Loop Qualifiersxx - Loop Iteration Prefix
xxyy - Outer Loop Iteration and Inner Loop Iteration
yy /
yyy - Loop Value Qualifier
xxyy /
xxyyy - Loop Iteration and Value Qualifier
Segment Modifiers:X - Distinguishing Identifier Suffix
nn - Segment Iteration (only after first iterartion)
nn - Element Repeat Iteration (only after first iterartion)
ISA | ISA | Interchange Control Header | | |
02 | | ISA_ISA02_NO_AUTH_NFO | String | No Authorization Information Present |
02 | | ISA_ISA02_ADDL_DATA_ID | String | Additional Data Identification |
04 | | ISA_ISA04_NO_SEC_NFO | String | No Security Information Present |
04 | | ISA_ISA04_PSSWD | String | Password |
06 | | ISA_ISA06_DUN_BRDST | String | Dun and Brandstreet |
06 | | ISA_ISA06_DUN_BRDST_SFX | String | Duns Plus Suffix |
06 | | ISA_ISA06_HIN | String | Health Industry Number |
06 | | ISA_ISA06_CARR_ID | String | Carrier Identification Number as assigned by Health Care Financing Administration |
06 | | ISA_ISA06_HCFA_FIIN | String | Fiscal Intermediary Identification Number as assigned by Health Care Financing Administration |
06 | | ISA_ISA06_HCFA_ID | String | Medicare Provider and Supplier Identification Number as assigned by Health Care Financing Administration |
06 | | ISA_ISA06_TAX_ID | String | US Federal Tax Identification Number |
06 | | ISA_ISA06_NAIC_CD | String | National Association of Insurance Commissioners Company Code |
06 | | ISA_ISA06_MUTLY_DEF | String | Mutually Defined |
08 | | ISA_ISA08_DUN_BRDST | String | Dun and Brandstreet |
08 | | ISA_ISA08_DUN_BRDST_SFX | String | Duns Plus Suffix |
08 | | ISA_ISA08_HIN | String | Health Industry Number |
08 | | ISA_ISA08_CARR_ID | String | Carrier Identification Number as assigned by Health Care Financing Administration |
08 | | ISA_ISA08_HCFA_FIIN | String | Fiscal Intermediary Identification Number as assigned by Health Care Financing Administration |
08 | | ISA_ISA08_HCFA_ID | String | Medicare Provider and Supplier Identification Number as assigned by Health Care Financing Administration |
08 | | ISA_ISA08_TAX_ID | String | US Federal Tax Identification Number |
08 | | ISA_ISA08_NAIC_CD | String | National Association of Insurance Commissioners Company Code |
08 | | ISA_ISA08_MUTLY_DEF | String | Mutually Defined |
09 | | ISA_ISA09_INTCHG_DT | Date (YYMMDD) | Interchange Date |
10 | | ISA_ISA10_INTCHG_TM | Time (HHMM) | Interchange Time |
11 | | ISA_ISA11_REPTN_SEP | String | Repetition Separator |
12 | | ISA_ISA12_ICN_VERS_NR | String | Interchang Control Version Number |
13 | | ISA_ISA13_ICN | Integer | Interchange Control Number |
14 | | ISA_ISA14_ACK_REQ | String | Acknowledgment Requested |
15 | | ISA_ISA15_ICN_USG_IND | String | Interchange Usage Indicator |
16 | | ISA_ISA16_COMP_ELE_SEP | String | Component Element Separator |
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 (YYYYMMDD) | Date |
05 | | GSHDR_GS05_TM | Time (HHMM) | Time |
05 | | GSHDR_GS05_TM8 | Time (HHMMSSCC) | 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 |
02 | | STHDR_BHT02_TS_PURP_CD | String | Transaction Set Purpose Code |
03 | | STHDR_BHT03_SBM_TRANS_ID | String | Submitter Transaction Identifier |
04 | | STHDR_BHT04_TS_CRTN_D8 | Date (YYYYMMDD) | Transaction Set Creation Date |
05 | | STHDR_BHT05_TS_CRTN_TM | Time (HHMM) | Transaction Set Creation Time |
05 | | STHDR_BHT05_TS_CRTN_TM8 | Time (HHMMSSCC) | 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 |
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 |
