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_VERS_REL_IND_ID | String | Version, Release, or Industry Identifier |
STHDR | BHT | Beginning of Hierarchical Transaction | ||
01 | STHDR_BHT01_HIER_STRUC_CD | String | Hierarchical Structure Code | |
02 | STHDR_BHT02_TS_PURP_CD | String | Transaction Set Purpose Code | |
03 | STHDR_BHT03_ORIG_APP_TRANS_ID | String | Originator Application 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_CLM_ID | String | Claim Identifier |
L1000A - SUBMITTER NAME |
L1000A | NM1 | Submitter Name | ||
03 | L1000A_NM103_PERSN_LNM | String | Person Last Name | |
03 | L1000A_NM103_NONPSNENT_NM | String | Non-Person Entity Name | |
04 | L1000A_NM104_SBM_FNM | String | Submitter First Name | |
05 | L1000A_NM105_SBM_MNM | String | Submitter Middle Name or Initial | |
09 | L1000A_NM109_SBM_ID | String | Submitter Identifier |
L1000A | PER | Submitter EDI Contact Information |
Iterated: [01-02] | |
02 | L1000A_nnPER02_SBM_CON_NM | String | Submitter Contact Name | |
04 | L1000A_nnPER04_EMAIL | String | Electronic Mail | |
04 | L1000A_nnPER04_FAX | String | Facsimile | |
04 | L1000A_nnPER04_PHN_NR | String | Telephone | |
06 | L1000A_nnPER06_EMAIL | String | Electronic Mail | |
06 | L1000A_nnPER06_PHN_EXT | String | Telephone Extension | |
06 | L1000A_nnPER06_FAX | String | Facsimile | |
06 | L1000A_nnPER06_PHN_NR | String | Telephone | |
08 | L1000A_nnPER08_EMAIL | String | Electronic Mail | |
08 | L1000A_nnPER08_PHN_EXT | String | Telephone Extension | |
08 | L1000A_nnPER08_FAX | String | Facsimile | |
08 | L1000A_nnPER08_PHN_NR | String | Telephone |
L1000B - RECEIVER NAME |
L1000B | NM1 | Receiver Name | ||
03 | L1000B_NM103_RCV_NM | String | Receiver Name | |
09 | L1000B_NM109_RCV_PRI_ID | String | Receiver Primary Identifier |
L2000A - BILLING PROVIDER HIERARCHICAL LEVEL |
L2000A | HL | Billing Provider Hierarchical Level | ||
01 | L2000A_HL01_HIER_ID_NR | String | Hierarchical ID Number |
L2000A | PRV | Billing Provider Specialty Information | ||
03 | L2000A_PRV03_PVR_TAX_CD | String | Provider Taxonomy Code |
L2000A | CUR | Foreign Currency Information | ||
02 | L2000A_CUR02_CURRNCY_CD | String | Currency Code |
L2010AA - BILLING PROVIDER NAME |
L2010AA | NM1 | Billing Provider Name | ||
03 | L2010AA_NM103_BILL_PVR_ORG_NM | String | Billing Provider Organizational Name | |
09 | L2010AA_NM109_BILL_PVR_ID | String | Billing Provider Identifier |
L2010AA | N3 | Billing Provider Address | ||
01 | L2010AA_N301_BILL_PROV_ADDR | String | Billing Provider Address Line | |
02 | L2010AA_N302_BILL_PROV_ADDR | String | Billing Provider Address Line |
L2010AA | N4 | Billing Provider City, State, ZIP Code | ||
01 | L2010AA_N401_BILL_PVR_CITY | String | Billing Provider City Name | |
02 | L2010AA_N402_BILL_PVR_STAT | String | Billing Provider State or Province Code | |
03 | L2010AA_N403_BILL_PVR_ZIP | String | Billing Provider Postal Zone or ZIP Code | |
04 | L2010AA_N404_CNTRY_CD | String | Country Code | |
07 | L2010AA_N407_CNTRY_SUBDV_CD | String | Country Subdivision Code |
L2010AA | REF | Billing Provider Tax Identification | ||
02 | L2010AA_REF_EMPLR_ID_NR | String | Employer?s Identification Number |
L2010AA | PER | Billing Provider Contact Information |
Iterated: [01-02] | |
02 | L2010AA_nnPER02_BL_PVR_CONT_NM | String | Billing Provider Contact Name | |
04 | L2010AA_nnPER04_EMAIL | String | Electronic Mail | |
04 | L2010AA_nnPER04_FAX | String | Facsimile | |
04 | L2010AA_nnPER04_PHN_NR | String | Telephone | |
06 | L2010AA_nnPER06_EMAIL | String | Electronic Mail | |
06 | L2010AA_nnPER06_PHN_EXT | String | Telephone Extension | |
06 | L2010AA_nnPER06_FAX | String | Facsimile | |
06 | L2010AA_nnPER06_PHN_NR | String | Telephone | |
08 | L2010AA_nnPER08_EMAIL | String | Electronic Mail | |
08 | L2010AA_nnPER08_PHN_EXT | String | Telephone Extension | |
08 | L2010AA_nnPER08_FAX | String | Facsimile | |
08 | L2010AA_nnPER08_PHN_NR | String | Telephone |
L2010AB - PAY-TO ADDRESS NAME |
L2010AB | NM1 | Pay-to Address Name |
L2010AB | N3 | Pay-to Address - ADDRESS | ||
01 | L2010AB_N301_PAY2_ADDR | String | Pay-To Address Line | |
02 | L2010AB_N302_PAY2_ADDR | String | Pay-To Address Line |
L2010AB | N4 | Pay-To Address City, State, ZIP Code | ||
01 | L2010AB_N401_PAY2_CITY | String | Pay-to Address City Name | |
02 | L2010AB_N402_PAY2_STAT | String | Pay-to Address State Code | |
03 | L2010AB_N403_PAY2_ZIP | String | Pay-to Address Postal Zone or ZIP Code | |
04 | L2010AB_N404_CNTRY_CD | String | Country Code | |
07 | L2010AB_N407_CNTRY_SUBDV_CD | String | Country Subdivision Code |
L2010AC - PAY-TO PLAN NAME |
L2010AC | NM1 | Pay-To Plan Name | ||
03 | L2010AC_NM103_PAY2_PLN_ORG_NM | String | Pay-To Plan Organizational Name | |
09 | L2010AC_NM109_PAYR_ID | String | Payor Identification | |
09 | L2010AC_NM109_HCFA_PLAN_ID | String | Centers for Medicare and Medicaid Services PlanID |
L2010AC | N3 | Pay-to Plan Address | ||
01 | L2010AC_N301_PAY2_PLN_ADDR | String | Pay-To Plan Address Line | |
02 | L2010AC_N302_PAY2_PLN_ADDR | String | Pay-To Plan Address Line |
L2010AC | N4 | Pay-To Plan City, State, ZIP Code | ||
01 | L2010AC_N401_PAY2_PLN_CITY | String | Pay-To Plan City Name | |
02 | L2010AC_N402_PAY2_PLN_STAT | String | Pay-To Plan State or Province Code | |
03 | L2010AC_N403_PAY2_PLN_ZIP | String | Pay-To Plan Postal Zone or ZIP Code | |
04 | L2010AC_N404_CNTRY_CD | String | Country Code | |
07 | L2010AC_N407_CNTRY_SUBDV_CD | String | Country Subdivision Code |
L2010AC | REF | Pay-to Plan Secondary Identification | ||
02 | L2010AC_REF_PYR_ID | String | Payer Identification Number | |
02 | L2010AC_REF_CLM_OFC_NR | String | Claim Office Number | |
02 | L2010AC_REF_NAIC | String | National Association of Insurance Commissioners (NAIC) Code |
L2010AC | REF | Pay-To Plan Tax Identification Number | ||
02 | L2010AC_REF_EMPLR_ID_NR | String | Employer?s Identification Number |
L2000B - SUBSCRIBER HIERARCHICAL LEVEL |
L2000B | HL | Subscriber Hierarchical 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 |
L2000B | SBR | Subscriber Information | ||
01 | L2000B_SBR01_PYR_RESP_SEQ_NR | String | Payer Responsibility Sequence Number Code | |
02 | L2000B_SBR02_IND_RELAT_CD | String | Individual Relationship Code | |
03 | L2000B_SBR03_SBR_POLCY_NR | String | Subscriber Group or Policy Number | |
04 | L2000B_SBR04_SBR_GRP_NM | String | Subscriber Group Name | |
09 | L2000B_SBR09_CLM_FIL_IND_CD | String | Claim Filing Indicator Code |
L2010BA - SUBSCRIBER NAME |
L2010BA | NM1 | Subscriber Name | ||
03 | L2010BA_NM103_PERSN_LNM | String | Person Last Name | |
03 | L2010BA_NM103_NONPSNENT_NM | String | Non-Person Entity Name | |
04 | L2010BA_NM104_SBR_FNM | String | Subscriber First Name | |
05 | L2010BA_NM105_SBR_MNM | String | Subscriber Middle Name or Initial | |
07 | L2010BA_NM107_SBR_SFX | String | Subscriber Name Suffix | |
09 | L2010BA_NM109_UNQ_HLTH_ID | String | Standard Unique Health Identifier for each Individual in the United States | |
09 | L2010BA_NM109_MEM_ID_NR | String | Member Identification Number |
L2010BA | N3 | Subscriber Address | ||
01 | L2010BA_N301_SBR_ADDR | String | Subscriber Address Line | |
02 | L2010BA_N302_SBR_ADDR | String | Subscriber Address Line |
L2010BA | N4 | Subscriber City, State, ZIP Code | ||
01 | L2010BA_N401_SBR_CITY | String | Subscriber City Name | |
02 | L2010BA_N402_SBR_STAT | String | Subscriber State Code | |
03 | L2010BA_N403_SBR_ZIP | String | Subscriber Postal Zone or ZIP Code | |
04 | L2010BA_N404_CNTRY_CD | String | Country Code | |
07 | L2010BA_N407_CNTRY_SUBDV_CD | String | Country Subdivision Code |
L2010BA | DMG | Subscriber Demographic Information | ||
02 | L2010BA_DMG02_SBR_DOB_D8 | Date/Time | Subscriber Birth Date | |
03 | L2010BA_DMG03_SUB_GENDR_CD | String | Subscriber Gender Code |
L2010BA | REF | Subscriber Secondary Identification | ||
02 | L2010BA_REF_SSN | String | Social Security Number |
L2010BA | REF | Property and Casualty Claim Number | ||
02 | L2010BA_REF_AGNCY_CLM_NR | String | Agency Claim Number |
L2010BB - PAYER NAME |
L2010BB | NM1 | Payer Name | ||
03 | L2010BB_NM103_PYR_NM | String | Payer Name | |
09 | L2010BB_NM109_PAYR_ID | String | Payor Identification | |
09 | L2010BB_NM109_HCFA_PLAN_ID | String | Centers for Medicare and Medicaid Services PlanID |
L2010BB | N3 | Payer Address | ||
01 | L2010BB_N301_PYR_ADDR_LN | String | Payer Address Line | |
