(C) Copyright 2012 Chiapas EDI Technologies, Inc.
4010_278_RESP 4010 Health Care Services Review - Response - Code:F0
ISA - GROUP HEADERS
| Loop | Segment | Segment Name | Chiapas Gate Mapping |
| OEISA | ISA | Interchange Control Header | |
| OEISA | ISA02 | No Authorization Information Present | OEISA_S01_ISA02_AUTH_NFO_OVL_NO_AUTH_NFO |
| OEISA | ISA02 | Additional Data Identification | OEISA_S01_ISA02_AUTH_NFO_OVL_ADDL_ID |
| OEISA | ISA04 | No Security Information Present | OEISA_S01_ISA04_SEC_NFO_OVL_NO_SEC_NFO |
| OEISA | ISA04 | Password | OEISA_S01_ISA04_SEC_NFO_OVL_PASSWD |
| OEISA | ISA06 | Dun and Brandstreet | OEISA_S01_ISA06_SENDR_ID_OVL_DUNS_ID |
| OEISA | ISA06 | Duns Plus Suffix | OEISA_S01_ISA06_SENDR_ID_OVL_DUNS_SUFFX_ID |
| OEISA | ISA06 | Health Industry Number | OEISA_S01_ISA06_SENDR_ID_OVL_HIN_ID |
| OEISA | ISA06 | Carrier Identification Number as assigned by Health Care Financing Administration | OEISA_S01_ISA06_SENDR_ID_OVL_HCFA_CARR_ID |
| OEISA | ISA06 | Fiscal Intermediary Identification Number as assigned by Health Care Financing Administration | OEISA_S01_ISA06_SENDR_ID_OVL_HCFA_FIIN_ID |
| OEISA | ISA06 | Medicare Provider and Supplier Identification Number as assigned by Health Care Financing Administration | OEISA_S01_ISA06_SENDR_ID_OVL_HCFA_MEDCR_ID |
| OEISA | ISA06 | US Federal Tax Identification Number | OEISA_S01_ISA06_SENDR_ID_OVL_TAX_ID |
| OEISA | ISA06 | National Association of Insurance Commissioners Company Code | OEISA_S01_ISA06_SENDR_ID_OVL_NAIC_ID |
| OEISA | ISA06 | Mutually Defined | OEISA_S01_ISA06_SENDR_ID_OVL_MUTLY_DEFND_ID |
| OEISA | ISA08 | Dun and Brandstreet | OEISA_S01_ISA08_RECVR_ID_OVL_DUNS_ID |
| OEISA | ISA08 | Duns Plus Suffix | OEISA_S01_ISA08_RECVR_ID_OVL_DUNS_SUFFX_ID |
| OEISA | ISA08 | Health Industry Number | OEISA_S01_ISA08_RECVR_ID_OVL_HIN_ID |
| OEISA | ISA08 | Carrier Identification Number as assigned by Health Care Financing Administration | OEISA_S01_ISA08_RECVR_ID_OVL_HCFA_CARR_ID |
| OEISA | ISA08 | Fiscal Intermediary Identification Number as assigned by Health Care Financing Administration | OEISA_S01_ISA08_RECVR_ID_OVL_HCFA_FIIN_ID |
| OEISA | ISA08 | Medicare Provider and Supplier Identification Number as assigned by Health Care Financing Administration | OEISA_S01_ISA08_RECVR_ID_OVL_HCFA_MEDCR_ID |
| OEISA | ISA08 | US Federal Tax Identification Number | OEISA_S01_ISA08_RECVR_ID_OVL_TAX_ID |
| OEISA | ISA08 | National Association of Insurance Commissioners Company Code | OEISA_S01_ISA08_RECVR_ID_OVL_NAIC_ID |
| OEISA | ISA08 | Mutually Defined | OEISA_S01_ISA08_RECVR_ID_OVL_MUTLY_DEFND_ID |
| OEISA | ISA09 | Interchange Date | OEISA_S01_ISA09_DT |
| OEISA | ISA10 | Interchange Time | OEISA_S01_ISA10_TM |
| OEISA | ISA11 | Repetition Separator | OEISA_S01_ISA11_REPTN_SEPRTR |
| OEISA | ISA12 | Interchang Control Version Number | OEISA_S01_ISA12_VERSN_NR |
| OEISA | ISA13 | Interchange Control Number | OEISA_S01_ISA13_ICN |
| OEISA | ISA14 | Acknowledgment Requested | OEISA_S01_ISA14_ACK_REQ |
| OEISA | ISA15 | Interchange Usage Indicator | OEISA_S01_ISA15_USG_IND |
| OEISA | ISA16 | Component Element Separator | OEISA_S01_ISA16_SUBELE_SEP |
| OEISA | IEA | Interchange Control Trailer | |
| OEISA | IEA01 | Number of Included Functional Groups | OEISA_S03_IEA01_GS_CT |
| OEISA | IEA02 | Interchange Control Number | OEISA_S03_IEA02_ICN |
GSHDR - GROUP HEADER
| Loop | Segment | Segment Name | Chiapas Gate Mapping |
| GSHDR | GS | Functional Group Header | |
| GSHDR | GS01 | Functional Identifier Code | GSHDR_S01_GS01_FUNCTL_ID_CD |
| GSHDR | GS02 | Application Senders Code | GSHDR_S01_GS02_APP_SENDR_CD |
| GSHDR | GS03 | Application Receivers Code | GSHDR_S01_GS03_APP_RECVR_CD |
| GSHDR | GS04 | Date | GSHDR_S01_GS04_DT |
| GSHDR | GS05 | Time | GSHDR_S01_GS05_TM |
| GSHDR | GS06 | Group Control Number | GSHDR_S01_GS06_GCN |
| GSHDR | GS07 | Responsible Agency Code | GSHDR_S01_GS07_RESP_AGNCY_CD |
| GSHDR | GE | Functional Group Trailer | |
| GSHDR | GE01 | Number of Transaction Sets Included | GSHDR_S03_GE01_TS_CT |
| GSHDR | GE02 | Group Control Number | GSHDR_S03_GE02_GCN |
STHDR - TRANSACTION SET HEADER
| Loop | Segment | Segment Name | Chiapas Gate Mapping |
| STHDR | ST | Transaction Set Header | |
| STHDR | ST01 | Transaction Set Identifier Code | STHDR_S01_ST01_ID_CD |
| STHDR | ST02 | Transaction Set Control Number | STHDR_S01_ST02_CONTRL_NR |
| STHDR | BHT | Beginning of Hierarchical Transaction | |
| STHDR | BHT01 | Hierarchical Structure Code | STHDR_S02_BHT01_STRUCTR_CD |
| STHDR | BHT02 | Transaction Set Purpose Code | STHDR_S02_BHT02_TS_PURPS_CD |
| STHDR | BHT03 | Submitter Transaction Identifier | STHDR_S02_BHT03_SUBMTR_TRANSCTN_ID |
| STHDR | BHT04 | Transaction Set Creation Date | STHDR_S02_BHT04_TS_CREATN_DT |
| STHDR | BHT05 | Transaction Set Creation Time | STHDR_S02_BHT05_TS_CREATN_TIM |
| STHDR | BHT06 | Transaction Type Code | STHDR_S02_BHT06_TRANSCTN_TYPE_CD |
| STHDR | SE | Transaction Set Trailer | |
| STHDR | SE01 | Transaction Segment Count | STHDR_S04_SE01_SEG_CT |
| STHDR | SE02 | Transaction Set Control Number | STHDR_S04_SE02_TCN |
2000A - UTILIZATION MANAGEMENT ORGANIZATION (UMO) LEVEL
| Loop | Segment | Segment Name | Chiapas Gate Mapping |
| L2000A | HL | Utilization Management Organization (UMO) Level | |
| L2000A | HL01 | Hierarchical ID Number | L2000A_S01_HL01_HIERCHCL_ID_NR |
| L2000A | HL04 | Hierarchical Child Code | L2000A_S01_HL04_HIERCHCL_CHILD_CD |
| L2000A | AAA | Request Validation | |
| L2000A | AAA01 | Valid Request Indicator | L2000A_S02_AAA01_REQST_IND |
| L2000A | AAA03 | Reject Reason Code | L2000A_S02_AAA03_REJCT_RSN_CD |
| L2000A | AAA04 | Follow-up Action Code | L2000A_S02_AAA04_FOLWP_ACTN_CD |
2010A - UTILIZATION MANAGEMENT ORGANIZATION (UMO) NAME
