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
 
Account Number Qualifier
Code indicating the type of account
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
H | | BPR08 | - | 569
H | | BPR14 | - | 569
 
Adjustment Amount
Adjustment amount for the associated reason code.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
D | 2320A | ADX01 | - | 782
D | 2215B | ADX01 | - | 782
 
Adjustment Reason Code
Code that indicates the reason for the adjustment.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
D | 2320A | ADX02 | - | 426
D | 2215B | ADX02 | - | 426
 
Allowance or Charge Indicator
Code which indicates an allowance or charge for the service specified.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
D | 2312A | SAC01 | - | 248
 
Amount
Monetary amount.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
D | 2312A | SAC05 | - | 610
 
Assigned Number
Number assigned for differentiation within a transaction set.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
D | 2000A | ENT01 | - | 554
 
Billed Premium Amount
The premium amount due or billed, if different from the paid amount.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
D | 2300A | RMR05 | - | 782
D | 2210B | RMR05 | - | 782
 
Birth Sequence Number
A number indicating the order of birth for the identified person in relationship to family members with the same date of birth.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
D | 2000B | INS17 | - | 1470
 
Check or EFT Trace Number
Check number or Electronic Funds Transfer (EFT) number that is unique within the sender/receiver relationship.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
H | | TRN02 | - | 127
 
Communication Number
Complete communications number including country or area code when applicable
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
H | 1000B | PER04 | - | 364
H | 1000B | PER06 | - | 364
H | 1000B | PER08 | - | 364
H | 1000C | PER04 | - | 364
H | 1000C | PER06 | - | 364
H | 1000C | PER08 | - | 364
 
Communication Number Qualifier
Code identifying the type of communication number.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
H | 1000B | PER03 | - | 365
H | 1000B | PER05 | - | 365
H | 1000B | PER07 | - | 365
H | 1000C | PER03 | - | 365
H | 1000C | PER05 | - | 365
H | 1000C | PER07 | - | 365
 
Contact Function Code
Code identifying the major duty or responsibility of the person or group named.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
H | 1000B | PER01 | - | 366
H | 1000C | PER01 | - | 366
 
Contract, Invoice, Account, Group, or Policy Number
The reference number to which this premium payment is associated, such as an account number, contract number , invoice number, group number, or policy number.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
D | 2300A | RMR02 | - | 127
 
Coverage Level Code
Code indicating the level of coverage being provided for this insured
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
D | 2200B | HD05 | - | 1207
 
Coverage Period
The coverage period associated with this premium payment.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
H | | DTM06 | - | 1251
D | 2300A | DTM06 | - | 1251
D | 2200B | DTP03 | - | 1251
D | 2210B | DTM06 | - | 1251
 
Credit or Debit Flag Code
Code indicating whether amount is a credit or debit
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
H | | BPR03 | - | 478
 
Date
Date expressed as CCYYMMDD where CC represents the first two digits of the calendar year.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
H | | DTM02 | - | 373
D | 2300A | DTM02 | - | 373
D | 2210B | DTM02 | - | 373
 
Date Time Period Format Qualifier
Code indicating the date format, time format, or date and time format.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
H | | DTM05 | - | 1250
D | 2300A | DTM05 | - | 1250
D | 2000B | INS11 | - | 1250
D | 2000B | DTP02 | - | 1250
D | 2200B | DTP02 | - | 1250
D | 2210B | DTM05 | - | 1250
D | 2300B | DTM05 | - | 1250
 
Date Time Qualifier
Code specifying the type of date or time or both date and time.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
H | | DTM01 | - | 374
H | | DTM01 | - | 374
H | | DTM01 | - | 374
H | | DTM01 | - | 374
D | 2300A | DTM01 | - | 374
D | 2000B | DTP01 | - | 374
D | 2200B | DTP01 | - | 374
D | 2210B | DTM01 | - | 374
D | 2300B | DTM01 | - | 374
 
Depository Financial Institution (DFI) Identification Number Qualifier
Code identifying the type of identification number of Depository Financial Institution (DFI).
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
H | | BPR06 | - | 506
H | | BPR12 | - | 506
 