02 | L2010BB_N302_PYR_ADDR_LN | String | Payer Address Line |
L2010BB | N4 | Payer City, State, ZIP Code | ||
01 | L2010BB_N401_PYR_CITY_NM | String | Payer City Name | |
02 | L2010BB_N402_PYR_STAT | String | Payer State Code | |
03 | L2010BB_N403_PYR_ZIP | String | Payer Postal Zone or ZIP Code | |
04 | L2010BB_N404_CNTRY_CD | String | Country Code | |
07 | L2010BB_N407_CNTRY_SUBDV_CD | String | Country Subdivision Code |
L2010BB | REF | Payer Secondary Identification |
Iterated: [01-03] | |
02 | L2010BB_nnREF_PYR_ID | String | Payer Identification Number | |
02 | L2010BB_nnREF_EMPLR_ID_NR | String | Employer?s Identification Number | |
02 | L2010BB_nnREF_CLM_OFC_NR | String | Claim Office Number | |
02 | L2010BB_nnREF_NAIC | String | National Association of Insurance Commissioners (NAIC) Code |
L2010BB | REF | Billing Provider Secondary Identification | ||
02 | L2010BB_REF_PVR_COMM_NR | String | Provider Commercial Number | |
02 | L2010BB_REF_LOC_NR | String | Location Number |
L2000C - PATIENT HIERARCHICAL LEVEL |
L2000C | HL | Patient Hierarchical Level | ||
01 | L2000C_HL01_HIER_ID_NR | String | Hierarchical ID Number | |
02 | L2000C_HL02_HIER_PARNT_ID_NR | String | Hierarchical Parent ID Number |
L2000C | PAT | Patient Information | ||
01 | L2000C_PAT01_IND_RELAT_CD | String | Individual Relationship Code |
L2010CA - PATIENT NAME |
L2010CA | NM1 | Patient Name | ||
03 | L2010CA_NM103_PT_LNM | String | Patient Last Name | |
04 | L2010CA_NM104_PT_FNM | String | Patient First Name | |
05 | L2010CA_NM105_PT_MNM | String | Patient Middle Name or Initial | |
07 | L2010CA_NM107_PT_SFX | String | Patient Name Suffix |
L2010CA | N3 | Patient Address | ||
01 | L2010CA_N301_PT_ADDR | String | Patient Address Line | |
02 | L2010CA_N302_PT_ADDR | String | Patient Address Line |
L2010CA | N4 | Patient City, State, ZIP Code | ||
01 | L2010CA_N401_PT_CITY | String | Patient City Name | |
02 | L2010CA_N402_PT_STAT | String | Patient State Code | |
03 | L2010CA_N403_PT_ZIP | String | Patient Postal Zone or ZIP Code | |
04 | L2010CA_N404_CNTRY_CD | String | Country Code | |
07 | L2010CA_N407_CNTRY_SUBDV_CD | String | Country Subdivision Code |
L2010CA | DMG | Patient Demographic Information | ||
02 | L2010CA_DMG02_PT_DOB_D8 | Date/Time | Patient Birth Date | |
03 | L2010CA_DMG03_PAT_GNDR_CD | String | Patient Gender Code |
L2010CA | REF | Property and Casualty Claim Number | ||
02 | L2010CA_REF_AGNCY_CLM_NR | String | Agency Claim Number |
L2300 - CLAIM INFORMATION |
L2300 | CLM | Claim Information | ||
01 | L2300_CLM01_PT_CTL_NR | String | Patient Control Number | |
02 | L2300_CLM02_TOT_CLM_CHG_AMT | Decimal | Total Claim Charge Amount | |
05 | 01 | L2300_CLM0501_FAC_TYP_CD | String | Facility Type Code |
05 | 03 | L2300_CLM0503_CLM_FREQ_CD | String | Claim Frequency Code |
07 | L2300_CLM07_PLAN_PART_CD | String | Assignment or Plan Participation Code | |
08 | L2300_CLM08_BEN_ASGT_CRT_IND | String | Benefits Assignment Certification Indicator | |
09 | L2300_CLM09_RELS_NFO_CD | String | Release of Information Code | |
20 | L2300_CLM20_DELAY_RSN_CD | String | Delay Reason Code |
L2300 | DTP | Discharge Hour |
L2300 | DTP | Statement Dates | ||
03 | L2300_DTP_STMNT_RD8_1 | Start Date | Statement (RD8) | |
03 | L2300_DTP_STMNT_RD8_2 | End Date | Statement (RD8) |
L2300 | DTP | Admission Date/Hour | ||
03 | L2300_DTP_ADMSN_D8 | Start Date | Admission (D8) |
L2300 | DTP | Date - Repricer Received Date | ||
03 | L2300_DTP_RCVD_D8 | Start Date | Received (D8) |
L2300 | CL1 | Institutional Claim Code | ||
01 | L2300_CL101_ADMSN_TYP_CD | String | Admission Type Code | |
02 | L2300_CL102_ADMSN_SRC_CD | String | Admission Source Code | |
03 | L2300_CL103_PT_STATS_CD | String | Patient Status Code |
L2300 | PWK | Claim Supplemental Information |
Iterated: [01-10] | |
01 | L2300_nnPWK01_ATT_REP_TYP_CD | String | Attachment Report Type Code | |
02 | L2300_nnPWK02_ATT_TRANS_CD | String | Attachment Transmission Code | |
06 | L2300_nnPWK06_ATTACH_CTL_NR | String | Attachment Control Number |
L2300 | CN1 | Contract Information | ||
01 | L2300_CN101_CNTRCT_TYP_CD | String | Contract Type Code | |
02 | L2300_CN102_CONTRCT_AMT | Decimal | Contract Amount | |
03 | L2300_CN103_CONTRCT_PERC | Decimal | Contract Percentage | |
04 | L2300_CN104_CONTRCT_CD | String | Contract Code | |
05 | L2300_CN105_TERMS_DISCT_PERC | Decimal | Terms Discount Percentage | |
06 | L2300_CN106_CONTRCT_VERS_ID | String | Contract Version Identifier |
L2300 | AMT | Patient Estimated Amount Due | ||
02 | L2300_AMT02_PAT_RESP_EST | Date Timestamp | Patient Responsibility - Estimated |
L2300 | REF | Service Authorization Exception Code | ||
02 | L2300_REF_SP_PMT_REF_NR | String | Special Payment Reference Number |
L2300 | REF | Referral Number | ||
02 | L2300_REF_REFRL_NR | String | Referral Number |
L2300 | REF | Prior Authorization | ||
02 | L2300_REF_PRIOR_AUTH | String | Prior Authorization Number |
L2300 | REF | Payer Claim Control Number | ||
02 | L2300_REF_ORIG_REF_NR | String | Original Reference Number |
L2300 | REF | Repriced Claim Number | ||
02 | L2300_REF_REP_CLM_ID | String | Repriced Claim Reference Number |
L2300 | REF | Adjusted Repriced Claim Number | ||
02 | L2300_REF_ADJ_REP_CLM_ID | String | Adjusted Repriced Claim Reference Number |
L2300 | REF | Investigational Device Exemption Number |
Iterated: [01-05] | |
02 | L2300_nnREF_QUAL_PRD_LST | String | Qualified Products List |
L2300 | REF | Claim Identifier For Transmission Intermediaries | ||
02 | L2300_REF_CLM_NR | String | Claim Number |
L2300 | REF | Auto Accident State | ||
02 | L2300_REF_LOC_NR | String | Location Number |
L2300 | REF | Medical Record Number | ||
02 | L2300_REF_MED_REC_ID | String | Medical Record Identification Number |
L2300 | REF | Demonstration Project Identifier | ||
02 | L2300_REF_PROJCT_CD | String | Project Code |
L2300 | REF | Peer Review Organization (PRO) Approval Number | ||
02 | L2300_REF_PPO_APPR_NR | String | Peer Review Organization (PRO) Approval Number |
L2300 | K3 | File Information |
Iterated: [01-10] | |
01 | L2300_nnK301_FIXD_FMT_NFO | String | Fixed Format Information |
L2300 | NTE | Claim Note |
Iterated: [01-10] | |
02 | L2300_nnNTE02_ALLRGS | String | Allergies | |
02 | L2300_nnNTE02_GOALS_DISCHG_PLN | String | Goals, Rehabilitation Potential, or Discharge Plans | |
02 | L2300_nnNTE02_DIAG_DESC | String | Diagnosis Description | |
02 | L2300_nnNTE02_DME_SUPP | String | Durable Medical Equipment (DME) and Supplies | |
02 | L2300_nnNTE02_MEDCTN | String | Medications | |
02 | L2300_nnNTE02_NUTRTL_REQ | String | Nutritional Requirements | |
02 | L2300_nnNTE02_ORD_DISC_TMTS | String | Orders for Disciplines and Treatments | |
02 | L2300_nnNTE02_RSN_HOMBND | String | Functional Limitations, Reason Homebound, or Both | |
02 | L2300_nnNTE02_RSN_PAT_LV_HM | String | Reasons Patient Leaves Home | |
02 | L2300_nnNTE02_TIME_RSN_PT | String | Times and Reasons Patient Not at Home | |
02 | L2300_nnNTE02_UNSL_HM_SOC_ENV | String | Unusual Home, Social Environment, or Both | |
02 | L2300_nnNTE02_SAFTY_MSRS | String | Safety Measures | |
02 | L2300_nnNTE02_SUPP_PLAN_TMNT | String | Supplementary Plan of Treatment | |
02 | L2300_nnNTE02_UPDTD_NFO | String | Updated Information |
L2300 | NTE | Billing Note | ||
02 | L2300_NTE02_BILL_NOT_TXT | String | Billing Note Text |
L2300 | CRC | EPSDT Referral |
Segment Suffix: | |
02 | L2300_CRCA02_CERT_COND_CD_IND | String | Certification Condition Code Applies Indicator | |
03 | L2300_CRCA03_CONDTN_IND | String | Condition Indicator | |
04 | L2300_CRCA04_CONDTN_IND | String | Condition Indicator | |
05 | L2300_CRCA05_CONDTN_IND | String | Condition Indicator |
L2300 | HI | Principal Diagnosis | ||
01 | 02 | L2300_HI0102_ICD10_PRIN_DIAG | String | International Classification of Diseases Clinical Modification (ICD-10-CM) Principal Diagnosis |
01 | 02 | L2300_HI0102_ICD9_PRIN_DIAG | String | International Classification of Diseases Clinical Modification (ICD-9-CM) Principal Diagnosis |
01 | 09 | L2300_HI0109_PRSNT_ADMN_IND | String | Present on Admission Indicator |
L2300 | HI | Admitting Diagnosis | ||
01 | 02 | L2300_HI0102_ICD10_ADMTG_DIAG | String | International Classification of Diseases Clinical Modification (ICD-10-CM) Admitting Diagnosis |
01 | 02 | L2300_HI0102_ICD9_ADMTG_DIAG | String | International Classification of Diseases Clinical Modification (ICD-9-CM) Admitting Diagnosis |
