Chiapas EDI 2012 Mapping Guide

4010_837I 4010 Health Care Claim: Institutional - Code:K0

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	Originator Application Transaction Identifier	STHDR_S02_BHT03_ORGNTR_APLCTN_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	Claim or Encounter Identifier	STHDR_S02_BHT06_CLM_ENCNTR_ID
STHDR	REF	Transmission Type Identification
STHDR	REF02	Functional Category	STHDR_S03_REF02_TYPE_CD_OVL_FUNCTNL_CATGRY
STHDR	SE	Transaction Set Trailer
STHDR	SE01	Transaction Segment Count	STHDR_S07_SE01_SEG_CT
STHDR	SE02	Transaction Set Control Number	STHDR_S07_SE02_TCN

1000A - SUBMITTER NAME

Loop	Segment	Segment Name	Chiapas Gate Mapping
L1000A	NM1	Submitter Name
L1000A	NM103	Person	L1000A_S01_NM103_SUBMTR_LAST_ORG_NM_OVL_PERSN
L1000A	NM103	Non-Person Entity	L1000A_S01_NM103_SUBMTR_LAST_ORG_NM_OVL_NONPRSN_ENTY
L1000A	NM104	Submitter First Name	L1000A_S01_NM104_SUBMTR_FNAME
L1000A	NM105	Submitter Middle Name	L1000A_S01_NM105_SUBMTR_MNAME
L1000A	NM109	Electronic Transmitter Identification Number (ETIN)	L1000A_S01_NM109_SUBMTR_ID_OVL_ETN_NR
L1000A	PER	Submitter EDI Contact Information
L1000A	PER01	Contact Function Code	L1000A_S02_PER01_FUNCTN_CD
L1000A	PER02	Submitter Contact Name	L1000A_S02_PER02_CONTCT_NM
L1000A	PER04	Electronic Data Interchange Access Number	L1000A_S02_PER04_COMM_NR_OVL_EDI_ACS_NR
L1000A	PER04	Electronic Mail	L1000A_S02_PER04_COMM_NR_OVL_EMAIL
L1000A	PER04	Facsimile	L1000A_S02_PER04_COMM_NR_OVL_FACSML
L1000A	PER04	Telephone	L1000A_S02_PER04_COMM_NR_OVL_TELPHN
L1000A	PER06	Facsimile	L1000A_S02_PER06_COMM_NR_OVL_FACSML
L1000A	PER06	Telephone	L1000A_S02_PER06_COMM_NR_OVL_TELPHN
L1000A	PER08	Electronic Data Interchange Access Number	L1000A_S02_PER08_COMM_NR_OVL_EDI_ACS_NR
L1000A	PER08	Electronic Mail	L1000A_S02_PER08_COMM_NR_OVL_EMAIL
L1000A	PER08	Telephone Extension	L1000A_S02_PER08_COMM_NR_OVL_PHN_EXTNS
L1000A	PER08	Facsimile	L1000A_S02_PER08_COMM_NR_OVL_FACSML
L1000A	PER08	Telephone	L1000A_S02_PER08_COMM_NR_OVL_TELPHN

1000B - RECEIVER NAME

Loop	Segment	Segment Name	Chiapas Gate Mapping
L1000B	NM1	Receiver Name
L1000B	NM103	Non-Person Entity	L1000B_S01_NM103_RECVR_NM_OVL_NONPRSN_ENTY
L1000B	NM108	Information Receiver Identification Number	L1000B_S01_NM108_NFO_RECVR_ID_NR
L1000B	NM109	Receiver Primary Identifier	L1000B_S01_NM109_PRIMRY_ID

2000A - BILLING/PAY-TO PROVIDER HIERARCHICAL LEVEL

Loop	Segment	Segment Name	Chiapas Gate Mapping
L2000A	HL	Billing/Pay-To Provider Hierarchical Level
L2000A	HL01	Hierarchical ID Number	L2000A_S01_HL01_HIERCHCL_ID_NR
L2000A	HL04	Hierarchical Child Code	L2000A_S01_HL04_HIERCHCL_CHILD_CD
L2000A	PRV	Billing/Pay-To Provider Specialty Information
L2000A	PRV01	Provider Code	L2000A_S02_PRV01_PROV_CD
L2000A	PRV03	Mutually Defined	L2000A_S02_PRV03_TAXNMY_CD_OVL_MUTLY_DEFND
L2000A	CUR	Foreign Currency Information
L2000A	CUR01	Entity Identifier Code	L2000A_S03_CUR01_ENTY_ID_CD
L2000A	CUR02	Currency Code	L2000A_S03_CUR02_CURNCY_CD

2010AA - BILLING PROVIDER NAME

Loop	Segment	Segment Name	Chiapas Gate Mapping
L2010AA	NM1	Billing Provider Name
L2010AA	NM103	Non-Person Entity	L2010AA_S01_NM103_LAST_ORGL_NM_OVL_NONPRSN_ENTY
L2010AA	NM109	Employer’s Identification Number	L2010AA_S01_NM109_PROV_ID_OVL_EMPLYR_ID_NR
L2010AA	NM109	Social Security Number	L2010AA_S01_NM109_PROV_ID_OVL_SSN
L2010AA	NM109	Health Care Financing Administration National	L2010AA_S01_NM109_PROV_ID_OVL_HCFA_NATNL
L2010AA	N3	Billing Provider Address
L2010AA	N301	Billing Provider Address Line	L2010AA_S02_N301_BILNG_PROV_ADRS_LIN
L2010AA	N302	Billing Provider Address Line	L2010AA_S02_N302_BILNG_PROV_ADRS_LIN
L2010AA	N4	Billing Provider City/State/ZIP Code
L2010AA	N401	Billing Provider City Name	L2010AA_S03_N401_BILNG_PROV_CITY_NM
L2010AA	N402	Billing Provider State or Province Code	L2010AA_S03_N402_STAT_PROVNC_CD
L2010AA	N403	Billing Provider Postal Zone or ZIP Code	L2010AA_S03_N403_POSTL_ZON_ZIP_CD
L2010AA	N404	Country Code	L2010AA_S03_N404_CNTRY_CD
L2010AA	REF	Billing Provider Secondary Identification
L2010AA	REF02	State License Number	L2010AA_S04_REF02_BILNG_PROV_ADDL_ID_OVL_STAT_LICNS_NR
L2010AA	REF02	Blue Cross Provider Number	L2010AA_S04_REF02_BILNG_PROV_ADDL_ID_OVL_BLUE_CROS_PROV_NR
L2010AA	REF02	Blue Shield Provider Number	L2010AA_S04_REF02_BILNG_PROV_ADDL_ID_OVL_BLUE_SHIELD_PROV_NR
L2010AA	REF02	Medicare Provider Number	L2010AA_S04_REF02_BILNG_PROV_ADDL_ID_OVL_MEDCR_PROV_NR
L2010AA	REF02	Medicaid Provider Number	L2010AA_S04_REF02_BILNG_PROV_ADDL_ID_OVL_MEDCD_PROV_NR
L2010AA	REF02	Provider UPIN Number	L2010AA_S04_REF02_BILNG_PROV_ADDL_ID_OVL_PROV_UPN_NR
L2010AA	REF02	CHAMPUS Identification Number	L2010AA_S04_REF02_BILNG_PROV_ADDL_ID_OVL_CHAMPS_ID_NR
L2010AA	REF02	Facility ID Number	L2010AA_S04_REF02_BILNG_PROV_ADDL_ID_OVL_FACLTY_ID_NR
L2010AA	REF02	Preferred Provider Organization Number	L2010AA_S04_REF02_BILNG_PROV_ADDL_ID_OVL_PREFD_PROV_ORG_NR
L2010AA	REF02	Health Maintenance Organization Code Number	L2010AA_S04_REF02_BILNG_PROV_ADDL_ID_OVL_HMO_COD_NR
L2010AA	REF02	Employer’s Identification Number	L2010AA_S04_REF02_BILNG_PROV_ADDL_ID_OVL_EMPLYR_ID_NR
L2010AA	REF02	Clinic Number	L2010AA_S04_REF02_BILNG_PROV_ADDL_ID_OVL_CLINC_NR
L2010AA	REF02	Provider Commercial Number	L2010AA_S04_REF02_BILNG_PROV_ADDL_ID_OVL_PROV_COMRCL_NR
L2010AA	REF02	Provider Site Number	L2010AA_S04_REF02_BILNG_PROV_ADDL_ID_OVL_PROV_SIT_NR
L2010AA	REF02	Location Number	L2010AA_S04_REF02_BILNG_PROV_ADDL_ID_OVL_LOC_NR
L2010AA	REF02	Social Security Number	L2010AA_S04_REF02_BILNG_PROV_ADDL_ID_OVL_SSN
L2010AA	REF02	State Industrial Accident Provider Number	L2010AA_S04_REF02_BILNG_PROV_ADDL_ID_OVL_STAT_INDSTRL_ACDNT_PROV_NR
L2010AA	REF	Credit/Debit Card Billing Information
L2010AA	REF02	System Number	L2010AA_S05_REF02_BILNG_PROV_CC_ID_OVL_SYS_NR
L2010AA	REF02	Bank Assigned Security Identifier	L2010AA_S05_REF02_BILNG_PROV_CC_ID_OVL_BANK_ASGND_SECRTY_ID
L2010AA	REF02	Electronic Payment Reference Number	L2010AA_S05_REF02_BILNG_PROV_CC_ID_OVL_ELCTRNC_PMT_REF_NR
L2010AA	REF02	Standard Industry Classification (SIC) Code	L2010AA_S05_REF02_BILNG_PROV_CC_ID_OVL_SIC_CD
L2010AA	REF02	Location Number	L2010AA_S05_REF02_BILNG_PROV_CC_ID_OVL_LOC_NR
L2010AA	REF02	Rate code number	L2010AA_S05_REF02_BILNG_PROV_CC_ID_OVL_RAT_COD_NR
L2010AA	REF02	Store Number	L2010AA_S05_REF02_BILNG_PROV_CC_ID_OVL_ST_NR
L2010AA	REF02	Terminal Code	L2010AA_S05_REF02_BILNG_PROV_CC_ID_OVL_TERMNL_CD
L2010AA	PER	Billing Provider Contact Information
L2010AA	PER01	Contact Function Code	L2010AA_S06_PER01_FUNCTN_CD
L2010AA	PER02	Billing Provider Contact Name	L2010AA_S06_PER02_BILNG_PROV_CONTCT_NM
L2010AA	PER04	Electronic Mail	L2010AA_S06_PER04_COMM_NR_OVL_EMAIL
L2010AA	PER04	Facsimile	L2010AA_S06_PER04_COMM_NR_OVL_FACSML
L2010AA	PER04	Telephone	L2010AA_S06_PER04_COMM_NR_OVL_TELPHN
L2010AA	PER06	Electronic Mail	L2010AA_S06_PER06_COMM_NR_OVL_EMAIL
L2010AA	PER06	Telephone Extension	L2010AA_S06_PER06_COMM_NR_OVL_PHN_EXTNS
L2010AA	PER06	Facsimile	L2010AA_S06_PER06_COMM_NR_OVL_FACSML
L2010AA	PER06	Telephone	L2010AA_S06_PER06_COMM_NR_OVL_TELPHN
L2010AA	PER08	Electronic Mail	L2010AA_S06_PER08_COMM_NR_OVL_EMAIL
L2010AA	PER08	Telephone Extension	L2010AA_S06_PER08_COMM_NR_OVL_PHN_EXTNS
L2010AA	PER08	Facsimile	L2010AA_S06_PER08_COMM_NR_OVL_FACSML
L2010AA	PER08	Telephone	L2010AA_S06_PER08_COMM_NR_OVL_TELPHN

2010AB - PAY-TO PROVIDER NAME

Loop	Segment	Segment Name	Chiapas Gate Mapping
L2010AB	NM1	Pay-To Provider Name
L2010AB	NM103	Non-Person Entity	L2010AB_S01_NM103_LAST_ORGL_NM_OVL_NONPRSN_ENTY
L2010AB	NM109	Employer’s Identification Number	L2010AB_S01_NM109_PROV_ID_OVL_EMPLYR_ID_NR
L2010AB	NM109	Social Security Number	L2010AB_S01_NM109_PROV_ID_OVL_SSN
L2010AB	NM109	Health Care Financing Administration National Provider Identifier	L2010AB_S01_NM109_PROV_ID_OVL_HCFA_NATNL_PROV_ID
L2010AB	N3	Pay-To Provider Address
L2010AB	N301	Pay-to Provider Address Line	L2010AB_S02_N301_PAYT_PROV_ADRS_LIN
L2010AB	N302	Pay-to Provider Address Line	L2010AB_S02_N302_PAYT_PROV_ADRS_LIN
L2010AB	N4	Pay-To Provider City/State/ZIP Code
L2010AB	N401	Pay-to Provider City Name	L2010AB_S03_N401_PAYT_PROV_CITY_NM
L2010AB	N402	Pay-to Provider State Code	L2010AB_S03_N402_PAYT_PROV_STAT_CD
L2010AB	N403	Pay-to Provider Postal Zone or ZIP Code	L2010AB_S03_N403_POSTL_ZON_ZIP_CD
L2010AB	N404	Country Code	L2010AB_S03_N404_CNTRY_CD
L2010AB	REF	Pay-To Provider Secondary Identification
L2010AB	REF02	State License Number	L2010AB_S04_REF02_PAYT_PROV_ADDL_ID_OVL_STAT_LICNS_NR
L2010AB	REF02	Blue Cross Provider Number	L2010AB_S04_REF02_PAYT_PROV_ADDL_ID_OVL_BLUE_CROS_PROV_NR
L2010AB	REF02	Blue Shield Provider Number	L2010AB_S04_REF02_PAYT_PROV_ADDL_ID_OVL_BLUE_SHIELD_PROV_NR
L2010AB	REF02	Medicare Provider Number	L2010AB_S04_REF02_PAYT_PROV_ADDL_ID_OVL_MEDCR_PROV_NR
L2010AB	REF02	Medicaid Provider Number	L2010AB_S04_REF02_PAYT_PROV_ADDL_ID_OVL_MEDCD_PROV_NR
L2010AB	REF02	Provider UPIN Number	L2010AB_S04_REF02_PAYT_PROV_ADDL_ID_OVL_PROV_UPN_NR
L2010AB	REF02	CHAMPUS Identification Number	L2010AB_S04_REF02_PAYT_PROV_ADDL_ID_OVL_CHAMPS_ID_NR
L2010AB	REF02	Facility ID Number	L2010AB_S04_REF02_PAYT_PROV_ADDL_ID_OVL_FACLTY_ID_NR
L2010AB	REF02	Preferred Provider Organization Number	L2010AB_S04_REF02_PAYT_PROV_ADDL_ID_OVL_PREFD_PROV_ORG_NR
L2010AB	REF02	Health Maintenance Organization Code Number	L2010AB_S04_REF02_PAYT_PROV_ADDL_ID_OVL_HMO_COD_NR
L2010AB	REF02	Employer’s Identification Number	L2010AB_S04_REF02_PAYT_PROV_ADDL_ID_OVL_EMPLYR_ID_NR
L2010AB	REF02	Clinic Number	L2010AB_S04_REF02_PAYT_PROV_ADDL_ID_OVL_CLINC_NR
L2010AB	REF02	Provider Commercial Number	L2010AB_S04_REF02_PAYT_PROV_ADDL_ID_OVL_PROV_COMRCL_NR
L2010AB	REF02	Provider Site Number	L2010AB_S04_REF02_PAYT_PROV_ADDL_ID_OVL_PROV_SIT_NR
L2010AB	REF02	Location Number	L2010AB_S04_REF02_PAYT_PROV_ADDL_ID_OVL_LOC_NR
L2010AB	REF02	Social Security Number	L2010AB_S04_REF02_PAYT_PROV_ADDL_ID_OVL_SSN
L2010AB	REF02	State Industrial Accident Provider Number	L2010AB_S04_REF02_PAYT_PROV_ADDL_ID_OVL_STAT_INDSTRL_ACDNT_PROV_NR

2000B - SUBSCRIBER HIERARCHICAL LEVEL

Loop	Segment	Segment Name	Chiapas Gate Mapping
L2000B	HL	Subscriber Hierarchical 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
L2000B	SBR	Subscriber Information
L2000B	SBR01	Payer Responsibility Sequence Number Code	L2000B_S02_SBR01_PAYR_RESP_SEQNC_NR_CD
L2000B	SBR02	Individual Relationship Code	L2000B_S02_SBR02_INDVDL_REL_CD
L2000B	SBR03	Insured Group or Policy Number	L2000B_S02_SBR03_INSRD_GRP_POLCY_NR
L2000B	SBR04	Insured Group Name	L2000B_S02_SBR04_INSRD_GRP_NM
L2000B	SBR09	Claim Filing Indicator Code	L2000B_S02_SBR09_CLM_FILNG_IND_CD
L2000B	PAT	Patient Information
L2000B	PAT08	Gram	L2000B_S03_PAT08_PATNT_WEIGHT_OVL_GRAM
L2000B	PAT09	Pregnancy Indicator	L2000B_S03_PAT09_PREGNCY_IND

