Loop Qualifiersxx - 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 | ISA | Interchange Control Header | | |
02 | | ISA_ISA02_NO_AUTH_NFO | String | No Authorization Information Present |
02 | | ISA_ISA02_ADDL_DATA_ID | String | Additional Data Identification |
04 | | ISA_ISA04_NO_SEC_NFO | String | No Security Information Present |
04 | | ISA_ISA04_PSSWD | String | Password |
06 | | ISA_ISA06_DUN_BRDST | String | Dun and Brandstreet |
06 | | ISA_ISA06_DUN_BRDST_SFX | String | Duns Plus Suffix |
06 | | ISA_ISA06_HIN | String | Health Industry Number |
06 | | ISA_ISA06_CARR_ID | String | Carrier Identification Number as assigned by Health Care Financing Administration |
06 | | ISA_ISA06_HCFA_FIIN | String | Fiscal Intermediary Identification Number as assigned by Health Care Financing Administration |
06 | | ISA_ISA06_HCFA_ID | String | Medicare Provider and Supplier Identification Number as assigned by Health Care Financing Administration |
06 | | ISA_ISA06_TAX_ID | String | US Federal Tax Identification Number |
06 | | ISA_ISA06_NAIC_CD | String | National Association of Insurance Commissioners Company Code |
06 | | ISA_ISA06_MUTLY_DEF | String | Mutually Defined |
08 | | ISA_ISA08_DUN_BRDST | String | Dun and Brandstreet |
08 | | ISA_ISA08_DUN_BRDST_SFX | String | Duns Plus Suffix |
08 | | ISA_ISA08_HIN | String | Health Industry Number |
08 | | ISA_ISA08_CARR_ID | String | Carrier Identification Number as assigned by Health Care Financing Administration |
08 | | ISA_ISA08_HCFA_FIIN | String | Fiscal Intermediary Identification Number as assigned by Health Care Financing Administration |
08 | | ISA_ISA08_HCFA_ID | String | Medicare Provider and Supplier Identification Number as assigned by Health Care Financing Administration |
08 | | ISA_ISA08_TAX_ID | String | US Federal Tax Identification Number |
08 | | ISA_ISA08_NAIC_CD | String | National Association of Insurance Commissioners Company Code |
08 | | ISA_ISA08_MUTLY_DEF | String | Mutually Defined |
09 | | ISA_ISA09_INTCHG_DT | Date (YYMMDD) | Interchange Date |
10 | | ISA_ISA10_INTCHG_TM | Time (HHMM) | Interchange Time |
11 | | ISA_ISA11_REPTN_SEP | String | Repetition Separator |
13 | | ISA_ISA13_ICN | Integer | Interchange Control Number |
14 | | ISA_ISA14_ACK_REQ | String | Acknowledgment Requested |
15 | | ISA_ISA15_ICN_USG_IND | String | Interchange Usage Indicator |
16 | | ISA_ISA16_COMP_ELE_SEP | String | Component Element Separator |
GSHDR | GS | Functional Group Header | | |
02 | | GSHDR_GS02_APP_SNDR_CD | String | Application Senders Code |
03 | | GSHDR_GS03_APP_RCV_CD | String | Application Receivers Code |
04 | | GSHDR_GS04_D8 | Date (YYYYMMDD) | Date |
05 | | GSHDR_GS05_TM | Time (HHMM) | Time |
05 | | GSHDR_GS05_TM8 | Time (HHMMSSCC) | Time |
06 | | GSHDR_GS06_GCN | Integer | Group Control Number |
STHDR - Transaction Set Header |
STHDR | ST | Transaction Set Header | | |
02 | | STHDR_ST02_TCN | String | Transaction Set Control Number |
03 | | STHDR_ST03_IMP_GUID_VERS_NM | String | Implementation Guide Version Name |
STHDR | BHT | Beginning of Hierarchical Transaction | | |
02 | | STHDR_BHT02_TS_PURP_CD | String | Transaction Set Purpose Code |
03 | | STHDR_BHT03_SBM_TRANS_ID | String | Submitter Transaction Identifier |
04 | | STHDR_BHT04_TS_CRTN_D8 | Date (YYYYMMDD) | Transaction Set Creation Date |
05 | | STHDR_BHT05_TS_CRTN_TM | Time (HHMM) | Transaction Set Creation Time |
05 | | STHDR_BHT05_TS_CRTN_TM8 | Time (HHMMSSCC) | Transaction Set Creation Time |
L2000A - Information Source Level |
L2000A | HL | Information Source Level | | |
01 | | L2000A_HL01_HIER_ID_NR | String | Hierarchical ID Number |
04 | | L2000A_HL04_HL_CHLD_CD | String | Hierarchical Child Code |
L2000A | AAA | Notification Validation | | |
03 | | L2000A_nnAAA03_REJ_RSN_CD | String | Reject Reason Code |
04 | | L2000A_nnAAA04_FWUP_ACTCD | String | Follow-up Action Code |
L2010A - Information Source Name |
L2010A | NM1 | Information Source Name | | |
01 | | L2010A_NM101_ENTY_ID_CD | String | Entity Identifier Code |
03 | | L2010A_NM103_PERSN | String | Person |
03 | | L2010A_NM103_NONPSN_ENTY | String | Non-Person Entity |
04 | | L2010A_NM104_NFO_SRC_FNM | String | Information Source First Name |
05 | | L2010A_NM105_NFO_SRC_MNM | String | Information Source Middle Name |
07 | | L2010A_NM107_NFO_SRC_SFX | String | Information Source Name Suffix |