L2300 | HI | Patient?s Reason For Visit |
Segment Suffix: | |
01 | 02 | L2300_HIB0102_ICD10_RSN_VISIT | String | International Classification of Diseases Clinical Modification (ICD-10-CM) Patient?s Reason for Visit |
01 | 02 | L2300_HIB0102_ICD9_RSN_VISIT | String | International Classification of Diseases Clinical Modification (ICD-9-CM) Patient?s Reason for Visit |
02 | 02 | L2300_HIB0202_ICD10_RSN_VISIT | String | International Classification of Diseases Clinical Modification (ICD-10-CM) Patient?s Reason for Visit |
02 | 02 | L2300_HIB0202_ICD9_RSN_VISIT | String | International Classification of Diseases Clinical Modification (ICD-9-CM) Patient?s Reason for Visit |
03 | 02 | L2300_HIB0302_ICD10_RSN_VISIT | String | International Classification of Diseases Clinical Modification (ICD-10-CM) Patient?s Reason for Visit |
03 | 02 | L2300_HIB0302_ICD9_RSN_VISIT | String | International Classification of Diseases Clinical Modification (ICD-9-CM) Patient?s Reason for Visit |
L2300 | HI | External Cause of Injury |
Segment Suffix: | |
01 | 02 | L2300_HIC0102_ICD10_EXT_INJRY | String | International Classification of Diseases Clinical Modification (ICD-10-CM) External Cause of Injury |
01 | 02 | L2300_HIC0102_ICD9_ECODE | String | International Classification of Diseases Clinical Modification (ICD-9-CM) External Cause of Injury Code (E-codes) |
01 | 09 | L2300_HIC0109_PRSNT_ADMN_IND | String | Present on Admission Indicator |
02 | 02 | L2300_HIC0202_ICD10_EXT_INJRY | String | International Classification of Diseases Clinical Modification (ICD-10-CM) External Cause of Injury |
02 | 02 | L2300_HIC0202_ICD9_ECODE | String | International Classification of Diseases Clinical Modification (ICD-9-CM) External Cause of Injury Code (E-codes) |
02 | 09 | L2300_HIC0209_PRSNT_ADMN_IND | String | Present on Admission Indicator |
03 | 02 | L2300_HIC0302_ICD10_EXT_INJRY | String | International Classification of Diseases Clinical Modification (ICD-10-CM) External Cause of Injury |
03 | 02 | L2300_HIC0302_ICD9_ECODE | String | International Classification of Diseases Clinical Modification (ICD-9-CM) External Cause of Injury Code (E-codes) |
03 | 09 | L2300_HIC0309_PRSNT_ADMN_IND | String | Present on Admission Indicator |
04 | 02 | L2300_HIC0402_ICD10_EXT_INJRY | String | International Classification of Diseases Clinical Modification (ICD-10-CM) External Cause of Injury |
04 | 02 | L2300_HIC0402_ICD9_ECODE | String | International Classification of Diseases Clinical Modification (ICD-9-CM) External Cause of Injury Code (E-codes) |
04 | 09 | L2300_HIC0409_PRSNT_ADMN_IND | String | Present on Admission Indicator |
05 | 02 | L2300_HIC0502_ICD10_EXT_INJRY | String | International Classification of Diseases Clinical Modification (ICD-10-CM) External Cause of Injury |
05 | 02 | L2300_HIC0502_ICD9_ECODE | String | International Classification of Diseases Clinical Modification (ICD-9-CM) External Cause of Injury Code (E-codes) |
05 | 09 | L2300_HIC0509_PRSNT_ADMN_IND | String | Present on Admission Indicator |
06 | 02 | L2300_HIC0602_ICD10_EXT_INJRY | String | International Classification of Diseases Clinical Modification (ICD-10-CM) External Cause of Injury |
06 | 02 | L2300_HIC0602_ICD9_ECODE | String | International Classification of Diseases Clinical Modification (ICD-9-CM) External Cause of Injury Code (E-codes) |
06 | 09 | L2300_HIC0609_PRSNT_ADMN_IND | String | Present on Admission Indicator |
07 | 02 | L2300_HIC0702_ICD10_EXT_INJRY | String | International Classification of Diseases Clinical Modification (ICD-10-CM) External Cause of Injury |
07 | 02 | L2300_HIC0702_ICD9_ECODE | String | International Classification of Diseases Clinical Modification (ICD-9-CM) External Cause of Injury Code (E-codes) |
07 | 09 | L2300_HIC0709_PRSNT_ADMN_IND | String | Present on Admission Indicator |
08 | 02 | L2300_HIC0802_ICD10_EXT_INJRY | String | International Classification of Diseases Clinical Modification (ICD-10-CM) External Cause of Injury |
08 | 02 | L2300_HIC0802_ICD9_ECODE | String | International Classification of Diseases Clinical Modification (ICD-9-CM) External Cause of Injury Code (E-codes) |
08 | 09 | L2300_HIC0809_PRSNT_ADMN_IND | String | Present on Admission Indicator |
09 | 02 | L2300_HIC0902_ICD10_EXT_INJRY | String | International Classification of Diseases Clinical Modification (ICD-10-CM) External Cause of Injury |
09 | 02 | L2300_HIC0902_ICD9_ECODE | String | International Classification of Diseases Clinical Modification (ICD-9-CM) External Cause of Injury Code (E-codes) |
09 | 09 | L2300_HIC0909_PRSNT_ADMN_IND | String | Present on Admission Indicator |
10 | 02 | L2300_HIC1002_ICD10_EXT_INJRY | String | International Classification of Diseases Clinical Modification (ICD-10-CM) External Cause of Injury |
10 | 02 | L2300_HIC1002_ICD9_ECODE | String | International Classification of Diseases Clinical Modification (ICD-9-CM) External Cause of Injury Code (E-codes) |
10 | 09 | L2300_HIC1009_PRSNT_ADMN_IND | String | Present on Admission Indicator |
11 | 02 | L2300_HIC1102_ICD10_EXT_INJRY | String | International Classification of Diseases Clinical Modification (ICD-10-CM) External Cause of Injury |
11 | 02 | L2300_HIC1102_ICD9_ECODE | String | International Classification of Diseases Clinical Modification (ICD-9-CM) External Cause of Injury Code (E-codes) |
11 | 09 | L2300_HIC1109_PRSNT_ADMN_IND | String | Present on Admission Indicator |
12 | 02 | L2300_HIC1202_ICD10_EXT_INJRY | String | International Classification of Diseases Clinical Modification (ICD-10-CM) External Cause of Injury |
12 | 02 | L2300_HIC1202_ICD9_ECODE | String | International Classification of Diseases Clinical Modification (ICD-9-CM) External Cause of Injury Code (E-codes) |
12 | 09 | L2300_HIC1209_PRSNT_ADMN_IND | String | Present on Admission Indicator |
L2300 | HI | Diagnosis Related Group (DRG) Information |
Segment Suffix: | |
01 | 02 | L2300_HID0102_DRG | String | Diagnosis Related Group (DRG) |
L2300 | HI | Other Diagnosis Information |
Segment Suffix: Iterated: [01-02] | |
01 | 02 | L2300_nnHIE0102_ICD10_DIAG | String | International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis |
01 | 02 | L2300_nnHIE0102_ICD9_DIAG | String | International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis |
01 | 09 | L2300_nnHIE0109_PRSNT_ADMN_IND | String | Present on Admission Indicator |
02 | 02 | L2300_nnHIE0202_ICD10_DIAG | String | International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis |
02 | 02 | L2300_nnHIE0202_ICD9_DIAG | String | International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis |
02 | 09 | L2300_nnHIE0209_PRSNT_ADMN_IND | String | Present on Admission Indicator |
03 | 02 | L2300_nnHIE0302_ICD10_DIAG | String | International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis |
03 | 02 | L2300_nnHIE0302_ICD9_DIAG | String | International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis |
03 | 09 | L2300_nnHIE0309_PRSNT_ADMN_IND | String | Present on Admission Indicator |
04 | 02 | L2300_nnHIE0402_ICD10_DIAG | String | International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis |
04 | 02 | L2300_nnHIE0402_ICD9_DIAG | String | International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis |
04 | 09 | L2300_nnHIE0409_PRSNT_ADMN_IND | String | Present on Admission Indicator |
05 | 02 | L2300_nnHIE0502_ICD10_DIAG | String | International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis |
05 | 02 | L2300_nnHIE0502_ICD9_DIAG | String | International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis |
05 | 09 | L2300_nnHIE0509_PRSNT_ADMN_IND | String | Present on Admission Indicator |
06 | 02 | L2300_nnHIE0602_ICD10_DIAG | String | International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis |
06 | 02 | L2300_nnHIE0602_ICD9_DIAG | String | International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis |
06 | 09 | L2300_nnHIE0609_PRSNT_ADMN_IND | String | Present on Admission Indicator |
07 | 02 | L2300_nnHIE0702_ICD10_DIAG | String | International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis |
07 | 02 | L2300_nnHIE0702_ICD9_DIAG | String | International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis |
07 | 09 | L2300_nnHIE0709_PRSNT_ADMN_IND | String | Present on Admission Indicator |
08 | 02 | L2300_nnHIE0802_ICD10_DIAG | String | International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis |
