Appendix E - Data Element Glossary

Data Element Name Index

This section contains an alphabetic listing of data elements used in this implementation guide. Consult the X12N Data Element Dictionary for a complete list of all X12N Data Elements. Data element names in normal type are generic ASC X12 names. Italic type indicates a health care industry defined name.

Legend

Industry Name
Industry name definition.
800 - Transaction Set ID and Name
H=Header, D=Detail, S=Summary | Loop ID | Reference Designator | Composite ID-Position in Composite | X12 Data Element Number
 
Admission Date/Hour or Start of Care Date
The date and time of the admission to the facility or the start date for this episode of care.
837 - Health Care Services Data Reporting
D | 2300 | DTP03 | - | 1251
 
Admission Source Code
Code indicating the source of this admission.
837 - Health Care Services Data Reporting
D | 2300 | CL102 | - | 1314
 
Admission Type Code
Code indicating the priority of this admission.
837 - Health Care Services Data Reporting
D | 2300 | CL101 | - | 1315
 
Admitting Diagnosis Code
The diagnosis code describing the patient's diagnosis at the time of admission.
837 - Health Care Services Data Reporting
D | 2300 | HI01 | C022-02 | 1271
 
Amount Qualifier Code
Code to qualify amount.
837 - Health Care Services Data Reporting
D | 2320 | AMT01 | - | 522
D | 2400 | AMT01 | - | 522
 
Assigned Number
Number assigned for differentiation within a transaction set.
837 - Health Care Services Data Reporting
D | 2400 | LX01 | - | 554
 
Attachment Control Number
Identification number of attachment related to the claim.
837 - Health Care Services Data Reporting
D | 2300 | PWK06 | - | 67
 
Attachment Report Type Code
Code to specify the type of attachment that is related to the claim.
837 - Health Care Services Data Reporting
D | 2300 | PWK01 | - | 755
 
Attachment Transmission Code
Code defining timing, transmission method or format by which an attachment report is to be sent or has been sent.
837 - Health Care Services Data Reporting
D | 2300 | PWK02 | - | 756
 
Attending Provider First Name
First Name of the provider responsible for the care of the patient.
837 - Health Care Services Data Reporting
D | 2310A | NM104 | - | 1036
 
Attending Provider Last Name
Last Name of the provider responsible for the care of the patient.
837 - Health Care Services Data Reporting
D | 2310A | NM103 | - | 1035
 
Attending Provider Middle Name or Initial
Middle name or initial of the provider responsible for care of the patient.
837 - Health Care Services Data Reporting
D | 2310A | NM105 | - | 1037
 
Attending Provider Name Suffix
Suffix to the name of the provider responsible for the care of the patient.
837 - Health Care Services Data Reporting
D | 2310A | NM107 | - | 1039
 
Attending Provider Primary Identifier
Primary identifier for the provider responsible for the care of the patient.
837 - Health Care Services Data Reporting
D | 2310A | NM109 | - | 67
 
Attending Provider Secondary Identifier
Additional identifier for the provider responsible for the care of the patient.
837 - Health Care Services Data Reporting
D | 2310A | REF02 | - | 127
 
Auto Accident State or Province Code
State or Province where auto accident occurred.
837 - Health Care Services Data Reporting
D | 2300 | CLM11 | C024-04 | 156
 
Claim Filing Indicator Code
Code identifying type of claim or expected adjudication process.
837 - Health Care Services Data Reporting
D | 2000B | SBR09 | - | 1032
D | 2320 | SBR09 | - | 1032
 
Claim Frequency Code
Code specifying the frequency of the claim. This is the third position of the Uniform Billing Claim Form Bill Type.
837 - Health Care Services Data Reporting
D | 2300 | CLM05 | C023-03 | 1325
 
Claim Note Text
Narrative text providing additional information related to the claim.
837 - Health Care Services Data Reporting
D | 2300 | NTE02 | - | 352
 
Code List Qualifier Code
Code identifying a specific industry code list.
837 - Health Care Services Data Reporting
D | 2010BA | DMG05 | C056-02 | 1270
D | 2010BA | DMG10 | - | 1270
D | 2010CA | DMG05 | C056-02 | 1270
D | 2010CA | DMG10 | - | 1270
D | 2300 | HI01 | C022-01 | 1270
D | 2300 | HI01 | C022-01 | 1270
D | 2300 | HI01 | C022-01 | 1270
D | 2300 | HI02 | C022-01 | 1270
D | 2300 | HI03 | C022-01 | 1270
D | 2300 | HI01 | C022-01 | 1270
D | 2300 | HI02 | C022-01 | 1270
D | 2300 | HI03 | C022-01 | 1270
D | 2300 | HI04 | C022-01 | 1270
D | 2300 | HI05 | C022-01 | 1270
D | 2300 | HI06 | C022-01 | 1270
D | 2300 | HI07 | C022-01 | 1270
D | 2300 | HI08 | C022-01 | 1270
D | 2300 | HI09 | C022-01 | 1270
D | 2300 | HI10 | C022-01 | 1270
D | 2300 | HI11 | C022-01 | 1270
D | 2300 | HI12 | C022-01 | 1270
D | 2300 | HI01 | C022-01 | 1270
D | 2300 | HI01 | C022-01 | 1270
D | 2300 | HI02 | C022-01 | 1270
D | 2300 | HI03 | C022-01 | 1270
D | 2300 | HI04 | C022-01 | 1270
D | 2300 | HI05 | C022-01 | 1270
D | 2300 | HI06 | C022-01 | 1270
D | 2300 | HI07 | C022-01 | 1270
D | 2300 | HI08 | C022-01 | 1270
D | 2300 | HI09 | C022-01 | 1270
D | 2300 | HI10 | C022-01 | 1270
D | 2300 | HI11 | C022-01 | 1270
D | 2300 | HI12 | C022-01 | 1270
D | 2300 | HI01 | C022-01 | 1270
D | 2300 | HI01 | C022-01 | 1270
D | 2300 | HI02 | C022-01 | 1270
D | 2300 | HI03 | C022-01 | 1270
D | 2300 | HI04 | C022-01 | 1270
D | 2300 | HI05 | C022-01 | 1270
D | 2300 | HI06 | C022-01 | 1270
D | 2300 | HI07 | C022-01 | 1270
D | 2300 | HI08 | C022-01 | 1270
D | 2300 | HI09 | C022-01 | 1270
D | 2300 | HI10 | C022-01 | 1270
D | 2300 | HI11 | C022-01 | 1270
D | 2300 | HI12 | C022-01 | 1270
D | 2300 | HI01 | C022-01 | 1270
D | 2300 | HI02 | C022-01 | 1270
D | 2300 | HI03 | C022-01 | 1270
D | 2300 | HI04 | C022-01 | 1270
D | 2300 | HI05 | C022-01 | 1270
D | 2300 | HI06 | C022-01 | 1270
D | 2300 | HI07 | C022-01 | 1270
D | 2300 | HI08 | C022-01 | 1270
D | 2300 | HI09 | C022-01 | 1270
D | 2300 | HI10 | C022-01 | 1270
D | 2300 | HI11 | C022-01 | 1270
D | 2300 | HI12 | C022-01 | 1270
D | 2300 | HI01 | C022-01 | 1270
D | 2300 | HI02 | C022-01 | 1270
D | 2300 | HI03 | C022-01 | 1270
D | 2300 | HI04 | C022-01 | 1270
D | 2300 | HI05 | C022-01 | 1270
D | 2300 | HI06 | C022-01 | 1270
D | 2300 | HI07 | C022-01 | 1270
D | 2300 | HI08 | C022-01 | 1270
D | 2300 | HI09 | C022-01 | 1270
D | 2300 | HI10 | C022-01 | 1270
D | 2300 | HI11 | C022-01 | 1270
D | 2300 | HI12 | C022-01 | 1270
D | 2300 | HI01 | C022-01 | 1270
D | 2300 | HI02 | C022-01 | 1270
D | 2300 | HI03 | C022-01 | 1270
D | 2300 | HI04 | C022-01 | 1270
D | 2300 | HI05 | C022-01 | 1270
D | 2300 | HI06 | C022-01 | 1270
D | 2300 | HI07 | C022-01 | 1270
D | 2300 | HI08 | C022-01 | 1270
D | 2300 | HI09 | C022-01 | 1270
D | 2300 | HI10 | C022-01 | 1270
D | 2300 | HI11 | C022-01 | 1270
D | 2300 | HI12 | C022-01 | 1270
D | 2300 | HI01 | C022-01 | 1270
D | 2300 | HI02 | C022-01 | 1270
D | 2300 | HI03 | C022-01 | 1270
D | 2300 | HI04 | C022-01 | 1270
D | 2300 | HI05 | C022-01 | 1270
D | 2300 | HI06 | C022-01 | 1270
D | 2300 | HI07 | C022-01 | 1270
D | 2300 | HI08 | C022-01 | 1270
D | 2300 | HI09 | C022-01 | 1270
D | 2300 | HI10 | C022-01 | 1270
D | 2300 | HI11 | C022-01 | 1270
D | 2300 | HI12 | C022-01 | 1270
D | 2300 | HI01 | C022-01 | 1270
D | 2300 | HI02 | C022-01 | 1270
D | 2300 | HI03 | C022-01 | 1270
D | 2300 | HI04 | C022-01 | 1270
 
