5010 Health Care Services Review - Request for Review [Q0]


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
12ISA_ISA12_ICN_VERS_NRStringInterchang Control Version Number
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
01STHDR_BHT01_HIER_STRUC_CDStringHierarchical Structure Code
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
06STHDR_BHT06_TRANS_TYP_CDStringTransaction Type Code
L2000A - UTILIZATION MANAGEMENT ORGANIZATION (UMO) LEVEL
L2000AHLUtilization Management Organization (UMO) Level
01L2000A_HL01_HIER_ID_NRStringHierarchical ID Number
L2010A - UTILIZATION MANAGEMENT ORGANIZATION (UMO) NAME (Value Qualified)
Mapping Prefix: L2010A_2B - Third-Party Administrator
Mapping Prefix: L2010A_36 - Employer
Mapping Prefix: L2010A_PR - Payer
Mapping Prefix: L2010A_X3 - Utilization Management Organization
L2010ANM1Utilization Management Organization (UMO) Name
02L2010A_yy_NM102_ENT_TYP_QUALStringEntity Type Qualifier
03L2010A_yy_NM103_UMO_LNMStringUtilization Management Organization (UMO) Name Last or Organization Name
04L2010A_yy_NM104_UMO_FNMStringUtilization Management Organization (UMO) Name First
05L2010A_yy_NM105_UMO_MNMStringUtilization Management Organization (UMO) Name Middle
07L2010A_yy_NM107_UMO_SFXStringUtilization Management Organization (UMO) Name Suffix
09L2010A_yy_NM109_EMPLYR_IDStringEmployer's Identification Number
09L2010A_yy_NM109_SSNStringSocial Security Number
09L2010A_yy_NM109_ETN_NRStringElectronic Transmitter Identification Number (ETIN)
09L2010A_yy_NM109_PAYR_IDStringPayor Identification
09L2010A_yy_NM109_HCFA_PLAN_IDStringCenters for Medicare and Medicaid Services PlanID
L2000B - REQUESTER LEVEL
L2000BHLRequester Level
01L2000B_HL01_HIER_ID_NRStringHierarchical ID Number
02L2000B_HL02_HIER_PARNT_ID_NRStringHierarchical Parent ID Number
L2010B - REQUESTER NAME (Value Qualified)
Mapping Prefix: L2010B_1P - Provider
Mapping Prefix: L2010B_2B - Third-Party Administrator
Mapping Prefix: L2010B_36 - Employer
Mapping Prefix: L2010B_FA - Facility
Mapping Prefix: L2010B_PR - Payer
L2010BNM1Requester Name
02L2010B_yy_NM102_ENT_TYP_QUALStringEntity Type Qualifier
03L2010B_yy_NM103_REQ_LNMStringRequester Last or Organization Name
04L2010B_yy_NM104_REQ_FNMStringRequester First Name
05L2010B_yy_NM105_REQ_MNMStringRequester Middle Name
07L2010B_yy_NM107_REQ_SFXStringRequester Name Suffix
09L2010B_yy_NM109_EMPLYR_IDStringEmployer's Identification Number
09L2010B_yy_NM109_SSNStringSocial Security Number
09L2010B_yy_NM109_ETN_NRStringElectronic Transmitter Identification Number (ETIN)
09L2010B_yy_NM109_HCFA_PLAN_IDStringCenters for Medicare and Medicaid Services PlanID
09L2010B_yy_NM109_NPIStringCenters for Medicare and Medicaid Services National Provider Identifier
L2010BREFRequester Supplemental Identification
02L2010B_yy_REF_UPINStringProvider UPIN Number
02L2010B_yy_REF_FAC_IDStringFacility ID Number
02L2010B_yy_REF_EMPLR_ID_NRStringEmployer's Identification Number
02L2010B_yy_REF_PVR_SIT_NRStringProvider Site Number
02L2010B_yy_REF_PRV_PLN_IDStringProvider Plan Network Identification Number
02L2010B_yy_REF_FAC_NET_IDStringFacility Network Identification Number
02L2010B_yy_REF_SSNStringSocial Security Number
02L2010B_yy_REF_CRR_AS_REF_NRStringCarrier Assigned Reference Number
L2010BN3Requester Address
01L2010B_yy_N301_REQ_ADDRStringRequester Address Line
02L2010B_yy_N302_REQ_ADDRStringRequester Address Line
L2010BN4Requester City, State, ZIP Code
01L2010B_yy_N401_REQSTR_CITYStringRequester City Name
02L2010B_yy_N402_REQ_STATStringRequester State or Province Code
03L2010B_yy_N403_REQ_ZIPStringRequester Postal Zone or ZIP Code
04L2010B_yy_N404_CNTRY_CDStringCountry Code
07L2010B_yy_N407_CNTRY_SUBDV_CDStringCountry Subdivision Code
L2010BPERRequester Contact Information
02L2010B_yy_PER02_REQ_CON_NMStringRequester Contact Name
04L2010B_yy_PER04_EMAILStringElectronic Mail
04L2010B_yy_PER04_FAXStringFacsimile
04L2010B_yy_PER04_PHN_NRStringTelephone
04L2010B_yy_PER04_URLStringUniform Resource Locator (URL)
06L2010B_yy_PER06_EMAILStringElectronic Mail
06L2010B_yy_PER06_PHN_EXTStringTelephone Extension
