last or Organization Name
04		L2010EA_yy_NM104_PTEVT_PVR_FNM	String	Patient Event Provider First Name
05		L2010EA_yy_NM105_PTEVT_PVR_MNM	String	Patient Event Provider Middle Name
06		L2010EA_yy_NM106_PTEVT_PVR_PFX	String	Patient Event Provider Name Prefix
07		L2010EA_yy_NM107_PTEVT_PVR_SFX	String	Patient Event Provider Name Suffix
09		L2010EA_yy_NM109_EMPLYR_ID	String	Employer?s Identification Number
09		L2010EA_yy_NM109_SSN	String	Social Security Number
09		L2010EA_yy_NM109_ETN_NR	String	Electronic Transmitter Identification Number (ETIN)
09		L2010EA_yy_NM109_NPI	String	Centers for Medicare and Medicaid Services National Provider Identifier

L2010EA	REF	Patient Event Provider Supplemental Identification	Iterated: [01-07]
02		L2010EA_yy_nnREF_STAT_LIC_NR	String	State License Number
02		L2010EA_yy_nnREF_UPIN	String	Provider UPIN Number
02		L2010EA_yy_nnREF_FAC_ID	String	Facility ID Number
02		L2010EA_yy_nnREF_EMPLR_ID_NR	String	Employer?s Identification Number
02		L2010EA_yy_nnREF_PRV_PLN_ID	String	Provider Plan Network Identification Number
02		L2010EA_yy_nnREF_FAC_NET_ID	String	Facility Network Identification Number
02		L2010EA_yy_nnREF_SSN	String	Social Security Number
02		L2010EA_yy_nnREF_CRR_AS_REF_NR	String	Carrier Assigned Reference Number
03		L2010EA_yy_nnREF03_LIC_NR_STAT	String	License Number State Code

L2010EA	N3	Patient Event Provider Address
01		L2010EA_yy_N301_PTEVT_PVR_ADDR	String	Patient Event Provider Address Line
02		L2010EA_yy_N302_PTEVT_PVR_ADDR	String	Patient Event Provider Address Line

L2010EA	N4	Patient Event Provider City, State, ZIP Code
01		L2010EA_yy_N401_PTEVT_PVR_CITY	String	Patient Event Provider City Name
02		L2010EA_yy_N402_PTEVT_PVR_STAT	String	Patient Event Provider State Code
03		L2010EA_yy_N403_PTEVT_PVR_ZIP	String	Patient Event Provider Postal Zone or ZIP Code
04		L2010EA_yy_N404_CNTRY_CD	String	Country Code
07		L2010EA_yy_N407_CNTRY_SUBDV_CD	String	Country Subdivision Code

L2010EA	PER	Provider Contact Information
02		L2010EA_yy_PER02_PTEVT_PVR_CON	String	Patient Event Provider Contact Name
04		L2010EA_yy_PER04_EMAIL	String	Electronic Mail
04		L2010EA_yy_PER04_FAX	String	Facsimile
04		L2010EA_yy_PER04_PHN_NR	String	Telephone
04		L2010EA_yy_PER04_URL	String	Uniform Resource Locator (URL)
06		L2010EA_yy_PER06_EMAIL	String	Electronic Mail
06		L2010EA_yy_PER06_PHN_EXT	String	Telephone Extension
06		L2010EA_yy_PER06_FAX	String	Facsimile
06		L2010EA_yy_PER06_PHN_NR	String	Telephone
06		L2010EA_yy_PER06_URL	String	Uniform Resource Locator (URL)
08		L2010EA_yy_PER08_EMAIL	String	Electronic Mail
08		L2010EA_yy_PER08_PHN_EXT	String	Telephone Extension
08		L2010EA_yy_PER08_FAX	String	Facsimile
08		L2010EA_yy_PER08_PHN_NR	String	Telephone
08		L2010EA_yy_PER08_URL	String	Uniform Resource Locator (URL)

L2010EA	AAA	Patient Event Provider Request Validation	Iterated: [01-09]
03		L2010EA_yy_nnAAA03_REJ_RSN_CD	String	Reject Reason Code
04		L2010EA_yy_nnAAA04_FWUP_ACTCD	String	Follow-up Action Code