01 | | L2000B_HL01_HIER_ID_NR | String | Hierarchical ID Number |
02 | | L2000B_HL02_HIER_PARNT_ID_NR | String | Hierarchical Parent ID Number |
L2010B - REQUESTER NAME (Value Qualified) |
Mapping Prefix: L2010B_1P - Provider |
Mapping Prefix: L2010B_2B - Third-Party Administrator |
Mapping Prefix: L2010B_36 - Employer |
Mapping Prefix: L2010B_FA - Facility |
Mapping Prefix: L2010B_PR - Payer |
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_EMPLYR_ID | String | Employer's Identification Number |
09 | | L2010B_yy_NM109_SSN | String | Social Security Number |
09 | | L2010B_yy_NM109_ETN_NR | String | Electronic Transmitter Identification Number (ETIN) |
09 | | L2010B_yy_NM109_HCFA_PLAN_ID | String | Centers for Medicare and Medicaid Services PlanID |
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 | N3 | Requester Address | | |
01 | | L2010B_yy_N301_REQ_ADDR | String | Requester Address Line |
02 | | L2010B_yy_N302_REQ_ADDR | String | Requester Address Line |
L2010B | N4 | Requester City, State, ZIP Code | | |
01 | | L2010B_yy_N401_REQSTR_CITY | String | Requester City Name |
02 | | L2010B_yy_N402_REQ_STAT | String | Requester State or Province Code |
03 | | L2010B_yy_N403_REQ_ZIP | String | Requester Postal Zone or ZIP Code |
04 | | L2010B_yy_N404_CNTRY_CD | String | Country Code |
07 | | L2010B_yy_N407_CNTRY_SUBDV_CD | String | Country Subdivision Code |
L2010B | PER | Requester Contact Information | | |
02 | | L2010B_yy_PER02_REQ_CON_NM | String | Requester Contact Name |
04 | | L2010B_yy_PER04_EMAIL | String | Electronic Mail |
04 | | L2010B_yy_PER04_FAX | String | Facsimile |
04 | | L2010B_yy_PER04_PHN_NR | String | Telephone |
04 | | L2010B_yy_PER04_URL | String | Uniform Resource Locator (URL) |
06 | | L2010B_yy_PER06_EMAIL | String | Electronic Mail |
06 | | L2010B_yy_PER06_PHN_EXT | String | Telephone Extension |
06 | | L2010B_yy_PER06_FAX | String | Facsimile |
06 | | L2010B_yy_PER06_PHN_NR | String | Telephone |
06 | | L2010B_yy_PER06_URL | String | Uniform Resource Locator (URL) |
08 | | L2010B_yy_PER08_EMAIL | String | Electronic Mail |
08 | | L2010B_yy_PER08_PHN_EXT | String | Telephone Extension |
08 | | L2010B_yy_PER08_FAX | String | Facsimile |
08 | | L2010B_yy_PER08_PHN_NR | String | Telephone |
08 | | L2010B_yy_PER08_URL | String | Uniform Resource Locator (URL) |
L2010B | PRV | Requester Provider Information | | |
01 | | L2010B_yy_PRV01_PVD_CD | String | Provider Code |
03 | | L2010B_yy_PRV03_PVD_TAXNMY_CD | String | Health Care Provider Taxonomy Code |
L2000C - SUBSCRIBER LEVEL |
01 | | L2000C_HL01_HIER_ID_NR | String | Hierarchical ID Number |
02 | | L2000C_HL02_HIER_PARNT_ID_NR | String | Hierarchical Parent ID Number |
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 | | |
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 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 | DMG | Subscriber Demographic Information | | |
02 | | L2010C_DMG02_D8 | DateTime | 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 |
01 | | L2000D_HL01_HIER_ID_NR | String | Hierarchical ID Number |
02 | | L2000D_HL02_HIER_PARNT_ID_NR | String | Hierarchical Parent ID Number |
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 |
L2010D | REF | Dependent Supplemental Identification | | |
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 | DMG | Dependent Demographic Information | | |
02 | | L2010D_DMG02_D8 | DateTime | 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 | | |
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 | 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 |