06L2010B_yy_PER06_FAXStringFacsimile
06L2010B_yy_PER06_PHN_NRStringTelephone
06L2010B_yy_PER06_URLStringUniform Resource Locator (URL)
08L2010B_yy_PER08_EMAILStringElectronic Mail
08L2010B_yy_PER08_PHN_EXTStringTelephone Extension
08L2010B_yy_PER08_FAXStringFacsimile
08L2010B_yy_PER08_PHN_NRStringTelephone
08L2010B_yy_PER08_URLStringUniform Resource Locator (URL)
L2010BPRVRequester Provider Information
01L2010B_yy_PRV01_PVD_CDStringProvider Code
03L2010B_yy_PRV03_PVD_TAXNMY_CDStringHealth Care Provider Taxonomy Code
L2000C - SUBSCRIBER LEVEL
L2000CHLSubscriber Level
01L2000C_HL01_HIER_ID_NRStringHierarchical ID Number
02L2000C_HL02_HIER_PARNT_ID_NRStringHierarchical Parent ID Number
L2010C - SUBSCRIBER NAME
L2010CNM1Subscriber Name
03L2010C_NM103_SBR_LNMStringSubscriber Last Name
04L2010C_NM104_SBR_FNMStringSubscriber First Name
05L2010C_NM105_SBR_MNMStringSubscriber Middle Name or Initial
06L2010C_NM106_SBR_PFXStringSubscriber Name Prefix
07L2010C_NM107_SBR_SFXStringSubscriber Name Suffix
09L2010C_NM109_UNQ_HLTH_IDStringStandard Unique Health Identifier for each Individual in the United States
09L2010C_NM109_MEM_ID_NRStringMember Identification Number
L2010CREFSubscriber Supplemental Identification
02L2010C_nnREF_GRP_POLCY_NRStringGroup or Policy Number
02L2010C_nnREF_BRNCH_IDStringBranch Identifier
02L2010C_nnREF_GRP_NRStringGroup Number
02L2010C_nnREF_DEPT_NRStringDepartment Number
02L2010C_nnREF_PATNT_ACCT_NRStringPatient Account Number
02L2010C_nnREF_HIC_NRStringHealth Insurance Claim (HIC) Number
02L2010C_nnREF_ID_CRD_NRStringIdentity Card Number
02L2010C_nnREF_INS_PLCY_NRStringInsurance Policy Number
02L2010C_nnREF_PLN_NET_IDStringPlan Network Identification Number
02L2010C_nnREF_MDCD_ID_NRStringMedicaid Recipient Identification Number
02L2010C_nnREF_SSNStringSocial Security Number
L2010CN3Subscriber Address
01L2010C_N301_SBR_ADDRStringSubscriber Address Line
02L2010C_N302_SBR_ADDRStringSubscriber Address Line
L2010CN4Subscriber City, State, ZIP Code
01L2010C_N401_SBR_CITYStringSubscriber City Name
02L2010C_N402_SBR_STATStringSubscriber State Code
03L2010C_N403_SBR_ZIPStringSubscriber Postal Zone or ZIP Code
04L2010C_N404_CNTRY_CDStringCountry Code
07L2010C_N407_CNTRY_SUBDV_CDStringCountry Subdivision Code
L2010CDMGSubscriber Demographic Information
02L2010C_DMG02_D8DateTimeSubscriber 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
L2010D - DEPENDENT NAME
L2010DNM1Dependent Name
03L2010D_NM103_DEP_LNMStringDependent Last Name
04L2010D_NM104_DEP_FNMStringDependent First Name
05L2010D_NM105_DEP_MNMStringDependent Middle Name
07L2010D_NM107_DEP_SFXStringDependent Name Suffix
L2010DREFDependent Supplemental Identification
02L2010D_nnREF_PATNT_ACCT_NRStringPatient Account Number
02L2010D_nnREF_SSNStringSocial Security Number
L2010DN3Dependent Address
01L2010D_N301_DEP_ADDRStringDependent Address Line
02L2010D_N302_DEP_ADDRStringDependent Address Line
L2010DN4Dependent City, State, ZIP Code
01L2010D_N401_DEP_CITYStringDependent City Name
02L2010D_N402_DEP_STATStringDependent State Code
03L2010D_N403_DEP_POSTL_ZIPStringDependent Postal Zone or ZIP Code
04L2010D_N404_CNTRY_CDStringCountry Code
07L2010D_N407_CNTRY_SUBDV_CDStringCountry Subdivision Code
L2010DDMGDependent Demographic Information
02L2010D_DMG02_D8DateTimeDependent Birth Date
03L2010D_DMG03_DEP_GNDR_CDStringDependent Gender Code
L2010DINSDependent Relationship
02L2010D_INS02_IND_RELAT_CDStringIndividual Relationship Code
17L2010D_INS17_BRTH_SEQ_NRStringBirth 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
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
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
0402L2000E_UM0402_FAC_CD_QUALStringFacility Code Qualifier
0501L2000E_UM0501_RELTD_CAUS_CDStringRelated Causes Code
0502L2000E_UM0502_RELTD_CAUS_CDStringRelated Causes Code
0503L2000E_UM0503_RELTD_CAUS_CDStringRelated Causes Code
0504L2000E_UM0504_STATStringState or Province Code
0505L2000E_UM0505_CNTRY_CDStringCountry Code
06L2000E_UM06_LVL_SVC_CDStringLevel of Service Code
07L2000E_UM07_CURR_HLTH_CND_CDStringCurrent Health Condition Code