08 | 02 | L2300_nnHIE0802_ICD9_DIAG | String | International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis |
08 | 09 | L2300_nnHIE0809_PRSNT_ADMN_IND | String | Present on Admission Indicator |
09 | 02 | L2300_nnHIE0902_ICD10_DIAG | String | International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis |
09 | 02 | L2300_nnHIE0902_ICD9_DIAG | String | International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis |
09 | 09 | L2300_nnHIE0909_PRSNT_ADMN_IND | String | Present on Admission Indicator |
10 | 02 | L2300_nnHIE1002_ICD10_DIAG | String | International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis |
10 | 02 | L2300_nnHIE1002_ICD9_DIAG | String | International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis |
10 | 09 | L2300_nnHIE1009_PRSNT_ADMN_IND | String | Present on Admission Indicator |
11 | 02 | L2300_nnHIE1102_ICD10_DIAG | String | International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis |
11 | 02 | L2300_nnHIE1102_ICD9_DIAG | String | International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis |
11 | 09 | L2300_nnHIE1109_PRSNT_ADMN_IND | String | Present on Admission Indicator |
12 | 02 | L2300_nnHIE1202_ICD10_DIAG | String | International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis |
12 | 02 | L2300_nnHIE1202_ICD9_DIAG | String | International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis |
12 | 09 | L2300_nnHIE1209_PRSNT_ADMN_IND | String | Present on Admission Indicator |
L2300 | HI | Principal Procedure Information |
Segment Suffix: | |
01 | 02 | L2300_HIF0102_ICD10_PRIN_PROC | String | International Classification of Diseases Clinical Modification (ICD-10-PCS) Principal Procedure |
01 | 02 | L2300_HIF0102_ICD9_PRN_PROC_CD | String | International Classification of Diseases Clinical Modification (ICD-9-CM) Principal Procedure Codes |
01 | 02 | L2300_HIF0102_ABC_CD | String | Advanced Billing Concepts (ABC) Codes |
01 | 04 | L2300_HIF0104_D8_D8 | Date/Time | Date Expressed in Format CCYYMMDD |
L2300 | HI | Other Procedure Information |
Segment Suffix: Iterated: [01-02] | |
01 | 02 | L2300_nnHIG0102_ICD10_OPROC_CD | String | International Classification of Diseases Clinical Modification (ICD-10-PCS) Other Procedure Codes |
01 | 02 | L2300_nnHIG0102_ICD9_OPROC_CD | String | International Classification of Diseases Clinical Modification (ICD-9-CM) Other Procedure Codes |
01 | 04 | L2300_nnHIG0104_D8_D8 | Date/Time | Date Expressed in Format CCYYMMDD |
02 | 02 | L2300_nnHIG0202_ICD10_OPROC_CD | String | International Classification of Diseases Clinical Modification (ICD-10-PCS) Other Procedure Codes |
02 | 02 | L2300_nnHIG0202_ICD9_OPROC_CD | String | International Classification of Diseases Clinical Modification (ICD-9-CM) Other Procedure Codes |
02 | 04 | L2300_nnHIG0204_D8_D8 | Date/Time | Date Expressed in Format CCYYMMDD |
03 | 02 | L2300_nnHIG0302_ICD10_OPROC_CD | String | International Classification of Diseases Clinical Modification (ICD-10-PCS) Other Procedure Codes |
03 | 02 | L2300_nnHIG0302_ICD9_OPROC_CD | String | International Classification of Diseases Clinical Modification (ICD-9-CM) Other Procedure Codes |
03 | 04 | L2300_nnHIG0304_D8_D8 | Date/Time | Date Expressed in Format CCYYMMDD |
04 | 02 | L2300_nnHIG0402_ICD10_OPROC_CD | String | International Classification of Diseases Clinical Modification (ICD-10-PCS) Other Procedure Codes |
04 | 02 | L2300_nnHIG0402_ICD9_OPROC_CD | String | International Classification of Diseases Clinical Modification (ICD-9-CM) Other Procedure Codes |
04 | 04 | L2300_nnHIG0404_D8_D8 | Date/Time | Date Expressed in Format CCYYMMDD |
05 | 02 | L2300_nnHIG0502_ICD10_OPROC_CD | String | International Classification of Diseases Clinical Modification (ICD-10-PCS) Other Procedure Codes |
05 | 02 | L2300_nnHIG0502_ICD9_OPROC_CD | String | International Classification of Diseases Clinical Modification (ICD-9-CM) Other Procedure Codes |
05 | 04 | L2300_nnHIG0504_D8_D8 | Date/Time | Date Expressed in Format CCYYMMDD |
06 | 02 | L2300_nnHIG0602_ICD10_OPROC_CD | String | International Classification of Diseases Clinical Modification (ICD-10-PCS) Other Procedure Codes |
06 | 02 | L2300_nnHIG0602_ICD9_OPROC_CD | String | International Classification of Diseases Clinical Modification (ICD-9-CM) Other Procedure Codes |
06 | 04 | L2300_nnHIG0604_D8_D8 | Date/Time | Date Expressed in Format CCYYMMDD |
07 | 02 | L2300_nnHIG0702_ICD10_OPROC_CD | String | International Classification of Diseases Clinical Modification (ICD-10-PCS) Other Procedure Codes |
07 | 02 | L2300_nnHIG0702_ICD9_OPROC_CD | String | International Classification of Diseases Clinical Modification (ICD-9-CM) Other Procedure Codes |
07 | 04 | L2300_nnHIG0704_D8_D8 | Date/Time | Date Expressed in Format CCYYMMDD |
08 | 02 | L2300_nnHIG0802_ICD10_OPROC_CD | String | International Classification of Diseases Clinical Modification (ICD-10-PCS) Other Procedure Codes |
08 | 02 | L2300_nnHIG0802_ICD9_OPROC_CD | String | International Classification of Diseases Clinical Modification (ICD-9-CM) Other Procedure Codes |
08 | 04 | L2300_nnHIG0804_D8_D8 | Date/Time | Date Expressed in Format CCYYMMDD |
09 | 02 | L2300_nnHIG0902_ICD10_OPROC_CD | String | International Classification of Diseases Clinical Modification (ICD-10-PCS) Other Procedure Codes |
09 | 02 | L2300_nnHIG0902_ICD9_OPROC_CD | String | International Classification of Diseases Clinical Modification (ICD-9-CM) Other Procedure Codes |
09 | 04 | L2300_nnHIG0904_D8_D8 | Date/Time | Date Expressed in Format CCYYMMDD |
10 | 02 | L2300_nnHIG1002_ICD10_OPROC_CD | String | International Classification of Diseases Clinical Modification (ICD-10-PCS) Other Procedure Codes |
10 | 02 | L2300_nnHIG1002_ICD9_OPROC_CD | String | International Classification of Diseases Clinical Modification (ICD-9-CM) Other Procedure Codes |
10 | 04 | L2300_nnHIG1004_D8_D8 | Date/Time | Date Expressed in Format CCYYMMDD |
11 | 02 | L2300_nnHIG1102_ICD10_OPROC_CD | String | International Classification of Diseases Clinical Modification (ICD-10-PCS) Other Procedure Codes |
11 | 02 | L2300_nnHIG1102_ICD9_OPROC_CD | String | International Classification of Diseases Clinical Modification (ICD-9-CM) Other Procedure Codes |
11 | 04 | L2300_nnHIG1104_D8_D8 | Date/Time | Date Expressed in Format CCYYMMDD |
12 | 02 | L2300_nnHIG1202_ICD10_OPROC_CD | String | International Classification of Diseases Clinical Modification (ICD-10-PCS) Other Procedure Codes |
12 | 02 | L2300_nnHIG1202_ICD9_OPROC_CD | String | International Classification of Diseases Clinical Modification (ICD-9-CM) Other Procedure Codes |
12 | 04 | L2300_nnHIG1204_D8_D8 | Date/Time | Date Expressed in Format CCYYMMDD |
L2300 | HI | Occurrence Span Information |
Segment Suffix: Iterated: [01-02] | |
01 | 02 | L2300_nnHIH0102_OCCRNC_SPAN | String | Occurrence Span |
01 | 04 | L2300_nnHIH0104__RD8_1_D8 | String | Span Start Date |
01 | 04 | L2300_nnHIH0104__RD8_2_D8 | String | Span End Date |
02 | 02 | L2300_nnHIH0202_OCCRNC_SPAN | String | Occurrence Span |
02 | 04 | L2300_nnHIH0204__RD8_1_D8 | String | Span Start Date |
02 | 04 | L2300_nnHIH0204__RD8_2_D8 | String | Span End Date |
03 | 02 | L2300_nnHIH0302_OCCRNC_SPAN | String | Occurrence Span |
03 | 04 | L2300_nnHIH0304__RD8_1_D8 | String | Span Start Date |
03 | 04 | L2300_nnHIH0304__RD8_2_D8 | String | Span End Date |
04 | 02 | L2300_nnHIH0402_OCCRNC_SPAN | String | Occurrence Span |
04 | 04 | L2300_nnHIH0404__RD8_1_D8 | String | Span Start Date |
04 | 04 | L2300_nnHIH0404__RD8_2_D8 | String | Span End Date |
05 | 02 | L2300_nnHIH0502_OCCRNC_SPAN | String | Occurrence Span |
05 | 04 | L2300_nnHIH0504__RD8_1_D8 | String | Span Start Date |
05 | 04 | L2300_nnHIH0504__RD8_2_D8 | String | Span End Date |
06 | 02 | L2300_nnHIH0602_OCCRNC_SPAN | String | Occurrence Span |
06 | 04 | L2300_nnHIH0604__RD8_1_D8 | String | Span Start Date |
06 | 04 | L2300_nnHIH0604__RD8_2_D8 | String | Span End Date |
07 | 02 | L2300_nnHIH0702_OCCRNC_SPAN | String | Occurrence Span |
07 | 04 | L2300_nnHIH0704__RD8_1_D8 | String | Span Start Date |
07 | 04 | L2300_nnHIH0704__RD8_2_D8 | String | Span End Date |
08 | 02 | L2300_nnHIH0802_OCCRNC_SPAN | String | Occurrence Span |
08 | 04 | L2300_nnHIH0804__RD8_1_D8 | String | Span Start Date |
08 | 04 | L2300_nnHIH0804__RD8_2_D8 | String | Span End Date |
09 | 02 | L2300_nnHIH0902_OCCRNC_SPAN | String | Occurrence Span |
09 | 04 | L2300_nnHIH0904__RD8_1_D8 | String | Span Start Date |