Code Qualifier
Code identifying the type of unit or measurement.
837 - Health Care Services Data Reporting
D | 2410 | CTP05 | C001-01 | 355
 
Collection Method Code
Describes the method in which the race and ethnicity codes were collected.
837 - Health Care Services Data Reporting
D | 2010BA | DMG11 | - | 1271
D | 2010CA | DMG11 | - | 1271
 
Communication Number
Complete communications number including country or area code when applicable
837 - Health Care Services Data Reporting
H | 1000A | PER04 | - | 364
H | 1000A | PER06 | - | 364
H | 1000A | PER08 | - | 364
 
Communication Number Qualifier
Code identifying the type of communication number.
837 - Health Care Services Data Reporting
H | 1000A | PER03 | - | 365
H | 1000A | PER05 | - | 365
H | 1000A | PER07 | - | 365
 
Condition Code
Code(s) used to identify condition(s) relating to this bill or relating to the patient.
837 - Health Care Services Data Reporting
D | 2300 | HI01 | C022-02 | 1271
D | 2300 | HI02 | C022-02 | 1271
D | 2300 | HI03 | C022-02 | 1271
D | 2300 | HI04 | C022-02 | 1271
D | 2300 | HI05 | C022-02 | 1271
D | 2300 | HI06 | C022-02 | 1271
D | 2300 | HI07 | C022-02 | 1271
D | 2300 | HI08 | C022-02 | 1271
D | 2300 | HI09 | C022-02 | 1271
D | 2300 | HI10 | C022-02 | 1271
D | 2300 | HI11 | C022-02 | 1271
D | 2300 | HI12 | C022-02 | 1271
 
Contact Function Code
Code identifying the major duty or responsibility of the person or group named.
837 - Health Care Services Data Reporting
H | 1000A | PER01 | - | 366
 
Country Code
Code indicating the geographic location.
837 - Health Care Services Data Reporting
D | 2300 | CLM11 | C024-05 | 26
 
Date Time Period
Expression of a date, a time, or a range of dates, times, or dates and times.
837 - Health Care Services Data Reporting
D | 2300 | DTP03 | - | 1251
 
Date Time Period Format Qualifier
Code indicating the date format, time format, or date and time format.
837 - Health Care Services Data Reporting
D | 2010BA | DMG01 | - | 1250
D | 2010CA | DMG01 | - | 1250
D | 2300 | DTP02 | - | 1250
D | 2300 | DTP02 | - | 1250
D | 2300 | DTP02 | - | 1250
D | 2300 | DTP02 | - | 1250
D | 2300 | HI01 | C022-03 | 1250
D | 2300 | HI01 | C022-03 | 1250
D | 2300 | HI02 | C022-03 | 1250
D | 2300 | HI03 | C022-03 | 1250
D | 2300 | HI04 | C022-03 | 1250
D | 2300 | HI05 | C022-03 | 1250
D | 2300 | HI06 | C022-03 | 1250
D | 2300 | HI07 | C022-03 | 1250
D | 2300 | HI08 | C022-03 | 1250
D | 2300 | HI09 | C022-03 | 1250
D | 2300 | HI10 | C022-03 | 1250
D | 2300 | HI11 | C022-03 | 1250
D | 2300 | HI12 | C022-03 | 1250
D | 2300 | HI01 | C022-03 | 1250
D | 2300 | HI02 | C022-03 | 1250
D | 2300 | HI03 | C022-03 | 1250
D | 2300 | HI04 | C022-03 | 1250
D | 2300 | HI05 | C022-03 | 1250
D | 2300 | HI06 | C022-03 | 1250
D | 2300 | HI07 | C022-03 | 1250
D | 2300 | HI08 | C022-03 | 1250
D | 2300 | HI09 | C022-03 | 1250
D | 2300 | HI10 | C022-03 | 1250
D | 2300 | HI11 | C022-03 | 1250
D | 2300 | HI12 | C022-03 | 1250
D | 2300 | HI01 | C022-03 | 1250
D | 2300 | HI02 | C022-03 | 1250
D | 2300 | HI03 | C022-03 | 1250
D | 2300 | HI04 | C022-03 | 1250
D | 2300 | HI05 | C022-03 | 1250
D | 2300 | HI06 | C022-03 | 1250
D | 2300 | HI07 | C022-03 | 1250
D | 2300 | HI08 | C022-03 | 1250
D | 2300 | HI09 | C022-03 | 1250
D | 2300 | HI10 | C022-03 | 1250
D | 2300 | HI11 | C022-03 | 1250
D | 2300 | HI12 | C022-03 | 1250
D | 2400 | DTP02 | - | 1250
 