08L2000E_UM08_PROGNS_CDStringPrognosis Code
09L2000E_UM09_RELS_NFO_CDStringRelease of Information Code
10L2000E_UM10_DELAY_RSN_CDStringDelay Reason Code
L2000EREFPrevious Review Authorization Number
02L2000E_REF_AUTH_NRStringAuthorization Number
L2000EREFPrevious Review Administrative Reference Number
02L2000E_REF_ADMIN_REF_NRStringAdministrator's Reference Number
L2000EDTPAccident Date
03L2000E_DTP_ACCDNT_D8Date (YYYYMMDD)Accident Date
L2000EDTPLast Menstrual Period Date
03L2000E_DTP_MENS_PERD_D8Date (YYYYMMDD)Last Menstrual Period Date
L2000EDTPEstimated Date of Birth
03L2000E_DTP_EST_DOB_D8Date (YYYYMMDD)Estimated Date of Birth Date
L2000EDTPOnset of Current Symptoms or Illness Date
03L2000E_DTP_ONST_CURR_SYMPTM_D8Date (YYYYMMDD)Onset of Current Symptoms or Illness Date
L2000EDTPEvent Date
03L2000E_DTP_EVNT_D8Date (YYYYMMDD)Event Date
03L2000E_DTP_EVNT_RD8_1Start Date (YYYYMMDD)Event Date
03L2000E_DTP_EVNT_RD8_2End Date (YYYYMMDD)Event Date
L2000EDTPAdmission Date
03L2000E_DTP_ADMSN_D8Date (YYYYMMDD)Admission Date
03L2000E_DTP_ADMSN_RD8_1Start Date (YYYYMMDD)Admission Date
03L2000E_DTP_ADMSN_RD8_2End Date (YYYYMMDD)Admission Date
L2000EDTPDischarge Date
03L2000E_DTP_DISCHG_D8Date (YYYYMMDD)Discharge Date
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_ICD10_RSN_VISITStringInternational 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_ICD9_RSN_VISITStringInternational Classification of Diseases Clinical Modification (ICD-9-CM) Patient's Reason for Visit
0104L2000E_HI0104_DIAGDateTimeDiagnosis 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_ICD10_RSN_VISITStringInternational 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_ICD9_RSN_VISITStringInternational Classification of Diseases Clinical Modification (ICD-9-CM) Patient's Reason for Visit
0204L2000E_HI0204_DIAGDateTimeDiagnosis Date
0302L2000E_HI0302_ICD10_DIAGStringInternational Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis
0302L2000E_HI0302_ICD10_RSN_VISITStringInternational 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_ICD9_RSN_VISITStringInternational Classification of Diseases Clinical Modification (ICD-9-CM) Patient's Reason for Visit
0304L2000E_HI0304_DIAGDateTimeDiagnosis Date
0402L2000E_HI0402_ICD10_DIAGStringInternational Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis
0402L2000E_HI0402_ICD10_RSN_VISITStringInternational 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_ICD9_RSN_VISITStringInternational Classification of Diseases Clinical Modification (ICD-9-CM) Patient's Reason for Visit
0404L2000E_HI0404_DIAGDateTimeDiagnosis Date
0502L2000E_HI0502_ICD10_DIAGStringInternational Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis
0502L2000E_HI0502_ICD10_RSN_VISITStringInternational 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_ICD9_RSN_VISITStringInternational Classification of Diseases Clinical Modification (ICD-9-CM) Patient's Reason for Visit
0504L2000E_HI0504_DIAGDateTimeDiagnosis Date
0602L2000E_HI0602_ICD10_DIAGStringInternational Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis
0602L2000E_HI0602_ICD10_RSN_VISITStringInternational 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_ICD9_RSN_VISITStringInternational Classification of Diseases Clinical Modification (ICD-9-CM) Patient's Reason for Visit
0604L2000E_HI0604_DIAGDateTimeDiagnosis Date
0702L2000E_HI0702_ICD10_DIAGStringInternational Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis
0702L2000E_HI0702_ICD10_RSN_VISITStringInternational 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_ICD9_RSN_VISITStringInternational Classification of Diseases Clinical Modification (ICD-9-CM) Patient's Reason for Visit
0704L2000E_HI0704_DIAGDateTimeDiagnosis Date
0802L2000E_HI0802_ICD10_DIAGStringInternational Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis
0802L2000E_HI0802_ICD10_RSN_VISITStringInternational 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_ICD9_RSN_VISITStringInternational Classification of Diseases Clinical Modification (ICD-9-CM) Patient's Reason for Visit
0804L2000E_HI0804_DIAGDateTimeDiagnosis Date