05 | 01 | L2000E_UM0501_RELTD_CAUS_CD | String | Related Causes Code |
05 | 02 | L2000E_UM0502_RELTD_CAUS_CD | String | Related Causes Code |
05 | 03 | L2000E_UM0503_RELTD_CAUS_CD | String | Related Causes Code |
05 | 04 | L2000E_UM0504_STAT | String | State or Province Code |
05 | 05 | L2000E_UM0505_CNTRY_CD | String | Country Code |
06 | | L2000E_UM06_LVL_SVC_CD | String | Level of Service Code |
07 | | L2000E_UM07_CURR_HLTH_CND_CD | String | Current Health Condition Code |
08 | | L2000E_UM08_PROGNS_CD | String | Prognosis Code |
09 | | L2000E_UM09_RELS_NFO_CD | String | Release of Information Code |
10 | | L2000E_UM10_DELAY_RSN_CD | String | Delay Reason Code |
L2000E | REF | Previous Review Authorization Number | | |
02 | | L2000E_REF_AUTH_NR | String | Authorization Number |
L2000E | REF | Previous Review Administrative Reference Number | | |
02 | | L2000E_REF_ADMIN_REF_NR | String | Administrator's Reference Number |
03 | | L2000E_DTP_ACCDNT_D8 | Date (YYYYMMDD) | Accident Date |
L2000E | DTP | Last Menstrual Period Date | | |
03 | | L2000E_DTP_MENS_PERD_D8 | Date (YYYYMMDD) | Last Menstrual Period Date |
L2000E | DTP | Estimated Date of Birth | | |
03 | | L2000E_DTP_EST_DOB_D8 | Date (YYYYMMDD) | Estimated Date of Birth Date |
L2000E | DTP | Onset of Current Symptoms or Illness Date | | |
03 | | L2000E_DTP_ONST_CURR_SYMPTM_D8 | Date (YYYYMMDD) | Onset of Current Symptoms or Illness Date |
03 | | L2000E_DTP_EVNT_D8 | Date (YYYYMMDD) | Event Date |
03 | | L2000E_DTP_EVNT_RD8_1 | Start Date (YYYYMMDD) | Event Date |
03 | | L2000E_DTP_EVNT_RD8_2 | End Date (YYYYMMDD) | Event Date |
03 | | L2000E_DTP_ADMSN_D8 | Date (YYYYMMDD) | Admission Date |
03 | | L2000E_DTP_ADMSN_RD8_1 | Start Date (YYYYMMDD) | Admission Date |
03 | | L2000E_DTP_ADMSN_RD8_2 | End Date (YYYYMMDD) | Admission Date |
03 | | L2000E_DTP_DISCHG_D8 | Date (YYYYMMDD) | Discharge Date |
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_ICD9_RSN_VISIT | String | International Classification of Diseases Clinical Modification (ICD-9-CM) Patient's Reason for Visit |
01 | 04 | L2000E_HI0104_DIAG | DateTime | Diagnosis Date |
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_ICD9_RSN_VISIT | String | International Classification of Diseases Clinical Modification (ICD-9-CM) Patient's Reason for Visit |
02 | 04 | L2000E_HI0204_DIAG | DateTime | Diagnosis Date |
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_ICD9_RSN_VISIT | String | International Classification of Diseases Clinical Modification (ICD-9-CM) Patient's Reason for Visit |
03 | 04 | L2000E_HI0304_DIAG | DateTime | Diagnosis Date |
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_ICD9_RSN_VISIT | String | International Classification of Diseases Clinical Modification (ICD-9-CM) Patient's Reason for Visit |
04 | 04 | L2000E_HI0404_DIAG | DateTime | Diagnosis Date |
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_ICD9_RSN_VISIT | String | International Classification of Diseases Clinical Modification (ICD-9-CM) Patient's Reason for Visit |
05 | 04 | L2000E_HI0504_DIAG | DateTime | Diagnosis Date |
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_ICD9_RSN_VISIT | String | International Classification of Diseases Clinical Modification (ICD-9-CM) Patient's Reason for Visit |
06 | 04 | L2000E_HI0604_DIAG | DateTime | Diagnosis Date |
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_ICD9_RSN_VISIT | String | International Classification of Diseases Clinical Modification (ICD-9-CM) Patient's Reason for Visit |