L2010EA	PRV	Patient Event Provider Information
01		L2010EA_yy_PRV01_PVD_CD	String	Provider Code
03		L2010EA_yy_PRV03_PVR_TAX_CD	String	Provider Taxonomy Code

L2010EB - ADDITIONAL PATIENT INFORMATION CONTACT NAME

L2010EB	NM1	Additional Patient Information Contact Name
02		L2010EB_NM102_ENT_TYP_QUAL	String	Entity Type Qualifier
03		L2010EB_NM103_RSP_CON_LNM	String	Response Contact Last or Organization Name
04		L2010EB_NM104_RESP_CON_FNM	String	Response Contact First Name
05		L2010EB_NM105_RSP_CON_MNM	String	Response Contact Middle Name
07		L2010EB_NM107_RESP_CON_SFX	String	Response Contact Name Suffix
09		L2010EB_NM109_EMPLYR_ID	String	Employer?s Identification Number
09		L2010EB_NM109_SSN	String	Social Security Number
09		L2010EB_NM109_ETN_NR	String	Electronic Transmitter Identification Number (ETIN)
09		L2010EB_NM109_PAYR_ID	String	Payor Identification
09		L2010EB_NM109_HCFA_PLAN_ID	String	Centers for Medicare and Medicaid Services PlanID
09		L2010EB_NM109_NPI	String	Centers for Medicare and Medicaid Services National Provider Identifier

L2010EB	N3	Additional Patient Information Contact Address
01		L2010EB_N301_RESP_CON_ADDR	String	Response Contact Address Line
02		L2010EB_N302_RESP_CON_ADDR	String	Response Contact Address Line

L2010EB	N4	Additional Patient Information Contact City, State, ZIP Code
01		L2010EB_N401_ADDTL_PT_NFO_CITY	String	Additional Patient Information Contact City Name
02		L2010EB_N402_ADDL_PTNFO_STAT	String	Additional Patient Information Contact State Code
03		L2010EB_N403_ADDL_PT_NFO_POSTL	String	Additional Patient Information Contact Postal
04		L2010EB_N404_CNTRY_CD	String	Country Code
07		L2010EB_N407_CNTRY_SUBDV_CD	String	Country Subdivision Code

L2010EB	PER	Additional Patient Information Contact Information
02		L2010EB_PER02_RSP_CON_NM	String	Response Contact Name
04		L2010EB_PER04_EMAIL	String	Electronic Mail
04		L2010EB_PER04_FAX	String	Facsimile
04		L2010EB_PER04_PHN_NR	String	Telephone
04		L2010EB_PER04_URL	String	Uniform Resource Locator (URL)
06		L2010EB_PER06_EMAIL	String	Electronic Mail
06		L2010EB_PER06_PHN_EXT	String	Telephone Extension
06		L2010EB_PER06_FAX	String	Facsimile
06		L2010EB_PER06_PHN_NR	String	Telephone
08		L2010EB_PER08_EMAIL	String	Electronic Mail
08		L2010EB_PER08_PHN_EXT	String	Telephone Extension
08		L2010EB_PER08_FAX	String	Facsimile
08		L2010EB_PER08_PHN_NR	String	Telephone

L2010EC - PATIENT EVENT TRANSPORT INFORMATION (Value Qualified)

Mapping Prefix: L2010EC_45 - Drop-off Location

Mapping Prefix: L2010EC_FS - Final Scheduled Destination

Mapping Prefix: L2010EC_ND - Next Destination

Mapping Prefix: L2010EC_PW - Pickup Address

Mapping Prefix: L2010EC_R3 - Next Scheduled Destination

L2010EC	NM1	Patient Event Transport Information
03		L2010EC_yy_NM103_PTEVT_TRN_LOC	String	Patient Event Transport Location Name

L2010EC	N3	Patient Event Transport Location Address
01		L2010EC_yy_N301_PTEVT_TRN_ADDR	String	Patient Event Transport Location Address Line
02		L2010EC_yy_N302_PTEVT_TRN_ADDR	String	Patient Event Transport Location Address Line