0902L2000E_HI0902_ICD10_DIAGStringInternational Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis
0902L2000E_HI0902_ICD10_RSN_VISITStringInternational 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_ICD9_RSN_VISITStringInternational Classification of Diseases Clinical Modification (ICD-9-CM) Patient's Reason for Visit
0904L2000E_HI0904_DIAGDateTimeDiagnosis Date
1002L2000E_HI1002_ICD10_DIAGStringInternational Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis
1002L2000E_HI1002_ICD10_RSN_VISITStringInternational 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_ICD9_RSN_VISITStringInternational Classification of Diseases Clinical Modification (ICD-9-CM) Patient's Reason for Visit
1004L2000E_HI1004_DIAGDateTimeDiagnosis Date
1102L2000E_HI1102_ICD10_DIAGStringInternational Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis
1102L2000E_HI1102_ICD10_RSN_VISITStringInternational 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_ICD9_RSN_VISITStringInternational Classification of Diseases Clinical Modification (ICD-9-CM) Patient's Reason for Visit
1104L2000E_HI1104_DIAGDateTimeDiagnosis Date
1202L2000E_HI1202_ICD10_DIAGStringInternational Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis
1202L2000E_HI1202_ICD10_RSN_VISITStringInternational 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_ICD9_RSN_VISITStringInternational Classification of Diseases Clinical Modification (ICD-9-CM) Patient's Reason for Visit
1204L2000E_HI1204_DIAGDateTimeDiagnosis Date
L2000EHSDHealth Care Services Delivery
02L2000E_HSD02_DAYSNumberDays
02L2000E_HSD02_UNNumberUnits
02L2000E_HSD02_HRNumberHours
02L2000E_HSD02_MONumberMonth
02L2000E_HSD02_VISTNumberVisits
04L2000E_HSD04_DAYSNumberDays
04L2000E_HSD04_MOSNumberMonths
04L2000E_HSD04_WKNumberWeek
06L2000E_HSD06_HRIntegerHour
06L2000E_HSD06_DAYIntegerDay
06L2000E_HSD06_YEARSIntegerYears
06L2000E_HSD06_EPISDIntegerEpisode
06L2000E_HSD06_VISTIntegerVisit
06L2000E_HSD06_MOIntegerMonth
06L2000E_HSD06_WKIntegerWeek
07L2000E_HSD07_DLVY_FREQ_CDStringDelivery Frequency Code
08L2000E_HSD08_DVY_PT_TM_CDStringDelivery Pattern Time Code
L2000ECRCAmbulance Certification InformationSegment Suffix: A
02L2000E_CRCA02_CERT_COND_INDStringCertification Condition Indicator
03L2000E_CRCA03_CONDTN_CDStringCondition Code
04L2000E_CRCA04_CONDTN_CDStringCondition Code
05L2000E_CRCA05_CONDTN_CDStringCondition Code
06L2000E_CRCA06_CONDTN_CDStringCondition Code
07L2000E_CRCA07_CONDTN_CDStringCondition Code
L2000ECRCChiropractic Certification InformationSegment Suffix: B
02L2000E_CRCB02_CERT_COND_INDStringCertification Condition Indicator
03L2000E_CRCB03_CONDTN_CDStringCondition Code
04L2000E_CRCB04_CONDTN_CDStringCondition Code
05L2000E_CRCB05_CONDTN_CDStringCondition Code
06L2000E_CRCB06_CONDTN_CDStringCondition Code
07L2000E_CRCB07_CONDTN_CDStringCondition Code
L2000ECRCDurable Medical Equipment InformationSegment Suffix: C
02L2000E_CRCC02_CERT_COND_INDStringCertification Condition Indicator
03L2000E_CRCC03_CONDTN_CDStringCondition Code
04L2000E_CRCC04_CONDTN_CDStringCondition Code
05L2000E_CRCC05_CONDTN_CDStringCondition Code
06L2000E_CRCC06_CONDTN_CDStringCondition Code
07L2000E_CRCC07_CONDTN_CDStringCondition Code
L2000ECRCOxygen Therapy Certification InformationSegment Suffix: D
02L2000E_CRCD02_CERT_COND_INDStringCertification Condition Indicator
03L2000E_CRCD03_CONDTN_CDStringCondition Code
04L2000E_CRCD04_CONDTN_CDStringCondition Code
05L2000E_CRCD05_CONDTN_CDStringCondition Code
06L2000E_CRCD06_CONDTN_CDStringCondition Code
07L2000E_CRCD07_CONDTN_CDStringCondition Code
L2000ECRCFunctional Limitations InformationSegment Suffix: E
02L2000E_CRCE02_CERT_COND_INDStringCertification Condition Indicator
03L2000E_CRCE03_CONDTN_CDStringCondition Code
04L2000E_CRCE04_CONDTN_CDStringCondition Code
05L2000E_CRCE05_CONDTN_CDStringCondition Code
06L2000E_CRCE06_CONDTN_CDStringCondition Code
07L2000E_CRCE07_CONDTN_CDStringCondition Code
L2000ECRCActivities Permitted InformationSegment Suffix: F
02L2000E_CRCF02_CERT_COND_INDStringCertification Condition Indicator