07 | 04 | L2000E_HI0704_DIAG | DateTime | Diagnosis Date |
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_ICD9_RSN_VISIT | String | International Classification of Diseases Clinical Modification (ICD-9-CM) Patient's Reason for Visit |
08 | 04 | L2000E_HI0804_DIAG | DateTime | Diagnosis Date |
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_ICD9_RSN_VISIT | String | International Classification of Diseases Clinical Modification (ICD-9-CM) Patient's Reason for Visit |
09 | 04 | L2000E_HI0904_DIAG | DateTime | Diagnosis Date |
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_ICD9_RSN_VISIT | String | International Classification of Diseases Clinical Modification (ICD-9-CM) Patient's Reason for Visit |
10 | 04 | L2000E_HI1004_DIAG | DateTime | Diagnosis Date |
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_ICD9_RSN_VISIT | String | International Classification of Diseases Clinical Modification (ICD-9-CM) Patient's Reason for Visit |
11 | 04 | L2000E_HI1104_DIAG | DateTime | Diagnosis Date |
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_ICD9_RSN_VISIT | String | International Classification of Diseases Clinical Modification (ICD-9-CM) Patient's Reason for Visit |
12 | 04 | L2000E_HI1204_DIAG | DateTime | Diagnosis Date |
L2000E | HSD | Health Care Services Delivery | | |
02 | | L2000E_HSD02_DAYS | Number | Days |
02 | | L2000E_HSD02_UN | Number | Units |
02 | | L2000E_HSD02_HR | Number | Hours |
02 | | L2000E_HSD02_MO | Number | Month |
02 | | L2000E_HSD02_VIST | Number | Visits |
04 | | L2000E_HSD04_DAYS | Number | Days |
04 | | L2000E_HSD04_MOS | Number | Months |
04 | | L2000E_HSD04_WK | Number | 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 | CRC | Ambulance Certification Information | Segment Suffix: A
| |
02 | | L2000E_CRCA02_CERT_COND_IND | String | Certification Condition Indicator |
03 | | L2000E_CRCA03_CONDTN_CD | String | Condition Code |
04 | | L2000E_CRCA04_CONDTN_CD | String | Condition Code |
05 | | L2000E_CRCA05_CONDTN_CD | String | Condition Code |
06 | | L2000E_CRCA06_CONDTN_CD | String | Condition Code |
07 | | L2000E_CRCA07_CONDTN_CD | String | Condition Code |
L2000E | CRC | Chiropractic Certification Information | Segment Suffix: B
| |
02 | | L2000E_CRCB02_CERT_COND_IND | String | Certification Condition Indicator |
03 | | L2000E_CRCB03_CONDTN_CD | String | Condition Code |
04 | | L2000E_CRCB04_CONDTN_CD | String | Condition Code |
05 | | L2000E_CRCB05_CONDTN_CD | String | Condition Code |
06 | | L2000E_CRCB06_CONDTN_CD | String | Condition Code |
07 | | L2000E_CRCB07_CONDTN_CD | String | Condition Code |
L2000E | CRC | Durable Medical Equipment Information | Segment Suffix: C
| |
02 | | L2000E_CRCC02_CERT_COND_IND | String | Certification Condition Indicator |
03 | | L2000E_CRCC03_CONDTN_CD | String | Condition Code |
04 | | L2000E_CRCC04_CONDTN_CD | String | Condition Code |
05 | | L2000E_CRCC05_CONDTN_CD | String | Condition Code |
06 | | L2000E_CRCC06_CONDTN_CD | String | Condition Code |
07 | | L2000E_CRCC07_CONDTN_CD | String | Condition Code |
L2000E | CRC | Oxygen Therapy Certification Information | Segment Suffix: D
| |
02 | | L2000E_CRCD02_CERT_COND_IND | String | Certification Condition Indicator |
03 | | L2000E_CRCD03_CONDTN_CD | String | Condition Code |
04 | | L2000E_CRCD04_CONDTN_CD | String | Condition Code |
05 | | L2000E_CRCD05_CONDTN_CD | String | Condition Code |
06 | | L2000E_CRCD06_CONDTN_CD | String | Condition Code |