09 | | L2010A_NM109_EIN | String | Employer's Identification Number |
09 | | L2010A_NM109_SSN | String | Social Security Number |
09 | | L2010A_NM109_ETN_NR | String | Electronic Transmitter Identification Number (ETIN) |
09 | | L2010A_NM109_PAYR_ID | String | Payor Identification |
09 | | L2010A_NM109_HCFA_PLAN_ID | String | Centers for Medicare and Medicaid Services PlanID |
09 | | L2010A_NM109_NPI | String | Centers for Medicare and Medicaid Services National Provider Identifier |
L2010A | REF | Information Source Supplemental Identification | | |
02 | | L2010A_nnREF_UPIN | String | Provider UPIN Number |
02 | | L2010A_nnREF_FAC_ID | String | Facility ID Number |
02 | | L2010A_nnREF_EIN | String | Employer's Identification Number |
02 | | L2010A_nnREF_PVR_SIT_NR | String | Provider Site Number |
02 | | L2010A_nnREF_PRV_PLN_ID | String | Provider Plan Network Identification Number |
02 | | L2010A_nnREF_FAC_NET_ID | String | Facility Network Identification Number |
02 | | L2010A_nnREF_SSN | String | Social Security Number |
02 | | L2010A_nnREF_CRR_AS_REF_NR | String | Carrier Assigned Reference Number |
L2010A | AAA | Information Source Validation | | |
03 | | L2010A_nnAAA03_REJ_RSN_CD | String | Reject Reason Code |
04 | | L2010A_nnAAA04_FWUP_ACTCD | String | Follow-up Action Code |
L2010A | PRV | Information Source Provider Information | | |
01 | | L2010A_PRV01_PVD_CD | String | Provider Code |
03 | | L2010A_PRV03_PVD_TAXNMY_CD | String | Health Care Provider Taxonomy Code |
L2000B - Information Receiver Level |
L2000B | HL | Information Receiver Level | | |
01 | | L2000B_HL01_HIER_ID_NR | String | Hierarchical ID Number |
02 | | L2000B_HL02_HIER_PARNT_ID_NR | String | Hierarchical Parent ID Number |
04 | | L2000B_HL04_HL_CHLD_CD | String | Hierarchical Child Code |
L2010B - Information Receiver Name |
L2010B | NM1 | Information Receiver Name | | |
01 | | L2010B_NM101_ENTY_ID_CD | String | Entity Identifier Code |
03 | | L2010B_NM103_PERSN | String | Person |
03 | | L2010B_NM103_NONPSN_ENTY | String | Non-Person Entity |
04 | | L2010B_NM104_NFO_REC_FNM | String | Information Receiver First Name |
05 | | L2010B_NM105_NFO_REC_MNM | String | Information Receiver Middle Name |
07 | | L2010B_NM107_NFO_RCV_SFX | String | Information Receiver Name Suffix |
09 | | L2010B_NM109_EIN | String | Employer's Identification Number |
09 | | L2010B_NM109_SSN | String | Social Security Number |
09 | | L2010B_NM109_ETN_NR | String | Electronic Transmitter Identification Number (ETIN) |
09 | | L2010B_NM109_PAYR_ID | String | Payor Identification |
09 | | L2010B_NM109_HCFA_PLAN_ID | String | Centers for Medicare and Medicaid Services PlanID |
09 | | L2010B_NM109_NPI | String | Centers for Medicare and Medicaid Services National Provider Identifier |
L2010B | PER | Information Receiver Contact Information | | |
02 | | L2010B_PER02_NFO_RC_CN_NM | String | Information Receiver Contact Name |
04 | | L2010B_PER04_EMAIL | String | Electronic Mail |
04 | | L2010B_PER04_FAX | String | Facsimile |
04 | | L2010B_PER04_PHN_NR | String | Telephone |
06 | | L2010B_PER06_EMAIL | String | Electronic Mail |
06 | | L2010B_PER06_PHN_EXT | String | Telephone Extension |
06 | | L2010B_PER06_FAX | String | Facsimile |
06 | | L2010B_PER06_PHN_NR | String | Telephone |
08 | | L2010B_PER08_EMAIL | String | Electronic Mail |
08 | | L2010B_PER08_PHN_EXT | String | Telephone Extension |
08 | | L2010B_PER08_FAX | String | Facsimile |
08 | | L2010B_PER08_PHN_NR | String | Telephone |
L2010B | AAA | Information Receiver Notification Validation | | |
03 | | L2010B_nnAAA03_REJ_RSN_CD | String | Reject Reason Code |
04 | | L2010B_nnAAA04_FWUP_ACTCD | String | Follow-up Action Code |
L2000C - Subscriber Level |
01 | | L2000C_HL01_HIER_ID_NR | String | Hierarchical ID Number |
02 | | L2000C_HL02_HIER_PARNT_ID_NR | String | Hierarchical Parent ID Number |
04 | | L2000C_HL04_HL_CHLD_CD | String | Hierarchical Child Code |
L2000C | TRN | Subscriber Trace Number | | |
01 | | L2000C_nnTRN01_TRAC_TYP_CD | String | Trace Type Code |
02 | | L2000C_nnTRN02_PTEVT_TRCK_NR | String | Patient Event Tracking Number |
03 | | L2000C_nnTRN03_TRAC_ASS_ID | String | Trace Assigning Entity Identifier |
04 | | L2000C_nnTRN04_TRC_ASS_ADDL_ID | String | Trace Assigning Entity Additional Identifier |
L2000C | AAA | Subscriber Notification Validation | | |
03 | | L2000C_nnAAA03_REJ_RSN_CD | String | Reject Reason Code |