L2010EC	N4	Patient Event Transport Location City/State/ZIP Code
01		L2010EC_yy_N401_PTEVT_TRN_CITY	String	Patient Event Transport Location City Name
02		L2010EC_yy_N402_PTEVT_TRN_STAT	String	Patient Event Transport Location State or
03		L2010EC_yy_N403_PTEVT_ZIP	String	Patient Event Transport Location Postal Zone or

L2010EC	AAA	Patient Event Transport Location Request Validation	Iterated: [01-09]
03		L2010EC_yy_nnAAA03_REJ_RSN_CD	String	Reject Reason Code
04		L2010EC_yy_nnAAA04_FWUP_ACTCD	String	Follow-up Action Code

L2000F - SERVICE LEVEL

L2000F	HL	Service Level
01		L2000F_HL01_HIER_ID_NR	String	Hierarchical ID Number
02		L2000F_HL02_HIER_PARNT_ID_NR	String	Hierarchical Parent ID Number

L2000F	TRN	Service Trace Number	Iterated: [01-03]
01		L2000F_nnTRN01_TRAC_TYP_CD	String	Trace Type Code
02		L2000F_nnTRN02_SVC_TRAC_NR	String	Service Trace Number
03		L2000F_nnTRN03_TRAC_ASS_ID	String	Trace Assigning Entity Identifier
04		L2000F_nnTRN04_TRC_ASS_ADDL_ID	String	Trace Assigning Entity Additional Identifier

L2000F	AAA	Service Request Validation	Iterated: [01-09]
03		L2000F_nnAAA03_REJ_RSN_CD	String	Reject Reason Code
04		L2000F_nnAAA04_FWUP_ACTCD	String	Follow-up Action Code

L2000F	UM	Health Care Services Review Information
01		L2000F_UM01_REQST_CAT_CD	String	Request Category Code
02		L2000F_UM02_CERT_TYP_CD	String	Certification Type Code
03		L2000F_UM03_SVC_TYP_CD	String	Service Type Code
04	01	L2000F_UM0401_FAC_TYP_CD	String	Facility Type Code
04	02	L2000F_UM0402_FAC_CD_QUAL	String	Facility Code Qualifier

L2000F	HCR	Health Care Services Review
01		L2000F_HCR01_ACTN_CD	String	Action Code
02		L2000F_HCR02_RVW_ID_NR	String	Review Identification Number
03		L2000F_HCR03_Enn_RVW_DEC_RSN_CD	String	Review Decision Reason Code
04		L2000F_HCR04_2ND_SURG_OPN_IND	String	Second Surgical Opinion Indicator

L2000F	REF	Administrative Reference Number
02		L2000F_REF_ADMIN_REF_NR	String	Administrator?s Reference Number

L2000F	REF	Previous Review Authorization Number
02		L2000F_REF_AUTH_NR	String	Authorization Number

L2000F	DTP	Service Date
03		L2000F_DTP_SVC_D8	Start Date	Service (D8)
03		L2000F_DTP_SVC_RD8_1	Start Date	Service (D8)
03		L2000F_DTP_SVC_RD8_2	End Date	Service (D8)

L2000F	DTP	Certification Issue Date
03		L2000F_DTP_ISSU_D8	Start Date	Issue (D8)

L2000F	DTP	Certification Expiration Date
03		L2000F_DTP_EXP_D8	Start Date	Expiration (D8)

L2000F	DTP	Certification Effective Date
03		L2000F_DTP_EFF_D8	Start Date	Effective (D8)
03		L2000F_DTP_EFF_RD8_1	Start Date	Effective (D8)
03		L2000F_DTP_EFF_RD8_2	End Date	Effective (D8)

