Chiapas EDI 2012 Mapping Guide

5010_278_REQ 5010 Health Care Services Review - Request for Review - Code:Q0

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	ST03	Implementation Guide Version Name	STHDR_S01_ST03_IMPLMNTN_GUID_VERSN_NM
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

2010A - UTILIZATION MANAGEMENT ORGANIZATION (UMO) NAME

Loop	Segment	Segment Name	Chiapas Gate Mapping
2010A		Qualified Loop
L2010A		Third-Party Administrator	L2010A_2B
L2010A		Employer	L2010A_36
L2010A		Payer	L2010A_PR
L2010A		Utilization Management Organization	L2010A_X3
L2010A	NM1	Utilization Management Organization (UMO) Name
L2010A	NM102	Entity Type Qualifier	L2010A_XX_S01_NM102_ENTY_TYPE_QUAL
L2010A	NM103	Utilization Management Organization (UMO) Name Last or Organization Name	L2010A_XX_S01_NM103_UMO_NM_LAST_ORG_NM
L2010A	NM104	Utilization Management Organization (UMO) Name First	L2010A_XX_S01_NM104_NM_1ST
L2010A	NM105	Utilization Management Organization (UMO) Name Middle	L2010A_XX_S01_NM105_NM_MIDL
L2010A	NM107	Utilization Management Organization (UMO) Name Suffix	L2010A_XX_S01_NM107_NM_SUFX
L2010A	NM109	Employer’s Identification Number	L2010A_XX_S01_NM109_ID_CD_OVL_EMPLYR_ID_NR
L2010A	NM109	Social Security Number	L2010A_XX_S01_NM109_ID_CD_OVL_SSN
L2010A	NM109	Electronic Transmitter Identification Number (ETIN)	L2010A_XX_S01_NM109_ID_CD_OVL_ETN_NR
L2010A	NM109	Payor Identification	L2010A_XX_S01_NM109_ID_CD_OVL_PAYR_ID
L2010A	NM109	Centers for Medicare and Medicaid Services PlanID	L2010A_XX_S01_NM109_ID_CD_OVL_MDCR_MDCD_SVCS_PLAND

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		Third-Party Administrator	L2010B_2B
L2010B		Employer	L2010B_36
L2010B		Facility	L2010B_FA
L2010B		Payer	L2010B_PR
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	Centers for Medicare and Medicaid Services PlanID	L2010B_XX_S01_NM109_REQSTR_ID_OVL_MDCR_MDCD_SVCS_PLAND
L2010B	NM109	Centers for Medicare and Medicaid Services National Provider Identifier	L2010B_XX_S01_NM109_REQSTR_ID_OVL_MDCR_MDCD_SVCS_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	Employer’s Identification Number	L2010B_XX_S02_REF02_SUPP_ID_OVL_EMPLYR_ID_NR
L2010B	REF02	Provider Site Number	L2010B_XX_S02_REF02_SUPP_ID_OVL_PROV_SIT_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	N3	Requester Address
L2010B	N301	Requester Address Line	L2010B_XX_S03_N301_ADRS_LIN
L2010B	N302	Requester Address Line	L2010B_XX_S03_N302_ADRS_LIN
L2010B	N4	Requester City, State, ZIP Code
L2010B	N401	Requester City Name	L2010B_XX_S04_N401_CITY_NM
L2010B	N402	Requester State or Province Code	L2010B_XX_S04_N402_REQSTR_STAT_PROVNC_CD
L2010B	N403	Requester Postal Zone or ZIP Code	L2010B_XX_S04_N403_REQSTR_POSTL_ZON_ZIP_CD
L2010B	N404	Country Code	L2010B_XX_S04_N404_CNTRY_CD
L2010B	N407	Country Subdivision Code	L2010B_XX_S04_N407_COUNTRY_SUBDVSN_CD
L2010B	PER	Requester Contact Information
L2010B	PER01	Contact Function Code	L2010B_XX_S05_PER01_FUNCTN_CD
L2010B	PER02	Requester Contact Name	L2010B_XX_S05_PER02_CONTCT_NM
L2010B	PER04	Electronic Mail	L2010B_XX_S05_PER04_REQSTR_CONTCT_COMNCTN_NR_OVL_EMAIL
L2010B	PER04	Facsimile	L2010B_XX_S05_PER04_REQSTR_CONTCT_COMNCTN_NR_OVL_FACSML
L2010B	PER04	Telephone	L2010B_XX_S05_PER04_REQSTR_CONTCT_COMNCTN_NR_OVL_TELPHN
L2010B	PER04	Uniform Resource Locator (URL)	L2010B_XX_S05_PER04_REQSTR_CONTCT_COMNCTN_NR_OVL_URL
L2010B	PER06	Electronic Mail	L2010B_XX_S05_PER06_REQSTR_CONTCT_COMNCTN_NR_OVL_EMAIL
L2010B	PER06	Telephone Extension	L2010B_XX_S05_PER06_REQSTR_CONTCT_COMNCTN_NR_OVL_PHN_EXTNS
L2010B	PER06	Facsimile	L2010B_XX_S05_PER06_REQSTR_CONTCT_COMNCTN_NR_OVL_FACSML
L2010B	PER06	Telephone	L2010B_XX_S05_PER06_REQSTR_CONTCT_COMNCTN_NR_OVL_TELPHN
L2010B	PER06	Uniform Resource Locator (URL)	L2010B_XX_S05_PER06_REQSTR_CONTCT_COMNCTN_NR_OVL_URL
L2010B	PER08	Electronic Mail	L2010B_XX_S05_PER08_REQSTR_CONTCT_COMNCTN_NR_OVL_EMAIL
L2010B	PER08	Telephone Extension	L2010B_XX_S05_PER08_REQSTR_CONTCT_COMNCTN_NR_OVL_PHN_EXTNS
L2010B	PER08	Facsimile	L2010B_XX_S05_PER08_REQSTR_CONTCT_COMNCTN_NR_OVL_FACSML
L2010B	PER08	Telephone	L2010B_XX_S05_PER08_REQSTR_CONTCT_COMNCTN_NR_OVL_TELPHN
L2010B	PER08	Uniform Resource Locator (URL)	L2010B_XX_S05_PER08_REQSTR_CONTCT_COMNCTN_NR_OVL_URL
L2010B	PRV	Requester Provider Information
L2010B	PRV01	Provider Code	L2010B_XX_S06_PRV01_PROV_CD
L2010B	PRV03	Health Care Provider Taxonomy Code	L2010B_XX_S06_PRV03_TAXNMY_CD_OVL_HLTHCR_PROV_TAXNMY_CD

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

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 or Initial	L2010C_S01_NM105_MNAME_INTL
L2010C	NM106	Subscriber Name Prefix	L2010C_S01_NM106_NM_PREFX
L2010C	NM107	Subscriber Name Suffix	L2010C_S01_NM107_NM_SUFX
L2010C	NM109	Standard Unique Health Identifier for each Individual in the United States	L2010C_S01_NM109_PRIMRY_ID_OVL_STANDRD_UNQ_HEALTH_ID
L2010C	NM109	Member Identification Number	L2010C_S01_NM109_PRIMRY_ID_OVL_MEM_ID_NR
L2010C	REF	Subscriber Supplemental Identification
L2010C	REF02	Group or Policy Number	L2010C_S02_REF02_SUPP_ID_OVL_GRP_POLCY_NR
L2010C	REF02	Branch Identifier	L2010C_S02_REF02_SUPP_ID_OVL_BRANCH_ID
L2010C	REF02	Group Number	L2010C_S02_REF02_SUPP_ID_OVL_GRP_NR
L2010C	REF02	Department Number	L2010C_S02_REF02_SUPP_ID_OVL_DEPRTMNT_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	N3	Subscriber Address
L2010C	N301	Subscriber Address Line	L2010C_S03_N301_ADRS_LIN
L2010C	N302	Subscriber Address Line	L2010C_S03_N302_ADRS_LIN
L2010C	N4	Subscriber City, State, ZIP Code
L2010C	N401	Subscriber City Name	L2010C_S04_N401_CITY_NM
L2010C	N402	Subscriber State Code	L2010C_S04_N402_STAT_CD
L2010C	N403	Subscriber Postal Zone or ZIP Code	L2010C_S04_N403_SUB_POSTL_ZON_ZIP_CD
L2010C	N404	Country Code	L2010C_S04_N404_CNTRY_CD
L2010C	N407	Country Subdivision Code	L2010C_S04_N407_COUNTRY_SUBDVSN_CD
L2010C	DMG	Subscriber Demographic Information
L2010C	DMG02	Date Expressed in Format CCYYMMDD	L2010C_S05_DMG02_BIRTH_DT_OVL_DT_CCYYMMDD
L2010C	DMG03	Subscriber Gender Code	L2010C_S05_DMG03_GENDR_CD
L2010C	INS	Subscriber Relationship
L2010C	INS01	Insured Indicator	L2010C_S06_INS01_INSRD_IND
L2010C	INS02	Individual Relationship Code	L2010C_S06_INS02_INDVDL_REL_CD
L2010C	INS08	Employment Status Code	L2010C_S06_INS08_EMPLYMNT_STATS_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