09 | 04 | L2300_nnHIH0904__RD8_2_D8 | String | Span End Date |
10 | 02 | L2300_nnHIH1002_OCCRNC_SPAN | String | Occurrence Span |
10 | 04 | L2300_nnHIH1004__RD8_1_D8 | String | Span Start Date |
10 | 04 | L2300_nnHIH1004__RD8_2_D8 | String | Span End Date |
11 | 02 | L2300_nnHIH1102_OCCRNC_SPAN | String | Occurrence Span |
11 | 04 | L2300_nnHIH1104__RD8_1_D8 | String | Span Start Date |
11 | 04 | L2300_nnHIH1104__RD8_2_D8 | String | Span End Date |
12 | 02 | L2300_nnHIH1202_OCCRNC_SPAN | String | Occurrence Span |
12 | 04 | L2300_nnHIH1204__RD8_1_D8 | String | Span Start Date |
12 | 04 | L2300_nnHIH1204__RD8_2_D8 | String | Span End Date |
L2300 | HI | Occurrence Information |
Segment Suffix: Iterated: [01-02] | |
01 | 02 | L2300_nnHII0102_OCCRNC | String | Occurrence |
01 | 04 | L2300_nnHII0104_D8_D8 | Date/Time | Date Expressed in Format CCYYMMDD |
02 | 02 | L2300_nnHII0202_OCCRNC | String | Occurrence |
02 | 04 | L2300_nnHII0204_D8_D8 | Date/Time | Date Expressed in Format CCYYMMDD |
03 | 02 | L2300_nnHII0302_OCCRNC | String | Occurrence |
03 | 04 | L2300_nnHII0304_D8_D8 | Date/Time | Date Expressed in Format CCYYMMDD |
04 | 02 | L2300_nnHII0402_OCCRNC | String | Occurrence |
04 | 04 | L2300_nnHII0404_D8_D8 | Date/Time | Date Expressed in Format CCYYMMDD |
05 | 02 | L2300_nnHII0502_OCCRNC | String | Occurrence |
05 | 04 | L2300_nnHII0504_D8_D8 | Date/Time | Date Expressed in Format CCYYMMDD |
06 | 02 | L2300_nnHII0602_OCCRNC | String | Occurrence |
06 | 04 | L2300_nnHII0604_D8_D8 | Date/Time | Date Expressed in Format CCYYMMDD |
07 | 02 | L2300_nnHII0702_OCCRNC | String | Occurrence |
07 | 04 | L2300_nnHII0704_D8_D8 | Date/Time | Date Expressed in Format CCYYMMDD |
08 | 02 | L2300_nnHII0802_OCCRNC | String | Occurrence |
08 | 04 | L2300_nnHII0804_D8_D8 | Date/Time | Date Expressed in Format CCYYMMDD |
09 | 02 | L2300_nnHII0902_OCCRNC | String | Occurrence |
09 | 04 | L2300_nnHII0904_D8_D8 | Date/Time | Date Expressed in Format CCYYMMDD |
10 | 02 | L2300_nnHII1002_OCCRNC | String | Occurrence |
10 | 04 | L2300_nnHII1004_D8_D8 | Date/Time | Date Expressed in Format CCYYMMDD |
11 | 02 | L2300_nnHII1102_OCCRNC | String | Occurrence |
11 | 04 | L2300_nnHII1104_D8_D8 | Date/Time | Date Expressed in Format CCYYMMDD |
12 | 02 | L2300_nnHII1202_OCCRNC | String | Occurrence |
12 | 04 | L2300_nnHII1204_D8_D8 | Date/Time | Date Expressed in Format CCYYMMDD |
L2300 | HI | Value Information |
Segment Suffix: Iterated: [01-02] | |
01 | 02 | L2300_nnHIJ0102_VALUE | String | Value |
01 | 05 | L2300_nnHIJ0105_VAL_CD_AMT | Decimal | Value Code Amount |
02 | 02 | L2300_nnHIJ0202_VALUE | String | Value |
02 | 05 | L2300_nnHIJ0205_VAL_CD_AMT | String | Value Code Amount |
03 | 02 | L2300_nnHIJ0302_VALUE | String | Value |
03 | 05 | L2300_nnHIJ0305_VAL_CD_AMT | Decimal | Value Code Amount |
04 | 02 | L2300_nnHIJ0402_VALUE | String | Value |
04 | 05 | L2300_nnHIJ0405_VAL_CD_AMT | Decimal | Value Code Amount |
05 | 02 | L2300_nnHIJ0502_VALUE | String | Value |
05 | 05 | L2300_nnHIJ0505_VAL_CD_AMT | Decimal | Value Code Amount |
06 | 02 | L2300_nnHIJ0602_VALUE | String | Value |
06 | 05 | L2300_nnHIJ0605_VAL_CD_AMT | Decimal | Value Code Amount |
07 | 02 | L2300_nnHIJ0702_VALUE | String | Value |
07 | 05 | L2300_nnHIJ0705_VAL_CD_AMT | Decimal | Value Code Amount |
08 | 02 | L2300_nnHIJ0802_VALUE | String | Value |
08 | 05 | L2300_nnHIJ0805_VAL_CD_AMT | Decimal | Value Code Amount |
09 | 02 | L2300_nnHIJ0902_VALUE | String | Value |
09 | 05 | L2300_nnHIJ0905_VAL_CD_AMT | Decimal | Value Code Amount |
10 | 02 | L2300_nnHIJ1002_VALUE | String | Value |
10 | 05 | L2300_nnHIJ1005_VAL_CD_AMT | Decimal | Value Code Amount |
11 | 02 | L2300_nnHIJ1102_VALUE | String | Value |
11 | 05 | L2300_nnHIJ1105_VAL_CD_AMT | Decimal | Value Code Amount |
12 | 02 | L2300_nnHIJ1202_VALUE | String | Value |
12 | 05 | L2300_nnHIJ1205_VAL_CD_AMT | Decimal | Value Code Amount |
L2300 | HI | Condition Information |
Segment Suffix: Iterated: [01-02] | |
01 | 02 | L2300_nnHIA0102_COND | String | Condition |
02 | 02 | L2300_nnHIA0202_COND | String | Condition |
03 | 02 | L2300_nnHIA0302_COND | String | Condition |
04 | 02 | L2300_nnHIA0402_COND | String | Condition |
05 | 02 | L2300_nnHIA0502_COND | String | Condition |
06 | 02 | L2300_nnHIA0602_COND | String | Condition |
07 | 02 | L2300_nnHIA0702_COND | String | Condition |
08 | 02 | L2300_nnHIA0802_COND | String | Condition |
09 | 02 | L2300_nnHIA0902_COND | String | Condition |
10 | 02 | L2300_nnHIA1002_COND | String | Condition |
11 | 02 | L2300_nnHIA1102_COND | String | Condition |
12 | 02 | L2300_nnHIA1202_COND | String | Condition |
L2300 | HI | Treatment Code Information |
Segment Suffix: Iterated: [01-02] | |
01 | 02 | L2300_nnHIL0102_TMT_CD | String | Treatment Codes |
02 | 02 | L2300_nnHIL0202_TMT_CD | String | Treatment Codes |
03 | 02 | L2300_nnHIL0302_TMT_CD | String | Treatment Codes |
04 | 02 | L2300_nnHIL0402_TMT_CD | String | Treatment Codes |
05 | 02 | L2300_nnHIL0502_TMT_CD | String | Treatment Codes |
06 | 02 | L2300_nnHIL0602_TMT_CD | String | Treatment Codes |
07 | 02 | L2300_nnHIL0702_TMT_CD | String | Treatment Codes |
08 | 02 | L2300_nnHIL0802_TMT_CD | String | Treatment Codes |
09 | 02 | L2300_nnHIL0902_TMT_CD | String | Treatment Codes |
10 | 02 | L2300_nnHIL1002_TMT_CD | String | Treatment Codes |
11 | 02 | L2300_nnHIL1102_TMT_CD | String | Treatment Codes |
12 | 02 | L2300_nnHIL1202_TMT_CD | String | Treatment Codes |
L2300 | HCP | Claim Pricing/Repricing Information | ||
01 | L2300_HCP01_PRIC_METHD | String | Pricing Methodology | |
02 | L2300_HCP02_REPRCD_ALLWD_AMT | Decimal | Repriced Allowed Amount | |
03 | L2300_HCP03_REPRCD_SAVNG_AMT | Decimal | Repriced Saving Amount | |
04 | L2300_HCP04_REPRCNG_ORG_ID | String | Repricing Organization Identifier | |
05 | L2300_HCP05_REPRCD_PERDIEM_AMT | Decimal | Repricing Per Diem or Flat Rate Amount | |
06 | L2300_HCP06_REP_APP_DRG_CD | String | Repriced Approved DRG Code | |
07 | L2300_HCP07_REPR_APPR_AMT | Decimal | Repriced Approved Amount | |
08 | L2300_HCP08_REPR_APPR_REV_CD | String | Repriced Approved Revenue Code | |
12 | L2300_HCP12_DAYS | Decimal | Days | |
12 | L2300_HCP12_UN | Decimal | Unit | |
13 | L2300_HCP13_REJ_RSN_CD | String | Reject Reason Code | |
14 | L2300_HCP14_POLCY_COMP_CD | String | Policy Compliance Code | |
15 | L2300_HCP15_EXCPTN_CD | String | Exception Code |
L2310A - ATTENDING PROVIDER NAME |
L2310A | NM1 | Attending Provider Name | ||
03 | L2310A_NM103_ATT_PVR_LNM | String | Attending Provider Last Name | |
04 | L2310A_NM104_ATT_PVR_FNM | String | Attending Provider First Name | |
05 | L2310A_NM105_ATT_PVR_MNM | String | Attending Provider Middle Name or Initial | |
07 | L2310A_NM107_ATT_PVR_SFX | String | Attending Provider Name Suffix | |
09 | L2310A_NM109_ATT_PVR_PRI_ID | String | Attending Provider Primary Identifier |
L2310A | PRV | Attending Provider Specialty Information | ||
03 | L2310A_PRV03_PVR_TAX_CD | String | Provider Taxonomy Code |
L2310A | REF | Attending Provider Secondary Identification | ||
02 | L2310A_REF_STAT_LIC_NR | String | State License Number | |
02 | L2310A_REF_UPIN | String | Provider UPIN Number | |
02 | L2310A_REF_PVR_COMM_NR | String | Provider Commercial Number | |
02 | L2310A_REF_LOC_NR | String | Location Number |
L2310B - OPERATING PHYSICIAN NAME |
L2310B | NM1 | Operating Physician Name | ||
03 | L2310B_NM103_OPER_PHYS_LNM | String | Operating Physician Last Name | |
04 | L2310B_NM104_OPER_PHYS_FNM | String | Operating Physician First Name | |
05 | L2310B_NM105_OPER_PHYS_MNM | String | Operating Physician Middle Name or Initial | |
07 | L2310B_NM107_OPER_PHYS_SFX | String | Operating Physician Name Suffix | |
09 | L2310B_NM109_OPER_PHYS_PRI_ID | String | Operating Physician Primary Identifier |
L2310B | REF | Operating Physician Secondary Identification | ||
02 | L2310B_REF_STAT_LIC_NR | String | State License Number | |
02 | L2310B_REF_UPIN | String | Provider UPIN Number | |
02 | L2310B_REF_PVR_COMM_NR | String | Provider Commercial Number | |
02 | L2310B_REF_LOC_NR | String | Location Number |
L2310C - OTHER OPERATING PHYSICIAN NAME |
L2310C | NM1 | Other Operating Physician Name | ||
03 | L2310C_NM103_OOPER_PHYS_LNM | String | Other Operating Physician Last Name | |
04 | L2310C_NM104_OOPER_PHYS_FNM | String | Other Operating Physician First Name | |
05 | L2310C_NM105_OOPER_PHYS_MNM | String | Other Operating Physician Middle Name or Initial | |
