(C) Copyright 2012 Chiapas EDI Technologies, Inc.
5010_824 5010 Application Reporting for Insurance - Code:P7
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 | Qualified Loop | ||
| GSHDR | 5010_824_CD | GSHDR_005010X186 | |
| GSHDR | 5010_824_A1_CD | GSHDR_005010X186A1 | |
| GSHDR | GS | Functional Group Header | |
| GSHDR | GS01 | Functional Identifier Code | GSHDR_XX_S01_GS01_FUNCTL_ID_CD |
| GSHDR | GS02 | Application Senders Code | GSHDR_XX_S01_GS02_APP_SENDR_CD |
| GSHDR | GS03 | Application Receivers Code | GSHDR_XX_S01_GS03_APP_RECVR_CD |
| GSHDR | GS04 | Date | GSHDR_XX_S01_GS04_DT |
| GSHDR | GS05 | Time | GSHDR_XX_S01_GS05_TM |
| GSHDR | GS06 | Group Control Number | GSHDR_XX_S01_GS06_GCN |
| GSHDR | GS07 | Responsible Agency Code | GSHDR_XX_S01_GS07_RESP_AGNCY_CD |
| GSHDR | GE | Functional Group Trailer | |
| GSHDR | GE01 | Number of Transaction Sets Included | GSHDR_XX_S03_GE01_TS_CT |
| GSHDR | GE02 | Group Control Number | GSHDR_XX_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 Convention Reference Identifier | STHDR_S01_ST03_IMP_CONV_REF_ID |
| STHDR | BGN | Beginning Segment | |
| STHDR | BGN01 | Transaction Set Purpose Code | STHDR_S02_BGN01_TS_PURPS_CD |
| STHDR | BGN02 | Transaction Set Identifier Code | STHDR_S02_BGN02_TS_ID_CD |
| STHDR | BGN03 | Transaction Set Creation Date | STHDR_S02_BGN03_TS_CRTN_DT |
| STHDR | BGN04 | Transaction Set Creation Time | STHDR_S02_BGN04_TS_CREATN_TM |
| STHDR | BGN06 | Referenced Interchange Control Number | STHDR_S02_BGN06_REF_ICN |
| STHDR | BGN08 | Action Code | STHDR_S02_BGN08_ACTN_CD |
| STHDR | SE | Transaction Set Trailer | |
| STHDR | SE01 | Transaction Segment Count | STHDR_S06_SE01_SEG_CT |
| STHDR | SE02 | Transaction Set Control Number | STHDR_S06_SE02_TCN |
1000A - Submitter Name
| Loop | Segment | Segment Name | Chiapas Gate Mapping |
| L1000A | N1 | Submitter Name | |
| L1000A | N102 | Submitter Name | L1000A_S01_N102_SUBMTR_NM |
| L1000A | N104 | D-U-N-S Number, Dun and Bradstreet | L1000A_S01_N104_SUBMTR_ID_OVL_DUNS_NR_DUN_BRADSTRT |
| L1000A | N104 | D-U-N-S+4, D-U-N-S Number with Four Character Suffix | L1000A_S01_N104_SUBMTR_ID_OVL_DUNS4_DUNS_NR_WITH_4CHAR_SUFX |
| L1000A | N104 | Employers Identification Number | L1000A_S01_N104_SUBMTR_ID_OVL_EMPLYR_ID_NR |
| L1000A | N104 | Electronic Transmitter Identification Number (ETIN) | L1000A_S01_N104_SUBMTR_ID_OVL_ETIN |
| L1000A | N104 | State or Province Assigned Number | L1000A_S01_N104_SUBMTR_ID_OVL_STAT_PROVNC_ASGND_NR |
| L1000A | N104 | Insurance Company Assigned Identification Number | L1000A_S01_N104_SUBMTR_ID_OVL_INS_CO_ASGND_ID_NR |
| L1000A | N104 | Federal Taxpayers Identification Number | L1000A_S01_N104_SUBMTR_ID_OVL_FED_TAX_ID_NR |
| L1000A | N104 | Payor Identification | L1000A_S01_N104_SUBMTR_ID_OVL_PAYR_ID |
| L1000A | N104 | Centers for Medicare and Medicaid Services Plan ID | L1000A_S01_N104_SUBMTR_ID_OVL_MDCR_MDCD_PLN_ID |
| L1000A | N104 | Centers for Medicare and Medicaid Services National Provider Identifier | L1000A_S01_N104_SUBMTR_ID_OVL_MDCR_MDCD_NPI |
| L1000A | REF | Submitter Secondary Identifier | |
| L1000A | REF02 | Branch Identifier | L1000A_S02_REF02_SBMTR_BRNCH_ID_CD_OVL_BRNCH_ID |
| L1000A | PER | Submitter EDI Contact Information | |
| L1000A | PER01 | Contact Function Code | L1000A_S03_PER01_FUNCTN_CD |
| L1000A | PER02 | Submitter Contact Name | L1000A_S03_PER02_SUB_CONTCT_NM |
| L1000A | PER04 | Electronic Mail | L1000A_S03_PER04_COMNCTN_NR_OVL_EMAIL |
| L1000A | PER04 | Facsimile | L1000A_S03_PER04_COMNCTN_NR_OVL_FACSML |
| L1000A | PER04 | Telephone | L1000A_S03_PER04_COMNCTN_NR_OVL_TELPHN |
| L1000A | PER06 | Electronic Mail | L1000A_S03_PER06_NFO_RECVR_COMNCTN_NR_OVL_EMAIL |
| L1000A | PER06 | Telephone Extension | L1000A_S03_PER06_NFO_RECVR_COMNCTN_NR_OVL_PHN_EXTNS |
| L1000A | PER06 | Facsimile | L1000A_S03_PER06_NFO_RECVR_COMNCTN_NR_OVL_FACSML |
| L1000A | PER06 | Telephone | L1000A_S03_PER06_NFO_RECVR_COMNCTN_NR_OVL_TELPHN |
| L1000A | PER08 | Electronic Mail | L1000A_S03_PER08_NFO_RECVR_COMNCTN_NR_OVL_EMAIL |
| L1000A | PER08 | Telephone Extension | L1000A_S03_PER08_NFO_RECVR_COMNCTN_NR_OVL_PHN_EXTNS |
| L1000A | PER08 | Facsimile | L1000A_S03_PER08_NFO_RECVR_COMNCTN_NR_OVL_FACSML |
| L1000A | PER08 | Telephone | L1000A_S03_PER08_NFO_RECVR_COMNCTN_NR_OVL_TELPHN |
1000B - Receiver Name
| Loop | Segment | Segment Name | Chiapas Gate Mapping |
| L1000B | N1 | Receiver Name | |
| L1000B | N102 | Reciever Name | L1000B_S01_N102_RCVR_NM |
| L1000B | N104 | D-U-N-S Number, Dun and Bradstreet | L1000B_S01_N104_RECVR_ID_OVL_DUNS_NR_DUN_BRADSTRT |
| L1000B | N104 | D-U-N-S+4, D-U-N-S Number with Four Character Suffix | L1000B_S01_N104_RECVR_ID_OVL_DUNS4_DUNS_NR_WITH_4CHAR_SUFX |
| L1000B | N104 | Employers Identification Number | L1000B_S01_N104_RECVR_ID_OVL_EMPLYR_ID_NR |
| L1000B | N104 | Electronic Transmitter Identification Number (ETIN) | L1000B_S01_N104_RECVR_ID_OVL_ETIN |
| L1000B | N104 | State or Province Assigned Number | L1000B_S01_N104_RECVR_ID_OVL_STAT_PROVNC_ASGND_NR |
| L1000B | N104 | Insurance Company Assigned Identification Number | L1000B_S01_N104_RECVR_ID_OVL_INS_CO_ASGND_ID_NR |
| L1000B | N104 | Federal Taxpayers Identification Number | L1000B_S01_N104_RECVR_ID_OVL_FED_TAX_ID_NR |
| L1000B | N104 | Payor Identification | L1000B_S01_N104_RECVR_ID_OVL_PAYR_ID |
| L1000B | N104 | Centers for Medicare and Medicaid Services Plan ID | L1000B_S01_N104_RECVR_ID_OVL_MDCR_MDCD_PLN_ID |