03L2000E_CRCF03_CONDTN_CDStringCondition Code
04L2000E_CRCF04_CONDTN_CDStringCondition Code
05L2000E_CRCF05_CONDTN_CDStringCondition Code
06L2000E_CRCF06_CONDTN_CDStringCondition Code
07L2000E_CRCF07_CONDTN_CDStringCondition Code
L2000ECRCMental Status InformationSegment Suffix: G
02L2000E_CRCG02_CERT_COND_INDStringCertification Condition Indicator
03L2000E_CRCG03_CONDTN_CDStringCondition Code
04L2000E_CRCG04_CONDTN_CDStringCondition Code
05L2000E_CRCG05_CONDTN_CDStringCondition Code
06L2000E_CRCG06_CONDTN_CDStringCondition Code
07L2000E_CRCG07_CONDTN_CDStringCondition Code
L2000ECL1Institutional Claim Code
01L2000E_CL101_ADMSN_TYP_CDStringAdmission Type Code
02L2000E_CL102_ADMSN_SRC_CDStringAdmission Source Code
03L2000E_CL103_PT_STATS_CDStringPatient Status Code
04L2000E_CL104_NRSG_RES_STAT_CDStringNursing Home Residential Status Code
L2000ECR1Ambulance Transport Information
02L2000E_CR102_KGNumberKilogram
02L2000E_CR102_POUNDNumberPound
03L2000E_CR103_AMB_TRANS_CDStringAmbulance Transport Code
04L2000E_CR104_AMB_TRANS_RSN_CDStringAmbulance Transport Reason Code
06L2000E_CR106_MILESNumberMiles
06L2000E_CR106_KMNumberKilometers
09L2000E_CR109_RNDTRP_PRPS_DESCStringRound Trip Purpose Description
10L2000E_CR110_STRTCHR_PURP_DESCStringStretcher Purpose Description
L2000ECR2Spinal Manipulation Service Information
01L2000E_CR201_TMT_SERS_NRIntegerTreatment Series Number
02L2000E_CR202_TMT_CTNumberTreatment Count
03L2000E_CR203_SUBLUX_LVL_CDStringSubluxation Level Code
04L2000E_CR204_SUBLUX_LVL_CDStringSubluxation Level Code
08L2000E_CR208_PAT_COND_CDStringPatient Condition Code
09L2000E_CR209_CMPLCTN_INDStringComplication Indicator
10L2000E_CR210_PT_COND_DESCStringPatient Condition Description
11L2000E_CR211_PT_COND_DESCStringPatient Condition Description
12L2000E_CR212_XRAY_AVL_INDStringX-ray Availability Indicator
L2000ECR5Home Oxygen Therapy Information
03L2000E_CR503_OXY_EQP_TYP_CDStringOxygen Equipment Type Code
04L2000E_CR504_OXY_EQP_TYP_CDStringOxygen Equipment Type Code
05L2000E_CR505_EQUP_RSN_DESCStringEquipment Reason Description
06L2000E_CR506_OXYGN_FLOW_RTNumberOxygen Flow Rate
07L2000E_CR507_DLY_OXY_USE_CTNumberDaily Oxygen Use Count
08L2000E_CR508_OXY_USE_HOUR_CTNumberOxygen Use Period Hour Count
09L2000E_CR509_RSP_THRP_ORD_TXTStringRespiratory Therapist Order Text
10L2000E_CR510_ART_BLD_GAS_QTYNumberArterial Blood Gas Quantity
11L2000E_CR511_OXY_SATUR_QTYNumberOxygen Saturation Quantity
12L2000E_CR512_OXY_TST_CND_CDStringOxygen Test Condition Code
13L2000E_CR513_OXY_TST_FND_CDStringOxygen Test Findings Code
14L2000E_CR514_OXY_TST_FND_CDStringOxygen Test Findings Code
15L2000E_CR515_OXY_TST_FND_CDStringOxygen Test Findings Code
16L2000E_CR516_PORT_OXY_FLOW_RTNumberPortable Oxygen System Flow Rate
17L2000E_CR517_OXY_DEL_SYS_CDStringOxygen Delivery System Code
18L2000E_CR518_OXY_EQP_TYP_CDStringOxygen Equipment Type Code
L2000ECR6Home Health Care Information
01L2000E_CR601_PROGNS_CDStringPrognosis Code
02L2000E_CR602_HOMHLTH_START_D8Date (YYYYMMDD)Home Health Start Date
04L2000E_CR604_RD8StringHome Health Certification Period
04L2000E_CR604_RD8StringHome Health Certification Period
08L2000E_CR608_CERT_TYP_CDStringCertification Type Code
09L2000E_CR609_SURGY_D8Date (YYYYMMDD)Surgery Date
11L2000E_CR611_HCPCS_CDStringHealth Care Financing Administration Common Procedural Coding System (HCPCS) Codes
11L2000E_CR611_ICD9_PROCStringInternational Classification of Diseases Clinical Modification (ICD-9-CM) - Procedure
12L2000E_CR612_PHYS_ORD_D8Date (YYYYMMDD)Physician Order Date
13L2000E_CR613_LAST_VIST_D8Date (YYYYMMDD)Last Visit Date
14L2000E_CR614_PHYS_CONT_D8Date (YYYYMMDD)Physician Contact Date
16L2000E_CR616_RD8StringLast Admission Period
16L2000E_CR616_RD8StringLast Admission Period
17L2000E_CR617_PAT_LOC_CDStringPatient Location Code
L2000EPWKAdditional Patient Information
01L2000E_nnPWK01_ATT_REP_TYP_CDStringAttachment Report Type Code
02L2000E_nnPWK02_REPT_TRNS_CDStringReport Transmission Code
06L2000E_nnPWK06_ATTACH_CTL_NRStringAttachment Control Number
07L2000E_nnPWK07_ATTCH_DESCRStringAttachment Description
L2000EMSGMessage Text