2010BA - SUBSCRIBER NAME

Loop	Segment	Segment Name	Chiapas Gate Mapping
L2010BA	NM1	Subscriber Name
L2010BA	NM103	Person	L2010BA_S01_NM103_SUB_LNAME_OVL_PERSN
L2010BA	NM103	Non-Person Entity	L2010BA_S01_NM103_SUB_LNAME_OVL_NONPRSN_ENTY
L2010BA	NM104	Subscriber First Name	L2010BA_S01_NM104_SUB_FNAME
L2010BA	NM105	Subscriber Middle Name	L2010BA_S01_NM105_SUB_MNAME
L2010BA	NM107	Subscriber Name Suffix	L2010BA_S01_NM107_NM_SUFX
L2010BA	NM109	Member Identification Number	L2010BA_S01_NM109_PRIMRY_ID_OVL_MEM_ID_NR
L2010BA	NM109	Mutually Defined	L2010BA_S01_NM109_PRIMRY_ID_OVL_MUTLY_DEFND
L2010BA	N3	Subscriber Address
L2010BA	N301	Subscriber Address Line	L2010BA_S02_N301_ADRS_LIN
L2010BA	N302	Subscriber Address Line	L2010BA_S02_N302_ADRS_LIN
L2010BA	N4	Subscriber City/State/ZIP Code
L2010BA	N401	Subscriber City Name	L2010BA_S03_N401_CITY_NM
L2010BA	N402	Subscriber State Code	L2010BA_S03_N402_STAT_CD
L2010BA	N403	Subscriber Postal Zone or ZIP Code	L2010BA_S03_N403_SUB_POSTL_ZON_ZIP_CD
L2010BA	N404	Country Code	L2010BA_S03_N404_CNTRY_CD
L2010BA	DMG	Subscriber Demographic Information
L2010BA	DMG02	Date Expressed in Format CCYYMMDD	L2010BA_S04_DMG02_BIRTH_DT_OVL_DT_CCYYMMDD
L2010BA	DMG03	Subscriber Gender Code	L2010BA_S04_DMG03_GENDR_CD
L2010BA	REF	Subscriber Secondary Identification
L2010BA	REF02	Member Identification Number	L2010BA_S05_REF02_SUPP_ID_OVL_MEM_ID_NR
L2010BA	REF02	Client Number	L2010BA_S05_REF02_SUPP_ID_OVL_CLIENT_NR
L2010BA	REF02	Insurance Policy Number	L2010BA_S05_REF02_SUPP_ID_OVL_INS_POLCY_NR
L2010BA	REF02	Social Security Number	L2010BA_S05_REF02_SUPP_ID_OVL_SSN
L2010BA	REF	Property and Casualty Claim Number
L2010BA	REF02	Agency Claim Number	L2010BA_S06_REF02_PROPRTY_CASLTY_CLM_NR_OVL_AGNCY_CLM_NR

2010BB - CREDIT/DEBIT CARD ACCOUNT HOLDER NAME

Loop	Segment	Segment Name	Chiapas Gate Mapping
L2010BB	NM1	Credit/Debit Card Account Holder Name
L2010BB	NM103	Person	L2010BB_S01_NM103_CC_HOLDR_LAST_ORGL_NM_OVL_PERSN
L2010BB	NM103	Non-Person Entity	L2010BB_S01_NM103_CC_HOLDR_LAST_ORGL_NM_OVL_NONPRSN_ENTY
L2010BB	NM104	Credit or Debit Card Holder First Name	L2010BB_S01_NM104_HOLDR_FNAME
L2010BB	NM105	Credit or Debit Card Holder Middle Name	L2010BB_S01_NM105_HOLDR_MNAME
L2010BB	NM107	Credit or Debit Card Holder Name Suffix	L2010BB_S01_NM107_CC_HOLDR_NM_SUFX
L2010BB	NM109	Member Identification Number	L2010BB_S01_NM109_CC_NR_OVL_MEM_ID_NR
L2010BB	REF	Credit/Debit Card Information
L2010BB	REF02	Acceptable Source Purchaser ID	L2010BB_S02_REF02_AUTH_NR_OVL_ACPTBL_SOURC_PURCHSR_ID
L2010BB	REF02	Authorization Number	L2010BB_S02_REF02_AUTH_NR_OVL_AUTH_NR

2010BC - PAYER NAME

Loop	Segment	Segment Name	Chiapas Gate Mapping
L2010BC	NM1	Payer Name
L2010BC	NM103	Non-Person Entity	L2010BC_S01_NM103_PAYR_NM_OVL_NONPRSN_ENTY
L2010BC	NM109	Payor Identification	L2010BC_S01_NM109_PAYR_ID_OVL_PAYR_ID
L2010BC	NM109	Health Care Financing Administration National PlanID	L2010BC_S01_NM109_PAYR_ID_OVL_HCFA_NATNL_PLAND
L2010BC	N3	Payer Address
L2010BC	N301	Payer Address Line	L2010BC_S02_N301_ADRS_LIN
L2010BC	N302	Payer Address Line	L2010BC_S02_N302_ADRS_LIN
L2010BC	N4	Payer City/State/ZIP Code
L2010BC	N401	Payer City Name	L2010BC_S03_N401_CITY_NM
L2010BC	N402	Payer State Code	L2010BC_S03_N402_STAT_CD
L2010BC	N403	Payer Postal Zone or ZIP Code	L2010BC_S03_N403_PAYR_POSTL_ZON_ZIP_CD
L2010BC	N404	Country Code	L2010BC_S03_N404_CNTRY_CD
L2010BC	REF	Payer Secondary Identification
L2010BC	REF02	Payer Identification Number	L2010BC_S04_REF02_ADDL_ID_OVL_PAYR_ID_NR
L2010BC	REF02	Claim Office Number	L2010BC_S04_REF02_ADDL_ID_OVL_CLM_OFC_NR
L2010BC	REF02	National Association of Insurance Commissioners (NAIC) Code	L2010BC_S04_REF02_ADDL_ID_OVL_NAIC_CD
L2010BC	REF02	Federal Taxpayer’s Identification Number	L2010BC_S04_REF02_ADDL_ID_OVL_FED_TAX_ID_NR

2010BD - RESPONSIBLE PARTY NAME

Loop	Segment	Segment Name	Chiapas Gate Mapping
L2010BD	NM1	Responsible Party Name
L2010BD	NM103	Person	L2010BD_S01_NM103_LAST_ORG_NM_OVL_PERSN
L2010BD	NM103	Non-Person Entity	L2010BD_S01_NM103_LAST_ORG_NM_OVL_NONPRSN_ENTY
L2010BD	NM104	Responsible Party First Name	L2010BD_S01_NM104_PARTY_FNAME
L2010BD	NM105	Responsible Party Middle Name	L2010BD_S01_NM105_PARTY_MNAME
L2010BD	NM107	Responsible Party Suffix Name	L2010BD_S01_NM107_RESPNSBL_PARTY_SUFX_NM
L2010BD	N3	Responsible Party Address
L2010BD	N301	Responsible Party Address Line	L2010BD_S02_N301_RESPNSBL_PARTY_ADRS_LIN
L2010BD	N302	Responsible Party Address Line	L2010BD_S02_N302_RESPNSBL_PARTY_ADRS_LIN
L2010BD	N4	Responsible Party City/State/ZIP Code
L2010BD	N401	Responsible Party City Name	L2010BD_S03_N401_RESPNSBL_PARTY_CITY_NM
L2010BD	N402	Responsible Party State Code	L2010BD_S03_N402_RESPNSBL_PARTY_STAT_CD
L2010BD	N403	Responsible Party Postal Zone or ZIP Code	L2010BD_S03_N403_POSTL_ZON_ZIP_CD
L2010BD	N404	Country Code	L2010BD_S03_N404_CNTRY_CD

2000C - PATIENT HIERARCHICAL LEVEL

Loop	Segment	Segment Name	Chiapas Gate Mapping
L2000C	HL	Patient Hierarchical 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	PAT	Patient Information
L2000C	PAT01	Individual Relationship Code	L2000C_S02_PAT01_INDVDL_REL_CD
L2000C	PAT08	Gram	L2000C_S02_PAT08_PATNT_WEIGHT_OVL_GRAM
L2000C	PAT09	Pregnancy Indicator	L2000C_S02_PAT09_PREGNCY_IND

2010CA - PATIENT NAME

Loop	Segment	Segment Name	Chiapas Gate Mapping
L2010CA	NM1	Patient Name
L2010CA	NM103	Person	L2010CA_S01_NM103_PATNT_LNAME_OVL_PERSN
L2010CA	NM104	Patient First Name	L2010CA_S01_NM104_PATNT_FNAME
L2010CA	NM105	Patient Middle Name	L2010CA_S01_NM105_PATNT_MNAME
L2010CA	NM107	Patient Name Suffix	L2010CA_S01_NM107_NM_SUFX
L2010CA	NM109	Member Identification Number	L2010CA_S01_NM109_PRIMRY_ID_OVL_MEM_ID_NR
L2010CA	NM109	Mutually Defined	L2010CA_S01_NM109_PRIMRY_ID_OVL_MUTLY_DEFND
L2010CA	N3	Patient Address
L2010CA	N301	Patient Address Line	L2010CA_S02_N301_ADRS_LIN
L2010CA	N302	Patient Address Line	L2010CA_S02_N302_ADRS_LIN
L2010CA	N4	Patient City/State/ZIP Code
L2010CA	N401	Patient City Name	L2010CA_S03_N401_CITY_NM
L2010CA	N402	Patient State Code	L2010CA_S03_N402_STAT_CD
L2010CA	N403	Patient Postal Zone or ZIP Code	L2010CA_S03_N403_PATNT_POSTL_ZON_ZIP_CD
L2010CA	N404	Country Code	L2010CA_S03_N404_CNTRY_CD
L2010CA	DMG	Patient Demographic Information
L2010CA	DMG02	Date Expressed in Format CCYYMMDD	L2010CA_S04_DMG02_BIRTH_DT_OVL_DT_CCYYMMDD
L2010CA	DMG03	Patient Gender Code	L2010CA_S04_DMG03_GENDR_CD
L2010CA	REF	Patient Secondary Identification Number
L2010CA	REF02	Member Identification Number	L2010CA_S05_REF02_2ND_ID_OVL_MEM_ID_NR
L2010CA	REF02	Client Number	L2010CA_S05_REF02_2ND_ID_OVL_CLIENT_NR
L2010CA	REF02	Insurance Policy Number	L2010CA_S05_REF02_2ND_ID_OVL_INS_POLCY_NR
L2010CA	REF02	Social Security Number	L2010CA_S05_REF02_2ND_ID_OVL_SSN
L2010CA	REF	Property and Casualty Claim Number
L2010CA	REF02	Agency Claim Number	L2010CA_S06_REF02_PROPRTY_CASLTY_CLM_NR_OVL_AGNCY_CLM_NR