| L1000B | N104 | Centers for Medicare and Medicaid Services National Provider Identifier | L1000B_S01_N104_RECVR_ID_OVL_MDCR_MDCD_NPI |
2000 - Original Transaction Identification
| Loop | Segment | Segment Name | Chiapas Gate Mapping |
| L2000 | OTI | Original Transaction Identification | |
| L2000 | OTI01 | Application Acknowledgment Code | L2000_S01_OTI01_APP_ACK_CD |
| L2000 | OTI03 | Batch Number | L2000_S01_OTI03_EDT_LVL_REF_ID_OVL_BATCH_NR |
| L2000 | OTI03 | Item Number | L2000_S01_OTI03_EDT_LVL_REF_ID_OVL_ITEM_NR |
| L2000 | OTI03 | Transaction Reference Number | L2000_S01_OTI03_EDT_LVL_REF_ID_OVL_TS_REF_NR |
| L2000 | OTI06 | Functional Group Creation Date | L2000_S01_OTI06_FUNC_GRP_CRTN_DT |
| L2000 | OTI07 | Functional Group Creation Time | L2000_S01_OTI07_FUNC_GRP_CRTN_TM |
| L2000 | OTI08 | Functional Group Control Number | L2000_S01_OTI08_GCN |
| L2000 | OTI09 | Transaction Set Control Number | L2000_S01_OTI09_TCN |
| L2000 | OTI10 | Transaction Set Identifier Code | L2000_S01_OTI10_TS_ID_CD |
| L2000 | OTI11 | Version Release Industry Identifier | L2000_S01_OTI11_VERS_RLS_ID |
| L2000 | REF | Exchange Report Document Control Number | |
| L2000 | REF02 | System Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_SYS_NR |
| L2000 | REF02 | State License Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_ST_LIC_NR |
| L2000 | REF02 | Subscriber Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_SUB_NR |
| L2000 | REF02 | Mortgage Identification Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_MORTG_ID_NR |
| L2000 | REF02 | Account Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_ACCT_NR |
| L2000 | REF02 | Master Account Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_MASTR_ACCT_NR |
| L2000 | REF02 | Client Reporting Category | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_CLNT_REP_CAT |
| L2000 | REF02 | Plan Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_PLAN_NR |
| L2000 | REF02 | Blue Cross Provider Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_BC_PROV_NR |
| L2000 | REF02 | Blue Shield Provider Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_BS_PROV_NR |
| L2000 | REF02 | Medicare Provider Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_MDCR_PROV_NR |
| L2000 | REF02 | Medicaid Provider Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_MDCD_PROV_NR |
| L2000 | REF02 | Dentist License Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_DENT_LIC_NR |
| L2000 | REF02 | Anesthesia License Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_ANES_LIC_NR |
| L2000 | REF02 | Provider UPIN Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_PROV_UPIN_NR |
| L2000 | REF02 | CHAMPUS Identification Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_CHAMPUS_ID |
| L2000 | REF02 | Facility ID Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_FAC_ID_NR |
| L2000 | REF02 | Payors Claim Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_PAYRS_CLM_NR |
| L2000 | REF02 | Group or Policy Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_GRP_POLCY_NR |
| L2000 | REF02 | Ambulatory Patient Group (APG) Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_APG_NR |
| L2000 | REF02 | Member Identification Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_MEM_ID_NR |
| L2000 | REF02 | Client Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_CLIENT_NR |
| L2000 | REF02 | Employee Identification Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_EMP_ID_NR |
| L2000 | REF02 | Consolidated Invoice Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_CONSLDT_INVC_NR |
| L2000 | REF02 | Tracking Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_TRACKNG_NR |
| L2000 | REF02 | Payer Identification Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_PAYR_ID_NR |
| L2000 | REF02 | Lender Case Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_LENDR_CASE_NR |
| L2000 | REF02 | Master Policy Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_MASTR_POLCY_NR |
| L2000 | REF02 | Case Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_CASE_NR |
| L2000 | REF02 | Office Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_OFFC_NR |
| L2000 | REF02 | Family Unit Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_FAM_UNT_NR |
| L2000 | REF02 | Personal Identification Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_PIN |
| L2000 | REF02 | Special Payment Reference Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_SPEC_PMT_REF_NR |
| L2000 | REF02 | Complaint | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_COMPLNT |
| L2000 | REF02 | Incident | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_INCIDENT |
| L2000 | REF02 | Account Suffix Code | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_ACCT_SFX_CD |
| L2000 | REF02 | Claimant Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_CLMNT_NR |
| L2000 | REF02 | Group Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_GRP_NR |
| L2000 | REF02 | Provider Control Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_PROV_CTL_NR |
| L2000 | REF02 | Schedule Reference Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_SCHED_REF_NR |
| L2000 | REF02 | Subscriber Authorization Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_SUB_AUTH_NR |
| L2000 | REF02 | List of Materials | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_LST_MTLS |
| L2000 | REF02 | Functional Category | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_FUNC_CAT |
| L2000 | REF02 | Assembly Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_ASSBLY_NR |