07 | L2310C_NM107_OOPER_PHYS_SFX | String | Other Operating Physician Name Suffix | |
09 | L2310C_NM109_OOPER_PHYS_ID | String | Other Operating Physician Identifier |
L2310C | REF | Other Operating Physician Secondary Identification | ||
02 | L2310C_REF_STAT_LIC_NR | String | State License Number | |
02 | L2310C_REF_UPIN | String | Provider UPIN Number | |
02 | L2310C_REF_PVR_COMM_NR | String | Provider Commercial Number | |
02 | L2310C_REF_LOC_NR | String | Location Number |
L2310D - RENDERING PROVIDER NAME |
L2310D | NM1 | Rendering Provider Name | ||
03 | L2310D_NM103_REND_PVR_LNM | String | Rendering Provider Last Name | |
04 | L2310D_NM104_REND_PVR_FNM | String | Rendering Provider First Name | |
05 | L2310D_NM105_REND_PVR_MNM | String | Rendering Provider Middle Name or Initial | |
07 | L2310D_NM107_REND_PROV_SFX | String | Rendering Provider Name Suffix | |
09 | L2310D_NM109_REND_PROV_ID | String | Rendering Provider Identifier |
L2310D | REF | Rendering Provider Secondary Identification | ||
02 | L2310D_REF_STAT_LIC_NR | String | State License Number | |
02 | L2310D_REF_UPIN | String | Provider UPIN Number | |
02 | L2310D_REF_PVR_COMM_NR | String | Provider Commercial Number | |
02 | L2310D_REF_LOC_NR | String | Location Number |
L2310E - SERVICE FACILITY LOCATION NAME |
L2310E | NM1 | Service Facility Location Name | ||
03 | L2310E_NM103_LAB_FAC_NM | String | Laboratory or Facility Name | |
09 | L2310E_NM109_LAB_FAC_PRI_ID | String | Laboratory or Facility Primary Identifier |
L2310E | N3 | Service Facility Location Address | ||
01 | L2310E_N301_LAB_FAC_ADDR | String | Laboratory or Facility Address Line | |
02 | L2310E_N302_LAB_FAC_ADDR | String | Laboratory or Facility Address Line |
L2310E | N4 | Service Facility Location City, State, ZIP Code | ||
01 | L2310E_N401_LAB_FAC_CITY | String | Laboratory or Facility City Name | |
02 | L2310E_N402_LAB_FAC_STAT | String | Laboratory or Facility State or Province Code | |
03 | L2310E_N403_LAB_ZIP | String | Laboratory or Facility Postal Zone or ZIP Code | |
04 | L2310E_N404_CNTRY_CD | String | Country Code | |
07 | L2310E_N407_CNTRY_SUBDV_CD | String | Country Subdivision Code |
L2310E | REF | Service Facility Location Secondary Identification | ||
02 | L2310E_REF_STAT_LIC_NR | String | State License Number | |
02 | L2310E_REF_PVR_COMM_NR | String | Provider Commercial Number | |
02 | L2310E_REF_LOC_NR | String | Location Number |
L2310F - REFERRING PROVIDER NAME |
L2310F | NM1 | Referring Provider Name | ||
03 | L2310F_NM103_REF_PVR_LNM | String | Referring Provider Last Name | |
04 | L2310F_NM104_REF_PVR_FNM | String | Referring Provider First Name | |
05 | L2310F_NM105_REF_PVR_MNM | String | Referring Provider Middle Name or Initial | |
07 | L2310F_NM107_REF_PVR_SFX | String | Referring Provider Name Suffix | |
09 | L2310F_NM109_REF_PVR_ID | String | Referring Provider Identifier |
L2310F | REF | Referring Provider Secondary Identification | ||
02 | L2310F_REF_STAT_LIC_NR | String | State License Number | |
02 | L2310F_REF_UPIN | String | Provider UPIN Number | |
02 | L2310F_REF_PVR_COMM_NR | String | Provider Commercial Number |
L2320 - OTHER SUBSCRIBER INFORMATION (Single Iteration) |
L2320 | SBR | Other Subscriber Information | ||
01 | L2320_xx_SBR01_PYR_RESP_SEQ_NR | String | Payer Responsibility Sequence Number Code | |
02 | L2320_xx_SBR02_IND_RELAT_CD | String | Individual Relationship Code | |
03 | L2320_xx_SBR03_INS_GRP_PLCY_NR | String | Insured Group or Policy Number | |
04 | L2320_xx_SBR04_OINS_GRP_NM | String | Other Insured Group Name | |
09 | L2320_xx_SBR09_CLM_FIL_IND_CD | String | Claim Filing Indicator Code |
L2320 | CAS | Claim Level Adjustments |
Iterated: [01-05] | |
01 | L2320_xx_nnCAS01_CLMADJ_GRP_CD | String | Claim Adjustment Group Code | |
02 | L2320_xx_nnCAS02_ADJ_RSN_CD | String | Adjustment Reason Code | |
03 | L2320_xx_nnCAS03_ADJ_AMT | Decimal | Adjustment Amount | |
04 | L2320_xx_nnCAS04_ADJ_QTY | Decimal | Adjustment Quantity | |
05 | L2320_xx_nnCAS05_ADJ_RSN_CD | String | Adjustment Reason Code | |
06 | L2320_xx_nnCAS06_ADJ_AMT | Decimal | Adjustment Amount | |
07 | L2320_xx_nnCAS07_ADJ_QTY | Decimal | Adjustment Quantity | |
08 | L2320_xx_nnCAS08_ADJ_RSN_CD | String | Adjustment Reason Code | |
09 | L2320_xx_nnCAS09_ADJ_AMT | Decimal | Adjustment Amount | |
10 | L2320_xx_nnCAS10_ADJ_QTY | Decimal | Adjustment Quantity | |
11 | L2320_xx_nnCAS11_ADJ_RSN_CD | String | Adjustment Reason Code | |
12 | L2320_xx_nnCAS12_ADJ_AMT | Decimal | Adjustment Amount | |
13 | L2320_xx_nnCAS13_ADJ_QTY | Decimal | Adjustment Quantity | |
14 | L2320_xx_nnCAS14_ADJ_RSN_CD | String | Adjustment Reason Code | |
15 | L2320_xx_nnCAS15_ADJ_AMT | Decimal | Adjustment Amount | |
16 | L2320_xx_nnCAS16_ADJ_QTY | Decimal | Adjustment Quantity | |
17 | L2320_xx_nnCAS17_ADJ_RSN_CD | String | Adjustment Reason Code | |
18 | L2320_xx_nnCAS18_ADJ_AMT | Decimal | Adjustment Amount | |
19 | L2320_xx_nnCAS19_ADJ_QTY | Decimal | Adjustment Quantity |
L2320 | AMT | Coordination of Benefits (COB) Payer Paid Amount | ||
02 | L2320_xx_AMT02_PAYR_AMT_PD | Date Timestamp | Payor Amount Paid |
L2320 | AMT | Remaining Patient Liability | ||
02 | L2320_xx_AMT02_AMT_OWED | Date Timestamp | Amount Owed |
L2320 | AMT | Coordination of Benefits (COB) Total Non-Covered Amount | ||
02 | L2320_xx_AMT02_NONCVD_CHG_ACTL | Date Timestamp | Noncovered Charges - Actual |
L2320 | OI | Other Insurance Coverage Information | ||
03 | L2320_xx_OI03_BEN_ASGT_CRT_IND | String | Benefits Assignment Certification Indicator | |
06 | L2320_xx_OI06_RELS_NFO_CD | String | Release of Information Code |
L2320 | MIA | Inpatient Adjudication Information | ||
01 | L2320_xx_MIA01_COV_DAYS_VST_CT | Decimal | Covered Days or Visits Count | |
03 | L2320_xx_MIA03_LFTM_PSYCH_DAYS | Decimal | Lifetime Psychiatric Days Count | |
04 | L2320_xx_MIA04_CLM_DRG_AMT | Decimal | Claim DRG Amount | |
05 | L2320_xx_MIA05_CLM_PMT_RMK_CD | String | Claim Payment Remark Code | |
06 | L2320_xx_MIA06_CLM_DIS_SHR_AMT | Decimal | Claim Disproportionate Share Amount | |
07 | L2320_xx_MIA07_CLM_MSP_PSS_AMT | Decimal | Claim MSP Pass-through Amount | |
08 | L2320_xx_MIA08_CLM_PPS_CAP_AMT | Decimal | Claim PPS Capital Amount | |
09 | L2320_xx_MIA09_PPS_FSP_DRG_AMT | Decimal | PPS-Capital FSP DRG Amount | |
10 | L2320_xx_MIA10_PPS_HSP_DRG_AMT | Decimal | PPS-Capital HSP DRG Amount | |
11 | L2320_xx_MIA11_PPS_DSH_DRG_AMT | Decimal | PPS-Capital DSH DRG Amount | |
12 | L2320_xx_MIA12_OLD_CAP_AMT | Decimal | Old Capital Amount | |
13 | L2320_xx_MIA13_PPS_CAP_IME_AMT | Decimal | PPS-Capital IME amount | |
14 | L2320_xx_MIA14_PPS_OPRS_DRGAMT | Decimal | PPS-Operating Hospital Specific DRG Amount | |
15 | L2320_xx_MIA15_COST_RPT_DAY_CT | Decimal | Cost Report Day Count | |
16 | L2320_xx_MIA16_PPS_FED_DRG_AMT | Decimal | PPS-Operating Federal Specific DRG Amount | |
17 | L2320_xx_MIA17_CLM_CAP_OUT_AMT | Decimal | Claim PPS Capital Outlier Amount | |
18 | L2320_xx_MIA18_CLM_IND_TCH_AMT | Decimal | Claim Indirect Teaching Amount | |
19 | L2320_xx_MIA19_NONPAY_PROF_BLL | Decimal | Non-Payable Professional Component Billed | |
20 | L2320_xx_MIA20_CLM_PMT_RMK_CD | String | Claim Payment Remark Code | |
21 | L2320_xx_MIA21_CLM_PMT_RMK_CD | String | Claim Payment Remark Code | |
22 | L2320_xx_MIA22_CLM_PMT_RMK_CD | String | Claim Payment Remark Code | |
23 | L2320_xx_MIA23_CLM_PMT_RMK_CD | String | Claim Payment Remark Code | |
24 | L2320_xx_MIA24_PPS_EXCPTN_AMT | Decimal | PPS-Capital Exception Amount |
L2320 | MOA | Outpatient Adjudication Information | ||
01 | L2320_xx_MOA01_REIMBRSMT_RT | Decimal | Reimbursement Rate | |
02 | L2320_xx_MOA02_HCPCS_PAYBL_AMT | Decimal | HCPCS Payable Amount | |
03 | L2320_xx_MOA03_CLM_PMT_RMK_CD | String | Claim Payment Remark Code | |
04 | L2320_xx_MOA04_CLM_PMT_RMK_CD | String | Claim Payment Remark Code | |
05 | L2320_xx_MOA05_CLM_PMT_RMK_CD | String | Claim Payment Remark Code | |
06 | L2320_xx_MOA06_CLM_PMT_RMK_CD | String | Claim Payment Remark Code | |
07 | L2320_xx_MOA07_CLM_PMT_RMK_CD | String | Claim Payment Remark Code | |
08 | L2320_xx_MOA08_ESRD_PMT_AMT | Decimal | End Stage Renal Disease Payment Amount | |
09 | L2320_xx_MOA09_NONPAY_PROF_BLL | String | Non-Payable Professional Component Billed |
L2330A - OTHER SUBSCRIBER NAME (Inherited Loop Iteration) |
L2330A | NM1 | Other Subscriber Name | ||
