stupidedi 1.1.0

This diff represents the content of publicly available package versions that have been released to one of the supported registries. The information contained in this diff is provided for informational purposes only and reflects changes between package versions as they appear in their respective public registries.
Files changed (500) hide show
  1. data/README.md +215 -0
  2. data/Rakefile +108 -0
  3. data/bin/edi-ed +71 -0
  4. data/bin/edi-pp +81 -0
  5. data/doc/Defining.md +0 -0
  6. data/doc/Generating.md +321 -0
  7. data/doc/LICENSE.md +0 -0
  8. data/doc/Navigating.md +645 -0
  9. data/doc/Parsing.md +0 -0
  10. data/doc/Serializing.md +7 -0
  11. data/doc/Tokenizing.md +0 -0
  12. data/doc/Validating.md +0 -0
  13. data/doc/design/Parser.md +0 -0
  14. data/doc/design/Reader.md +0 -0
  15. data/lib/ruby/array.rb +164 -0
  16. data/lib/ruby/blank.rb +67 -0
  17. data/lib/ruby/enumerable.rb +35 -0
  18. data/lib/ruby/exception.rb +33 -0
  19. data/lib/ruby/hash.rb +4 -0
  20. data/lib/ruby/instance_exec.rb +26 -0
  21. data/lib/ruby/module.rb +79 -0
  22. data/lib/ruby/object.rb +63 -0
  23. data/lib/ruby/string.rb +73 -0
  24. data/lib/ruby/symbol.rb +24 -0
  25. data/lib/ruby/to_d.rb +81 -0
  26. data/lib/ruby/to_date.rb +33 -0
  27. data/lib/ruby/to_time.rb +24 -0
  28. data/lib/ruby/try.rb +43 -0
  29. data/lib/stupidedi/blank_slate.rb +11 -0
  30. data/lib/stupidedi/builder/builder_dsl.rb +281 -0
  31. data/lib/stupidedi/builder/constraint_table.rb +418 -0
  32. data/lib/stupidedi/builder/generation.rb +112 -0
  33. data/lib/stupidedi/builder/instruction.rb +102 -0
  34. data/lib/stupidedi/builder/instruction_table.rb +204 -0
  35. data/lib/stupidedi/builder/navigation.rb +655 -0
  36. data/lib/stupidedi/builder/state_machine.rb +55 -0
  37. data/lib/stupidedi/builder/states/abstract_state.rb +332 -0
  38. data/lib/stupidedi/builder/states/failure_state.rb +69 -0
  39. data/lib/stupidedi/builder/states/functional_group_state.rb +97 -0
  40. data/lib/stupidedi/builder/states/initial_state.rb +63 -0
  41. data/lib/stupidedi/builder/states/interchange_state.rb +94 -0
  42. data/lib/stupidedi/builder/states/loop_state.rb +79 -0
  43. data/lib/stupidedi/builder/states/table_state.rb +96 -0
  44. data/lib/stupidedi/builder/states/transaction_set_state.rb +112 -0
  45. data/lib/stupidedi/builder/states/transmission_state.rb +59 -0
  46. data/lib/stupidedi/builder/tokenization.rb +196 -0
  47. data/lib/stupidedi/builder.rb +23 -0
  48. data/lib/stupidedi/color.rb +93 -0
  49. data/lib/stupidedi/config/code_list_config.rb +42 -0
  50. data/lib/stupidedi/config/editor_config.rb +51 -0
  51. data/lib/stupidedi/config/functional_group_config.rb +62 -0
  52. data/lib/stupidedi/config/interchange_config.rb +79 -0
  53. data/lib/stupidedi/config/transaction_set_config.rb +91 -0
  54. data/lib/stupidedi/config.rb +101 -0
  55. data/lib/stupidedi/editor/00501.rb +341 -0
  56. data/lib/stupidedi/editor/005010/N2.rb +0 -0
  57. data/lib/stupidedi/editor/005010/N3.rb +0 -0
  58. data/lib/stupidedi/editor/005010/N4.rb +63 -0
  59. data/lib/stupidedi/editor/005010/NM1.rb +0 -0
  60. data/lib/stupidedi/editor/005010.rb +469 -0
  61. data/lib/stupidedi/editor/X222-HC837.rb +195 -0
  62. data/lib/stupidedi/editor/abstract_ed.rb +36 -0
  63. data/lib/stupidedi/editor/claim_ack.rb +9 -0
  64. data/lib/stupidedi/editor/implementation_ack.rb +213 -0
  65. data/lib/stupidedi/editor/interchange_ack.rb +9 -0
  66. data/lib/stupidedi/editor/result.rb +100 -0
  67. data/lib/stupidedi/editor/result_set.rb +69 -0
  68. data/lib/stupidedi/editor/transaction_set_ed.rb +275 -0
  69. data/lib/stupidedi/editor/transmission_ed.rb +90 -0
  70. data/lib/stupidedi/editor.rb +37 -0
  71. data/lib/stupidedi/either.rb +287 -0
  72. data/lib/stupidedi/exceptions/invalid_element_error.rb +8 -0
  73. data/lib/stupidedi/exceptions/invalid_schema_error.rb +8 -0
  74. data/lib/stupidedi/exceptions/output_error.rb +8 -0
  75. data/lib/stupidedi/exceptions/parse_error.rb +8 -0
  76. data/lib/stupidedi/exceptions/stupidedi_error.rb +8 -0
  77. data/lib/stupidedi/exceptions/tokenize_error.rb +8 -0