| L2000 | REF02 | Bank Assigned Security Identifier | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_BANK_ASS_SEC_ID |
| L2000 | REF02 | Transaction Category or Type | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_TRANS_CAT_TYP |
| L2000 | REF02 | File Identification Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_FILE_ID_NR |
| L2000 | REF02 | Repriced Claim Reference Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_REP_CLM_REF_NR |
| L2000 | REF02 | Repriced Line Item Reference Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_REP_LIN_ITM_REF_NR |
| L2000 | REF02 | Adjusted Repriced Claim Reference Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_ADJ_REP_CLM_REF_NR |
| L2000 | REF02 | Adjusted Repriced Line Item Reference Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_ADJ_REP_LIN_ITM_REF_NR |
| L2000 | REF02 | Servicer | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_SERVCR |
| L2000 | REF02 | Investor | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_INVSTR |
| L2000 | REF02 | Job Order Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_JOB_ORD_NR |
| L2000 | REF02 | Health Insurance Account Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_HLTH_INS_ACCT_NR |
| L2000 | REF02 | Agent Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_AGNT_NR |
| L2000 | REF02 | Acceptable Source Purchaser ID | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_ACC_SRC_PURCH_ID |
| L2000 | REF02 | Master Property Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_MASTR_PROP_NR |
| L2000 | REF02 | Health Insurance Policy Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_HLTH_INS_POLCY_NR |
| L2000 | REF02 | Preferred Provider Organization Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_PPO_NR |
| L2000 | REF02 | Life Insurance Policy Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_LIF_INS_POLCY_NR |
| L2000 | REF02 | Retirement Plan Policy Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_RET_PLAN_POLCY_NR |
| L2000 | REF02 | Authorization Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_AUTH_NR |
| L2000 | REF02 | Billing Type | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_BLLNG_TYP |
| L2000 | REF02 | Health Maintenance Organization Code Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_HMO_CD_NR |
| L2000 | REF02 | Broker or Sales Office Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_BROKR_SALS_OFFC_NR |
| L2000 | REF02 | Batch Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_BATCH_NR |
| L2000 | REF02 | Class of Contract Code | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_CLASS_CONTR_CD |
| L2000 | REF02 | Check Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_CHECK_NR |
| L2000 | REF02 | Casualty Report Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_CAS_REPT_NR |
| L2000 | REF02 | Contract Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_CONTRCT_NR |
| L2000 | REF02 | National Council for Prescription Drug Programs Pharmacy Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_NCPDP_PHARM_NR |
| L2000 | REF02 | Loss Report Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_LOSS_RPT_NR |
| L2000 | REF02 | Claim Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_CLM_NR |
| L2000 | REF02 | Document Identification Code | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_DOC_ID_CD |
| L2000 | REF02 | Department/Agency Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_DPT_AGNCY_NR |
| L2000 | REF02 | Claimants Claim Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_CLMNT_CLM_NR |
| L2000 | REF02 | Attachment Code | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_ATTCHMT_CD |
| L2000 | REF02 | Medical Record Identification Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_MED_REC_ID_NR |
| L2000 | REF02 | Employers Identification Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_EMPLR_ID_NR |
| L2000 | REF02 | Patient Account Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_PATNT_ACCT_NR |
| L2000 | REF02 | Electronic device pin number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_ELEC_DEV_PIN |
| L2000 | REF02 | Electronic Payment Reference Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_ELEC_PMT_REF_NR |
| L2000 | REF02 | Submitter Identification Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_SUB_ID_NR |
| L2000 | REF02 | Receiver Identification Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_RECVR_ID_NR |
| L2000 | REF02 | Mammography Certification Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_MAMMGRPY_CERT_NR |
| L2000 | REF02 | Version Code - Local | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_VERS_CD_LOCAL |
| L2000 | REF02 | Facility Certification Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_FAC_CERT_NR |
| L2000 | REF02 | Medicare Version Code | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_MDCR_VERS_CD |
| L2000 | REF02 | Health Insurance Claim (HIC) Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_HIC_NR |
| L2000 | REF02 | Original Reference Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_ORIG_REF_NR |
| L2000 | REF02 | Clinic Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_CLINIC_NR |
| L2000 | REF02 | File Identifier | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_FILE_ID |
| L2000 | REF02 | Line Item Control Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_LIN_ITM_CTL_NR |
| L2000 | REF02 | Claim Office Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_CLM_OFFC_NR |