01L2000E_MSG01_FRFM_MSG_TXTStringFree Form Message Text
L2010EA - PATIENT EVENT PROVIDER NAME (Value Qualified)
Mapping Prefix: L2010EA_71 - Attending Physician
Mapping Prefix: L2010EA_72 - Operating Physician
Mapping Prefix: L2010EA_73 - Other Physician
Mapping Prefix: L2010EA_77 - Service Location
Mapping Prefix: L2010EA_AAJ - Admitting Services
Mapping Prefix: L2010EA_DD - Assistant Surgeon
Mapping Prefix: L2010EA_DK - Ordering Physician
Mapping Prefix: L2010EA_DN - Referring Provider
Mapping Prefix: L2010EA_FA - Facility
Mapping Prefix: L2010EA_G3 - Clinic
Mapping Prefix: L2010EA_P3 - Primary Care Provider
Mapping Prefix: L2010EA_QB - Purchase Service Provider
Mapping Prefix: L2010EA_QV - Group Practice
Mapping Prefix: L2010EA_SJ - Service Provider
L2010EANM1Patient Event Provider Name
02L2010EA_yy_NM102_ENT_TYP_QUALStringEntity Type Qualifier
03L2010EA_yy_NM103_PTEVT_PVR_LNMStringPatient Event Provider Last or Organization Name
04L2010EA_yy_NM104_PTEVT_PVR_FNMStringPatient Event Provider First Name
05L2010EA_yy_NM105_PTEVT_PVR_MNMStringPatient Event Provider Middle Name
06L2010EA_yy_NM106_PTEVT_PVR_PFXStringPatient Event Provider Name Prefix
07L2010EA_yy_NM107_PTEVT_PVR_SFXStringPatient Event Provider Name Suffix
09L2010EA_yy_NM109_EMPLYR_IDStringEmployer's Identification Number
09L2010EA_yy_NM109_SSNStringSocial Security Number
09L2010EA_yy_NM109_ETN_NRStringElectronic Transmitter Identification Number (ETIN)
09L2010EA_yy_NM109_NPIStringCenters for Medicare and Medicaid Services National Provider Identifier
L2010EAREFPatient Event Provider Supplemental Information
02L2010EA_yy_nnREF_STAT_LIC_NRStringState License Number
02L2010EA_yy_nnREF_UPINStringProvider UPIN Number
02L2010EA_yy_nnREF_FAC_IDStringFacility ID Number
02L2010EA_yy_nnREF_EMPLR_ID_NRStringEmployer's Identification Number
02L2010EA_yy_nnREF_PRV_PLN_IDStringProvider Plan Network Identification Number
02L2010EA_yy_nnREF_FAC_NET_IDStringFacility Network Identification Number
02L2010EA_yy_nnREF_SSNStringSocial Security Number
02L2010EA_yy_nnREF_CRR_AS_REF_NRStringCarrier Assigned Reference Number
03L2010EA_yy_nnREF03_LIC_NR_STATString
L2010EAN3Patient Event Provider Address
01L2010EA_yy_N301_PTEVT_PVR_ADDRStringPatient Event Provider Address Line
02L2010EA_yy_N302_PTEVT_PVR_ADDRStringPatient Event Provider Address Line
L2010EAN4Patient Event Provider City, State, ZIP Code
01L2010EA_yy_N401_PTEVT_PVR_CITYStringPatient Event Provider City Name
02L2010EA_yy_N402_PTEVT_PVR_STATStringPatient Event Provider State Code
03L2010EA_yy_N403_PTEVT_PVR_ZIPStringPatient Event Provider Postal Zone or ZIP Code
04L2010EA_yy_N404_CNTRY_CDStringCountry Code
07L2010EA_yy_N407_CNTRY_SUBDV_CDStringCountry Subdivision Code
L2010EAPERPatient Event Provider Contact Information
02L2010EA_yy_PER02_PTEVT_PVR_CONStringPatient Event Provider Contact Name
04L2010EA_yy_PER04_EMAILStringElectronic Mail
04L2010EA_yy_PER04_FAXStringFacsimile
04L2010EA_yy_PER04_PHN_NRStringTelephone
04L2010EA_yy_PER04_URLStringUniform Resource Locator (URL)
06L2010EA_yy_PER06_EMAILStringElectronic Mail
06L2010EA_yy_PER06_PHN_EXTStringTelephone Extension
06L2010EA_yy_PER06_FAXStringFacsimile
06L2010EA_yy_PER06_PHN_NRStringTelephone
06L2010EA_yy_PER06_URLStringUniform Resource Locator (URL)
08L2010EA_yy_PER08_EMAILStringElectronic Mail
08L2010EA_yy_PER08_PHN_EXTStringTelephone Extension
08L2010EA_yy_PER08_FAXStringFacsimile
08L2010EA_yy_PER08_PHN_NRStringTelephone
08L2010EA_yy_PER08_URLStringUniform Resource Locator (URL)
L2010EAPRVPatient Event Provider Information
01L2010EA_yy_PRV01_PVD_CDStringProvider Code
03L2010EA_yy_PRV03_PVD_TAXNMY_CDStringHealth Care Provider Taxonomy Code
L2010EB - PATIENT EVENT TRANSPORT INFORMATION (Value Qualified)
Mapping Prefix: L2010EB_45 - Drop-off Location
Mapping Prefix: L2010EB_FS - Final Scheduled Destination
Mapping Prefix: L2010EB_ND - Next Destination
Mapping Prefix: L2010EB_PW - Pickup Address
Mapping Prefix: L2010EB_R3 - Next Scheduled Destination
L2010EBNM1Patient Event Transport Information
03L2010EB_yy_NM103_PTEVT_TRN_LOCStringPatient Event Transport Location Name