| Loop | Segment | Segment Name | Chiapas Gate Mapping |
| L2010A | NM1 | Utilization Management Organization (UMO) Name | |
| L2010A | NM102 | Entity Type Qualifier | L2010A_S01_NM102_ENTY_TYPE_QUAL |
| L2010A | NM103 | Utilization Management Organization (UMO) Last or Individual last name or organizational name | L2010A_S01_NM103_UMO_LAST_INDVDL_LNAME_OR |
| L2010A | NM104 | Utilization Management Organization (UMO) First Name | L2010A_S01_NM104_UMO_FNAME |
| L2010A | NM105 | Utilization Management Organization (UMO) Middle Name | L2010A_S01_NM105_UMO_MNAME |
| L2010A | NM107 | Utilization Management Organization (UMO) Name Suffix | L2010A_S01_NM107_NM_SUFX |
| L2010A | NM109 | Employer’s Identification Number | L2010A_S01_NM109_UMO_ID_OVL_EMPLYR_ID_NR |
| L2010A | NM109 | Social Security Number | L2010A_S01_NM109_UMO_ID_OVL_SSN |
| L2010A | NM109 | Electronic Transmitter Identification Number (ETIN) | L2010A_S01_NM109_UMO_ID_OVL_ETN_NR |
| L2010A | NM109 | Payor Identification | L2010A_S01_NM109_UMO_ID_OVL_PAYR_ID |
| L2010A | NM109 | Health Care Financing Administration National PlanID | L2010A_S01_NM109_UMO_ID_OVL_HCFA_NATNL_PLAND |
| L2010A | NM109 | Health Care Financing Administration National | L2010A_S01_NM109_UMO_ID_OVL_HCFA_NATNL |
| L2010A | PER | Utilization Management Organization (UMO) Contact Information | |
| L2010A | PER01 | Contact Function Code | L2010A_S02_PER01_FUNCTN_CD |
| L2010A | PER02 | Utilization Management Organization (UMO) Contact Name | L2010A_S02_PER02_CONTCT_NM |
| L2010A | PER04 | Electronic Mail | L2010A_S02_PER04_CONTCT_APLCBL_OVL_EMAIL |
| L2010A | PER04 | Facsimile | L2010A_S02_PER04_CONTCT_APLCBL_OVL_FACSML |
| L2010A | PER04 | Telephone | L2010A_S02_PER04_CONTCT_APLCBL_OVL_TELPHN |
| L2010A | PER06 | Electronic Mail | L2010A_S02_PER06_CONTCT_APLCBL_OVL_EMAIL |
| L2010A | PER06 | Telephone Extension | L2010A_S02_PER06_CONTCT_APLCBL_OVL_PHN_EXTNS |
| L2010A | PER06 | Facsimile | L2010A_S02_PER06_CONTCT_APLCBL_OVL_FACSML |
| L2010A | PER06 | Telephone | L2010A_S02_PER06_CONTCT_APLCBL_OVL_TELPHN |
| L2010A | PER08 | Electronic Mail | L2010A_S02_PER08_CONTCT_APLCBL_OVL_EMAIL |
| L2010A | PER08 | Telephone Extension | L2010A_S02_PER08_CONTCT_APLCBL_OVL_PHN_EXTNS |
| L2010A | PER08 | Facsimile | L2010A_S02_PER08_CONTCT_APLCBL_OVL_FACSML |
| L2010A | PER08 | Telephone | L2010A_S02_PER08_CONTCT_APLCBL_OVL_TELPHN |
| L2010A | AAA | Utilization Management Organization (UMO) Request Validation | |
| L2010A | AAA01 | Valid Request Indicator | L2010A_S03_AAA01_REQST_IND |
| L2010A | AAA03 | Reject Reason Code | L2010A_S03_AAA03_REJCT_RSN_CD |
| L2010A | AAA04 | Follow-up Action Code | L2010A_S03_AAA04_FOLWP_ACTN_CD |
2000B - REQUESTER LEVEL
| Loop | Segment | Segment Name | Chiapas Gate Mapping |
| L2000B | HL | Requester Level | |
| L2000B | HL01 | Hierarchical ID Number | L2000B_S01_HL01_HIERCHCL_ID_NR |
| L2000B | HL02 | Hierarchical Parent ID Number | L2000B_S01_HL02_HIERCHCL_PARNT_ID_NR |
| L2000B | HL04 | Hierarchical Child Code | L2000B_S01_HL04_HIERCHCL_CHILD_CD |
2010B - REQUESTER NAME
| Loop | Segment | Segment Name | Chiapas Gate Mapping |
| 2010B | Qualified Loop | ||
| L2010B | Provider | L2010B_1P | |
| L2010B | Facility | L2010B_FA | |
| L2010B | NM1 | Requester Name | |
| L2010B | NM102 | Entity Type Qualifier | L2010B_XX_S01_NM102_ENTY_TYPE_QUAL |
| L2010B | NM103 | Requester Last or Organization Name | L2010B_XX_S01_NM103_REQSTR_LAST_ORG_NM |
| L2010B | NM104 | Requester First Name | L2010B_XX_S01_NM104_REQSTR_FNAME |
| L2010B | NM105 | Requester Middle Name | L2010B_XX_S01_NM105_REQSTR_MNAME |
| L2010B | NM107 | Requester Name Suffix | L2010B_XX_S01_NM107_NM_SUFX |
| L2010B | NM109 | Employer’s Identification Number | L2010B_XX_S01_NM109_REQSTR_ID_OVL_EMPLYR_ID_NR |
| L2010B | NM109 | Social Security Number | L2010B_XX_S01_NM109_REQSTR_ID_OVL_SSN |
| L2010B | NM109 | Electronic Transmitter Identification Number (ETIN) | L2010B_XX_S01_NM109_REQSTR_ID_OVL_ETN_NR |
| L2010B | NM109 | Health Care Financing Administration National Provider Identifier | L2010B_XX_S01_NM109_REQSTR_ID_OVL_HCFA_NATNL_PROV_ID |
| L2010B | REF | Requester Supplemental Identification | |
| L2010B | REF02 | Provider UPIN Number | L2010B_XX_S02_REF02_SUPP_ID_OVL_PROV_UPN_NR |
| L2010B | REF02 | Facility ID Number | L2010B_XX_S02_REF02_SUPP_ID_OVL_FACLTY_ID_NR |
| L2010B | REF02 | Contract Number | L2010B_XX_S02_REF02_SUPP_ID_OVL_CONTRCT_NR |
| L2010B | REF02 | Employer’s Identification Number | L2010B_XX_S02_REF02_SUPP_ID_OVL_EMPLYR_ID_NR |
| L2010B | REF02 | Provider Plan Network Identification Number | L2010B_XX_S02_REF02_SUPP_ID_OVL_PROV_PLAN_NETWRK_ID_NR |
| L2010B | REF02 | Facility Network Identification Number | L2010B_XX_S02_REF02_SUPP_ID_OVL_FACLTY_NETWRK_ID_NR |
| L2010B | REF02 | Social Security Number | L2010B_XX_S02_REF02_SUPP_ID_OVL_SSN |
| L2010B | REF02 | Carrier Assigned Reference Number | L2010B_XX_S02_REF02_SUPP_ID_OVL_CAR_ASGND_REF_NR |
| L2010B | AAA | Requester Request Validation | |
| L2010B | AAA01 | Valid Request Indicator | L2010B_XX_S03_AAA01_REQST_IND |
| L2010B | AAA03 | Reject Reason Code | L2010B_XX_S03_AAA03_REJCT_RSN_CD |
| L2010B | AAA04 | Follow-up Action Code | L2010B_XX_S03_AAA04_FOLWP_ACTN_CD |
| L2010B | PRV | Requester Provider Information | |
| L2010B | PRV01 | Provider Code | L2010B_XX_S04_PRV01_PROV_CD |
| L2010B | PRV03 | Mutually Defined | L2010B_XX_S04_PRV03_TAXNMY_CD_OVL_MUTLY_DEFND |
2000C - SUBSCRIBER LEVEL
| Loop | Segment | Segment Name | Chiapas Gate Mapping |
| L2000C | HL | Subscriber Level | |
| L2000C | HL01 | Hierarchical ID Number | L2000C_S01_HL01_HIERCHCL_ID_NR |
| L2000C | HL02 | Hierarchical Parent ID Number | L2000C_S01_HL02_HIERCHCL_PARNT_ID_NR |
| L2000C | HL04 | Hierarchical Child Code | L2000C_S01_HL04_HIERCHCL_CHILD_CD |
| L2000C | AAA | Subscriber Request Validation | |