| L2000 | REF02 | Prior Authorization Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_PRIOR_AUTH_NR |
| L2000 | REF02 | Provider Commercial Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_PROV_COMM_NR |
| L2000 | REF02 | Predetermination of Benefits Identification Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_PRED_BENFT_ID_NR |
| L2000 | REF02 | Peer Review Organization (PRO) Approval Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_PRO_APPRVL_NR |
| L2000 | REF02 | Provider Site Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_PROV_SIT_NR |
| L2000 | REF02 | Health Industry Number (HIN) | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_HIN |
| L2000 | REF02 | Identity Card Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_ID_CARD_NR |
| L2000 | REF02 | Centers for Medicare and Medicaid Services National Provider Identifier | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_CNTR_MDCD_MDCD_SVC_NP |
| L2000 | REF02 | Issue Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_ISSU_NR |
| L2000 | REF02 | Insurance Policy Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_INS_POLCY_NR |
| L2000 | REF02 | Standard Industry Classification (SIC) Code | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_SIC_CD |
| L2000 | REF02 | Inspection Report Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_INSPCTN_RPT_NR |
| L2000 | REF02 | Item Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_ITM_NR |
| L2000 | REF02 | User Identification | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_USER_ID |
| L2000 | REF02 | Certification | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_CERTFCTN |
| L2000 | REF02 | Lease Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_LEAS_NR |
| L2000 | REF02 | Loan Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_LOAN_NR |
| L2000 | REF02 | Location Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_LOCATN_NR |
| L2000 | REF02 | Qualified Products List | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_QUAL_PROD_LIST |
| L2000 | REF02 | Lender Account Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_LENDR_ACCT_NR |
| L2000 | REF02 | Message Address or ID | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_MSG_ADDRS_ID |
| L2000 | REF02 | Provider Plan Network Identification Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_PROV_PLAN_NET_ID_NR |
| L2000 | REF02 | Plan Network Identification Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_PLAN_NET_ID_NR |
| L2000 | REF02 | Facility Network Identification Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_FAC_NET_ID_NR |
| L2000 | REF02 | National Association of Insurance Commissioners (NAIC) Code | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_NAIC_CD |
| L2000 | REF02 | Medicaid Recipient Identification Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_MDCD_REC_ID_NR |
| L2000 | REF02 | Product Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_PROD_NR |
| L2000 | REF02 | Project Code | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_PROJCT_CD |
| L2000 | REF02 | Product Group | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_PROD_GRP |
| L2000 | REF02 | Part Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_PART_NR |
| L2000 | REF02 | Policy Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_POLCY_NR |
| L2000 | REF02 | Payee Identification | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_PAYEE_ID |
| L2000 | REF02 | Prior Identifier Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_PRIOR_ID_NR |
| L2000 | REF02 | Property Control Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_PROP_CTL_NR |
| L2000 | REF02 | Unit Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_UNIT_NR |
| L2000 | REF02 | Rate code number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_RATE_CD_NR |
| L2000 | REF02 | Specification Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_SPEC_NR |
| L2000 | REF02 | Store Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_STOR_NR |
| L2000 | REF02 | Social Security Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_SSN |
| L2000 | REF02 | Signal Code | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_SIGNL_CD |
| L2000 | REF02 | Affected Subsystem Code | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_AFF_SUB_CD |
| L2000 | REF02 | Federal Taxpayers Identification Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_FED_TAX_ID_NR |
| L2000 | REF02 | Transaction Reference Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_TRANS_REF_NR |
| L2000 | REF02 | Terminal Code | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_TERMNL_CD |
| L2000 | REF02 | Tax Exempt Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_TAX_EXPMT_NR |
| L2000 | REF02 | Unique Supplier Identification Number (USIN) | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_USIN |
| L2000 | REF02 | Mortgage Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_MORTG_NR |
| L2000 | REF02 | Volume Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_VOL_NR |
| L2000 | REF02 | Vendor Abbreviation Code | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_VENDR_ABBREV_CD |
| L2000 | REF02 | Vendor Product Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_VENDR_PROD_NR |
| L2000 | REF02 | Vendor ID Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_VEND_ID_NR |
| L2000 | REF02 | Motor Vehicle ID Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_MOTR_VEH_ID_NR |