L2010EBN3Patient Event Transport Location Address
01L2010EB_yy_N301_PTEVT_TRN_ADDRStringPatient Event Transport Location Address Line
02L2010EB_yy_N302_PTEVT_TRN_ADDRStringPatient Event Transport Location Address Line
L2010EBN4Patient Event Transport Location City/State/ZIP Code
01L2010EB_yy_N401_PTEVT_TRN_CITYStringPatient Event Transport Location City Name
02L2010EB_yy_N402_PTEVT_TRN_STATStringPatient Event Transport Location State or
03L2010EB_yy_N403_PTEVT_ZIPStringPatient Event Transport Location Postal Zone or
L2010EC - PATIENT EVENT OTHER UMO NAME (Value Qualified)
Mapping Prefix: L2010EC_00 - Alternate Insurer
Mapping Prefix: L2010EC_CA - Carrier
Mapping Prefix: L2010EC_GG - Intermediary
L2010ECNM1Patient Event Other UMO Name
03L2010EC_yy_NM103_OUMO_NMStringOther UMO Name
L2010ECREFOther UMO Denial Reason
02L2010EC_yy_REF_MUTLY_DEFStringMutually Defined
0402L2010EC_yy_REF0402_OUMO_DENL_RSNStringMutually Defined
0404L2010EC_yy_REF0404_OUMO_DENL_RSNStringMutually Defined
0406L2010EC_yy_REF0406_REF_IDStringMutually Defined
L2010ECDTPOther UMO Denial Date
03L2010EC_yy_DTP_REJCT_D8Date (YYYYMMDD)Rejected Date
L2000F - SERVICE LEVEL
L2000FHLService Level
01L2000F_HL01_HIER_ID_NRStringHierarchical ID Number
02L2000F_HL02_HIER_PARNT_ID_NRStringHierarchical Parent ID Number
L2000FTRNService Trace Number
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
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
0402L2000F_UM0402_FAC_CD_QUALStringFacility Code Qualifier
L2000FREFPrevious Review Authorization Number
02L2000F_REF_AUTH_NRStringAuthorization Number
L2000FREFPrevious Review Administrative Reference Number
02L2000F_REF_ADMIN_REF_NRStringAdministrator's Reference Number
L2000FDTPService Date
03L2000F_DTP_SVC_D8Date (YYYYMMDD)Service Date
03L2000F_DTP_SVC_RD8_1Start Date (YYYYMMDD)Service Date
03L2000F_DTP_SVC_RD8_2End Date (YYYYMMDD)Service Date
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
0107L2000F_SV10107_PROC_CD_DESCStringProcedure Code Description
0108L2000F_SV10108_PROC_CDStringProcedure Code
02L2000F_SV102_SVC_LIN_AMTNumberService Line Amount
04L2000F_SV104_INTL_UNNumberInternational Unit
04L2000F_SV104_MINNumberMinutes
04L2000F_SV104_UNNumberUnit
0701L2000F_SV10701_DIAG_CD_PTRIntegerDiagnosis Code Pointer
0702L2000F_SV10702_DIAG_CD_PTRIntegerDiagnosis Code Pointer
0703L2000F_SV10703_DIAG_CD_PTRIntegerDiagnosis Code Pointer
0704L2000F_SV10704_DIAG_CD_PTRIntegerDiagnosis Code Pointer
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
0202L2000F_SV20202_ICD9_PROCStringInternational Classification of Diseases 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_ABC_CDStringAdvanced Billing Concepts (ABC) Codes
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
0207L2000F_SV20207_PROC_CD_DESCStringProcedure Code Description
0208L2000F_SV20208_PROC_CDStringProcedure Code
03L2000F_SV203_SVC_LIN_AMTNumberService Line Amount
05L2000F_SV205_DAYSNumberDays
05L2000F_SV205_INTL_UNNumberInternational Unit
05L2000F_SV205_UNNumberUnit
06L2000F_SV206_SVC_LIN_RTNumberService Line Rate
09L2000F_SV209_NRSG_RES_STAT_CDStringNursing Home Residential Status Code
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
0107L2000F_SV30107_PROC_CD_DESCStringProcedure Code Description
0108L2000F_SV30108_PROC_CDStringProcedure Code
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
07L2000F_SV307_DESCRStringDescription
L2000FX - SERVICE LEVEL - TOO CUTOUT
L2000FXTOOTooth Information
02L2000FX_TOO02_NTL_TTH_DES_SYSStringUniversal National Tooth Designation System
0301L2000FX_TOO0301_TOOTH_SURF_CDStringTooth Surface Code
0302L2000FX_TOO0302_TOOTH_SURF_CDStringTooth Surface Code
0303L2000FX_TOO0303_TOOTH_SURF_CDStringTooth Surface Code
0304L2000FX_TOO0304_TOOTH_SURF_CDStringTooth Surface Code
0305L2000FX_TOO0305_TOOTH_SURF_CDStringTooth Surface Code
L2000FHSDHealth Care Services Delivery
02L2000F_HSD02_DAYSNumberDays
02L2000F_HSD02_UNNumberUnits
02L2000F_HSD02_HRNumberHours
02L2000F_HSD02_MONumberMonth
02L2000F_HSD02_VISTNumberVisits
04L2000F_HSD04_DAYSNumberDays
04L2000F_HSD04_MOSNumberMonths