Date Time Qualifier
Code specifying the type of date or time or both date and time.
837 - Health Care Services Data Reporting
D | 2300 | DTP01 | - | 374
D | 2300 | DTP01 | - | 374
D | 2300 | DTP01 | - | 374
D | 2300 | DTP01 | - | 374
D | 2400 | DTP01 | - | 374
 
Description
A free-form description to clarify the related data elements and their content.
837 - Health Care Services Data Reporting
D | 2400 | SV202 | C003-07 | 352
 
Device Identifier of the Unique Device Identifier
A mandatory, fixed portion of a UDI that identifies the labeler and the specific version of model of a device.
837 - Health Care Services Data Reporting
D | 2300 | CR806 | - | 127
 
Diagnosis Related Group (DRG) Code
Code identifying the Diagnosis Related Group.
837 - Health Care Services Data Reporting
D | 2300 | HI01 | C022-02 | 1271
 
Discharge Time
Time the patient was discharged from the inpatient care.
837 - Health Care Services Data Reporting
D | 2300 | DTP03 | - | 1251
 
Drug Quantity Administered
The quantity of the drug administered, based upon the unit of measure as defined by the National Drug Code.
837 - Health Care Services Data Reporting
D | 2410 | CTP04 | - | 380
 
Entity Identifier Code
Code identifying an organizational entity, a physical location, property or an individual.
837 - Health Care Services Data Reporting
H | 1000A | NM101 | - | 98
D | 2010AA | NM101 | - | 98
D | 2010BA | NM101 | - | 98
D | 2010BB | NM101 | - | 98
D | 2010CA | NM101 | - | 98
D | 2310A | NM101 | - | 98
D | 2310B | NM101 | - | 98
D | 2310C | NM101 | - | 98
D | 2310D | NM101 | - | 98
D | 2310F | NM101 | - | 98
D | 2330A | NM101 | - | 98
D | 2330B | NM101 | - | 98
D | 2420A | NM101 | - | 98
D | 2420B | NM101 | - | 98
 
Entity Type Qualifier
Code qualifying the type of entity.
837 - Health Care Services Data Reporting
H | 1000A | NM102 | - | 1065
H | 1000B | NM102 | - | 1065
D | 2010AA | NM102 | - | 1065
D | 2010BA | NM102 | - | 1065
D | 2010BB | NM102 | - | 1065
D | 2010CA | NM102 | - | 1065
D | 2310A | NM102 | - | 1065
D | 2310B | NM102 | - | 1065
D | 2310C | NM102 | - | 1065
D | 2310D | NM102 | - | 1065
D | 2310F | NM102 | - | 1065
D | 2330A | NM102 | - | 1065
D | 2330B | NM102 | - | 1065
D | 2420A | NM102 | - | 1065
D | 2420B | NM102 | - | 1065
 
External Cause of Injury Code
Code identifying the cause of the injury.
837 - Health Care Services Data Reporting
D | 2300 | HI01 | C022-02 | 1271
D | 2300 | HI02 | C022-02 | 1271
D | 2300 | HI03 | C022-02 | 1271
D | 2300 | HI04 | C022-02 | 1271
D | 2300 | HI05 | C022-02 | 1271
D | 2300 | HI06 | C022-02 | 1271
D | 2300 | HI07 | C022-02 | 1271
D | 2300 | HI08 | C022-02 | 1271
D | 2300 | HI09 | C022-02 | 1271
D | 2300 | HI10 | C022-02 | 1271
D | 2300 | HI11 | C022-02 | 1271
D | 2300 | HI12 | C022-02 | 1271
 
Facility Code Qualifier
Code identifying the type of facility referenced.
837 - Health Care Services Data Reporting
D | 2300 | CLM05 | C023-02 | 1332
 
Facility Type Code
Code identifying the type of facility where services were performed; the first and second positions of the Uniform Bill Type code or the Place of Service code from the Electronic Media Claims National Standard Format.
837 - Health Care Services Data Reporting
D | 2300 | CLM05 | C023-01 | 1331
 
Hierarchical Child Code
Code indicating if there are hierarchical child data segments subordinate to the level being described.
837 - Health Care Services Data Reporting
D | 2000A | HL04 | - | 736
D | 2000B | HL04 | - | 736
D | 2000C | HL04 | - | 736
 
Hierarchical ID Number
A unique number assigned by the sender to identify a particular data segment in a hierarchical structure.
837 - Health Care Services Data Reporting
D | 2000A | HL01 | - | 628
D | 2000B | HL01 | - | 628
D | 2000C | HL01 | - | 628
 
Hierarchical Level Code
Code defining the characteristic of a level in a hierarchical structure.
837 - Health Care Services Data Reporting
D | 2000A | HL03 | - | 735
D | 2000B | HL03 | - | 735
D | 2000C | HL03 | - | 735
 
Hierarchical Parent ID Number
Identification number of the next higher hierarchical data segment that the data segment being described is subordinate to.
837 - Health Care Services Data Reporting
D | 2000B | HL02 | - | 734
D | 2000C | HL02 | - | 734
 
Hierarchical Structure Code
Code indicating the hierarchical application structure of a transaction set that utilizes the HL segment to define the structure of the transaction set
837 - Health Care Services Data Reporting
H | | BHT01 | - | 1005
 
Identification Code Qualifier
Code designating the system/method of code structure used for Identification Code (67).
837 - Health Care Services Data Reporting
H | 1000A | NM108 | - | 66
H | 1000B | NM101 | - | 98
D | 2010AA | NM108 | - | 66
D | 2010BA | NM108 | - | 66
D | 2010BA | LUI01 | - | 66
D | 2010BB | NM108 | - | 66
D | 2010CA | LUI01 | - | 66
D | 2300 | PWK05 | - | 66
D | 2310A | NM108 | - | 66
D | 2310B | NM108 | - | 66
D | 2310C | NM108 | - | 66
D | 2310D | NM108 | - | 66
D | 2310F | NM108 | - | 66
D | 2330A | NM108 | - | 66
D | 2330B | NM108 | - | 66
D | 2420A | NM108 | - | 66
D | 2420B | NM108 | - | 66
 
Implant Status Code
Code identifying the status of implant components
837 - Health Care Services Data Reporting
D | 2300 | CR802 | - | 1404
 
Implant Type Code
Code identifying implant components
837 - Health Care Services Data Reporting
D | 2300 | CR801 | - | 1403
 
Individual Relationship Code
Code indicating the relationship between two individuals or entities.
837 - Health Care Services Data Reporting
D | 2000B | SBR02 | - | 1069
D | 2000C | PAT01 | - | 1069
D | 2320 | SBR02 | - | 1069
 
Information Receiver Identification Number
The identification number of the individual or organization who expects to receive information in response to a query.
837 - Health Care Services Data Reporting
H | 1000B | NM108 | - | 66
 