  78. data/lib/stupidedi/exceptions/zipper_error.rb +8 -0
  79. data/lib/stupidedi/exceptions.rb +11 -0
  80. data/lib/stupidedi/guides/005010/X214-HN277.rb +409 -0
  81. data/lib/stupidedi/guides/005010/X221-HP835.rb +613 -0
  82. data/lib/stupidedi/guides/005010/X221A1-HP835.rb +613 -0
  83. data/lib/stupidedi/guides/005010/X222-HC837P.rb +2291 -0
  84. data/lib/stupidedi/guides/005010/X222A1-HC837P.rb +2297 -0
  85. data/lib/stupidedi/guides/005010/X231-FA999.rb +123 -0
  86. data/lib/stupidedi/guides/005010/X231A1-FA999.rb +119 -0
  87. data/lib/stupidedi/guides/005010/element_reqs.rb +38 -0
  88. data/lib/stupidedi/guides/005010/guide_builder.rb +180 -0
  89. data/lib/stupidedi/guides/005010/segment_reqs.rb +32 -0
  90. data/lib/stupidedi/guides/005010.rb +64 -0
  91. data/lib/stupidedi/guides.rb +5 -0
  92. data/lib/stupidedi/inspect.rb +26 -0
  93. data/lib/stupidedi/reader/input/abstract_input.rb +133 -0
  94. data/lib/stupidedi/reader/input/delegated_input.rb +111 -0
  95. data/lib/stupidedi/reader/input/file_input.rb +155 -0
  96. data/lib/stupidedi/reader/input.rb +30 -0
  97. data/lib/stupidedi/reader/position.rb +69 -0
  98. data/lib/stupidedi/reader/result.rb +168 -0
  99. data/lib/stupidedi/reader/segment_dict.rb +175 -0
  100. data/lib/stupidedi/reader/separators.rb +85 -0
  101. data/lib/stupidedi/reader/stream_reader.rb +172 -0
  102. data/lib/stupidedi/reader/token_reader.rb +466 -0
  103. data/lib/stupidedi/reader/tokens/component_element_tok.rb +56 -0
  104. data/lib/stupidedi/reader/tokens/composite_element_tok.rb +64 -0
  105. data/lib/stupidedi/reader/tokens/repeated_element_tok.rb +64 -0
  106. data/lib/stupidedi/reader/tokens/segment_tok.rb +51 -0
  107. data/lib/stupidedi/reader/tokens/simple_element_tok.rb +63 -0
  108. data/lib/stupidedi/reader.rb +121 -0
  109. data/lib/stupidedi/schema/abstract_def.rb +74 -0
  110. data/lib/stupidedi/schema/abstract_use.rb +73 -0
  111. data/lib/stupidedi/schema/code_list.rb +94 -0
  112. data/lib/stupidedi/schema/element_def.rb +173 -0
  113. data/lib/stupidedi/schema/element_req.rb +56 -0
  114. data/lib/stupidedi/schema/element_use.rb +251 -0
  115. data/lib/stupidedi/schema/functional_group_def.rb +114 -0
  116. data/lib/stupidedi/schema/interchange_def.rb +93 -0
  117. data/lib/stupidedi/schema/loop_def.rb +152 -0
  118. data/lib/stupidedi/schema/repeat_count.rb +85 -0
  119. data/lib/stupidedi/schema/segment_def.rb +108 -0
  120. data/lib/stupidedi/schema/segment_req.rb +43 -0
  121. data/lib/stupidedi/schema/segment_use.rb +98 -0
  122. data/lib/stupidedi/schema/syntax_note.rb +63 -0
  123. data/lib/stupidedi/schema/table_def.rb +139 -0
  124. data/lib/stupidedi/schema/transaction_set_def.rb +88 -0
  125. data/lib/stupidedi/schema.rb +28 -0
  126. data/lib/stupidedi/sets/absolute_set.rb +297 -0
  127. data/lib/stupidedi/sets/abstract_set.rb +174 -0
  128. data/lib/stupidedi/sets/null_set.rb +125 -0
  129. data/lib/stupidedi/sets/relative_complement.rb +137 -0
  130. data/lib/stupidedi/sets/relative_set.rb +269 -0
  131. data/lib/stupidedi/sets/universal_set.rb +104 -0
  132. data/lib/stupidedi/sets.rb +57 -0
  133. data/lib/stupidedi/tail_call.rb +109 -0
  134. data/lib/stupidedi/thread_local.rb +174 -0
  135. data/lib/stupidedi/values/abstract_element_val.rb +19 -0
  136. data/lib/stupidedi/values/abstract_val.rb +130 -0
  137. data/lib/stupidedi/values/composite_element_val.rb +95 -0
  138. data/lib/stupidedi/values/functional_group_val.rb +102 -0
  139. data/lib/stupidedi/values/interchange_val.rb +86 -0
  140. data/lib/stupidedi/values/invalid_envelope_val.rb +61 -0
  141. data/lib/stupidedi/values/invalid_segment_val.rb +78 -0
  142. data/lib/stupidedi/values/loop_val.rb +70 -0
  143. data/lib/stupidedi/values/repeated_element_val.rb +105 -0
  144. data/lib/stupidedi/values/segment_val.rb +104 -0
  145. data/lib/stupidedi/values/segment_val_group.rb +20 -0
  146. data/lib/stupidedi/values/simple_element_val.rb +80 -0
  147. data/lib/stupidedi/values/table_val.rb +66 -0
  148. data/lib/stupidedi/values/transaction_set_val.rb +66 -0
  149. data/lib/stupidedi/values/transmission_val.rb +52 -0
  150. data/lib/stupidedi/values.rb +21 -0
