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 - Health Insurance Exchange Related Payments
H | | BPR14 | - | 569
 
Assigned Number
Number assigned for differentiation within a transaction set.
820 - Health Insurance Exchange Related Payments
D | 2000 | ENT01 | - | 554
 
Check Issue or EFT Effective Date
Date the check was issued or the electronic funds transfer (EFT) effective date.
820 - Health Insurance Exchange Related Payments
H | | BPR16 | - | 373
 
Check or EFT Trace Number
Check number or Electronic Funds Transfer (EFT) number that is unique within the sender/receiver relationship.
820 - Health Insurance Exchange Related Payments
H | | TRN02 | - | 127
 
Communication Number
Complete communications number including country or area code when applicable
820 - Health Insurance Exchange Related Payments
H | 1000B | PER04 | - | 364
H | 1000B | PER06 | - | 364
H | 1000B | PER08 | - | 364
 
Communication Number Qualifier
Code identifying the type of communication number.
820 - Health Insurance Exchange Related Payments
H | 1000B | PER03 | - | 365
H | 1000B | PER05 | - | 365
H | 1000B | PER07 | - | 365
 
Contact Function Code
Code identifying the major duty or responsibility of the person or group named.
820 - Health Insurance Exchange Related Payments
H | 1000B | PER01 | - | 366
 
Coverage Period
The coverage period associated with this premium payment.
820 - Health Insurance Exchange Related Payments
D | 2300 | DTM06 | - | 1251
 
Credit or Debit Flag Code
Code indicating whether amount is a credit or debit
820 - Health Insurance Exchange Related Payments
H | | BPR03 | - | 478
 
Date Time Period Format Qualifier
Code indicating the date format, time format, or date and time format.
820 - Health Insurance Exchange Related Payments
D | 2300 | DTM05 | - | 1250
 
Date Time Qualifier
Code specifying the type of date or time or both date and time.
820 - Health Insurance Exchange Related Payments
D | 2300 | DTM01 | - | 374
 
Depository Financial Institution (DFI) Identification Number Qualifier
Code identifying the type of identification number of Depository Financial Institution (DFI).
820 - Health Insurance Exchange Related Payments
H | | BPR12 | - | 506
 
Entity Identifier Code
Code identifying an organizational entity, a physical location, property or an individual.
820 - Health Insurance Exchange Related Payments
H | 1000A | N101 | - | 98
H | 1000B | N101 | - | 98
D | 2100 | NM101 | - | 98
 
Entity Type Qualifier
Code qualifying the type of entity.
820 - Health Insurance Exchange Related Payments
D | 2100 | NM102 | - | 1065
 
Exchange Assigned APTC Contributor/Tax Payer Identifier
Identification number assigned to the APTC Contributor/Tax Payer by the Exchange.
820 - Health Insurance Exchange Related Payments
D | 2100 | REF02 | - | 127
 
Exchange Assigned Dependent Identifier
Identification number assigned to the Individual/Dependent by the Exchange.
820 - Health Insurance Exchange Related Payments
D | 2100 | REF02 | - | 127
 
Exchange Assigned Employer Group Identifier
Identification number assigned to the Employer Group by the Exchange.
820 - Health Insurance Exchange Related Payments
H | | REF02 | - | 127
D | 2100 | REF02 | - | 127
 
Exchange Assigned Policy Identifier
Identification number assigned to the Policy by the Exchange.
820 - Health Insurance Exchange Related Payments
D | 2100 | REF02 | - | 127
 
Exchange Assigned Qualified Health Plan Identifier
Identification number assigned to the Health Plan by the Exchange.
820 - Health Insurance Exchange Related Payments
H | | REF02 | - | 127
D | 2100 | REF02 | - | 127
 
Exchange Assigned Subscriber Identifier
Identification number assigned to the Subscriber by the Exchange.
820 - Health Insurance Exchange Related Payments
D | 2100 | NM109 | - | 67
 
Exchange Payment Type
Code identifying the Exchange Payment Type.
820 - Health Insurance Exchange Related Payments
D | 2300 | RMR02 | - | 127
 
Exchange Report Document Control Number
Document Control Number assigned to the supplemental payment report.
820 - Health Insurance Exchange Related Payments
D | 2300 | REF03 | - | 352
 
Exchange-related Report Type
Code identifying the Exchange Report Type.
820 - Health Insurance Exchange Related Payments
D | 2300 | REF02 | - | 127
 
Identification Code Qualifier
Code designating the system/method of code structure used for Identification Code (67).
820 - Health Insurance Exchange Related Payments
H | 1000A | N103 | - | 66
H | 1000B | N103 | - | 66
D | 2100 | NM108 | - | 66
 
Implementation Convention Reference
Reference assigned to identify Implementation Convention.
820 - Health Insurance Exchange Related Payments
H | | ST03 | - | 1705
 
Individual First Name
The first name of an individual to whom specific remittance amounts apply.
820 - Health Insurance Exchange Related Payments
D | 2100 | NM104 | - | 1036
 
Individual Last Name
The last name of an individual to which specific remittance amount(s) apply.
820 - Health Insurance Exchange Related Payments
D | 2100 | NM103 | - | 1035
 