04 | | L2000C_nnAAA04_FWUP_ACTCD | String | Follow-up Action Code |
L2000C | REF | Notification Receipt Number | | |
02 | | L2000C_REF_RECPT_NR | String | Receipt Number |
03 | | L2010C_NM103_PERSN | String | Person |
04 | | L2010C_NM104_SBR_FNM | String | Subscriber First Name |
05 | | L2010C_NM105_SBR_MNM | String | Subscriber Middle Name or Initial |
07 | | L2010C_NM107_SBR_SFX | String | Subscriber Name Suffix |
09 | | L2010C_NM109_MEM_ID_NR | String | Member Identification Number |
09 | | L2010C_NM109_MUTLY_DEF | String | Mutually Defined |
L2010C | REF | Subscriber Supplemental Identification | | |
02 | | L2010C_REF_GRP_POLCY_NR | String | Group or Policy Number |
02 | | L2010C_REF_GRP_NR | String | Group Number |
02 | | L2010C_REF_PATNT_ACCT_NR | String | Patient Account Number |
02 | | L2010C_REF_HIC_NR | String | Health Insurance Claim (HIC) Number |
02 | | L2010C_REF_ID_CRD_NR | String | Identity Card Number |
02 | | L2010C_REF_INS_PLCY_NR | String | Insurance Policy Number |
02 | | L2010C_REF_PLN_NET_ID | String | Plan Network Identification Number |
02 | | L2010C_REF_MDCD_ID_NR | String | Medicaid Recipient Identification Number |
02 | | L2010C_REF_SSN | String | Social Security Number |
L2010C | AAA | Subscriber Notification Validation | | |
03 | | L2010C_nnAAA03_REJ_RSN_CD | String | Reject Reason Code |
04 | | L2010C_nnAAA04_FWUP_ACTCD | String | Follow-up Action Code |
L2010C | DMG | Subscriber Demographic Information | | |
02 | | L2010C_DMG02_D8 | String | Subscriber Birth Date |
03 | | L2010C_DMG03_SUB_GENDR_CD | String | Subscriber Gender Code |
L2010C | INS | Subscriber Relationship | | |
08 | | L2010C_INS08_EMPMT_STAT_CD | String | Employment Status Code |
01 | | L2000D_HL01_HIER_ID_NR | String | Hierarchical ID Number |
02 | | L2000D_HL02_HIER_PARNT_ID_NR | String | Hierarchical Parent ID Number |
04 | | L2000D_HL04_HL_CHLD_CD | String | Hierarchical Child Code |
L2000D | TRN | Dependent Trace Number | | |
01 | | L2000D_nnTRN01_TRAC_TYP_CD | String | Trace Type Code |
02 | | L2000D_nnTRN02_PTEVT_TRCK_NR | String | Patient Event Tracking Number |
03 | | L2000D_nnTRN03_TRAC_ASS_ID | String | Trace Assigning Entity Identifier |
04 | | L2000D_nnTRN04_TRC_ASS_ADDL_ID | String | Trace Assigning Entity Additional Identifier |
L2000D | AAA | Dependent Notification Validation | | |
03 | | L2000D_nnAAA03_REJ_RSN_CD | String | Reject Reason Code |
04 | | L2000D_nnAAA04_FWUP_ACTCD | String | Follow-up Action Code |
L2000D | REF | Notification Receipt Number | | |
02 | | L2000D_REF_RECPT_NR | String | Receipt Number |
03 | | L2010D_NM103_PERSN | String | Person |
04 | | L2010D_NM104_DEP_FNM | String | Dependent First Name |
05 | | L2010D_NM105_DEP_MNM | String | Dependent Middle Name |
07 | | L2010D_NM107_DEP_SFX | String | Dependent Name Suffix |
09 | | L2010D_NM109_MEM_ID_NR | String | Member Identification Number |
09 | | L2010D_NM109_MUTLY_DEF | String | Mutually Defined |
L2010D | REF | Dependent Supplemental Identification | | |
02 | | L2010D_nnREF_PATNT_ACCT_NR | String | Patient Account Number |
02 | | L2010D_nnREF_SSN | String | Social Security Number |
L2010D | AAA | Dependent Notification Validation | | |
03 | | L2010D_nnAAA03_REJ_RSN_CD | String | Reject Reason Code |
04 | | L2010D_nnAAA04_FWUP_ACTCD | String | Follow-up Action Code |
L2010D | DMG | Dependent Demographic Information | | |
02 | | L2010D_DMG02_D8 | String | Dependent Birth Date |
03 | | L2010D_DMG03_DEP_GNDR_CD | String | Dependent Gender Code |
L2010D | INS | Dependent Relationship | | |
02 | | L2010D_INS02_IND_RELAT_CD | String | Individual Relationship Code |
17 | | L2010D_INS17_BRTH_SEQ_NR | Integer | Birth Sequence Number |
L2000E - Patient Event Level |
L2000E | HL | Patient Event Level | | |
01 | | L2000E_HL01_HIER_ID_NR | String | Hierarchical ID Number |
02 | | L2000E_HL02_HIER_PARNT_ID_NR | String | Hierarchical Parent ID Number |
04 | | L2000E_HL04_HL_CHLD_CD | String | Hierarchical Child Code |
L2000E | TRN | Patient Event Tracking Number | | |
01 | | L2000E_nnTRN01_TRAC_TYP_CD | String | Trace Type Code |
02 | | L2000E_nnTRN02_PTEVT_TRAC_NR | String | Patient Event Trace Number |
03 | | L2000E_nnTRN03_TRAC_ASS_ID | String | Trace Assigning Entity Identifier |
04 | | L2000E_nnTRN04_TRC_ASS_ADDL_ID | String | Trace Assigning Entity Additional Identifier |
L2000E | AAA | Patient Event Request Validation | | |