04L2000F_HSD04_WKNumberWeek
06L2000F_HSD06_HRIntegerHour
06L2000F_HSD06_DAYIntegerDay
06L2000F_HSD06_YEARSIntegerYears
06L2000F_HSD06_EPISDIntegerEpisode
06L2000F_HSD06_VISTIntegerVisit
06L2000F_HSD06_MOIntegerMonth
06L2000F_HSD06_WKIntegerWeek
07L2000F_HSD07_DLVY_FREQ_CDStringDelivery Frequency Code
08L2000F_HSD08_DVY_PT_TM_CDStringDelivery Pattern Time Code
L2000FPWKAdditional Service Information
01L2000F_nnPWK01_ATT_REP_TYP_CDStringAttachment Report Type Code
02L2000F_nnPWK02_REPT_TRNS_CDStringReport Transmission Code
06L2000F_nnPWK06_ATTACH_CTL_NRStringAttachment Control Number
07L2000F_nnPWK07_ATTCH_DESCRStringAttachment Description
L2000FMSGMessage Text
01L2000F_MSG01_FRFM_MSG_TXTStringFree Form Message Text
L2010F - SERVICE PROVIDER NAME (Value Qualified)
Mapping Prefix: L2010F_1T - Physician, Clinic or Group Practice
Mapping Prefix: L2010F_72 - Operating Physician
Mapping Prefix: L2010F_73 - Other Physician
Mapping Prefix: L2010F_77 - Service Location
Mapping Prefix: L2010F_DD - Assistant Surgeon
Mapping Prefix: L2010F_DK - Ordering Physician
Mapping Prefix: L2010F_DQ - Supervising Physician
Mapping Prefix: L2010F_FA - Facility
Mapping Prefix: L2010F_G3 - Clinic
Mapping Prefix: L2010F_P3 - Primary Care Provider
Mapping Prefix: L2010F_QB - Purchase Service Provider
Mapping Prefix: L2010F_QV - Group Practice
Mapping Prefix: L2010F_SJ - Service Provider
L2010FNM1Service Provider Name
02L2010F_yy_NM102_ENT_TYP_QUALStringEntity Type Qualifier
03L2010F_yy_NM103_SVC_PVR_LNMStringService Provider Last or Organization Name
04L2010F_yy_NM104_SVC_PVR_FNMStringService Provider First Name
05L2010F_yy_NM105_SVC_PVR_MNMStringService Provider Middle Name
06L2010F_yy_NM106_SVC_PVR_PFXStringService Provider Name Prefix
07L2010F_yy_NM107_SVC_PVR_SFXStringService Provider Name Suffix
09L2010F_yy_NM109_EMPLYR_IDStringEmployer's Identification Number
09L2010F_yy_NM109_SSNStringSocial Security Number
09L2010F_yy_NM109_ETN_NRStringElectronic Transmitter Identification Number (ETIN)
09L2010F_yy_NM109_NPIStringCenters for Medicare and Medicaid Services National Provider Identifier
L2010FREFService Provider Supplemental Identification
02L2010F_yy_REF_STAT_LIC_NRStringState License Number
02L2010F_yy_REF_UPINStringProvider UPIN Number
02L2010F_yy_REF_FAC_IDStringFacility ID Number
02L2010F_yy_REF_EMPLR_ID_NRStringEmployer's Identification Number
02L2010F_yy_REF_PRV_PLN_IDStringProvider Plan Network Identification Number
02L2010F_yy_REF_FAC_NET_IDStringFacility Network Identification Number
02L2010F_yy_REF_SSNStringSocial Security Number
02L2010F_yy_REF_CRR_AS_REF_NRStringCarrier Assigned Reference Number
03L2010F_yy_REF03_LIC_NR_STATString
L2010FN3Service Provider Address
01L2010F_yy_N301_SVC_PVR_ADD_LNStringService Provider Address Line
02L2010F_yy_N302_SVC_PVR_ADD_LNStringService Provider Address Line
L2010FN4Service Provider City, State, ZIP Code
01L2010F_yy_N401_SVC_PVR_CITYStringService Provider City Name
02L2010F_yy_N402_SVC_PVR_STATStringService Provider State or Province Code
03L2010F_yy_N403_SVC_PVR_ZIPStringService Provider Postal Zone or ZIP Code
04L2010F_yy_N404_CNTRY_CDStringCountry Code
07L2010F_yy_N407_CNTRY_SUBDV_CDStringCountry Subdivision Code
L2010FPERService Provider Contact Information
02L2010F_yy_PER02_SVC_PVR_CN_NMStringService Provider Contact Name
04L2010F_yy_PER04_EMAILStringElectronic Mail
04L2010F_yy_PER04_FAXStringFacsimile
04L2010F_yy_PER04_PHN_NRStringTelephone
04L2010F_yy_PER04_URLStringUniform Resource Locator (URL)
06L2010F_yy_PER06_EMAILStringElectronic Mail
06L2010F_yy_PER06_PHN_EXTStringTelephone Extension
06L2010F_yy_PER06_FAXStringFacsimile
06L2010F_yy_PER06_PHN_NRStringTelephone
06L2010F_yy_PER06_URLStringUniform Resource Locator (URL)
08L2010F_yy_PER08_EMAILStringElectronic Mail
08L2010F_yy_PER08_PHN_EXTStringTelephone Extension
08L2010F_yy_PER08_FAXStringFacsimile
08L2010F_yy_PER08_PHN_NRStringTelephone
08L2010F_yy_PER08_URLStringUniform Resource Locator (URL)
L2010FPRVService Provider Information
01L2010F_yy_PRV01_PVD_CDStringProvider Code
03L2010F_yy_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