  151. data/lib/stupidedi/version.rb +3 -0
  152. data/lib/stupidedi/versions/functional_groups/004010/element_defs.rb +54 -0
  153. data/lib/stupidedi/versions/functional_groups/004010/element_reqs.rb +18 -0
  154. data/lib/stupidedi/versions/functional_groups/004010/element_types/date_val.rb +527 -0
  155. data/lib/stupidedi/versions/functional_groups/004010/element_types/fixnum_val.rb +335 -0
  156. data/lib/stupidedi/versions/functional_groups/004010/element_types/float_val.rb +299 -0
  157. data/lib/stupidedi/versions/functional_groups/004010/element_types/identifier_val.rb +287 -0
  158. data/lib/stupidedi/versions/functional_groups/004010/element_types/string_val.rb +338 -0
  159. data/lib/stupidedi/versions/functional_groups/004010/element_types/time_val.rb +309 -0
  160. data/lib/stupidedi/versions/functional_groups/004010/element_types.rb +124 -0
  161. data/lib/stupidedi/versions/functional_groups/004010/functional_group_def.rb +30 -0
  162. data/lib/stupidedi/versions/functional_groups/004010/segment_defs/GE.rb +20 -0
  163. data/lib/stupidedi/versions/functional_groups/004010/segment_defs/GS.rb +27 -0
  164. data/lib/stupidedi/versions/functional_groups/004010/segment_defs/SE.rb +20 -0
  165. data/lib/stupidedi/versions/functional_groups/004010/segment_defs/ST.rb +20 -0
  166. data/lib/stupidedi/versions/functional_groups/004010/segment_defs.rb +23 -0
  167. data/lib/stupidedi/versions/functional_groups/004010/segment_reqs.rb +18 -0
  168. data/lib/stupidedi/versions/functional_groups/004010/syntax_notes.rb +174 -0
  169. data/lib/stupidedi/versions/functional_groups/004010.rb +38 -0
  170. data/lib/stupidedi/versions/functional_groups/005010/element_defs.rb +1405 -0
  171. data/lib/stupidedi/versions/functional_groups/005010/element_reqs.rb +18 -0
  172. data/lib/stupidedi/versions/functional_groups/005010/element_types/date_val.rb +577 -0
  173. data/lib/stupidedi/versions/functional_groups/005010/element_types/fixnum_val.rb +322 -0
  174. data/lib/stupidedi/versions/functional_groups/005010/element_types/float_val.rb +354 -0
  175. data/lib/stupidedi/versions/functional_groups/005010/element_types/identifier_val.rb +368 -0
  176. data/lib/stupidedi/versions/functional_groups/005010/element_types/operators.rb +117 -0
  177. data/lib/stupidedi/versions/functional_groups/005010/element_types/string_val.rb +398 -0
  178. data/lib/stupidedi/versions/functional_groups/005010/element_types/time_val.rb +327 -0
  179. data/lib/stupidedi/versions/functional_groups/005010/element_types.rb +132 -0
  180. data/lib/stupidedi/versions/functional_groups/005010/functional_group_def.rb +30 -0
  181. data/lib/stupidedi/versions/functional_groups/005010/segment_defs/AK1.rb +21 -0
  182. data/lib/stupidedi/versions/functional_groups/005010/segment_defs/AK2.rb +21 -0
  183. data/lib/stupidedi/versions/functional_groups/005010/segment_defs/AK9.rb +28 -0
  184. data/lib/stupidedi/versions/functional_groups/005010/segment_defs/AMT.rb +21 -0
  185. data/lib/stupidedi/versions/functional_groups/005010/segment_defs/BHT.rb +24 -0
  186. data/lib/stupidedi/versions/functional_groups/005010/segment_defs/BPR.rb +49 -0
  187. data/lib/stupidedi/versions/functional_groups/005010/segment_defs/CAS.rb +56 -0
  188. data/lib/stupidedi/versions/functional_groups/005010/segment_defs/CL1.rb +22 -0
  189. data/lib/stupidedi/versions/functional_groups/005010/segment_defs/CLM.rb +41 -0
  190. data/lib/stupidedi/versions/functional_groups/005010/segment_defs/CLP.rb +34 -0
  191. data/lib/stupidedi/versions/functional_groups/005010/segment_defs/CN1.rb +24 -0
  192. data/lib/stupidedi/versions/functional_groups/005010/segment_defs/CR1.rb +32 -0
  193. data/lib/stupidedi/versions/functional_groups/005010/segment_defs/CR2.rb +35 -0
  194. data/lib/stupidedi/versions/functional_groups/005010/segment_defs/CR3.rb +25 -0
  195. data/lib/stupidedi/versions/functional_groups/005010/segment_defs/CRC.rb +26 -0
  196. data/lib/stupidedi/versions/functional_groups/005010/segment_defs/CTP.rb +36 -0
  197. data/lib/stupidedi/versions/functional_groups/005010/segment_defs/CTX.rb +24 -0
  198. data/lib/stupidedi/versions/functional_groups/005010/segment_defs/CUR.rb +57 -0