01 | | L2000E_nnAAA01_VLDREQ_IND | String | Valid Request Indicator |
03 | | L2000E_nnAAA03_REJ_RSN_CD | String | Reject Reason Code |
04 | | L2000E_nnAAA04_FWUP_ACTCD | String | Follow-up Action Code |
L2000E | UM | Health Care Services Review Information | | |
01 | | L2000E_UM01_REQST_CAT_CD | String | Request Category Code |
02 | | L2000E_UM02_CERT_TYP_CD | String | Certification Type Code |
03 | | L2000E_UM03_SVC_TYP_CD | String | Service Type Code |
04 | 01 | L2000E_UM0401_FAC_TYP_CD | String | Facility Type Code |
06 | | L2000E_UM06_LVL_SVC_CD | String | Level of Service Code |
L2000E | HCR | Health Care Services Review | | |
01 | | L2000E_HCR01_ACTN_CD | String | Action Code |
02 | | L2000E_HCR02_RVW_ID_NR | String | Review Identification Number |
03 | | L2000E_HCR03_RVW_DEC_RSN | String | Review Decision Reason Code |
04 | | L2000E_HCR04_2ND_SURG_OPN_IND | String | Second Surgical Opinion Indicator |
L2000E | REF | Administrative Reference Number | | |
02 | | L2000E_REF_ADMIN_REF_NR | String | Administrator's Reference Number |
L2000E | REF | Previous Review Authorization Number | | |
02 | | L2000E_REF_AUTH_NR | String | Authorization Number |
03 | | L2000E_DTP_EVNT_D8 | Date (YYYYMMDD) | Event |
03 | | L2000E_DTP_EVNT_RD8_1 | Start Date (YYYYMMDD) | Event |
03 | | L2000E_DTP_EVNT_RD8_2 | End Date (YYYYMMDD) | Event |
03 | | L2000E_DTP_ADMSN_D8 | Date (YYYYMMDD) | Admission |
03 | | L2000E_DTP_ADMSN_RD8_1 | Start Date (YYYYMMDD) | Admission |
03 | | L2000E_DTP_ADMSN_RD8_2 | End Date (YYYYMMDD) | Admission |
03 | | L2000E_DTP_DISCHG_D8 | Date (YYYYMMDD) | Discharge |
L2000E | DTP | Certification Issue Date | | |
03 | | L2000E_DTP_ISSU_D8 | Date (YYYYMMDD) | Issue |
L2000E | DTP | Certification Expiration Date | | |
03 | | L2000E_DTP_EXP_D8 | Date (YYYYMMDD) | Expiration |
L2000E | DTP | Certification Effective Date | | |
03 | | L2000E_DTP_EFF_D8 | Date (YYYYMMDD) | Effective |
03 | | L2000E_DTP_EFF_RD8_1 | Start Date (YYYYMMDD) | Effective |
03 | | L2000E_DTP_EFF_RD8_2 | End Date (YYYYMMDD) | Effective |
L2000E | HI | Patient Diagnosis | | |
01 | 02 | L2000E_HI0102_ICD10_DIAG | String | International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis |
01 | 02 | L2000E_HI0102_ICD10_ADMTG_DIAG | String | International Classification of Diseases Clinical Modification (ICD-10-CM) Admitting Diagnosis |
01 | 02 | L2000E_HI0102_ICD10_PRIN_DIAG | String | International Classification of Diseases Clinical Modification (ICD-10-CM) Principal Diagnosis |
01 | 02 | L2000E_HI0102_ICD10CM_PAT_RSN | String | International Classification of Diseases Clinical Modification (ICD-10-CM) Patient's Reason for Visit |
01 | 02 | L2000E_HI0102_ICD9_DIAG | String | International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis |
01 | 02 | L2000E_HI0102_ICD9_ADMTG_DIAG | String | International Classification of Diseases Clinical Modification (ICD-9-CM) Admitting Diagnosis |
01 | 02 | L2000E_HI0102_ICD9_PRIN_DIAG | String | International Classification of Diseases Clinical Modification (ICD-9-CM) Principal Diagnosis |
01 | 02 | L2000E_HI0102_DRG | String | Diagnosis Related Group (DRG) |
01 | 02 | L2000E_HI0102_ICD9CM_RSN_VST | String | International Classification of Diseases Clinical Modification (ICD-9-CM) Patient's Reason for Visit |
01 | 04 | L2000E_HI0104_DIAG | String | Diagnosis Date |
02 | 02 | L2000E_HI0202_ICD10_DIAG | String | International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis |
02 | 02 | L2000E_HI0202_ICD10_ADMTG_DIAG | String | International Classification of Diseases Clinical Modification (ICD-10-CM) Admitting Diagnosis |
02 | 02 | L2000E_HI0202_ICD10CM_PAT_RSN | String | International Classification of Diseases Clinical Modification (ICD-10-CM) Patient's Reason for Visit |
02 | 02 | L2000E_HI0202_ICD9_DIAG | String | International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis |
02 | 02 | L2000E_HI0202_ICD9_ADMTG_DIAG | String | International Classification of Diseases Clinical Modification (ICD-9-CM) Admitting Diagnosis |
02 | 02 | L2000E_HI0202_DRG | String | Diagnosis Related Group (DRG) |
02 | 02 | L2000E_HI0202_ICD9CM_RSN_VST | String | International Classification of Diseases Clinical Modification (ICD-9-CM) Patient's Reason for Visit |
02 | 04 | L2000E_HI0204_DIAG | String | Diagnosis Date |
03 | 02 | L2000E_HI0302_ICD10_DIAG | String | International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis |
03 | 02 | L2000E_HI0302_ICD10CM_PAT_RSN | String | International Classification of Diseases Clinical Modification (ICD-10-CM) Patient's Reason for Visit |
03 | 02 | L2000E_HI0302_ICD9_DIAG | String | International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis |
03 | 02 | L2000E_HI0302_DRG | String | Diagnosis Related Group (DRG) |
03 | 02 | L2000E_HI0302_ICD9CM_RSN_VST | String | International Classification of Diseases Clinical Modification (ICD-9-CM) Patient's Reason for Visit |
03 | 04 | L2000E_HI0304_DIAG | String | Diagnosis Date |
04 | 02 | L2000E_HI0402_ICD10_DIAG | String | International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis |
04 | 02 | L2000E_HI0402_ICD10CM_PAT_RSN | String | International Classification of Diseases Clinical Modification (ICD-10-CM) Patient's Reason for Visit |
04 | 02 | L2000E_HI0402_ICD9_DIAG | String | International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis |
04 | 02 | L2000E_HI0402_DRG | String | Diagnosis Related Group (DRG) |
04 | 02 | L2000E_HI0402_ICD9CM_RSN_VST | String | International Classification of Diseases Clinical Modification (ICD-9-CM) Patient's Reason for Visit |
04 | 04 | L2000E_HI0404_DIAG | String | Diagnosis Date |
05 | 02 | L2000E_HI0502_ICD10_DIAG | String | International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis |
05 | 02 | L2000E_HI0502_ICD10CM_PAT_RSN | String | International Classification of Diseases Clinical Modification (ICD-10-CM) Patient's Reason for Visit |
05 | 02 | L2000E_HI0502_ICD9_DIAG | String | International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis |
05 | 02 | L2000E_HI0502_DRG | String | Diagnosis Related Group (DRG) |
05 | 02 | L2000E_HI0502_ICD9CM_RSN_VST | String | International Classification of Diseases Clinical Modification (ICD-9-CM) Patient's Reason for Visit |
05 | 04 | L2000E_HI0504_DIAG | String | Diagnosis Date |
06 | 02 | L2000E_HI0602_ICD10_DIAG | String | International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis |
06 | 02 | L2000E_HI0602_ICD10CM_PAT_RSN | String | International Classification of Diseases Clinical Modification (ICD-10-CM) Patient's Reason for Visit |
06 | 02 | L2000E_HI0602_ICD9_DIAG | String | International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis |
06 | 02 | L2000E_HI0602_DRG | String | Diagnosis Related Group (DRG) |
06 | 02 | L2000E_HI0602_ICD9CM_RSN_VST | String | International Classification of Diseases Clinical Modification (ICD-9-CM) Patient's Reason for Visit |
06 | 04 | L2000E_HI0604_DIAG | String | Diagnosis Date |
07 | 02 | L2000E_HI0702_ICD10_DIAG | String | International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis |
07 | 02 | L2000E_HI0702_ICD10CM_PAT_RSN | String | International Classification of Diseases Clinical Modification (ICD-10-CM) Patient's Reason for Visit |
07 | 02 | L2000E_HI0702_ICD9_DIAG | String | International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis |
07 | 02 | L2000E_HI0702_DRG | String | Diagnosis Related Group (DRG) |
07 | 02 | L2000E_HI0702_ICD9CM_RSN_VST | String | International Classification of Diseases Clinical Modification (ICD-9-CM) Patient's Reason for Visit |
07 | 04 | L2000E_HI0704_DIAG | String | Diagnosis Date |
08 | 02 | L2000E_HI0802_ICD10_DIAG | String | International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis |
08 | 02 | L2000E_HI0802_ICD10CM_PAT_RSN | String | International Classification of Diseases Clinical Modification (ICD-10-CM) Patient's Reason for Visit |
08 | 02 | L2000E_HI0802_ICD9_DIAG | String | International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis |
08 | 02 | L2000E_HI0802_DRG | String | Diagnosis Related Group (DRG) |
08 | 02 | L2000E_HI0802_ICD9CM_RSN_VST | String | International Classification of Diseases Clinical Modification (ICD-9-CM) Patient's Reason for Visit |
08 | 04 | L2000E_HI0804_DIAG | String | Diagnosis Date |
09 | 02 | L2000E_HI0902_ICD10_DIAG | String | International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis |
09 | 02 | L2000E_HI0902_ICD10CM_PAT_RSN | String | International Classification of Diseases Clinical Modification (ICD-10-CM) Patient's Reason for Visit |
09 | 02 | L2000E_HI0902_ICD9_DIAG | String | International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis |
09 | 02 | L2000E_HI0902_DRG | String | Diagnosis Related Group (DRG) |