Detail Premium Payment Amount
Detailed remittance amount on the transaction.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
D | 2300A | RMR04 | - | 782
D | 2210B | RMR04 | - | 782
 
Entity Identifier Code
Code identifying an organizational entity, a physical location, property or an individual.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
H | 1000A | N101 | - | 98
H | 1000B | N101 | - | 98
H | 1000C | N101 | - | 98
D | 2000A | ENT02 | - | 98
D | 2000B | NM101 | - | 98
D | 2300B | N101 | - | 98
 
Entity Type Qualifier
Code qualifying the type of entity.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
D | 2000B | NM102 | - | 1065
 
Head Count
Number of members/insured under this summary line item remittance.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
D | 2315A | SLN04 | - | 380
 
Identification Code Qualifier
Code designating the system/method of code structure used for Identification Code (67).
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
H | 1000A | N103 | - | 66
H | 1000B | N103 | - | 66
H | 1000C | N103 | - | 66
D | 2000A | ENT03 | - | 66
D | 2000B | NM108 | - | 66
 
Implementation Convention Reference
Reference assigned to identify Implementation Convention.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
H | | ST03 | - | 1705
 
Individual Relationship Code
Code indicating the relationship between two individuals or entities.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
D | 2000B | INS02 | - | 1069
 
Information Only Indicator
An indicator that this segment is informational only
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
D | 2315A | SLN03 | - | 662
 
Insurance Line Code
Code identifying a group of insurance products
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
D | 2200B | HD03 | - | 1205
 
Insurance Remittance Reference Number
The reference number for this individual premium remittance, such as a policy number, account number, invoice number.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
D | 2210B | RMR02 | - | 127
 
Intermediary Bank Additional Name
Additional name for the intermediary bank.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
H | 1000C | N201 | - | 93
 
Intermediary Bank Address Line
Address line for the intermediary bank's address.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
H | 1000C | N301 | - | 166
H | 1000C | N302 | - | 166
 
Intermediary Bank City Name
The city name of the intermediary bank's address.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
H | 1000C | N401 | - | 19
 
Intermediary Bank Contact Name
Name identifying the contact person at the intermediary bank.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
H | 1000C | PER02 | - | 93
 
Intermediary Bank Country Code
The country code of the intermediary bank.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
H | 1000C | N404 | - | 26
 
Intermediary Bank Country Subdivision Code
The country subdivision code of the intermediary bank.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
H | 1000C | N407 | - | 1715
 
Intermediary Bank Identifier
Number identifying the organization responsible for transferring funds between the banks.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
H | 1000C | N104 | - | 67
 
Intermediary Bank Name
Name identifying the organization responsible for transferring funds between the banks.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
H | 1000C | N102 | - | 93
 
Intermediary Bank Postal Zone or ZIP Code
The postal zone code of the intermediary bank's address.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
H | 1000C | N403 | - | 116
 
Intermediary Bank State Code
State postal code of the intermediary bank's address.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
H | 1000C | N402 | - | 156
 
Late Enrollment Indicator
Code identifying if the insured is a late enrollee.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
D | 2200B | HD09 | - | 1073
 
Line Item Control Number
Identifier assigned by the submitter/provider to this line item.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
D | 2310A | IT101 | - | 350
D | 2315A | SLN01 | - | 350
 
Maintenance Type Code
Code identifying a specific type of item maintenance
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
D | 2200B | HD01 | - | 875
 
Member First Name
The first name of the insured individual to the coverage.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
D | 2000B | NM104 | - | 1036
 
Member 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.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
D | 2000B | REF02 | - | 127
D | 2200B | REF02 | - | 127
 
Member Identifier
Member's unique identification number assigned by a payer.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
D | 2000B | NM109 | - | 67
 
Member Indicator
Indicates whether the member is the subscriber or a dependent.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
D | 2000B | INS01 | - | 1073
 
Member Individual Death Date
Date of death for subscriber or dependent.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
D | 2000B | INS12 | - | 1251
 
Member Last Name
The last name of the insured individual to the coverage.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
D | 2000B | NM103 | - | 1035
 