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	REF	Dependent Supplemental Identification
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	N3	Dependent Address
L2010D	N301	Dependent Address Line	L2010D_S03_N301_ADRS_LIN
L2010D	N302	Dependent Address Line	L2010D_S03_N302_ADRS_LIN
L2010D	N4	Dependent City, State, ZIP Code
L2010D	N401	Dependent City Name	L2010D_S04_N401_CITY_NM
L2010D	N402	Dependent State Code	L2010D_S04_N402_STAT_CD
L2010D	N403	Dependent Postal Zone or ZIP Code	L2010D_S04_N403_DEPNDNT_POSTL_ZON_ZIP_CD
L2010D	N404	Country Code	L2010D_S04_N404_CNTRY_CD
L2010D	N407	Country Subdivision Code	L2010D_S04_N407_COUNTRY_SUBDVSN_CD
L2010D	DMG	Dependent Demographic Information
L2010D	DMG02	Date Expressed in Format CCYYMMDD	L2010D_S05_DMG02_BIRTH_DT_OVL_DT_CCYYMMDD
L2010D	DMG03	Dependent Gender Code	L2010D_S05_DMG03_GENDR_CD
L2010D	INS	Dependent Relationship
L2010D	INS01	Insured Indicator	L2010D_S06_INS01_INSRD_IND
L2010D	INS02	Individual Relationship Code	L2010D_S06_INS02_INDVDL_REL_CD
L2010D	INS17	Birth Sequence Number	L2010D_S06_INS17_BIRTH_SEQNC_NR

