Health Care Services Review Information - Acknowledgment [R1]


Loop Qualifiers
xx - Loop Iteration Prefix
xxyy - Outer Loop Iteration and Inner Loop Iteration
yy / yyy - Loop Value Qualifier
xxyy / xxyyy - Loop Iteration and Value Qualifier
Segment Modifiers:
X - Distinguishing Identifier Suffix
nn - Segment Iteration (only after first iterartion)
nn - Element Repeat Iteration (only after first iterartion)

ISA - GROUP HEADERS
ISAISAInterchange Control Header
02ISA_ISA02_NO_AUTH_NFOStringNo Authorization Information Present
02ISA_ISA02_ADDL_DATA_IDStringAdditional Data Identification
04ISA_ISA04_NO_SEC_NFOStringNo Security Information Present
04ISA_ISA04_PSSWDStringPassword
06ISA_ISA06_DUN_BRDSTStringDun and Brandstreet
06ISA_ISA06_DUN_BRDST_SFXStringDuns Plus Suffix
06ISA_ISA06_HINStringHealth Industry Number
06ISA_ISA06_CARR_IDStringCarrier Identification Number as assigned by Health Care Financing Administration
06ISA_ISA06_HCFA_FIINStringFiscal Intermediary Identification Number as assigned by Health Care Financing Administration
06ISA_ISA06_HCFA_IDStringMedicare Provider and Supplier Identification Number as assigned by Health Care Financing Administration
06ISA_ISA06_TAX_IDStringUS Federal Tax Identification Number
06ISA_ISA06_NAIC_CDStringNational Association of Insurance Commissioners Company Code
06ISA_ISA06_MUTLY_DEFStringMutually Defined
08ISA_ISA08_DUN_BRDSTStringDun and Brandstreet
08ISA_ISA08_DUN_BRDST_SFXStringDuns Plus Suffix
08ISA_ISA08_HINStringHealth Industry Number
08ISA_ISA08_CARR_IDStringCarrier Identification Number as assigned by Health Care Financing Administration
08ISA_ISA08_HCFA_FIINStringFiscal Intermediary Identification Number as assigned by Health Care Financing Administration
08ISA_ISA08_HCFA_IDStringMedicare Provider and Supplier Identification Number as assigned by Health Care Financing Administration
08ISA_ISA08_TAX_IDStringUS Federal Tax Identification Number
08ISA_ISA08_NAIC_CDStringNational Association of Insurance Commissioners Company Code
08ISA_ISA08_MUTLY_DEFStringMutually Defined
09ISA_ISA09_INTCHG_DTDate (YYMMDD)Interchange Date
10ISA_ISA10_INTCHG_TMTime (HHMM)Interchange Time
11ISA_ISA11_REPTN_SEPStringRepetition Separator
13ISA_ISA13_ICNIntegerInterchange Control Number
14ISA_ISA14_ACK_REQStringAcknowledgment Requested
15ISA_ISA15_ICN_USG_INDStringInterchange Usage Indicator
16ISA_ISA16_COMP_ELE_SEPStringComponent Element Separator
GSHDR - GROUP HEADER
GSHDRGSFunctional Group Header
02GSHDR_GS02_APP_SNDR_CDStringApplication Senders Code
03GSHDR_GS03_APP_RCV_CDStringApplication Receivers Code
04GSHDR_GS04_D8Date (YYYYMMDD)Date
05GSHDR_GS05_TMTime (HHMM)Time
05GSHDR_GS05_TM8Time (HHMMSSCC)Time
06GSHDR_GS06_GCNIntegerGroup Control Number
STHDR - Transaction Set Header
STHDRSTTransaction Set Header
02STHDR_ST02_TCNStringTransaction Set Control Number
03STHDR_ST03_IMP_GUID_VERS_NMStringImplementation Guide Version Name
STHDRBHTBeginning of Hierarchical Transaction
02STHDR_BHT02_TS_PURP_CDStringTransaction Set Purpose Code
03STHDR_BHT03_SBM_TRANS_IDStringSubmitter Transaction Identifier
04STHDR_BHT04_TS_CRTN_D8Date (YYYYMMDD)Transaction Set Creation Date
05STHDR_BHT05_TS_CRTN_TMTime (HHMM)Transaction Set Creation Time
05STHDR_BHT05_TS_CRTN_TM8Time (HHMMSSCC)Transaction Set Creation Time
L2000A - Information Source Level
L2000AHLInformation Source Level
01L2000A_HL01_HIER_ID_NRStringHierarchical ID Number
04L2000A_HL04_HL_CHLD_CDStringHierarchical Child Code
L2000AAAANotification Validation
03L2000A_nnAAA03_REJ_RSN_CDStringReject Reason Code
04L2000A_nnAAA04_FWUP_ACTCDStringFollow-up Action Code
L2010A - Information Source Name
L2010ANM1Information Source Name
01L2010A_NM101_ENTY_ID_CDStringEntity Identifier Code
03L2010A_NM103_PERSNStringPerson
