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
 
Claim Received Date
This is the date the claim was accepted into the payer's adjudication system for processing.
277 - Health Care Claim Pending Status Information
D | 2200D | DTP03 | - | 1251
 
Claim Service Period
The beginning and end dates for the service period covered by a claim.
277 - Health Care Claim Pending Status Information
D | 2200D | DTP03 | - | 1251
 
Clearinghouse Trace Number
Unique tracking number for the transaction assigned by a clearinghouse.
277 - Health Care Claim Pending Status Information
D | 2200D | REF02 | - | 127
 
Code List Qualifier Code
Code identifying a specific industry code list.
277 - Health Care Claim Pending Status Information
D | 2200D | STC01 | C043-04 | 1270
D | 2200D | STC10 | C043-04 | 1270
D | 2200D | STC11 | C043-04 | 1270
D | 2220D | STC01 | C043-04 | 1270
D | 2220D | STC10 | C043-04 | 1270
D | 2220D | STC11 | C043-04 | 1270
D | 2220D | TOO01 | - | 1270
 
Date Time Period Format Qualifier
Code indicating the date format, time format, or date and time format.
277 - Health Care Claim Pending Status Information
D | 2200D | DTP02 | - | 1250
D | 2200D | DTP02 | - | 1250
D | 2220D | DTP02 | - | 1250
 
Date Time Qualifier
Code specifying the type of date or time or both date and time.
277 - Health Care Claim Pending Status Information
D | 2200D | DTP01 | - | 374
D | 2200D | DTP01 | - | 374
D | 2220D | DTP01 | - | 374
 
Entity Identifier Code
Code identifying an organizational entity, a physical location, property or an individual.
277 - Health Care Claim Pending Status Information
D | 2100A | NM101 | - | 98
D | 2100B | NM101 | - | 98
D | 2100C | NM101 | - | 98
D | 2100D | NM101 | - | 98
D | 2200D | STC01 | C043-03 | 98
D | 2200D | STC10 | C043-03 | 98
D | 2200D | STC11 | C043-03 | 98
D | 2220D | STC01 | C043-03 | 98
D | 2220D | STC10 | C043-03 | 98
D | 2220D | STC11 | C043-03 | 98
 
Entity Type Qualifier
Code qualifying the type of entity.
277 - Health Care Claim Pending Status Information
D | 2100A | NM102 | - | 1065
D | 2100B | NM102 | - | 1065
D | 2100C | NM102 | - | 1065
D | 2100D | NM102 | - | 1065
 
Health Care Claim Status Category Code
Code indicating the category of the associated claim status code.
277 - Health Care Claim Pending Status Information
D | 2200D | STC01 | C043-01 | 1271
D | 2200D | STC10 | C043-01 | 1271
D | 2200D | STC11 | C043-01 | 1271
D | 2220D | STC01 | C043-01 | 1271
D | 2220D | STC10 | C043-01 | 1271
D | 2220D | STC11 | C043-01 | 1271
 
Hierarchical Child Code
Code indicating if there are hierarchical child data segments subordinate to the level being described.
277 - Health Care Claim Pending Status Information
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.
277 - Health Care Claim Pending Status Information
D | 2000A | HL01 | - | 628
D | 2000B | HL01 | - | 628
D | 2000C | HL01 | - | 628
D | 2000D | HL01 | - | 628
 
Hierarchical Level Code
Code defining the characteristic of a level in a hierarchical structure.
277 - Health Care Claim Pending Status Information
D | 2000A | HL03 | - | 735
D | 2000B | HL03 | - | 735
D | 2000C | HL03 | - | 735
D | 2000D | HL03 | - | 735
 
Hierarchical Parent ID Number
Identification number of the next higher hierarchical data segment that the data segment being described is subordinate to.
277 - Health Care Claim Pending Status Information
D | 2000B | HL02 | - | 734
D | 2000C | HL02 | - | 734
D | 2000D | 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
277 - Health Care Claim Pending Status Information
H | | BHT01 | - | 1005
 
Identification Code Qualifier
Code designating the system/method of code structure used for Identification Code (67).
277 - Health Care Claim Pending Status Information
D | 2100A | NM108 | - | 66
D | 2100B | NM108 | - | 66
D | 2100C | NM108 | - | 66
D | 2100D | NM108 | - | 66
 
Information Receiver First Name
The first name of the individual or organization who expects to receive information in response to a query.
277 - Health Care Claim Pending Status Information
D | 2100B | NM104 | - | 1036
 