2000E - PATIENT EVENT LEVEL

Loop	Segment	Segment Name	Chiapas Gate Mapping
L2000E	HL	Patient Event 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	TRN	Patient Event Tracking Number
L2000E	TRN01	Trace Type Code	L2000E_S02_TRN01_TYPE_CD
L2000E	TRN02	Patient Event Trace Number	L2000E_S02_TRN02_PATNT_EVNT_TRAC_NR
L2000E	TRN03	Trace Assigning Entity Identifier	L2000E_S02_TRN03_TRAC_ASGNG_ENTY_ID
L2000E	TRN04	Trace Assigning Entity Additional Identifier	L2000E_S02_TRN04_TRAC_ASGNG_ENTY_ADDL_ID
L2000E	UM	Health Care Services Review Information
L2000E	UM01	Request Category Code	L2000E_S03_UM01_REQST_CATGRY_CD
L2000E	UM02	Certification Type Code	L2000E_S03_UM02_CERT_TYPE_CD
L2000E	UM03	Service Type Code	L2000E_S03_UM03_TYPE_CD
L2000E	UM04-01	Facility Type Code	L2000E_S03_UM04_01_FACLTY_TYPE_CD
L2000E	UM04-02	Facility Code Qualifier	L2000E_S03_UM04_02_FACLTY_CD_QUAL
L2000E	UM05-01	Related Causes Code	L2000E_S03_UM05_01_RELTD_CAUS_CD
L2000E	UM05-02	Related Causes Code	L2000E_S03_UM05_02_RELTD_CAUS_CD
L2000E	UM05-03	Related Causes Code	L2000E_S03_UM05_03_RELTD_CAUS_CD
L2000E	UM05-04	State or Province Code	L2000E_S03_UM05_04_STAT_PROVNC_CD
L2000E	UM05-05	Country Code	L2000E_S03_UM05_05_CNTRY_CD
L2000E	UM06	Level of Service Code	L2000E_S03_UM06_LEVL_SVC_CD
L2000E	UM07	Current Health Condition Code	L2000E_S03_UM07_CURNT_HEALTH_CONDTN_CD
L2000E	UM08	Prognosis Code	L2000E_S03_UM08_PROGNS_CD
L2000E	UM09	Release of Information Code	L2000E_S03_UM09_RELS_NFO_CD
L2000E	UM10	Delay Reason Code	L2000E_S03_UM10_DELY_RSN_CD
L2000E	REF	Previous Review Authorization Number
L2000E	REF02	Authorization Number	L2000E_S04_REF02_PREVS_REVW_AUTH_NR_OVL_AUTH_NR
L2000E	REF	Previous Review Administrative Reference Number
L2000E	REF02	Administrator’s Reference Number	L2000E_S05_REF02_PREVS_ADMIN_REF_NR_OVL_ADMNSTRTR_REF_NR
L2000E	DTP	Accident Date
L2000E	DTP03	Accident (D8)	L2000E_S06_DTP03_ACDNT_DT_OVL_ACDNT_D8
L2000E	DTP	Last Menstrual Period Date
L2000E	DTP03	Last Menstrual Period (D8)	L2000E_S07_DTP03_LAST_MENSTRL_PERD_DT_OVL_LAST_MENSTRL_PERD_D8
L2000E	DTP	Estimated Date of Birth
L2000E	DTP03	Estimated Date of Birth (D8)	L2000E_S08_DTP03_BIRTH_DT_OVL_EST_DOB_D8
L2000E	DTP	Onset of Current Symptoms or Illness Date
L2000E	DTP03	Onset of Current Symptoms or Illness (D8)	L2000E_S09_DTP03_ONST_DT_OVL_ONST_CURNT_SYMPTMS_ILNS_D8
L2000E	DTP	Event Date
L2000E	DTP03	Event (D8)	L2000E_S10_DTP03_PROPSD_ACTL_EVNT_DT_OVL_EVNT_D8
L2000E	DTP03	Event (RD8)	L2000E_S10_DTP03_PROPSD_ACTL_EVNT_DT_OVL_EVNT_RD8
L2000E	DTP	Admission Date
L2000E	DTP03	Admission (D8)	L2000E_S11_DTP03_PROPSD_ACTL_ADMSN_DT_OVL_ADMSN_D8
L2000E	DTP03	Admission (RD8)	L2000E_S11_DTP03_PROPSD_ACTL_ADMSN_DT_OVL_ADMSN_RD8
L2000E	DTP	Discharge Date
L2000E	DTP03	Discharge (D8)	L2000E_S12_DTP03_PROPSD_ACTL_DISCHRG_DT_OVL_DISCHRG_D8
L2000E	HI	Patient Diagnosis
L2000E	HI01-02	International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis	L2000E_S13_HI01_02_DIAG_CD_OVL_ICD10CM_DIAG
L2000E	HI01-02	International Classification of Diseases Clinical Modification (ICD-10-CM) Admitting Diagnosis	L2000E_S13_HI01_02_DIAG_CD_OVL_ICD10CM_ADMTNG_DIAG
L2000E	HI01-02	International Classification of Diseases Clinical Modification (ICD-10-CM) Principal Diagnosis	L2000E_S13_HI01_02_DIAG_CD_OVL_ICD10CM_PRINCPL_DIAG
L2000E	HI01-02	International Classification of Diseases Clinical Modification (ICD-10-CM) Patient’s Reason for Visit	L2000E_S13_HI01_02_DIAG_CD_OVL_ICD10CM_PATNT_RSN_VIST
L2000E	HI01-02	International Classification of Diseases Clinical	L2000E_S13_HI01_02_DIAG_CD_OVL_INTRNTNL_CLASFCTN_DIS_CLINCL
L2000E	HI01-02	International Classification of Diseases Clinical Modification (ICD-9-CM) Admitting Diagnosis	L2000E_S13_HI01_02_DIAG_CD_OVL_ICD9CM_ADMTNG_DIAG
L2000E	HI01-02	International Classification of Diseases Clinical	L2000E_S13_HI01_02_DIAG_CD_OVL_INTRNTNL_CLASFCTN_DIS_CLINCL
L2000E	HI01-02	Diagnosis Related Group (DRG)	L2000E_S13_HI01_02_DIAG_CD_OVL_DIAG_RELTD_GRP
L2000E	HI01-02	International Classification of Diseases Clinical Modification (ICD-9-CM) Patient’s Reason for Visit	L2000E_S13_HI01_02_DIAG_CD_OVL_ICD9CM_PATNT_RSN_VIST
L2000E	HI01-04	Date Expressed in Format CCYYMMDD	L2000E_S13_HI01_04_DIAG_DT_OVL_DT_CCYYMMDD
L2000E	HI02-02	International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis	L2000E_S13_HI02_02_DIAG_CD_OVL_ICD10CM_DIAG
L2000E	HI02-02	International Classification of Diseases Clinical Modification (ICD-10-CM) Admitting Diagnosis	L2000E_S13_HI02_02_DIAG_CD_OVL_ICD10CM_ADMTNG_DIAG
L2000E	HI02-02	International Classification of Diseases Clinical Modification (ICD-10-CM) Patient’s Reason for Visit	L2000E_S13_HI02_02_DIAG_CD_OVL_ICD10CM_PATNT_RSN_VIST
L2000E	HI02-02	International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis	L2000E_S13_HI02_02_DIAG_CD_OVL_ICD9CM_DIAG
L2000E	HI02-02	International Classification of Diseases Clinical Modification (ICD-9-CM) Admitting Diagnosis	L2000E_S13_HI02_02_DIAG_CD_OVL_ICD9CM_ADMTNG_DIAG
L2000E	HI02-02	Diagnosis Related Group (DRG)	L2000E_S13_HI02_02_DIAG_CD_OVL_DIAG_RELTD_GRP
L2000E	HI02-02	International Classification of Diseases Clinical Modification (ICD-9-CM) Patient’s Reason for Visit	L2000E_S13_HI02_02_DIAG_CD_OVL_ICD9CM_PATNT_RSN_VIST
L2000E	HI02-04	Date Expressed in Format CCYYMMDD	L2000E_S13_HI02_04_DIAG_DT_OVL_DT_CCYYMMDD
L2000E	HI03-02	International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis	L2000E_S13_HI03_02_DIAG_CD_OVL_ICD10CM_DIAG
L2000E	HI03-02	International Classification of Diseases Clinical	L2000E_S13_HI03_02_DIAG_CD_OVL_INTRNTNL_CLASFCTN_DIS_CLINCL
L2000E	HI03-02	International Classification of Diseases Clinical	L2000E_S13_HI03_02_DIAG_CD_OVL_INTRNTNL_CLASFCTN_DIS_CLINCL
L2000E	HI03-02	Diagnosis Related Group (DRG)	L2000E_S13_HI03_02_DIAG_CD_OVL_DIAG_RELTD_GRP
L2000E	HI03-02	International Classification of Diseases Clinical Modification (ICD-9-CM) Patient’s Reason for Visit	L2000E_S13_HI03_02_DIAG_CD_OVL_ICD9CM_PATNT_RSN_VIST
L2000E	HI03-04	Date Expressed in Format CCYYMMDD	L2000E_S13_HI03_04_DIAG_DT_OVL_DT_CCYYMMDD
L2000E	HI04-02	International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis	L2000E_S13_HI04_02_DIAG_CD_OVL_ICD10CM_DIAG
L2000E	HI04-02	International Classification of Diseases Clinical Modification (ICD-10-CM) Patient’s Reason for Visit	L2000E_S13_HI04_02_DIAG_CD_OVL_ICD10CM_PATNT_RSN_VIST
L2000E	HI04-02	International Classification of Diseases Clinical	L2000E_S13_HI04_02_DIAG_CD_OVL_INTRNTNL_CLASFCTN_DIS_CLINCL
L2000E	HI04-02	Diagnosis Related Group (DRG)	L2000E_S13_HI04_02_DIAG_CD_OVL_DIAG_RELTD_GRP
L2000E	HI04-02	International Classification of Diseases Clinical Modification (ICD-9-CM) Patient’s Reason for Visit	L2000E_S13_HI04_02_DIAG_CD_OVL_ICD9CM_PATNT_RSN_VIST
L2000E	HI04-04	Date Expressed in Format CCYYMMDD	L2000E_S13_HI04_04_DIAG_DT_OVL_DT_CCYYMMDD
L2000E	HI05-02	International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis	L2000E_S13_HI05_02_DIAG_CD_OVL_ICD10CM_DIAG
L2000E	HI05-02	International Classification of Diseases Clinical Modification (ICD-10-CM) Patient’s Reason for Visit	L2000E_S13_HI05_02_DIAG_CD_OVL_ICD10CM_PATNT_RSN_VIST