03L2010A_NM103_NONPSN_ENTYStringNon-Person Entity
04L2010A_NM104_NFO_SRC_FNMStringInformation Source First Name
05L2010A_NM105_NFO_SRC_MNMStringInformation Source Middle Name
07L2010A_NM107_NFO_SRC_SFXStringInformation Source Name Suffix
09L2010A_NM109_EINStringEmployer's Identification Number
09L2010A_NM109_SSNStringSocial Security Number
09L2010A_NM109_ETN_NRStringElectronic Transmitter Identification Number (ETIN)
09L2010A_NM109_PAYR_IDStringPayor Identification
09L2010A_NM109_HCFA_PLAN_IDStringCenters for Medicare and Medicaid Services PlanID
09L2010A_NM109_NPIStringCenters for Medicare and Medicaid Services National Provider Identifier
L2010AREFInformation Source Supplemental Identification
02L2010A_nnREF_UPINStringProvider UPIN Number
02L2010A_nnREF_FAC_IDStringFacility ID Number
02L2010A_nnREF_EINStringEmployer's Identification Number
02L2010A_nnREF_PVR_SIT_NRStringProvider Site Number
02L2010A_nnREF_PRV_PLN_IDStringProvider Plan Network Identification Number
02L2010A_nnREF_FAC_NET_IDStringFacility Network Identification Number
02L2010A_nnREF_SSNStringSocial Security Number
02L2010A_nnREF_CRR_AS_REF_NRStringCarrier Assigned Reference Number
L2010AAAAInformation Source Validation
03L2010A_nnAAA03_REJ_RSN_CDStringReject Reason Code
04L2010A_nnAAA04_FWUP_ACTCDStringFollow-up Action Code
L2010APRVInformation Source Provider Information
01L2010A_PRV01_PVD_CDStringProvider Code
03L2010A_PRV03_PVD_TAXNMY_CDStringHealth Care Provider Taxonomy Code
L2000B - Information Receiver Level
L2000BHLInformation Receiver Level
01L2000B_HL01_HIER_ID_NRStringHierarchical ID Number
02L2000B_HL02_HIER_PARNT_ID_NRStringHierarchical Parent ID Number
04L2000B_HL04_HL_CHLD_CDStringHierarchical Child Code
L2010B - Information Receiver Name
L2010BNM1Information Receiver Name
01L2010B_NM101_ENTY_ID_CDStringEntity Identifier Code
03L2010B_NM103_PERSNStringPerson
03L2010B_NM103_NONPSN_ENTYStringNon-Person Entity
04L2010B_NM104_NFO_REC_FNMStringInformation Receiver First Name
05L2010B_NM105_NFO_REC_MNMStringInformation Receiver Middle Name
07L2010B_NM107_NFO_RCV_SFXStringInformation Receiver Name Suffix
09L2010B_NM109_EINStringEmployer's Identification Number
09L2010B_NM109_SSNStringSocial Security Number
09L2010B_NM109_ETN_NRStringElectronic Transmitter Identification Number (ETIN)
09L2010B_NM109_PAYR_IDStringPayor Identification
09L2010B_NM109_HCFA_PLAN_IDStringCenters for Medicare and Medicaid Services PlanID
09L2010B_NM109_NPIStringCenters for Medicare and Medicaid Services National Provider Identifier
L2010BPERInformation Receiver Contact Information
02L2010B_PER02_NFO_RC_CN_NMStringInformation Receiver Contact Name
04L2010B_PER04_EMAILStringElectronic Mail
04L2010B_PER04_FAXStringFacsimile
04L2010B_PER04_PHN_NRStringTelephone
06L2010B_PER06_EMAILStringElectronic Mail
06L2010B_PER06_PHN_EXTStringTelephone Extension
06L2010B_PER06_FAXStringFacsimile
06L2010B_PER06_PHN_NRStringTelephone
08L2010B_PER08_EMAILStringElectronic Mail
08L2010B_PER08_PHN_EXTStringTelephone Extension
08L2010B_PER08_FAXStringFacsimile
08L2010B_PER08_PHN_NRStringTelephone
L2010BAAAInformation Receiver Notification Validation
03L2010B_nnAAA03_REJ_RSN_CDStringReject Reason Code
04L2010B_nnAAA04_FWUP_ACTCDStringFollow-up Action Code
L2000C - Subscriber Level
L2000CHLSubscriber Level
01L2000C_HL01_HIER_ID_NRStringHierarchical ID Number
02L2000C_HL02_HIER_PARNT_ID_NRStringHierarchical Parent ID Number
04L2000C_HL04_HL_CHLD_CDStringHierarchical Child Code
L2000CTRNSubscriber Trace Number
01L2000C_nnTRN01_TRAC_TYP_CDStringTrace Type Code
02L2000C_nnTRN02_PTEVT_TRCK_NRStringPatient Event Tracking Number
03L2000C_nnTRN03_TRAC_ASS_IDStringTrace Assigning Entity Identifier
04L2000C_nnTRN04_TRC_ASS_ADDL_IDStringTrace Assigning Entity Additional Identifier