Member Middle Name
The middle name of the insured individual to the coverage.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
D | 2000B | NM105 | - | 1037
 
Member Name Prefix
The name prefix of the insured individual to the coverage.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
D | 2000B | NM106 | - | 1038
 
Member Name Suffix
The name suffix of the insured individual to the coverage.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
D | 2000B | NM107 | - | 1039
 
Member Reporting Category Effective Date(s)
The date the reporting category is effective or terminated.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
D | 2300B | DTM06 | - | 1251
 
Member Reporting Category Name
The name of the reporting category.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
D | 2300B | N102 | - | 93
 
Member Reporting Category Reference ID
Identifier associated with the reporting category.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
D | 2300B | REF02 | - | 127
 
Member Supplemental Identifier
Identifies another or additional distinguishing code number associated with the member.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
D | 2000B | REF02 | - | 127
 
Organization Identification Code
The code identifying the organization providing the summary level premium remittance.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
D | 2000A | ENT04 | - | 67
 
Organizational Reference Identification Qualifier
Code designating the system/method of code structure used for Organizational reference Identifier.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
D | 2300A | REF01 | - | 128
 
Organizational Reference Identifier
A reference identifier used by the sending and/or receiving organizations.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
D | 2300A | REF02 | - | 127
D | 2210B | REF02 | - | 127
 
Originating Company Identifier
A unique identifier designating the company originating the transaction.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
H | | TRN03 | - | 509
 
Originating Company Supplemental Code
Number identifying a further subdivision within the entity originating the transaction.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
H | | BPR11 | - | 510
H | | TRN04 | - | 127
 
Originating Depository Financial Institution (DFI) Identifier
Number identifying the financial institution originating the transaction in an ACH network.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
H | | BPR07 | - | 507
 
Payer Identifier
Number identifying the payer organization.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
H | | BPR10 | - | 509
 
Payer Process Date
The date the payer generated the remittance advice.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
H | | DTM02 | - | 373
 
Payment Action Code
A code that specifies the payer's intent to pay the open amount due, make a partial payment, or pay in advance or on account.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
D | 2300A | RMR03 | - | 482
 
Payment Effective Date
The effective date of the payment.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
H | | BPR16 | - | 373
 
Payment Format Code
Type of format chosen to send payment
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
H | | BPR05 | - | 812
 
Payment Method Code
Code identifying the method for the movement of payment instructions.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
H | | BPR04 | - | 591
 
Plan Coverage Description
A description or number that identifies the plan or coverage
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
D | 2200B | HD04 | - | 1204
 
Premium Delivery Date
The date the premium payment was delivered to the originating depository financial institution.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
H | | DTM02 | - | 373
 
Premium Payer Additional Name
Additional name for the premium payer.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
H | 1000B | N201 | - | 93
 
Premium Payer Address Line
Address line for the premium payer's address.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
H | 1000B | N301 | - | 166
H | 1000B | N302 | - | 166
 
Premium Payer City Name
The city name of the premium payer's address.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
H | 1000B | N401 | - | 19
 
Premium Payer Contact Name
Name identifying the contact person at the premium payer organization.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
H | 1000B | PER02 | - | 93
 
Premium Payer Country Code
The country code of the premium payer.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
H | 1000B | N404 | - | 26
 
Premium Payer Country Subdivision Code
The country subdivision code of the premium payer.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
H | 1000B | N407 | - | 1715
 
Premium Payer Identifier
Number identifying the organization remitting the payment.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
H | 1000B | N104 | - | 67
 
Premium Payer Name
Name identifying the organization remitting the payment.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
H | 1000B | N102 | - | 93
 
Premium Payer Postal Zone or ZIP Code
The postal zone code of the premium payer's address.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
H | 1000B | N403 | - | 116
 
Premium Payer State Code
State postal code of the premium payer's address.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
H | 1000B | N402 | - | 156
 
Premium Payment Adjustment Amount
An amount by which a premium payment is adjusted.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
D | 2200A | ADX01 | - | 782
D | 2100B | ADX01 | - | 782
 
Premium Payment Adjustment Reason
A code indicating the reason for a premium payment adjustment.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
D | 2200A | ADX02 | - | 426
D | 2100B | ADX02 | - | 426
 