| L2000 | REF02 | Vessel | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_VSSL |
| L2000 | REF02 | Provider Claim Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_PROV_CLM_NR |
| L2000 | REF02 | Clinical Laboratory Improvement Amendment Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_CLIN_LAB_IMP_AMNDT_NR |
| L2000 | REF02 | State Industrial Accident Provider Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_ST_IND_ACC_PROV_NR |
| L2000 | REF02 | Agency Claim Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_AGNCY_CLM_NR |
| L2000 | REF02 | Federal Housing Administration Case Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_FED_HSING_ADMIN_CASE_NR |
| L2000 | REF02 | Veterans Affairs Case Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_VET_AFFR_CASE_NR |
| L2000 | REF02 | Carrier Assigned Reference Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_CARR_ASS_REF_NR |
| L2000 | REF02 | Software Application Number | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_SOFT_APP_NR |
| L2000 | REF02 | Mutually Defined | L2000_S02_REF02_ADDL_REF_ID_NR_OVL_MUTLY_DFND |
| L2000 | DTM | Date Time Reference | |
| L2000 | DTM02 | Invoice | L2000_S03_DTM02_ADDL_REF_DT_OVL_INVC |
| L2000 | DTM02 | Effective | L2000_S03_DTM02_ADDL_REF_DT_OVL_EFF |
| L2000 | DTM02 | Process | L2000_S03_DTM02_ADDL_REF_DT_OVL_PROC |
| L2000 | DTM02 | Shipped | L2000_S03_DTM02_ADDL_REF_DT_OVL_SHIPD |
| L2000 | DTM02 | Estimated Delivery | L2000_S03_DTM02_ADDL_REF_DT_OVL_EST_DELVRY |
| L2000 | DTM02 | Delivered | L2000_S03_DTM02_ADDL_REF_DT_OVL_DELVRD |
| L2000 | DTM02 | Expiration | L2000_S03_DTM02_ADDL_REF_DT_OVL_EXP |
| L2000 | DTM02 | Received | L2000_S03_DTM02_ADDL_REF_DT_OVL_RCVD |
| L2000 | DTM02 | Inquiry | L2000_S03_DTM02_ADDL_REF_DT_OVL_INQURY |
| L2000 | DTM02 | Report Start | L2000_S03_DTM02_ADDL_REF_DT_OVL_RPT_START |
| L2000 | DTM02 | Report End | L2000_S03_DTM02_ADDL_REF_DT_OVL_RPT_END |
| L2000 | DTM02 | Discharge | L2000_S03_DTM02_ADDL_REF_DT_OVL_DISCHRG |
| L2000 | DTM02 | Transaction Creation | L2000_S03_DTM02_ADDL_REF_DT_OVL_TS_CRTN |
| L2000 | DTM02 | Issue | L2000_S03_DTM02_ADDL_REF_DT_OVL_ISSU |
| L2000 | DTM02 | Test Performed | L2000_S03_DTM02_ADDL_REF_DT_OVL_TST_PERFMD |
| L2000 | DTM02 | Loss | L2000_S03_DTM02_ADDL_REF_DT_OVL_LOSS |
| L2000 | DTM02 | Service Period Start | L2000_S03_DTM02_ADDL_REF_DT_OVL_SVC_PRD_START |
| L2000 | DTM02 | Service Period End | L2000_S03_DTM02_ADDL_REF_DT_OVL_SVC_PRD_END |
| L2000 | DTM02 | Invoice Period Start | L2000_S03_DTM02_ADDL_REF_DT_OVL_INV_PRD_START |
| L2000 | DTM02 | Invoice Period End | L2000_S03_DTM02_ADDL_REF_DT_OVL_INV_PRD_END |
| L2000 | DTM02 | Period Start | L2000_S03_DTM02_ADDL_REF_DT_OVL_PRD_START |
| L2000 | DTM02 | Period End | L2000_S03_DTM02_ADDL_REF_DT_OVL_PRD_END |
| L2000 | DTM02 | Completion | L2000_S03_DTM02_ADDL_REF_DT_OVL_COMPLTN |
| L2000 | DTM02 | Lease Term Start | L2000_S03_DTM02_ADDL_REF_DT_OVL_LEAS_TRM_START |
| L2000 | DTM02 | Lease Term End | L2000_S03_DTM02_ADDL_REF_DT_OVL_LEAS_TRM_END |
| L2000 | DTM02 | Claim Statement Period Start | L2000_S03_DTM02_ADDL_REF_DT_OVL_CLM_STATMNT |
| L2000 | DTM02 | Claim Statement Period End | L2000_S03_DTM02_ADDL_REF_DT_OVL_CLM_STATMNT_PRD_END |
| L2000 | DTM02 | Actual Start | L2000_S03_DTM02_ADDL_REF_DT_OVL_CLM_STATMNT_PRD_START |
| L2000 | DTM02 | Estimated Completion | L2000_S03_DTM02_ADDL_REF_DT_OVL_EST_COMPLTN |
| L2000 | DTM02 | Employment or Hire | L2000_S03_DTM02_ADDL_REF_DT_OVL_EMP_OR_HIR |
| L2000 | DTM02 | Retirement | L2000_S03_DTM02_ADDL_REF_DT_OVL_RETRMNT |
| L2000 | DTM02 | Initial Disability Period Return To Work | L2000_S03_DTM02_ADDL_REF_DT_OVL_INIT_DIS_PRD_RTW |
| L2000 | DTM02 | Initial Disability Period Last Day Worked | L2000_S03_DTM02_ADDL_REF_DT_OVL_INIT_DIS_PRD_LDW |
| L2000 | DTM02 | Enrollment Signature Date | L2000_S03_DTM02_ADDL_REF_DT_OVL_ENRLL_SIG_DT |
| L2000 | DTM02 | Consolidated Omnibus Budget Reconciliation Act (COBRA) Qualifying Event | L2000_S03_DTM02_ADDL_REF_DT_OVL_COBRA_QUAL_EVNT |
| L2000 | DTM02 | Maintenance Effective | L2000_S03_DTM02_ADDL_REF_DT_OVL_MAINT_EFF |
| L2000 | DTM02 | Latest Visit or Consultation | L2000_S03_DTM02_ADDL_REF_DT_OVL_LATEST_VST_CONS |
| L2000 | DTM02 | Eligibility | L2000_S03_DTM02_ADDL_REF_DT_OVL_ELIG |
| L2000 | DTM02 | Date of Closing | L2000_S03_DTM02_ADDL_REF_DT_OVL_DT_CLOSNG |
| L2000 | DTM02 | Cycle | L2000_S03_DTM02_ADDL_REF_DT_OVL_CYCLE |
| L2000 | DTM02 | Referral Date | L2000_S03_DTM02_ADDL_REF_DT_OVL_REFRL_DT |
| L2000 | DTM02 | Employment Begin | L2000_S03_DTM02_ADDL_REF_DT_OVL_EMP_BGN |
| L2000 | DTM02 | Employment End | L2000_S03_DTM02_ADDL_REF_DT_OVL_EMP_END |
| L2000 | DTM02 | Medicare Begin | L2000_S03_DTM02_ADDL_REF_DT_OVL_MDCR_BGN |
| L2000 | DTM02 | Medicare End | L2000_S03_DTM02_ADDL_REF_DT_OVL_MDCR_END |
| L2000 | DTM02 | Consolidated Omnibus Budget Reconciliation Act (COBRA) Begin | L2000_S03_DTM02_ADDL_REF_DT_OVL_COBRA_BGN |
| L2000 | DTM02 | Consolidated Omnibus Budget Reconciliation Act (COBRA) End | L2000_S03_DTM02_ADDL_REF_DT_OVL_COBRA_END |
| L2000 | DTM02 | Coordination of Benefits Begin | L2000_S03_DTM02_ADDL_REF_DT_OVL_COB_BGN |
| L2000 | DTM02 | Coordination of Benefits End | L2000_S03_DTM02_ADDL_REF_DT_OVL_COB_END |
| L2000 | DTM02 | Benefit Begin | L2000_S03_DTM02_ADDL_REF_DT_OVL_BEN_BGN |
| L2000 | DTM02 | Benefit End | L2000_S03_DTM02_ADDL_REF_DT_OVL_BEN_END |
| L2000 | DTM02 | Education Begin | L2000_S03_DTM02_ADDL_REF_DT_OVL_EDU_BGN |
| L2000 | DTM02 | Education End | L2000_S03_DTM02_ADDL_REF_DT_OVL_EDU_END |