Insured Group or Policy Number
The identification number, control number, or code assigned by the carrier or administrator to identify the group under which the individual is covered.
837 - Health Care Services Data Reporting
D | 2320 | SBR03 | - | 127
 
Line Item Charge Amount
Charges related to this service.
837 - Health Care Services Data Reporting
D | 2400 | SV203 | - | 782
 
Line Item Denied Charge or Non-Covered Charge Amount
Line item charges denied or not covered.
837 - Health Care Services Data Reporting
D | 2400 | SV207 | - | 782
 
Location Identifier
Code which identifies a specific location.
837 - Health Care Services Data Reporting
D | 2010BA | N406 | - | 310
D | 2010CA | N406 | - | 310
 
Location Qualifier
Code identifying type of location.
837 - Health Care Services Data Reporting
D | 2010BA | N405 | - | 309
D | 2010CA | N405 | - | 309
 
Marital Status Code
Code defining the marital status of a person.
837 - Health Care Services Data Reporting
D | 2010BA | DMG04 | - | 1067
D | 2010CA | DMG04 | - | 1067
 
Medical Record Number
A unique number assigned to patient by the provider to assist in retrieval of medical records.
837 - Health Care Services Data Reporting
D | 2300 | REF02 | - | 127
 
Mother's Medical Record Number
The medical record number of the newborn child's mother which links the newborn's hospital stay and the mother's stay.
837 - Health Care Services Data Reporting
D | 2300 | REF02 | - | 127
 
Name Last or Organization Name
Individual last name or organization name.
837 - Health Care Services Data Reporting
D | 2010AA | NM112 | - | 1035
 
National Drug Code or Device Identifier of the Unique Device Identifier
The national drug identification number assigned by the Food and Drug Administration (FDA), or the unique product identification number or Device Identifier of the Unique Device Identifier that unambiguously identifies a medical/surgical device.
837 - Health Care Services Data Reporting
D | 2410 | LIN03 | - | 234
 
North American Industry Classification System
North American Industrial Classification System (NAICS) is the standard used by Federal statistical agencies in classifying business establishments for the purpose of collecting, analyzing, and publishing statistical data related to the US business economy.
837 - Health Care Services Data Reporting
D | 2300 | REF02 | - | 127
D | 2300 | REF02 | - | 127
D | 2300 | REF02 | - | 127
D | 2300 | REF02 | - | 127
 
Note Reference Code
Code identifying the functional area or purpose for which the note applies.
837 - Health Care Services Data Reporting
D | 2300 | NTE01 | - | 363
 
Occurrence Code
A code defining a significant event relating to this bill that may affect payer processing.
837 - Health Care Services Data Reporting
D | 2300 | HI01 | C022-02 | 1271
D | 2300 | HI02 | C022-02 | 1271
D | 2300 | HI03 | C022-02 | 1271
D | 2300 | HI04 | C022-02 | 1271
D | 2300 | HI05 | C022-02 | 1271
D | 2300 | HI06 | C022-02 | 1271
D | 2300 | HI07 | C022-02 | 1271
D | 2300 | HI08 | C022-02 | 1271
D | 2300 | HI09 | C022-02 | 1271
D | 2300 | HI10 | C022-02 | 1271
D | 2300 | HI11 | C022-02 | 1271
D | 2300 | HI12 | C022-02 | 1271
 
Occurrence Code Date
Date associated with the Occurrence Code reported in this composite element.
837 - Health Care Services Data Reporting
D | 2300 | HI01 | C022-04 | 1251
D | 2300 | HI02 | C022-04 | 1251
D | 2300 | HI03 | C022-04 | 1251
D | 2300 | HI04 | C022-04 | 1251
D | 2300 | HI05 | C022-04 | 1251
D | 2300 | HI06 | C022-04 | 1251
D | 2300 | HI07 | C022-04 | 1251
D | 2300 | HI08 | C022-04 | 1251
D | 2300 | HI09 | C022-04 | 1251
D | 2300 | HI10 | C022-04 | 1251
D | 2300 | HI11 | C022-04 | 1251
D | 2300 | HI12 | C022-04 | 1251
 
Occurrence Span Code
A code that identifies an event that relates to payment of the claim. This event occurs over a span of days.
837 - Health Care Services Data Reporting
D | 2300 | HI01 | C022-02 | 1271
D | 2300 | HI02 | C022-02 | 1271
D | 2300 | HI03 | C022-02 | 1271
D | 2300 | HI04 | C022-02 | 1271
D | 2300 | HI05 | C022-02 | 1271
D | 2300 | HI06 | C022-02 | 1271
D | 2300 | HI07 | C022-02 | 1271
D | 2300 | HI08 | C022-02 | 1271
D | 2300 | HI09 | C022-02 | 1271
D | 2300 | HI10 | C022-02 | 1271
D | 2300 | HI11 | C022-02 | 1271
D | 2300 | HI12 | C022-02 | 1271
 
Occurrence Span Code Date
Date associated with the Occurrence Span Code reported in this composite element.
837 - Health Care Services Data Reporting
D | 2300 | HI01 | C022-04 | 1251
D | 2300 | HI02 | C022-04 | 1251
D | 2300 | HI03 | C022-04 | 1251
D | 2300 | HI04 | C022-04 | 1251
D | 2300 | HI05 | C022-04 | 1251
D | 2300 | HI06 | C022-04 | 1251
D | 2300 | HI07 | C022-04 | 1251
D | 2300 | HI08 | C022-04 | 1251
D | 2300 | HI09 | C022-04 | 1251
D | 2300 | HI10 | C022-04 | 1251
D | 2300 | HI11 | C022-04 | 1251
D | 2300 | HI12 | C022-04 | 1251
 
Operating Physician First Name
First name of the physician performing the principle procedure.
837 - Health Care Services Data Reporting
D | 2310B | NM104 | - | 1036
D | 2420A | NM104 | - | 1036
 
Operating Physician Last Name
Last name of the physician performing the principle procedure.
837 - Health Care Services Data Reporting
D | 2310B | NM103 | - | 1035
D | 2420A | NM103 | - | 1035
 
Operating Physician Middle Name or Initial
Middle name or initial of the physician performing the principal procedure.
837 - Health Care Services Data Reporting
D | 2310B | NM105 | - | 1037
D | 2420A | NM105 | - | 1037
 
Operating Physician Name Suffix
Suffix to the name of the physician performing the principal procedure.
837 - Health Care Services Data Reporting
D | 2310B | NM107 | - | 1039
D | 2420A | NM107 | - | 1039
 
Operating Physician Primary Identifier
Primary identifier of the physician performing the principle procedure.
837 - Health Care Services Data Reporting
D | 2310B | NM109 | - | 67
D | 2420A | NM109 | - | 67
 
Operating Physician Secondary Identifier
Additional identifier for the physician performing the principal procedure.
837 - Health Care Services Data Reporting
D | 2310B | REF02 | - | 127
D | 2420A | REF02 | - | 127
 