2300 - CLAIM INFORMATION

Loop	Segment	Segment Name	Chiapas Gate Mapping
L2300	CLM	Claim information
L2300	CLM01	Patient Account Number	L2300_S01_CLM01_PATNT_ACNT_NR
L2300	CLM02	Total Claim Charge Amount	L2300_S01_CLM02_TOTL_CLM_CHG_AMT
L2300	CLM05-01	Facility Type Code	L2300_S01_CLM05_01_FACLTY_TYPE_CD
L2300	CLM05-03	Uniform Billing Claim Form Bill Type	L2300_S01_CLM05_03_CLM_FREQNCY_CD_OVL_UBC_FORM_BIL_TYPE
L2300	CLM06	Provider or Supplier Signature Indicator	L2300_S01_CLM06_PROV_SUPLR_SIGNTR_IND
L2300	CLM07	Medicare Assignment Code	L2300_S01_CLM07_MEDCR_ASGNMNT_CD
L2300	CLM08	Benefits Assignment Certification Indicator	L2300_S01_CLM08_BENFTS_ASGNMNT_CERT_IND
L2300	CLM09	Release of Information Code	L2300_S01_CLM09_RELS_NFO_CD
L2300	CLM11-01	Related Causes Code	L2300_S01_CLM11_01_RELTD_CAUS_CD
L2300	CLM11-02	Related Causes Code	L2300_S01_CLM11_02_RELTD_CAUS_CD
L2300	CLM11-03	Related Causes Code	L2300_S01_CLM11_03_RELTD_CAUS_CD
L2300	CLM11-04	Auto Accident State or Province Code	L2300_S01_CLM11_04_AUT_ACDNT_STAT_PROVNC_CD
L2300	CLM11-05	Country Code	L2300_S01_CLM11_05_CNTRY_CD
L2300	CLM12	Special Program Indicator	L2300_S01_CLM12_SPECL_PROGRM_IND
L2300	CLM18	Explanation of Benefits Indicator	L2300_S01_CLM18_EXPLNTN_BENFTS_IND
L2300	CLM20	Delay Reason Code	L2300_S01_CLM20_DELY_RSN_CD
L2300	DTP	Discharge Hour
L2300	DTP03	Discharge (TM)	L2300_S02_DTP03_DISCHRG_HOUR_OVL_DISCHRG_TM
L2300	DTP	Statement Dates
L2300	DTP03	Statement (D8)	L2300_S03_DTP03_STATMNT_FROM_TO_DT_OVL_STATMNT_D8
L2300	DTP03	Statement (RD8)	L2300_S03_DTP03_STATMNT_FROM_TO_DT_OVL_STATMNT_RD8
L2300	DTP	Admission Date/Hour
L2300	DTP03	Admission (DT)	L2300_S04_DTP03_DAT_HOUR_OVL_ADMSN_DT
L2300	CL1	Institutional Claim Code
L2300	CL101	Admission Type Code	L2300_S05_CL101_ADMSN_TYPE_CD
L2300	CL102	Admission Source Code	L2300_S05_CL102_ADMSN_SOURC_CD
L2300	CL103	Patient Status Code	L2300_S05_CL103_PATNT_STATS_CD
L2300	PWK	Claim Supplemental Information
L2300	PWK01	Attachment Report Type Code	L2300_S06_PWK01_ATCHMNT_REPRT_TYPE_CD
L2300	PWK02	Attachment Transmission Code	L2300_S06_PWK02_ATCHMNT_TRANSMSN_CD
L2300	PWK06	Attachment Control Number	L2300_S06_PWK06_ATCHMNT_CONTRL_NR_OVL_ATCHMNT_CONTRL_NR
L2300	PWK07	Attachment Description	L2300_S06_PWK07_ATCHMNT_DESCRPTN
L2300	CN1	Contract Information
L2300	CN101	Contract Type Code	L2300_S07_CN101_TYPE_CD
L2300	CN102	Contract Amount	L2300_S07_CN102_CONTRCT_AMT
L2300	CN103	Contract Percentage	L2300_S07_CN103_CONTRCT_PERCNTG
L2300	CN104	Contract Code	L2300_S07_CN104_CONTRCT_CD
L2300	CN105	Terms Discount Percentage	L2300_S07_CN105_TERMS_DISCNT_PERCNTG
L2300	CN106	Contract Version Identifier	L2300_S07_CN106_VERSN_ID
L2300	AMT	Payer Estimated Amount Due
L2300	AMT02	Claim Amount Due - Estimated	L2300_S08_AMT02_EST_CLM_DUE_AMT_OVL_CLM_AMT_DUE_EST
L2300	AMT	Patient Estimated Amount Due
L2300	AMT02	Patient Responsibility - Estimated	L2300_S09_AMT02_RESP_AMT_OVL_PATNT_RESP_EST
L2300	AMT	Patient Paid Amount
L2300	AMT01	Amount Qualifier Code	L2300_S10_AMT01_AMT_QUAL_CD
L2300	AMT02	Patient Amount Paid	L2300_S10_AMT02_AMT_PD
L2300	AMT	Credit/Debit Card Maximum Amount
L2300	AMT02	Maximum Amount	L2300_S11_AMT02_MAX_AMT_OVL_MAX_AMT
L2300	REF	Adjusted Repriced Claim Number
L2300	REF02	Adjusted Repriced Claim Reference Number	L2300_S12_REF02_REF_NR_OVL_ADJSTD_REPRCD_CLM_REF_NR
L2300	REF	Repriced Claim Number
L2300	REF02	Repriced Claim Reference Number	L2300_S13_REF02_REPRCD_CLM_REF_NR_OVL_REPRCD_CLM_REF_NR
L2300	REF	Claim Identification Number For Clearinghouses and Other Transmission Intermediaries
L2300	REF02	Claim Number	L2300_S14_REF02_VAL_AD_NETWRK_TRAC_NR_OVL_CLM_NR
L2300	REF	Document Identification Code
L2300	REF02	Document Identification Code	L2300_S15_REF02_CONTRL_ID_OVL_DOCMNT_ID_CD
L2300	REF	Original Reference Number (ICN/DCN)
L2300	REF02	Original Reference Number	L2300_S16_REF02_CLM_ORGNL_REF_NR_OVL_ORGNL_REF_NR
L2300	REF	Investigational Device Exemption Number
L2300	REF02	Qualified Products List	L2300_S17_REF02_INVSTGTNL_DEVC_EXMPTN_ID_OVL_QUALFD_PRODCTS_LIST
L2300	REF	Service Authorization Exception Code
L2300	REF02	Special Payment Reference Number	L2300_S18_REF02_SVC_AUTH_EXCPTN_CD_OVL_SPECL_PMT_REF_NR
L2300	REF	Peer Review Organization (PRO) Approval Number
L2300	REF02	Peer Review Organization (PRO) Approval Number	L2300_S19_REF02_PER_REVW_AUTH_NR_OVL_PER_REVW_ORG_APRVL_NR
L2300	REF	Prior Authorization or Referral Number
L2300	REF02	Referral Number	L2300_S20_REF02_AUTH_NR_OVL_REFL_NR
L2300	REF02	Prior Authorization Number	L2300_S20_REF02_AUTH_NR_OVL_PRI_AUTH_NR
L2300	REF	Medical Record Number
L2300	REF02	Medical Record Identification Number	L2300_S21_REF02_RECRD_NR_OVL_MEDCL_RECRD_ID_NR
L2300	REF	Demonstration Project Identifier
L2300	REF02	Project Code	L2300_S22_REF02_PROJCT_ID_OVL_PROJCT_CD
L2300	K3	File Information
L2300	K301	Fixed Format Information	L2300_S23_K301_FIXD_FORMT_NFO
L2300	NTE	Claim Note
L2300	NTE02	Allergies	L2300_S24_NTE02_NOT_TEXT_OVL_ALRGS
L2300	NTE02	Goals, Rehabilitation Potential, or Discharge Plans	L2300_S24_NTE02_NOT_TEXT_OVL_GOALS_REHBLTN_POTNTL_DISCHRG_PLANS
L2300	NTE02	Diagnosis Description	L2300_S24_NTE02_NOT_TEXT_OVL_DIAG_DESCRPTN
L2300	NTE02	Durable Medical Equipment (DME) and Supplies	L2300_S24_NTE02_NOT_TEXT_OVL_DME_SUPLS
L2300	NTE02	Medications	L2300_S24_NTE02_NOT_TEXT_OVL_MEDCTNS
L2300	NTE02	Nutritional Requirements	L2300_S24_NTE02_NOT_TEXT_OVL_NUTRTNL_REQRMNTS
L2300	NTE02	Orders for Disciplines and Treatments	L2300_S24_NTE02_NOT_TEXT_OVL_ORDRS_F_DISCPLNS_TREATMNTS
L2300	NTE02	Functional Limitations, Reason Homebound, or Both	L2300_S24_NTE02_NOT_TEXT_OVL_FUNCTNL_LIMTNS_RSN_HOMBND_BOTH
L2300	NTE02	Reasons Patient Leaves Home	L2300_S24_NTE02_NOT_TEXT_OVL_RSNS_PATNT_LEAVS_HOM
L2300	NTE02	Times and Reasons Patient Not at Home	L2300_S24_NTE02_NOT_TEXT_OVL_TIMS_RSNS_PATNT_NOT_AT_HOM
L2300	NTE02	Unusual Home, Social Environment, or Both	L2300_S24_NTE02_NOT_TEXT_OVL_UNSL_HOM_SOCL_ENVRNMNT_BOTH
L2300	NTE02	Safety Measures	L2300_S24_NTE02_NOT_TEXT_OVL_SAFTY_MEASRS
L2300	NTE02	Supplementary Plan of Treatment	L2300_S24_NTE02_NOT_TEXT_OVL_SUPLMNTRY_PLAN_TREATMNT
L2300	NTE02	Updated Information	L2300_S24_NTE02_NOT_TEXT_OVL_UPDTD_NFO
L2300	NTE	Billing Note
L2300	NTE02	Additional Information	L2300_S25_NTE02_NOT_TEXT_OVL_ADDL_NFO
L2300	CR6	Home Health Care Information
L2300	CR601	Prognosis Code	L2300_S26_CR601_PROGNS_CD
L2300	CR602	Service From Date	L2300_S26_CR602_SVC_FROM_DT
L2300	CR604	Range of Dates Expressed in Format CCYYMMDD- CCYYMMDD	L2300_S26_CR604_HOM_HEALTH_CERT_PERD_OVL_RANG_DT_CCYYMMDD
L2300	CR605	Diagnosis Date	L2300_S26_CR605_DIAG_DT
L2300	CR606	Skilled Nursing Facility Indicator	L2300_S26_CR606_SKILD_NURSNG_FACLTY_IND
L2300	CR607	Medicare Coverage Indicator	L2300_S26_CR607_MEDCR_COVG_IND
L2300	CR608	Certification Type Code	L2300_S26_CR608_CERT_TYPE_CD
L2300	CR609	Surgery Date	L2300_S26_CR609_SURGRY_DT
L2300	CR611	Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes	L2300_S26_CR611_SURGCL_PROC_CD_OVL_HCPCS_CD
L2300	CR611	International Classification of Diseases Clinical Modification (ICD-9-CM) - Procedure	L2300_S26_CR611_SURGCL_PROC_CD_OVL_ICD9CM_PROC
L2300	CR612	Physician Order Date	L2300_S26_CR612_PHYSCN_ORDR_DT
L2300	CR613	Last Visit Date	L2300_S26_CR613_LAST_VIST_DT
L2300	CR614	Physician Contact Date	L2300_S26_CR614_PHYSCN_CONTCT_DT
L2300	CR616	Range of Dates Expressed in Format CCYYMMDD- CCYYMMDD	L2300_S26_CR616_LAST_ADMSN_PERD_OVL_RANG_DT_CCYYMMDD
L2300	CR617	Patient Discharge Facility Type Code	L2300_S26_CR617_PATNT_DISCHRG_FACLTY_TYPE_CD
L2300	CR618	Diagnosis Date	L2300_S26_CR618_DIAG_DT
L2300	CR619	Diagnosis Date	L2300_S26_CR619_DIAG_DT
L2300	CR620	Diagnosis Date	L2300_S26_CR620_DIAG_DT
L2300	CR621	Diagnosis Date	L2300_S26_CR621_DIAG_DT
L2300	CRC	Home Health Functional Limitations
L2300	CRC01	Code Category	L2300_S27_CRC01_CD_CATGRY
L2300	CRC02	Certification Condition Indicator	L2300_S27_CRC02_CERT_CONDTN_IND
L2300	CRC03	Functional Limitation Code	L2300_S27_CRC03_LIMTN_CD
L2300	CRC04	Functional Limitation Code	L2300_S27_CRC04_LIMTN_CD
L2300	CRC05	Functional Limitation Code	L2300_S27_CRC05_LIMTN_CD
L2300	CRC06	Functional Limitation Code	L2300_S27_CRC06_LIMTN_CD
L2300	CRC07	Functional Limitation Code	L2300_S27_CRC07_LIMTN_CD
L2300	CRC	Home Health Activities Permitted
L2300	CRC01	Certification Condition Indicator	L2300_S28_CRC01_CERT_CONDTN_IND
L2300	CRC02	Functional Limitation Code	L2300_S28_CRC02_FUNCTNL_LIMTN_CD
L2300	CRC03	Activities Permitted Code	L2300_S28_CRC03_PERMTD_CD
L2300	CRC04	Activities Permitted Code	L2300_S28_CRC04_PERMTD_CD
L2300	CRC05	Activities Permitted Code	L2300_S28_CRC05_PERMTD_CD
L2300	CRC06	Activities Permitted Code	L2300_S28_CRC06_PERMTD_CD
L2300	CRC07	Activities Permitted Code	L2300_S28_CRC07_PERMTD_CD
L2300	CRC	Home Health Mental Status
L2300	CRC01	Certification Condition Indicator	L2300_S29_CRC01_CERT_CONDTN_IND
L2300	CRC02	Functional Limitation Code	L2300_S29_CRC02_FUNCTNL_LIMTN_CD
L2300	CRC03	Mental Status Code	L2300_S29_CRC03_STATS_CD
L2300	CRC04	Mental Status Code	L2300_S29_CRC04_STATS_CD
L2300	CRC05	Mental Status Code	L2300_S29_CRC05_STATS_CD
L2300	CRC06	Mental Status Code	L2300_S29_CRC06_STATS_CD
L2300	CRC07	Mental Status Code	L2300_S29_CRC07_STATS_CD
L2300	HI	Principal, Admitting, E-Code and Patient Reason For Visit Diagnosis Information
L2300	HI01-02	Principal Diagnosis	L2300_S30_HI01_02_INDSTRY_CD_OVL_PRINCPL_DIAG
L2300	HI02-02	Admitting Diagnosis	L2300_S30_HI02_02_INDSTRY_CD_OVL_ADMTNG_DIAG
L2300	HI02-02	Mutually Defined	L2300_S30_HI02_02_INDSTRY_CD_OVL_MUTLY_DEFND
L2300	HI03-02	United States Department of Health and Human Services, Office of Vital Statistics E-code	L2300_S30_HI03_02_INDSTRY_CD_OVL_USDHHS_OFC_OF_VITL_STATS_E_CD
L2300	HI	Diagnosis Related Group (DRG) Information
L2300	HI01-02	Diagnosis Related Group (DRG)	L2300_S31_HI01_02_DRG_CD_OVL_DIAG_RELTD_GRP
L2300	HI	Other Diagnosis Information
L2300	HI01-02	Diagnosis	L2300_S32_HI01_02_OTHR_DIAG_OVL_DIAG
L2300	HI02-02	Diagnosis	L2300_S32_HI02_02_OTHR_DIAG_OVL_DIAG
L2300	HI03-02	Diagnosis	L2300_S32_HI03_02_OTHR_DIAG_OVL_DIAG
L2300	HI04-02	Diagnosis	L2300_S32_HI04_02_OTHR_DIAG_OVL_DIAG
L2300	HI05-02	Diagnosis	L2300_S32_HI05_02_OTHR_DIAG_OVL_DIAG
L2300	HI06-02	Diagnosis	L2300_S32_HI06_02_OTHR_DIAG_OVL_DIAG
L2300	HI07-02	Diagnosis	L2300_S32_HI07_02_OTHR_DIAG_OVL_DIAG
L2300	HI08-02	Diagnosis	L2300_S32_HI08_02_OTHR_DIAG_OVL_DIAG
L2300	HI09-02	Diagnosis	L2300_S32_HI09_02_OTHR_DIAG_OVL_DIAG
L2300	HI10-02	Diagnosis	L2300_S32_HI10_02_OTHR_DIAG_OVL_DIAG
L2300	HI11-02	Diagnosis	L2300_S32_HI11_02_OTHR_DIAG_OVL_DIAG
L2300	HI12-02	Diagnosis	L2300_S32_HI12_02_OTHR_DIAG_OVL_DIAG
L2300	HI	Principal Procedure Information
L2300	HI01-02	Health Care Financing Administration Common Procedural Coding System Principal Procedure	L2300_S33_HI01_02_PRINCPL_PROC_CD_OVL_HCPCS_PRINCPL_PROC
L2300	HI01-02	International Classification of Diseases Clinical Modification (ICD-9-CM) Principal Procedure	L2300_S33_HI01_02_PRINCPL_PROC_CD_OVL_ICD9CM_PRINCPL_PROC
L2300	HI01-04	Date Expressed in Format CCYYMMDD	L2300_S33_HI01_04_DT_TM_PERD_OVL_DT_CCYYMMDD
L2300	HI	Other Procedure Information
L2300	HI01-02	Health Care Financing Administration Common Procedural Coding System	L2300_S34_HI01_02_PROC_CD_OVL_HCPCSTEM
L2300	HI01-02	International Classification of Diseases Clinical Modification (ICD-9-CM) Procedure	L2300_S34_HI01_02_PROC_CD_OVL_ICD9CM_PROC
L2300	HI01-04	Date Expressed in Format CCYYMMDD	L2300_S34_HI01_04_PROC_DT_OVL_DT_CCYYMMDD
L2300	HI02-02	Health Care Financing Administration Common Procedural Coding System	L2300_S34_HI02_02_PROC_CD_OVL_HCPCSTEM
L2300	HI02-02	International Classification of Diseases Clinical Modification (ICD-9-CM) Procedure	L2300_S34_HI02_02_PROC_CD_OVL_ICD9CM_PROC
L2300	HI02-04	Date Expressed in Format CCYYMMDD	L2300_S34_HI02_04_PROC_DT_OVL_DT_CCYYMMDD
L2300	HI03-02	Health Care Financing Administration Common	L2300_S34_HI03_02_PROC_CD_OVL_HCFA_COMN
L2300	HI03-02	International Classification of Diseases Clinical Modification (ICD-9-CM) Procedure	L2300_S34_HI03_02_PROC_CD_OVL_ICD9CM_PROC
L2300	HI03-04	Date Expressed in Format CCYYMMDD	L2300_S34_HI03_04_PROC_DT_OVL_DT_CCYYMMDD
L2300	HI04-02	Health Care Financing Administration Common Procedural Coding System	L2300_S34_HI04_02_PROC_CD_OVL_HCPCSTEM
L2300	HI04-02	International Classification of Diseases Clinical	L2300_S34_HI04_02_PROC_CD_OVL_INTRNTNL_CLASFCTN_DIS_CLINCL
L2300	HI04-04	Date Expressed in Format CCYYMMDD	L2300_S34_HI04_04_PROC_DT_OVL_DT_CCYYMMDD
L2300	HI05-02	Health Care Financing Administration Common	L2300_S34_HI05_02_PROC_CD_OVL_HCFA_COMN
L2300	HI05-02	International Classification of Diseases Clinical	L2300_S34_HI05_02_PROC_CD_OVL_INTRNTNL_CLASFCTN_DIS_CLINCL
L2300	HI05-04	Date Expressed in Format CCYYMMDD	L2300_S34_HI05_04_PROC_DT_OVL_DT_CCYYMMDD
L2300	HI06-02	Health Care Financing Administration Common	L2300_S34_HI06_02_PROC_CD_OVL_HCFA_COMN
L2300	HI06-02	International Classification of Diseases Clinical	L2300_S34_HI06_02_PROC_CD_OVL_INTRNTNL_CLASFCTN_DIS_CLINCL
L2300	HI06-04	Date Expressed in Format CCYYMMDD	L2300_S34_HI06_04_PROC_DT_OVL_DT_CCYYMMDD
L2300	HI07-02	Health Care Financing Administration Common Procedural Coding System	L2300_S34_HI07_02_PROC_CD_OVL_HCPCSTEM
L2300	HI07-02	International Classification of Diseases Clinical Modification (ICD-9-CM) Procedure	L2300_S34_HI07_02_PROC_CD_OVL_ICD9CM_PROC
L2300	HI07-04	Date Expressed in Format CCYYMMDD	L2300_S34_HI07_04_PROC_DT_OVL_DT_CCYYMMDD
L2300	HI08-02	Health Care Financing Administration Common	L2300_S34_HI08_02_PROC_CD_OVL_HCFA_COMN
L2300	HI08-02	International Classification of Diseases Clinical	L2300_S34_HI08_02_PROC_CD_OVL_INTRNTNL_CLASFCTN_DIS_CLINCL
L2300	HI08-04	Date Expressed in Format CCYYMMDD	L2300_S34_HI08_04_PROC_DT_OVL_DT_CCYYMMDD
L2300	HI09-02	Health Care Financing Administration Common Procedural Coding System	L2300_S34_HI09_02_PROC_CD_OVL_HCPCSTEM
L2300	HI09-02	International Classification of Diseases Clinical Modification (ICD-9-CM) Procedure	L2300_S34_HI09_02_PROC_CD_OVL_ICD9CM_PROC
L2300	HI09-04	Date Expressed in Format CCYYMMDD	L2300_S34_HI09_04_PROC_DT_OVL_DT_CCYYMMDD
L2300	HI10-02	Health Care Financing Administration Common	L2300_S34_HI10_02_PROC_CD_OVL_HCFA_COMN
L2300	HI10-02	International Classification of Diseases Clinical Modification (ICD-9-CM) Procedure	L2300_S34_HI10_02_PROC_CD_OVL_ICD9CM_PROC
L2300	HI10-04	Date Expressed in Format CCYYMMDD	L2300_S34_HI10_04_PROC_DT_OVL_DT_CCYYMMDD
L2300	HI11-02	Health Care Financing Administration Common	L2300_S34_HI11_02_PROC_CD_OVL_HCFA_COMN
L2300	HI11-02	International Classification of Diseases Clinical Modification (ICD-9-CM) Procedure	L2300_S34_HI11_02_PROC_CD_OVL_ICD9CM_PROC
L2300	HI11-04	Date Expressed in Format CCYYMMDD	L2300_S34_HI11_04_PROC_DT_OVL_DT_CCYYMMDD
L2300	HI12-02	Health Care Financing Administration Common Procedural Coding System	L2300_S34_HI12_02_PROC_CD_OVL_HCPCSTEM
L2300	HI12-02	International Classification of Diseases Clinical Modification (ICD-9-CM) Procedure	L2300_S34_HI12_02_PROC_CD_OVL_ICD9CM_PROC
L2300	HI12-04	Date Expressed in Format CCYYMMDD	L2300_S34_HI12_04_PROC_DT_OVL_DT_CCYYMMDD
L2300	HI	Occurrence Span Information
L2300	HI01-02	Occurrence Span	L2300_S35_HI01_02_OCRNC_SPAN_CD_OVL_OCRNC_SPAN
L2300	HI01-04	Range of Dates Expressed in Format CCYYMMDD- CCYYMMDD	L2300_S35_HI01_04_OCRNC_SPAN_CD_ASCTD_OVL_RANG_DT_CCYYMMDD
L2300	HI02-02	Occurrence Span	L2300_S35_HI02_02_OCRNC_SPAN_CD_OVL_OCRNC_SPAN
L2300	HI02-04	Range of Dates Expressed in Format CCYYMMDD- CCYYMMDD	L2300_S35_HI02_04_OCRNC_SPAN_CD_ASCTD_OVL_RANG_DT_CCYYMMDD
L2300	HI03-02	Occurrence Span	L2300_S35_HI03_02_OCRNC_SPAN_CD_OVL_OCRNC_SPAN
L2300	HI03-04	Range of Dates Expressed in Format CCYYMMDD-	L2300_S35_HI03_04_OCRNC_SPAN_CD_ASCTD_OVL_RANG_DT_FORMT_CCYYMMDD
L2300	HI04-02	Occurrence Span	L2300_S35_HI04_02_OCRNC_SPAN_CD_OVL_OCRNC_SPAN
L2300	HI04-04	Range of Dates Expressed in Format CCYYMMDD- CCYYMMDD	L2300_S35_HI04_04_OCRNC_SPAN_CD_ASCTD_OVL_RANG_DT_CCYYMMDD
L2300	HI05-02	Occurrence Span	L2300_S35_HI05_02_OCRNC_SPAN_CD_OVL_OCRNC_SPAN
L2300	HI05-04	Range of Dates Expressed in Format CCYYMMDD- CCYYMMDD	L2300_S35_HI05_04_OCRNC_SPAN_CD_ASCTD_OVL_RANG_DT_CCYYMMDD
L2300	HI06-02	Occurrence Span	L2300_S35_HI06_02_OCRNC_SPAN_CD_OVL_OCRNC_SPAN
L2300	HI06-04	Range of Dates Expressed in Format CCYYMMDD- CCYYMMDD	L2300_S35_HI06_04_OCRNC_SPAN_CD_ASCTD_OVL_RANG_DT_CCYYMMDD
L2300	HI07-02	Occurrence Span	L2300_S35_HI07_02_OCRNC_SPAN_CD_OVL_OCRNC_SPAN
L2300	HI07-04	Range of Dates Expressed in Format CCYYMMDD- CCYYMMDD	L2300_S35_HI07_04_OCRNC_SPAN_CD_ASCTD_OVL_RANG_DT_CCYYMMDD
L2300	HI08-02	Occurrence Span	L2300_S35_HI08_02_OCRNC_SPAN_CD_OVL_OCRNC_SPAN
L2300	HI08-04	Range of Dates Expressed in Format CCYYMMDD- CCYYMMDD	L2300_S35_HI08_04_OCRNC_SPAN_CD_ASCTD_OVL_RANG_DT_CCYYMMDD
L2300	HI09-02	Occurrence Span	L2300_S35_HI09_02_OCRNC_SPAN_CD_OVL_OCRNC_SPAN
L2300	HI09-04	Range of Dates Expressed in Format CCYYMMDD-	L2300_S35_HI09_04_OCRNC_SPAN_CD_ASCTD_OVL_RANG_DT_FORMT_CCYYMMDD
L2300	HI10-02	Occurrence Span	L2300_S35_HI10_02_OCRNC_SPAN_CD_OVL_OCRNC_SPAN
L2300	HI10-04	Range of Dates Expressed in Format CCYYMMDD- CCYYMMDD	L2300_S35_HI10_04_OCRNC_SPAN_CD_ASCTD_OVL_RANG_DT_CCYYMMDD
L2300	HI11-02	Occurrence Span	L2300_S35_HI11_02_OCRNC_SPAN_CD_OVL_OCRNC_SPAN
L2300	HI11-04	Range of Dates Expressed in Format CCYYMMDD- CCYYMMDD	L2300_S35_HI11_04_OCRNC_SPAN_CD_ASCTD_OVL_RANG_DT_CCYYMMDD
L2300	HI12-02	Occurrence Span	L2300_S35_HI12_02_OCRNC_SPAN_CD_OVL_OCRNC_SPAN
L2300	HI12-04	Range of Dates Expressed in Format CCYYMMDD- CCYYMMDD	L2300_S35_HI12_04_OCRNC_SPAN_CD_ASCTD_OVL_RANG_DT_CCYYMMDD
L2300	HI	Occurrence Information
L2300	HI01-02	Occurrence	L2300_S36_HI01_02_OCRNC_CD_OVL_OCRNC
L2300	HI01-04	Date Expressed in Format CCYYMMDD	L2300_S36_HI01_04_OCRNC_SPAN_CD_ASCTD_OVL_DT_CCYYMMDD
L2300	HI02-02	Occurrence	L2300_S36_HI02_02_OCRNC_CD_OVL_OCRNC
L2300	HI02-04	Date Expressed in Format CCYYMMDD	L2300_S36_HI02_04_OCRNC_SPAN_CD_ASCTD_OVL_DT_CCYYMMDD
L2300	HI03-02	Occurrence	L2300_S36_HI03_02_OCRNC_CD_OVL_OCRNC
L2300	HI03-04	Date Expressed in Format CCYYMMDD	L2300_S36_HI03_04_OCRNC_SPAN_CD_ASCTD_OVL_DT_CCYYMMDD
L2300	HI04-02	Occurrence	L2300_S36_HI04_02_OCRNC_CD_OVL_OCRNC
L2300	HI04-04	Date Expressed in Format CCYYMMDD	L2300_S36_HI04_04_OCRNC_SPAN_CD_ASCTD_OVL_DT_CCYYMMDD
L2300	HI05-02	Occurrence	L2300_S36_HI05_02_OCRNC_CD_OVL_OCRNC
L2300	HI05-04	Date Expressed in Format CCYYMMDD	L2300_S36_HI05_04_OCRNC_SPAN_CD_ASCTD_OVL_DT_CCYYMMDD
L2300	HI06-02	Occurrence	L2300_S36_HI06_02_OCRNC_CD_OVL_OCRNC
L2300	HI06-04	Date Expressed in Format CCYYMMDD	L2300_S36_HI06_04_OCRNC_SPAN_CD_ASCTD_OVL_DT_CCYYMMDD
L2300	HI07-02	Occurrence	L2300_S36_HI07_02_OCRNC_CD_OVL_OCRNC
L2300	HI07-04	Date Expressed in Format CCYYMMDD	L2300_S36_HI07_04_OCRNC_SPAN_CD_ASCTD_OVL_DT_CCYYMMDD
L2300	HI08-02	Occurrence	L2300_S36_HI08_02_OCRNC_CD_OVL_OCRNC
L2300	HI08-04	Date Expressed in Format CCYYMMDD	L2300_S36_HI08_04_OCRNC_SPAN_CD_ASCTD_OVL_DT_CCYYMMDD
L2300	HI09-02	Occurrence	L2300_S36_HI09_02_OCRNC_CD_OVL_OCRNC
L2300	HI09-04	Date Expressed in Format CCYYMMDD	L2300_S36_HI09_04_OCRNC_SPAN_CD_ASCTD_OVL_DT_CCYYMMDD
L2300	HI10-02	Occurrence	L2300_S36_HI10_02_OCRNC_CD_OVL_OCRNC
L2300	HI10-04	Date Expressed in Format CCYYMMDD	L2300_S36_HI10_04_OCRNC_SPAN_CD_ASCTD_OVL_DT_CCYYMMDD
L2300	HI11-02	Occurrence	L2300_S36_HI11_02_OCRNC_CD_OVL_OCRNC
L2300	HI11-04	Date Expressed in Format CCYYMMDD	L2300_S36_HI11_04_OCRNC_SPAN_CD_ASCTD_OVL_DT_CCYYMMDD
L2300	HI12-02	Occurrence	L2300_S36_HI12_02_OCRNC_CD_OVL_OCRNC
L2300	HI12-04	Date Expressed in Format CCYYMMDD	L2300_S36_HI12_04_OCRNC_SPAN_CD_ASCTD_OVL_DT_CCYYMMDD
L2300	HI	Value Information
L2300	HI01-02	Value	L2300_S37_HI01_02_VAL_CD_OVL_VAL
L2300	HI01-05	Value Code Associated Amount	L2300_S37_HI01_05_VAL_CD_ASCTD_AMT
L2300	HI02-02	Value	L2300_S37_HI02_02_VAL_CD_OVL_VAL
L2300	HI02-05	Value Code Associated Amount	L2300_S37_HI02_05_VAL_CD_ASCTD_AMT
L2300	HI03-02	Value	L2300_S37_HI03_02_VAL_CD_OVL_VAL
L2300	HI03-05	Value Code Associated Amount	L2300_S37_HI03_05_VAL_CD_ASCTD_AMT
L2300	HI04-02	Value	L2300_S37_HI04_02_VAL_CD_OVL_VAL
L2300	HI04-05	Value Code Associated Amount	L2300_S37_HI04_05_VAL_CD_ASCTD_AMT
L2300	HI05-02	Value	L2300_S37_HI05_02_VAL_CD_OVL_VAL
L2300	HI05-05	Value Code Associated Amount	L2300_S37_HI05_05_VAL_CD_ASCTD_AMT
L2300	HI06-02	Value	L2300_S37_HI06_02_VAL_CD_OVL_VAL
L2300	HI06-05	Value Code Associated Amount	L2300_S37_HI06_05_VAL_CD_ASCTD_AMT
L2300	HI07-02	Value	L2300_S37_HI07_02_VAL_CD_OVL_VAL
L2300	HI07-05	Value Code Associated Amount	L2300_S37_HI07_05_VAL_CD_ASCTD_AMT
L2300	HI08-02	Value	L2300_S37_HI08_02_VAL_CD_OVL_VAL
L2300	HI08-05	Value Code Associated Amount	L2300_S37_HI08_05_VAL_CD_ASCTD_AMT
L2300	HI09-02	Value	L2300_S37_HI09_02_VAL_CD_OVL_VAL
L2300	HI09-05	Value Code Associated Amount	L2300_S37_HI09_05_VAL_CD_ASCTD_AMT
L2300	HI10-02	Value	L2300_S37_HI10_02_VAL_CD_OVL_VAL
L2300	HI10-05	Value Code Associated Amount	L2300_S37_HI10_05_VAL_CD_ASCTD_AMT
L2300	HI11-02	Value	L2300_S37_HI11_02_VAL_CD_OVL_VAL
L2300	HI11-05	Value Code Associated Amount	L2300_S37_HI11_05_VAL_CD_ASCTD_AMT
L2300	HI12-02	Value	L2300_S37_HI12_02_VAL_CD_OVL_VAL
L2300	HI12-05	Value Code Associated Amount	L2300_S37_HI12_05_VAL_CD_ASCTD_AMT
L2300	HI	Condition Information
L2300	HI01-02	Condition	L2300_S38_HI01_02_CONDTN_CD_OVL_CONDTN
L2300	HI02-02	Condition	L2300_S38_HI02_02_CONDTN_CD_OVL_CONDTN
L2300	HI03-02	Condition	L2300_S38_HI03_02_CONDTN_CD_OVL_CONDTN
L2300	HI04-02	Condition	L2300_S38_HI04_02_CONDTN_CD_OVL_CONDTN
L2300	HI05-02	Condition	L2300_S38_HI05_02_CONDTN_CD_OVL_CONDTN
L2300	HI06-02	Condition	L2300_S38_HI06_02_CONDTN_CD_OVL_CONDTN
L2300	HI07-02	Condition	L2300_S38_HI07_02_CONDTN_CD_OVL_CONDTN
L2300	HI08-02	Condition	L2300_S38_HI08_02_CONDTN_CD_OVL_CONDTN
L2300	HI09-02	Condition	L2300_S38_HI09_02_CONDTN_CD_OVL_CONDTN
L2300	HI10-02	Condition	L2300_S38_HI10_02_CONDTN_CD_OVL_CONDTN
L2300	HI11-02	Condition	L2300_S38_HI11_02_CONDTN_CD_OVL_CONDTN
L2300	HI12-02	Condition	L2300_S38_HI12_02_CONDTN_CD_OVL_CONDTN
L2300	HI	Treatment Code Information
L2300	HI01-02	Treatment Codes	L2300_S39_HI01_02_TREATMNT_CD_OVL_TREATMNT_CD
L2300	HI02-02	Treatment Codes	L2300_S39_HI02_02_TREATMNT_CD_OVL_TREATMNT_CD
L2300	HI03-02	Treatment Codes	L2300_S39_HI03_02_TREATMNT_CD_OVL_TREATMNT_CD
L2300	HI04-02	Treatment Codes	L2300_S39_HI04_02_TREATMNT_CD_OVL_TREATMNT_CD
L2300	HI05-02	Treatment Codes	L2300_S39_HI05_02_TREATMNT_CD_OVL_TREATMNT_CD
L2300	HI06-02	Treatment Codes	L2300_S39_HI06_02_TREATMNT_CD_OVL_TREATMNT_CD
L2300	HI07-02	Treatment Codes	L2300_S39_HI07_02_TREATMNT_CD_OVL_TREATMNT_CD
L2300	HI08-02	Treatment Codes	L2300_S39_HI08_02_TREATMNT_CD_OVL_TREATMNT_CD
L2300	HI09-02	Treatment Codes	L2300_S39_HI09_02_TREATMNT_CD_OVL_TREATMNT_CD
L2300	HI10-02	Treatment Codes	L2300_S39_HI10_02_TREATMNT_CD_OVL_TREATMNT_CD
L2300	HI11-02	Treatment Codes	L2300_S39_HI11_02_TREATMNT_CD_OVL_TREATMNT_CD
L2300	HI12-02	Treatment Codes	L2300_S39_HI12_02_TREATMNT_CD_OVL_TREATMNT_CD
L2300	QTY	Claim Quantity
L2300	QTY02	Covered - Actual	L2300_S40_QTY02_DAYS_CT_OVL_COVRD_ACTL
L2300	QTY02	Co-insured - Actual	L2300_S40_QTY02_DAYS_CT_OVL_CONSRD_ACTL
L2300	QTY02	Life-time Reserve - Actual	L2300_S40_QTY02_DAYS_CT_OVL_LIFTM_RESRV_ACTL
L2300	QTY02	Number of Non-covered Days	L2300_S40_QTY02_DAYS_CT_OVL_NR_NONCVRD_DAYS
L2300	QTY03-01	Unit or Basis for Measurement Code	L2300_S40_QTY03_01_UN_BAS_MEASRMNT_CD
L2300	HCP	Claim Pricing/Repricing Information
L2300	HCP01	Pricing Methodology	L2300_S41_HCP01_PRICNG_METHDLGY
L2300	HCP02	Repriced Allowed Amount	L2300_S41_HCP02_REPRCD_ALWD_AMT
L2300	HCP03	Repriced Saving Amount	L2300_S41_HCP03_REPRCD_SAVNG_AMT
L2300	HCP04	Repricing Organization Identifier	L2300_S41_HCP04_REPRCNG_ORG_ID
L2300	HCP05	Repricing Per Diem or Flat Rate Amount	L2300_S41_HCP05_REPRCNG_DIEM_FLAT_RT_AMT
L2300	HCP06	Repriced Approved DRG Code	L2300_S41_HCP06_REPRCD_APRVD_DRG_CD
L2300	HCP07	Repriced Approved Amount	L2300_S41_HCP07_REPRCD_APRVD_AMT
L2300	HCP08	Repriced Approved Revenue Code	L2300_S41_HCP08_REPRCD_APRVD_REVN_CD
L2300	HCP10	Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes	L2300_S41_HCP10_REPRCD_APRVD_HCPCS_CD_OVL_HCPCS_CD
L2300	HCP12	Days	L2300_S41_HCP12_REPRCD_APRVD_SVC_UNT_CT_OVL_DAYS
L2300	HCP12	Unit	L2300_S41_HCP12_REPRCD_APRVD_SVC_UNT_CT_OVL_UNT
L2300	HCP13	Reject Reason Code	L2300_S41_HCP13_REJCT_RSN_CD
L2300	HCP14	Policy Compliance Code	L2300_S41_HCP14_POLCY_COMPLNC_CD
L2300	HCP15	Exception Code	L2300_S41_HCP15_EXCPTN_CD