L2000CAAASubscriber Notification Validation
03L2000C_nnAAA03_REJ_RSN_CDStringReject Reason Code
04L2000C_nnAAA04_FWUP_ACTCDStringFollow-up Action Code
L2000CREFNotification Receipt Number
02L2000C_REF_RECPT_NRStringReceipt Number
L2010C - Subscriber Name
L2010CNM1Subscriber Name
03L2010C_NM103_PERSNStringPerson
04L2010C_NM104_SBR_FNMStringSubscriber First Name
05L2010C_NM105_SBR_MNMStringSubscriber Middle Name or Initial
07L2010C_NM107_SBR_SFXStringSubscriber Name Suffix
09L2010C_NM109_MEM_ID_NRStringMember Identification Number
09L2010C_NM109_MUTLY_DEFStringMutually Defined
L2010CREFSubscriber Supplemental Identification
02L2010C_REF_GRP_POLCY_NRStringGroup or Policy Number
02L2010C_REF_GRP_NRStringGroup Number
02L2010C_REF_PATNT_ACCT_NRStringPatient Account Number
02L2010C_REF_HIC_NRStringHealth Insurance Claim (HIC) Number
02L2010C_REF_ID_CRD_NRStringIdentity Card Number
02L2010C_REF_INS_PLCY_NRStringInsurance Policy Number
02L2010C_REF_PLN_NET_IDStringPlan Network Identification Number
02L2010C_REF_MDCD_ID_NRStringMedicaid Recipient Identification Number
02L2010C_REF_SSNStringSocial Security Number
L2010CAAASubscriber Notification Validation
03L2010C_nnAAA03_REJ_RSN_CDStringReject Reason Code
04L2010C_nnAAA04_FWUP_ACTCDStringFollow-up Action Code
L2010CDMGSubscriber Demographic Information
02L2010C_DMG02_D8StringSubscriber Birth Date
03L2010C_DMG03_SUB_GENDR_CDStringSubscriber Gender Code
L2010CINSSubscriber Relationship
08L2010C_INS08_EMPMT_STAT_CDStringEmployment Status Code
L2000D - Dependent Level
L2000DHLDependent Level
01L2000D_HL01_HIER_ID_NRStringHierarchical ID Number
02L2000D_HL02_HIER_PARNT_ID_NRStringHierarchical Parent ID Number
04L2000D_HL04_HL_CHLD_CDStringHierarchical Child Code
L2000DTRNDependent Trace Number
01L2000D_nnTRN01_TRAC_TYP_CDStringTrace Type Code
02L2000D_nnTRN02_PTEVT_TRCK_NRStringPatient Event Tracking Number
03L2000D_nnTRN03_TRAC_ASS_IDStringTrace Assigning Entity Identifier
04L2000D_nnTRN04_TRC_ASS_ADDL_IDStringTrace Assigning Entity Additional Identifier
L2000DAAADependent Notification Validation
03L2000D_nnAAA03_REJ_RSN_CDStringReject Reason Code
04L2000D_nnAAA04_FWUP_ACTCDStringFollow-up Action Code
L2000DREFNotification Receipt Number
02L2000D_REF_RECPT_NRStringReceipt Number
L2010D - Dependent Name
L2010DNM1Dependent Name
03L2010D_NM103_PERSNStringPerson
04L2010D_NM104_DEP_FNMStringDependent First Name
05L2010D_NM105_DEP_MNMStringDependent Middle Name
07L2010D_NM107_DEP_SFXStringDependent Name Suffix
09L2010D_NM109_MEM_ID_NRStringMember Identification Number
09L2010D_NM109_MUTLY_DEFStringMutually Defined
L2010DREFDependent Supplemental Identification
02L2010D_nnREF_PATNT_ACCT_NRStringPatient Account Number
02L2010D_nnREF_SSNStringSocial Security Number
L2010DAAADependent Notification Validation
03L2010D_nnAAA03_REJ_RSN_CDStringReject Reason Code
04L2010D_nnAAA04_FWUP_ACTCDStringFollow-up Action Code
L2010DDMGDependent Demographic Information
02L2010D_DMG02_D8StringDependent Birth Date
03L2010D_DMG03_DEP_GNDR_CDStringDependent Gender Code
L2010DINSDependent Relationship
02L2010D_INS02_IND_RELAT_CDStringIndividual Relationship Code
17L2010D_INS17_BRTH_SEQ_NRIntegerBirth Sequence Number
L2000E - Patient Event Level
L2000EHLPatient Event Level
01L2000E_HL01_HIER_ID_NRStringHierarchical ID Number
02L2000E_HL02_HIER_PARNT_ID_NRStringHierarchical Parent ID Number
04L2000E_HL04_HL_CHLD_CDStringHierarchical Child Code
L2000ETRNPatient Event Tracking Number
01L2000E_nnTRN01_TRAC_TYP_CDStringTrace Type Code
02L2000E_nnTRN02_PTEVT_TRAC_NRStringPatient Event Trace Number
03L2000E_nnTRN03_TRAC_ASS_IDStringTrace Assigning Entity Identifier
04L2000E_nnTRN04_TRC_ASS_ADDL_IDStringTrace Assigning Entity Additional Identifier