  199. data/lib/stupidedi/versions/functional_groups/005010/segment_defs/DMG.rb +34 -0
  200. data/lib/stupidedi/versions/functional_groups/005010/segment_defs/DN1.rb +22 -0
  201. data/lib/stupidedi/versions/functional_groups/005010/segment_defs/DN2.rb +24 -0
  202. data/lib/stupidedi/versions/functional_groups/005010/segment_defs/DTM.rb +24 -0
  203. data/lib/stupidedi/versions/functional_groups/005010/segment_defs/DTP.rb +21 -0
  204. data/lib/stupidedi/versions/functional_groups/005010/segment_defs/FRM.rb +25 -0
  205. data/lib/stupidedi/versions/functional_groups/005010/segment_defs/GE.rb +20 -0
  206. data/lib/stupidedi/versions/functional_groups/005010/segment_defs/GS.rb +27 -0
  207. data/lib/stupidedi/versions/functional_groups/005010/segment_defs/HCP.rb +39 -0
  208. data/lib/stupidedi/versions/functional_groups/005010/segment_defs/HI.rb +31 -0
  209. data/lib/stupidedi/versions/functional_groups/005010/segment_defs/HL.rb +22 -0
  210. data/lib/stupidedi/versions/functional_groups/005010/segment_defs/IK3.rb +22 -0
  211. data/lib/stupidedi/versions/functional_groups/005010/segment_defs/IK4.rb +22 -0
  212. data/lib/stupidedi/versions/functional_groups/005010/segment_defs/IK5.rb +24 -0
  213. data/lib/stupidedi/versions/functional_groups/005010/segment_defs/K3.rb +21 -0
  214. data/lib/stupidedi/versions/functional_groups/005010/segment_defs/LIN.rb +69 -0
  215. data/lib/stupidedi/versions/functional_groups/005010/segment_defs/LQ.rb +22 -0
  216. data/lib/stupidedi/versions/functional_groups/005010/segment_defs/LX.rb +19 -0
  217. data/lib/stupidedi/versions/functional_groups/005010/segment_defs/MEA.rb +39 -0
  218. data/lib/stupidedi/versions/functional_groups/005010/segment_defs/MIA.rb +45 -0
  219. data/lib/stupidedi/versions/functional_groups/005010/segment_defs/MOA.rb +28 -0
  220. data/lib/stupidedi/versions/functional_groups/005010/segment_defs/N1.rb +24 -0
  221. data/lib/stupidedi/versions/functional_groups/005010/segment_defs/N2.rb +20 -0
  222. data/lib/stupidedi/versions/functional_groups/005010/segment_defs/N3.rb +20 -0
  223. data/lib/stupidedi/versions/functional_groups/005010/segment_defs/N4.rb +30 -0
  224. data/lib/stupidedi/versions/functional_groups/005010/segment_defs/NM1.rb +35 -0
  225. data/lib/stupidedi/versions/functional_groups/005010/segment_defs/NTE.rb +20 -0
  226. data/lib/stupidedi/versions/functional_groups/005010/segment_defs/OI.rb +24 -0
  227. data/lib/stupidedi/versions/functional_groups/005010/segment_defs/PAT.rb +31 -0
  228. data/lib/stupidedi/versions/functional_groups/005010/segment_defs/PER.rb +32 -0
  229. data/lib/stupidedi/versions/functional_groups/005010/segment_defs/PLB.rb +40 -0
  230. data/lib/stupidedi/versions/functional_groups/005010/segment_defs/PRV.rb +26 -0
  231. data/lib/stupidedi/versions/functional_groups/005010/segment_defs/PS1.rb +21 -0
  232. data/lib/stupidedi/versions/functional_groups/005010/segment_defs/PWK.rb +30 -0
  233. data/lib/stupidedi/versions/functional_groups/005010/segment_defs/QTY.rb +25 -0
  234. data/lib/stupidedi/versions/functional_groups/005010/segment_defs/RDM.rb +23 -0
  235. data/lib/stupidedi/versions/functional_groups/005010/segment_defs/REF.rb +23 -0
  236. data/lib/stupidedi/versions/functional_groups/005010/segment_defs/SBR.rb +28 -0
  237. data/lib/stupidedi/versions/functional_groups/005010/segment_defs/SE.rb +20 -0
  238. data/lib/stupidedi/versions/functional_groups/005010/segment_defs/ST.rb +21 -0
  239. data/lib/stupidedi/versions/functional_groups/005010/segment_defs/STC.rb +30 -0
  240. data/lib/stupidedi/versions/functional_groups/005010/segment_defs/SV1.rb +44 -0
  241. data/lib/stupidedi/versions/functional_groups/005010/segment_defs/SV2.rb +29 -0
  242. data/lib/stupidedi/versions/functional_groups/005010/segment_defs/SV3.rb +30 -0
  243. data/lib/stupidedi/versions/functional_groups/005010/segment_defs/SV5.rb +29 -0
  244. data/lib/stupidedi/versions/functional_groups/005010/segment_defs/SVC.rb +26 -0
  245. data/lib/stupidedi/versions/functional_groups/005010/segment_defs/SVD.rb +24 -0
  246. data/lib/stupidedi/versions/functional_groups/005010/segment_defs/TOO.rb +21 -0