2305 - HOME HEALTH CARE PLAN INFORMATION

Loop	Segment	Segment Name	Chiapas Gate Mapping
L2305	CR7	Home Health Care Plan Information
L2305	CR701	Discipline Type Code	L2305_S01_CR701_DISCPLN_TYPE_CD
L2305	CR702	Visits Prior to Recertification Date Count	L2305_S01_CR702_VISTS_PRI_TO_RECRTFCTN_DAT_CT
L2305	CR703	Total Visits Projected This Certification Count	L2305_S01_CR703_TOTL_VISTS_PROJCTD_THIS_CERT_CT
L2305	HSD	Health Care Services Delivery
L2305	HSD01	Visits Code specifying the type of quantity	L2305_S02_HSD01_VISTS_CD_SPECFYNG_THE_TYPE_QTY
L2305	HSD02	Number of Visits	L2305_S02_HSD02_NR_VISTS
L2305	HSD03	Frequency Period	L2305_S02_HSD03_FREQNCY_PERD
L2305	HSD04	Frequency Count	L2305_S02_HSD04_FREQ_CT
L2305	HSD05	Duration of Visits Units	L2305_S02_HSD05_DURTN_VISTS_UNTS
L2305	HSD06	Duration of Visits, Number of Units	L2305_S02_HSD06_DURTN_VISTS_NR_UNTS
L2305	HSD07	Ship, Delivery or Calendar Pattern Code	L2305_S02_HSD07_SHIP_DELVRY_CALNDR_PATRN_CD
L2305	HSD08	Delivery Pattern Time Code	L2305_S02_HSD08_DELVRY_PATRN_TIM_CD