L2000EAAAPatient Event Request Validation
01L2000E_nnAAA01_VLDREQ_INDStringValid Request Indicator
03L2000E_nnAAA03_REJ_RSN_CDStringReject Reason Code
04L2000E_nnAAA04_FWUP_ACTCDStringFollow-up Action Code
L2000EUMHealth Care Services Review Information
01L2000E_UM01_REQST_CAT_CDStringRequest Category Code
02L2000E_UM02_CERT_TYP_CDStringCertification Type Code
03L2000E_UM03_SVC_TYP_CDStringService Type Code
0401L2000E_UM0401_FAC_TYP_CDStringFacility Type Code
06L2000E_UM06_LVL_SVC_CDStringLevel of Service Code
L2000EHCRHealth Care Services Review
01L2000E_HCR01_ACTN_CDStringAction Code
02L2000E_HCR02_RVW_ID_NRStringReview Identification Number
03L2000E_HCR03_RVW_DEC_RSNStringReview Decision Reason Code
04L2000E_HCR04_2ND_SURG_OPN_INDStringSecond Surgical Opinion Indicator
L2000EREFAdministrative Reference Number
02L2000E_REF_ADMIN_REF_NRStringAdministrator's Reference Number
L2000EREFPrevious Review Authorization Number
02L2000E_REF_AUTH_NRStringAuthorization Number
L2000EDTPEvent Date
03L2000E_DTP_EVNT_D8Date (YYYYMMDD)Event
03L2000E_DTP_EVNT_RD8_1Start Date (YYYYMMDD)Event
03L2000E_DTP_EVNT_RD8_2End Date (YYYYMMDD)Event
L2000EDTPAdmission Date
03L2000E_DTP_ADMSN_D8Date (YYYYMMDD)Admission
03L2000E_DTP_ADMSN_RD8_1Start Date (YYYYMMDD)Admission
03L2000E_DTP_ADMSN_RD8_2End Date (YYYYMMDD)Admission
L2000EDTPDischarge Date
03L2000E_DTP_DISCHG_D8Date (YYYYMMDD)Discharge
L2000EDTPCertification Issue Date
03L2000E_DTP_ISSU_D8Date (YYYYMMDD)Issue
L2000EDTPCertification Expiration Date
03L2000E_DTP_EXP_D8Date (YYYYMMDD)Expiration
L2000EDTPCertification Effective Date
03L2000E_DTP_EFF_D8Date (YYYYMMDD)Effective
03L2000E_DTP_EFF_RD8_1Start Date (YYYYMMDD)Effective
03L2000E_DTP_EFF_RD8_2End Date (YYYYMMDD)Effective
L2000EHIPatient Diagnosis
0102L2000E_HI0102_ICD10_DIAGStringInternational Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis
0102L2000E_HI0102_ICD10_ADMTG_DIAGStringInternational Classification of Diseases Clinical Modification (ICD-10-CM) Admitting Diagnosis
0102L2000E_HI0102_ICD10_PRIN_DIAGStringInternational Classification of Diseases Clinical Modification (ICD-10-CM) Principal Diagnosis
0102L2000E_HI0102_ICD10CM_PAT_RSNStringInternational Classification of Diseases Clinical Modification (ICD-10-CM) Patient's Reason for Visit
0102L2000E_HI0102_ICD9_DIAGStringInternational Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis
0102L2000E_HI0102_ICD9_ADMTG_DIAGStringInternational Classification of Diseases Clinical Modification (ICD-9-CM) Admitting Diagnosis
0102L2000E_HI0102_ICD9_PRIN_DIAGStringInternational Classification of Diseases Clinical Modification (ICD-9-CM) Principal Diagnosis
0102L2000E_HI0102_DRGStringDiagnosis Related Group (DRG)
0102L2000E_HI0102_ICD9CM_RSN_VSTStringInternational Classification of Diseases Clinical Modification (ICD-9-CM) Patient's Reason for Visit
0104L2000E_HI0104_DIAGStringDiagnosis Date
0202L2000E_HI0202_ICD10_DIAGStringInternational Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis
0202L2000E_HI0202_ICD10_ADMTG_DIAGStringInternational Classification of Diseases Clinical Modification (ICD-10-CM) Admitting Diagnosis
0202L2000E_HI0202_ICD10CM_PAT_RSNStringInternational Classification of Diseases Clinical Modification (ICD-10-CM) Patient's Reason for Visit
0202L2000E_HI0202_ICD9_DIAGStringInternational Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis
0202L2000E_HI0202_ICD9_ADMTG_DIAGStringInternational Classification of Diseases Clinical Modification (ICD-9-CM) Admitting Diagnosis
0202L2000E_HI0202_DRGStringDiagnosis Related Group (DRG)
0202L2000E_HI0202_ICD9CM_RSN_VSTStringInternational Classification of Diseases Clinical Modification (ICD-9-CM) Patient's Reason for Visit
0204L2000E_HI0204_DIAGStringDiagnosis Date