| L2000C | AAA01 | Valid Request Indicator | L2000C_S02_AAA01_REQST_IND |
| L2000C | AAA03 | Reject Reason Code | L2000C_S02_AAA03_REJCT_RSN_CD |
| L2000C | AAA04 | Follow-up Action Code | L2000C_S02_AAA04_FOLWP_ACTN_CD |
| L2000C | DTP | Accident Date | |
| L2000C | DTP03 | Accident (D8) | L2000C_S03_DTP03_ACDNT_DT_OVL_ACDNT_D8 |
| L2000C | DTP | Last Menstrual Period Date | |
| L2000C | DTP03 | Last Menstrual Period (D8) | L2000C_S04_DTP03_LAST_MENSTRL_PERD_DT_OVL_LAST_MENSTRL_PERD_D8 |
| L2000C | DTP | Estimated Date of Birth | |
| L2000C | DTP03 | Estimated Date of Birth (D8) | L2000C_S05_DTP03_BIRTH_DT_OVL_EST_DOB_D8 |
| L2000C | DTP | Onset of Current Symptoms or Illness Date | |
| L2000C | DTP03 | Onset of Current Symptoms or Illness (D8) | L2000C_S06_DTP03_ONST_DT_OVL_ONST_CURNT_SYMPTMS_ILNS_D8 |
| L2000C | HI | Subscriber Diagnosis | |
| L2000C | HI01-02 | Diagnosis | L2000C_S07_HI01_02_DIAG_CD_OVL_DIAG |
| L2000C | HI01-02 | Admitting Diagnosis | L2000C_S07_HI01_02_DIAG_CD_OVL_ADMTNG_DIAG |
| L2000C | HI01-02 | Principal Diagnosis | L2000C_S07_HI01_02_DIAG_CD_OVL_PRINCPL_DIAG |
| L2000C | HI01-04 | Date Expressed in Format CCYYMMDD | L2000C_S07_HI01_04_DIAG_DT_OVL_DT_CCYYMMDD |
| L2000C | HI02-02 | Diagnosis | L2000C_S07_HI02_02_DIAG_CD_OVL_DIAG |
| L2000C | HI02-02 | Admitting Diagnosis | L2000C_S07_HI02_02_DIAG_CD_OVL_ADMTNG_DIAG |
| L2000C | HI02-04 | Date Expressed in Format CCYYMMDD | L2000C_S07_HI02_04_DIAG_DT_OVL_DT_CCYYMMDD |
| L2000C | HI03-02 | Diagnosis | L2000C_S07_HI03_02_DIAG_CD_OVL_DIAG |
| L2000C | HI03-04 | Date Expressed in Format CCYYMMDD | L2000C_S07_HI03_04_DIAG_DT_OVL_DT_CCYYMMDD |
| L2000C | HI04-02 | Diagnosis | L2000C_S07_HI04_02_DIAG_CD_OVL_DIAG |
| L2000C | HI04-04 | Date Expressed in Format CCYYMMDD | L2000C_S07_HI04_04_DIAG_DT_OVL_DT_CCYYMMDD |
| L2000C | HI05-02 | Diagnosis | L2000C_S07_HI05_02_DIAG_CD_OVL_DIAG |
| L2000C | HI05-04 | Date Expressed in Format CCYYMMDD | L2000C_S07_HI05_04_DIAG_DT_OVL_DT_CCYYMMDD |
| L2000C | HI06-02 | Diagnosis | L2000C_S07_HI06_02_DIAG_CD_OVL_DIAG |
| L2000C | HI06-04 | Date Expressed in Format CCYYMMDD | L2000C_S07_HI06_04_DIAG_DT_OVL_DT_CCYYMMDD |
| L2000C | HI07-02 | Diagnosis | L2000C_S07_HI07_02_DIAG_CD_OVL_DIAG |
| L2000C | HI07-04 | Date Expressed in Format CCYYMMDD | L2000C_S07_HI07_04_DIAG_DT_OVL_DT_CCYYMMDD |
| L2000C | HI08-02 | Diagnosis | L2000C_S07_HI08_02_DIAG_CD_OVL_DIAG |
| L2000C | HI08-04 | Date Expressed in Format CCYYMMDD | L2000C_S07_HI08_04_DIAG_DT_OVL_DT_CCYYMMDD |
| L2000C | HI09-02 | Diagnosis | L2000C_S07_HI09_02_DIAG_CD_OVL_DIAG |
| L2000C | HI09-04 | Date Expressed in Format CCYYMMDD | L2000C_S07_HI09_04_DIAG_DT_OVL_DT_CCYYMMDD |
| L2000C | HI10-02 | Diagnosis | L2000C_S07_HI10_02_DIAG_CD_OVL_DIAG |
| L2000C | HI10-04 | Date Expressed in Format CCYYMMDD | L2000C_S07_HI10_04_DIAG_DT_OVL_DT_CCYYMMDD |
| L2000C | HI11-02 | Diagnosis | L2000C_S07_HI11_02_DIAG_CD_OVL_DIAG |
| L2000C | HI11-04 | Date Expressed in Format CCYYMMDD | L2000C_S07_HI11_04_DIAG_DT_OVL_DT_CCYYMMDD |
| L2000C | HI12-02 | Diagnosis | L2000C_S07_HI12_02_DIAG_CD_OVL_DIAG |
| L2000C | HI12-04 | Date Expressed in Format CCYYMMDD | L2000C_S07_HI12_04_DIAG_DT_OVL_DT_CCYYMMDD |
2010C - SUBSCRIBER NAME
| Loop | Segment | Segment Name | Chiapas Gate Mapping |
| L2010C | NM1 | Subscriber Name | |
| L2010C | NM102 | Entity Type Qualifier | L2010C_S01_NM102_ENTY_TYPE_QUAL |
| L2010C | NM103 | Subscriber Last Name | L2010C_S01_NM103_SUB_LNAME |
| L2010C | NM104 | Subscriber First Name | L2010C_S01_NM104_SUB_FNAME |
| L2010C | NM105 | Subscriber Middle Name | L2010C_S01_NM105_SUB_MNAME |
| L2010C | NM107 | Subscriber Name Suffix | L2010C_S01_NM107_NM_SUFX |
| L2010C | NM109 | Member Identification Number | L2010C_S01_NM109_PRIMRY_ID_OVL_MEM_ID_NR |
| L2010C | NM109 | Mutually Defined | L2010C_S01_NM109_PRIMRY_ID_OVL_MUTLY_DEFND |
| L2010C | REF | Subscriber Supplemental Identification | |
| L2010C | REF02 | Group or Policy Number | L2010C_S02_REF02_SUPP_ID_OVL_GRP_POLCY_NR |
| L2010C | REF02 | Member Identification Number | L2010C_S02_REF02_SUPP_ID_OVL_MEM_ID_NR |
| L2010C | REF02 | Group Number | L2010C_S02_REF02_SUPP_ID_OVL_GRP_NR |
| L2010C | REF02 | Employee Identification Number | L2010C_S02_REF02_SUPP_ID_OVL_EMPLY_ID_NR |
| L2010C | REF02 | Patient Account Number | L2010C_S02_REF02_SUPP_ID_OVL_PATNT_ACNT_NR |
| L2010C | REF02 | Health Insurance Claim (HIC) Number | L2010C_S02_REF02_SUPP_ID_OVL_HIC_NR |
| L2010C | REF02 | Identity Card Number | L2010C_S02_REF02_SUPP_ID_OVL_IDNTY_CARD_NR |
| L2010C | REF02 | Insurance Policy Number | L2010C_S02_REF02_SUPP_ID_OVL_INS_POLCY_NR |
| L2010C | REF02 | Plan Network Identification Number | L2010C_S02_REF02_SUPP_ID_OVL_PLAN_NETWRK_ID_NR |
| L2010C | REF02 | Medicaid Recipient Identification Number | L2010C_S02_REF02_SUPP_ID_OVL_MEDCD_RECPNT_ID_NR |
| L2010C | REF02 | Social Security Number | L2010C_S02_REF02_SUPP_ID_OVL_SSN |
| L2010C | AAA | Subscriber Request Validation | |
| L2010C | AAA01 | Valid Request Indicator | L2010C_S03_AAA01_REQST_IND |
| L2010C | AAA03 | Reject Reason Code | L2010C_S03_AAA03_REJCT_RSN_CD |
| L2010C | AAA04 | Follow-up Action Code | L2010C_S03_AAA04_FOLWP_ACTN_CD |
| L2010C | DMG | Subscriber Demographic Information | |
| L2010C | DMG02 | Date Expressed in Format CCYYMMDD | L2010C_S04_DMG02_BIRTH_DT_OVL_DT_CCYYMMDD |
| L2010C | DMG03 | Subscriber Gender Code | L2010C_S04_DMG03_GENDR_CD |
2000D - DEPENDENT LEVEL
| Loop | Segment | Segment Name | Chiapas Gate Mapping |
| L2000D | HL | Dependent Level | |
| L2000D | HL01 | Hierarchical ID Number | L2000D_S01_HL01_HIERCHCL_ID_NR |
| L2000D | HL02 | Hierarchical Parent ID Number | L2000D_S01_HL02_HIERCHCL_PARNT_ID_NR |
| L2000D | HL04 | Hierarchical Child Code | L2000D_S01_HL04_HIERCHCL_CHILD_CD |