03 | L2330A_xx_NM103_PERSN_LNM | String | Person Last Name | |
03 | L2330A_xx_NM103_NONPSNENT_NM | String | Non-Person Entity Name | |
04 | L2330A_xx_NM104_OINS_FNM | String | Other Insured First Name | |
05 | L2330A_xx_NM105_OINS_MNM | String | Other Insured Middle Name | |
07 | L2330A_xx_NM107_OINS_SFX | String | Other Insured Name Suffix | |
09 | L2330A_xx_NM109_UNQ_IND_ID | String | Standard Unique Health Identifier for each Individual in the United States | |
09 | L2330A_xx_NM109_MEM_ID_NR | String | Member Identification Number |
L2330A | N3 | Other Subscriber Address | ||
01 | L2330A_xx_N301_OINS_ADDR | String | Other Insured Address Line | |
02 | L2330A_xx_N302_OINS_ADDR | String | Other Insured Address Line |
L2330A | N4 | Other Subscriber City, State, ZIP Code | ||
01 | L2330A_xx_N401_OINS_CITY | String | Other Insured City Name | |
02 | L2330A_xx_N402_OINS_STAT | String | Other Insured State Code | |
03 | L2330A_xx_N403_OINS_ZIP | String | Other Insured Postal Zone or ZIP Code | |
04 | L2330A_xx_N404_CNTRY_CD | String | Country Code | |
07 | L2330A_xx_N407_CNTRY_SUBDV_CD | String | Country Subdivision Code |
L2330A | REF | Other Subscriber Secondary Identification |
Iterated: [01-02] | |
02 | L2330A_xx_nnREF_SSN | String | Social Security Number |
L2330B - OTHER PAYER NAME (Inherited Loop Iteration) |
L2330B | NM1 | Other Payer Name | ||
03 | L2330B_xx_NM103_OPYR_LSTORG_NM | String | Other Payer Last or Organization Name | |
09 | L2330B_xx_NM109_PAYR_ID | String | Payor Identification | |
09 | L2330B_xx_NM109_HCFA_PLAN_ID | String | Centers for Medicare and Medicaid Services PlanID |
L2330B | N3 | Other Payer Address | ||
01 | L2330B_xx_N301_OPYR_ADDR | String | Other Payer Address Line | |
02 | L2330B_xx_N302_OPYR_ADDR | String | Other Payer Address Line |
L2330B | N4 | Other Payer City, State, ZIP Code | ||
01 | L2330B_xx_N401_OPYR_CITY_NM | String | Other Payer City Name | |
02 | L2330B_xx_N402_OPYR_STAT | String | Other Payer State Code | |
03 | L2330B_xx_N403_OPYR_POSTL_ZIP | String | Other Payer Postal Zone or ZIP Code | |
04 | L2330B_xx_N404_CNTRY_CD | String | Country Code | |
07 | L2330B_xx_N407_CNTRY_SUBDV_CD | String | Country Subdivision Code |
L2330B | DTP | Claim Check or Remittance Date | ||
03 | L2330B_xx_DTP_CLM_PD_D8 | Start Date | Date Claim Paid (D8) |
L2330B | REF | Other Payer Secondary Identifier |
Iterated: [01-02] | |
02 | L2330B_xx_nnREF_PYR_ID | String | Payer Identification Number | |
02 | L2330B_xx_nnREF_EMPLR_ID_NR | String | Employer?s Identification Number | |
02 | L2330B_xx_nnREF_CLM_OFC_NR | String | Claim Office Number | |
02 | L2330B_xx_nnREF_NAIC | String | National Association of Insurance Commissioners (NAIC) Code |
L2330B | REF | Other Payer Prior Authorization Number | ||
02 | L2330B_xx_REF_PRIOR_AUTH | String | Prior Authorization Number |
L2330B | REF | Other Payer Referral Number | ||
02 | L2330B_xx_REF_REFRL_NR | String | Referral Number |
L2330B | REF | Other Payer Claim Adjustment Indicator | ||
02 | L2330B_xx_REF_SIGNL_CD | String | Signal Code |
L2330B | REF | Other Payer Claim Control Number | ||
02 | L2330B_xx_REF_ORIG_REF_NR | String | Original Reference Number |
L2330C - OTHER PAYER ATTENDING PROVIDER (Inherited Loop Iteration) |
L2330C | NM1 | Other Payer Attending Provider |
L2330C | REF | Other Payer Attending Provider Secondary Identification | ||
02 | L2330C_xx_REF_STAT_LIC_NR | String | State License Number | |
02 | L2330C_xx_REF_UPIN | String | Provider UPIN Number | |
02 | L2330C_xx_REF_PVR_COMM_NR | String | Provider Commercial Number | |
02 | L2330C_xx_REF_LOC_NR | String | Location Number |
L2330D - OTHER PAYER OPERATING PHYSICIAN (Inherited Loop Iteration) |
L2330D | NM1 | Other Payer Operating Physician |
L2330D | REF | Other Payer Operating Physician Secondary Identification | ||
02 | L2330D_xx_REF_STAT_LIC_NR | String | State License Number | |
02 | L2330D_xx_REF_UPIN | String | Provider UPIN Number | |
02 | L2330D_xx_REF_PVR_COMM_NR | String | Provider Commercial Number | |
02 | L2330D_xx_REF_LOC_NR | String | Location Number |
L2330E - OTHER PAYER OTHER OPERATING PHYSICIAN (Inherited Loop Iteration) |
L2330E | NM1 | Other Payer Other Operating Physician |
L2330E | REF | Other Payer Other Operating Physician Secondary Identification | ||
02 | L2330E_xx_REF_STAT_LIC_NR | String | State License Number | |
02 | L2330E_xx_REF_UPIN | String | Provider UPIN Number | |
02 | L2330E_xx_REF_PVR_COMM_NR | String | Provider Commercial Number | |
02 | L2330E_xx_REF_LOC_NR | String | Location Number |
L2330F - OTHER PAYER SERVICE FACILITY LOCATION (Inherited Loop Iteration) |
L2330F | NM1 | Other Payer Service Facility Location |
L2330F | REF | Other Payer Service Facility Location Secondary Identification | ||
02 | L2330F_xx_REF_STAT_LIC_NR | String | State License Number | |
02 | L2330F_xx_REF_PVR_COMM_NR | String | Provider Commercial Number | |
02 | L2330F_xx_REF_LOC_NR | String | Location Number |
L2330G - OTHER PAYER RENDERING PROVIDER NAME (Inherited Loop Iteration) |
L2330G | NM1 | Other Payer Rendering Provider Name |
L2330G | REF | Other Payer Rendering Provider Secondary Identification | ||
02 | L2330G_xx_REF_STAT_LIC_NR | String | State License Number | |
02 | L2330G_xx_REF_UPIN | String | Provider UPIN Number | |
02 | L2330G_xx_REF_PVR_COMM_NR | String | Provider Commercial Number | |
02 | L2330G_xx_REF_LOC_NR | String | Location Number |
L2330H - OTHER PAYER REFERRING PROVIDER (Inherited Loop Iteration) |
L2330H | NM1 | Other Payer Referring Provider |
L2330H | REF | Other Payer Referring Provider Secondary Identification | ||
02 | L2330H_xx_REF_STAT_LIC_NR | String | State License Number | |
02 | L2330H_xx_REF_UPIN | String | Provider UPIN Number | |
02 | L2330H_xx_REF_PVR_COMM_NR | String | Provider Commercial Number |
L2330I - OTHER PAYER BILLING PROVIDER (Inherited Loop Iteration) |
L2330I | NM1 | Other Payer Billing Provider |
L2330I | REF | Other Payer Billing Provider Secondary Identification | ||
02 | L2330I_xx_REF_PVR_COMM_NR | String | Provider Commercial Number | |
02 | L2330I_xx_REF_LOC_NR | String | Location Number |
L2400 - SERVICE LINE NUMBER |
L2400 | LX | Service Line Number | ||
01 | L2400_LX01_ASSGD_NR | Integer | Assigned Number |
L2400 | SV2 | Institutional Service Line | ||
01 | L2400_SV201_SVC_LIN_REV_CD | String | Service Line Revenue Code | |
02 | 02 | L2400_SV20202_JS_PRC_SPY_CD | String | Jurisdiction Specific Procedure and Supply Codes |
02 | 02 | L2400_SV20202_HCPCS_CD | String | Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes |
02 | 02 | L2400_SV20202_HIPPA_SNF_RT_CD | String | Health Insurance Prospective Payment System (HIPPS) Skilled Nursing Facility Rate Code |
02 | 02 | L2400_SV20202_HIC_PRD_SVCCD | String | Home Infusion EDI Coalition (HIEC) Product/Service Code |
02 | 02 | L2400_SV20202_ABC_CD | String | Advanced Billing Concepts (ABC) Codes |
02 | 03 | L2400_SV20203_PROC_MOD | String | Procedure Modifier |
02 | 04 | L2400_SV20204_PROC_MOD | String | Procedure Modifier |
02 | 05 | L2400_SV20205_PROC_MOD | String | Procedure Modifier |
02 | 06 | L2400_SV20206_PROC_MOD | String | Procedure Modifier |
02 | 07 | L2400_SV20207_DESCR | String | Description |
03 | L2400_SV203_LIN_ITM_CHG_AMT | Decimal | Line Item Charge Amount | |
05 | L2400_SV205_DAYS | Decimal | Days | |
05 | L2400_SV205_UN | Decimal | Unit | |
07 | L2400_SV207_LIN_ITM_DENY_CHG | Decimal | Line Item Denied Charge or Non-Covered Charge |
L2400 | PWK | Line Supplemental Information |
Iterated: [01-10] | |
01 | L2400_nnPWK01_ATT_REP_TYP_CD | String | Attachment Report Type Code | |
02 | L2400_nnPWK02_ATT_TRANS_CD | String | Attachment Transmission Code | |
06 | L2400_nnPWK06_ATTACH_CTL_NR | String | Attachment Control Number |
L2400 | DTP | Date - Service Date | ||
03 | L2400_DTP_SVC_D8 | Start Date | Service (D8) | |
03 | L2400_DTP_SVC_RD8_1 | Start Date | Service (D8) | |
03 | L2400_DTP_SVC_RD8_2 | End Date | Service (D8) |
L2400 | REF | Line Item Control Number | ||
02 | L2400_REF_PRV_CTL_NR | String | Provider Control Number |
L2400 | REF | Repriced Line Item Reference Number | ||
02 | L2400_REF_REP_LIN_ITM | String | Repriced Line Item Reference Number |
L2400 | REF | Adjusted Repriced Line Item Reference Number | ||
02 | L2400_REF_ADJ_REP_LIN_ITM | String | Adjusted Repriced Line Item Reference Number |
L2400 | AMT | Service Tax Amount | ||
02 | L2400_AMT02_GDS_SVCS_TAX | Date Timestamp | Goods and Services Tax |