0302L2000E_HI0302_ICD10_DIAGStringInternational Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis
0302L2000E_HI0302_ICD10CM_PAT_RSNStringInternational Classification of Diseases Clinical Modification (ICD-10-CM) Patient's Reason for Visit
0302L2000E_HI0302_ICD9_DIAGStringInternational Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis
0302L2000E_HI0302_DRGStringDiagnosis Related Group (DRG)
0302L2000E_HI0302_ICD9CM_RSN_VSTStringInternational Classification of Diseases Clinical Modification (ICD-9-CM) Patient's Reason for Visit
0304L2000E_HI0304_DIAGStringDiagnosis Date
0402L2000E_HI0402_ICD10_DIAGStringInternational Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis
0402L2000E_HI0402_ICD10CM_PAT_RSNStringInternational Classification of Diseases Clinical Modification (ICD-10-CM) Patient's Reason for Visit
0402L2000E_HI0402_ICD9_DIAGStringInternational Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis
0402L2000E_HI0402_DRGStringDiagnosis Related Group (DRG)
0402L2000E_HI0402_ICD9CM_RSN_VSTStringInternational Classification of Diseases Clinical Modification (ICD-9-CM) Patient's Reason for Visit
0404L2000E_HI0404_DIAGStringDiagnosis Date
0502L2000E_HI0502_ICD10_DIAGStringInternational Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis
0502L2000E_HI0502_ICD10CM_PAT_RSNStringInternational Classification of Diseases Clinical Modification (ICD-10-CM) Patient's Reason for Visit
0502L2000E_HI0502_ICD9_DIAGStringInternational Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis
0502L2000E_HI0502_DRGStringDiagnosis Related Group (DRG)
0502L2000E_HI0502_ICD9CM_RSN_VSTStringInternational Classification of Diseases Clinical Modification (ICD-9-CM) Patient's Reason for Visit
0504L2000E_HI0504_DIAGStringDiagnosis Date
0602L2000E_HI0602_ICD10_DIAGStringInternational Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis
0602L2000E_HI0602_ICD10CM_PAT_RSNStringInternational Classification of Diseases Clinical Modification (ICD-10-CM) Patient's Reason for Visit
0602L2000E_HI0602_ICD9_DIAGStringInternational Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis
0602L2000E_HI0602_DRGStringDiagnosis Related Group (DRG)
0602L2000E_HI0602_ICD9CM_RSN_VSTStringInternational Classification of Diseases Clinical Modification (ICD-9-CM) Patient's Reason for Visit
0604L2000E_HI0604_DIAGStringDiagnosis Date
0702L2000E_HI0702_ICD10_DIAGStringInternational Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis
0702L2000E_HI0702_ICD10CM_PAT_RSNStringInternational Classification of Diseases Clinical Modification (ICD-10-CM) Patient's Reason for Visit
0702L2000E_HI0702_ICD9_DIAGStringInternational Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis
0702L2000E_HI0702_DRGStringDiagnosis Related Group (DRG)
0702L2000E_HI0702_ICD9CM_RSN_VSTStringInternational Classification of Diseases Clinical Modification (ICD-9-CM) Patient's Reason for Visit
0704L2000E_HI0704_DIAGStringDiagnosis Date
0802L2000E_HI0802_ICD10_DIAGStringInternational Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis
0802L2000E_HI0802_ICD10CM_PAT_RSNStringInternational Classification of Diseases Clinical Modification (ICD-10-CM) Patient's Reason for Visit
0802L2000E_HI0802_ICD9_DIAGStringInternational Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis
0802L2000E_HI0802_DRGStringDiagnosis Related Group (DRG)
0802L2000E_HI0802_ICD9CM_RSN_VSTStringInternational Classification of Diseases Clinical Modification (ICD-9-CM) Patient's Reason for Visit
0804L2000E_HI0804_DIAGStringDiagnosis Date
0902L2000E_HI0902_ICD10_DIAGStringInternational Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis
0902L2000E_HI0902_ICD10CM_PAT_RSNStringInternational Classification of Diseases Clinical Modification (ICD-10-CM) Patient's Reason for Visit