Originator Application Transaction Identifier
An identification number that identifies a transaction within the originator's applications system.
837 - Health Care Services Data Reporting
H | | BHT03 | - | 127
 
Other Diagnosis
Other diagnosis for this claim.
837 - Health Care Services Data Reporting
D | 2300 | HI01 | C022-02 | 1271
D | 2300 | HI02 | C022-02 | 1271
D | 2300 | HI03 | C022-02 | 1271
D | 2300 | HI04 | C022-02 | 1271
D | 2300 | HI05 | C022-02 | 1271
D | 2300 | HI06 | C022-02 | 1271
D | 2300 | HI07 | C022-02 | 1271
D | 2300 | HI08 | C022-02 | 1271
D | 2300 | HI09 | C022-02 | 1271
D | 2300 | HI10 | C022-02 | 1271
D | 2300 | HI11 | C022-02 | 1271
D | 2300 | HI12 | C022-02 | 1271
 
Other Insured Group Name
Name of the group or plan through which the insurance is provided to the other insured.
837 - Health Care Services Data Reporting
D | 2320 | SBR04 | - | 93
 
Other Operating Physician First Name
First Name of the individual performing a secondary surgical procedure or assisting the Operating Physician.
837 - Health Care Services Data Reporting
D | 2310C | NM104 | - | 1036
D | 2420B | NM104 | - | 1036
 
Other Operating Physician Identifier
National identifier for the individual performing a secondary surgical procedure or assisting the Operating Physician.
837 - Health Care Services Data Reporting
D | 2310C | NM109 | - | 67
D | 2420B | NM109 | - | 67
 
Other Operating Physician Last Name
Last Name of the individual performing a secondary surgical procedure or assisting the Operating Physician.
837 - Health Care Services Data Reporting
D | 2310C | NM103 | - | 1035
D | 2420B | NM103 | - | 1035
 
Other Operating Physician Middle Name or Initial
Middle name or initial of the individual performing a secondary surgical procedure or assisting the Operating Physician.
837 - Health Care Services Data Reporting
D | 2310C | NM105 | - | 1037
D | 2420B | NM105 | - | 1037
 
Other Operating Physician Name Suffix
Suffix to the name of the individual performing a secondary surgical procedure or assisting the Operating Physician.
837 - Health Care Services Data Reporting
D | 2310C | NM107 | - | 1039
D | 2420B | NM107 | - | 1039
 
Other Operating Physician Secondary Identifier
Additional identification number of the other operating physician as defined by the payer organization.
837 - Health Care Services Data Reporting
D | 2310C | REF02 | - | 127
 
Other Payer Organization Name
Organization name of this non-destination (COB) payer.
837 - Health Care Services Data Reporting
D | 2330B | NM103 | - | 1035
 
Other Payer Primary Identifier
An identification number for the other payer.
837 - Health Care Services Data Reporting
D | 2330B | NM109 | - | 67
D | 2420A | REF04 | C040-02 | 127
D | 2420B | REF04 | C040-02 | 127
 
Other Payer Responsibility Sequence Code
Code indicating the order in which benefits will be adjudicated when multiple payers are involved.
837 - Health Care Services Data Reporting
D | 2320 | SBR01 | - | 1138
 
Other Payer Secondary Identifier
Additional identifier for the other payer organization
837 - Health Care Services Data Reporting
D | 2330B | REF02 | - | 127
 
Other Provider Secondary Identifier
Additional identification number of the other provider as defined by the payer organization.
837 - Health Care Services Data Reporting
D | 2420B | REF02 | - | 127
 
Other Subscriber First Name
The first name of the Other Subscriber.
837 - Health Care Services Data Reporting
D | 2330A | NM104 | - | 1036
 
Other Subscriber Identifier
An identification number, assigned by the third party payer, to identify the Other Subscriber.
837 - Health Care Services Data Reporting
D | 2330A | NM109 | - | 67
 
Other Subscriber Last Name
The last name of the Other Subscriber.
837 - Health Care Services Data Reporting
D | 2330A | NM103 | - | 1035
 
Other Subscriber Middle Name or Initial
This is the middle name or initial of the Other Subscriber.
837 - Health Care Services Data Reporting
D | 2330A | NM105 | - | 1037
 
Other Subscriber Name Suffix
The suffix to the name of the Other Subscriber.
837 - Health Care Services Data Reporting
D | 2330A | NM107 | - | 1039
 
Other Subscriber Secondary Identifier
Number providing additional identification of the Other Subscriber.
837 - Health Care Services Data Reporting
D | 2330A | REF02 | - | 127
 
Patient Address Line
Address line of the street mailing address of the patient.
837 - Health Care Services Data Reporting
D | 2010CA | N301 | - | 166
D | 2010CA | N302 | - | 166
 
Patient Birth Date
Date of birth of the patient.
837 - Health Care Services Data Reporting
D | 2010CA | DMG02 | - | 1251
 
Patient City Name
The city name of the patient.
837 - Health Care Services Data Reporting
D | 2010CA | N401 | - | 19
 
Patient Country Code
The country code of the patient.
837 - Health Care Services Data Reporting
D | 2010CA | N404 | - | 26
 
Patient Country Subdivision Code
The country subdivision code of the patient.
837 - Health Care Services Data Reporting
D | 2010CA | N407 | - | 1715
 
Patient First Name
The first name of the individual to whom the services were provided.
837 - Health Care Services Data Reporting
D | 2010CA | NM104 | - | 1036
 
Patient Gender Code
A code indicating the sex of the patient.
837 - Health Care Services Data Reporting
D | 2010CA | DMG03 | - | 1068
 
Patient Last Name
The last name of the individual to whom the services were provided.
837 - Health Care Services Data Reporting
D | 2010CA | NM103 | - | 1035
 
Patient Middle Name or Initial
The middle name or initial of the individual to whom the services were provided.
837 - Health Care Services Data Reporting
D | 2010CA | NM105 | - | 1037
 
Patient Name Suffix
Suffix to the name of the individual to whom the services were provided.
837 - Health Care Services Data Reporting
D | 2010CA | NM107 | - | 1039
 
Patient Postal Zone or ZIP Code
The ZIP Code of the patient.
837 - Health Care Services Data Reporting
D | 2010CA | N403 | - | 116
 
Patient Reason For Visit
The diagnosis code describing the patient's reason for visit at the time of outpatient registration.
837 - Health Care Services Data Reporting
D | 2300 | HI01 | C022-02 | 1271
D | 2300 | HI02 | C022-02 | 1271
D | 2300 | HI03 | C022-02 | 1271
 
Patient Secondary Identifier
Additional identifier assigned to the patient by the payer.
837 - Health Care Services Data Reporting
D | 2010CA | REF02 | - | 127
 
Patient State or Province Code
The State Postal Code of the patient.
837 - Health Care Services Data Reporting
D | 2010CA | N402 | - | 156
 