L2000F	HI	Request For Additional Information
01	02	L2000F_HI0102_LOINC	String	Logical Observation Identifier Names and Codes (LOINC) Codes
02	02	L2000F_HI0202_LOINC	String	Logical Observation Identifier Names and Codes (LOINC) Codes
03	02	L2000F_HI0302_LOINC	String	Logical Observation Identifier Names and Codes (LOINC) Codes
04	02	L2000F_HI0402_LOINC	String	Logical Observation Identifier Names and Codes (LOINC) Codes
05	02	L2000F_HI0502_LOINC	String	Logical Observation Identifier Names and Codes (LOINC) Codes
06	02	L2000F_HI0602_LOINC	String	Logical Observation Identifier Names and Codes (LOINC) Codes
07	02	L2000F_HI0702_LOINC	String	Logical Observation Identifier Names and Codes (LOINC) Codes
08	02	L2000F_HI0802_LOINC	String	Logical Observation Identifier Names and Codes (LOINC) Codes
09	02	L2000F_HI0902_LOINC	String	Logical Observation Identifier Names and Codes (LOINC) Codes
10	02	L2000F_HI1002_LOINC	String	Logical Observation Identifier Names and Codes (LOINC) Codes
11	02	L2000F_HI1102_LOINC	String	Logical Observation Identifier Names and Codes (LOINC) Codes
12	02	L2000F_HI1202_LOINC	String	Logical Observation Identifier Names and Codes (LOINC) Codes

L2000F	SV1	Professional Service
01	02	L2000F_SV10102_HCPCS_CD	String	Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes
01	02	L2000F_SV10102_HIC_PRD_SVCCD	String	Home Infusion EDI Coalition (HIEC) Product/Service Code
01	02	L2000F_SV10102_NDC542	String	National Drug Code in 5-4-2 Format
01	02	L2000F_SV10102_ABC_CD	String	Advanced Billing Concepts (ABC) Codes
01	03	L2000F_SV10103_PROC_MOD	String	Procedure Modifier
01	04	L2000F_SV10104_PROC_MOD	String	Procedure Modifier
01	05	L2000F_SV10105_PROC_MOD	String	Procedure Modifier
01	06	L2000F_SV10106_PROC_MOD	String	Procedure Modifier
01	07	L2000F_SV10107_PROC_CD_DESC	String	Procedure Code Description
01	08	L2000F_SV10108_PROC_CD	String	Procedure Code
02		L2000F_SV102_SVC_LIN_AMT	Decimal	Service Line Amount
04		L2000F_SV104_INTL_UN	Decimal	International Unit
04		L2000F_SV104_MIN	Decimal	Minutes
04		L2000F_SV104_UN	Decimal	Unit
11		L2000F_SV111_EPSDT_IND	String	EPSDT Indicator
20		L2000F_SV120_NRSG_LVL_CAR	String	Nursing Home Level of Care

L2000F	SV2	Institutional Service Line
01		L2000F_SV201_SVC_LIN_REV_CD	String	Service Line Revenue Code
02	02	L2000F_SV20202_HCPCS_CD	String	Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes
02	02	L2000F_SV20202_ICD9_PROC	String	International Classification of Diseases Clinical Modification (ICD-9-CM) - Procedure
02	02	L2000F_SV20202_HIC_PRD_SVCCD	String	Home Infusion EDI Coalition (HIEC) Product/Service Code
02	02	L2000F_SV20202_NDC542	String	National Drug Code in 5-4-2 Format
02	02	L2000F_SV20202_ABC_CD	String	Advanced Billing Concepts (ABC) Codes
02	02	L2000F_SV20202_MUTLY_DEF	String	Mutually Defined
02	03	L2000F_SV20203_PROC_MOD	String	Procedure Modifier
02	04	L2000F_SV20204_PROC_MOD	String	Procedure Modifier
02	05	L2000F_SV20205_PROC_MOD	String	Procedure Modifier
02	06	L2000F_SV20206_PROC_MOD	String	Procedure Modifier
02	07	L2000F_SV20207_PROC_CD_DESC	String	Procedure Code Description
02	08	L2000F_SV20208_PROC_CD	String	Procedure Code
03		L2000F_SV203_SVC_LIN_AMT	Decimal	Service Line Amount
05		L2000F_SV205_DAYS	Decimal	Days
05		L2000F_SV205_INTL_UN	Decimal	International Unit
05		L2000F_SV205_UN	Decimal	Unit
06		L2000F_SV206_SVC_LIN_RT	Decimal	Service Line Rate
10		L2000F_SV210_NRSG_LVL_CAR	String	Nursing Home Level of Care