09 | 02 | L2000E_HI0902_ICD9CM_RSN_VST | String | International Classification of Diseases Clinical Modification (ICD-9-CM) Patient's Reason for Visit |
09 | 04 | L2000E_HI0904_DIAG | String | Diagnosis Date |
10 | 02 | L2000E_HI1002_ICD10_DIAG | String | International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis |
10 | 02 | L2000E_HI1002_ICD10CM_PAT_RSN | String | International Classification of Diseases Clinical Modification (ICD-10-CM) Patient's Reason for Visit |
10 | 02 | L2000E_HI1002_ICD9_DIAG | String | International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis |
10 | 02 | L2000E_HI1002_DRG | String | Diagnosis Related Group (DRG) |
10 | 02 | L2000E_HI1002_ICD9CM_RSN_VST | String | International Classification of Diseases Clinical Modification (ICD-9-CM) Patient's Reason for Visit |
10 | 04 | L2000E_HI1004_DIAG | String | Diagnosis Date |
11 | 02 | L2000E_HI1102_ICD10_DIAG | String | International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis |
11 | 02 | L2000E_HI1102_ICD10CM_PAT_RSN | String | International Classification of Diseases Clinical Modification (ICD-10-CM) Patient's Reason for Visit |
11 | 02 | L2000E_HI1102_ICD9_DIAG | String | International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis |
11 | 02 | L2000E_HI1102_DRG | String | Diagnosis Related Group (DRG) |
11 | 02 | L2000E_HI1102_ICD9CM_RSN_VST | String | International Classification of Diseases Clinical Modification (ICD-9-CM) Patient's Reason for Visit |
11 | 04 | L2000E_HI1104_DIAG | String | Diagnosis Date |
12 | 02 | L2000E_HI1202_ICD10_DIAG | String | International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis |
12 | 02 | L2000E_HI1202_ICD10CM_PAT_RSN | String | International Classification of Diseases Clinical Modification (ICD-10-CM) Patient's Reason for Visit |
12 | 02 | L2000E_HI1202_ICD9_DIAG | String | International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis |
12 | 02 | L2000E_HI1202_DRG | String | Diagnosis Related Group (DRG) |
12 | 02 | L2000E_HI1202_LOINC_CD | String | Logical Observation Identifier Names and Codes (LOINC<190>) Codes |
12 | 02 | L2000E_HI1202_ICD9CM_RSN_VST | String | International Classification of Diseases Clinical Modification (ICD-9-CM) Patient's Reason for Visit |
12 | 04 | L2000E_HI1204_DIAG | String | Diagnosis Date |
L2010E - Patient Event Provider Name |
L2010E | NM1 | Patient Event Provider Name | | |
01 | | L2010E_NM101_ENTY_ID_CD | String | Entity Identifier Code |
03 | | L2010E_NM103_PERSN | String | Person |
03 | | L2010E_NM103_NONPSN_ENTY | String | Non-Person Entity |
04 | | L2010E_NM104_PTEVT_PVR_FNM | String | Patient Event Provider First Name |
05 | | L2010E_NM105_PTEVT_PVR_MNM | String | Patient Event Provider Middle Name |
06 | | L2010E_NM106_PTEVT_PVR_PFX | String | Patient Event Provider Name Prefix |
07 | | L2010E_NM107_PTEVT_PVR_SFX | String | Patient Event Provider Name Suffix |
09 | | L2010E_NM109_EIN | String | Employer's Identification Number |
09 | | L2010E_NM109_SSN | String | Social Security Number |
09 | | L2010E_NM109_ETN_NR | String | Electronic Transmitter Identification Number (ETIN) |
09 | | L2010E_NM109_NPI | String | Centers for Medicare and Medicaid Services National Provider Identifier |
L2010E | REF | Patient Event Provider Supplemental Identification | | |
02 | | L2010E_nnREF_STAT_LIC_NR | String | State License Number |
02 | | L2010E_nnREF_UPIN | String | Provider UPIN Number |
02 | | L2010E_nnREF_FAC_ID | String | Facility ID Number |
02 | | L2010E_nnREF_EIN | String | Employer's Identification Number |
02 | | L2010E_nnREF_PRV_PLN_ID | String | Provider Plan Network Identification Number |
02 | | L2010E_nnREF_FAC_NET_ID | String | Facility Network Identification Number |
02 | | L2010E_nnREF_SSN | String | Social Security Number |
02 | | L2010E_nnREF_CRR_AS_REF_NR | String | Carrier Assigned Reference Number |
03 | | L2010E_nnREF03_LIC_NR_STAT | String | |
L2010E | AAA | Patient Event Provider Request Validation | | |
01 | | L2010E_nnAAA01_VLDREQ_IND | String | Valid Request Indicator |
03 | | L2010E_nnAAA03_REJ_RSN_CD | String | Reject Reason Code |
04 | | L2010E_nnAAA04_FWUP_ACTCD | String | Follow-up Action Code |
L2010E | PRV | Patient Event Provider Information | | |
01 | | L2010E_PRV01_PVD_CD | String | Provider Code |
03 | | L2010E_PRV03_PVD_TAXNMY_CD | String | Health Care Provider Taxonomy Code |
01 | | L2000F_HL01_HIER_ID_NR | String | Hierarchical ID Number |