Patient Status Code
A code indicating the patient's status at the date of admission, outpatient service, or start of care.
837 - Health Care Services Data Reporting
D | 2300 | CL103 | - | 1352
 
Payer Additional Identifier
Additional identifier for the payer.
837 - Health Care Services Data Reporting
D | 2010BB | REF02 | - | 127
 
Payer Identifier
Number identifying the payer organization.
837 - Health Care Services Data Reporting
D | 2010BB | NM109 | - | 67
 
Payer Name
Name identifying the payer organization.
837 - Health Care Services Data Reporting
D | 2010BB | NM103 | - | 1035
 
Payer Paid Amount
The amount paid by the payer on this claim.
837 - Health Care Services Data Reporting
D | 2320 | AMT02 | - | 782
 
Payer Responsibility Sequence Code
Code indicating the order in which benefits for this payer will be adjudicated when multiple payers are involved.
837 - Health Care Services Data Reporting
D | 2000B | SBR01 | - | 1138
 
Preferred Language Spoken
Language is the one the patient prefers to use in discussing with those in the health care community.
837 - Health Care Services Data Reporting
D | 2010BA | LUI02 | - | 67
D | 2010CA | LUI02 | - | 67
 
Pregnancy Indicator
A yes/no code indicating whether a patient is pregnant.
837 - Health Care Services Data Reporting
D | 2000B | PAT09 | - | 1073
D | 2000C | PAT09 | - | 1073
 
Prescription or Link Sequence Number
The unique identification number assigned by the pharmacy or supplier to the prescription or compound drug ingredient.
837 - Health Care Services Data Reporting
D | 2410 | REF02 | - | 127
 
Present On Admission Indicator
Code which provides an indication as to whether the diagnosis was present at the time of admission.
837 - Health Care Services Data Reporting
D | 2300 | HI01 | C022-09 | 1271
D | 2300 | HI01 | C022-09 | 1271
D | 2300 | HI02 | C022-09 | 1271
D | 2300 | HI03 | C022-09 | 1271
D | 2300 | HI04 | C022-09 | 1271
D | 2300 | HI05 | C022-09 | 1271
D | 2300 | HI06 | C022-09 | 1271
D | 2300 | HI07 | C022-09 | 1271
D | 2300 | HI08 | C022-09 | 1271
D | 2300 | HI09 | C022-09 | 1271
D | 2300 | HI10 | C022-09 | 1271
D | 2300 | HI11 | C022-09 | 1271
D | 2300 | HI12 | C022-09 | 1271
D | 2300 | HI01 | C022-09 | 1271
D | 2300 | HI02 | C022-09 | 1271
D | 2300 | HI03 | C022-09 | 1271
D | 2300 | HI04 | C022-09 | 1271
D | 2300 | HI05 | C022-09 | 1271
D | 2300 | HI06 | C022-09 | 1271
D | 2300 | HI07 | C022-09 | 1271
D | 2300 | HI08 | C022-09 | 1271
D | 2300 | HI09 | C022-09 | 1271
D | 2300 | HI10 | C022-09 | 1271
D | 2300 | HI11 | C022-09 | 1271
D | 2300 | HI12 | C022-09 | 1271
 
Principal Diagnosis Code
The diagnosis code describing the condition established, after study, to be chiefly responsible for occasioning the admission of the patient for care.
837 - Health Care Services Data Reporting
D | 2300 | HI01 | C022-02 | 1271
 
Principal Procedure Code
Code identifying the principal procedure, product or service.
837 - Health Care Services Data Reporting
D | 2300 | HI01 | C022-02 | 1271
 
Principal Procedure Date
Date on which the Principal Procedure was performed.
837 - Health Care Services Data Reporting
D | 2300 | HI01 | C022-04 | 1251
 
Procedure Code
Code identifying the procedure, product or service.
837 - Health Care Services Data Reporting
D | 2300 | HI01 | C022-02 | 1271
D | 2300 | HI02 | C022-02 | 1271
D | 2300 | HI03 | C022-02 | 1271
D | 2300 | HI04 | C022-02 | 1271
D | 2300 | HI05 | C022-02 | 1271
D | 2300 | HI06 | C022-02 | 1271
D | 2300 | HI07 | C022-02 | 1271
D | 2300 | HI08 | C022-02 | 1271
D | 2300 | HI09 | C022-02 | 1271
D | 2300 | HI10 | C022-02 | 1271
D | 2300 | HI11 | C022-02 | 1271
D | 2300 | HI12 | C022-02 | 1271
D | 2400 | SV202 | C003-02 | 234
 
Procedure Date
Date when the health care procedure was performed.
837 - Health Care Services Data Reporting
D | 2300 | HI01 | C022-04 | 1251
D | 2300 | HI02 | C022-04 | 1251
D | 2300 | HI03 | C022-04 | 1251
D | 2300 | HI04 | C022-04 | 1251
D | 2300 | HI05 | C022-04 | 1251
D | 2300 | HI06 | C022-04 | 1251
D | 2300 | HI07 | C022-04 | 1251
D | 2300 | HI08 | C022-04 | 1251
D | 2300 | HI09 | C022-04 | 1251
D | 2300 | HI10 | C022-04 | 1251
D | 2300 | HI11 | C022-04 | 1251
D | 2300 | HI12 | C022-04 | 1251
 
Procedure Modifier
This identifies special circumstances related to the performance of the service.
837 - Health Care Services Data Reporting
D | 2400 | SV202 | C003-03 | 1339
D | 2400 | SV202 | C003-04 | 1339
D | 2400 | SV202 | C003-05 | 1339
D | 2400 | SV202 | C003-06 | 1339
D | 2400 | SV202 | C003-09 | 1339
D | 2400 | SV202 | C003-10 | 1339
D | 2400 | SV202 | C003-11 | 1339
D | 2400 | SV202 | C003-12 | 1339
 
Product or Service ID Qualifier
Code identifying the type/source of the descriptive number used in Product/Service ID (234).
837 - Health Care Services Data Reporting
D | 2400 | SV202 | C003-01 | 235
D | 2410 | LIN02 | - | 235
 
Provider's Assigned Claim Identifier
The identifier generated by the provider for the purposes of reassociation to their claim accounts receivable.
837 - Health Care Services Data Reporting
D | 2300 | CLM01 | - | 1028
 
Race or Ethnicity Code
Code indicating the racial or ethnic background of a person.
837 - Health Care Services Data Reporting
D | 2010BA | DMG05 | C056-03 | 1271
D | 2010CA | DMG05 | C056-03 | 1271
 
Receiver Name
Name of organization receiving the transaction.
837 - Health Care Services Data Reporting
H | 1000B | NM103 | - | 1035
 
Receiver Primary Identifier
Primary identification number for the receiver of the transaction.
837 - Health Care Services Data Reporting
H | 1000B | NM109 | - | 67
 