L2000E	HI05-02	International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis	L2000E_S13_HI05_02_DIAG_CD_OVL_ICD9CM_DIAG
L2000E	HI05-02	Diagnosis Related Group (DRG)	L2000E_S13_HI05_02_DIAG_CD_OVL_DIAG_RELTD_GRP
L2000E	HI05-02	International Classification of Diseases Clinical Modification (ICD-9-CM) Patient’s Reason for Visit	L2000E_S13_HI05_02_DIAG_CD_OVL_ICD9CM_PATNT_RSN_VIST
L2000E	HI05-04	Date Expressed in Format CCYYMMDD	L2000E_S13_HI05_04_DIAG_DT_OVL_DT_CCYYMMDD
L2000E	HI06-02	International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis	L2000E_S13_HI06_02_DIAG_CD_OVL_ICD10CM_DIAG
L2000E	HI06-02	International Classification of Diseases Clinical Modification (ICD-10-CM) Patient’s Reason for Visit	L2000E_S13_HI06_02_DIAG_CD_OVL_ICD10CM_PATNT_RSN_VIST
L2000E	HI06-02	International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis	L2000E_S13_HI06_02_DIAG_CD_OVL_ICD9CM_DIAG
L2000E	HI06-02	Diagnosis Related Group (DRG)	L2000E_S13_HI06_02_DIAG_CD_OVL_DIAG_RELTD_GRP
L2000E	HI06-02	International Classification of Diseases Clinical	L2000E_S13_HI06_02_DIAG_CD_OVL_INTRNTNL_CLASFCTN_DIS_CLINCL
L2000E	HI06-04	Date Expressed in Format CCYYMMDD	L2000E_S13_HI06_04_DIAG_DT_OVL_DT_CCYYMMDD
L2000E	HI07-02	International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis	L2000E_S13_HI07_02_DIAG_CD_OVL_ICD10CM_DIAG
L2000E	HI07-02	International Classification of Diseases Clinical Modification (ICD-10-CM) Patient’s Reason for Visit	L2000E_S13_HI07_02_DIAG_CD_OVL_ICD10CM_PATNT_RSN_VIST
L2000E	HI07-02	International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis	L2000E_S13_HI07_02_DIAG_CD_OVL_ICD9CM_DIAG
L2000E	HI07-02	Diagnosis Related Group (DRG)	L2000E_S13_HI07_02_DIAG_CD_OVL_DIAG_RELTD_GRP
L2000E	HI07-02	International Classification of Diseases Clinical Modification (ICD-9-CM) Patient’s Reason for Visit	L2000E_S13_HI07_02_DIAG_CD_OVL_ICD9CM_PATNT_RSN_VIST
L2000E	HI07-04	Date Expressed in Format CCYYMMDD	L2000E_S13_HI07_04_DIAG_DT_OVL_DT_CCYYMMDD
L2000E	HI08-02	International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis	L2000E_S13_HI08_02_DIAG_CD_OVL_ICD10CM_DIAG
L2000E	HI08-02	International Classification of Diseases Clinical Modification (ICD-10-CM) Patient’s Reason for Visit	L2000E_S13_HI08_02_DIAG_CD_OVL_ICD10CM_PATNT_RSN_VIST
L2000E	HI08-02	International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis	L2000E_S13_HI08_02_DIAG_CD_OVL_ICD9CM_DIAG
L2000E	HI08-02	Diagnosis Related Group (DRG)	L2000E_S13_HI08_02_DIAG_CD_OVL_DIAG_RELTD_GRP
L2000E	HI08-02	International Classification of Diseases Clinical Modification (ICD-9-CM) Patient’s Reason for Visit	L2000E_S13_HI08_02_DIAG_CD_OVL_ICD9CM_PATNT_RSN_VIST
L2000E	HI08-04	Date Expressed in Format CCYYMMDD	L2000E_S13_HI08_04_DIAG_DT_OVL_DT_CCYYMMDD
L2000E	HI09-02	International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis	L2000E_S13_HI09_02_DIAG_CD_OVL_ICD10CM_DIAG
L2000E	HI09-02	International Classification of Diseases Clinical Modification (ICD-10-CM) Patient’s Reason for Visit	L2000E_S13_HI09_02_DIAG_CD_OVL_ICD10CM_PATNT_RSN_VIST
L2000E	HI09-02	International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis	L2000E_S13_HI09_02_DIAG_CD_OVL_ICD9CM_DIAG
L2000E	HI09-02	Diagnosis Related Group (DRG)	L2000E_S13_HI09_02_DIAG_CD_OVL_DIAG_RELTD_GRP
L2000E	HI09-02	International Classification of Diseases Clinical	L2000E_S13_HI09_02_DIAG_CD_OVL_INTRNTNL_CLASFCTN_DIS_CLINCL
L2000E	HI09-04	Date Expressed in Format CCYYMMDD	L2000E_S13_HI09_04_DIAG_DT_OVL_DT_CCYYMMDD
L2000E	HI10-02	International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis	L2000E_S13_HI10_02_DIAG_CD_OVL_ICD10CM_DIAG
L2000E	HI10-02	International Classification of Diseases Clinical Modification (ICD-10-CM) Patient’s Reason for Visit	L2000E_S13_HI10_02_DIAG_CD_OVL_ICD10CM_PATNT_RSN_VIST
L2000E	HI10-02	International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis	L2000E_S13_HI10_02_DIAG_CD_OVL_ICD9CM_DIAG
L2000E	HI10-02	Diagnosis Related Group (DRG)	L2000E_S13_HI10_02_DIAG_CD_OVL_DIAG_RELTD_GRP
L2000E	HI10-02	International Classification of Diseases Clinical Modification (ICD-9-CM) Patient’s Reason for Visit	L2000E_S13_HI10_02_DIAG_CD_OVL_ICD9CM_PATNT_RSN_VIST
L2000E	HI10-04	Date Expressed in Format CCYYMMDD	L2000E_S13_HI10_04_DIAG_DT_OVL_DT_CCYYMMDD
L2000E	HI11-02	International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis	L2000E_S13_HI11_02_DIAG_CD_OVL_ICD10CM_DIAG
L2000E	HI11-02	International Classification of Diseases Clinical Modification (ICD-10-CM) Patient’s Reason for Visit	L2000E_S13_HI11_02_DIAG_CD_OVL_ICD10CM_PATNT_RSN_VIST
L2000E	HI11-02	International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis	L2000E_S13_HI11_02_DIAG_CD_OVL_ICD9CM_DIAG
L2000E	HI11-02	Diagnosis Related Group (DRG)	L2000E_S13_HI11_02_DIAG_CD_OVL_DIAG_RELTD_GRP
L2000E	HI11-02	International Classification of Diseases Clinical Modification (ICD-9-CM) Patient’s Reason for Visit	L2000E_S13_HI11_02_DIAG_CD_OVL_ICD9CM_PATNT_RSN_VIST
L2000E	HI11-04	Date Expressed in Format CCYYMMDD	L2000E_S13_HI11_04_DIAG_DT_OVL_DT_CCYYMMDD
L2000E	HI12-02	International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis	L2000E_S13_HI12_02_DIAG_CD_OVL_ICD10CM_DIAG
L2000E	HI12-02	International Classification of Diseases Clinical Modification (ICD-10-CM) Patient’s Reason for Visit	L2000E_S13_HI12_02_DIAG_CD_OVL_ICD10CM_PATNT_RSN_VIST
L2000E	HI12-02	International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis	L2000E_S13_HI12_02_DIAG_CD_OVL_ICD9CM_DIAG
L2000E	HI12-02	Diagnosis Related Group (DRG)	L2000E_S13_HI12_02_DIAG_CD_OVL_DIAG_RELTD_GRP
L2000E	HI12-02	International Classification of Diseases Clinical	L2000E_S13_HI12_02_DIAG_CD_OVL_INTRNTNL_CLASFCTN_DIS_CLINCL
L2000E	HI12-04	Date Expressed in Format CCYYMMDD	L2000E_S13_HI12_04_DIAG_DT_OVL_DT_CCYYMMDD
L2000E	HSD	Health Care Services Delivery
L2000E	HSD02	Days	L2000E_S14_HSD02_UNT_CT_OVL_DAYS
L2000E	HSD02	Units	L2000E_S14_HSD02_UNT_CT_OVL_UNTS
L2000E	HSD02	Hours	L2000E_S14_HSD02_UNT_CT_OVL_HOURS
L2000E	HSD02	Month	L2000E_S14_HSD02_UNT_CT_OVL_MONTH
L2000E	HSD02	Visits	L2000E_S14_HSD02_UNT_CT_OVL_VISTS
L2000E	HSD04	Days	L2000E_S14_HSD04_SAMPL_SELCTN_MODLS_OVL_DAYS
L2000E	HSD04	Months	L2000E_S14_HSD04_SAMPL_SELCTN_MODLS_OVL_MONTHS
L2000E	HSD04	Week	L2000E_S14_HSD04_SAMPL_SELCTN_MODLS_OVL_WEK
L2000E	HSD06	Hour	L2000E_S14_HSD06_PERD_CT_OVL_HOUR
L2000E	HSD06	Day	L2000E_S14_HSD06_PERD_CT_OVL_DAY
L2000E	HSD06	Years	L2000E_S14_HSD06_PERD_CT_OVL_YRS
L2000E	HSD06	Episode	L2000E_S14_HSD06_PERD_CT_OVL_EPSD
L2000E	HSD06	Visit	L2000E_S14_HSD06_PERD_CT_OVL_VIST
L2000E	HSD06	Month	L2000E_S14_HSD06_PERD_CT_OVL_MONTH
L2000E	HSD06	Week	L2000E_S14_HSD06_PERD_CT_OVL_WEK
L2000E	HSD07	Delivery Frequency Code	L2000E_S14_HSD07_DELVRY_FREQNCY_CD
L2000E	HSD08	Delivery Pattern Time Code	L2000E_S14_HSD08_DELVRY_PATRN_TIM_CD
L2000E	CRC	Ambulance Certification Information
L2000E	CRC01	Code Category	L2000E_S15_CRC01_CD_CATGRY
L2000E	CRC02	Certification Condition Indicator	L2000E_S15_CRC02_CONDTN_IND
L2000E	CRC03	Condition Code	L2000E_S15_CRC03_CONDTN_CD
L2000E	CRC04	Condition Code	L2000E_S15_CRC04_CONDTN_CD
L2000E	CRC05	Condition Code	L2000E_S15_CRC05_CONDTN_CD
L2000E	CRC06	Condition Code	L2000E_S15_CRC06_CONDTN_CD
L2000E	CRC07	Condition Code	L2000E_S15_CRC07_CONDTN_CD