| L2000 | DTM02 | Eligibility Begin | L2000_S03_DTM02_ADDL_REF_DT_OVL_ELIG_BGN |
| L2000 | DTM02 | Eligibility End | L2000_S03_DTM02_ADDL_REF_DT_OVL_ELIG_END |
| L2000 | DTM02 | Initial Disability Period Start | L2000_S03_DTM02_ADDL_REF_DT_OVL_INIT_DIS_PRD_START |
| L2000 | DTM02 | Initial Disability Period End | L2000_S03_DTM02_ADDL_REF_DT_OVL_INIT_DIS_PRD_END |
| L2000 | DTM02 | Actual Departure Date | L2000_S03_DTM02_ADDL_REF_DT_OVL_ACTL_DEP_DT |
| L2000 | DTM02 | Actual Arrival Date | L2000_S03_DTM02_ADDL_REF_DT_OVL_ACTL_ARR_DT |
| L2000 | DTM02 | Adjusted Hire | L2000_S03_DTM02_ADDL_REF_DT_OVL_ADJ_HIR |
| L2000 | DTM02 | Payment Commencement | L2000_S03_DTM02_ADDL_REF_DT_OVL_PMT_COMM |
| L2000 | DTM02 | Plan Participation Suspension | L2000_S03_DTM02_ADDL_REF_DT_OVL_PLAN_PART_SUSP |
| L2000 | DTM02 | Rehire | L2000_S03_DTM02_ADDL_REF_DT_OVL_REHIRE |
| L2000 | DTM02 | Production | L2000_S03_DTM02_ADDL_REF_DT_OVL_PRODCTN |
| L2000 | DTM02 | Onset of Current Symptoms or Illness | L2000_S03_DTM02_ADDL_REF_DT_OVL_ONSET_SYMPT_ILL |
| L2000 | DTM02 | Statement | L2000_S03_DTM02_ADDL_REF_DT_OVL_STATMNT |
| L2000 | DTM02 | Admission | L2000_S03_DTM02_ADDL_REF_DT_OVL_ADMSSN |
| L2000 | DTM02 | Onset of Similar Symptoms or Illness | L2000_S03_DTM02_ADDL_REF_DT_OVL_ONSET_SIM_SYMPT_ILL |
| L2000 | DTM02 | Accident | L2000_S03_DTM02_ADDL_REF_DT_OVL_ACCDNT |
| L2000 | DTM02 | Prior Placement | L2000_S03_DTM02_ADDL_REF_DT_OVL_PRIOR_PLACMNT |
| L2000 | DTM02 | Replacement | L2000_S03_DTM02_ADDL_REF_DT_OVL_REPLCMNT |
| L2000 | DTM02 | Appliance Placement | L2000_S03_DTM02_ADDL_REF_DT_OVL_APP_PLACMNT |
| L2000 | DTM02 | Acute Manifestation of a Chronic Condition | L2000_S03_DTM02_ADDL_REF_DT_OVL_ACUTE_MAN_CHRNC_COND |
| L2000 | DTM02 | Initial Treatment | L2000_S03_DTM02_ADDL_REF_DT_OVL_INIT_TREAT |
| L2000 | DTM02 | Last X-Ray | L2000_S03_DTM02_ADDL_REF_DT_OVL_LAST_XRAY |
| L2000 | DTM02 | Surgery | L2000_S03_DTM02_ADDL_REF_DT_OVL_SURGRY |
| L2000 | DTM02 | Last Certification | L2000_S03_DTM02_ADDL_REF_DT_OVL_LAST_CERT |
| L2000 | DTM02 | Begin Therapy | L2000_S03_DTM02_ADDL_REF_DT_OVL_BEGN_THRPY |
| L2000 | DTM02 | Prescription | L2000_S03_DTM02_ADDL_REF_DT_OVL_RX |
| L2000 | DTM02 | Service | L2000_S03_DTM02_ADDL_REF_DT_OVL_SRVC |
| L2000 | DTM02 | Medicaid Begin | L2000_S03_DTM02_ADDL_REF_DT_OVL_MDCD_BEGIN |
| L2000 | DTM02 | Medicaid End | L2000_S03_DTM02_ADDL_REF_DT_OVL_MDCD_END |
| L2000 | DTM02 | Arterial Blood Gas Test | L2000_S03_DTM02_ADDL_REF_DT_OVL_ART_BLOOD_GAS_TST |
| L2000 | DTM02 | Oxygen Saturation Test | L2000_S03_DTM02_ADDL_REF_DT_OVL_OXY_SAT_TEST |
| L2000 | DTM02 | Last Menstrual Period | L2000_S03_DTM02_ADDL_REF_DT_OVL_LST_MEN_PRD |
| L2000 | DTM02 | Injury Begin | L2000_S03_DTM02_ADDL_REF_DT_OVL_INJRY_BGN |
| L2000 | DTM02 | Injury End | L2000_S03_DTM02_ADDL_REF_DT_OVL_INJRY_END |
| L2000 | DTM02 | Inspected | L2000_S03_DTM02_ADDL_REF_DT_OVL_INSPCTD |
| L2000 | DTM02 | Date of Claim | L2000_S03_DTM02_ADDL_REF_DT_OVL_DT_OF_CLM |
| L2000 | DTM02 | Policy Effective | L2000_S03_DTM02_ADDL_REF_DT_OVL_POLCY_EFF |
| L2000 | DTM02 | Policy Expiration | L2000_S03_DTM02_ADDL_REF_DT_OVL_POLCY_EXP |
| L2000 | DTM02 | Last Premium Paid Date | L2000_S03_DTM02_ADDL_REF_DT_OVL_LAST_PREM_PD_DT |
| L2000 | DTM02 | Date of Loan | L2000_S03_DTM02_ADDL_REF_DT_OVL_DT_LOAN |
| L2000 | DTM02 | Date Claim Paid | L2000_S03_DTM02_ADDL_REF_DT_OVL_DT_CLM_PD |
| L2000 | DTM02 | Report Period | L2000_S03_DTM02_ADDL_REF_DT_OVL_RPT_PRD |
| L2000 | DTM02 | Certification Revision | L2000_S03_DTM02_ADDL_REF_DT_OVL_CERT_RVSN |
| L2000 | DTM02 | Date Paid | L2000_S03_DTM02_ADDL_REF_DT_OVL_DT_PD |
| L2000 | DTM02 | Most Recent Hemoglobin or Hematocrit or Both | L2000_S03_DTM02_ADDL_REF_DT_OVL_RECNT_HEMO_HEMA |
| L2000 | DTM02 | Most Recent Serum Creatine | L2000_S03_DTM02_ADDL_REF_DT_OVL_RECNT_SERM_CRTN |
| L2000 | DTM02 | Posted | L2000_S03_DTM02_ADDL_REF_DT_OVL_POSTD |
| L2000 | DTM02 | Examination | L2000_S03_DTM02_ADDL_REF_DT_OVL_EXAMNTN |
| L2000 | DTM02 | Request | L2000_S03_DTM02_ADDL_REF_DT_OVL_REQST |
| L2000 | DTM02 | Order | L2000_S03_DTM02_ADDL_REF_DT_OVL_ORDR |
| L2000 | DTM02 | Document Date | L2000_S03_DTM02_ADDL_REF_DT_OVL_DOC_DT |
| L2000 | DTM02 | Estimated Date of Birth | L2000_S03_DTM02_ADDL_REF_DT_OVL_EST_DOB |
| L2000 | DTM02 | Incident | L2000_S03_DTM02_ADDL_REF_DT_OVL_INCDNT |
| L2000 | DTM02 | Mutually Defined | L2000_S03_DTM02_ADDL_REF_DT_OVL_MUTLY_DEFND |
| L2000 | AMT | Monetary Amount Information | |
| L2000 | AMT02 | Line Item Total | L2000_S04_AMT02_ADDL_REF_AMT_OVL_LIN_ITM_TOT |
| L2000 | AMT02 | Batch Total | L2000_S04_AMT02_ADDL_REF_AMT_OVL_BATCH_TOT |
| L2000 | AMT02 | Total Invoice Amount | L2000_S04_AMT02_ADDL_REF_AMT_OVL_TOT_INV_AMT |
| L2000 | AMT02 | Mortgage | L2000_S04_AMT02_ADDL_REF_AMT_OVL_MORTG |
| L2000 | AMT02 | Non-operational Fixed Assets | L2000_S04_AMT02_ADDL_REF_AMT_OVL_NONOP_FXD_ASST |
| L2000 | AMT02 | Damages | L2000_S04_AMT02_ADDL_REF_AMT_OVL_DMGS |
| L2000 | AMT02 | Services | L2000_S04_AMT02_ADDL_REF_AMT_OVL_SVCS |
| L2000 | AMT02 | Share Premium Capital | L2000_S04_AMT02_ADDL_REF_AMT_OVL_SHAR_PREM_CAP |
| L2000 | AMT02 | Noncovered Charges - Actual | L2000_S04_AMT02_ADDL_REF_AMT_OVL_NONCOV_CHG_ACTL |
| L2000 | AMT02 | Allocated | L2000_S04_AMT02_ADDL_REF_AMT_OVL_ALLCTD |
| L2000 | AMT02 | Approved Amount | L2000_S04_AMT02_ADDL_REF_AMT_OVL_APPRVD_AMT |
| L2000 | AMT02 | Coverage Amount | L2000_S04_AMT02_ADDL_REF_AMT_OVL_COVG_AMT |
| L2000 | AMT02 | Benefit Amount | L2000_S04_AMT02_ADDL_REF_AMT_OVL_BENFT_AMT |