Reference Identification Qualifier
Code qualifying the reference identification.
837 - Health Care Services Data Reporting
D | 2010AA | REF01 | - | 128
D | 2010BA | REF01 | - | 128
D | 2010BB | REF01 | - | 128
D | 2010CA | REF01 | - | 128
D | 2300 | REF01 | - | 128
D | 2300 | REF01 | - | 128
D | 2300 | REF01 | - | 128
D | 2300 | REF01 | - | 128
D | 2300 | REF01 | - | 128
D | 2300 | REF01 | - | 128
D | 2300 | REF01 | - | 128
D | 2310A | REF01 | - | 128
D | 2310B | REF01 | - | 128
D | 2310C | REF01 | - | 128
D | 2310D | REF01 | - | 128
D | 2310F | REF01 | - | 128
D | 2330A | REF01 | - | 128
D | 2330B | REF01 | - | 128
D | 2410 | REF01 | - | 128
D | 2420A | REF01 | - | 128
D | 2420A | REF04 | C040-01 | 128
D | 2420B | REF01 | - | 128
D | 2420B | REF04 | C040-01 | 128
 
Referring Provider First Name
The first name of provider who referred the patient to the provider of service on this claim.
837 - Health Care Services Data Reporting
D | 2310F | NM104 | - | 1036
 
Referring Provider Identifier
The identification number for the referring physician.
837 - Health Care Services Data Reporting
D | 2310F | NM109 | - | 67
 
Referring Provider Last Name
The Last Name of Provider who referred the patient to the provider of service on this claim.
837 - Health Care Services Data Reporting
D | 2310F | NM103 | - | 1035
 
Referring Provider Middle Name or Initial
Middle name or initial of the provider who is referring patient for care.
837 - Health Care Services Data Reporting
D | 2310F | NM105 | - | 1037
 
Referring Provider Name Suffix
Suffix to the name of the provider referring the patient for care.
837 - Health Care Services Data Reporting
D | 2310F | NM107 | - | 1039
 
Referring Provider Secondary Identifier
Additional identification number for the provider referring the patient for service.
837 - Health Care Services Data Reporting
D | 2310F | REF02 | - | 127
 
Related Causes Code
Code identifying an accompanying cause of an illness, injury, or an accident.
837 - Health Care Services Data Reporting
D | 2300 | CLM11 | C024-01 | 1362
 
Rendering Provider First Name
The first name of the provider who performed the service.
837 - Health Care Services Data Reporting
D | 2310D | NM104 | - | 1036
 
Rendering Provider Identifier
The identifier assigned by the Payer to the provider who performed the service.
837 - Health Care Services Data Reporting
D | 2310D | NM109 | - | 67
 
Rendering Provider Last Name
The last name of the provider who performed the service.
837 - Health Care Services Data Reporting
D | 2310D | NM103 | - | 1035
 
Rendering Provider Middle Name or Initial
Middle name or initial of the provider who has provided the services to the patient.
837 - Health Care Services Data Reporting
D | 2310D | NM105 | - | 1037
 
Rendering Provider Name Suffix
Name suffix of the provider who has provided the services to the patient.
837 - Health Care Services Data Reporting
D | 2310D | NM107 | - | 1039
 
Rendering Provider Secondary Identifier
Additional identifier for the provider providing care to the patient.
837 - Health Care Services Data Reporting
D | 2310D | REF02 | - | 127
 
Service Line Revenue Code
UB92 Revenue Code pertaining to the service line.
837 - Health Care Services Data Reporting
D | 2400 | SV201 | - | 234
 
Service Provider Identifier
Code uniquely identifying the provider to whom the patient has been or will be referred for service or the provider that performed the service or where the service was performed.
837 - Health Care Services Data Reporting
D | 2010AA | NM109 | - | 67
 
Service Provider Last or Organization Name
Last name or organization name of the provider to whom the patient has been or will be referred for service or the provider that performed the service or where the service was performed.
837 - Health Care Services Data Reporting
D | 2010AA | NM103 | - | 1035
 
Service Provider Secondary Identification
Secondary identification number for the provider or organization who performed the services reported.
837 - Health Care Services Data Reporting
D | 2010AA | REF02 | - | 127
 
Service Unit Count
The quantity of units, times, days, visits, services, or treatments for the service described by the HCPCS codes, revenue code or procedure code.
837 - Health Care Services Data Reporting
D | 2400 | SV205 | - | 380
 
Service/Assessment Date
Date on which patient assessment or other required assessment was performed or the date of service, such as the start date of the service, the end date of the service, or the single date of the service.
837 - Health Care Services Data Reporting
D | 2400 | DTP03 | - | 1251
 
Source of Payment
Source of Payment is the organization that provides payment, (such as the Medicare or Medicaid programs), other government agencies, (such as the Department of Veteran's Affairs) or the Health Resources and Services Administration, private insurance companies, charity care, or out-of-pocket payments by individuals.
837 - Health Care Services Data Reporting
D | 2000B | SBR10 | - | 1732
D | 2320 | SBR10 | - | 1732
 
Standard Occupational Classification System (SOC)
Standard Occupational Classification (SOC) is used by Federal statistical agencies to classify workers into occupational categories for the purpose of collecting, calculating, or disseminating data.
837 - Health Care Services Data Reporting
D | 2300 | HI01 | C022-02 | 1271
D | 2300 | HI02 | C022-02 | 1271
D | 2300 | HI03 | C022-02 | 1271
D | 2300 | HI04 | C022-02 | 1271
 
State Care Tax
Tax reported for State purposes (not Sales Tax).
837 - Health Care Services Data Reporting
D | 2400 | AMT02 | - | 782
 
State of Claim Jurisdiction
Jurisdictional state that defines the rules, regulations, statutes, or guidelines under which the electronic claim/bill is being submitted.
837 - Health Care Services Data Reporting
D | 2300 | REF02 | - | 127
 
Statement From and Through Date
The start and end date of the period covered on the claim.
837 - Health Care Services Data Reporting
D | 2300 | DTP03 | - | 1251
 
Submitter Contact Name
Name of the person at the submitter organization to whom inquiries about the transaction should be directed.
837 - Health Care Services Data Reporting
H | 1000A | PER02 | - | 93
 
Submitter First Name
The first name of the person submitting the transaction or receiving the transaction, as identified by the preceding identification code.
837 - Health Care Services Data Reporting
H | 1000A | NM104 | - | 1036
 
Submitter Identifier
Code or number identifying the entity submitting the claim.
837 - Health Care Services Data Reporting
H | 1000A | NM109 | - | 67
 
Submitter Last or Organization Name
The last name or the organizational name of the entity submitting the transaction
837 - Health Care Services Data Reporting
H | 1000A | NM103 | - | 1035
 
Submitter Middle Name or Initial
The middle name or initial of the person submitting the transaction.
837 - Health Care Services Data Reporting
H | 1000A | NM105 | - | 1037
 
Subscriber Address Line
Address line of the current mailing address of the insured individual or subscriber to the coverage.
837 - Health Care Services Data Reporting
D | 2010BA | N301 | - | 166
D | 2010BA | N302 | - | 166
 