Information Receiver Identification Number
The identification number of the individual or organization who expects to receive information in response to a query.
277 - Health Care Claim Pending Status Information
D | 2100B | NM109 | - | 67
 
Information Receiver Last or Organization Name
The name of the organization or last name of the individual that expects to receive information or is receiving information.
277 - Health Care Claim Pending Status Information
D | 2100B | NM103 | - | 1035
 
Information Receiver Middle Name
The middle name of the individual or organization who expects to receive information in response to a query.
277 - Health Care Claim Pending Status Information
D | 2100B | NM105 | - | 1037
 
Line Item Control Number
Identifier assigned by the submitter/provider to this line item.
277 - Health Care Claim Pending Status Information
D | 2220D | REF02 | - | 127
 
Monetary Amount
Monetary amount.
277 - Health Care Claim Pending Status Information
D | 2220D | SVC02 | - | 782
 
Patient First Name
The first name of the individual to whom the services were provided.
277 - Health Care Claim Pending Status Information
D | 2100D | NM104 | - | 1036
 
Patient Identification Number
The Identification number of the individual who is the patient in a claim within this transaction.
277 - Health Care Claim Pending Status Information
D | 2100D | NM109 | - | 67
 
Patient Last Name
The last name of the individual to whom the services were provided.
277 - Health Care Claim Pending Status Information
D | 2100D | NM103 | - | 1035
 
Patient Middle Name or Initial
The middle name or initial of the individual to whom the services were provided.
277 - Health Care Claim Pending Status Information
D | 2100D | NM105 | - | 1037
 
Patient Name Suffix
Suffix to the name of the individual to whom the services were provided.
277 - Health Care Claim Pending Status Information
D | 2100D | NM107 | - | 1039
 
Payer Claim Control Number
A number assigned by the payer to identify a claim. The number is usually referred to as an Internal Control Number (ICN), Claim Control Number (CCN) or a Document Control Number (DCN).
277 - Health Care Claim Pending Status Information
D | 2200D | TRN02 | - | 127
 
Payer Identifier
Number identifying the payer organization.
277 - Health Care Claim Pending Status Information
D | 2100A | NM109 | - | 67
 
Payer Name
Name identifying the payer organization.
277 - Health Care Claim Pending Status Information
D | 2100A | NM103 | - | 1035
 
Pharmacy Prescription Number
A unique identification number assigned to the prescription claim for the purpose of identification.
277 - Health Care Claim Pending Status Information
D | 2200D | REF02 | - | 127
D | 2220D | REF02 | - | 127
 
Predetermination of Benefits Code
Code indicating that the associated claim is a predetermination of benefits request rather than a claim or encounter.
277 - Health Care Claim Pending Status Information
D | 2200D | STC13 | - | 1383
 
Procedure Modifier
This identifies special circumstances related to the performance of the service.
277 - Health Care Claim Pending Status Information
D | 2220D | SVC01 | C003-03 | 1339
D | 2220D | SVC01 | C003-04 | 1339
D | 2220D | SVC01 | C003-05 | 1339
D | 2220D | SVC01 | C003-06 | 1339
D | 2220D | SVC01 | C003-09 | 1339
D | 2220D | SVC01 | C003-10 | 1339
D | 2220D | SVC01 | C003-11 | 1339
D | 2220D | SVC01 | C003-12 | 1339
 
Product or Service ID
Identifying number for a product or service.
277 - Health Care Claim Pending Status Information
D | 2220D | SVC01 | C003-02 | 234
D | 2220D | SVC04 | - | 234
 
Product or Service ID Qualifier
Code identifying the type/source of the descriptive number used in Product/Service ID (234).
277 - Health Care Claim Pending Status Information
D | 2220D | SVC01 | C003-01 | 235
 
Property Casualty Claim Number
Identification number for property casualty claim associated with the services identified on the bill.
277 - Health Care Claim Pending Status Information
D | 2200D | REF02 | - | 127
 
Provider First Name
The first name of the provider of care submitting a transaction or related to the information provided in or request by the transaction.
277 - Health Care Claim Pending Status Information
D | 2100C | NM104 | - | 1036
 
Provider Identifier
Number assigned by the payer, regulatory authority, or other authorized body or agency to identify the provider.
277 - Health Care Claim Pending Status Information
D | 2100C | NM109 | - | 67
 
Provider Last or Organization Name
The last name of the provider of care or name of the provider organization submitting a transaction or related to the information provided in or request by the transaction.
277 - Health Care Claim Pending Status Information
D | 2100C | NM103 | - | 1035
 