  247. data/lib/stupidedi/versions/functional_groups/005010/segment_defs/TRN.rb +22 -0
  248. data/lib/stupidedi/versions/functional_groups/005010/segment_defs/TS2.rb +40 -0
  249. data/lib/stupidedi/versions/functional_groups/005010/segment_defs/TS3.rb +45 -0
  250. data/lib/stupidedi/versions/functional_groups/005010/segment_defs.rb +227 -0
  251. data/lib/stupidedi/versions/functional_groups/005010/segment_reqs.rb +18 -0
  252. data/lib/stupidedi/versions/functional_groups/005010/syntax_notes.rb +165 -0
  253. data/lib/stupidedi/versions/functional_groups/005010/transaction_set_defs/FA999.rb +38 -0
  254. data/lib/stupidedi/versions/functional_groups/005010/transaction_set_defs/HB271.rb +85 -0
  255. data/lib/stupidedi/versions/functional_groups/005010/transaction_set_defs/HC837.rb +163 -0
  256. data/lib/stupidedi/versions/functional_groups/005010/transaction_set_defs/HI278.rb +64 -0
  257. data/lib/stupidedi/versions/functional_groups/005010/transaction_set_defs/HN277.rb +74 -0
  258. data/lib/stupidedi/versions/functional_groups/005010/transaction_set_defs/HP835.rb +68 -0
  259. data/lib/stupidedi/versions/functional_groups/005010/transaction_set_defs/HR276.rb +57 -0
  260. data/lib/stupidedi/versions/functional_groups/005010/transaction_set_defs/HS270.rb +53 -0
  261. data/lib/stupidedi/versions/functional_groups/005010/transaction_set_defs/RA820.rb +240 -0
  262. data/lib/stupidedi/versions/functional_groups/005010/transaction_set_defs.rb +68 -0
  263. data/lib/stupidedi/versions/functional_groups/005010.rb +38 -0
  264. data/lib/stupidedi/versions/functional_groups.rb +8 -0
  265. data/lib/stupidedi/versions/interchanges/00401/element_defs.rb +224 -0
  266. data/lib/stupidedi/versions/interchanges/00401/interchange_def.rb +45 -0
  267. data/lib/stupidedi/versions/interchanges/00401/segment_defs/IEA.rb +20 -0
  268. data/lib/stupidedi/versions/interchanges/00401/segment_defs/ISA.rb +34 -0
  269. data/lib/stupidedi/versions/interchanges/00401/segment_defs/TA1.rb +23 -0
  270. data/lib/stupidedi/versions/interchanges/00401/segment_defs.rb +28 -0
  271. data/lib/stupidedi/versions/interchanges/00401.rb +23 -0
  272. data/lib/stupidedi/versions/interchanges/00501/element_defs.rb +269 -0
  273. data/lib/stupidedi/versions/interchanges/00501/interchange_def.rb +47 -0
  274. data/lib/stupidedi/versions/interchanges/00501/segment_defs/IEA.rb +20 -0
  275. data/lib/stupidedi/versions/interchanges/00501/segment_defs/ISA.rb +34 -0
  276. data/lib/stupidedi/versions/interchanges/00501/segment_defs/ISB.rb +18 -0
  277. data/lib/stupidedi/versions/interchanges/00501/segment_defs/ISE.rb +18 -0
  278. data/lib/stupidedi/versions/interchanges/00501/segment_defs/TA1.rb +23 -0
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data/lib/stupidedi/guides/005010/X222A1-HC837P.rb ADDED
@@ -0,0 +1,2297 @@
1
+ module Stupidedi
2
+ module Guides
3
+ module FiftyTen
4
+ module X222A1
5
+
6
+ b = GuideBuilder
7
+ d = Schema
8
+ r = SegmentReqs
9
+ e = ElementReqs
10
+ s = Versions::FunctionalGroups::FiftyTen::SegmentDefs
11
+ t = Versions::FunctionalGroups::FiftyTen::TransactionSetDefs
12
+
13
+ # With only a quick glance at X222, it appears that 2300 is a child of
14
+ # the 2000C HL loop. But there is a nasty little note that reads:
15
+ #
16
+ # For the purposes of this documentation, the claim detail information
17
+ # is presented only in the dependent level. Specific claim detail
18
+ # information can be given in either the subscriber or the dependent
19
+ # hierarchical level. Because of this, the claim information is said
20
+ # to "float." Claim information is positioned in the same hierarchical
21
+ # level that describes its owner-participant, either the subscriber or
22
+ # the dependent. In other words, the claim information, Loop 2300, is
23
+ # placed in the hierarchical level when the patient is the subscriber,
24
+ # or it is placed at the patient/dependent hierarchical level when the
25
+ # patient is the dependent of the subscriber as shown here. When the
26
+ # patient is the subscriber, loops 2000C and 2010CA are not sent. See
27
+ # 1.4.3.2.2.1, HL Segment, for details.