2310A - ATTENDING PHYSICIAN NAME

Loop	Segment	Segment Name	Chiapas Gate Mapping
L2310A	NM1	Attending Physician Name
L2310A	NM103	Person	L2310A_S01_NM103_PHYSCN_LNAME_OVL_PERSN
L2310A	NM103	Non-Person Entity	L2310A_S01_NM103_PHYSCN_LNAME_OVL_NONPRSN_ENTY
L2310A	NM104	Attending Physician First Name	L2310A_S01_NM104_PHYSCN_FNAME
L2310A	NM105	Attending Physician Middle Name	L2310A_S01_NM105_PHYSCN_MNAME
L2310A	NM107	Attending Physician Name Suffix	L2310A_S01_NM107_ATNDNG_PHYSCN_NM_SUFX
L2310A	NM109	Employer’s Identification Number	L2310A_S01_NM109_ATNDNG_PHYSCN_PRIMRY_ID_OVL_EMPLYR_ID_NR
L2310A	NM109	Social Security Number	L2310A_S01_NM109_ATNDNG_PHYSCN_PRIMRY_ID_OVL_SSN
L2310A	NM109	Health Care Financing Administration National Provider Identifier	L2310A_S01_NM109_ATNDNG_PHYSCN_PRIMRY_ID_OVL_HCFA_NATNL_PROV_ID
L2310A	PRV	Attending Physician Specialty Information
L2310A	PRV01	Provider Code	L2310A_S02_PRV01_PROV_CD
L2310A	PRV03	Mutually Defined	L2310A_S02_PRV03_PROV_TAXNMY_CD_OVL_MUTLY_DEFND
L2310A	REF	Attending Physician Secondary Identification
L2310A	REF02	State License Number	L2310A_S03_REF02_ATNDNG_PHYSCN_2ND_ID_OVL_STAT_LICNS_NR
L2310A	REF02	Blue Cross Provider Number	L2310A_S03_REF02_ATNDNG_PHYSCN_2ND_ID_OVL_BLUE_CROS_PROV_NR
L2310A	REF02	Blue Shield Provider Number	L2310A_S03_REF02_ATNDNG_PHYSCN_2ND_ID_OVL_BLUE_SHIELD_PROV_NR
L2310A	REF02	Medicare Provider Number	L2310A_S03_REF02_ATNDNG_PHYSCN_2ND_ID_OVL_MEDCR_PROV_NR
L2310A	REF02	Medicaid Provider Number	L2310A_S03_REF02_ATNDNG_PHYSCN_2ND_ID_OVL_MEDCD_PROV_NR
L2310A	REF02	Provider UPIN Number	L2310A_S03_REF02_ATNDNG_PHYSCN_2ND_ID_OVL_PROV_UPN_NR
L2310A	REF02	CHAMPUS Identification Number	L2310A_S03_REF02_ATNDNG_PHYSCN_2ND_ID_OVL_CHAMPS_ID_NR
L2310A	REF02	Employer’s Identification Number	L2310A_S03_REF02_ATNDNG_PHYSCN_2ND_ID_OVL_EMPLYR_ID_NR
L2310A	REF02	Provider Commercial Number	L2310A_S03_REF02_ATNDNG_PHYSCN_2ND_ID_OVL_PROV_COMRCL_NR
L2310A	REF02	Location Number	L2310A_S03_REF02_ATNDNG_PHYSCN_2ND_ID_OVL_LOC_NR
L2310A	REF02	Provider Plan Network Identification Number	L2310A_S03_REF02_ATNDNG_PHYSCN_2ND_ID_OVL_PROV_PLAN_NETWRK_ID_NR
L2310A	REF02	Social Security Number	L2310A_S03_REF02_ATNDNG_PHYSCN_2ND_ID_OVL_SSN
L2310A	REF02	State Industrial Accident Provider Number	L2310A_S03_REF02_ATNDNG_PHYSCN_2ND_ID_OVL_STAT_INDSTRL_ACDNT_PROV_NR

2310B - OPERATING PHYSICIAN NAME

Loop	Segment	Segment Name	Chiapas Gate Mapping
L2310B	NM1	Operating Physician Name
L2310B	NM103	Person	L2310B_S01_NM103_PHYSCN_LNAME_OVL_PERSN
L2310B	NM104	Operating Physician First Name	L2310B_S01_NM104_PHYSCN_FNAME
L2310B	NM105	Operating Physican Middle Name	L2310B_S01_NM105_PHYSCN_MNAME
L2310B	NM107	Operating Physician Name Suffix	L2310B_S01_NM107_OPRTNG_PHYSCN_NM_SUFX
L2310B	NM109	Employer’s Identification Number	L2310B_S01_NM109_OPRTNG_PHYSCN_PRIMRY_ID_OVL_EMPLYR_ID_NR
L2310B	NM109	Social Security Number	L2310B_S01_NM109_OPRTNG_PHYSCN_PRIMRY_ID_OVL_SSN
L2310B	NM109	Health Care Financing Administration National	L2310B_S01_NM109_OPRTNG_PHYSCN_PRIMRY_ID_OVL_HCFA_NATNL
L2310B	PRV	Operating Physician Specialty Information
L2310B	PRV01	Provider Code	L2310B_S02_PRV01_PROV_CD
L2310B	PRV03	Mutually Defined	L2310B_S02_PRV03_PROV_TAXNMY_CD_OVL_MUTLY_DEFND
L2310B	REF	Operating Physician Secondary Identification
L2310B	REF02	State License Number	L2310B_S03_REF02_OPRTNG_PHYSCN_2ND_ID_OVL_STAT_LICNS_NR
L2310B	REF02	Blue Cross Provider Number	L2310B_S03_REF02_OPRTNG_PHYSCN_2ND_ID_OVL_BLUE_CROS_PROV_NR
L2310B	REF02	Blue Shield Provider Number	L2310B_S03_REF02_OPRTNG_PHYSCN_2ND_ID_OVL_BLUE_SHIELD_PROV_NR
L2310B	REF02	Medicare Provider Number	L2310B_S03_REF02_OPRTNG_PHYSCN_2ND_ID_OVL_MEDCR_PROV_NR
L2310B	REF02	Medicaid Provider Number	L2310B_S03_REF02_OPRTNG_PHYSCN_2ND_ID_OVL_MEDCD_PROV_NR
L2310B	REF02	Provider UPIN Number	L2310B_S03_REF02_OPRTNG_PHYSCN_2ND_ID_OVL_PROV_UPN_NR
L2310B	REF02	CHAMPUS Identification Number	L2310B_S03_REF02_OPRTNG_PHYSCN_2ND_ID_OVL_CHAMPS_ID_NR
L2310B	REF02	Employer’s Identification Number	L2310B_S03_REF02_OPRTNG_PHYSCN_2ND_ID_OVL_EMPLYR_ID_NR
L2310B	REF02	Provider Commercial Number	L2310B_S03_REF02_OPRTNG_PHYSCN_2ND_ID_OVL_PROV_COMRCL_NR
L2310B	REF02	Location Number	L2310B_S03_REF02_OPRTNG_PHYSCN_2ND_ID_OVL_LOC_NR
L2310B	REF02	Provider Plan Network Identification Number	L2310B_S03_REF02_OPRTNG_PHYSCN_2ND_ID_OVL_PROV_PLAN_NETWRK_ID_NR
L2310B	REF02	Social Security Number	L2310B_S03_REF02_OPRTNG_PHYSCN_2ND_ID_OVL_SSN
L2310B	REF02	State Industrial Accident Provider Number	L2310B_S03_REF02_OPRTNG_PHYSCN_2ND_ID_OVL_STAT_INDSTRL_ACDNT_PROV_NR

2310C - OTHER PROVIDER NAME

Loop	Segment	Segment Name	Chiapas Gate Mapping
L2310C	NM1	Other Provider Name
L2310C	NM103	Person	L2310C_S01_NM103_PHYSCN_LNAME_OVL_PERSN
L2310C	NM103	Non-Person Entity	L2310C_S01_NM103_PHYSCN_LNAME_OVL_NONPRSN_ENTY
L2310C	NM104	Other Physician First Name	L2310C_S01_NM104_PHYSCN_FNAME
L2310C	NM105	Other Provider Middle Name	L2310C_S01_NM105_PROV_MNAME
L2310C	NM107	Other Provider Name Suffix	L2310C_S01_NM107_OTHR_PROV_NM_SUFX
L2310C	NM109	Employer’s Identification Number	L2310C_S01_NM109_PHYSCN_ID_OVL_EMPLYR_ID_NR
L2310C	NM109	Social Security Number	L2310C_S01_NM109_PHYSCN_ID_OVL_SSN
L2310C	NM109	Health Care Financing Administration National Provider Identifier	L2310C_S01_NM109_PHYSCN_ID_OVL_HCFA_NATNL_PROV_ID
L2310C	PRV	Other Provider Specialty Information
L2310C	PRV01	Provider Code	L2310C_S02_PRV01_PROV_CD
L2310C	PRV03	Mutually Defined	L2310C_S02_PRV03_TAXNMY_CD_OVL_MUTLY_DEFND
L2310C	REF	Other Provider Secondary Identification
L2310C	REF02	State License Number	L2310C_S03_REF02_OTHR_PROV_2ND_ID_OVL_STAT_LICNS_NR
L2310C	REF02	Blue Cross Provider Number	L2310C_S03_REF02_OTHR_PROV_2ND_ID_OVL_BLUE_CROS_PROV_NR
L2310C	REF02	Blue Shield Provider Number	L2310C_S03_REF02_OTHR_PROV_2ND_ID_OVL_BLUE_SHIELD_PROV_NR
L2310C	REF02	Medicare Provider Number	L2310C_S03_REF02_OTHR_PROV_2ND_ID_OVL_MEDCR_PROV_NR
L2310C	REF02	Medicaid Provider Number	L2310C_S03_REF02_OTHR_PROV_2ND_ID_OVL_MEDCD_PROV_NR
L2310C	REF02	Provider UPIN Number	L2310C_S03_REF02_OTHR_PROV_2ND_ID_OVL_PROV_UPN_NR
L2310C	REF02	CHAMPUS Identification Number	L2310C_S03_REF02_OTHR_PROV_2ND_ID_OVL_CHAMPS_ID_NR
L2310C	REF02	Employer’s Identification Number	L2310C_S03_REF02_OTHR_PROV_2ND_ID_OVL_EMPLYR_ID_NR
L2310C	REF02	Provider Commercial Number	L2310C_S03_REF02_OTHR_PROV_2ND_ID_OVL_PROV_COMRCL_NR
L2310C	REF02	Location Number	L2310C_S03_REF02_OTHR_PROV_2ND_ID_OVL_LOC_NR
L2310C	REF02	Provider Plan Network Identification Number	L2310C_S03_REF02_OTHR_PROV_2ND_ID_OVL_PROV_PLAN_NETWRK_ID_NR
L2310C	REF02	Social Security Number	L2310C_S03_REF02_OTHR_PROV_2ND_ID_OVL_SSN
L2310C	REF02	State Industrial Accident Provider Number	L2310C_S03_REF02_OTHR_PROV_2ND_ID_OVL_STAT_INDSTRL_ACDNT_PROV_NR

2310D - REFERRING PROVIDER NAME

Loop	Segment	Segment Name	Chiapas Gate Mapping
2310D		Qualified Loop
L2310D		Referring Provider	L2310D_DN
L2310D		Primary Care Provider	L2310D_P3
L2310D	NM1	Referring Provider Name
L2310D	NM103	Person	L2310D_XX_S01_NM103_PROV_LNAME_OVL_PERSN
L2310D	NM103	Non-Person Entity	L2310D_XX_S01_NM103_PROV_LNAME_OVL_NONPRSN_ENTY
L2310D	NM104	Referring Provider First Name	L2310D_XX_S01_NM104_PROV_FNAME
L2310D	NM105	Referring Provider Middle Name	L2310D_XX_S01_NM105_PROV_MNAME
L2310D	NM107	Referring Provider Name Suffix	L2310D_XX_S01_NM107_REFNG_PROV_NM_SUFX
L2310D	NM109	Employer’s Identification Number	L2310D_XX_S01_NM109_PROV_ID_OVL_EMPLYR_ID_NR
L2310D	NM109	Social Security Number	L2310D_XX_S01_NM109_PROV_ID_OVL_SSN
L2310D	NM109	Health Care Financing Administration National Provider Identifier	L2310D_XX_S01_NM109_PROV_ID_OVL_HCFA_NATNL_PROV_ID
L2310D	PRV	Referring Provider Specialty Information
L2310D	PRV01	Provider Code	L2310D_XX_S02_PRV01_PROV_CD
L2310D	PRV03	Mutually Defined	L2310D_XX_S02_PRV03_TAXNMY_CD_OVL_MUTLY_DEFND
L2310D	REF	Referring Provider Secondary Identification
L2310D	REF02	State License Number	L2310D_XX_S03_REF02_REFNG_PROV_2ND_ID_OVL_STAT_LICNS_NR
L2310D	REF02	Blue Cross Provider Number	L2310D_XX_S03_REF02_REFNG_PROV_2ND_ID_OVL_BLUE_CROS_PROV_NR
L2310D	REF02	Blue Shield Provider Number	L2310D_XX_S03_REF02_REFNG_PROV_2ND_ID_OVL_BLUE_SHIELD_PROV_NR
L2310D	REF02	Medicare Provider Number	L2310D_XX_S03_REF02_REFNG_PROV_2ND_ID_OVL_MEDCR_PROV_NR
L2310D	REF02	Medicaid Provider Number	L2310D_XX_S03_REF02_REFNG_PROV_2ND_ID_OVL_MEDCD_PROV_NR
L2310D	REF02	Provider UPIN Number	L2310D_XX_S03_REF02_REFNG_PROV_2ND_ID_OVL_PROV_UPN_NR
L2310D	REF02	Preferred Provider Organization Number	L2310D_XX_S03_REF02_REFNG_PROV_2ND_ID_OVL_PREFD_PROV_ORG_NR
L2310D	REF02	Health Maintenance Organization Code Number	L2310D_XX_S03_REF02_REFNG_PROV_2ND_ID_OVL_HMO_COD_NR
L2310D	REF02	Employer’s Identification Number	L2310D_XX_S03_REF02_REFNG_PROV_2ND_ID_OVL_EMPLYR_ID_NR
L2310D	REF02	Provider Commercial Number	L2310D_XX_S03_REF02_REFNG_PROV_2ND_ID_OVL_PROV_COMRCL_NR
L2310D	REF02	Location Number	L2310D_XX_S03_REF02_REFNG_PROV_2ND_ID_OVL_LOC_NR
L2310D	REF02	Provider Plan Network Identification Number	L2310D_XX_S03_REF02_REFNG_PROV_2ND_ID_OVL_PROV_PLAN_NETWRK_ID_NR
L2310D	REF02	Social Security Number	L2310D_XX_S03_REF02_REFNG_PROV_2ND_ID_OVL_SSN
L2310D	REF02	State Industrial Accident Provider Number	L2310D_XX_S03_REF02_REFNG_PROV_2ND_ID_OVL_STAT_INDSTRL_ACDNT_PROV_NR