0902L2000E_HI0902_ICD9_DIAGStringInternational Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis
0902L2000E_HI0902_DRGStringDiagnosis Related Group (DRG)
0902L2000E_HI0902_ICD9CM_RSN_VSTStringInternational Classification of Diseases Clinical Modification (ICD-9-CM) Patient's Reason for Visit
0904L2000E_HI0904_DIAGStringDiagnosis Date
1002L2000E_HI1002_ICD10_DIAGStringInternational Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis
1002L2000E_HI1002_ICD10CM_PAT_RSNStringInternational Classification of Diseases Clinical Modification (ICD-10-CM) Patient's Reason for Visit
1002L2000E_HI1002_ICD9_DIAGStringInternational Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis
1002L2000E_HI1002_DRGStringDiagnosis Related Group (DRG)
1002L2000E_HI1002_ICD9CM_RSN_VSTStringInternational Classification of Diseases Clinical Modification (ICD-9-CM) Patient's Reason for Visit
1004L2000E_HI1004_DIAGStringDiagnosis Date
1102L2000E_HI1102_ICD10_DIAGStringInternational Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis
1102L2000E_HI1102_ICD10CM_PAT_RSNStringInternational Classification of Diseases Clinical Modification (ICD-10-CM) Patient's Reason for Visit
1102L2000E_HI1102_ICD9_DIAGStringInternational Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis
1102L2000E_HI1102_DRGStringDiagnosis Related Group (DRG)
1102L2000E_HI1102_ICD9CM_RSN_VSTStringInternational Classification of Diseases Clinical Modification (ICD-9-CM) Patient's Reason for Visit
1104L2000E_HI1104_DIAGStringDiagnosis Date
1202L2000E_HI1202_ICD10_DIAGStringInternational Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis
1202L2000E_HI1202_ICD10CM_PAT_RSNStringInternational Classification of Diseases Clinical Modification (ICD-10-CM) Patient's Reason for Visit
1202L2000E_HI1202_ICD9_DIAGStringInternational Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis
1202L2000E_HI1202_DRGStringDiagnosis Related Group (DRG)
1202L2000E_HI1202_LOINC_CDStringLogical Observation Identifier Names and Codes (LOINC<190>) Codes
1202L2000E_HI1202_ICD9CM_RSN_VSTStringInternational Classification of Diseases Clinical Modification (ICD-9-CM) Patient's Reason for Visit
1204L2000E_HI1204_DIAGStringDiagnosis Date
L2010E - Patient Event Provider Name
L2010ENM1Patient Event Provider Name
01L2010E_NM101_ENTY_ID_CDStringEntity Identifier Code
03L2010E_NM103_PERSNStringPerson
03L2010E_NM103_NONPSN_ENTYStringNon-Person Entity
04L2010E_NM104_PTEVT_PVR_FNMStringPatient Event Provider First Name
05L2010E_NM105_PTEVT_PVR_MNMStringPatient Event Provider Middle Name
06L2010E_NM106_PTEVT_PVR_PFXStringPatient Event Provider Name Prefix
07L2010E_NM107_PTEVT_PVR_SFXStringPatient Event Provider Name Suffix
09L2010E_NM109_EINStringEmployer's Identification Number
09L2010E_NM109_SSNStringSocial Security Number
09L2010E_NM109_ETN_NRStringElectronic Transmitter Identification Number (ETIN)
09L2010E_NM109_NPIStringCenters for Medicare and Medicaid Services National Provider Identifier
L2010EREFPatient Event Provider Supplemental Identification
02L2010E_nnREF_STAT_LIC_NRStringState License Number
02L2010E_nnREF_UPINStringProvider UPIN Number
02L2010E_nnREF_FAC_IDStringFacility ID Number
02L2010E_nnREF_EINStringEmployer's Identification Number
02L2010E_nnREF_PRV_PLN_IDStringProvider Plan Network Identification Number
02L2010E_nnREF_FAC_NET_IDStringFacility Network Identification Number
02L2010E_nnREF_SSNStringSocial Security Number
02L2010E_nnREF_CRR_AS_REF_NRStringCarrier Assigned Reference Number
03L2010E_nnREF03_LIC_NR_STATString
L2010EAAAPatient Event Provider Request Validation
01L2010E_nnAAA01_VLDREQ_INDStringValid Request Indicator
03L2010E_nnAAA03_REJ_RSN_CDStringReject Reason Code
04L2010E_nnAAA04_FWUP_ACTCDStringFollow-up Action Code