Provider Middle Name
The middle name of the provider of care submitting a transaction or related to the information provided in or request by the transaction.
277 - Health Care Claim Pending Status Information
D | 2100C | NM105 | - | 1037
 
Provider Name Suffix
The name suffix of the provider of care submitting a transaction or related to the information provided in or request by the transaction.
277 - Health Care Claim Pending Status Information
D | 2100C | NM107 | - | 1039
 
Provider's Assigned Claim Identifier
The identifier generated by the provider for the purposes of reassociation to their claim accounts receivable.
277 - Health Care Claim Pending Status Information
D | 2200D | REF02 | - | 127
 
Reference Identification
The identification value assigned by the sender for this particular transaction.
277 - Health Care Claim Pending Status Information
H | | BHT03 | - | 127
D | 2200D | REF02 | - | 127
 
Reference Identification Qualifier
Code qualifying the reference identification.
277 - Health Care Claim Pending Status Information
D | 2200D | REF01 | - | 128
D | 2200D | REF01 | - | 128
D | 2200D | REF01 | - | 128
D | 2200D | REF01 | - | 128
D | 2200D | REF01 | - | 128
D | 2220D | REF01 | - | 128
D | 2220D | REF01 | - | 128
 
Service Line Date
Date of service of the identified service line on the claim.
277 - Health Care Claim Pending Status Information
D | 2220D | DTP03 | - | 1251
 
Service Line Predetermination of Benefits Code
Code indicating that the associated service line is a predetermination of benefits request rather than a claim or encounter.
277 - Health Care Claim Pending Status Information
D | 2220D | STC13 | - | 1383
 
Status Code
Code conveying the status of a health care claim.
277 - Health Care Claim Pending Status Information
D | 2200D | STC01 | C043-02 | 1271
D | 2200D | STC10 | C043-02 | 1271
D | 2200D | STC11 | C043-02 | 1271
D | 2220D | STC01 | C043-02 | 1271
D | 2220D | STC10 | C043-02 | 1271
D | 2220D | STC11 | C043-02 | 1271
 
Status Information Effective Date
The date that the status information provided is effective.
277 - Health Care Claim Pending Status Information
D | 2200D | STC02 | - | 373
D | 2220D | STC02 | - | 373
 
Tooth Code
An indication of the tooth on which services were performed or will be performed.
277 - Health Care Claim Pending Status Information
D | 2220D | TOO02 | - | 1271
 
Tooth Surface Code
The surface(s) of the tooth on which services were performed or will be performed.
277 - Health Care Claim Pending Status Information
D | 2220D | TOO03 | C005-01 | 1369
D | 2220D | TOO03 | C005-02 | 1369
D | 2220D | TOO03 | C005-03 | 1369
D | 2220D | TOO03 | C005-04 | 1369
D | 2220D | TOO03 | C005-05 | 1369
 
Total Claim Charge Amount
The sum of all charges included within this claim.
277 - Health Care Claim Pending Status Information
D | 2200D | STC04 | - | 782
 
Trace Type Code
Code identifying the type of re-association which needs to be performed.
277 - Health Care Claim Pending Status Information
D | 2200D | TRN01 | - | 481
 
Transaction Segment Count
A tally of all segments between the ST and the SE segments including the ST and SE segments.
277 - Health Care Claim Pending Status Information
D | | SE01 | - | 96
 
Transaction Set Control Number
The unique identification number within a transaction set.
277 - Health Care Claim Pending Status Information
H | | ST02 | - | 329
D | | SE02 | - | 329
 
Transaction Set Creation Date
Identifies the date the submitter created the transaction.
277 - Health Care Claim Pending Status Information
H | | BHT04 | - | 373
 
Transaction Set Creation Time
Time file is created for transmission.
277 - Health Care Claim Pending Status Information
H | | BHT05 | - | 337
 
Transaction Set Identifier Code
Code uniquely identifying a Transaction Set.
277 - Health Care Claim Pending Status Information
H | | ST01 | - | 143
 
Transaction Set Purpose Code
Code identifying purpose of transaction set.
277 - Health Care Claim Pending Status Information
H | | BHT02 | - | 353
 
Transaction Type Code
Code specifying the type of transaction.
277 - Health Care Claim Pending Status Information
H | | BHT06 | - | 640
 
Units of Service Count
The number of units of service associated with this service line item.
277 - Health Care Claim Pending Status Information
D | 2220D | SVC07 | - | 380
 
Version, Release, or Industry Identifier
Code indicating the version, release, sub-release and industry identification of the EDI standard being used.
277 - Health Care Claim Pending Status Information
H | | ST03 | - | 1705