| L2000D | AAA | Dependent Request Validation | |
| L2000D | AAA01 | Valid Request Indicator | L2000D_S02_AAA01_REQST_IND |
| L2000D | AAA03 | Reject Reason Code | L2000D_S02_AAA03_REJCT_RSN_CD |
| L2000D | AAA04 | Follow-up Action Code | L2000D_S02_AAA04_FOLWP_ACTN_CD |
| L2000D | DTP | Accident Date | |
| L2000D | DTP03 | Accident (D8) | L2000D_S03_DTP03_ACDNT_DT_OVL_ACDNT_D8 |
| L2000D | DTP | Last Menstrual Period Date | |
| L2000D | DTP03 | Last Menstrual Period (D8) | L2000D_S04_DTP03_LAST_MENSTRL_PERD_DT_OVL_LAST_MENSTRL_PERD_D8 |
| L2000D | DTP | Estimated Date of Birth | |
| L2000D | DTP03 | Estimated Date of Birth (D8) | L2000D_S05_DTP03_BIRTH_DT_OVL_EST_DOB_D8 |
| L2000D | DTP | Onset of Current Symptoms or Illness Date | |
| L2000D | DTP03 | Onset of Current Symptoms or Illness (D8) | L2000D_S06_DTP03_ONST_DT_OVL_ONST_CURNT_SYMPTMS_ILNS_D8 |
| L2000D | HI | Dependent Diagnosis | |
| L2000D | HI01-02 | Diagnosis | L2000D_S07_HI01_02_DIAG_CD_OVL_DIAG |
| L2000D | HI01-02 | Admitting Diagnosis | L2000D_S07_HI01_02_DIAG_CD_OVL_ADMTNG_DIAG |
| L2000D | HI01-02 | Principal Diagnosis | L2000D_S07_HI01_02_DIAG_CD_OVL_PRINCPL_DIAG |
| L2000D | HI01-04 | Date Expressed in Format CCYYMMDD | L2000D_S07_HI01_04_DIAG_DT_OVL_DT_CCYYMMDD |
| L2000D | HI02-02 | Diagnosis | L2000D_S07_HI02_02_DIAG_CD_OVL_DIAG |
| L2000D | HI02-02 | Admitting Diagnosis | L2000D_S07_HI02_02_DIAG_CD_OVL_ADMTNG_DIAG |
| L2000D | HI02-04 | Date Expressed in Format CCYYMMDD | L2000D_S07_HI02_04_DIAG_DT_OVL_DT_CCYYMMDD |
| L2000D | HI03-02 | Diagnosis | L2000D_S07_HI03_02_DIAG_CD_OVL_DIAG |
| L2000D | HI03-04 | Date Expressed in Format CCYYMMDD | L2000D_S07_HI03_04_DIAG_DT_OVL_DT_CCYYMMDD |
| L2000D | HI04-02 | Diagnosis | L2000D_S07_HI04_02_DIAG_CD_OVL_DIAG |
| L2000D | HI04-04 | Date Expressed in Format CCYYMMDD | L2000D_S07_HI04_04_DIAG_DT_OVL_DT_CCYYMMDD |
| L2000D | HI05-02 | Diagnosis | L2000D_S07_HI05_02_DIAG_CD_OVL_DIAG |
| L2000D | HI05-04 | Date Expressed in Format CCYYMMDD | L2000D_S07_HI05_04_DIAG_DT_OVL_DT_CCYYMMDD |
| L2000D | HI06-02 | Diagnosis | L2000D_S07_HI06_02_DIAG_CD_OVL_DIAG |
| L2000D | HI06-04 | Date Expressed in Format CCYYMMDD | L2000D_S07_HI06_04_DIAG_DT_OVL_DT_CCYYMMDD |
| L2000D | HI07-02 | Diagnosis | L2000D_S07_HI07_02_DIAG_CD_OVL_DIAG |
| L2000D | HI07-04 | Date Expressed in Format CCYYMMDD | L2000D_S07_HI07_04_DIAG_DT_OVL_DT_CCYYMMDD |
| L2000D | HI08-02 | Diagnosis | L2000D_S07_HI08_02_DIAG_CD_OVL_DIAG |
| L2000D | HI08-04 | Date Expressed in Format CCYYMMDD | L2000D_S07_HI08_04_DIAG_DT_OVL_DT_CCYYMMDD |
| L2000D | HI09-02 | Diagnosis | L2000D_S07_HI09_02_DIAG_CD_OVL_DIAG |
| L2000D | HI09-04 | Date Expressed in Format CCYYMMDD | L2000D_S07_HI09_04_DIAG_DT_OVL_DT_CCYYMMDD |
| L2000D | HI10-02 | Diagnosis | L2000D_S07_HI10_02_DIAG_CD_OVL_DIAG |
| L2000D | HI10-04 | Date Expressed in Format CCYYMMDD | L2000D_S07_HI10_04_DIAG_DT_OVL_DT_CCYYMMDD |
| L2000D | HI11-02 | Diagnosis | L2000D_S07_HI11_02_DIAG_CD_OVL_DIAG |
| L2000D | HI11-04 | Date Expressed in Format CCYYMMDD | L2000D_S07_HI11_04_DIAG_DT_OVL_DT_CCYYMMDD |
| L2000D | HI12-02 | Diagnosis | L2000D_S07_HI12_02_DIAG_CD_OVL_DIAG |
| L2000D | HI12-04 | Date Expressed in Format CCYYMMDD | L2000D_S07_HI12_04_DIAG_DT_OVL_DT_CCYYMMDD |
2010D - DEPENDENT NAME
| Loop | Segment | Segment Name | Chiapas Gate Mapping |
| L2010D | NM1 | Dependent Name | |
| L2010D | NM102 | Entity Type Qualifier | L2010D_S01_NM102_ENTY_TYPE_QUAL |
| L2010D | NM103 | Dependent Last Name | L2010D_S01_NM103_DEPNDNT_LNAME |
| L2010D | NM104 | Dependent First Name | L2010D_S01_NM104_DEPNDNT_FNAME |
| L2010D | NM105 | Dependent Middle Name | L2010D_S01_NM105_DEPNDNT_MNAME |
| L2010D | NM107 | Dependent Name Suffix | L2010D_S01_NM107_NM_SUFX |
| L2010D | NM109 | Member Identification Number | L2010D_S01_NM109_PRIMRY_ID_OVL_MEM_ID_NR |
| L2010D | NM109 | Mutually Defined | L2010D_S01_NM109_PRIMRY_ID_OVL_MUTLY_DEFND |
| L2010D | REF | Dependent Supplemental Identification | |
| L2010D | REF02 | Employee Identification Number | L2010D_S02_REF02_SUPP_ID_OVL_EMPLY_ID_NR |
| L2010D | REF02 | Patient Account Number | L2010D_S02_REF02_SUPP_ID_OVL_PATNT_ACNT_NR |
| L2010D | REF02 | Social Security Number | L2010D_S02_REF02_SUPP_ID_OVL_SSN |
| L2010D | AAA | Dependent Request Validation | |
| L2010D | AAA01 | Valid Request Indicator | L2010D_S03_AAA01_REQST_IND |
| L2010D | AAA03 | Reject Reason Code | L2010D_S03_AAA03_REJCT_RSN_CD |
| L2010D | AAA04 | Follow-up Action Code | L2010D_S03_AAA04_FOLWP_ACTN_CD |
| L2010D | DMG | Dependent Demographic Information | |
| L2010D | DMG02 | Date Expressed in Format CCYYMMDD | L2010D_S04_DMG02_BIRTH_DT_OVL_DT_CCYYMMDD |
| L2010D | DMG03 | Dependent Gender Code | L2010D_S04_DMG03_GENDR_CD |
| L2010D | INS | Dependent Relationship | |
| L2010D | INS01 | Insured Indicator | L2010D_S05_INS01_INSRD_IND |
| L2010D | INS02 | Individual Relationship Code | L2010D_S05_INS02_INDVDL_REL_CD |
| L2010D | INS17 | Birth Sequence Number | L2010D_S05_INS17_BIRTH_SEQNC_NR |
2000E - SERVICE PROVIDER LEVEL
| Loop | Segment | Segment Name | Chiapas Gate Mapping |
| L2000E | HL | Service Provider Level | |
| L2000E | HL01 | Hierarchical ID Number | L2000E_S01_HL01_HIERCHCL_ID_NR |
| L2000E | HL02 | Hierarchical Parent ID Number | L2000E_S01_HL02_HIERCHCL_PARNT_ID_NR |
| L2000E | HL04 | Hierarchical Child Code | L2000E_S01_HL04_HIERCHCL_CHILD_CD |
| L2000E | MSG | Message Text | |
| L2000E | MSG01 | Free Form Message Text | L2000E_S02_MSG01_FRE_FORM_MESG_TEXT |
2010E - SERVICE PROVIDER NAME
| Loop | Segment | Segment Name | Chiapas Gate Mapping |
| 2010E | Qualified Loop | ||
| L2010E | Physician, Clinic or Group Practice | L2010E_1T | |
| L2010E | Facility | L2010E_FA | |
| L2010E | Service Provider | L2010E_SJ | |
| L2010E | NM1 | Service Provider Name | |