L2010EPRVPatient Event Provider Information
01L2010E_PRV01_PVD_CDStringProvider Code
03L2010E_PRV03_PVD_TAXNMY_CDStringHealth Care Provider Taxonomy Code
L2000F - Service Level
L2000FHLService Level
01L2000F_HL01_HIER_ID_NRStringHierarchical ID Number
02L2000F_HL02_HIER_PARNT_ID_NRStringHierarchical Parent ID Number
L2000FTRNService Trace Number
01L2000F_nnTRN01_TRAC_TYP_CDStringTrace Type Code
02L2000F_nnTRN02_SVC_TRAC_NRStringService Trace Number
03L2000F_nnTRN03_TRAC_ASS_IDStringTrace Assigning Entity Identifier
04L2000F_nnTRN04_TRC_ASS_ADDL_IDStringTrace Assigning Entity Additional Identifier
L2000FAAAService Request Validation
03L2000F_nnAAA03_REJ_RSN_CDStringReject Reason Code
04L2000F_nnAAA04_FWUP_ACTCDStringFollow-up Action Code
L2000FUMHealth Care Services Review Information
01L2000F_UM01_REQST_CAT_CDStringRequest Category Code
02L2000F_UM02_CERT_TYP_CDStringCertification Type Code
03L2000F_UM03_SVC_TYP_CDStringService Type Code
0401L2000F_UM0401_FAC_TYP_CDStringFacility Type Code
L2000FHCRHealth Care Services Review
01L2000F_HCR01_ACTN_CDStringAction Code
02L2000F_HCR02_RVW_ID_NRStringReview Identification Number
03L2000F_HCR03_RVW_DEC_RSNStringReview Decision Reason Code
04L2000F_HCR04_COND_RESP_CDStringYes No Condition or Response Code
L2000FREFPrevious Review Authorization Number
02L2000F_REF_AUTH_NRStringAuthorization Number
L2000FREFAdministrative Reference Number
02L2000F_REF_ADMIN_REF_NRStringAdministrator's Reference Number
L2000FDTPService Date
03L2000F_DTP_SVC_D8Date (YYYYMMDD)Service
03L2000F_DTP_SVC_RD8_1Start Date (YYYYMMDD)Service
03L2000F_DTP_SVC_RD8_2End Date (YYYYMMDD)Service
L2000FDTPCertification Issue Date
03L2000F_DTP_ISSU_D8Date (YYYYMMDD)Issue
L2000FDTPCertification Expiration Date
03L2000F_DTP_EXP_D8Date (YYYYMMDD)Expiration
L2000FDTPCertification Effective Date
03L2000F_DTP_EFF_D8Date (YYYYMMDD)Effective
03L2000F_DTP_EFF_RD8_1Start Date (YYYYMMDD)Effective
03L2000F_DTP_EFF_RD8_2End Date (YYYYMMDD)Effective
L2000FSV1Professional Service
0102L2000F_SV10102_HCPCS_CDStringHealth Care Financing Administration Common Procedural Coding System (HCPCS) Codes
0102L2000F_SV10102_HIC_PRD_SVCCDStringHome Infusion EDI Coalition (HIEC) Product/Service Code
0102L2000F_SV10102_NDC542StringNational Drug Code in 5-4-2 Format
0102L2000F_SV10102_ABC_CDStringAdvanced Billing Concepts (ABC) Codes
0103L2000F_SV10103_PROC_MODStringProcedure Modifier
0104L2000F_SV10104_PROC_MODStringProcedure Modifier
0105L2000F_SV10105_PROC_MODStringProcedure Modifier
0106L2000F_SV10106_PROC_MODStringProcedure Modifier
0108L2000F_SV10108_PROD_SVC_IDStringProduct or Service ID
02L2000F_SV102_SVC_LIN_AMTNumberService Line Amount
03L2000F_SV103_UNIT_MSMT_CDStringUnit or Basis for Measurement Code
04L2000F_SV104_SVC_UN_CTNumberService Unit Count
11L2000F_SV111_EPSDT_INDStringEPSDT Indicator
20L2000F_SV120_NRSG_LVL_CARStringNursing Home Level of Care
L2000FSV2Institutional Service Line
01L2000F_SV201_SVC_LIN_REV_CDStringService Line Revenue Code
0202L2000F_SV20202_HCPCS_CDStringHealth Care Financing Administration Common Procedural Coding System (HCPCS) Codes
0202L2000F_SV20202_ICD9CM_PROCStringInternational Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) - Procedure
0202L2000F_SV20202_HIC_PRD_SVCCDStringHome Infusion EDI Coalition (HIEC) Product/Service Code
0202L2000F_SV20202_NDC542StringNational Drug Code in 5-4-2 Format
0202L2000F_SV20202_MUTLY_DEFStringMutually Defined
0203L2000F_SV20203_PROC_MODStringProcedure Modifier
0204L2000F_SV20204_PROC_MODStringProcedure Modifier
0205L2000F_SV20205_PROC_MODStringProcedure Modifier
0206L2000F_SV20206_PROC_MODStringProcedure Modifier
0208L2000F_SV20208_PROD_SVC_IDStringProduct or Service ID
03L2000F_SV203_SVC_LIN_AMTNumberService Line Amount