L2000F	SV3	Dental Service
01	02	L2000F_SV30102_ADA_CD	String	American Dental Association Codes
01	03	L2000F_SV30103_PROC_MOD	String	Procedure Modifier
01	04	L2000F_SV30104_PROC_MOD	String	Procedure Modifier
01	05	L2000F_SV30105_PROC_MOD	String	Procedure Modifier
01	06	L2000F_SV30106_PROC_MOD	String	Procedure Modifier
01	07	L2000F_SV30107_PROC_CD_DESC	String	Procedure Code Description
01	08	L2000F_SV30108_PROC_CD	String	Procedure Code
02		L2000F_SV302_SVC_LIN_AMT	Decimal	Service Line Amount
04	01	L2000F_SV30401_ORAL_CAV_DES_CD	String	Oral Cavity Designation Code
04	02	L2000F_SV30402_ORAL_CAV_DES_CD	String	Oral Cavity Designation Code
04	03	L2000F_SV30403_ORAL_CAV_DES_CD	String	Oral Cavity Designation Code
04	04	L2000F_SV30404_ORAL_CAV_DES_CD	String	Oral Cavity Designation Code
04	05	L2000F_SV30405_ORAL_CAV_DES_CD	String	Oral Cavity Designation Code
05		L2000F_SV305_PROS_CWN_INLY_CD	String	Prosthesis, Crown, or Inlay Code
06		L2000F_SV306_SVC_UN_CT	Decimal	Service Unit Count

L2000FX - SERVICE LEVEL - TOO CUTOUT

L2000FX	TOO	Tooth Information
02		L2000FX_TOO02_TOOTH_CD	String	Tooth Code
03	01	L2000FX_TOO0301_TOOTH_SURF_CD	String	Tooth Surface Code
03	02	L2000FX_TOO0302_TOOTH_SURF_CD	String	Tooth Surface Code
03	03	L2000FX_TOO0303_TOOTH_SURF_CD	String	Tooth Surface Code
03	04	L2000FX_TOO0304_TOOTH_SURF_CD	String	Tooth Surface Code
03	05	L2000FX_TOO0305_TOOTH_SURF_CD	String	Tooth Surface Code

L2000F	HSD	Health Care Services Delivery
02		L2000F_HSD02_DAYS	Decimal	Days
02		L2000F_HSD02_UN	Decimal	Units
02		L2000F_HSD02_HR	Decimal	Hours
02		L2000F_HSD02_MO	Decimal	Month
02		L2000F_HSD02_VIST	Decimal	Visits
04		L2000F_HSD04_DAYS	Decimal	Days
04		L2000F_HSD04_MOS	Decimal	Months
04		L2000F_HSD04_WK	Decimal	Week
06		L2000F_HSD06_HR	Integer	Hour
06		L2000F_HSD06_DAY	Integer	Day
06		L2000F_HSD06_YEARS	Integer	Years
06		L2000F_HSD06_EPISD	Integer	Episode
06		L2000F_HSD06_VIST	Integer	Visit
06		L2000F_HSD06_REMNG	Integer	Remaining
06		L2000F_HSD06_MO	Integer	Month
06		L2000F_HSD06_WK	Integer	Week
07		L2000F_HSD07_DLVY_FREQ_CD	String	Delivery Frequency Code
08		L2000F_HSD08_DVY_PT_TM_CD	String	Delivery Pattern Time Code

L2000F	PWK	Additional Service Information	Iterated: [01-10]
01		L2000F_nnPWK01_ATT_REP_TYP_CD	String	Attachment Report Type Code
02		L2000F_nnPWK02_REPT_TRNS_CD	String	Report Transmission Code
06		L2000F_nnPWK06_ATTACH_CTL_NR	String	Attachment Control Number
07		L2000F_nnPWK07_ATTCH_DESCR	String	Attachment Description

L2000F	MSG	Message Text
01		L2000F_MSG01_FRFM_MSG_TXT	String	Free Form Message Text

L2010FA - SERVICE PROVIDER NAME (Value Qualified)