02 | | L2000F_HL02_HIER_PARNT_ID_NR | String | Hierarchical Parent ID Number |
L2000F | TRN | Service Trace Number | | |
01 | | L2000F_nnTRN01_TRAC_TYP_CD | String | Trace Type Code |
02 | | L2000F_nnTRN02_SVC_TRAC_NR | String | Service Trace Number |
03 | | L2000F_nnTRN03_TRAC_ASS_ID | String | Trace Assigning Entity Identifier |
04 | | L2000F_nnTRN04_TRC_ASS_ADDL_ID | String | Trace Assigning Entity Additional Identifier |
L2000F | AAA | Service Request Validation | | |
03 | | L2000F_nnAAA03_REJ_RSN_CD | String | Reject Reason Code |
04 | | L2000F_nnAAA04_FWUP_ACTCD | String | Follow-up Action Code |
L2000F | UM | Health Care Services Review Information | | |
01 | | L2000F_UM01_REQST_CAT_CD | String | Request Category Code |
02 | | L2000F_UM02_CERT_TYP_CD | String | Certification Type Code |
03 | | L2000F_UM03_SVC_TYP_CD | String | Service Type Code |
04 | 01 | L2000F_UM0401_FAC_TYP_CD | String | Facility Type Code |
L2000F | HCR | Health Care Services Review | | |
01 | | L2000F_HCR01_ACTN_CD | String | Action Code |
02 | | L2000F_HCR02_RVW_ID_NR | String | Review Identification Number |
03 | | L2000F_HCR03_RVW_DEC_RSN | String | Review Decision Reason Code |
04 | | L2000F_HCR04_COND_RESP_CD | String | Yes No Condition or Response Code |
L2000F | REF | Previous Review Authorization Number | | |
02 | | L2000F_REF_AUTH_NR | String | Authorization Number |
L2000F | REF | Administrative Reference Number | | |
02 | | L2000F_REF_ADMIN_REF_NR | String | Administrator's Reference Number |
03 | | L2000F_DTP_SVC_D8 | Date (YYYYMMDD) | Service |
03 | | L2000F_DTP_SVC_RD8_1 | Start Date (YYYYMMDD) | Service |
03 | | L2000F_DTP_SVC_RD8_2 | End Date (YYYYMMDD) | Service |
L2000F | DTP | Certification Issue Date | | |
03 | | L2000F_DTP_ISSU_D8 | Date (YYYYMMDD) | Issue |
L2000F | DTP | Certification Expiration Date | | |
03 | | L2000F_DTP_EXP_D8 | Date (YYYYMMDD) | Expiration |
L2000F | DTP | Certification Effective Date | | |
03 | | L2000F_DTP_EFF_D8 | Date (YYYYMMDD) | Effective |
03 | | L2000F_DTP_EFF_RD8_1 | Start Date (YYYYMMDD) | Effective |
03 | | L2000F_DTP_EFF_RD8_2 | End Date (YYYYMMDD) | Effective |
L2000F | SV1 | Professional Service | | |
01 | 02 | L2000F_SV10102_HCPCS_CD | String | Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes |
01 | 02 | L2000F_SV10102_HIC_PRD_SVCCD | String | Home Infusion EDI Coalition (HIEC) Product/Service Code |
01 | 02 | L2000F_SV10102_NDC542 | String | National Drug Code in 5-4-2 Format |
01 | 02 | L2000F_SV10102_ABC_CD | String | Advanced Billing Concepts (ABC) Codes |
01 | 03 | L2000F_SV10103_PROC_MOD | String | Procedure Modifier |
01 | 04 | L2000F_SV10104_PROC_MOD | String | Procedure Modifier |
01 | 05 | L2000F_SV10105_PROC_MOD | String | Procedure Modifier |
01 | 06 | L2000F_SV10106_PROC_MOD | String | Procedure Modifier |
01 | 08 | L2000F_SV10108_PROD_SVC_ID | String | Product or Service ID |
02 | | L2000F_SV102_SVC_LIN_AMT | Number | Service Line Amount |
03 | | L2000F_SV103_UNIT_MSMT_CD | String | Unit or Basis for Measurement Code |
04 | | L2000F_SV104_SVC_UN_CT | Number | Service Unit Count |
11 | | L2000F_SV111_EPSDT_IND | String | EPSDT Indicator |
20 | | L2000F_SV120_NRSG_LVL_CAR | String | Nursing Home Level of Care |
L2000F | SV2 | Institutional Service Line | | |
01 | | L2000F_SV201_SVC_LIN_REV_CD | String | Service Line Revenue Code |
02 | 02 | L2000F_SV20202_HCPCS_CD | String | Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes |
02 | 02 | L2000F_SV20202_ICD9CM_PROC | String | International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) - Procedure |
02 | 02 | L2000F_SV20202_HIC_PRD_SVCCD | String | Home Infusion EDI Coalition (HIEC) Product/Service Code |
02 | 02 | L2000F_SV20202_NDC542 | String | National Drug Code in 5-4-2 Format |
02 | 02 | L2000F_SV20202_MUTLY_DEF | String | Mutually Defined |
02 | 03 | L2000F_SV20203_PROC_MOD | String | Procedure Modifier |
02 | 04 | L2000F_SV20204_PROC_MOD | String | Procedure Modifier |
02 | 05 | L2000F_SV20205_PROC_MOD | String | Procedure Modifier |
02 | 06 | L2000F_SV20206_PROC_MOD | String | Procedure Modifier |
02 | 08 | L2000F_SV20208_PROD_SVC_ID | String | Product or Service ID |
03 | | L2000F_SV203_SVC_LIN_AMT | Number | Service Line Amount |
04 | | L2000F_SV204_UNIT_MSMT_CD | String | Unit or Basis for Measurement Code |
05 | | L2000F_SV205_SVC_UN_CT | Number | Service Unit Count |