28
+ #
29
+ # So here we build the 2300 LoopDef and later copy it as a child of the
30
+ # 2000B and 2000C loops. The actual transaction set begins below with
31
+ # the line that starts HC837 = ...
32
+
33
+ loop2300 =
34
+ d::LoopDef.build("2300 CLAIM INFORMATION",
35
+ d::RepeatCount.bounded(100),
36
+ b::Segment(1300, s::CLM, "Claim Information",
37
+ # The spec is Required, but that doesn't seem right. This loop
38
+ # is not required to occur in both the Subscriber and Patient
39
+ # tables, it must appear in only one of them.
40
+ r::Situational, d::RepeatCount.bounded(1),
41
+ b::Element(e::Required, "Patient Control Number", b::MaxLength(20)),
42
+ b::Element(e::Required, "Total Claim Charge Amount"),
43
+ b::Element(e::NotUsed, "Claim Filing Indicator Code"),
44
+ b::Element(e::NotUsed, "Non-Institutional Claim Type Code"),
45
+ b::Element(e::Required, "HEALTH CARE SERVICE LOCATION INFORMATION",
46
+ b::Element(e::Required, "Place of Service Code"),
47
+ b::Element(e::Required, "Facility Code Qualifier", b::Values("B")),
48
+ b::Element(e::Required, "Claim Frequency Code")),
49
+ b::Element(e::Required, "Provider or Supplier Signature Indicator", b::Values("N", "Y")),
50
+ b::Element(e::Required, "Assignment or Plan Participation Code", b::Values("A", "B", "C")),
51
+ b::Element(e::Required, "Benefits Assignment Certification Indicator", b::Values("N", "W", "Y")),
52
+ b::Element(e::Required, "Release of Information Code", b::Values("I", "Y")),
53
+ b::Element(e::Situational, "Patient Signature Source Code", b::Values("P")),
54
+ b::Element(e::Situational, "RELATED CAUSES INFORMATION",
55
+ b::Element(e::Required, "Related Causes Code", b::Values("AA", "EM", "OA")),
56
+ b::Element(e::Situational, "Related Causes Code", b::Values("AA", "EM", "OA")),
57
+ b::Element(e::NotUsed, "Related Causes Code"),
58
+ b::Element(e::Situational, "Auto Accident State or Province Code"),
59
+ b::Element(e::Situational, "Country Code")),
60
+ b::Element(e::Situational, "Special Program Indicator", b::Values("02", "03", "05", "09")),
61
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code"),
62
+ b::Element(e::NotUsed, "Level of Service Code"),
63
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code"),
64
+ b::Element(e::NotUsed, "Provider Agreement Code"),
65
+ b::Element(e::NotUsed, "Claim Status Code"),
66
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code"),
67
+ b::Element(e::NotUsed, "Claim Submission Reason Code"),
68
+ b::Element(e::Situational, "Delay Reason Code", b::Values("1", "2", "3", "4", "5", "6", "7", "8", "9", "10", "11", "15"))),
69
+ b::Segment(1350, s::DTP, "Onset of Current Illness or Symptom",
70
+ r::Situational, d::RepeatCount.bounded(1),
71
+ b::Element(e::Required, "Date Time Qualifier", b::Values("431")),
72
+ b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
73
+ b::Element(e::Required, "Onset of Current Illness or Injury Date")),
74
+ b::Segment(1350, s::DTP, "Initial Treatment Date",
75
+ r::Situational, d::RepeatCount.bounded(1),
76
+ b::Element(e::Required, "Date Time Qualifier", b::Values("454")),
77
+ b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
78
+ b::Element(e::Required, "Initial Treatment Date")),
79
+ b::Segment(1350, s::DTP, "Last Seen Date",
80
+ r::Situational, d::RepeatCount.bounded(1),
81
+ b::Element(e::Required, "Date Time Qualifier", b::Values("304")),
82
+ b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
83
+ b::Element(e::Required, "Last Seen Date")),
84
+ b::Segment(1350, s::DTP, "Acute Manifestation Date",
85
+ r::Situational, d::RepeatCount.bounded(1),
86
+ b::Element(e::Required, "Date Time Qualifier", b::Values("453")),
87
+ b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
88
+ b::Element(e::Required, "Acute Manifestation Date")),
89
+ b::Segment(1350, s::DTP, "Accident Date",
90
+ r::Situational, d::RepeatCount.bounded(1),
91
+ b::Element(e::Required, "Date Time Qualifier", b::Values("439")),
92
+ b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
93
+ b::Element(e::Required, "Accident Date")),
94
+ b::Segment(1350, s::DTP, "Last Menstrual Period Date",
95
+ r::Situational, d::RepeatCount.bounded(1),
96
+ b::Element(e::Required, "Date Time Qualifier", b::Values("484")),
97
+ b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
98
+ b::Element(e::Required, "Last Menstrual Period Date")),
99
+ b::Segment(1350, s::DTP, "Last X-ray Date",
100
+ r::Situational, d::RepeatCount.bounded(1),
101
+ b::Element(e::Required, "Date Time Qualifier", b::Values("455")),
102
+ b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
103
+ b::Element(e::Required, "Last X-ray Date")),
104
+ b::Segment(1350, s::DTP, "Hearing and Vision Prescription Date",
105
+ r::Situational, d::RepeatCount.bounded(1),
106
+ b::Element(e::Required, "Date Time Qualifier", b::Values("471")),