Individual Middle Name
Middle name of an individual to whom specific remittance amounts apply.
820 - Health Insurance Exchange Related Payments
D | 2100 | NM105 | - | 1037
 
Individual Name Prefix
Prefix to the name of an individual to whom specific remittance amounts apply.
820 - Health Insurance Exchange Related Payments
D | 2100 | NM106 | - | 1038
 
Individual Name Suffix
Suffix to the name of an individual to whom specific remittance amounts apply.
820 - Health Insurance Exchange Related Payments
D | 2100 | NM107 | - | 1039
 
Issuer Assigned APTC Contributor/Tax Payer Identifier
Identification number assigned to the APTC Contributor/Tax Payer by the Issuer.
820 - Health Insurance Exchange Related Payments
D | 2100 | REF02 | - | 127
 
Issuer Assigned Dependent Identifier
Identification number assigned to the Individual/Dependent by the issuer.
820 - Health Insurance Exchange Related Payments
D | 2100 | REF02 | - | 127
 
Issuer Assigned Employer Group Identifier
Identification number assigned to the Employer Group by the Issuer.
820 - Health Insurance Exchange Related Payments
H | | REF02 | - | 127
D | 2100 | REF02 | - | 127
 
Issuer Assigned Policy Identifier
Identification number assigned to the Policy by the Issuer.
820 - Health Insurance Exchange Related Payments
D | 2100 | REF02 | - | 127
 
Issuer Assigned Qualified Health Plan Identifier
Identification number assigned to the Qualified Health Plan by the Issuer.
820 - Health Insurance Exchange Related Payments
H | | REF02 | - | 127
D | 2100 | REF02 | - | 127
 
Issuer Assigned Subscriber Identifier
Identification number assigned to the Subscriber by the issuer.
820 - Health Insurance Exchange Related Payments
D | 2100 | REF02 | - | 127
 
Payee Organization Name
Name identifying the payee organization.
820 - Health Insurance Exchange Related Payments
H | 1000A | N102 | - | 93
 
Payee's Tax Identification Number
Tax identification number of the payee to whom payment should be made.
820 - Health Insurance Exchange Related Payments
H | 1000A | N104 | - | 67
 
Payer Identifier
Number identifying the payer organization.
820 - Health Insurance Exchange Related Payments
H | 1000B | N104 | - | 67
 
Payer Name
Name identifying the payer organization.
820 - Health Insurance Exchange Related Payments
H | 1000B | N102 | - | 93
 
Payment Amount
The amount paid.
820 - Health Insurance Exchange Related Payments
D | 2300 | RMR04 | - | 782
 
Payment Format Code
Type of format chosen to send payment
820 - Health Insurance Exchange Related Payments
H | | BPR05 | - | 812
 
Payment Method Code
Code identifying the method for the movement of payment instructions.
820 - Health Insurance Exchange Related Payments
H | | BPR04 | - | 591
 
Premium Payer Contact Name
Name identifying the contact person at the premium payer organization.
820 - Health Insurance Exchange Related Payments
H | 1000B | PER02 | - | 93
 
Receiver Bank Account Number
The receiver's bank account number at the Receiving Depository Financial Institution.
820 - Health Insurance Exchange Related Payments
H | | BPR15 | - | 508
 
Receiving Depository Financial Institution (DFI) Identifier
Number identifying the financial institution receiving the transaction from an ACH network.
820 - Health Insurance Exchange Related Payments
H | | BPR13 | - | 507
 
Reference Identification Qualifier
Code qualifying the reference identification.
820 - Health Insurance Exchange Related Payments
H | | REF01 | - | 128
H | | REF01 | - | 128
H | | REF01 | - | 128
H | | REF01 | - | 128
H | 1000A | REF01 | - | 128
D | 2100 | REF01 | - | 128
D | 2100 | REF01 | - | 128
D | 2100 | REF01 | - | 128
D | 2100 | REF01 | - | 128
D | 2100 | REF01 | - | 128
D | 2100 | REF01 | - | 128
D | 2100 | REF01 | - | 128
D | 2100 | REF01 | - | 128
D | 2100 | REF01 | - | 128
D | 2100 | REF01 | - | 128
D | 2100 | REF01 | - | 128
D | 2300 | RMR01 | - | 128
D | 2300 | REF01 | - | 128
 
Total Payment Amount
The Total Payment Amount.
820 - Health Insurance Exchange Related Payments
H | | BPR02 | - | 782
 
Trace Type Code
Code identifying the type of re-association which needs to be performed.
820 - Health Insurance Exchange Related Payments
H | | TRN01 | - | 481
 
Transaction Handling Code
This code designates whether and how the money and remittance information will be processed.
820 - Health Insurance Exchange Related Payments
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 - Health Insurance Exchange Related Payments
S | | SE01 | - | 96
 
Transaction Set Control Number
The unique identification number within a transaction set.
820 - Health Insurance Exchange Related Payments
H | | ST02 | - | 329
S | | SE02 | - | 329
 
Transaction Set Identifier Code
Code uniquely identifying a Transaction Set.
820 - Health Insurance Exchange Related Payments
H | | ST01 | - | 143
 
Unique Health Plan Identifier
Unique Health Plan Identifier assigned to the health plan.
820 - Health Insurance Exchange Related Payments
H | 1000A | REF02 | - | 127