L2000E	CRC	Chiropractic Certification Information
L2000E	CRC01	Code Category	L2000E_S16_CRC01_CD_CATGRY
L2000E	CRC02	Certification Condition Indicator	L2000E_S16_CRC02_CONDTN_IND
L2000E	CRC03	Condition Code	L2000E_S16_CRC03_CONDTN_CD
L2000E	CRC04	Condition Code	L2000E_S16_CRC04_CONDTN_CD
L2000E	CRC05	Condition Code	L2000E_S16_CRC05_CONDTN_CD
L2000E	CRC06	Condition Code	L2000E_S16_CRC06_CONDTN_CD
L2000E	CRC07	Condition Code	L2000E_S16_CRC07_CONDTN_CD
L2000E	CRC	Durable Medical Equipment Information
L2000E	CRC01	Code Category	L2000E_S17_CRC01_CD_CATGRY
L2000E	CRC02	Certification Condition Indicator	L2000E_S17_CRC02_CERT_CONDTN_IND
L2000E	CRC03	Condition Code	L2000E_S17_CRC03_CONDTN_CD
L2000E	CRC04	Condition Code	L2000E_S17_CRC04_CONDTN_CD
L2000E	CRC05	Condition Code	L2000E_S17_CRC05_CONDTN_CD
L2000E	CRC06	Condition Code	L2000E_S17_CRC06_CONDTN_CD
L2000E	CRC07	Condition Code	L2000E_S17_CRC07_CONDTN_CD
L2000E	CRC	Oxygen Therapy Certification Information
L2000E	CRC01	Code Category	L2000E_S18_CRC01_CD_CATGRY
L2000E	CRC02	Certification Condition Indicator	L2000E_S18_CRC02_CONDTN_IND
L2000E	CRC03	Condition Code	L2000E_S18_CRC03_CONDTN_CD
L2000E	CRC04	Condition Code	L2000E_S18_CRC04_CONDTN_CD
L2000E	CRC05	Condition Code	L2000E_S18_CRC05_CONDTN_CD
L2000E	CRC06	Condition Code	L2000E_S18_CRC06_CONDTN_CD
L2000E	CRC07	Condition Code	L2000E_S18_CRC07_CONDTN_CD
L2000E	CRC	Functional Limitations Information
L2000E	CRC01	Code Category	L2000E_S19_CRC01_CD_CATGRY
L2000E	CRC02	Certification Condition Indicator	L2000E_S19_CRC02_CERT_CONDTN_IND
L2000E	CRC03	Condition Code	L2000E_S19_CRC03_CONDTN_CD
L2000E	CRC04	Condition Code	L2000E_S19_CRC04_CONDTN_CD
L2000E	CRC05	Condition Code	L2000E_S19_CRC05_CONDTN_CD
L2000E	CRC06	Condition Code	L2000E_S19_CRC06_CONDTN_CD
L2000E	CRC07	Condition Code	L2000E_S19_CRC07_CONDTN_CD
L2000E	CRC	Activities Permitted Information
L2000E	CRC01	Code Category	L2000E_S20_CRC01_CD_CATGRY
L2000E	CRC02	Certification Condition Indicator	L2000E_S20_CRC02_CERT_CONDTN_IND
L2000E	CRC03	Condition Code	L2000E_S20_CRC03_CONDTN_CD
L2000E	CRC04	Condition Code	L2000E_S20_CRC04_CONDTN_CD
L2000E	CRC05	Condition Code	L2000E_S20_CRC05_CONDTN_CD
L2000E	CRC06	Condition Code	L2000E_S20_CRC06_CONDTN_CD
L2000E	CRC07	Condition Code	L2000E_S20_CRC07_CONDTN_CD
L2000E	CRC	Mental Status Information
L2000E	CRC01	Code Category	L2000E_S21_CRC01_CD_CATGRY
L2000E	CRC02	Certification Condition Indicator	L2000E_S21_CRC02_CERT_CONDTN_IND
L2000E	CRC03	Condition Code	L2000E_S21_CRC03_CONDTN_CD
L2000E	CRC04	Condition Code	L2000E_S21_CRC04_CONDTN_CD
L2000E	CRC05	Condition Code	L2000E_S21_CRC05_CONDTN_CD
L2000E	CRC06	Condition Code	L2000E_S21_CRC06_CONDTN_CD
L2000E	CRC07	Condition Code	L2000E_S21_CRC07_CONDTN_CD
L2000E	CL1	Institutional Claim Code
L2000E	CL101	Admission Type Code	L2000E_S22_CL101_ADMSN_TYPE_CD
L2000E	CL102	Admission Source Code	L2000E_S22_CL102_ADMSN_SOURC_CD
L2000E	CL103	Patient Status Code	L2000E_S22_CL103_PATNT_STATS_CD
L2000E	CL104	Nursing Home Residential Status Code	L2000E_S22_CL104_NRSNG_HM_RES_STATS_CD
L2000E	CR1	Ambulance Transport Information
L2000E	CR102	Kilogram	L2000E_S23_CR102_PATNT_WEIGHT_OVL_KILGRM
L2000E	CR102	Pound	L2000E_S23_CR102_PATNT_WEIGHT_OVL_POUND
L2000E	CR103	Ambulance Transport Code	L2000E_S23_CR103_TRANSPRT_CD
L2000E	CR104	Ambulance Transport Reason Code	L2000E_S23_CR104_AMBLNC_TRANSPRT_RSN_CD
L2000E	CR106	Miles	L2000E_S23_CR106_TRANSPRT_DISTNC_OVL_MILS
L2000E	CR106	Kilometers	L2000E_S23_CR106_TRANSPRT_DISTNC_OVL_KILMTRS
L2000E	CR109	Round Trip Purpose Description	L2000E_S23_CR109_ROUND_TRIP_PURPS_DESCRPTN
L2000E	CR110	Stretcher Purpose Description	L2000E_S23_CR110_STRETCHR_PURPS_DESCRPTN
L2000E	CR2	Spinal Manipulation Service Information
L2000E	CR201	Treatment Series Number	L2000E_S24_CR201_TREATMNT_SERS_NR
L2000E	CR202	Treatment Count	L2000E_S24_CR202_TREATMNT_CT
L2000E	CR203	Subluxation Level Code	L2000E_S24_CR203_SUBLXTN_LEVL_CD
L2000E	CR204	Subluxation Level Code	L2000E_S24_CR204_SUBLXTN_LEVL_CD
L2000E	CR208	Patient Condition Code	L2000E_S24_CR208_PATNT_CONDTN_CD
L2000E	CR209	Complication Indicator	L2000E_S24_CR209_COMPLCTN_IND
L2000E	CR210	Patient Condition Description	L2000E_S24_CR210_PATNT_CONDTN_DESCRPTN
L2000E	CR211	Patient Condition Description	L2000E_S24_CR211_PATNT_CONDTN_DESCRPTN
L2000E	CR212	X-ray Availability Indicator	L2000E_S24_CR212_XRAY_AVLBLTY_IND
L2000E	CR5	Home Oxygen Therapy Information
L2000E	CR503	Oxygen Equipment Type Code	L2000E_S25_CR503_OXY_EQPMNT_TYPE_CD
L2000E	CR504	Oxygen Equipment Type Code	L2000E_S25_CR504_OXY_EQPMNT_TYPE_CD
L2000E	CR505	Equipment Reason Description	L2000E_S25_CR505_EQPMNT_RSN_DESCRPTN
L2000E	CR506	Oxygen Flow Rate	L2000E_S25_CR506_FLOW_RAT
L2000E	CR507	Daily Oxygen Use Count	L2000E_S25_CR507_DAILY_OXY_US_CT
L2000E	CR508	Oxygen Use Period Hour Count	L2000E_S25_CR508_OXY_US_PERD_HOUR_CT
L2000E	CR509	Respiratory Therapist Order Text	L2000E_S25_CR509_RESP_THERPST_ORDR_TEXT
L2000E	CR510	Arterial Blood Gas Quantity	L2000E_S25_CR510_ARTRL_BLOD_GAS_QTY
L2000E	CR511	Oxygen Saturation Quantity	L2000E_S25_CR511_SATRTN_QTY
L2000E	CR512	Oxygen Test Condition Code	L2000E_S25_CR512_OXY_TEST_CONDTN_CD
L2000E	CR513	Oxygen Test Findings Code	L2000E_S25_CR513_OXY_TEST_FINDNGS_CD
L2000E	CR514	Oxygen Test Findings Code	L2000E_S25_CR514_OXY_TEST_FINDNGS_CD
L2000E	CR515	Oxygen Test Findings Code	L2000E_S25_CR515_OXY_TEST_FINDNGS_CD
L2000E	CR516	Portable Oxygen System Flow Rate	L2000E_S25_CR516_PORTBL_OXY_SYS_FLOW_RAT
L2000E	CR517	Oxygen Delivery System Code	L2000E_S25_CR517_OXY_DELVRY_SYS_CD
L2000E	CR518	Oxygen Equipment Type Code	L2000E_S25_CR518_OXY_EQPMNT_TYPE_CD
L2000E	CR6	Home Health Care Information
L2000E	CR601	Prognosis Code	L2000E_S26_CR601_PROGNS_CD
L2000E	CR602	Home Health Start Date	L2000E_S26_CR602_HOM_HEALTH_START_DT
L2000E	CR604	Range of Dates Expressed in Format CCYYMMDD- CCYYMMDD	L2000E_S26_CR604_HOM_HEALTH_CERT_PERD_OVL_RANG_DT_CCYYMMDD
L2000E	CR607	Medicare Coverage Indicator	L2000E_S26_CR607_MEDCR_COVG_IND
L2000E	CR608	Certification Type Code	L2000E_S26_CR608_CERT_TYPE_CD
L2000E	CR609	Surgery Date	L2000E_S26_CR609_SURGRY_DT
L2000E	CR611	Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes	L2000E_S26_CR611_SURGCL_PROC_CD_OVL_HCPCS_CD
L2000E	CR611	International Classification of Diseases, 9th	L2000E_S26_CR611_SURGCL_PROC_CD_OVL_ICD9
L2000E	CR612	Physician Order Date	L2000E_S26_CR612_PHYSCN_ORDR_DT
L2000E	CR613	Last Visit Date	L2000E_S26_CR613_LAST_VIST_DT
L2000E	CR614	Physician Contact Date	L2000E_S26_CR614_PHYSCN_CONTCT_DT
L2000E	CR616	Range of Dates Expressed in Format CCYYMMDD- CCYYMMDD	L2000E_S26_CR616_LAST_ADMSN_PERD_OVL_RANG_DT_CCYYMMDD
L2000E	CR617	Patient Location Code	L2000E_S26_CR617_PATNT_LOC_CD
L2000E	PWK	Additional Patient Information
L2000E	PWK01	Attachment Report Type Code	L2000E_S27_PWK01_ATCHMNT_REPRT_TYPE_CD
L2000E	PWK02	Report Transmission Code	L2000E_S27_PWK02_REPRT_TRANSMSN_CD
L2000E	PWK06	Attachment Control Number	L2000E_S27_PWK06_ATCHMNT_CONTRL_NR_OVL_ATCHMNT_CONTRL_NR
L2000E	PWK07	Attachment Description	L2000E_S27_PWK07_ATCHMNT_DESCRPTN
L2000E	MSG	Message Text
L2000E	MSG01	Free Form Message Text	L2000E_S28_MSG01_FRE_FORM_MESG_TEXT