07 | | L2000E_CRCD07_CONDTN_CD | String | Condition Code |
L2000E | CRC | Functional Limitations Information | Segment Suffix: E
| |
02 | | L2000E_CRCE02_CERT_COND_IND | String | Certification Condition Indicator |
03 | | L2000E_CRCE03_CONDTN_CD | String | Condition Code |
04 | | L2000E_CRCE04_CONDTN_CD | String | Condition Code |
05 | | L2000E_CRCE05_CONDTN_CD | String | Condition Code |
06 | | L2000E_CRCE06_CONDTN_CD | String | Condition Code |
07 | | L2000E_CRCE07_CONDTN_CD | String | Condition Code |
L2000E | CRC | Activities Permitted Information | Segment Suffix: F
| |
02 | | L2000E_CRCF02_CERT_COND_IND | String | Certification Condition Indicator |
03 | | L2000E_CRCF03_CONDTN_CD | String | Condition Code |
04 | | L2000E_CRCF04_CONDTN_CD | String | Condition Code |
05 | | L2000E_CRCF05_CONDTN_CD | String | Condition Code |
06 | | L2000E_CRCF06_CONDTN_CD | String | Condition Code |
07 | | L2000E_CRCF07_CONDTN_CD | String | Condition Code |
L2000E | CRC | Mental Status Information | Segment Suffix: G
| |
02 | | L2000E_CRCG02_CERT_COND_IND | String | Certification Condition Indicator |
03 | | L2000E_CRCG03_CONDTN_CD | String | Condition Code |
04 | | L2000E_CRCG04_CONDTN_CD | String | Condition Code |
05 | | L2000E_CRCG05_CONDTN_CD | String | Condition Code |
06 | | L2000E_CRCG06_CONDTN_CD | String | Condition Code |
07 | | L2000E_CRCG07_CONDTN_CD | String | Condition 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 |
04 | | L2000E_CL104_NRSG_RES_STAT_CD | String | Nursing Home Residential Status Code |
L2000E | CR1 | Ambulance Transport Information | | |
02 | | L2000E_CR102_KG | Number | Kilogram |
02 | | L2000E_CR102_POUND | Number | Pound |
03 | | L2000E_CR103_AMB_TRANS_CD | String | Ambulance Transport Code |
04 | | L2000E_CR104_AMB_TRANS_RSN_CD | String | Ambulance Transport Reason Code |
06 | | L2000E_CR106_MILES | Number | Miles |
06 | | L2000E_CR106_KM | Number | Kilometers |
09 | | L2000E_CR109_RNDTRP_PRPS_DESC | String | Round Trip Purpose Description |
10 | | L2000E_CR110_STRTCHR_PURP_DESC | String | Stretcher Purpose Description |
L2000E | CR2 | Spinal Manipulation Service Information | | |
01 | | L2000E_CR201_TMT_SERS_NR | Integer | Treatment Series Number |
02 | | L2000E_CR202_TMT_CT | Number | Treatment Count |
03 | | L2000E_CR203_SUBLUX_LVL_CD | String | Subluxation Level Code |
04 | | L2000E_CR204_SUBLUX_LVL_CD | String | Subluxation Level Code |
08 | | L2000E_CR208_PAT_COND_CD | String | Patient Condition Code |
09 | | L2000E_CR209_CMPLCTN_IND | String | Complication Indicator |
10 | | L2000E_CR210_PT_COND_DESC | String | Patient Condition Description |
11 | | L2000E_CR211_PT_COND_DESC | String | Patient Condition Description |
12 | | L2000E_CR212_XRAY_AVL_IND | String | X-ray Availability Indicator |
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 |
05 | | L2000E_CR505_EQUP_RSN_DESC | String | Equipment Reason Description |
06 | | L2000E_CR506_OXYGN_FLOW_RT | Number | Oxygen Flow Rate |
07 | | L2000E_CR507_DLY_OXY_USE_CT | Number | Daily Oxygen Use Count |
08 | | L2000E_CR508_OXY_USE_HOUR_CT | Number | Oxygen Use Period Hour Count |
09 | | L2000E_CR509_RSP_THRP_ORD_TXT | String | Respiratory Therapist Order Text |
10 | | L2000E_CR510_ART_BLD_GAS_QTY | Number | Arterial Blood Gas Quantity |
11 | | L2000E_CR511_OXY_SATUR_QTY | Number | Oxygen Saturation Quantity |
12 | | L2000E_CR512_OXY_TST_CND_CD | String | Oxygen Test Condition Code |
13 | | L2000E_CR513_OXY_TST_FND_CD | String | Oxygen Test Findings Code |