Mapping Prefix: L2010FA_72 - Operating Physician

Mapping Prefix: L2010FA_73 - Other Physician

Mapping Prefix: L2010FA_77 - Service Location

Mapping Prefix: L2010FA_DD - Assistant Surgeon

Mapping Prefix: L2010FA_DK - Ordering Physician

Mapping Prefix: L2010FA_DQ - Supervising Physician

Mapping Prefix: L2010FA_FA - Facility

Mapping Prefix: L2010FA_G3 - Clinic

Mapping Prefix: L2010FA_P3 - Primary Care Provider

Mapping Prefix: L2010FA_QB - Purchase Service Provider

Mapping Prefix: L2010FA_QV - Group Practice

Mapping Prefix: L2010FA_SJ - Service Provider

L2010FA	NM1	Service Provider Name
02		L2010FA_yy_NM102_ENT_TYP_QUAL	String	Entity Type Qualifier
03		L2010FA_yy_NM103_SVC_PVR_LNM	String	Service Provider Last or Organization Name
04		L2010FA_yy_NM104_SVC_PVR_FNM	String	Service Provider First Name
05		L2010FA_yy_NM105_SVC_PVR_MNM	String	Service Provider Middle Name
06		L2010FA_yy_NM106_SVC_PVR_PFX	String	Service Provider Name Prefix
07		L2010FA_yy_NM107_SVC_PVR_SFX	String	Service Provider Name Suffix
09		L2010FA_yy_NM109_EMPLYR_ID	String	Employer?s Identification Number
09		L2010FA_yy_NM109_SSN	String	Social Security Number
09		L2010FA_yy_NM109_ETN_NR	String	Electronic Transmitter Identification Number (ETIN)
09		L2010FA_yy_NM109_NPI	String	Centers for Medicare and Medicaid Services National Provider Identifier

L2010FA	REF	Service Provider Supplemental Identification	Iterated: [01-08]
02		L2010FA_yy_nnREF_STAT_LIC_NR	String	State License Number
02		L2010FA_yy_nnREF_UPIN	String	Provider UPIN Number
02		L2010FA_yy_nnREF_FAC_ID	String	Facility ID Number
02		L2010FA_yy_nnREF_EMPLR_ID_NR	String	Employer?s Identification Number
02		L2010FA_yy_nnREF_PVR_SIT_NR	String	Provider Site Number
02		L2010FA_yy_nnREF_PRV_PLN_ID	String	Provider Plan Network Identification Number
02		L2010FA_yy_nnREF_FAC_NET_ID	String	Facility Network Identification Number
02		L2010FA_yy_nnREF_SSN	String	Social Security Number
02		L2010FA_yy_nnREF_CRR_AS_REF_NR	String	Carrier Assigned Reference Number
03		L2010FA_yy_nnREF03_LIC_NR_STAT	String	License Number State Code

L2010FA	N3	Service Provider Address
01		L2010FA_yy_N301_SVC_PVR_ADD_LN	String	Service Provider Address Line
02		L2010FA_yy_N302_SVC_PVR_ADD_LN	String	Service Provider Address Line

L2010FA	N4	Service Provider City, State, ZIP Code
01		L2010FA_yy_N401_SVC_PVR_CITY	String	Service Provider City Name
02		L2010FA_yy_N402_SVC_PVR_STAT	String	Service Provider State or Province Code
03		L2010FA_yy_N403_SVC_PVR_ZIP	String	Service Provider Postal Zone or ZIP Code
04		L2010FA_yy_N404_CNTRY_CD	String	Country Code
07		L2010FA_yy_N407_CNTRY_SUBDV_CD	String	Country Subdivision Code

L2010FA	PER	Service Provider Contact Information
02		L2010FA_yy_PER02_SVC_PVR_CN_NM	String	Service Provider Contact Name
04		L2010FA_yy_PER04_EMAIL	String	Electronic Mail
04		L2010FA_yy_PER04_FAX	String	Facsimile
04		L2010FA_yy_PER04_PHN_NR	String	Telephone
04		L2010FA_yy_PER04_URL	String	Uniform Resource Locator (URL)
06		L2010FA_yy_PER06_EMAIL	String	Electronic Mail
06		L2010FA_yy_PER06_PHN_EXT	String	Telephone Extension
06		L2010FA_yy_PER06_FAX	String	Facsimile
06		L2010FA_yy_PER06_PHN_NR	String	Telephone
06		L2010FA_yy_PER06_URL	String	Uniform Resource Locator (URL)
08		L2010FA_yy_PER08_EMAIL	String	Electronic Mail
08		L2010FA_yy_PER08_PHN_EXT	String	Telephone Extension
08		L2010FA_yy_PER08_PHN_NR	String	Telephone
08		L2010FA_yy_PER08_URL	String	Uniform Resource Locator (URL)