L2400 | AMT | Facility Tax Amount | ||
02 | L2400_AMT02_MISC_TAX | Date Timestamp | Miscellaneous Taxes |
L2400 | NTE | Third Party Organization Notes | ||
02 | L2400_NTE02_LIN_NOT_TXT | String | Line Note Text |
L2400 | HCP | Line Pricing/Repricing Information | ||
01 | L2400_HCP01_PRIC_METHD | String | Pricing Methodology | |
02 | L2400_HCP02_MONTRY_AMT | Decimal | Monetary Amount | |
03 | L2400_HCP03_MONTRY_AMT | Decimal | Monetary Amount | |
04 | L2400_HCP04_REF_ID | String | Reference Identification | |
05 | L2400_HCP05_RATE | Decimal | Rate | |
06 | L2400_HCP06_REF_ID | String | Reference Identification | |
07 | L2400_HCP07_MONTRY_AMT | Decimal | Monetary Amount | |
08 | L2400_HCP08_PROD_SVC_ID | String | Product or Service ID | |
10 | L2400_HCP10_JS_PRC_SPY_CD | String | Jurisdiction Specific Procedure and Supply Codes | |
10 | L2400_HCP10_HCPCS_CD | String | Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes | |
10 | L2400_HCP10_HIPPA_SNF_RT_CD | String | Health Insurance Prospective Payment System (HIPPS) Skilled Nursing Facility Rate Code | |
10 | L2400_HCP10_HIC_PRD_SVCCD | String | Home Infusion EDI Coalition (HIEC) Product/Service Code | |
10 | L2400_HCP10_ABC_CD | String | Advanced Billing Concepts (ABC) Codes | |
12 | L2400_HCP12_DAYS | Decimal | Days | |
12 | L2400_HCP12_UN | Decimal | Unit | |
13 | L2400_HCP13_REJ_RSN_CD | String | Reject Reason Code | |
14 | L2400_HCP14_POLCY_COMP_CD | String | Policy Compliance Code | |
15 | L2400_HCP15_EXCPTN_CD | String | Exception Code |
L2410 - DRUG IDENTIFICATION |
L2410 | LIN | Drug Identification | ||
03 | L2410_LIN03_NDC | String | National Drug Code |
L2410 | CTP | Drug Quantity | ||
04 | L2410_CTP04_NATL_DRG_UNIT_CT | Decimal | National Drug Unit Count | |
05 | 01 | L2410_CTP0501_CD_QUAL | String | Code Qualifier |
L2410 | REF | Prescription or Compound Drug Association Number | ||
02 | L2410_REF_LNK_SEQ_NR | String | Link Sequence Number | |
02 | L2410_REF_PHRM_RX_NR | String | Pharmacy Prescription Number |
L2420A - OPERATING PHYSICIAN NAME |
L2420A | NM1 | Operating Physician Name | ||
03 | L2420A_NM103_OPER_PHYS_LNM | String | Operating Physician Last Name | |
04 | L2420A_NM104_OPER_PHYS_FNM | String | Operating Physician First Name | |
05 | L2420A_NM105_OPER_PHYS_MNM | String | Operating Physician Middle Name or Initial | |
07 | L2420A_NM107_OPER_PHYS_SFX | String | Operating Physician Name Suffix | |
09 | L2420A_NM109_OPER_PHYS_PRI_ID | String | Operating Physician Primary Identifier |
L2420A | REF | Operating Physician Secondary Identification |
Iterated: [01-20] | |
02 | L2420A_nnREF_STAT_LIC_NR | String | State License Number | |
02 | L2420A_nnREF_UPIN | String | Provider UPIN Number | |
02 | L2420A_nnREF_PVR_COMM_NR | String | Provider Commercial Number | |
02 | L2420A_nnREF_LOC_NR | String | Location Number | |
04 | 02 | L2420A_nnREF0402_PYR_ID | String | Payer Identification Number |
L2420B - OTHER OPERATING PHYSICIAN NAME |
L2420B | NM1 | Other Operating Physician Name | ||
03 | L2420B_NM103_OOPER_PHYS_LNM | String | Other Operating Physician Last Name | |
04 | L2420B_NM104_OOPER_PHYS_FNM | String | Other Operating Physician First Name | |
05 | L2420B_NM105_OOPER_PHYS_MNM | String | Other Operating Physician Middle Name or Initial | |
07 | L2420B_NM107_OOPER_PHYS_SFX | String | Other Operating Physician Name Suffix | |
09 | L2420B_NM109_OOPER_PHYS_ID | String | Other Operating Physician Identifier |
L2420B | REF | Other Operating Physician Secondary Identification |
Iterated: [01-20] | |
02 | L2420B_nnREF_STAT_LIC_NR | String | State License Number | |
02 | L2420B_nnREF_UPIN | String | Provider UPIN Number | |
02 | L2420B_nnREF_PVR_COMM_NR | String | Provider Commercial Number | |
02 | L2420B_nnREF_LOC_NR | String | Location Number | |
04 | 02 | L2420B_nnREF0402_PYR_ID | String | Payer Identification Number |
L2420C - RENDERING PROVIDER NAME |
L2420C | NM1 | Rendering Provider Name | ||
03 | L2420C_NM103_REND_PVR_LNM | String | Rendering Provider Last Name | |
04 | L2420C_NM104_REND_PVR_FNM | String | Rendering Provider First Name | |
05 | L2420C_NM105_REND_PVR_MNM | String | Rendering Provider Middle Name or Initial | |
07 | L2420C_NM107_REND_PROV_SFX | String | Rendering Provider Name Suffix | |
09 | L2420C_NM109_REND_PROV_ID | String | Rendering Provider Identifier |
L2420C | REF | Rendering Provider Secondary Identification |
Iterated: [01-20] | |
02 | L2420C_nnREF_STAT_LIC_NR | String | State License Number | |
02 | L2420C_nnREF_UPIN | String | Provider UPIN Number | |
02 | L2420C_nnREF_PVR_COMM_NR | String | Provider Commercial Number | |
02 | L2420C_nnREF_LOC_NR | String | Location Number | |
04 | 02 | L2420C_nnREF0402_PYR_ID | String | Payer Identification Number |
L2420D - REFERRING PROVIDER NAME |
L2420D | NM1 | Referring Provider Name | ||
03 | L2420D_NM103_REF_PVR_LNM | String | Referring Provider Last Name | |
04 | L2420D_NM104_REF_PVR_FNM | String | Referring Provider First Name | |
05 | L2420D_NM105_REF_PVR_MNM | String | Referring Provider Middle Name or Initial | |
07 | L2420D_NM107_REF_PVR_SFX | String | Referring Provider Name Suffix | |
09 | L2420D_NM109_REF_PVR_ID | String | Referring Provider Identifier |
L2420D | REF | Referring Provider Secondary Identification |
Iterated: [01-20] | |
02 | L2420D_nnREF_STAT_LIC_NR | String | State License Number | |
02 | L2420D_nnREF_UPIN | String | Provider UPIN Number | |
02 | L2420D_nnREF_PVR_COMM_NR | String | Provider Commercial Number | |
04 | 02 | L2420D_nnREF0402_PYR_ID | String | Payer Identification Number |
L2430 - LINE ADJUDICATION INFORMATION (Single Iteration) |
L2430 | SVD | Line Adjudication Information | ||
01 | L2430_xx_SVD01_OPYR_PRI_ID | String | Other Payer Primary Identifier | |
02 | L2430_xx_SVD02_SVC_LIN_PD_AMT | Decimal | Service Line Paid Amount | |
03 | 02 | L2430_xx_SVD0302_JS_PRC_SPY_CD | String | Jurisdiction Specific Procedure and Supply Codes |
03 | 02 | L2430_xx_SVD0302_HCPCS_CD | String | Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes |
03 | 02 | L2430_xx_SVD0302_HPPS | String | Health Insurance Prospective Payment System |
03 | 02 | L2430_xx_SVD0302_HIC_PRD_SVCCD | String | Home Infusion EDI Coalition (HIEC) Product/Service |
03 | 02 | L2430_xx_SVD0302_ABC_CD | String | Advanced Billing Concepts (ABC) Codes |
03 | 03 | L2430_xx_SVD0303_PROC_MOD | String | Procedure Modifier |
03 | 04 | L2430_xx_SVD0304_PROC_MOD | String | Procedure Modifier |
03 | 05 | L2430_xx_SVD0305_PROC_MOD | String | Procedure Modifier |
03 | 06 | L2430_xx_SVD0306_PROC_MOD | String | Procedure Modifier |
03 | 07 | L2430_xx_SVD0307_PROC_CD_DESC | String | Procedure Code Description |
05 | L2430_xx_SVD05_PD_SVC_UN_CT | Decimal | Paid Service Unit Count | |
06 | L2430_xx_SVD06_BUNDL_LIN_NR | Integer | Bundled Line Number |
L2430 | CAS | Line Adjustment |
Iterated: [01-05] | |
01 | L2430_xx_nnCAS01_CLMADJ_GRP_CD | String | Claim Adjustment Group Code | |
02 | L2430_xx_nnCAS02_ADJ_RSN_CD | String | Adjustment Reason Code | |
03 | L2430_xx_nnCAS03_ADJ_AMT | Decimal | Adjustment Amount | |
04 | L2430_xx_nnCAS04_ADJ_QTY | Decimal | Adjustment Quantity | |
05 | L2430_xx_nnCAS05_ADJ_RSN_CD | String | Adjustment Reason Code | |
06 | L2430_xx_nnCAS06_ADJ_AMT | Decimal | Adjustment Amount | |
07 | L2430_xx_nnCAS07_ADJ_QTY | Decimal | Adjustment Quantity | |
08 | L2430_xx_nnCAS08_ADJ_RSN_CD | String | Adjustment Reason Code | |
09 | L2430_xx_nnCAS09_ADJ_AMT | Decimal | Adjustment Amount | |
10 | L2430_xx_nnCAS10_ADJ_QTY | Decimal | Adjustment Quantity | |
11 | L2430_xx_nnCAS11_ADJ_RSN_CD | String | Adjustment Reason Code | |
12 | L2430_xx_nnCAS12_ADJ_AMT | Decimal | Adjustment Amount | |
13 | L2430_xx_nnCAS13_ADJ_QTY | Decimal | Adjustment Quantity | |
14 | L2430_xx_nnCAS14_ADJ_RSN_CD | String | Adjustment Reason Code | |
15 | L2430_xx_nnCAS15_ADJ_AMT | Decimal | Adjustment Amount | |
16 | L2430_xx_nnCAS16_ADJ_QTY | Decimal | Adjustment Quantity | |
17 | L2430_xx_nnCAS17_ADJ_RSN_CD | String | Adjustment Reason Code | |
18 | L2430_xx_nnCAS18_ADJ_AMT | Decimal | Adjustment Amount | |
19 | L2430_xx_nnCAS19_ADJ_QTY | Decimal | Adjustment Quantity |
L2430 | DTP | Line Check or Remittance Date | ||
03 | L2430_xx_DTP_CLM_PD_D8 | Start Date | Date Claim Paid (D8) |
L2430 | AMT | Remaining Patient Liability | ||
02 | L2430_xx_AMT02_AMT_OWED | Date Timestamp | Amount Owed |
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 |