14 | | L2000E_CR514_OXY_TST_FND_CD | String | Oxygen Test Findings Code |
15 | | L2000E_CR515_OXY_TST_FND_CD | String | Oxygen Test Findings Code |
16 | | L2000E_CR516_PORT_OXY_FLOW_RT | Number | 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 (YYYYMMDD) | Home Health Start Date |
04 | | L2000E_CR604_RD8 | String | Home Health Certification Period |
04 | | L2000E_CR604_RD8 | String | Home Health Certification Period |
08 | | L2000E_CR608_CERT_TYP_CD | String | Certification Type Code |
09 | | L2000E_CR609_SURGY_D8 | Date (YYYYMMDD) | Surgery Date |
11 | | L2000E_CR611_HCPCS_CD | String | Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes |
11 | | L2000E_CR611_ICD9_PROC | String | International Classification of Diseases Clinical Modification (ICD-9-CM) - Procedure |
12 | | L2000E_CR612_PHYS_ORD_D8 | Date (YYYYMMDD) | Physician Order Date |
13 | | L2000E_CR613_LAST_VIST_D8 | Date (YYYYMMDD) | Last Visit Date |
14 | | L2000E_CR614_PHYS_CONT_D8 | Date (YYYYMMDD) | Physician Contact Date |
16 | | L2000E_CR616_RD8 | String | Last Admission Period |
16 | | L2000E_CR616_RD8 | String | Last Admission Period |
17 | | L2000E_CR617_PAT_LOC_CD | String | Patient Location Code |
L2000E | PWK | Additional Patient Information | | |
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 |
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 Information | | |
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 | |
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 | Patient Event 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 | PRV | Patient Event Provider Information | | |
01 | | L2010EA_yy_PRV01_PVD_CD | String | Provider Code |
03 | | L2010EA_yy_PRV03_PVD_TAXNMY_CD | String | Health Care Provider Taxonomy Code |
L2010EB - PATIENT EVENT TRANSPORT INFORMATION (Value Qualified) |
Mapping Prefix: L2010EB_45 - Drop-off Location |
Mapping Prefix: L2010EB_FS - Final Scheduled Destination |
Mapping Prefix: L2010EB_ND - Next Destination |
Mapping Prefix: L2010EB_PW - Pickup Address |
Mapping Prefix: L2010EB_R3 - Next Scheduled Destination |
L2010EB | NM1 | Patient Event Transport Information | | |
03 | | L2010EB_yy_NM103_PTEVT_TRN_LOC | String | Patient Event Transport Location Name |
L2010EB | N3 | Patient Event Transport Location Address | | |
01 | | L2010EB_yy_N301_PTEVT_TRN_ADDR | String | Patient Event Transport Location Address Line |
02 | | L2010EB_yy_N302_PTEVT_TRN_ADDR | String | Patient Event Transport Location Address Line |
L2010EB | N4 | Patient Event Transport Location City/State/ZIP Code | | |
01 | | L2010EB_yy_N401_PTEVT_TRN_CITY | String | Patient Event Transport Location City Name |
02 | | L2010EB_yy_N402_PTEVT_TRN_STAT | String | Patient Event Transport Location State or |
03 | | L2010EB_yy_N403_PTEVT_ZIP | String | Patient Event Transport Location Postal Zone or |
L2010EC - PATIENT EVENT OTHER UMO NAME (Value Qualified) |
Mapping Prefix: L2010EC_00 - Alternate Insurer |
Mapping Prefix: L2010EC_CA - Carrier |
Mapping Prefix: L2010EC_GG - Intermediary |
L2010EC | NM1 | Patient Event Other UMO Name | | |
03 | | L2010EC_yy_NM103_OUMO_NM | String | Other UMO Name |
L2010EC | REF | Other UMO Denial Reason | | |
02 | | L2010EC_yy_REF_MUTLY_DEF | String | Mutually Defined |
04 | 02 | L2010EC_yy_REF0402_OUMO_DENL_RSN | String | Mutually Defined |
04 | 04 | L2010EC_yy_REF0404_OUMO_DENL_RSN | String | Mutually Defined |
04 | 06 | L2010EC_yy_REF0406_REF_ID | String | Mutually Defined |
L2010EC | DTP | Other UMO Denial Date | | |