2310E - SERVICE FACILITY NAME

Loop	Segment	Segment Name	Chiapas Gate Mapping
L2310E	NM1	Service Facility Name
L2310E	NM103	Non-Person Entity	L2310E_S01_NM103_LAB_FACLTY_NM_OVL_NONPRSN_ENTY
L2310E	NM109	Employer’s Identification Number	L2310E_S01_NM109_LAB_FACLTY_PRIMRY_ID_OVL_EMPLYR_ID_NR
L2310E	NM109	Social Security Number	L2310E_S01_NM109_LAB_FACLTY_PRIMRY_ID_OVL_SSN
L2310E	NM109	Health Care Financing Administration National Provider Identifier	L2310E_S01_NM109_LAB_FACLTY_PRIMRY_ID_OVL_HCFA_NATNL_PROV_ID
L2310E	PRV	Service Facility Specialty Information
L2310E	PRV01	Provider Code	L2310E_S02_PRV01_PROV_CD
L2310E	PRV03	Mutually Defined	L2310E_S02_PRV03_PROV_TAXNMY_CD_OVL_MUTLY_DEFND
L2310E	N3	Service Facility Address
L2310E	N301	Laboratory or Facility Address Line	L2310E_S03_N301_LAB_FACLTY_ADRS_LIN
L2310E	N302	Laboratory or Facility Address Line	L2310E_S03_N302_LAB_FACLTY_ADRS_LIN
L2310E	N4	Service Facility City/State/Zip Code
L2310E	N401	Laboratory or Facility City Name	L2310E_S04_N401_LAB_FACLTY_CITY_NM
L2310E	N402	Laboratory or Facility State or Province Code	L2310E_S04_N402_LAB_FACLTY_STAT_PROVNC_CD
L2310E	N403	Laboratory or Facility Postal Zone or ZIP Code	L2310E_S04_N403_LAB_FACLTY_POSTL_ZON_ZIP_CD
L2310E	N404	Country Code	L2310E_S04_N404_CNTRY_CD
L2310E	REF	Service Facility Secondary Identification
L2310E	REF02	State License Number	L2310E_S05_REF02_LAB_FACLTY_2ND_ID_OVL_STAT_LICNS_NR
L2310E	REF02	Blue Cross Provider Number	L2310E_S05_REF02_LAB_FACLTY_2ND_ID_OVL_BLUE_CROS_PROV_NR
L2310E	REF02	Blue Shield Provider Number	L2310E_S05_REF02_LAB_FACLTY_2ND_ID_OVL_BLUE_SHIELD_PROV_NR
L2310E	REF02	Medicare Provider Number	L2310E_S05_REF02_LAB_FACLTY_2ND_ID_OVL_MEDCR_PROV_NR
L2310E	REF02	Medicaid Provider Number	L2310E_S05_REF02_LAB_FACLTY_2ND_ID_OVL_MEDCD_PROV_NR
L2310E	REF02	Provider UPIN Number	L2310E_S05_REF02_LAB_FACLTY_2ND_ID_OVL_PROV_UPN_NR
L2310E	REF02	CHAMPUS Identification Number	L2310E_S05_REF02_LAB_FACLTY_2ND_ID_OVL_CHAMPS_ID_NR
L2310E	REF02	Facility ID Number	L2310E_S05_REF02_LAB_FACLTY_2ND_ID_OVL_FACLTY_ID_NR
L2310E	REF02	Employer’s Identification Number	L2310E_S05_REF02_LAB_FACLTY_2ND_ID_OVL_EMPLYR_ID_NR
L2310E	REF02	Clinic Number	L2310E_S05_REF02_LAB_FACLTY_2ND_ID_OVL_CLINC_NR
L2310E	REF02	Provider Commercial Number	L2310E_S05_REF02_LAB_FACLTY_2ND_ID_OVL_PROV_COMRCL_NR
L2310E	REF02	Provider Site Number	L2310E_S05_REF02_LAB_FACLTY_2ND_ID_OVL_PROV_SIT_NR
L2310E	REF02	Location Number	L2310E_S05_REF02_LAB_FACLTY_2ND_ID_OVL_LOC_NR
L2310E	REF02	Provider Plan Network Identification Number	L2310E_S05_REF02_LAB_FACLTY_2ND_ID_OVL_PROV_PLAN_NETWRK_ID_NR
L2310E	REF02	State Industrial Accident Provider Number	L2310E_S05_REF02_LAB_FACLTY_2ND_ID_OVL_STAT_INDSTRL_ACDNT_PROV_NR

2320 - OTHER SUBSCRIBER INFORMATION

Loop	Segment	Segment Name	Chiapas Gate Mapping
L2320	SBR	Other Subscriber Information
L2320	SBR01	Payer Responsibility Sequence Number Code	L2320_S01_SBR01_PAYR_RESP_SEQNC_NR_CD
L2320	SBR02	Individual Relationship Code	L2320_S01_SBR02_INDVDL_REL_CD
L2320	SBR03	Insured Group or Policy Number	L2320_S01_SBR03_INSRD_GRP_POLCY_NR
L2320	SBR04	Other Insured Group Name	L2320_S01_SBR04_OTHR_INSRD_GRP_NM
L2320	SBR09	Claim Filing Indicator Code	L2320_S01_SBR09_CLM_FILNG_IND_CD
L2320	CAS	Claim Level Adjustment
L2320	CAS01	Claim Adjustment Group Code	L2320_S02_CAS01_CLM_ADJ_GRP_CD
L2320	CAS02	Adjustment Reason Code	L2320_S02_CAS02_ADJ_RSN_CD
L2320	CAS03	Adjustment Amount	L2320_S02_CAS03_ADJ_AMT
L2320	CAS04	Adjustment Quantity	L2320_S02_CAS04_ADJ_QTY
L2320	CAS05	Adjustment Reason Code	L2320_S02_CAS05_ADJ_RSN_CD
L2320	CAS06	Adjustment Amount	L2320_S02_CAS06_ADJ_AMT
L2320	CAS07	Adjustment Quantity	L2320_S02_CAS07_ADJ_QTY
L2320	CAS08	Adjustment Reason Code	L2320_S02_CAS08_ADJ_RSN_CD
L2320	CAS09	Adjustment Amount	L2320_S02_CAS09_ADJ_AMT
L2320	CAS10	Adjustment Quantity	L2320_S02_CAS10_ADJ_QTY
L2320	CAS11	Adjustment Reason Code	L2320_S02_CAS11_ADJ_RSN_CD
L2320	CAS12	Adjustment Amount	L2320_S02_CAS12_ADJ_AMT
L2320	CAS13	Adjustment Quantity	L2320_S02_CAS13_ADJ_QTY
L2320	CAS14	Adjustment Reason Code	L2320_S02_CAS14_ADJ_RSN_CD
L2320	CAS15	Adjustment Amount	L2320_S02_CAS15_ADJ_AMT
L2320	CAS16	Adjustment Quantity	L2320_S02_CAS16_ADJ_QTY
L2320	CAS17	Adjustment Reason Code	L2320_S02_CAS17_ADJ_RSN_CD
L2320	CAS18	Adjustment Amount	L2320_S02_CAS18_ADJ_AMT
L2320	CAS19	Adjustment Quantity	L2320_S02_CAS19_ADJ_QTY
L2320	AMT	Payer Prior Payment
L2320	AMT02	Prior Payment - Actual	L2320_S03_AMT02_OTHR_PAYR_PATNT_PD_AMT_OVL_PRI_PMT_ACTL
L2320	AMT	Coordination of Benefits (COB) Total Allowed Amount
L2320	AMT02	Allowed - Actual	L2320_S04_AMT02_ALWD_AMT_OVL_ALWD_ACTL
L2320	AMT	Coordination of Benefits (COB) Total Submitted Charges
L2320	AMT02	Total Submitted Charges	L2320_S05_AMT02_AMT_OVL_TOTL_SUBMTD_CHGS
L2320	AMT	Diagnostic Related Group (DRG) Outlier Amount
L2320	AMT02	Mutually Defined	L2320_S06_AMT02_CLM_DRG_OUTLR_AMT_OVL_MUTLY_DEFND
L2320	AMT	Coordination of Benefits (COB) Total Medicare Paid Amount
L2320	AMT02	Net Worth	L2320_S07_AMT02_TOTL_MEDCR_PD_AMT_OVL_NET_WORTH
L2320	AMT	Medicare Paid Amount - 100%
L2320	AMT02	Net Paid Amount	L2320_S08_AMT02_AT_100_AMT_OVL_NET_PD_AMT
L2320	AMT	Medicare Paid Amount - 80%
L2320	AMT02	Payoff	L2320_S09_AMT02_AT_80_AMT_OVL_PAYF
L2320	AMT	Coordination of Benefits (COB) Medicare A Trust Fund Paid Amount
L2320	AMT02	Allocated	L2320_S10_AMT02_PD_FROM_PART_A_MEDCR_TRUST_FUND_AMT_OVL_ALCTD
L2320	AMT	Coordination of Benefits (COB) Medicare B Trust Fund Paid Amount
L2320	AMT02	Benefit Amount	L2320_S11_AMT02_PD_FROM_PART_B_MEDCR_TRUST_FUND_AMT_OVL_BENFT_AMT
L2320	AMT	Coordination of Benefits (COB) Total Non-covered Amount
L2320	AMT02	Noncovered Charges - Actual	L2320_S12_AMT02_CHG_AMT_OVL_NONCVRD_CHGS_ACTL
L2320	AMT	Coordination of Benefits (COB) Total Denied Amount
L2320	AMT02	Denied	L2320_S13_AMT02_CLM_TOTL_DEND_CHG_AMT_OVL_DEND
L2320	DMG	Other Subscriber Demographic Information
L2320	DMG02	Date Expressed in Format CCYYMMDD	L2320_S14_DMG02_OTHR_INSRD_BIRTH_DT_OVL_DT_CCYYMMDD
L2320	DMG03	Other Insured Gender Code	L2320_S14_DMG03_OTHR_INSRD_GENDR_CD
L2320	OI	Other Insurance Coverage Information
L2320	OI03	Benefits Assignment Certification Indicator	L2320_S15_OI03_BENFTS_ASGNMNT_CERT_IND
L2320	OI06	Release of Information Code	L2320_S15_OI06_RELS_NFO_CD
L2320	MIA	Medicare Inpatient Adjudication Information
L2320	MIA01	Covered Days or Visits Count	L2320_S16_MIA01_COVRD_DAYS_VISTS_CT
L2320	MIA02	Lifetime Reserve Days Count	L2320_S16_MIA02_LIFTM_RESRV_DAYS_CT
L2320	MIA03	Lifetime Psychiatric Days Count	L2320_S16_MIA03_LIFTM_PSYCH_DAYS_CT
L2320	MIA04	Claim DRG Amount	L2320_S16_MIA04_CLM_DRG_AMT
L2320	MIA05	Remark Code	L2320_S16_MIA05_REMRK_CD
L2320	MIA06	Claim Disproportionate Share Amount	L2320_S16_MIA06_CLM_DISPRPRTNT_SHAR_AMT
L2320	MIA07	Claim MSP Pass-through Amount	L2320_S16_MIA07_CLM_MSP_PASTHRGH_AMT
L2320	MIA08	Claim PPS Capital Amount	L2320_S16_MIA08_CLM_PS_CAPTL_AMT
L2320	MIA09	PPS-Capital FSP DRG Amount	L2320_S16_MIA09_PSCAPTL_FSP_DRG_AMT
L2320	MIA10	PPS-Capital HSP DRG Amount	L2320_S16_MIA10_PSCAPTL_HSP_DRG_AMT
L2320	MIA11	PPS-Capital DSH DRG Amount	L2320_S16_MIA11_PSCAPTL_DSH_DRG_AMT
L2320	MIA12	Old Capital Amount	L2320_S16_MIA12_OLD_CAPTL_AMT
L2320	MIA13	PPS-Capital IME amount	L2320_S16_MIA13_PSCAPTL_IM_AMT
L2320	MIA14	PPS-Operating Hospital Specific DRG Amount	L2320_S16_MIA14_HOSPTL_SPECFC_DRG_AMT
L2320	MIA15	Cost Report Day Count	L2320_S16_MIA15_COST_REPRT_DAY_CT
L2320	MIA16	PPS-Operating Federal Specific DRG Amount	L2320_S16_MIA16_FEDRL_SPECFC_DRG_AMT
L2320	MIA17	Claim PPS Capital Outlier Amount	L2320_S16_MIA17_CLM_PS_CAPTL_OUTLR_AMT
L2320	MIA18	Claim Indirect Teaching Amount	L2320_S16_MIA18_CLM_INDRCT_TEACHNG_AMT
L2320	MIA19	Nonpayable Professional Component Amount	L2320_S16_MIA19_NONPYBL_PROF_COMPNT_AMT
L2320	MIA20	Remark Code	L2320_S16_MIA20_REMRK_CD
L2320	MIA21	Remark Code	L2320_S16_MIA21_REMRK_CD
L2320	MIA22	Remark Code	L2320_S16_MIA22_REMRK_CD
L2320	MIA23	Remark Code	L2320_S16_MIA23_REMRK_CD
L2320	MIA24	PPS-Capital Exception Amount	L2320_S16_MIA24_PSCAPTL_EXCPTN_AMT
L2320	MOA	Medicare Outpatient Adjudication Information
L2320	MOA01	Reimbursement Rate	L2320_S17_MOA01_REIMBRSMNT_RAT
L2320	MOA02	Claim HCPCS Payable Amount	L2320_S17_MOA02_CLM_HCPCS_PAYBL_AMT
L2320	MOA03	Remark Code	L2320_S17_MOA03_REMRK_CD
L2320	MOA04	Remark Code	L2320_S17_MOA04_REMRK_CD
L2320	MOA05	Remark Code	L2320_S17_MOA05_REMRK_CD
L2320	MOA06	Remark Code	L2320_S17_MOA06_REMRK_CD
L2320	MOA07	Remark Code	L2320_S17_MOA07_REMRK_CD
L2320	MOA08	Claim ESRD Payment Amount	L2320_S17_MOA08_CLM_ESRD_PMT_AMT
L2320	MOA09	Nonpayable Professional Component Amount	L2320_S17_MOA09_NONPYBL_PROF_COMPNT_AMT

2330A - OTHER SUBSCRIBER NAME

Loop	Segment	Segment Name	Chiapas Gate Mapping
L2330A	NM1	Other Subscriber Name
L2330A	NM103	Person	L2330A_S01_NM103_INSRD_LNAME_OVL_PERSN
L2330A	NM103	Non-Person Entity	L2330A_S01_NM103_INSRD_LNAME_OVL_NONPRSN_ENTY
L2330A	NM104	Other Insured First Name	L2330A_S01_NM104_INSRD_FNAME
L2330A	NM105	Other Insured Middle Name	L2330A_S01_NM105_INSRD_MNAME
L2330A	NM107	Other Insured Name Suffix	L2330A_S01_NM107_OTHR_INSRD_NM_SUFX
L2330A	NM109	Member Identification Number	L2330A_S01_NM109_INSRD_ID_OVL_MEM_ID_NR
L2330A	NM109	Mutually Defined	L2330A_S01_NM109_INSRD_ID_OVL_MUTLY_DEFND
L2330A	N3	Other Subscriber Address
L2330A	N301	Other Insured Address Line	L2330A_S02_N301_OTHR_INSRD_ADRS_LIN
L2330A	N302	Other Insured Address Line	L2330A_S02_N302_OTHR_INSRD_ADRS_LIN
L2330A	N4	Other Subscriber City/State/ZIP Code
L2330A	N401	Other Insured City Name	L2330A_S03_N401_OTHR_INSRD_CITY_NM
L2330A	N402	Other Insured State Code	L2330A_S03_N402_OTHR_INSRD_STAT_CD
L2330A	N403	Other Insured Postal Zone or ZIP Code	L2330A_S03_N403_OTHR_INSRD_POSTL_ZON_ZIP_CD
L2330A	N404	Country Code	L2330A_S03_N404_CNTRY_CD
L2330A	REF	Other Subscriber Secondary Information
L2330A	REF02	Member Identification Number	L2330A_S04_REF02_OTHR_INSRD_ADDL_ID_OVL_MEM_ID_NR
L2330A	REF02	Client Number	L2330A_S04_REF02_OTHR_INSRD_ADDL_ID_OVL_CLIENT_NR
L2330A	REF02	Insurance Policy Number	L2330A_S04_REF02_OTHR_INSRD_ADDL_ID_OVL_INS_POLCY_NR
L2330A	REF02	Social Security Number	L2330A_S04_REF02_OTHR_INSRD_ADDL_ID_OVL_SSN

2330B - OTHER PAYER NAME

Loop	Segment	Segment Name	Chiapas Gate Mapping
L2330B	NM1	Other Payer Name
L2330B	NM103	Non-Person Entity	L2330B_S01_NM103_LAST_ORG_NM_OVL_NONPRSN_ENTY
L2330B	NM109	Payor Identification	L2330B_S01_NM109_OTHR_PAYR_PRIMRY_ID_OVL_PAYR_ID
L2330B	NM109	Health Care Financing Administration National PlanID	L2330B_S01_NM109_OTHR_PAYR_PRIMRY_ID_OVL_HCFA_NATNL_PLAND
L2330B	N3	Other Payer Address
L2330B	N301	Other Payer Address Line	L2330B_S02_N301_OTHR_PAYR_ADRS_LIN
L2330B	N302	Other Payer Address Line	L2330B_S02_N302_OTHR_PAYR_ADRS_LIN
L2330B	N4	Other Payer City/State/ZIP Code
L2330B	N401	Other Payer City Name	L2330B_S03_N401_OTHR_PAYR_CITY_NM
L2330B	N402	Other Payer State Code	L2330B_S03_N402_OTHR_PAYR_STAT_CD
L2330B	N403	Other Payer Postal Zone or ZIP Code	L2330B_S03_N403_POSTL_ZON_ZIP_CD
L2330B	N404	Country Code	L2330B_S03_N404_CNTRY_CD
L2330B	DTP	Claim Adjudication Date
L2330B	DTP03	Date Claim Paid (D8)	L2330B_S04_DTP03_PMT_DT_OVL_DAT_CLM_PAID_D8
L2330B	REF	Other Payer Secondary Identification and Reference Number
L2330B	REF02	Payer Identification Number	L2330B_S05_REF02_OTHR_PAYR_2ND_ID_OVL_PAYR_ID_NR
L2330B	REF02	Original Reference Number	L2330B_S05_REF02_OTHR_PAYR_2ND_ID_OVL_ORGNL_REF_NR
L2330B	REF02	Claim Office Number	L2330B_S05_REF02_OTHR_PAYR_2ND_ID_OVL_CLM_OFC_NR
L2330B	REF02	National Association of Insurance Commissioners (NAIC) Code	L2330B_S05_REF02_OTHR_PAYR_2ND_ID_OVL_NAIC_CD
L2330B	REF02	Federal Taxpayer’s Identification Number	L2330B_S05_REF02_OTHR_PAYR_2ND_ID_OVL_FED_TAX_ID_NR
L2330B	REF	Other Payer Prior Authorization or Referral Number
L2330B	REF02	Referral Number	L2330B_S06_REF02_AUTH_REFL_NR_OVL_REFL_NR
L2330B	REF02	Prior Authorization Number	L2330B_S06_REF02_AUTH_REFL_NR_OVL_PRI_AUTH_NR