| L2010E | NM102 | Entity Type Qualifier | L2010E_XX_S01_NM102_ENTY_TYPE_QUAL |
| L2010E | NM103 | Service Provider Last or Organization Name | L2010E_XX_S01_NM103_SVC_PROV_LAST_ORG_NM |
| L2010E | NM104 | Service Provider First Name | L2010E_XX_S01_NM104_SVC_PROV_FNAME |
| L2010E | NM105 | Service Provider Middle Name | L2010E_XX_S01_NM105_SVC_PROV_MNAME |
| L2010E | NM107 | Service Provider Name Suffix | L2010E_XX_S01_NM107_SVC_PROV_NM_SUFX |
| L2010E | NM109 | Employer’s Identification Number | L2010E_XX_S01_NM109_SVC_PROV_ID_OVL_EMPLYR_ID_NR |
| L2010E | NM109 | Social Security Number | L2010E_XX_S01_NM109_SVC_PROV_ID_OVL_SSN |
| L2010E | NM109 | Electronic Transmitter Identification Number (ETIN) | L2010E_XX_S01_NM109_SVC_PROV_ID_OVL_ETN_NR |
| L2010E | NM109 | Health Care Financing Administration National | L2010E_XX_S01_NM109_SVC_PROV_ID_OVL_HCFA_NATNL |
| L2010E | REF | Service Provider Supplemental Identification | |
| L2010E | REF02 | Provider UPIN Number | L2010E_XX_S02_REF02_SVC_PROV_SUPP_ID_OVL_PROV_UPN_NR |
| L2010E | REF02 | Facility ID Number | L2010E_XX_S02_REF02_SVC_PROV_SUPP_ID_OVL_FACLTY_ID_NR |
| L2010E | REF02 | Employer’s Identification Number | L2010E_XX_S02_REF02_SVC_PROV_SUPP_ID_OVL_EMPLYR_ID_NR |
| L2010E | REF02 | Provider Plan Network Identification Number | L2010E_XX_S02_REF02_SVC_PROV_SUPP_ID_OVL_PROV_PLAN_NETWRK_ID_NR |
| L2010E | REF02 | Facility Network Identification Number | L2010E_XX_S02_REF02_SVC_PROV_SUPP_ID_OVL_FACLTY_NETWRK_ID_NR |
| L2010E | REF02 | Social Security Number | L2010E_XX_S02_REF02_SVC_PROV_SUPP_ID_OVL_SSN |
| L2010E | REF02 | Carrier Assigned Reference Number | L2010E_XX_S02_REF02_SVC_PROV_SUPP_ID_OVL_CAR_ASGND_REF_NR |
| L2010E | N3 | Service Provider Address | |
| L2010E | N301 | Service Provider Address Line | L2010E_XX_S03_N301_SVC_PROV_ADRS_LIN |
| L2010E | N302 | Service Provider Address Line | L2010E_XX_S03_N302_SVC_PROV_ADRS_LIN |
| L2010E | N4 | Service Provider City/State/ZIP Code | |
| L2010E | N401 | Service Provider City Name | L2010E_XX_S04_N401_SVC_PROV_CITY_NM |
| L2010E | N402 | Service Provider State or Province Code | L2010E_XX_S04_N402_SVC_PROV_STAT_PROVNC_CD |
| L2010E | N403 | Service Provider Postal Zone or ZIP Code | L2010E_XX_S04_N403_SVC_PROV_POSTL_ZON_ZIP_CD |
| L2010E | N404 | Service Provider Country Code | L2010E_XX_S04_N404_SVC_PROV_CTRY_CD |
| L2010E | PER | Service Provider Contact Information | |
| L2010E | PER01 | Contact Function Code | L2010E_XX_S05_PER01_FUNCTN_CD |
| L2010E | PER02 | Service Provider Contact Name | L2010E_XX_S05_PER02_SVC_PROV_CONTCT_NM |
| L2010E | PER04 | Electronic Mail | L2010E_XX_S05_PER04_SVC_PROV_CONTCT_COMNCTN_NR_OVL_EMAIL |
| L2010E | PER04 | Facsimile | L2010E_XX_S05_PER04_SVC_PROV_CONTCT_COMNCTN_NR_OVL_FACSML |
| L2010E | PER04 | Telephone | L2010E_XX_S05_PER04_SVC_PROV_CONTCT_COMNCTN_NR_OVL_TELPHN |
| L2010E | PER06 | Electronic Mail | L2010E_XX_S05_PER06_SVC_PROV_CONTCT_COMNCTN_NR_OVL_EMAIL |
| L2010E | PER06 | Telephone Extension | L2010E_XX_S05_PER06_SVC_PROV_CONTCT_COMNCTN_NR_OVL_PHN_EXTNS |
| L2010E | PER06 | Facsimile | L2010E_XX_S05_PER06_SVC_PROV_CONTCT_COMNCTN_NR_OVL_FACSML |
| L2010E | PER06 | Telephone | L2010E_XX_S05_PER06_SVC_PROV_CONTCT_COMNCTN_NR_OVL_TELPHN |
| L2010E | PER08 | Electronic Mail | L2010E_XX_S05_PER08_SVC_PROV_CONTCT_COMNCTN_NR_OVL_EMAIL |
| L2010E | PER08 | Telephone Extension | L2010E_XX_S05_PER08_SVC_PROV_CONTCT_COMNCTN_NR_OVL_PHN_EXTNS |
| L2010E | PER08 | Facsimile | L2010E_XX_S05_PER08_SVC_PROV_CONTCT_COMNCTN_NR_OVL_FACSML |
| L2010E | PER08 | Telephone | L2010E_XX_S05_PER08_SVC_PROV_CONTCT_COMNCTN_NR_OVL_TELPHN |
| L2010E | AAA | Service Provider Request Validation | |
| L2010E | AAA01 | Valid Request Indicator | L2010E_XX_S06_AAA01_REQST_IND |
| L2010E | AAA03 | Reject Reason Code | L2010E_XX_S06_AAA03_REJCT_RSN_CD |
| L2010E | AAA04 | Follow-up Action Code | L2010E_XX_S06_AAA04_FOLWP_ACTN_CD |
| L2010E | PRV | Service Provider Information | |
| L2010E | PRV01 | Provider Code | L2010E_XX_S07_PRV01_PROV_CD |
| L2010E | PRV03 | Mutually Defined | L2010E_XX_S07_PRV03_TAXNMY_CD_OVL_MUTLY_DEFND |
2000F - SERVICE LEVEL
| Loop | Segment | Segment Name | Chiapas Gate Mapping |
| L2000F | HL | Service Level | |
| L2000F | HL01 | Hierarchical ID Number | L2000F_S01_HL01_HIERCHCL_ID_NR |
| L2000F | HL02 | Hierarchical Parent ID Number | L2000F_S01_HL02_HIERCHCL_PARNT_ID_NR |
| L2000F | HL04 | Hierarchical Child Code | L2000F_S01_HL04_HIERCHCL_CHILD_CD |
| L2000F | TRN | Service Trace Number | |
| L2000F | TRN01 | Trace Type Code | L2000F_S02_TRN01_TYPE_CD |
| L2000F | TRN02 | Service Trace Number | L2000F_S02_TRN02_SVC_TRAC_NR |
| L2000F | TRN03 | Trace Assigning Entity Identifier | L2000F_S02_TRN03_TRAC_ASGNG_ENTY_ID |
| L2000F | TRN04 | Trace Assigning Entity Additional Identifier | L2000F_S02_TRN04_TRAC_ASGNG_ENTY_ADDL_ID |
| L2000F | AAA | Service Request Validation | |
| L2000F | AAA01 | Valid Request Indicator | L2000F_S03_AAA01_REQST_IND |
| L2000F | AAA03 | Reject Reason Code | L2000F_S03_AAA03_REJCT_RSN_CD |
| L2000F | AAA04 | Follow-up Action Code | L2000F_S03_AAA04_FOLWP_ACTN_CD |
| L2000F | UM | Health Care Services Review Information | |
| L2000F | UM01 | Request Category Code | L2000F_S04_UM01_REQST_CATGRY_CD |
| L2000F | UM02 | Certification Type Code | L2000F_S04_UM02_CERT_TYPE_CD |
| L2000F | UM03 | Service Type Code | L2000F_S04_UM03_TYPE_CD |
| L2000F | UM04-01 | Facility Type Code | L2000F_S04_UM04_01_FACLTY_TYPE_CD |
| L2000F | UM04-02 | Facility Code Qualifier | L2000F_S04_UM04_02_FACLTY_CD_QUAL |
| L2000F | UM06 | Level of Service Code | L2000F_S04_UM06_LEVL_SVC_CD |
| L2000F | HCR | Health Care Services Review | |
| L2000F | HCR01 | Action Code | L2000F_S05_HCR01_ACTN_CD |
| L2000F | HCR02 | Certification Number | L2000F_S05_HCR02_CERT_NR |