2010EA - PATIENT EVENT PROVIDER NAME

Loop	Segment	Segment Name	Chiapas Gate Mapping
2010EA		Qualified Loop
L2010EA		Attending Physician	L2010EA_71
L2010EA		Operating Physician	L2010EA_72
L2010EA		Other Physician	L2010EA_73
L2010EA		Service Location	L2010EA_77
L2010EA		Admitting Services	L2010EA_AAJ
L2010EA		Assistant Surgeon	L2010EA_DD
L2010EA		Ordering Physician	L2010EA_DK
L2010EA		Referring Provider	L2010EA_DN
L2010EA		Facility	L2010EA_FA
L2010EA		Clinic	L2010EA_G3
L2010EA		Primary Care Provider	L2010EA_P3
L2010EA		Purchase Service Provider	L2010EA_QB
L2010EA		Group Practice	L2010EA_QV
L2010EA		Service Provider	L2010EA_SJ
L2010EA	NM1	Patient Event Provider Name
L2010EA	NM102	Entity Type Qualifier	L2010EA_XX_S01_NM102_ENTY_TYPE_QUAL
L2010EA	NM103	Patient Event Provider Last or Organization Name	L2010EA_XX_S01_NM103_LAST_ORG_NM
L2010EA	NM104	Patient Event Provider First Name	L2010EA_XX_S01_NM104_PATNT_EVNT_PROV_FNAME
L2010EA	NM105	Patient Event Provider Middle Name	L2010EA_XX_S01_NM105_PATNT_EVNT_PROV_MNAME
L2010EA	NM106	Patient Event Provider Name Prefix	L2010EA_XX_S01_NM106_NM_PREFX
L2010EA	NM107	Patient Event Provider Name Suffix	L2010EA_XX_S01_NM107_NM_SUFX
L2010EA	NM109	Employer’s Identification Number	L2010EA_XX_S01_NM109_PATNT_EVNT_PROV_ID_OVL_EMPLYR_ID_NR
L2010EA	NM109	Social Security Number	L2010EA_XX_S01_NM109_PATNT_EVNT_PROV_ID_OVL_SSN
L2010EA	NM109	Electronic Transmitter Identification Number (ETIN)	L2010EA_XX_S01_NM109_PATNT_EVNT_PROV_ID_OVL_ETN_NR
L2010EA	NM109	Centers for Medicare and Medicaid Services National Provider Identifier	L2010EA_XX_S01_NM109_PATNT_EVNT_PROV_ID_OVL_MDCR_MDCD_SVCS_NATNL_PROV_ID
L2010EA	REF	Patient Event Provider Supplemental Information
L2010EA	REF02	State License Number	L2010EA_XX_S02_REF02_ID_OVL_STAT_LICNS_NR
L2010EA	REF02	Provider UPIN Number	L2010EA_XX_S02_REF02_ID_OVL_PROV_UPN_NR
L2010EA	REF02	Facility ID Number	L2010EA_XX_S02_REF02_ID_OVL_FACLTY_ID_NR
L2010EA	REF02	Employer’s Identification Number	L2010EA_XX_S02_REF02_ID_OVL_EMPLYR_ID_NR
L2010EA	REF02	Provider Plan Network Identification Number	L2010EA_XX_S02_REF02_ID_OVL_PROV_PLAN_NETWRK_ID_NR
L2010EA	REF02	Facility Network Identification Number	L2010EA_XX_S02_REF02_ID_OVL_FACLTY_NETWRK_ID_NR
L2010EA	REF02	Social Security Number	L2010EA_XX_S02_REF02_ID_OVL_SSN
L2010EA	REF02	Carrier Assigned Reference Number	L2010EA_XX_S02_REF02_ID_OVL_CAR_ASGND_REF_NR
L2010EA	REF03	License Number State Code	L2010EA_XX_S02_REF03_LICNS_NR_STAT_CD
L2010EA	N3	Patient Event Provider Address
L2010EA	N301	Patient Event Provider Address Line	L2010EA_XX_S03_N301_ADRS_LIN
L2010EA	N302	Patient Event Provider Address Line	L2010EA_XX_S03_N302_ADRS_LIN
L2010EA	N4	Patient Event Provider City, State, ZIP Code
L2010EA	N401	Patient Event Provider City Name	L2010EA_XX_S04_N401_CITY_NM
L2010EA	N402	Patient Event Provider State Code	L2010EA_XX_S04_N402_STAT_CD
L2010EA	N403	Patient Event Provider Postal Zone or ZIP Code	L2010EA_XX_S04_N403_POSTL_ZON_ZIP_CD
L2010EA	N404	Country Code	L2010EA_XX_S04_N404_CNTRY_CD
L2010EA	N407	Country Subdivision Code	L2010EA_XX_S04_N407_COUNTRY_SUBDVSN_CD
L2010EA	PER	Patient Event Provider Contact Information
L2010EA	PER01	Contact Function Code	L2010EA_XX_S05_PER01_FUNCTN_CD
L2010EA	PER02	Patient Event Provider Contact Name	L2010EA_XX_S05_PER02_NM
L2010EA	PER04	Electronic Mail	L2010EA_XX_S05_PER04_COMM_OVL_EMAIL
L2010EA	PER04	Facsimile	L2010EA_XX_S05_PER04_COMM_OVL_FACSML
L2010EA	PER04	Telephone	L2010EA_XX_S05_PER04_COMM_OVL_TELPHN
L2010EA	PER04	Uniform Resource Locator (URL)	L2010EA_XX_S05_PER04_COMM_OVL_URL
L2010EA	PER06	Electronic Mail	L2010EA_XX_S05_PER06_COMM_OVL_EMAIL
L2010EA	PER06	Telephone Extension	L2010EA_XX_S05_PER06_COMM_OVL_PHN_EXTNS
L2010EA	PER06	Facsimile	L2010EA_XX_S05_PER06_COMM_OVL_FACSML
L2010EA	PER06	Telephone	L2010EA_XX_S05_PER06_COMM_OVL_TELPHN
L2010EA	PER06	Uniform Resource Locator (URL)	L2010EA_XX_S05_PER06_COMM_OVL_URL
L2010EA	PER08	Electronic Mail	L2010EA_XX_S05_PER08_COMM_OVL_EMAIL
L2010EA	PER08	Telephone Extension	L2010EA_XX_S05_PER08_COMM_OVL_PHN_EXTNS
L2010EA	PER08	Facsimile	L2010EA_XX_S05_PER08_COMM_OVL_FACSML
L2010EA	PER08	Telephone	L2010EA_XX_S05_PER08_COMM_OVL_TELPHN
L2010EA	PER08	Uniform Resource Locator (URL)	L2010EA_XX_S05_PER08_COMM_OVL_URL
L2010EA	PRV	Patient Event Provider Information
L2010EA	PRV01	Provider Code	L2010EA_XX_S06_PRV01_PROV_CD
L2010EA	PRV03	Health Care Provider Taxonomy Code	L2010EA_XX_S06_PRV03_TAXNMY_CD_OVL_HLTHCR_PROV_TAXNMY_CD

2010EB - PATIENT EVENT TRANSPORT INFORMATION

Loop	Segment	Segment Name	Chiapas Gate Mapping
2010EB		Qualified Loop
L2010EB		Drop-off Location	L2010EB_45
L2010EB		Final Scheduled Destination	L2010EB_FS
L2010EB		Next Destination	L2010EB_ND
L2010EB		Pickup Address	L2010EB_PW
L2010EB		Next Scheduled Destination	L2010EB_R3
L2010EB	NM1	Patient Event Transport Information
L2010EB	NM102	Entity Type Qualifier	L2010EB_XX_S01_NM102_ENTY_TYPE_QUAL
L2010EB	NM103	Patient Event Transport Location Name	L2010EB_XX_S01_NM103_LOC_NM
L2010EB	N3	Patient Event Transport Location Address
L2010EB	N301	Patient Event Transport Location Address Line	L2010EB_XX_S02_N301_ADRS_LIN
L2010EB	N302	Patient Event Transport Location Address Line	L2010EB_XX_S02_N302_ADRS_LIN
L2010EB	N4	Patient Event Transport Location City/State/ZIP Code
L2010EB	N401	Patient Event Transport Location City Name	L2010EB_XX_S03_N401_CITY_NM
L2010EB	N402	Patient Event Transport Location State or	L2010EB_XX_S03_N402_STAT_OR
L2010EB	N403	Patient Event Transport Location Postal Zone or	L2010EB_XX_S03_N403_POSTL_ZON

2010EC - PATIENT EVENT OTHER UMO NAME

Loop	Segment	Segment Name	Chiapas Gate Mapping
2010EC		Qualified Loop
L2010EC		Alternate Insurer	L2010EC_00
L2010EC		Carrier	L2010EC_CA
L2010EC		Intermediary	L2010EC_GG
L2010EC	NM1	Patient Event Other UMO Name
L2010EC	NM102	Entity Type Qualifier	L2010EC_XX_S01_NM102_ENTY_TYPE_QUAL
L2010EC	NM103	Other UMO Name	L2010EC_XX_S01_NM103_UM_NM
L2010EC	REF	Other UMO Denial Reason
L2010EC	REF02	Mutually Defined	L2010EC_XX_S02_REF02_OTHR_UM_DENL_RSN_OVL_MUTLY_DEFND
L2010EC	REF04-02	Mutually Defined	L2010EC_XX_S02_REF04_02_OTHR_UM_DENL_RSN_OVL_MUTLY_DEFND
L2010EC	REF04-04	Mutually Defined	L2010EC_XX_S02_REF04_04_OTHR_UM_DENL_RSN_OVL_MUTLY_DEFND
L2010EC	REF04-06	Mutually Defined	L2010EC_XX_S02_REF04_06_REF_ID_OVL_MUTLY_DEFND
L2010EC	DTP	Other UMO Denial Date
L2010EC	DTP03	Rejected (D8)	L2010EC_XX_S03_DTP03_OTHR_UM_DENL_DT_OVL_REJCTD_D8