06 | | L2000F_SV206_SVC_LIN_RT | Number | Service Line Rate |
10 | | L2000F_SV210_NRSG_LVL_CAR | String | Nursing Home Level of Care |
01 | 02 | L2000F_SV30102_PROC_CD | String | American Dental Association Codes |
01 | 03 | L2000F_SV30103_PROC_MOD | String | Procedure Modifier |
01 | 04 | L2000F_SV30104_PROC_MOD | String | Procedure Modifier |
01 | 05 | L2000F_SV30105_PROC_MOD | String | Procedure Modifier |
01 | 06 | L2000F_SV30106_PROC_MOD | String | Procedure Modifier |
01 | 08 | L2000F_SV30108_PROD_SVC_ID | String | Product or Service ID |
02 | | L2000F_SV302_SVC_LIN_AMT | Number | Service Line Amount |
04 | 01 | L2000F_SV30401_ORAL_CAV_DES_CD | String | Oral Cavity Designation Code |
04 | 02 | L2000F_SV30402_ORAL_CAV_DES_CD | String | Oral Cavity Designation Code |
04 | 03 | L2000F_SV30403_ORAL_CAV_DES_CD | String | Oral Cavity Designation Code |
04 | 04 | L2000F_SV30404_ORAL_CAV_DES_CD | String | Oral Cavity Designation Code |
04 | 05 | L2000F_SV30405_ORAL_CAV_DES_CD | String | Oral Cavity Designation Code |
05 | | L2000F_SV305_PROS_CWN_INLY_CD | String | Prosthesis, Crown, or Inlay Code |
06 | | L2000F_SV306_SVC_UN_CT | Number | Service Unit Count |
L2000F | TOO | Tooth Information | | |
02 | | L2000F_nnTOO02_NTL_TTH_DES_SYS | String | Universal National Tooth Designation System |
03 | 01 | L2000F_nnTOO0301_TOOTH_SURF_CD | String | Tooth Surface Code |
03 | 02 | L2000F_nnTOO0302_TOOTH_SURF_CD | String | Tooth Surface Code |
03 | 03 | L2000F_nnTOO0303_TOOTH_SURF_CD | String | Tooth Surface Code |
03 | 04 | L2000F_nnTOO0304_TOOTH_SURF_CD | String | Tooth Surface Code |
03 | 05 | L2000F_nnTOO0305_TOOTH_SURF_CD | String | Tooth Surface Code |
L2010F - Service Provider Name (Single Iteration) |
L2010F | NM1 | Service Provider Name | | |
01 | | L2010F_xx_NM101_ENTY_ID_CD | String | Entity Identifier Code |
03 | | L2010F_xx_NM103_PERSN | String | Person |
03 | | L2010F_xx_NM103_NONPSN_ENTY | String | Non-Person Entity |
04 | | L2010F_xx_NM104_SVC_PVR_FNM | String | Service Provider First Name |
05 | | L2010F_xx_NM105_SVC_PVR_MNM | String | Service Provider Middle Name |
06 | | L2010F_xx_NM106_SVC_PVR_PFX | String | Service Provider Name Prefix |
07 | | L2010F_xx_NM107_SVC_PVR_SFX | String | Service Provider Name Suffix |
09 | | L2010F_xx_NM109_EIN | String | Employer's Identification Number |
09 | | L2010F_xx_NM109_SSN | String | Social Security Number |
09 | | L2010F_xx_NM109_ETN_NR | String | Electronic Transmitter Identification Number (ETIN) |
09 | | L2010F_xx_NM109_NPI | String | Centers for Medicare and Medicaid Services National Provider Identifier |
L2010F | REF | Service Provider Supplemental Identification | | |
02 | | L2010F_xx_nnREF_STAT_LIC_NR | String | State License Number |
02 | | L2010F_xx_nnREF_UPIN | String | Provider UPIN Number |
02 | | L2010F_xx_nnREF_FAC_ID | String | Facility ID Number |
02 | | L2010F_xx_nnREF_EIN | String | Employer's Identification Number |
02 | | L2010F_xx_nnREF_PVR_SIT_NR | String | Provider Site Number |
02 | | L2010F_xx_nnREF_PRV_PLN_ID | String | Provider Plan Network Identification Number |
02 | | L2010F_xx_nnREF_FAC_NET_ID | String | Facility Network Identification Number |
02 | | L2010F_xx_nnREF_SSN | String | Social Security Number |
02 | | L2010F_xx_nnREF_CRR_AS_REF_NR | String | Carrier Assigned Reference Number |
03 | | L2010F_xx_nnREF03_LIC_NR_STAT | String | |
L2010F | AAA | Service Provider Request Validation | | |
01 | | L2010F_xx_nnAAA01_VLDREQ_IND | String | Valid Request Indicator |
03 | | L2010F_xx_nnAAA03_REJ_RSN_CD | String | Reject Reason Code |
04 | | L2010F_xx_nnAAA04_FWUP_ACTCD | String | Follow-up Action Code |
L2010F | PRV | Service Provider Information | | |
01 | | L2010F_xx_PRV01_PVD_CD | String | Provider Code |
03 | | L2010F_xx_PRV03_PVD_TAXNMY_CD | String | Health Care Provider Taxonomy Code |
STHDR | SE | Transaction Set Trailer | | |
01 | | STHDR_SE01_TS_SEG_CT | Integer | Transaction Segment Count |
02 | | STHDR_SE02_TCN | String | Transaction Set Control Number |
GSHDR | GE | Functional Group Trailer | | |
01 | | GSHDR_GE01_NR_TS_INCLUDED | Integer | Number of Transaction Sets Included |
02 | | GSHDR_GE02_GCN | Integer | Group Control Number |
ISA | IEA | Interchange Control Trailer | | |
01 | | ISA_IEA01_NR_INC_FUNC_GRP | Integer | Number of Included Functional Groups |
02 | | ISA_IEA02_ICN | Integer | Interchange Control Number |