107
+ b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
108
+ b::Element(e::Required, "Prescription Date")),
109
+ b::Segment(1350, s::DTP, "Disability Dates",
110
+ r::Situational, d::RepeatCount.bounded(1),
111
+ b::Element(e::Required, "Date Time Qualifier", b::Values("314", "360", "361")),
112
+ b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8", "RD8")),
113
+ b::Element(e::Required, "Disability From Date")),
114
+ b::Segment(1350, s::DTP, "Last Worked Date",
115
+ r::Situational, d::RepeatCount.bounded(1),
116
+ b::Element(e::Required, "Date Time Qualifier", b::Values("297")),
117
+ b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
118
+ b::Element(e::Required, "Last Worked Date")),
119
+ b::Segment(1350, s::DTP, "Authorized Return to Work Date",
120
+ r::Situational, d::RepeatCount.bounded(1),
121
+ b::Element(e::Required, "Date Time Qualifier", b::Values("296")),
122
+ b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
123
+ b::Element(e::Required, "Work Return Date")),
124
+ b::Segment(1350, s::DTP, "Admission Date",
125
+ r::Situational, d::RepeatCount.bounded(1),
126
+ b::Element(e::Required, "Date Time Qualifier", b::Values("435")),
127
+ b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
128
+ b::Element(e::Required, "Related Hospitalization Admission Date")),
129
+ b::Segment(1350, s::DTP, "Discharge Date",
130
+ r::Situational, d::RepeatCount.bounded(1),
131
+ b::Element(e::Required, "Date Time Qualifier", b::Values("096")),
132
+ b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
133
+ b::Element(e::Required, "Related Hospitalization Discharge Date")),
134
+ b::Segment(1350, s::DTP, "Assumed and Relinquished Care Dates",
135
+ r::Situational, d::RepeatCount.bounded(2),
136
+ b::Element(e::Required, "Date Time Qualifier", b::Values("090", "091")),
137
+ b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
138
+ b::Element(e::Required, "Asumed or Relinquished Care Date")),
139
+ b::Segment(1350, s::DTP, "Property and Casualty Date of First Contact",
140
+ r::Situational, d::RepeatCount.bounded(1),
141
+ b::Element(e::Required, "Date Time Qualifier", b::Values("444")),
142
+ b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
143
+ b::Element(e::Required, "Date")),
144
+ b::Segment(1350, s::DTP, "Repricer Received Date",
145
+ r::Situational, d::RepeatCount.bounded(1),
146
+ b::Element(e::Required, "Date Time Qualifier", b::Values("050")),
147
+ b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
148
+ b::Element(e::Required, "Repricer Received Date")),
149
+ b::Segment(1550, s::PWK, "Claim Supplemental Information",
150
+ r::Situational, d::RepeatCount.bounded(10),
151
+ b::Element(e::Required, "Report Type Code", b::Values("03", "04", "05", "06", "07", "08", "09", "10", "11", "13", "15", "21", "A3", "A4", "AM", "AS", "B2", "B3", "B4", "BR", "BS", "BT", "CB", "CK", "CT", "D2", "DA", "DB", "DG", "DJ", "DS", "EB", "HC", "HR", "I5", "IR", "LA", "M1", "MT", "NN", "OB", "OC", "OD", "OE", "OX", "OZ", "P4", "P5", "PE", "PN", "PO", "PQ", "PY", "PZ", "RB", "RR", "RT", "RX", "SG", "V5", "XP")),
152
+ b::Element(e::Required, "Attachment Transmission Code", b::Values("AA", "BM", "EL", "EM", "FT", "FX")),
153
+ b::Element(e::NotUsed, "Report Copies Needed"),
154
+ b::Element(e::NotUsed, "Entity Identifier Code"),
155
+ b::Element(e::Situational, "Identification Code Qualifier", b::Values("AC")),
156
+ b::Element(e::Situational, "Attachment Control Number", b::MaxLength(50)),
157
+ b::Element(e::NotUsed, "Description"),
158
+ b::Element(e::NotUsed, "ACTIONS INDICATED"),
159
+ b::Element(e::NotUsed, "Request Category Code")),
160
+ b::Segment(1600, s::CN1, "Contract Information",
161
+ r::Situational, d::RepeatCount.bounded(1),
162
+ b::Element(e::Required, "Contract Type Code", b::Values("01", "02", "03", "04", "05", "06", "09")),
163
+ b::Element(e::Situational, "Contract Amount"),
164
+ b::Element(e::Situational, "Contract Percentage"),
165
+ b::Element(e::Situational, "Contract Code"),
166
+ b::Element(e::Situational, "Terms Discount Percentage"),
167
+ b::Element(e::Situational, "Contract Version Number")),
168
+ b::Segment(1750, s::AMT, "Patient Amount Paid",
169
+ r::Situational, d::RepeatCount.bounded(1),
170
+ b::Element(e::Required, "Amount Qualifier Code", b::Values("F5")),
171
+ b::Element(e::Required, "Patient Amount Paid"),
172
+ b::Element(e::NotUsed, "Credit/Debit Flag Code")),
173
+ b::Segment(1800, s::REF, "Service Authorization Exception Code",
174
+ r::Situational, d::RepeatCount.bounded(1),
175
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("4N")),
176
+ b::Element(e::Required, "Service Authorization Exception Code", b::Values("1", "2", "3", "4", "5", "6", "7")),
177
+ b::Element(e::NotUsed, "Description"),
178
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
179