| L2000F | HCR03 | Reject Reason Code | L2000F_S05_HCR03_REJCT_RSN_CD |
| L2000F | HCR04 | Second Surgical Opinion Indicator | L2000F_S05_HCR04_SECND_SURGCL_OPN_IND |
| L2000F | REF | Previous Certification Identification | |
| L2000F | REF02 | Authorization Number | L2000F_S06_REF02_CERT_ID_OVL_AUTH_NR |
| L2000F | DTP | Service Date | |
| L2000F | DTP03 | Service (D8) | L2000F_S07_DTP03_PROPSD_ACTL_SVC_DT_OVL_SVC_D8 |
| L2000F | DTP03 | Service (RD8) | L2000F_S07_DTP03_PROPSD_ACTL_SVC_DT_OVL_SVC_RD8 |
| L2000F | DTP | Admission Date | |
| L2000F | DTP03 | Admission (D8) | L2000F_S08_DTP03_PROPSD_ACTL_ADMSN_DT_OVL_ADMSN_D8 |
| L2000F | DTP03 | Admission (RD8) | L2000F_S08_DTP03_PROPSD_ACTL_ADMSN_DT_OVL_ADMSN_RD8 |
| L2000F | DTP | Discharge Date | |
| L2000F | DTP03 | Discharge (D8) | L2000F_S09_DTP03_PROPSD_ACTL_DISCHRG_DT_OVL_DISCHRG_D8 |
| L2000F | DTP | Surgery Date | |
| L2000F | DTP03 | Surgery (D8) | L2000F_S10_DTP03_PROPSD_ACTL_SURGRY_DT_OVL_SURGRY_D8 |
| L2000F | DTP | Certification Issue Date | |
| L2000F | DTP03 | Issue (D8) | L2000F_S11_DTP03_ISS_DT_OVL_ISSU_D8 |
| L2000F | DTP | Certification Expiration Date | |
| L2000F | DTP03 | Expiration (D8) | L2000F_S12_DTP03_EXPRTN_DT_OVL_EXPRTN_D8 |
| L2000F | DTP | Certification Effective Date | |
| L2000F | DTP03 | Effective (D8) | L2000F_S13_DTP03_EFF_DT_OVL_EFF_D8 |
| L2000F | DTP03 | Effective (RD8) | L2000F_S13_DTP03_EFF_DT_OVL_EFF_RD8 |
| L2000F | HI | Procedures | |
| L2000F | HI01-02 | Health Care Financing Administration Common Procedural Coding System | L2000F_S14_HI01_02_PROC_CD_OVL_HCPCSTEM |
| L2000F | HI01-02 | International Classification of Diseases Clinical | L2000F_S14_HI01_02_PROC_CD_OVL_INTRNTNL_CLASFCTN_DIS_CLINCL |
| L2000F | HI01-02 | National Standard Tooth Numbering System | L2000F_S14_HI01_02_PROC_CD_OVL_NATNL_STANDRD_TOTH_NRNG_SYS |
| L2000F | HI01-02 | National Drug Code (NDC) | L2000F_S14_HI01_02_PROC_CD_OVL_NDC |
| L2000F | HI01-02 | Mutually Defined | L2000F_S14_HI01_02_PROC_CD_OVL_MUTLY_DEFND |
| L2000F | HI01-04 | Date Expressed in Format CCYYMMDD | L2000F_S14_HI01_04_PROC_DT_OVL_DT_CCYYMMDD |
| L2000F | HI01-04 | Range of Dates Expressed in Format CCYYMMDD- | L2000F_S14_HI01_04_PROC_DT_OVL_RANG_DT_FORMT_CCYYMMDD |
| L2000F | HI01-06 | Procedure Quantity | L2000F_S14_HI01_06_PROC_QTY |
| L2000F | HI01-07 | Version, Release, or Industry Identifier | L2000F_S14_HI01_07_VERS_RELS_INDSTRY_ID |
| L2000F | HI02-02 | Health Care Financing Administration Common Procedural Coding System | L2000F_S14_HI02_02_PROC_CD_OVL_HCPCSTEM |
| L2000F | HI02-02 | International Classification of Diseases Clinical | L2000F_S14_HI02_02_PROC_CD_OVL_INTRNTNL_CLASFCTN_DIS_CLINCL |
| L2000F | HI02-02 | National Standard Tooth Numbering System | L2000F_S14_HI02_02_PROC_CD_OVL_NATNL_STANDRD_TOTH_NRNG_SYS |
| L2000F | HI02-02 | National Drug Code (NDC) | L2000F_S14_HI02_02_PROC_CD_OVL_NDC |
| L2000F | HI02-02 | Mutually Defined | L2000F_S14_HI02_02_PROC_CD_OVL_MUTLY_DEFND |
| L2000F | HI02-04 | Date Expressed in Format CCYYMMDD | L2000F_S14_HI02_04_PROC_DT_OVL_DT_CCYYMMDD |
| L2000F | HI02-04 | Range of Dates Expressed in Format CCYYMMDD- CCYYMMDD | L2000F_S14_HI02_04_PROC_DT_OVL_RANG_DT_CCYYMMDD |
| L2000F | HI02-06 | Procedure Quantity | L2000F_S14_HI02_06_PROC_QTY |
| L2000F | HI02-07 | Version, Release, or Industry Identifier | L2000F_S14_HI02_07_VERS_RELS_INDSTRY_ID |
| L2000F | HI03-02 | Health Care Financing Administration Common Procedural Coding System | L2000F_S14_HI03_02_PROC_CD_OVL_HCPCSTEM |
| L2000F | HI03-02 | International Classification of Diseases Clinical | L2000F_S14_HI03_02_PROC_CD_OVL_INTRNTNL_CLASFCTN_DIS_CLINCL |
| L2000F | HI03-02 | National Standard Tooth Numbering System | L2000F_S14_HI03_02_PROC_CD_OVL_NATNL_STANDRD_TOTH_NRNG_SYS |
| L2000F | HI03-02 | National Drug Code (NDC) | L2000F_S14_HI03_02_PROC_CD_OVL_NDC |
| L2000F | HI03-02 | Mutually Defined | L2000F_S14_HI03_02_PROC_CD_OVL_MUTLY_DEFND |
| L2000F | HI03-04 | Date Expressed in Format CCYYMMDD | L2000F_S14_HI03_04_PROC_DT_OVL_DT_CCYYMMDD |
| L2000F | HI03-04 | Range of Dates Expressed in Format CCYYMMDD- CCYYMMDD | L2000F_S14_HI03_04_PROC_DT_OVL_RANG_DT_CCYYMMDD |
| L2000F | HI03-06 | Procedure Quantity | L2000F_S14_HI03_06_PROC_QTY |
| L2000F | HI03-07 | Version, Release, or Industry Identifier | L2000F_S14_HI03_07_VERS_RELS_INDSTRY_ID |
| L2000F | HI04-02 | Health Care Financing Administration Common Procedural Coding System | L2000F_S14_HI04_02_PROC_CD_OVL_HCPCSTEM |
| L2000F | HI04-02 | International Classification of Diseases Clinical | L2000F_S14_HI04_02_PROC_CD_OVL_INTRNTNL_CLASFCTN_DIS_CLINCL |
| L2000F | HI04-02 | National Standard Tooth Numbering System | L2000F_S14_HI04_02_PROC_CD_OVL_NATNL_STANDRD_TOTH_NRNG_SYS |
| L2000F | HI04-02 | National Drug Code (NDC) | L2000F_S14_HI04_02_PROC_CD_OVL_NDC |
| L2000F | HI04-02 | Mutually Defined | L2000F_S14_HI04_02_PROC_CD_OVL_MUTLY_DEFND |
| L2000F | HI04-04 | Date Expressed in Format CCYYMMDD | L2000F_S14_HI04_04_PROC_DT_OVL_DT_CCYYMMDD |
| L2000F | HI04-04 | Range of Dates Expressed in Format CCYYMMDD- CCYYMMDD | L2000F_S14_HI04_04_PROC_DT_OVL_RANG_DT_CCYYMMDD |
| L2000F | HI04-06 | Procedure Quantity | L2000F_S14_HI04_06_PROC_QTY |
| L2000F | HI04-07 | Version, Release, or Industry Identifier | L2000F_S14_HI04_07_VERS_RELS_INDSTRY_ID |
| L2000F | HI05-02 | Health Care Financing Administration Common Procedural Coding System | L2000F_S14_HI05_02_PROC_CD_OVL_HCPCSTEM |
| L2000F | HI05-02 | International Classification of Diseases Clinical | L2000F_S14_HI05_02_PROC_CD_OVL_INTRNTNL_CLASFCTN_DIS_CLINCL |
| L2000F | HI05-02 | National Standard Tooth Numbering System | L2000F_S14_HI05_02_PROC_CD_OVL_NATNL_STANDRD_TOTH_NRNG_SYS |
| L2000F | HI05-02 | National Drug Code (NDC) | L2000F_S14_HI05_02_PROC_CD_OVL_NDC |