04L2000F_SV204_UNIT_MSMT_CDStringUnit or Basis for Measurement Code
05L2000F_SV205_SVC_UN_CTNumberService Unit Count
06L2000F_SV206_SVC_LIN_RTNumberService Line Rate
10L2000F_SV210_NRSG_LVL_CARStringNursing Home Level of Care
L2000FSV3Dental Service
0102L2000F_SV30102_PROC_CDStringAmerican Dental Association Codes
0103L2000F_SV30103_PROC_MODStringProcedure Modifier
0104L2000F_SV30104_PROC_MODStringProcedure Modifier
0105L2000F_SV30105_PROC_MODStringProcedure Modifier
0106L2000F_SV30106_PROC_MODStringProcedure Modifier
0108L2000F_SV30108_PROD_SVC_IDStringProduct or Service ID
02L2000F_SV302_SVC_LIN_AMTNumberService Line Amount
0401L2000F_SV30401_ORAL_CAV_DES_CDStringOral Cavity Designation Code
0402L2000F_SV30402_ORAL_CAV_DES_CDStringOral Cavity Designation Code
0403L2000F_SV30403_ORAL_CAV_DES_CDStringOral Cavity Designation Code
0404L2000F_SV30404_ORAL_CAV_DES_CDStringOral Cavity Designation Code
0405L2000F_SV30405_ORAL_CAV_DES_CDStringOral Cavity Designation Code
05L2000F_SV305_PROS_CWN_INLY_CDStringProsthesis, Crown, or Inlay Code
06L2000F_SV306_SVC_UN_CTNumberService Unit Count
L2000FTOOTooth Information
02L2000F_nnTOO02_NTL_TTH_DES_SYSStringUniversal National Tooth Designation System
0301L2000F_nnTOO0301_TOOTH_SURF_CDStringTooth Surface Code
0302L2000F_nnTOO0302_TOOTH_SURF_CDStringTooth Surface Code
0303L2000F_nnTOO0303_TOOTH_SURF_CDStringTooth Surface Code
0304L2000F_nnTOO0304_TOOTH_SURF_CDStringTooth Surface Code
0305L2000F_nnTOO0305_TOOTH_SURF_CDStringTooth Surface Code
L2010F - Service Provider Name (Single Iteration)
L2010FNM1Service Provider Name
01L2010F_xx_NM101_ENTY_ID_CDStringEntity Identifier Code
03L2010F_xx_NM103_PERSNStringPerson
03L2010F_xx_NM103_NONPSN_ENTYStringNon-Person Entity
04L2010F_xx_NM104_SVC_PVR_FNMStringService Provider First Name
05L2010F_xx_NM105_SVC_PVR_MNMStringService Provider Middle Name
06L2010F_xx_NM106_SVC_PVR_PFXStringService Provider Name Prefix
07L2010F_xx_NM107_SVC_PVR_SFXStringService Provider Name Suffix
09L2010F_xx_NM109_EINStringEmployer's Identification Number
09L2010F_xx_NM109_SSNStringSocial Security Number
09L2010F_xx_NM109_ETN_NRStringElectronic Transmitter Identification Number (ETIN)
09L2010F_xx_NM109_NPIStringCenters for Medicare and Medicaid Services National Provider Identifier
L2010FREFService Provider Supplemental Identification
02L2010F_xx_nnREF_STAT_LIC_NRStringState License Number
02L2010F_xx_nnREF_UPINStringProvider UPIN Number
02L2010F_xx_nnREF_FAC_IDStringFacility ID Number
02L2010F_xx_nnREF_EINStringEmployer's Identification Number
02L2010F_xx_nnREF_PVR_SIT_NRStringProvider Site Number
02L2010F_xx_nnREF_PRV_PLN_IDStringProvider Plan Network Identification Number
02L2010F_xx_nnREF_FAC_NET_IDStringFacility Network Identification Number
02L2010F_xx_nnREF_SSNStringSocial Security Number
02L2010F_xx_nnREF_CRR_AS_REF_NRStringCarrier Assigned Reference Number
03L2010F_xx_nnREF03_LIC_NR_STATString
L2010FAAAService Provider Request Validation
01L2010F_xx_nnAAA01_VLDREQ_INDStringValid Request Indicator
03L2010F_xx_nnAAA03_REJ_RSN_CDStringReject Reason Code
04L2010F_xx_nnAAA04_FWUP_ACTCDStringFollow-up Action Code
L2010FPRVService Provider Information
01L2010F_xx_PRV01_PVD_CDStringProvider Code
03L2010F_xx_PRV03_PVD_TAXNMY_CDStringHealth Care Provider Taxonomy Code
STHDRSETransaction Set Trailer
01STHDR_SE01_TS_SEG_CTIntegerTransaction Segment Count
02STHDR_SE02_TCNStringTransaction Set Control Number
GSHDRGEFunctional Group Trailer
01GSHDR_GE01_NR_TS_INCLUDEDIntegerNumber of Transaction Sets Included
02GSHDR_GE02_GCNIntegerGroup Control Number
ISAIEAInterchange Control Trailer
01ISA_IEA01_NR_INC_FUNC_GRPIntegerNumber of Included Functional Groups
02ISA_IEA02_ICNIntegerInterchange Control Number