03 | | L2010EC_yy_DTP_REJCT_D8 | Date (YYYYMMDD) | Rejected Date |
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 | | |
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 | 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 | REF | Previous Review Authorization Number | | |
02 | | L2000F_REF_AUTH_NR | String | Authorization Number |
L2000F | REF | Previous Review Administrative Reference Number | | |
02 | | L2000F_REF_ADMIN_REF_NR | String | Administrator's Reference Number |
03 | | L2000F_DTP_SVC_D8 | Date (YYYYMMDD) | Service Date |
03 | | L2000F_DTP_SVC_RD8_1 | Start Date (YYYYMMDD) | Service Date |
03 | | L2000F_DTP_SVC_RD8_2 | End Date (YYYYMMDD) | Service Date |
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 | Number | Service Line Amount |
04 | | L2000F_SV104_INTL_UN | Number | International Unit |
04 | | L2000F_SV104_MIN | Number | Minutes |
04 | | L2000F_SV104_UN | Number | Unit |
07 | 01 | L2000F_SV10701_DIAG_CD_PTR | Integer | Diagnosis Code Pointer |
07 | 02 | L2000F_SV10702_DIAG_CD_PTR | Integer | Diagnosis Code Pointer |
07 | 03 | L2000F_SV10703_DIAG_CD_PTR | Integer | Diagnosis Code Pointer |
07 | 04 | L2000F_SV10704_DIAG_CD_PTR | Integer | Diagnosis Code Pointer |
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 |
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 | Number | Service Line Amount |
05 | | L2000F_SV205_DAYS | Number | Days |
05 | | L2000F_SV205_INTL_UN | Number | International Unit |
05 | | L2000F_SV205_UN | Number | Unit |
06 | | L2000F_SV206_SVC_LIN_RT | Number | Service Line Rate |
09 | | L2000F_SV209_NRSG_RES_STAT_CD | String | Nursing Home Residential Status Code |
10 | | L2000F_SV210_NRSG_LVL_CAR | String | Nursing Home Level of Care |
01 | 02 | L2000F_SV30102_PROC_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 | Number | 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 | Number | Service Unit Count |
07 | | L2000F_SV307_DESCR | String | Description |
L2000FX - SERVICE LEVEL - TOO CUTOUT |
L2000FX | TOO | Tooth Information | | |
02 | | L2000FX_TOO02_NTL_TTH_DES_SYS | String | Universal National Tooth Designation System |
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 | Number | Days |
02 | | L2000F_HSD02_UN | Number | Units |
02 | | L2000F_HSD02_HR | Number | Hours |
02 | | L2000F_HSD02_MO | Number | Month |
02 | | L2000F_HSD02_VIST | Number | Visits |
04 | | L2000F_HSD04_DAYS | Number | Days |
04 | | L2000F_HSD04_MOS | Number | Months |
04 | | L2000F_HSD04_WK | Number | 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_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 | | |
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 |
01 | | L2000F_MSG01_FRFM_MSG_TXT | String | Free Form Message Text |
L2010F - SERVICE PROVIDER NAME (Value Qualified) |
Mapping Prefix: L2010F_1T - Physician, Clinic or Group Practice |
Mapping Prefix: L2010F_72 - Operating Physician |
Mapping Prefix: L2010F_73 - Other Physician |
Mapping Prefix: L2010F_77 - Service Location |
Mapping Prefix: L2010F_DD - Assistant Surgeon |
Mapping Prefix: L2010F_DK - Ordering Physician |
Mapping Prefix: L2010F_DQ - Supervising Physician |
Mapping Prefix: L2010F_FA - Facility |
Mapping Prefix: L2010F_G3 - Clinic |
Mapping Prefix: L2010F_P3 - Primary Care Provider |
Mapping Prefix: L2010F_QB - Purchase Service Provider |
Mapping Prefix: L2010F_QV - Group Practice |
Mapping Prefix: L2010F_SJ - Service Provider |
L2010F | NM1 | Service Provider Name | | |
02 | | L2010F_yy_NM102_ENT_TYP_QUAL | String | Entity Type Qualifier |