| L2000F | HI05-02 | Mutually Defined | L2000F_S14_HI05_02_PROC_CD_OVL_MUTLY_DEFND |
| L2000F | HI05-04 | Date Expressed in Format CCYYMMDD | L2000F_S14_HI05_04_PROC_DT_OVL_DT_CCYYMMDD |
| L2000F | HI05-04 | Range of Dates Expressed in Format CCYYMMDD- CCYYMMDD | L2000F_S14_HI05_04_PROC_DT_OVL_RANG_DT_CCYYMMDD |
| L2000F | HI05-06 | Procedure Quantity | L2000F_S14_HI05_06_PROC_QTY |
| L2000F | HI05-07 | Version, Release, or Industry Identifier | L2000F_S14_HI05_07_VERS_RELS_INDSTRY_ID |
| L2000F | HI06-02 | Health Care Financing Administration Common Procedural Coding System | L2000F_S14_HI06_02_PROC_CD_OVL_HCPCSTEM |
| L2000F | HI06-02 | International Classification of Diseases Clinical Modification (ICD-9-CM) Procedure | L2000F_S14_HI06_02_PROC_CD_OVL_ICD9CM_PROC |
| L2000F | HI06-02 | National Standard Tooth Numbering System | L2000F_S14_HI06_02_PROC_CD_OVL_NATNL_STANDRD_TOTH_NRNG_SYS |
| L2000F | HI06-02 | National Drug Code (NDC) | L2000F_S14_HI06_02_PROC_CD_OVL_NDC |
| L2000F | HI06-02 | Mutually Defined | L2000F_S14_HI06_02_PROC_CD_OVL_MUTLY_DEFND |
| L2000F | HI06-04 | Date Expressed in Format CCYYMMDD | L2000F_S14_HI06_04_PROC_DT_OVL_DT_CCYYMMDD |
| L2000F | HI06-04 | Range of Dates Expressed in Format CCYYMMDD- CCYYMMDD | L2000F_S14_HI06_04_PROC_DT_OVL_RANG_DT_CCYYMMDD |
| L2000F | HI06-06 | Procedure Quantity | L2000F_S14_HI06_06_PROC_QTY |
| L2000F | HI06-07 | Version, Release, or Industry Identifier | L2000F_S14_HI06_07_VERS_RELS_INDSTRY_ID |
| L2000F | HI07-02 | Health Care Financing Administration Common Procedural Coding System | L2000F_S14_HI07_02_PROC_CD_OVL_HCPCSTEM |
| L2000F | HI07-02 | International Classification of Diseases Clinical Modification (ICD-9-CM) Procedure | L2000F_S14_HI07_02_PROC_CD_OVL_ICD9CM_PROC |
| L2000F | HI07-02 | National Standard Tooth Numbering System | L2000F_S14_HI07_02_PROC_CD_OVL_NATNL_STANDRD_TOTH_NRNG_SYS |
| L2000F | HI07-02 | National Drug Code (NDC) | L2000F_S14_HI07_02_PROC_CD_OVL_NDC |
| L2000F | HI07-02 | Mutually Defined | L2000F_S14_HI07_02_PROC_CD_OVL_MUTLY_DEFND |
| L2000F | HI07-04 | Date Expressed in Format CCYYMMDD | L2000F_S14_HI07_04_PROC_DT_OVL_DT_CCYYMMDD |
| L2000F | HI07-04 | Range of Dates Expressed in Format CCYYMMDD- CCYYMMDD | L2000F_S14_HI07_04_PROC_DT_OVL_RANG_DT_CCYYMMDD |
| L2000F | HI07-06 | Procedure Quantity | L2000F_S14_HI07_06_PROC_QTY |
| L2000F | HI07-07 | Version, Release, or Industry Identifier | L2000F_S14_HI07_07_VERS_RELS_INDSTRY_ID |
| L2000F | HI08-02 | Health Care Financing Administration Common Procedural Coding System | L2000F_S14_HI08_02_PROC_CD_OVL_HCPCSTEM |
| L2000F | HI08-02 | International Classification of Diseases Clinical | L2000F_S14_HI08_02_PROC_CD_OVL_INTRNTNL_CLASFCTN_DIS_CLINCL |
| L2000F | HI08-02 | National Standard Tooth Numbering System | L2000F_S14_HI08_02_PROC_CD_OVL_NATNL_STANDRD_TOTH_NRNG_SYS |
| L2000F | HI08-02 | National Drug Code (NDC) | L2000F_S14_HI08_02_PROC_CD_OVL_NDC |
| L2000F | HI08-02 | Mutually Defined | L2000F_S14_HI08_02_PROC_CD_OVL_MUTLY_DEFND |
| L2000F | HI08-04 | Date Expressed in Format CCYYMMDD | L2000F_S14_HI08_04_PROC_DT_OVL_DT_CCYYMMDD |
| L2000F | HI08-04 | Range of Dates Expressed in Format CCYYMMDD- CCYYMMDD | L2000F_S14_HI08_04_PROC_DT_OVL_RANG_DT_CCYYMMDD |
| L2000F | HI08-06 | Procedure Quantity | L2000F_S14_HI08_06_PROC_QTY |
| L2000F | HI08-07 | Version, Release, or Industry Identifier | L2000F_S14_HI08_07_VERS_RELS_INDSTRY_ID |
| L2000F | HI09-02 | Health Care Financing Administration Common Procedural Coding System | L2000F_S14_HI09_02_PROC_CD_OVL_HCPCSTEM |
| L2000F | HI09-02 | International Classification of Diseases Clinical | L2000F_S14_HI09_02_PROC_CD_OVL_INTRNTNL_CLASFCTN_DIS_CLINCL |
| L2000F | HI09-02 | National Standard Tooth Numbering System | L2000F_S14_HI09_02_PROC_CD_OVL_NATNL_STANDRD_TOTH_NRNG_SYS |
| L2000F | HI09-02 | National Drug Code (NDC) | L2000F_S14_HI09_02_PROC_CD_OVL_NDC |
| L2000F | HI09-02 | Mutually Defined | L2000F_S14_HI09_02_PROC_CD_OVL_MUTLY_DEFND |
| L2000F | HI09-04 | Date Expressed in Format CCYYMMDD | L2000F_S14_HI09_04_PROC_DT_OVL_DT_CCYYMMDD |
| L2000F | HI09-04 | Range of Dates Expressed in Format CCYYMMDD- CCYYMMDD | L2000F_S14_HI09_04_PROC_DT_OVL_RANG_DT_CCYYMMDD |
| L2000F | HI09-06 | Procedure Quantity | L2000F_S14_HI09_06_PROC_QTY |
| L2000F | HI09-07 | Version, Release, or Industry Identifier | L2000F_S14_HI09_07_VERS_RELS_INDSTRY_ID |
| L2000F | HI10-02 | Health Care Financing Administration Common Procedural Coding System | L2000F_S14_HI10_02_PROC_CD_OVL_HCPCSTEM |
| L2000F | HI10-02 | International Classification of Diseases Clinical | L2000F_S14_HI10_02_PROC_CD_OVL_INTRNTNL_CLASFCTN_DIS_CLINCL |
| L2000F | HI10-02 | National Standard Tooth Numbering System | L2000F_S14_HI10_02_PROC_CD_OVL_NATNL_STANDRD_TOTH_NRNG_SYS |
| L2000F | HI10-02 | National Drug Code (NDC) | L2000F_S14_HI10_02_PROC_CD_OVL_NDC |
| L2000F | HI10-02 | Mutually Defined | L2000F_S14_HI10_02_PROC_CD_OVL_MUTLY_DEFND |
| L2000F | HI10-04 | Date Expressed in Format CCYYMMDD | L2000F_S14_HI10_04_PROC_DT_OVL_DT_CCYYMMDD |
| L2000F | HI10-04 | Range of Dates Expressed in Format CCYYMMDD- CCYYMMDD | L2000F_S14_HI10_04_PROC_DT_OVL_RANG_DT_CCYYMMDD |
| L2000F | HI10-06 | Procedure Quantity | L2000F_S14_HI10_06_PROC_QTY |
| L2000F | HI10-07 | Version, Release, or Industry Identifier | L2000F_S14_HI10_07_VERS_RELS_INDSTRY_ID |
| L2000F | HI11-02 | Health Care Financing Administration Common Procedural Coding System | L2000F_S14_HI11_02_PROC_CD_OVL_HCPCSTEM |
| L2000F | HI11-02 | International Classification of Diseases Clinical Modification (ICD-9-CM) Procedure | L2000F_S14_HI11_02_PROC_CD_OVL_ICD9CM_PROC |
| L2000F | HI11-02 | National Standard Tooth Numbering System | L2000F_S14_HI11_02_PROC_CD_OVL_NATNL_STANDRD_TOTH_NRNG_SYS |
| L2000F | HI11-02 | National Drug Code (NDC) | L2000F_S14_HI11_02_PROC_CD_OVL_NDC |