Premium Receiver Reference Identifier
The key or reference number used by the premium receiver to designate to which plan, invoice, or account number the premium payment is to be applied.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
H | | REF02 | - | 127
 
Premium Receiver's Additional Name
Additional name for the premium receiver.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
H | 1000A | N201 | - | 93
 
Premium Receiver's Address Line
Address line for the premium receiver.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
H | 1000A | N301 | - | 166
H | 1000A | N302 | - | 166
 
Premium Receiver's City Name
The city name of the premium receiver's address.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
H | 1000A | N401 | - | 19
 
Premium Receiver's Communication Number
The communication number of the premium receiver.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
H | 1000A | RDM03 | - | 364
 
Premium Receiver's Country Code
The country code of the premium receiver.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
H | 1000A | N404 | - | 26
 
Premium Receiver's Country Subdivision Code
The country subdivision code of the premium receiver.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
H | 1000A | N407 | - | 1715
 
Premium Receiver's Identification Code
Code identifying the premium receiver.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
H | 1000A | N104 | - | 67
 
Premium Receiver's Last or Organization Name
Name identifying the organization receiving the payment.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
H | 1000A | N102 | - | 93
H | 1000A | RDM02 | - | 93
 
Premium Receiver's Postal Zone or Zip Code
The postal zone code of the premium receiver's address.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
H | 1000A | N403 | - | 116
 
Premium Receiver's State Code
State postal code of the premium receiver's address.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
H | 1000A | N402 | - | 156
 
Receiver Bank Account Number
The receiver's bank account number at the Receiving Depository Financial Institution.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
H | | BPR15 | - | 508
 
Receiving Depository Financial Institution (DFI) Identifier
Number identifying the financial institution receiving the transaction from an ACH network.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
H | | BPR13 | - | 507
 
Reference Identification
The identification value assigned by the sender for this particular transaction.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
D | 2200A | ADX04 | - | 127
D | 2100B | ADX04 | - | 127
 
Reference Identification Qualifier
Code qualifying the reference identification.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
H | | REF01 | - | 128
D | 2200A | ADX03 | - | 128
D | 2300A | RMR01 | - | 128
D | 2000B | REF01 | - | 128
D | 2000B | REF01 | - | 128
D | 2000B | REF01 | - | 128
D | 2100B | ADX03 | - | 128
D | 2200B | REF01 | - | 128
D | 2210B | RMR01 | - | 128
D | 2210B | REF01 | - | 128
D | 2300B | REF01 | - | 128
 
Remittance Delivery Method Code
Code qualifying the method the remittance will be delivered.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
H | 1000A | RDM01 | - | 756
 
Sender Bank Account Number
The sender's bank account number at the Originating Depository Financial Institution.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
H | | BPR09 | - | 508
 
Service, Promotion, Allowance, or Charge Code
Code identifying the service, promotion, allowance, or charge.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
D | 2312A | SAC02 | - | 1300
 
Status Information Effective Date
The date that the status information provided is effective.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
D | 2000B | DTP03 | - | 1251
 
Subscriber Identifier
Insured's or subscriber's unique identification number assigned by a payer.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
D | 2000B | REF02 | - | 127
 
Total Premium Payment Amount
The total premium payment for this batch or transaction.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
H | | BPR02 | - | 782
 
Trace Type Code
Code identifying the type of re-association which needs to be performed.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
H | | TRN01 | - | 481
 
Transaction Handling Code
This code designates whether and how the money and remittance information will be processed.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
H | | BPR01 | - | 305
 
Transaction Segment Count
A tally of all segments between the ST and the SE segments including the ST and SE segments.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
S | | SE01 | - | 96
 
Transaction Set Control Number
The unique identification number within a transaction set.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
H | | ST02 | - | 329
S | | SE02 | - | 329
 
Transaction Set Identifier Code
Code uniquely identifying a Transaction Set.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
H | | ST01 | - | 143
H | | ST01 | - | 143
 
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.
820 - Payroll Deducted and Other Group Premium Payment For Insurance Products
D | 2315A | SLN05 | C001-01 | 355