2330C - OTHER PAYER PATIENT INFORMATION

Loop	Segment	Segment Name	Chiapas Gate Mapping
L2330C	NM1	Other Payer Patient Information
L2330C	NM102	Entity Type Qualifier	L2330C_S01_NM102_ENTY_TYPE_QUAL
L2330C	NM109	Employee Identification Number	L2330C_S01_NM109_PRIMRY_ID_OVL_EMPLY_ID_NR
L2330C	NM109	Member Identification Number	L2330C_S01_NM109_PRIMRY_ID_OVL_MEM_ID_NR
L2330C	REF	Other Payer Patient Identification Number
L2330C	REF02	Member Identification Number	L2330C_S02_REF02_2ND_ID_OVL_MEM_ID_NR
L2330C	REF02	Insurance Policy Number	L2330C_S02_REF02_2ND_ID_OVL_INS_POLCY_NR
L2330C	REF02	Social Security Number	L2330C_S02_REF02_2ND_ID_OVL_SSN

2330D - OTHER PAYER ATTENDING PROVIDER

Loop	Segment	Segment Name	Chiapas Gate Mapping
L2330D	NM1	Other Payer Attending Provider
L2330D	NM102	Entity Type Qualifier	L2330D_S01_NM102_ENTY_TYPE_QUAL
L2330D	REF	Other Payer Attending Provider Identification
L2330D	REF02	Blue Cross Provider Number	L2330D_S02_REF02_ID_OVL_BLUE_CROS_PROV_NR
L2330D	REF02	Blue Shield Provider Number	L2330D_S02_REF02_ID_OVL_BLUE_SHIELD_PROV_NR
L2330D	REF02	Medicare Provider Number	L2330D_S02_REF02_ID_OVL_MEDCR_PROV_NR
L2330D	REF02	Medicaid Provider Number	L2330D_S02_REF02_ID_OVL_MEDCD_PROV_NR
L2330D	REF02	Provider UPIN Number	L2330D_S02_REF02_ID_OVL_PROV_UPN_NR
L2330D	REF02	CHAMPUS Identification Number	L2330D_S02_REF02_ID_OVL_CHAMPS_ID_NR
L2330D	REF02	Employer’s Identification Number	L2330D_S02_REF02_ID_OVL_EMPLYR_ID_NR
L2330D	REF02	Provider Commercial Number	L2330D_S02_REF02_ID_OVL_PROV_COMRCL_NR
L2330D	REF02	Location Number	L2330D_S02_REF02_ID_OVL_LOC_NR
L2330D	REF02	Provider Plan Network Identification Number	L2330D_S02_REF02_ID_OVL_PROV_PLAN_NETWRK_ID_NR

2330E - OTHER PAYER OPERATING PROVIDER

Loop	Segment	Segment Name	Chiapas Gate Mapping
L2330E	NM1	Other Payer Operating Provider
L2330E	NM102	Entity Type Qualifier	L2330E_S01_NM102_ENTY_TYPE_QUAL
L2330E	REF	Other Payer Operating Provider Identification
L2330E	REF02	Blue Cross Provider Number	L2330E_S02_REF02_ID_OVL_BLUE_CROS_PROV_NR
L2330E	REF02	Blue Shield Provider Number	L2330E_S02_REF02_ID_OVL_BLUE_SHIELD_PROV_NR
L2330E	REF02	Medicare Provider Number	L2330E_S02_REF02_ID_OVL_MEDCR_PROV_NR
L2330E	REF02	Medicaid Provider Number	L2330E_S02_REF02_ID_OVL_MEDCD_PROV_NR
L2330E	REF02	Provider UPIN Number	L2330E_S02_REF02_ID_OVL_PROV_UPN_NR
L2330E	REF02	CHAMPUS Identification Number	L2330E_S02_REF02_ID_OVL_CHAMPS_ID_NR
L2330E	REF02	Employer’s Identification Number	L2330E_S02_REF02_ID_OVL_EMPLYR_ID_NR
L2330E	REF02	Provider Commercial Number	L2330E_S02_REF02_ID_OVL_PROV_COMRCL_NR
L2330E	REF02	Location Number	L2330E_S02_REF02_ID_OVL_LOC_NR
L2330E	REF02	Provider Plan Network Identification Number	L2330E_S02_REF02_ID_OVL_PROV_PLAN_NETWRK_ID_NR

2330F - OTHER PAYER OTHER PROVIDER

Loop	Segment	Segment Name	Chiapas Gate Mapping
L2330F	NM1	Other Payer Other Provider
L2330F	NM102	Entity Type Qualifier	L2330F_S01_NM102_ENTY_TYPE_QUAL
L2330F	REF	Other Payer Other Provider Identification
L2330F	REF02	Blue Cross Provider Number	L2330F_S02_REF02_ID_OVL_BLUE_CROS_PROV_NR
L2330F	REF02	Blue Shield Provider Number	L2330F_S02_REF02_ID_OVL_BLUE_SHIELD_PROV_NR
L2330F	REF02	Medicare Provider Number	L2330F_S02_REF02_ID_OVL_MEDCR_PROV_NR
L2330F	REF02	Medicaid Provider Number	L2330F_S02_REF02_ID_OVL_MEDCD_PROV_NR
L2330F	REF02	Provider UPIN Number	L2330F_S02_REF02_ID_OVL_PROV_UPN_NR
L2330F	REF02	CHAMPUS Identification Number	L2330F_S02_REF02_ID_OVL_CHAMPS_ID_NR
L2330F	REF02	Employer’s Identification Number	L2330F_S02_REF02_ID_OVL_EMPLYR_ID_NR
L2330F	REF02	Provider Commercial Number	L2330F_S02_REF02_ID_OVL_PROV_COMRCL_NR
L2330F	REF02	Location Number	L2330F_S02_REF02_ID_OVL_LOC_NR
L2330F	REF02	Provider Plan Network Identification Number	L2330F_S02_REF02_ID_OVL_PROV_PLAN_NETWRK_ID_NR
L2330F	REF02	Social Security Number	L2330F_S02_REF02_ID_OVL_SSN

2330G - OTHER PAYER REFERRING PROVIDER

Loop	Segment	Segment Name	Chiapas Gate Mapping
2330G		Qualified Loop
L2330G		Referring Provider	L2330G_DN
L2330G		Primary Care Provider	L2330G_P3
L2330G	NM1	Other Payer Referring Provider
L2330G	NM102	Entity Type Qualifier	L2330G_XX_S01_NM102_ENTY_TYPE_QUAL
L2330G	REF	Other Payer Referring Provider Identification
L2330G	REF02	Blue Cross Provider Number	L2330G_XX_S02_REF02_ID_OVL_BLUE_CROS_PROV_NR
L2330G	REF02	Blue Shield Provider Number	L2330G_XX_S02_REF02_ID_OVL_BLUE_SHIELD_PROV_NR
L2330G	REF02	Medicare Provider Number	L2330G_XX_S02_REF02_ID_OVL_MEDCR_PROV_NR
L2330G	REF02	Medicaid Provider Number	L2330G_XX_S02_REF02_ID_OVL_MEDCD_PROV_NR
L2330G	REF02	Provider UPIN Number	L2330G_XX_S02_REF02_ID_OVL_PROV_UPN_NR
L2330G	REF02	Preferred Provider Organization Number	L2330G_XX_S02_REF02_ID_OVL_PREFD_PROV_ORG_NR
L2330G	REF02	Health Maintenance Organization Code Number	L2330G_XX_S02_REF02_ID_OVL_HMO_COD_NR
L2330G	REF02	Employer’s Identification Number	L2330G_XX_S02_REF02_ID_OVL_EMPLYR_ID_NR
L2330G	REF02	Provider Commercial Number	L2330G_XX_S02_REF02_ID_OVL_PROV_COMRCL_NR
L2330G	REF02	Location Number	L2330G_XX_S02_REF02_ID_OVL_LOC_NR
L2330G	REF02	Provider Plan Network Identification Number	L2330G_XX_S02_REF02_ID_OVL_PROV_PLAN_NETWRK_ID_NR
L2330G	REF02	Social Security Number	L2330G_XX_S02_REF02_ID_OVL_SSN
L2330G	REF02	State Industrial Accident Provider Number	L2330G_XX_S02_REF02_ID_OVL_STAT_INDSTRL_ACDNT_PROV_NR

2330H - OTHER PAYER SERVICE FACILITY PROVIDER

Loop	Segment	Segment Name	Chiapas Gate Mapping
L2330H	NM1	Other Payer Service Facility Provider
L2330H	NM102	Entity Type Qualifier	L2330H_S01_NM102_ENTY_TYPE_QUAL
L2330H	REF	Other Payer Service Facility Provider Identification
L2330H	REF02	Blue Shield Provider Number	L2330H_S02_REF02_PROV_ID_OVL_BLUE_SHIELD_PROV_NR
L2330H	REF02	Medicare Provider Number	L2330H_S02_REF02_PROV_ID_OVL_MEDCR_PROV_NR
L2330H	REF02	Medicaid Provider Number	L2330H_S02_REF02_PROV_ID_OVL_MEDCD_PROV_NR
L2330H	REF02	Employer’s Identification Number	L2330H_S02_REF02_PROV_ID_OVL_EMPLYR_ID_NR
L2330H	REF02	Provider Commercial Number	L2330H_S02_REF02_PROV_ID_OVL_PROV_COMRCL_NR
L2330H	REF02	Location Number	L2330H_S02_REF02_PROV_ID_OVL_LOC_NR
L2330H	REF02	Provider Plan Network Identification Number	L2330H_S02_REF02_PROV_ID_OVL_PROV_PLAN_NETWRK_ID_NR

2400 - SERVICE LINE NUMBER

Loop	Segment	Segment Name	Chiapas Gate Mapping
L2400	LX	Service Line Number
L2400	LX01	Assigned Number	L2400_S01_LX01_ASGND_NR
L2400	SV2	Institutional Service Line
L2400	SV201	Service Line Revenue Code	L2400_S02_SV201_SVC_LIN_REVN_CD
L2400	SV202-02	Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes	L2400_S02_SV202_02_PROC_CD_OVL_HCPCS_CD
L2400	SV202-02	Home Infusion EDI Coalition (HIEC) Product/Service Code	L2400_S02_SV202_02_PROC_CD_OVL_HIEC_PRODCT_SRVC_CD
L2400	SV202-02	National Drug Code in 4-4-2 Format	L2400_S02_SV202_02_PROC_CD_OVL_NDC_442_FORMT
L2400	SV202-02	National Drug Code in 5-3-2 Format	L2400_S02_SV202_02_PROC_CD_OVL_NDC_532_FORMT
L2400	SV202-02	National Drug Code in 5-4-1 Format	L2400_S02_SV202_02_PROC_CD_OVL_NDC_541_FORMT
L2400	SV202-02	National Drug Code in 5-4-2 Format	L2400_S02_SV202_02_PROC_CD_OVL_NDC_542_FORMT
L2400	SV202-02	Mutually Defined	L2400_S02_SV202_02_PROC_CD_OVL_MUTLY_DEFND
L2400	SV202-03	Procedure Modifier	L2400_S02_SV202_03_PROC_MODFR
L2400	SV202-04	Procedure Modifier	L2400_S02_SV202_04_PROC_MODFR
L2400	SV202-05	Procedure Modifier	L2400_S02_SV202_05_PROC_MODFR
L2400	SV202-06	Procedure Modifier	L2400_S02_SV202_06_PROC_MODFR
L2400	SV203	Line Item Charge Amount	L2400_S02_SV203_LIN_ITM_CHG_AMT
L2400	SV205	Days	L2400_S02_SV205_UNT_CT_OVL_DAYS
L2400	SV205	International Unit	L2400_S02_SV205_UNT_CT_OVL_INTRNTNL_UNT
L2400	SV205	Unit	L2400_S02_SV205_UNT_CT_OVL_UNT
L2400	SV206	Service Line Rate	L2400_S02_SV206_LIN_RAT
L2400	SV207	Line Item Denied Charge or Non-Covered Charge Amount	L2400_S02_SV207_LIN_ITM_DEND_CHG_NONCVRD_CHG_AMT
L2400	SV4	Prescription Number
L2400	SV401	Prescription Number	L2400_S03_SV401_RX_NR
L2400	PWK	Line Supplemental Information
L2400	PWK01	Attachment Report Type Code	L2400_S04_PWK01_ATCHMNT_REPRT_TYPE_CD
L2400	PWK02	Attachment Transmission Code	L2400_S04_PWK02_ATCHMNT_TRANSMSN_CD
L2400	PWK06	Attachment Control Number	L2400_S04_PWK06_ATCHMNT_CONTRL_NR_OVL_ATCHMNT_CONTRL_NR
L2400	DTP	Service Line Date
L2400	DTP03	Service (D8)	L2400_S05_DTP03_SVC_DT_OVL_SVC_D8
L2400	DTP03	Service (RD8)	L2400_S05_DTP03_SVC_DT_OVL_SVC_RD8
L2400	DTP	Assessment Date
L2400	DTP03	Examination (D8)	L2400_S06_DTP03_ASMNT_DT_OVL_EXMNTN_D8
L2400	AMT	Service Tax Amount
L2400	AMT02	Goods and Services Tax	L2400_S07_AMT02_SVC_TAX_AMT_OVL_GODS_SVCS_TAX
L2400	AMT	Facility Tax Amount
L2400	AMT02	Miscellaneous Taxes	L2400_S08_AMT02_TAX_AMT_OVL_MISCLNS_TAXS

2420A - ATTENDING PHYSICIAN NAME

Loop	Segment	Segment Name	Chiapas Gate Mapping
L2420A	NM1	Attending Physician Name
L2420A	NM103	Person	L2420A_S01_NM103_PHYSCN_LNAME_OVL_PERSN
L2420A	NM103	Non-Person Entity	L2420A_S01_NM103_PHYSCN_LNAME_OVL_NONPRSN_ENTY
L2420A	NM104	Attending Physician First Name	L2420A_S01_NM104_PHYSCN_FNAME
L2420A	NM105	Attending Physician Middle Name	L2420A_S01_NM105_PHYSCN_MNAME
L2420A	NM107	Attending Physician Name Suffix	L2420A_S01_NM107_ATNDNG_PHYSCN_NM_SUFX
L2420A	NM109	Employer’s Identification Number	L2420A_S01_NM109_ATNDNG_PHYSCN_PRIMRY_ID_OVL_EMPLYR_ID_NR
L2420A	NM109	Social Security Number	L2420A_S01_NM109_ATNDNG_PHYSCN_PRIMRY_ID_OVL_SSN
L2420A	NM109	Health Care Financing Administration National Provider Identifier	L2420A_S01_NM109_ATNDNG_PHYSCN_PRIMRY_ID_OVL_HCFA_NATNL_PROV_ID
L2420A	PRV	Attending Physician Specialty Information
L2420A	PRV01	Provider Code	L2420A_S02_PRV01_PROV_CD
L2420A	PRV03	Mutually Defined	L2420A_S02_PRV03_PROV_TAXNMY_CD_OVL_MUTLY_DEFND
L2420A	REF	Attending Physician Secondary Identification
L2420A	REF02	State License Number	L2420A_S03_REF02_ATNDNG_PHYSCN_2ND_ID_OVL_STAT_LICNS_NR
L2420A	REF02	Blue Cross Provider Number	L2420A_S03_REF02_ATNDNG_PHYSCN_2ND_ID_OVL_BLUE_CROS_PROV_NR
L2420A	REF02	Blue Shield Provider Number	L2420A_S03_REF02_ATNDNG_PHYSCN_2ND_ID_OVL_BLUE_SHIELD_PROV_NR
L2420A	REF02	Medicare Provider Number	L2420A_S03_REF02_ATNDNG_PHYSCN_2ND_ID_OVL_MEDCR_PROV_NR
L2420A	REF02	Medicaid Provider Number	L2420A_S03_REF02_ATNDNG_PHYSCN_2ND_ID_OVL_MEDCD_PROV_NR
L2420A	REF02	Provider UPIN Number	L2420A_S03_REF02_ATNDNG_PHYSCN_2ND_ID_OVL_PROV_UPN_NR
L2420A	REF02	CHAMPUS Identification Number	L2420A_S03_REF02_ATNDNG_PHYSCN_2ND_ID_OVL_CHAMPS_ID_NR
L2420A	REF02	Employer’s Identification Number	L2420A_S03_REF02_ATNDNG_PHYSCN_2ND_ID_OVL_EMPLYR_ID_NR
L2420A	REF02	Provider Commercial Number	L2420A_S03_REF02_ATNDNG_PHYSCN_2ND_ID_OVL_PROV_COMRCL_NR
L2420A	REF02	Location Number	L2420A_S03_REF02_ATNDNG_PHYSCN_2ND_ID_OVL_LOC_NR
L2420A	REF02	Provider Plan Network Identification Number	L2420A_S03_REF02_ATNDNG_PHYSCN_2ND_ID_OVL_PROV_PLAN_NETWRK_ID_NR
L2420A	REF02	Social Security Number	L2420A_S03_REF02_ATNDNG_PHYSCN_2ND_ID_OVL_SSN
L2420A	REF02	State Industrial Accident Provider Number	L2420A_S03_REF02_ATNDNG_PHYSCN_2ND_ID_OVL_STAT_INDSTRL_ACDNT_PROV_NR