| L2000F | HI11-02 | Mutually Defined | L2000F_S14_HI11_02_PROC_CD_OVL_MUTLY_DEFND |
| L2000F | HI11-04 | Date Expressed in Format CCYYMMDD | L2000F_S14_HI11_04_PROC_DT_OVL_DT_CCYYMMDD |
| L2000F | HI11-04 | Range of Dates Expressed in Format CCYYMMDD- CCYYMMDD | L2000F_S14_HI11_04_PROC_DT_OVL_RANG_DT_CCYYMMDD |
| L2000F | HI11-06 | Procedure Quantity | L2000F_S14_HI11_06_PROC_QTY |
| L2000F | HI11-07 | Version, Release, or Industry Identifier | L2000F_S14_HI11_07_VERS_RELS_INDSTRY_ID |
| L2000F | HI12-02 | Health Care Financing Administration Common Procedural Coding System | L2000F_S14_HI12_02_PROC_CD_OVL_HCPCSTEM |
| L2000F | HI12-02 | International Classification of Diseases Clinical Modification (ICD-9-CM) Procedure | L2000F_S14_HI12_02_PROC_CD_OVL_ICD9CM_PROC |
| L2000F | HI12-02 | National Standard Tooth Numbering System | L2000F_S14_HI12_02_PROC_CD_OVL_NATNL_STANDRD_TOTH_NRNG_SYS |
| L2000F | HI12-02 | National Drug Code (NDC) | L2000F_S14_HI12_02_PROC_CD_OVL_NDC |
| L2000F | HI12-02 | Mutually Defined | L2000F_S14_HI12_02_PROC_CD_OVL_MUTLY_DEFND |
| L2000F | HI12-04 | Date Expressed in Format CCYYMMDD | L2000F_S14_HI12_04_PROC_DT_OVL_DT_CCYYMMDD |
| L2000F | HI12-04 | Range of Dates Expressed in Format CCYYMMDD- CCYYMMDD | L2000F_S14_HI12_04_PROC_DT_OVL_RANG_DT_CCYYMMDD |
| L2000F | HI12-06 | Procedure Quantity | L2000F_S14_HI12_06_PROC_QTY |
| L2000F | HI12-07 | Version, Release, or Industry Identifier | L2000F_S14_HI12_07_VERS_RELS_INDSTRY_ID |
| L2000F | HSD | Health Care Services Delivery | |
| L2000F | HSD02 | Days | L2000F_S15_HSD02_UNT_CT_OVL_DAYS |
| L2000F | HSD02 | Units | L2000F_S15_HSD02_UNT_CT_OVL_UNTS |
| L2000F | HSD02 | Hours | L2000F_S15_HSD02_UNT_CT_OVL_HOURS |
| L2000F | HSD02 | Month | L2000F_S15_HSD02_UNT_CT_OVL_MONTH |
| L2000F | HSD02 | Visits | L2000F_S15_HSD02_UNT_CT_OVL_VISTS |
| L2000F | HSD04 | Days | L2000F_S15_HSD04_SAMPL_SELCTN_MODLS_OVL_DAYS |
| L2000F | HSD04 | Months | L2000F_S15_HSD04_SAMPL_SELCTN_MODLS_OVL_MONTHS |
| L2000F | HSD04 | Week | L2000F_S15_HSD04_SAMPL_SELCTN_MODLS_OVL_WEK |
| L2000F | HSD06 | Hour | L2000F_S15_HSD06_PERD_CT_OVL_HOUR |
| L2000F | HSD06 | Day | L2000F_S15_HSD06_PERD_CT_OVL_DAY |
| L2000F | HSD06 | Years | L2000F_S15_HSD06_PERD_CT_OVL_YRS |
| L2000F | HSD06 | Episode | L2000F_S15_HSD06_PERD_CT_OVL_EPSD |
| L2000F | HSD06 | Visit | L2000F_S15_HSD06_PERD_CT_OVL_VIST |
| L2000F | HSD06 | Month | L2000F_S15_HSD06_PERD_CT_OVL_MONTH |
| L2000F | HSD06 | Week | L2000F_S15_HSD06_PERD_CT_OVL_WEK |
| L2000F | HSD07 | Ship, Delivery or Calendar Pattern Code | L2000F_S15_HSD07_SHIP_DELVRY_CALNDR_PATRN_CD |
| L2000F | HSD08 | Delivery Pattern Time Code | L2000F_S15_HSD08_DELVRY_PATRN_TIM_CD |
| L2000F | CL1 | Institutional Claim Code | |
| L2000F | CL101 | Admission Type Code | L2000F_S16_CL101_ADMSN_TYPE_CD |
| L2000F | CL102 | Admission Source Code | L2000F_S16_CL102_ADMSN_SOURC_CD |
| L2000F | CL103 | Patient Status Code | L2000F_S16_CL103_PATNT_STATS_CD |
| L2000F | CL104 | Nursing Home Residential Status Code | L2000F_S16_CL104_NRSNG_HM_RES_STATS_CD |
| L2000F | CR1 | Ambulance Transport Information | |
| L2000F | CR103 | Ambulance Transport Code | L2000F_S17_CR103_TRANSPRT_CD |
| L2000F | CR106 | Miles | L2000F_S17_CR106_TRANSPRT_DISTNC_OVL_MILS |
| L2000F | CR106 | Kilometers | L2000F_S17_CR106_TRANSPRT_DISTNC_OVL_KILMTRS |
| L2000F | CR107 | Ambulance Trip Origin Address | L2000F_S17_CR107_AMBLNC_TRIP_ORGN_ADRS |
| L2000F | CR108 | Ambulance Trip Destination Address | L2000F_S17_CR108_AMBLNC_TRIP_DESTNTN_ADRS |
| L2000F | CR2 | Spinal Manipulation Service Information | |
| L2000F | CR201 | Treatment Series Number | L2000F_S18_CR201_TREATMNT_SERS_NR |
| L2000F | CR202 | Treatment Count | L2000F_S18_CR202_TREATMNT_CT |
| L2000F | CR203 | Subluxation Level Code | L2000F_S18_CR203_SUBLXTN_LEVL_CD |
| L2000F | CR204 | Subluxation Level Code | L2000F_S18_CR204_SUBLXTN_LEVL_CD |
| L2000F | CR206 | Days | L2000F_S18_CR206_TREATMNT_PERD_CT_OVL_DAYS |
| L2000F | CR206 | Months | L2000F_S18_CR206_TREATMNT_PERD_CT_OVL_MONTHS |
| L2000F | CR206 | Week | L2000F_S18_CR206_TREATMNT_PERD_CT_OVL_WEK |
| L2000F | CR206 | Years | L2000F_S18_CR206_TREATMNT_PERD_CT_OVL_YRS |
| L2000F | CR207 | Monthly Treatment Count | L2000F_S18_CR207_MONTHLY_TREATMNT_CT |
| L2000F | CR5 | Home Oxygen Therapy Information | |
| L2000F | CR503 | Oxygen Equipment Type Code | L2000F_S19_CR503_OXY_EQPMNT_TYPE_CD |
| L2000F | CR504 | Oxygen Equipment Type Code | L2000F_S19_CR504_OXY_EQPMNT_TYPE_CD |
| L2000F | CR505 | Equipment Reason Description | L2000F_S19_CR505_EQPMNT_RSN_DESCRPTN |
| L2000F | CR506 | Oxygen Flow Rate | L2000F_S19_CR506_FLOW_RAT |
| L2000F | CR507 | Daily Oxygen Use Count | L2000F_S19_CR507_DAILY_OXY_US_CT |
| L2000F | CR508 | Oxygen Use Period Hour Count | L2000F_S19_CR508_OXY_US_PERD_HOUR_CT |
| L2000F | CR509 | Respiratory Therapist Order Text | L2000F_S19_CR509_RESP_THERPST_ORDR_TEXT |
| L2000F | CR516 | Portable Oxygen System Flow Rate | L2000F_S19_CR516_PORTBL_OXY_SYS_FLOW_RAT |
| L2000F | CR517 | Oxygen Delivery System Code | L2000F_S19_CR517_OXY_DELVRY_SYS_CD |
| L2000F | CR518 | Oxygen Equipment Type Code | L2000F_S19_CR518_OXY_EQPMNT_TYPE_CD |
| L2000F | CR6 | Home Health Care Information | |
| L2000F | CR601 | Prognosis Code | L2000F_S20_CR601_PROGNS_CD |
| L2000F | CR602 | Service From Date | L2000F_S20_CR602_SVC_FROM_DT |
| L2000F | CR604 | Range of Dates Expressed in Format CCYYMMDD- | L2000F_S20_CR604_HOM_HEALTH_CERT_PERD_OVL_RANG_DT_FORMT_CCYYMMDD |
| L2000F | CR607 | Medicare Coverage Indicator | L2000F_S20_CR607_MEDCR_COVG_IND |
| L2000F | CR608 | Certification Type Code | L2000F_S20_CR608_CERT_TYPE_CD |
| L2000F | MSG | Message Text | |
| L2000F | MSG01 | Free Form Message Text | L2000F_S21_MSG01_FRE_FORM_MESG_TEXT |