| L2000 | AMT02 | Allowed - Actual | L2000_S04_AMT02_ADDL_REF_AMT_OVL_ALLWD_ACTL |
| L2000 | AMT02 | Deductible - Estimated | L2000_S04_AMT02_ADDL_REF_AMT_OVL_DEDUCT_EST |
| L2000 | AMT02 | Co-insurance - Actual | L2000_S04_AMT02_ADDL_REF_AMT_OVL_COINS_ACTL |
| L2000 | AMT02 | Adjustments | L2000_S04_AMT02_ADDL_REF_AMT_OVL_ADJSTMNTS |
| L2000 | AMT02 | Adjusted Insured Loss Amount | L2000_S04_AMT02_ADDL_REF_AMT_OVL_ADJ_INS_LSS_AMT |
| L2000 | AMT02 | Co-Payment Amount | L2000_S04_AMT02_ADDL_REF_AMT_OVL_COPAY_AMT |
| L2000 | AMT02 | Claim Amount Due - Estimated | L2000_S04_AMT02_ADDL_REF_AMT_OVL_CLM_AMT_DUE_EST |
| L2000 | AMT02 | Summary Amount | L2000_S04_AMT02_ADDL_REF_AMT_OVL_SUMMRY_AMT |
| L2000 | AMT02 | Funds Held for Insured | L2000_S04_AMT02_ADDL_REF_AMT_OVL_FNDS_HLD_INSRD |
| L2000 | AMT02 | Payor Amount Paid | L2000_S04_AMT02_ADDL_REF_AMT_OVL_PAYOR_AMT_PD |
| L2000 | AMT02 | Deductible Amount | L2000_S04_AMT02_ADDL_REF_AMT_OVL_DEDUCT_AMT |
| L2000 | AMT02 | Discount Amount | L2000_S04_AMT02_ADDL_REF_AMT_OVL_DISCOUNT_AMT |
| L2000 | AMT02 | Deductible Waived | L2000_S04_AMT02_ADDL_REF_AMT_OVL_DEDUCT_WVD |
| L2000 | AMT02 | Per Day Limit | L2000_S04_AMT02_ADDL_REF_AMT_OVL_PER_DAY_LIMT |
| L2000 | AMT02 | Patient Responsibility - Actual | L2000_S04_AMT02_ADDL_REF_AMT_OVL_PAT_RESP_ACTL |
| L2000 | AMT02 | Patient Responsibility - Estimated | L2000_S04_AMT02_ADDL_REF_AMT_OVL_PAT_RESP_EST |
| L2000 | AMT02 | Postage Claimed | L2000_S04_AMT02_ADDL_REF_AMT_OVL_POSTG_CLMD |
| L2000 | AMT02 | Patient Amount Paid | L2000_S04_AMT02_ADDL_REF_AMT_OVL_PAT_AMT_PD |
| L2000 | AMT02 | Sales Tax | L2000_S04_AMT02_ADDL_REF_AMT_OVL_SALES_TAX |
| L2000 | AMT02 | Goods and Services Tax | L2000_S04_AMT02_ADDL_REF_AMT_OVL_GDS_SVCS_TAX |
| L2000 | AMT02 | Total Charge | L2000_S04_AMT02_ADDL_REF_AMT_OVL_TOT_CHG |
| L2000 | AMT02 | Interest | L2000_S04_AMT02_ADDL_REF_AMT_OVL_INTRST |
| L2000 | AMT02 | Net Paid Amount | L2000_S04_AMT02_ADDL_REF_AMT_OVL_NET_PD_AMT |
| L2000 | AMT02 | Deduction Amount | L2000_S04_AMT02_ADDL_REF_AMT_OVL_DEDUCT_AMT |
| L2000 | AMT02 | Markup Amount | L2000_S04_AMT02_ADDL_REF_AMT_OVL_MARKUP_AMT |
| L2000 | AMT02 | Maximum Amount | L2000_S04_AMT02_ADDL_REF_AMT_OVL_MAX_AMT |
| L2000 | AMT02 | Net Worth | L2000_S04_AMT02_ADDL_REF_AMT_OVL_NET_WORTH |
| L2000 | AMT02 | Miscellaneous Taxes | L2000_S04_AMT02_ADDL_REF_AMT_OVL_MISC_TAX |
| L2000 | AMT02 | Net Billed | L2000_S04_AMT02_ADDL_REF_AMT_OVL_NET_BLLD |
| L2000 | AMT02 | Negative Ledger Balance | L2000_S04_AMT02_ADDL_REF_AMT_OVL_NEG_LEDG_BAL |
| L2000 | AMT02 | Premium Amount | L2000_S04_AMT02_ADDL_REF_AMT_OVL_PREM_AMT |
| L2000 | AMT02 | Payoff | L2000_S04_AMT02_ADDL_REF_AMT_OVL_PAYOFF |
| L2000 | AMT02 | Prior Gross Invoice Total | L2000_S04_AMT02_ADDL_REF_AMT_OVL_PRIOR_GRSS_INV_TOT |
| L2000 | AMT02 | Spend Down | L2000_S04_AMT02_ADDL_REF_AMT_OVL_SPND_DWN |
| L2000 | AMT02 | Repair | L2000_S04_AMT02_ADDL_REF_AMT_OVL_REPAIR |
| L2000 | AMT02 | Supplemental | L2000_S04_AMT02_ADDL_REF_AMT_OVL_SUPP |
| L2000 | AMT02 | Tax | L2000_S04_AMT02_ADDL_REF_AMT_OVL_TAX |
| L2000 | AMT02 | Total Claim Before Taxes | L2000_S04_AMT02_ADDL_REF_AMT_OVL_TOT_CLM_BEFR_TAX |
| L2000 | AMT02 | Total Submitted Charges | L2000_S04_AMT02_ADDL_REF_AMT_OVL_TOT_SUB_CHGS |
| L2000 | AMT02 | Total payment amount | L2000_S04_AMT02_ADDL_REF_AMT_OVL_TOT_PMT_AMT |
| L2000 | AMT02 | Total Transaction Amount | L2000_S04_AMT02_ADDL_REF_AMT_OVL_TOT_TRANS_AMT |
| L2000 | AMT02 | Denied | L2000_S04_AMT02_ADDL_REF_AMT_OVL_DENIED |
| L2000 | AMT02 | In Process | L2000_S04_AMT02_ADDL_REF_AMT_OVL_IN_PROCESS |
| L2000 | AMT02 | Returned | L2000_S04_AMT02_ADDL_REF_AMT_OVL_RETURNED |
| L2000 | AMT02 | Federal Medicare or Medicaid Payment Mandate - Category 1 | L2000_S04_AMT02_ADDL_REF_AMT_OVL_MDCR_MDCD_PMT_MAND_CAT1 |
| L2000 | AMT02 | Federal Medicare or Medicaid Payment Mandate - Category 2 | L2000_S04_AMT02_ADDL_REF_AMT_OVL_MDCR_MDCD_PMT_MAND_CAT2 |
| L2000 | AMT02 | Federal Medicare or Medicaid Payment Mandate - Category 3 | L2000_S04_AMT02_ADDL_REF_AMT_OVL_MDCR_MDCD_PMT_MAND_CAT3 |
| L2000 | AMT02 | Federal Medicare or Medicaid Payment Mandate - Category 4 | L2000_S04_AMT02_ADDL_REF_AMT_OVL_MDCR_MDCD_PMT_MAND_CAT4 |
| L2000 | AMT02 | Federal Medicare or Medicaid Payment Mandate - Category 5 | L2000_S04_AMT02_ADDL_REF_AMT_OVL_MDCR_MDCD_PMT_MAND_CAT5 |
| L2000 | AMT02 | Mutually Defined | L2000_S04_AMT02_ADDL_REF_AMT_OVL_MUTLY_DEFND |
| L2000 | QTY | Quantity Information | |
| L2000 | QTY02 | Discrete Quantity | L2000_S05_QTY02_ADDL_REF_QTY_OVL_DISCRT_QTY |
| L2000 | QTY02 | Cumulative Quantity | L2000_S05_QTY02_ADDL_REF_QTY_OVL_CUMLTV_QTY |
| L2000 | QTY02 | Scrap allowed | L2000_S05_QTY02_ADDL_REF_QTY_OVL_SCRP_ALWD |
| L2000 | QTY02 | Segments | L2000_S05_QTY02_ADDL_REF_QTY_OVL_SEGMNTS |
| L2000 | QTY02 | Functional Groups | L2000_S05_QTY02_ADDL_REF_QTY_OVL_FUNC_GRP |
| L2000 | QTY02 | Transaction Sets | L2000_S05_QTY02_ADDL_REF_QTY_OVL_TRAN_SET |
| L2000 | QTY02 | Total Debits | L2000_S05_QTY02_ADDL_REF_QTY_OVL_TOT_DBT |
| L2000 | QTY02 | Total Credits | L2000_S05_QTY02_ADDL_REF_QTY_OVL_TOT_CRED |
| L2000 | QTY02 | Number of Batches | L2000_S05_QTY02_ADDL_REF_QTY_OVL_NUM_BATCH |
| L2000 | QTY02 | Number of Checks | L2000_S05_QTY02_ADDL_REF_QTY_OVL_NUM_CHKS |
| L2000 | QTY02 | Total transactions | L2000_S05_QTY02_ADDL_REF_QTY_OVL_TOT_TRAN |
| L2000 | QTY02 | Acknowledged Quantity | L2000_S05_QTY02_ADDL_REF_QTY_OVL_ACK_QTY |