03 | | L2010F_yy_NM103_SVC_PVR_LNM | String | Service Provider Last or Organization Name |
04 | | L2010F_yy_NM104_SVC_PVR_FNM | String | Service Provider First Name |
05 | | L2010F_yy_NM105_SVC_PVR_MNM | String | Service Provider Middle Name |
06 | | L2010F_yy_NM106_SVC_PVR_PFX | String | Service Provider Name Prefix |
07 | | L2010F_yy_NM107_SVC_PVR_SFX | String | Service Provider Name Suffix |
09 | | L2010F_yy_NM109_EMPLYR_ID | String | Employer's Identification Number |
09 | | L2010F_yy_NM109_SSN | String | Social Security Number |
09 | | L2010F_yy_NM109_ETN_NR | String | Electronic Transmitter Identification Number (ETIN) |
09 | | L2010F_yy_NM109_NPI | String | Centers for Medicare and Medicaid Services National Provider Identifier |
L2010F | REF | Service Provider Supplemental Identification | | |
02 | | L2010F_yy_REF_STAT_LIC_NR | String | State License Number |
02 | | L2010F_yy_REF_UPIN | String | Provider UPIN Number |
02 | | L2010F_yy_REF_FAC_ID | String | Facility ID Number |
02 | | L2010F_yy_REF_EMPLR_ID_NR | String | Employer's Identification Number |
02 | | L2010F_yy_REF_PRV_PLN_ID | String | Provider Plan Network Identification Number |
02 | | L2010F_yy_REF_FAC_NET_ID | String | Facility Network Identification Number |
02 | | L2010F_yy_REF_SSN | String | Social Security Number |
02 | | L2010F_yy_REF_CRR_AS_REF_NR | String | Carrier Assigned Reference Number |
03 | | L2010F_yy_REF03_LIC_NR_STAT | String | |
L2010F | N3 | Service Provider Address | | |
01 | | L2010F_yy_N301_SVC_PVR_ADD_LN | String | Service Provider Address Line |
02 | | L2010F_yy_N302_SVC_PVR_ADD_LN | String | Service Provider Address Line |
L2010F | N4 | Service Provider City, State, ZIP Code | | |
01 | | L2010F_yy_N401_SVC_PVR_CITY | String | Service Provider City Name |
02 | | L2010F_yy_N402_SVC_PVR_STAT | String | Service Provider State or Province Code |
03 | | L2010F_yy_N403_SVC_PVR_ZIP | String | Service Provider Postal Zone or ZIP Code |
04 | | L2010F_yy_N404_CNTRY_CD | String | Country Code |
07 | | L2010F_yy_N407_CNTRY_SUBDV_CD | String | Country Subdivision Code |
L2010F | PER | Service Provider Contact Information | | |
02 | | L2010F_yy_PER02_SVC_PVR_CN_NM | String | Service Provider Contact Name |
04 | | L2010F_yy_PER04_EMAIL | String | Electronic Mail |
04 | | L2010F_yy_PER04_FAX | String | Facsimile |
04 | | L2010F_yy_PER04_PHN_NR | String | Telephone |
04 | | L2010F_yy_PER04_URL | String | Uniform Resource Locator (URL) |
06 | | L2010F_yy_PER06_EMAIL | String | Electronic Mail |
06 | | L2010F_yy_PER06_PHN_EXT | String | Telephone Extension |
06 | | L2010F_yy_PER06_FAX | String | Facsimile |
06 | | L2010F_yy_PER06_PHN_NR | String | Telephone |
06 | | L2010F_yy_PER06_URL | String | Uniform Resource Locator (URL) |
08 | | L2010F_yy_PER08_EMAIL | String | Electronic Mail |
08 | | L2010F_yy_PER08_PHN_EXT | String | Telephone Extension |
08 | | L2010F_yy_PER08_FAX | String | Facsimile |
08 | | L2010F_yy_PER08_PHN_NR | String | Telephone |
08 | | L2010F_yy_PER08_URL | String | Uniform Resource Locator (URL) |
L2010F | PRV | Service Provider Information | | |
01 | | L2010F_yy_PRV01_PVD_CD | String | Provider Code |
03 | | L2010F_yy_PRV03_PVD_TAXNMY_CD | String | Health Care Provider Taxonomy Code |
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 |
ISA | IEA | Interchange Control Trailer | | |
01 | | ISA_IEA01_NR_INC_FUNC_GRP | Integer | Number of Included Functional Groups |
02 | | ISA_IEA02_ICN | Integer | Interchange Control Number |