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	UM	Health Care Services Review Information
L2000F	UM01	Request Category Code	L2000F_S03_UM01_REQST_CATGRY_CD
L2000F	UM02	Certification Type Code	L2000F_S03_UM02_CERT_TYPE_CD
L2000F	UM03	Service Type Code	L2000F_S03_UM03_TYPE_CD
L2000F	UM04-01	Facility Type Code	L2000F_S03_UM04_01_FACLTY_TYPE_CD
L2000F	UM04-02	Facility Code Qualifier	L2000F_S03_UM04_02_FACLTY_CD_QUAL
L2000F	REF	Previous Review Authorization Number
L2000F	REF02	Authorization Number	L2000F_S04_REF02_PREVS_REVW_AUTH_NR_OVL_AUTH_NR
L2000F	REF	Previous Review Administrative Reference Number
L2000F	REF02	Administrator’s Reference Number	L2000F_S05_REF02_PREVS_ADMIN_REF_NR_OVL_ADMNSTRTR_REF_NR
L2000F	DTP	Service Date
L2000F	DTP03	Service (D8)	L2000F_S06_DTP03_PROPSD_ACTL_SVC_DT_OVL_SVC_D8
L2000F	DTP03	Service (RD8)	L2000F_S06_DTP03_PROPSD_ACTL_SVC_DT_OVL_SVC_RD8
L2000F	SV1	Professional Service
L2000F	SV101-02	Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes	L2000F_S07_SV101_02_PROC_CD_OVL_HCPCS_CD
L2000F	SV101-02	Home Infusion EDI Coalition (HIEC) Product/Service Code	L2000F_S07_SV101_02_PROC_CD_OVL_HIEC_PRODCT_SRVC_CD
L2000F	SV101-02	National Drug Code in 5-4-2 Format	L2000F_S07_SV101_02_PROC_CD_OVL_NDC_542_FORMT
L2000F	SV101-02	Advanced Billing Concepts (ABC) Codes	L2000F_S07_SV101_02_PROC_CD_OVL_ABC_CD
L2000F	SV101-03	Procedure Modifier	L2000F_S07_SV101_03_PROC_MODFR
L2000F	SV101-04	Procedure Modifier	L2000F_S07_SV101_04_PROC_MODFR
L2000F	SV101-05	Procedure Modifier	L2000F_S07_SV101_05_PROC_MODFR
L2000F	SV101-06	Procedure Modifier	L2000F_S07_SV101_06_PROC_MODFR
L2000F	SV101-07	Procedure Code Description	L2000F_S07_SV101_07_PROC_CD_DESCRPTN
L2000F	SV101-08	Procedure Code	L2000F_S07_SV101_08_PROC_CD
L2000F	SV102	Service Line Amount	L2000F_S07_SV102_SVC_LIN_AMT
L2000F	SV104	International Unit	L2000F_S07_SV104_SVC_UNT_CT_OVL_INTRNTNL_UNT
L2000F	SV104	Minutes	L2000F_S07_SV104_SVC_UNT_CT_OVL_MINTS
L2000F	SV104	Unit	L2000F_S07_SV104_SVC_UNT_CT_OVL_UNT
L2000F	SV107-01	Diagnosis Code Pointer	L2000F_S07_SV107_01_DIAG_CD_POINTR
L2000F	SV107-02	Diagnosis Code Pointer	L2000F_S07_SV107_02_DIAG_CD_POINTR
L2000F	SV107-03	Diagnosis Code Pointer	L2000F_S07_SV107_03_DIAG_CD_POINTR
L2000F	SV107-04	Diagnosis Code Pointer	L2000F_S07_SV107_04_DIAG_CD_POINTR
L2000F	SV111	EPSDT Indicator	L2000F_S07_SV111_EPSDT_IND
L2000F	SV120	Nursing Home Level of Care	L2000F_S07_SV120_NURSNG_HOM_LEVL_CAR
L2000F	SV2	Institutional Service Line
L2000F	SV201	Service Line Revenue Code	L2000F_S08_SV201_SVC_LIN_REVN_CD
L2000F	SV202-02	Health Care Financing Administration Common	L2000F_S08_SV202_02_PROC_CD_OVL_HCFA_COMN
L2000F	SV202-02	International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) -	L2000F_S08_SV202_02_PROC_CD_OVL_ICD9CM
L2000F	SV202-02	Home Infusion EDI Coalition (HIEC) Product/Service Code	L2000F_S08_SV202_02_PROC_CD_OVL_HIEC_PRODCT_SRVC_CD
L2000F	SV202-02	National Drug Code in 5-4-2 Format	L2000F_S08_SV202_02_PROC_CD_OVL_NDC_542_FORMT
L2000F	SV202-02	Advanced Billing Concepts (ABC) Codes	L2000F_S08_SV202_02_PROC_CD_OVL_ABC_CD
L2000F	SV202-02	Mutually Defined	L2000F_S08_SV202_02_PROC_CD_OVL_MUTLY_DEFND
L2000F	SV202-03	Procedure Modifier	L2000F_S08_SV202_03_PROC_MODFR
L2000F	SV202-04	Procedure Modifier	L2000F_S08_SV202_04_PROC_MODFR
L2000F	SV202-05	Procedure Modifier	L2000F_S08_SV202_05_PROC_MODFR
L2000F	SV202-06	Procedure Modifier	L2000F_S08_SV202_06_PROC_MODFR
L2000F	SV202-07	Procedure Code Description	L2000F_S08_SV202_07_PROC_CD_DESCRPTN
L2000F	SV202-08	Procedure Code	L2000F_S08_SV202_08_PROC_CD
L2000F	SV203	Service Line Amount	L2000F_S08_SV203_LIN_AMT
L2000F	SV205	Days	L2000F_S08_SV205_UNT_CT_OVL_DAYS
L2000F	SV205	International Unit	L2000F_S08_SV205_UNT_CT_OVL_INTRNTNL_UNT
L2000F	SV205	Unit	L2000F_S08_SV205_UNT_CT_OVL_UNT
L2000F	SV206	Service Line Rate	L2000F_S08_SV206_LIN_RAT
L2000F	SV209	Nursing Home Residential Status Code	L2000F_S08_SV209_NRSNG_HM_RES_STATS_CD
L2000F	SV210	Nursing Home Level of Care	L2000F_S08_SV210_NURSNG_HOM_LEVL_CAR
L2000F	SV3	Dental Service
L2000F	SV301-02	American Dental Association Codes	L2000F_S09_SV301_02_PROC_CD_OVL_AMRCN_DENTL_ASCTN_CD
L2000F	SV301-03	Procedure Modifier	L2000F_S09_SV301_03_PROC_MODFR
L2000F	SV301-04	Procedure Modifier	L2000F_S09_SV301_04_PROC_MODFR
L2000F	SV301-05	Procedure Modifier	L2000F_S09_SV301_05_PROC_MODFR
L2000F	SV301-06	Procedure Modifier	L2000F_S09_SV301_06_PROC_MODFR
L2000F	SV301-07	Procedure Code Description	L2000F_S09_SV301_07_PROC_CD_DESCRPTN
L2000F	SV301-08	Procedure Code	L2000F_S09_SV301_08_PROC_CD
L2000F	SV302	Service Line Amount	L2000F_S09_SV302_SVC_LIN_AMT
L2000F	SV304-01	Oral Cavity Designation Code	L2000F_S09_SV304_01_ORL_CAVTY_DESGNTN_CD
L2000F	SV304-02	Oral Cavity Designation Code	L2000F_S09_SV304_02_ORL_CAVTY_DESGNTN_CD
L2000F	SV304-03	Oral Cavity Designation Code	L2000F_S09_SV304_03_ORL_CAVTY_DESGNTN_CD
L2000F	SV304-04	Oral Cavity Designation Code	L2000F_S09_SV304_04_ORL_CAVTY_DESGNTN_CD
L2000F	SV304-05	Oral Cavity Designation Code	L2000F_S09_SV304_05_ORL_CAVTY_DESGNTN_CD
L2000F	SV305	Prosthesis, Crown, or Inlay Code	L2000F_S09_SV305_PROSTHS_CROWN_INLY_CD
L2000F	SV306	Service Unit Count	L2000F_S09_SV306_SVC_UNT_CT
L2000F	SV307	Description	L2000F_S09_SV307_DESCRPTN
L2000F	TOO	Tooth Information
L2000F	TOO02	Universal National Tooth Designation System	L2000F_S10_TOO02_TOTH_CD_OVL_UNVRSL_NATNL_TOTH_DESGNTN_SYS
L2000F	TOO03-01	Tooth Surface Code	L2000F_S10_TOO03_01_TOTH_SURFC_CD
L2000F	TOO03-02	Tooth Surface Code	L2000F_S10_TOO03_02_TOTH_SURFC_CD
L2000F	TOO03-03	Tooth Surface Code	L2000F_S10_TOO03_03_TOTH_SURFC_CD
L2000F	TOO03-04	Tooth Surface Code	L2000F_S10_TOO03_04_TOTH_SURFC_CD
L2000F	TOO03-05	Tooth Surface Code	L2000F_S10_TOO03_05_TOTH_SURFC_CD
L2000F	HSD	Health Care Services Delivery
L2000F	HSD02	Days	L2000F_S11_HSD02_UNT_CT_OVL_DAYS
L2000F	HSD02	Units	L2000F_S11_HSD02_UNT_CT_OVL_UNTS
L2000F	HSD02	Hours	L2000F_S11_HSD02_UNT_CT_OVL_HOURS
L2000F	HSD02	Month	L2000F_S11_HSD02_UNT_CT_OVL_MONTH
L2000F	HSD02	Visits	L2000F_S11_HSD02_UNT_CT_OVL_VISTS
L2000F	HSD04	Days	L2000F_S11_HSD04_SAMPL_SELCTN_MODLS_OVL_DAYS
L2000F	HSD04	Months	L2000F_S11_HSD04_SAMPL_SELCTN_MODLS_OVL_MONTHS
L2000F	HSD04	Week	L2000F_S11_HSD04_SAMPL_SELCTN_MODLS_OVL_WEK
L2000F	HSD06	Hour	L2000F_S11_HSD06_PERD_CT_OVL_HOUR
L2000F	HSD06	Day	L2000F_S11_HSD06_PERD_CT_OVL_DAY
L2000F	HSD06	Years	L2000F_S11_HSD06_PERD_CT_OVL_YRS
L2000F	HSD06	Episode	L2000F_S11_HSD06_PERD_CT_OVL_EPSD
L2000F	HSD06	Visit	L2000F_S11_HSD06_PERD_CT_OVL_VIST
L2000F	HSD06	Month	L2000F_S11_HSD06_PERD_CT_OVL_MONTH
L2000F	HSD06	Week	L2000F_S11_HSD06_PERD_CT_OVL_WEK
L2000F	HSD07	Delivery Frequency Code	L2000F_S11_HSD07_DELVRY_FREQNCY_CD
L2000F	HSD08	Delivery Pattern Time Code	L2000F_S11_HSD08_DELVRY_PATRN_TIM_CD
L2000F	PWK	Additional Service Information
L2000F	PWK01	Attachment Report Type Code	L2000F_S12_PWK01_ATCHMNT_REPRT_TYPE_CD
L2000F	PWK02	Report Transmission Code	L2000F_S12_PWK02_REPRT_TRANSMSN_CD
L2000F	PWK06	Attachment Control Number	L2000F_S12_PWK06_ATCHMNT_CONTRL_NR_OVL_ATCHMNT_CONTRL_NR
L2000F	PWK07	Attachment Description	L2000F_S12_PWK07_ATCHMNT_DESCRPTN
L2000F	MSG	Message Text
L2000F	MSG01	Free Form Message Text	L2000F_S13_MSG01_FRE_FORM_MESG_TEXT