L2010FA	AAA	Service Provider Request Validation	Iterated: [01-09]
03		L2010FA_yy_nnAAA03_REJ_RSN_CD	String	Reject Reason Code
04		L2010FA_yy_nnAAA04_FWUP_ACTCD	String	Follow-up Action Code

L2010FA	PRV	Service Provider Information
01		L2010FA_yy_PRV01_PVD_CD	String	Provider Code
03		L2010FA_yy_PRV03_PVR_TAX_CD	String	Provider Taxonomy Code

L2010FB - ADDITIONAL SERVICE INFORMATION CONTACT NAME

L2010FB	NM1	Additional Service Information Contact Name
02		L2010FB_NM102_ENT_TYP_QUAL	String	Entity Type Qualifier
03		L2010FB_NM103_RSP_CON_LNM	String	Response Contact Last or Organization Name
04		L2010FB_NM104_RESP_CON_FNM	String	Response Contact First Name
05		L2010FB_NM105_RSP_CON_MNM	String	Response Contact Middle Name
07		L2010FB_NM107_RESP_CON_SFX	String	Response Contact Name Suffix
09		L2010FB_NM109_EMPLYR_ID	String	Employer?s Identification Number
09		L2010FB_NM109_SSN	String	Social Security Number
09		L2010FB_NM109_ETN_NR	String	Electronic Transmitter Identification Number (ETIN)
09		L2010FB_NM109_PAYR_ID	String	Payor Identification
09		L2010FB_NM109_HCFA_PLAN_ID	String	Centers for Medicare and Medicaid Services PlanID
09		L2010FB_NM109_NPI	String	Centers for Medicare and Medicaid Services National Provider Identifier

L2010FB	N3	Additional Service Information Contact Address
01		L2010FB_N301_RESP_CON_ADDR	String	Response Contact Address Line
02		L2010FB_N302_RESP_CON_ADDR	String	Response Contact Address Line

L2010FB	N4	Additional Service Information Contact City, State, ZIP Code
01		L2010FB_N401_ADDL_SVC_NFO_CITY	String	Additional Service Information Contact City Name
02		L2010FB_N402_ADDL_SVC_NFO_STAT	String	Additional Service Information Contact State
03		L2010FB_N403_ADDL_SVC_ZIP_PSTL	String	Additional Service Information Contact Postal
04		L2010FB_N404_CNTRY_CD	String	Country Code
07		L2010FB_N407_CNTRY_SUBDV_CD	String	Country Subdivision Code

L2010FB	PER	Additional Service Information Contact Information
02		L2010FB_PER02_RSP_CON_NM	String	Response Contact Name
04		L2010FB_PER04_EMAIL	String	Electronic Mail
04		L2010FB_PER04_FAX	String	Facsimile
04		L2010FB_PER04_PHN_NR	String	Telephone
04		L2010FB_PER04_URL	String	Uniform Resource Locator (URL)
06		L2010FB_PER06_EMAIL	String	Electronic Mail
06		L2010FB_PER06_PHN_EXT	String	Telephone Extension
06		L2010FB_PER06_FAX	String	Facsimile
06		L2010FB_PER06_PHN_NR	String	Telephone
06		L2010FB_PER06_URL	String	Uniform Resource Locator (URL)
08		L2010FB_PER08_EMAIL	String	Electronic Mail
08		L2010FB_PER08_PHN_EXT	String	Telephone Extension
08		L2010FB_PER08_FAX	String	Facsimile
08		L2010FB_PER08_PHN_NR	String	Telephone
08		L2010FB_PER08_URL	String	Uniform Resource Locator (URL)

STHDR	SE	Transaction Set Trailer
01		STHDR_SE01_TS_SEG_CT	Integer	Transaction Segment Count
02		STHDR_SE02_TCN	String	Transaction Set Control Number

GSHDR	GE	Functional Group Trailer
01		GSHDR_GE01_NR_TS_INCLUDED	Integer	Number of Transaction Sets Included
02		GSHDR_GE02_GCN	Integer	Group Control Number