Subscriber Birth Date
The date of birth of the subscriber to the indicated coverage or policy.
837 - Health Care Services Data Reporting
D | 2010BA | DMG02 | - | 1251
 
Subscriber City Name
The City Name of the insured individual or subscriber to the coverage.
837 - Health Care Services Data Reporting
D | 2010BA | N401 | - | 19
 
Subscriber Country Code
The code identifying the country of the insured or subscriber address.
837 - Health Care Services Data Reporting
D | 2010BA | N404 | - | 26
 
Subscriber Country Subdivision Code
The country subdivision code of the insured or subscriber address.
837 - Health Care Services Data Reporting
D | 2010BA | N407 | - | 1715
 
Subscriber First Name
The first name of the insured individual or subscriber to the coverage.
837 - Health Care Services Data Reporting
D | 2010BA | NM104 | - | 1036
 
Subscriber Gender Code
Code indicating the sex of the subscriber to the indicated coverage or policy.
837 - Health Care Services Data Reporting
D | 2010BA | DMG03 | - | 1068
 
Subscriber Group Name
Name of the group through which the coverage is provided to the subscriber.
837 - Health Care Services Data Reporting
D | 2000B | SBR04 | - | 93
 
Subscriber Group or Policy Number
The identifier assigned by the health plan or administrator to identify the group through which the coverage is provided to the subscriber.
837 - Health Care Services Data Reporting
D | 2000B | SBR03 | - | 127
 
Subscriber Last Name
The surname of the insured individual or subscriber to the coverage.
837 - Health Care Services Data Reporting
D | 2010BA | NM103 | - | 1035
 
Subscriber Middle Name or Initial
The middle name or initial of the subscriber to the indicated coverage or policy.
837 - Health Care Services Data Reporting
D | 2010BA | NM105 | - | 1037
 
Subscriber Name Suffix
Suffix of the insured individual or subscriber to the coverage.
837 - Health Care Services Data Reporting
D | 2010BA | NM107 | - | 1039
 
Subscriber Postal Zone or ZIP Code
The ZIP Code of the insured individual or subscriber to the coverage.
837 - Health Care Services Data Reporting
D | 2010BA | N403 | - | 116
 
Subscriber Primary Identifier
Primary identification number of the subscriber to the coverage.
837 - Health Care Services Data Reporting
D | 2010BA | NM109 | - | 67
 
Subscriber Secondary Identifier
Identifies another or additional distinguishing code number associated with the subscriber.
837 - Health Care Services Data Reporting
D | 2010BA | REF02 | - | 127
 
Subscriber State or Province Code
The State Postal Code of the insured individual or subscriber to the coverage.
837 - Health Care Services Data Reporting
D | 2010BA | N402 | - | 156
 
Temporary Solution for a Statutory/Regulatory Requirement
The unexpected data requirement of a legislative authority.
837 - Health Care Services Data Reporting
D | 2300 | K301 | - | 449
 
Total Claim Charge Amount
The sum of all charges included within this claim.
837 - Health Care Services Data Reporting
D | 2300 | CLM02 | - | 782
 
Transaction Segment Count
A tally of all segments between the ST and the SE segments including the ST and SE segments.
837 - Health Care Services Data Reporting
D | | SE01 | - | 96
 
Transaction Set Control Number
The unique identification number within a transaction set.
837 - Health Care Services Data Reporting
H | | ST02 | - | 329
D | | SE02 | - | 329
 
Transaction Set Creation Date
Identifies the date the submitter created the transaction.
837 - Health Care Services Data Reporting
H | | BHT04 | - | 373
 
Transaction Set Creation Time
Time file is created for transmission.
837 - Health Care Services Data Reporting
H | | BHT05 | - | 337
 
Transaction Set Identifier Code
Code uniquely identifying a Transaction Set.
837 - Health Care Services Data Reporting
H | | ST01 | - | 143
 
Transaction Set Purpose Code
Code identifying purpose of transaction set.
837 - Health Care Services Data Reporting
H | | BHT02 | - | 353
 
Unit or Basis for Measurement Code
Code specifying the units in which a value is being expressed, or manner in which a measurement has been taken.
837 - Health Care Services Data Reporting
D | 2400 | SV204 | - | 355
 
Use of Language Indicator
Code indicating the use of a language.
837 - Health Care Services Data Reporting
D | 2010BA | LUI04 | - | 1303
D | 2010CA | LUI04 | - | 1303
 
Value Code
A code that identifies data of a monetary nature that is necessary for processing this claim as required by the payer organization.
837 - Health Care Services Data Reporting
D | 2300 | HI01 | C022-02 | 1271
D | 2300 | HI02 | C022-02 | 1271
D | 2300 | HI03 | C022-02 | 1271
D | 2300 | HI04 | C022-02 | 1271
D | 2300 | HI05 | C022-02 | 1271
D | 2300 | HI06 | C022-02 | 1271
D | 2300 | HI07 | C022-02 | 1271
D | 2300 | HI08 | C022-02 | 1271
D | 2300 | HI09 | C022-02 | 1271
D | 2300 | HI10 | C022-02 | 1271
D | 2300 | HI11 | C022-02 | 1271
D | 2300 | HI12 | C022-02 | 1271
 
Value Code - Monetary Amount
Non-Monetary value associated with the value code reported in this composite element.
837 - Health Care Services Data Reporting
D | 2300 | HI01 | C022-05 | 782
D | 2300 | HI02 | C022-05 | 782
D | 2300 | HI03 | C022-05 | 782
D | 2300 | HI04 | C022-05 | 782
D | 2300 | HI05 | C022-05 | 782
D | 2300 | HI06 | C022-05 | 782
D | 2300 | HI07 | C022-05 | 782
D | 2300 | HI08 | C022-05 | 782
D | 2300 | HI09 | C022-05 | 782
D | 2300 | HI10 | C022-05 | 782
D | 2300 | HI11 | C022-05 | 782
D | 2300 | HI12 | C022-05 | 782
 
Value Code - Non-monetary Value
Non-Monetary value associated with the value code reported in this composite element.
837 - Health Care Services Data Reporting
D | 2300 | HI01 | C022-10 | 1271
D | 2300 | HI02 | C022-10 | 1271
D | 2300 | HI03 | C022-10 | 1271
D | 2300 | HI04 | C022-10 | 1271
D | 2300 | HI05 | C022-10 | 1271
D | 2300 | HI06 | C022-10 | 1271
D | 2300 | HI07 | C022-10 | 1271
D | 2300 | HI08 | C022-10 | 1271
D | 2300 | HI09 | C022-10 | 1271
D | 2300 | HI10 | C022-10 | 1271
D | 2300 | HI11 | C022-10 | 1271
D | 2300 | HI12 | C022-10 | 1271
 
Version, Release, or Industry Identifier
Code indicating the version, release, sub-release and industry identification of the EDI standard being used.
837 - Health Care Services Data Reporting
H | | ST03 | - | 1705