2010F - SERVICE PROVIDER NAME

Loop	Segment	Segment Name	Chiapas Gate Mapping
2010F		Qualified Loop
L2010F		Physician, Clinic or Group Practice	L2010F_1T
L2010F		Operating Physician	L2010F_72
L2010F		Other Physician	L2010F_73
L2010F		Service Location	L2010F_77
L2010F		Assistant Surgeon	L2010F_DD
L2010F		Ordering Physician	L2010F_DK
L2010F		Supervising Physician	L2010F_DQ
L2010F		Facility	L2010F_FA
L2010F		Clinic	L2010F_G3
L2010F		Primary Care Provider	L2010F_P3
L2010F		Purchase Service Provider	L2010F_QB
L2010F		Group Practice	L2010F_QV
L2010F		Service Provider	L2010F_SJ
L2010F	NM1	Service Provider Name
L2010F	NM102	Entity Type Qualifier	L2010F_XX_S01_NM102_ENTY_TYPE_QUAL
L2010F	NM103	Service Provider Last or Organization Name	L2010F_XX_S01_NM103_SVC_PROV_LAST_ORG_NM
L2010F	NM104	Service Provider First Name	L2010F_XX_S01_NM104_SVC_PROV_FNAME
L2010F	NM105	Service Provider Middle Name	L2010F_XX_S01_NM105_SVC_PROV_MNAME
L2010F	NM106	Service Provider Name Prefix	L2010F_XX_S01_NM106_SVC_PROV_NM_PREFX
L2010F	NM107	Service Provider Name Suffix	L2010F_XX_S01_NM107_SVC_PROV_NM_SUFX
L2010F	NM109	Employer’s Identification Number	L2010F_XX_S01_NM109_SVC_PROV_ID_OVL_EMPLYR_ID_NR
L2010F	NM109	Social Security Number	L2010F_XX_S01_NM109_SVC_PROV_ID_OVL_SSN
L2010F	NM109	Electronic Transmitter Identification Number (ETIN)	L2010F_XX_S01_NM109_SVC_PROV_ID_OVL_ETN_NR
L2010F	NM109	Centers for Medicare and Medicaid Services National Provider Identifier	L2010F_XX_S01_NM109_SVC_PROV_ID_OVL_MDCR_MDCD_SVCS_NATNL_PROV_ID
L2010F	REF	Service Provider Supplemental Identification
L2010F	REF02	State License Number	L2010F_XX_S02_REF02_SVC_PROV_SUPP_ID_OVL_STAT_LICNS_NR
L2010F	REF02	Provider UPIN Number	L2010F_XX_S02_REF02_SVC_PROV_SUPP_ID_OVL_PROV_UPN_NR
L2010F	REF02	Facility ID Number	L2010F_XX_S02_REF02_SVC_PROV_SUPP_ID_OVL_FACLTY_ID_NR
L2010F	REF02	Employer’s Identification Number	L2010F_XX_S02_REF02_SVC_PROV_SUPP_ID_OVL_EMPLYR_ID_NR
L2010F	REF02	Provider Plan Network Identification Number	L2010F_XX_S02_REF02_SVC_PROV_SUPP_ID_OVL_PROV_PLAN_NETWRK_ID_NR
L2010F	REF02	Facility Network Identification Number	L2010F_XX_S02_REF02_SVC_PROV_SUPP_ID_OVL_FACLTY_NETWRK_ID_NR
L2010F	REF02	Social Security Number	L2010F_XX_S02_REF02_SVC_PROV_SUPP_ID_OVL_SSN
L2010F	REF02	Carrier Assigned Reference Number	L2010F_XX_S02_REF02_SVC_PROV_SUPP_ID_OVL_CAR_ASGND_REF_NR
L2010F	REF03	License Number State Code	L2010F_XX_S02_REF03_LICNS_NR_STAT_CD
L2010F	N3	Service Provider Address
L2010F	N301	Service Provider Address Line	L2010F_XX_S03_N301_SVC_PROV_ADRS_LIN
L2010F	N302	Service Provider Address Line	L2010F_XX_S03_N302_SVC_PROV_ADRS_LIN
L2010F	N4	Service Provider City, State, ZIP Code
L2010F	N401	Service Provider City Name	L2010F_XX_S04_N401_SVC_PROV_CITY_NM
L2010F	N402	Service Provider State or Province Code	L2010F_XX_S04_N402_SVC_PROV_STAT_PROVNC_CD
L2010F	N403	Service Provider Postal Zone or ZIP Code	L2010F_XX_S04_N403_SVC_PROV_POSTL_ZON_ZIP_CD
L2010F	N404	Country Code	L2010F_XX_S04_N404_CNTRY_CD
L2010F	N407	Country Subdivision Code	L2010F_XX_S04_N407_COUNTRY_SUBDVSN_CD
L2010F	PER	Service Provider Contact Information
L2010F	PER01	Contact Function Code	L2010F_XX_S05_PER01_FUNCTN_CD
L2010F	PER02	Service Provider Contact Name	L2010F_XX_S05_PER02_SVC_PROV_CONTCT_NM
L2010F	PER04	Electronic Mail	L2010F_XX_S05_PER04_SVC_PROV_CONTCT_COMNCTN_NR_OVL_EMAIL
L2010F	PER04	Facsimile	L2010F_XX_S05_PER04_SVC_PROV_CONTCT_COMNCTN_NR_OVL_FACSML
L2010F	PER04	Telephone	L2010F_XX_S05_PER04_SVC_PROV_CONTCT_COMNCTN_NR_OVL_TELPHN
L2010F	PER04	Uniform Resource Locator (URL)	L2010F_XX_S05_PER04_SVC_PROV_CONTCT_COMNCTN_NR_OVL_URL
L2010F	PER06	Electronic Mail	L2010F_XX_S05_PER06_SVC_PROV_CONTCT_COMNCTN_NR_OVL_EMAIL
L2010F	PER06	Telephone Extension	L2010F_XX_S05_PER06_SVC_PROV_CONTCT_COMNCTN_NR_OVL_PHN_EXTNS
L2010F	PER06	Facsimile	L2010F_XX_S05_PER06_SVC_PROV_CONTCT_COMNCTN_NR_OVL_FACSML
L2010F	PER06	Telephone	L2010F_XX_S05_PER06_SVC_PROV_CONTCT_COMNCTN_NR_OVL_TELPHN
L2010F	PER06	Uniform Resource Locator (URL)	L2010F_XX_S05_PER06_SVC_PROV_CONTCT_COMNCTN_NR_OVL_URL
L2010F	PER08	Electronic Mail	L2010F_XX_S05_PER08_SVC_PROV_CONTCT_COMNCTN_NR_OVL_EMAIL
L2010F	PER08	Telephone Extension	L2010F_XX_S05_PER08_SVC_PROV_CONTCT_COMNCTN_NR_OVL_PHN_EXTNS
L2010F	PER08	Facsimile	L2010F_XX_S05_PER08_SVC_PROV_CONTCT_COMNCTN_NR_OVL_FACSML
L2010F	PER08	Telephone	L2010F_XX_S05_PER08_SVC_PROV_CONTCT_COMNCTN_NR_OVL_TELPHN
L2010F	PER08	Uniform Resource Locator (URL)	L2010F_XX_S05_PER08_SVC_PROV_CONTCT_COMNCTN_NR_OVL_URL
L2010F	PRV	Service Provider Information
L2010F	PRV01	Provider Code	L2010F_XX_S06_PRV01_PROV_CD
L2010F	PRV03	Health Care Provider Taxonomy Code	L2010F_XX_S06_PRV03_TAXNMY_CD_OVL_HLTHCR_PROV_TAXNMY_CD