| L2000 | QTY02 | Unacknowledged Quantity | L2000_S05_QTY02_ADDL_REF_QTY_OVL_UNACK_QTY |
| L2000 | QTY02 | Age Modifying Units | L2000_S05_QTY02_ADDL_REF_QTY_OVL_AGE_MOD_UN |
| L2000 | QTY02 | Covered - Actual | L2000_S05_QTY02_ADDL_REF_QTY_OVL_COVD_ACTL |
| L2000 | QTY02 | Co-insured - Actual | L2000_S05_QTY02_ADDL_REF_QTY_OVL_COINS_ACTL |
| L2000 | QTY02 | Use of Extracorporeal Circulation | L2000_S05_QTY02_ADDL_REF_QTY_OVL_EXTRACORP_CIRC |
| L2000 | QTY02 | Emergency Modifying Units | L2000_S05_QTY02_ADDL_REF_QTY_OVL_EMGY_MOD_UN |
| L2000 | QTY02 | Invoices | L2000_S05_QTY02_ADDL_REF_QTY_OVL_INVCS |
| L2000 | QTY02 | Use of Hypothermia | L2000_S05_QTY02_ADDL_REF_QTY_OVL_USE_HYPOTHERM |
| L2000 | QTY02 | Use of Hypotension | L2000_S05_QTY02_ADDL_REF_QTY_OVL_USE_HYPOTENSN |
| L2000 | QTY02 | Use of Hyperbaric Pressurization | L2000_S05_QTY02_ADDL_REF_QTY_OVL_USE_HYPERBARIC |
| L2000 | QTY02 | Hours | L2000_S05_QTY02_ADDL_REF_QTY_OVL_HRS |
| L2000 | QTY02 | Life-time Reserve - Actual | L2000_S05_QTY02_ADDL_REF_QTY_OVL_LIFTIM_RSRV_ACTL |
| L2000 | QTY02 | Life-time Reserve - Estimated | L2000_S05_QTY02_ADDL_REF_QTY_OVL_LIFTIM_RSRV_EST |
| L2000 | QTY02 | Number of Non-covered Days | L2000_S05_QTY02_ADDL_REF_QTY_OVL_NUM_NONCOVRD_DYS |
| L2000 | QTY02 | Non-Covered - Estimated | L2000_S05_QTY02_ADDL_REF_QTY_OVL_NONCOVRD_EST |
| L2000 | QTY02 | Number of Members | L2000_S05_QTY02_ADDL_REF_QTY_OVL_NUM_MEMBR |
| L2000 | QTY02 | Not Replaced Blood Units | L2000_S05_QTY02_ADDL_REF_QTY_OVL_NOTREPL_BLD_UNT |
| L2000 | QTY02 | Outlier Days | L2000_S05_QTY02_ADDL_REF_QTY_OVL_OUTLR_DYS |
| L2000 | QTY02 | Physical Status III | L2000_S05_QTY02_ADDL_REF_QTY_OVL_PHYS_STAT_3 |
| L2000 | QTY02 | Physical Status IV | L2000_S05_QTY02_ADDL_REF_QTY_OVL_PHYS_STAT_4 |
| L2000 | QTY02 | Physical Status V | L2000_S05_QTY02_ADDL_REF_QTY_OVL_PHYS_STAT_5 |
| L2000 | QTY02 | Number of Services or Procedures | L2000_S05_QTY02_ADDL_REF_QTY_OVL_NUM_SVC_PROC |
| L2000 | QTY02 | Prescription | L2000_S05_QTY02_ADDL_REF_QTY_OVL_RX |
| L2000 | QTY02 | Swan-Ganz | L2000_S05_QTY02_ADDL_REF_QTY_OVL_SWAN_GANZ |
| L2000 | QTY02 | Total | L2000_S05_QTY02_ADDL_REF_QTY_OVL_TOTL |
| L2000 | QTY02 | Visits | L2000_S05_QTY02_ADDL_REF_QTY_OVL_VISTS |
| L2000 | QTY02 | Federal Medicare or Medicaid Payment Mandate - Category 1 | L2000_S05_QTY02_ADDL_REF_QTY_OVL_FED_MDCR_PMT_MNDT_CAT1 |
| L2000 | QTY02 | Federal Medicare or Medicaid Payment Mandate - Category 2 | L2000_S05_QTY02_ADDL_REF_QTY_OVL_FED_MDCR_PMT_MNDT_CAT2 |
| L2000 | QTY02 | Federal Medicare or Medicaid Payment Mandate - Category 3 | L2000_S05_QTY02_ADDL_REF_QTY_OVL_FED_MDCR_PMT_MNDT_CAT3 |
| L2000 | QTY02 | Federal Medicare or Medicaid Payment Mandate - Category 4 | L2000_S05_QTY02_ADDL_REF_QTY_OVL_FED_MDCR_PMT_MNDT_CAT4 |
| L2000 | QTY02 | Federal Medicare or Medicaid Payment Mandate - Category 5 | L2000_S05_QTY02_ADDL_REF_QTY_OVL_FED_MDCR_PMT_MNDT_CAT5 |
| L2000 | NM1 | Individual Name or Organizational Name | |
| L2000 | NM101 | Entity Identifier Code | L2000_S06_NM101_ENTY_ID_CD |
| L2000 | NM103 | Person | L2000_S06_NM103_ADDTL_REF_LAST_NM_OVL_PERSN |
| L2000 | NM103 | Non-Person Entity | L2000_S06_NM103_ADDTL_REF_LAST_NM_OVL_NONPERSN_ENTY |
| L2000 | NM104 | Additional Reference First Name | L2000_S06_NM104_ADDTL_REF_FRST_NM |
| L2000 | NM105 | Additional Reference Middle Name | L2000_S06_NM105_ADDTL_REF_MDDL_NM |
| L2000 | NM108 | Identification Code Qualifier | L2000_S06_NM108_ID_CD_QUAL |
| L2000 | NM109 | Identification Code | L2000_S06_NM109_ID_CD |
2100 - Error or Informational Message Location
| Loop | Segment | Segment Name | Chiapas Gate Mapping |
| L2100 | TED | Error of Informational Message Location | |
| L2100 | TED01 | Application Error Condition Code | L2100_S01_TED01_APP_ERR_COND_CD |
| L2100 | TED03 | Segment ID Code | L2100_S01_TED03_SEG_ID_CD |
| L2100 | TED04 | Segment Position in Transaction Set | L2100_S01_TED04_SEG_POS_TS |
| L2100 | TED05-01 | Element Position in Segment | L2100_S01_TED05_01_ELE_POS_SEG |
| L2100 | TED05-02 | Composite Data Element Position in Composite | L2100_S01_TED05_02_COMP_ELE_POS_COMP |
| L2100 | TED05-03 | Repeating Data Element Position | L2100_S01_TED05_03_REP_ELE_POS |
| L2100 | TED07 | Copy of Bad Data Element | L2100_S01_TED07_COPY_BAD_DATA |
| L2100 | TED08 | Data Element New Content | L2100_S01_TED08_DATA_ELE_NEW_CONTNT |
| L2100 | CTX | Situational Context Location | |
| L2100 | CTX01 | Context Name | L2100_S02_CTX01_CONTXT_NM |
| L2100 | CTX02 | Context Segment ID Code | L2100_S02_CTX02_CONTXT_SEG_ID_CD |
| L2100 | CTX03 | Context Segment Position in Transaction Set | L2100_S02_CTX03_CONTXT_SEG_POS_IN_TS |
| L2100 | CTX04 | Context Loop Identifier Code | L2100_S02_CTX04_CONTXT_LP_ID_CD |
| L2100 | CTX05-01 | Context Element Position in Segment | L2100_S02_CTX05_01_CONTXT_ELE_POS_SEG |
| L2100 | CTX05-02 | Context Component Data Element Position in Composite | L2100_S02_CTX05_02_CONTXT_COMP_ELE_POS_COMP |
| L2100 | CTX05-03 | Context Repeating Data Element Position | L2100_S02_CTX05_03_CONTXT_REP_ELE_POS |
| L2100 | CTX06 | Context Data Element Reference Number | L2100_S02_CTX06_CONTXT_ELE_REF_NR |
| L2100 | RED | Error or Informational Message | |
| L2100 | RED01 | Error Description | L2100_S03_RED01_ERR_DESC |
| L2100 | RED03 | Agency Qualifier Code | L2100_S03_RED03_ |
| L2100 | RED05 | Code List Qualifier Code | L2100_S03_RED05_CD_LST_QUAL_CD |
| L2100 | RED06 | Insurance Business Process Application Error Code | L2100_S03_RED06_INS_BIZ_APP_ERR_CD |