2420B - OPERATING PHYSICIAN NAME

Loop	Segment	Segment Name	Chiapas Gate Mapping
L2420B	NM1	Operating Physician Name
L2420B	NM103	Person	L2420B_S01_NM103_PHYSCN_LNAME_OVL_PERSN
L2420B	NM104	Operating Physician First Name	L2420B_S01_NM104_PHYSCN_FNAME
L2420B	NM105	Operating Physican Middle Name	L2420B_S01_NM105_PHYSCN_MNAME
L2420B	NM107	Operating Physician Name Suffix	L2420B_S01_NM107_OPRTNG_PHYSCN_NM_SUFX
L2420B	NM109	Employer’s Identification Number	L2420B_S01_NM109_OPRTNG_PHYSCN_PRIMRY_ID_OVL_EMPLYR_ID_NR
L2420B	NM109	Social Security Number	L2420B_S01_NM109_OPRTNG_PHYSCN_PRIMRY_ID_OVL_SSN
L2420B	NM109	Health Care Financing Administration National Provider Identifier	L2420B_S01_NM109_OPRTNG_PHYSCN_PRIMRY_ID_OVL_HCFA_NATNL_PROV_ID
L2420B	PRV	Operating Physician Specialty Information
L2420B	PRV01	Provider Code	L2420B_S02_PRV01_PROV_CD
L2420B	PRV03	Mutually Defined	L2420B_S02_PRV03_PROV_TAXNMY_CD_OVL_MUTLY_DEFND
L2420B	REF	Operating Physician Secondary Identification
L2420B	REF02	State License Number	L2420B_S03_REF02_OPRTNG_PHYSCN_2ND_ID_OVL_STAT_LICNS_NR
L2420B	REF02	Blue Cross Provider Number	L2420B_S03_REF02_OPRTNG_PHYSCN_2ND_ID_OVL_BLUE_CROS_PROV_NR
L2420B	REF02	Blue Shield Provider Number	L2420B_S03_REF02_OPRTNG_PHYSCN_2ND_ID_OVL_BLUE_SHIELD_PROV_NR
L2420B	REF02	Medicare Provider Number	L2420B_S03_REF02_OPRTNG_PHYSCN_2ND_ID_OVL_MEDCR_PROV_NR
L2420B	REF02	Medicaid Provider Number	L2420B_S03_REF02_OPRTNG_PHYSCN_2ND_ID_OVL_MEDCD_PROV_NR
L2420B	REF02	Provider UPIN Number	L2420B_S03_REF02_OPRTNG_PHYSCN_2ND_ID_OVL_PROV_UPN_NR
L2420B	REF02	CHAMPUS Identification Number	L2420B_S03_REF02_OPRTNG_PHYSCN_2ND_ID_OVL_CHAMPS_ID_NR
L2420B	REF02	Employer’s Identification Number	L2420B_S03_REF02_OPRTNG_PHYSCN_2ND_ID_OVL_EMPLYR_ID_NR
L2420B	REF02	Provider Commercial Number	L2420B_S03_REF02_OPRTNG_PHYSCN_2ND_ID_OVL_PROV_COMRCL_NR
L2420B	REF02	Location Number	L2420B_S03_REF02_OPRTNG_PHYSCN_2ND_ID_OVL_LOC_NR
L2420B	REF02	Provider Plan Network Identification Number	L2420B_S03_REF02_OPRTNG_PHYSCN_2ND_ID_OVL_PROV_PLAN_NETWRK_ID_NR
L2420B	REF02	Social Security Number	L2420B_S03_REF02_OPRTNG_PHYSCN_2ND_ID_OVL_SSN
L2420B	REF02	State Industrial Accident Provider Number	L2420B_S03_REF02_OPRTNG_PHYSCN_2ND_ID_OVL_STAT_INDSTRL_ACDNT_PROV_NR

2420C - OTHER PROVIDER NAME

Loop	Segment	Segment Name	Chiapas Gate Mapping
L2420C	NM1	Other Provider Name
L2420C	NM103	Person	L2420C_S01_NM103_PHYSCN_LNAME_OVL_PERSN
L2420C	NM103	Non-Person Entity	L2420C_S01_NM103_PHYSCN_LNAME_OVL_NONPRSN_ENTY
L2420C	NM104	Other Physician First Name	L2420C_S01_NM104_PHYSCN_FNAME
L2420C	NM105	Other Provider Middle Name	L2420C_S01_NM105_PROV_MNAME
L2420C	NM107	Other Provider Name Suffix	L2420C_S01_NM107_OTHR_PROV_NM_SUFX
L2420C	NM109	Employer’s Identification Number	L2420C_S01_NM109_PROV_ID_OVL_EMPLYR_ID_NR
L2420C	NM109	Social Security Number	L2420C_S01_NM109_PROV_ID_OVL_SSN
L2420C	NM109	Health Care Financing Administration National	L2420C_S01_NM109_PROV_ID_OVL_HCFA_NATNL
L2420C	PRV	Other Provider Specialty Information
L2420C	PRV01	Provider Code	L2420C_S02_PRV01_PROV_CD
L2420C	PRV03	Mutually Defined	L2420C_S02_PRV03_TAXNMY_CD_OVL_MUTLY_DEFND
L2420C	REF	Other Provider Secondary Identification
L2420C	REF02	State License Number	L2420C_S03_REF02_OTHR_PROV_2ND_ID_OVL_STAT_LICNS_NR
L2420C	REF02	Blue Cross Provider Number	L2420C_S03_REF02_OTHR_PROV_2ND_ID_OVL_BLUE_CROS_PROV_NR
L2420C	REF02	Blue Shield Provider Number	L2420C_S03_REF02_OTHR_PROV_2ND_ID_OVL_BLUE_SHIELD_PROV_NR
L2420C	REF02	Medicare Provider Number	L2420C_S03_REF02_OTHR_PROV_2ND_ID_OVL_MEDCR_PROV_NR
L2420C	REF02	Medicaid Provider Number	L2420C_S03_REF02_OTHR_PROV_2ND_ID_OVL_MEDCD_PROV_NR
L2420C	REF02	Provider UPIN Number	L2420C_S03_REF02_OTHR_PROV_2ND_ID_OVL_PROV_UPN_NR
L2420C	REF02	CHAMPUS Identification Number	L2420C_S03_REF02_OTHR_PROV_2ND_ID_OVL_CHAMPS_ID_NR
L2420C	REF02	Employer’s Identification Number	L2420C_S03_REF02_OTHR_PROV_2ND_ID_OVL_EMPLYR_ID_NR
L2420C	REF02	Provider Commercial Number	L2420C_S03_REF02_OTHR_PROV_2ND_ID_OVL_PROV_COMRCL_NR
L2420C	REF02	Location Number	L2420C_S03_REF02_OTHR_PROV_2ND_ID_OVL_LOC_NR
L2420C	REF02	Provider Plan Network Identification Number	L2420C_S03_REF02_OTHR_PROV_2ND_ID_OVL_PROV_PLAN_NETWRK_ID_NR
L2420C	REF02	Social Security Number	L2420C_S03_REF02_OTHR_PROV_2ND_ID_OVL_SSN
L2420C	REF02	State Industrial Accident Provider Number	L2420C_S03_REF02_OTHR_PROV_2ND_ID_OVL_STAT_INDSTRL_ACDNT_PROV_NR

2420D - REFERRING PROVIDER NAME

Loop	Segment	Segment Name	Chiapas Gate Mapping
L2420D	NM1	Referring Provider Name
L2420D	NM103	Person	L2420D_S01_NM103_PROV_LNAME_OVL_PERSN
L2420D	NM103	Non-Person Entity	L2420D_S01_NM103_PROV_LNAME_OVL_NONPRSN_ENTY
L2420D	NM104	Referring Provider First Name	L2420D_S01_NM104_PROV_FNAME
L2420D	NM105	Referring Provider Middle Name	L2420D_S01_NM105_PROV_MNAME
L2420D	NM107	Referring Provider Name Suffix	L2420D_S01_NM107_REFNG_PROV_NM_SUFX
L2420D	NM109	Employer’s Identification Number	L2420D_S01_NM109_OTHR_PHYSCN_ID_OVL_EMPLYR_ID_NR
L2420D	NM109	Social Security Number	L2420D_S01_NM109_OTHR_PHYSCN_ID_OVL_SSN
L2420D	NM109	Health Care Financing Administration National Provider Identifier	L2420D_S01_NM109_OTHR_PHYSCN_ID_OVL_HCFA_NATNL_PROV_ID
L2420D	PRV	Referring Provider Specialty Information
L2420D	PRV01	Provider Code	L2420D_S02_PRV01_PROV_CD
L2420D	PRV03	Mutually Defined	L2420D_S02_PRV03_TAXNMY_CD_OVL_MUTLY_DEFND
L2420D	REF	Referring Provider Secondary Identification
L2420D	REF02	State License Number	L2420D_S03_REF02_REFNG_PROV_2ND_ID_OVL_STAT_LICNS_NR
L2420D	REF02	Blue Cross Provider Number	L2420D_S03_REF02_REFNG_PROV_2ND_ID_OVL_BLUE_CROS_PROV_NR
L2420D	REF02	Blue Shield Provider Number	L2420D_S03_REF02_REFNG_PROV_2ND_ID_OVL_BLUE_SHIELD_PROV_NR
L2420D	REF02	Medicare Provider Number	L2420D_S03_REF02_REFNG_PROV_2ND_ID_OVL_MEDCR_PROV_NR
L2420D	REF02	Medicaid Provider Number	L2420D_S03_REF02_REFNG_PROV_2ND_ID_OVL_MEDCD_PROV_NR
L2420D	REF02	Provider UPIN Number	L2420D_S03_REF02_REFNG_PROV_2ND_ID_OVL_PROV_UPN_NR
L2420D	REF02	Preferred Provider Organization Number	L2420D_S03_REF02_REFNG_PROV_2ND_ID_OVL_PREFD_PROV_ORG_NR
L2420D	REF02	Health Maintenance Organization Code Number	L2420D_S03_REF02_REFNG_PROV_2ND_ID_OVL_HMO_COD_NR
L2420D	REF02	Employer’s Identification Number	L2420D_S03_REF02_REFNG_PROV_2ND_ID_OVL_EMPLYR_ID_NR
L2420D	REF02	Provider Commercial Number	L2420D_S03_REF02_REFNG_PROV_2ND_ID_OVL_PROV_COMRCL_NR
L2420D	REF02	Location Number	L2420D_S03_REF02_REFNG_PROV_2ND_ID_OVL_LOC_NR
L2420D	REF02	Provider Plan Network Identification Number	L2420D_S03_REF02_REFNG_PROV_2ND_ID_OVL_PROV_PLAN_NETWRK_ID_NR
L2420D	REF02	Social Security Number	L2420D_S03_REF02_REFNG_PROV_2ND_ID_OVL_SSN
L2420D	REF02	State Industrial Accident Provider Number	L2420D_S03_REF02_REFNG_PROV_2ND_ID_OVL_STAT_INDSTRL_ACDNT_PROV_NR

2430 - SERVICE LINE ADJUDICATION INFORMATION

Loop	Segment	Segment Name	Chiapas Gate Mapping
L2430	SVD	Service Line Adjudication Information
L2430	SVD01	Payer Identifier	L2430_S01_SVD01_PAYR_ID
L2430	SVD02	Service Line Paid Amount	L2430_S01_SVD02_SVC_LIN_PD_AMT
L2430	SVD03-02	Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes	L2430_S01_SVD03_02_PROC_CD_OVL_HCPCS_CD
L2430	SVD03-02	Home Infusion EDI Coalition (HIEC) Product/Service Code	L2430_S01_SVD03_02_PROC_CD_OVL_HIEC_PRODCT_SRVC_CD
L2430	SVD03-02	National Drug Code in 4-4-2 Format	L2430_S01_SVD03_02_PROC_CD_OVL_NDC_442_FORMT
L2430	SVD03-02	National Drug Code in 5-3-2 Format	L2430_S01_SVD03_02_PROC_CD_OVL_NDC_532_FORMT
L2430	SVD03-02	National Drug Code in 5-4-1 Format	L2430_S01_SVD03_02_PROC_CD_OVL_NDC_541_FORMT
L2430	SVD03-02	National Drug Code in 5-4-2 Format	L2430_S01_SVD03_02_PROC_CD_OVL_NDC_542_FORMT
L2430	SVD03-02	Mutually Defined	L2430_S01_SVD03_02_PROC_CD_OVL_MUTLY_DEFND
L2430	SVD03-03	Procedure Modifier	L2430_S01_SVD03_03_PROC_MODFR
L2430	SVD03-04	Procedure Modifier	L2430_S01_SVD03_04_PROC_MODFR
L2430	SVD03-05	Procedure Modifier	L2430_S01_SVD03_05_PROC_MODFR
L2430	SVD03-06	Procedure Modifier	L2430_S01_SVD03_06_PROC_MODFR
L2430	SVD03-07	Procedure Code Description	L2430_S01_SVD03_07_PROC_CD_DESCRPTN
L2430	SVD04	Service Line Revenue Code	L2430_S01_SVD04_SVC_LIN_REVN_CD
L2430	SVD05	Adjustment Quantity	L2430_S01_SVD05_ADJ_QTY
L2430	SVD06	Bundled or Unbundled Line Number	L2430_S01_SVD06_BUNDLD_UNBNDLD_LIN_NR
L2430	CAS	Service Line Adjustment
L2430	CAS01	Claim Adjustment Group Code	L2430_S02_CAS01_CLM_ADJ_GRP_CD
L2430	CAS02	Adjustment Reason Code	L2430_S02_CAS02_ADJ_RSN_CD
L2430	CAS03	Adjustment Amount	L2430_S02_CAS03_ADJ_AMT
L2430	CAS04	Adjustment Quantity	L2430_S02_CAS04_ADJ_QTY
L2430	CAS05	Adjustment Reason Code	L2430_S02_CAS05_ADJ_RSN_CD
L2430	CAS06	Adjustment Amount	L2430_S02_CAS06_ADJ_AMT
L2430	CAS07	Adjustment Quantity	L2430_S02_CAS07_ADJ_QTY
L2430	CAS08	Adjustment Reason Code	L2430_S02_CAS08_ADJ_RSN_CD
L2430	CAS09	Adjustment Amount	L2430_S02_CAS09_ADJ_AMT
L2430	CAS10	Adjustment Quantity	L2430_S02_CAS10_ADJ_QTY
L2430	CAS11	Adjustment Reason Code	L2430_S02_CAS11_ADJ_RSN_CD
L2430	CAS12	Adjustment Amount	L2430_S02_CAS12_ADJ_AMT
L2430	CAS13	Adjustment Quantity	L2430_S02_CAS13_ADJ_QTY
L2430	CAS14	Adjustment Reason Code	L2430_S02_CAS14_ADJ_RSN_CD
L2430	CAS15	Adjustment Amount	L2430_S02_CAS15_ADJ_AMT
L2430	CAS16	Adjustment Quantity	L2430_S02_CAS16_ADJ_QTY
L2430	CAS17	Adjustment Reason Code	L2430_S02_CAS17_ADJ_RSN_CD
L2430	CAS18	Adjustment Amount	L2430_S02_CAS18_ADJ_AMT
L2430	CAS19	Adjustment Quantity	L2430_S02_CAS19_ADJ_QTY
L2430	DTP	Service Adjudication Date
L2430	DTP03	Date Claim Paid (D8)	L2430_S03_DTP03_SVC_ADJDCTN_PMT_DT_OVL_DAT_CLM_PAID_D8