+ b::Segment(1800, s::REF, "Mandatory Medicare (Section 4081) Crossover Indicator",
180
+ r::Situational, d::RepeatCount.bounded(1),
181
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("F5")),
182
+ b::Element(e::Required, "Medicare Section 4081 Indicator", b::Values("Y", "N")),
183
+ b::Element(e::NotUsed, "Description"),
184
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
185
+ b::Segment(1800, s::REF, "Mammography Certification Number",
186
+ r::Situational, d::RepeatCount.bounded(1),
187
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("EW")),
188
+ b::Element(e::Required, "Mammography Certification Number"),
189
+ b::Element(e::NotUsed, "Description"),
190
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
191
+ b::Segment(1800, s::REF, "Referral Number",
192
+ r::Situational, d::RepeatCount.bounded(1),
193
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("9F")),
194
+ b::Element(e::Required, "Referral Number"),
195
+ b::Element(e::NotUsed, "Description"),
196
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
197
+ b::Segment(1800, s::REF, "Prior Authorization",
198
+ r::Situational, d::RepeatCount.bounded(1),
199
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("G1")),
200
+ b::Element(e::Required, "Prior Authorization Number"),
201
+ b::Element(e::NotUsed, "Description"),
202
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
203
+ b::Segment(1800, s::REF, "Payer Claim Control Number",
204
+ r::Situational, d::RepeatCount.bounded(1),
205
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("F8")),
206
+ b::Element(e::Required, "Payer Claim Control Number"),
207
+ b::Element(e::NotUsed, "Description"),
208
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
209
+ b::Segment(1800, s::REF, "Clinical Laboratory Improvement Amendment (CLIA) Number",
210
+ r::Situational, d::RepeatCount.bounded(1),
211
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("X4")),
212
+ b::Element(e::Required, "Clinical Laboratory Improvement Amendment Number"),
213
+ b::Element(e::NotUsed, "Description"),
214
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
215
+ b::Segment(1800, s::REF, "Repriced Claim Number",
216
+ r::Situational, d::RepeatCount.bounded(1),
217
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("9A")),
218
+ b::Element(e::Required, "Repriced Claim Reference Number"),
219
+ b::Element(e::NotUsed, "Description"),
220
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
221
+ b::Segment(1800, s::REF, "Adjusted Repriced Claim Number",
222
+ r::Situational, d::RepeatCount.bounded(1),
223
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("9C")),
224
+ b::Element(e::Required, "Adjusted Repriced Claim Reference Number"),
225
+ b::Element(e::NotUsed, "Description"),
226
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
227
+ b::Segment(1800, s::REF, "Investigational Device Exemption Number",
228
+ r::Situational, d::RepeatCount.bounded(1),
229
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("LX")),
230
+ b::Element(e::Required, "Investigational Device Exemption Identifier"),
231
+ b::Element(e::NotUsed, "Description"),
232
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
233
+ b::Segment(1800, s::REF, "Claim Identifier for Transmission Intermediaries",
234
+ r::Situational, d::RepeatCount.bounded(1),
235
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("D9")),
236
+ b::Element(e::Required, "Value Added Network Trace Number", b::MaxLength(20)),
237
+ b::Element(e::NotUsed, "Description"),
238
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
239
+ b::Segment(1800, s::REF, "Medical Record Number",
240
+ r::Situational, d::RepeatCount.bounded(1),
241
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("EA")),
242
+ b::Element(e::Required, "Medical Record Number"),
243
+ b::Element(e::NotUsed, "Description"),
244
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
245
+ b::Segment(1800, s::REF, "Demonstration Project Identifier",
246
+ r::Situational, d::RepeatCount.bounded(1),
247
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("P4")),
248
+ b::Element(e::Required, "Demonstration Project Number"),
249
+ b::Element(e::NotUsed, "Description"),
250
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
251
+ b::Segment(1800, s::REF, "Care Plan Oversight",
252
+ r::Situational, d::RepeatCount.bounded(1),
253
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("1J")),
254
+ b::Element(e::Required, "Care Plan Oversight Number"),
255
+ b::Element(e::NotUsed, "Description"),
256
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
257
+ b::Segment(1850, s::K3, "File Information",
258
+ r::Situational, d::RepeatCount.bounded(10),
259
+ b::Element(e::Required, "Fixed Format Information"),
260
+ b::Element(e::NotUsed, "Record Format Code"),
261
+ b::Element(e::NotUsed, "COMPOSITE UNIT OF MEASURE")),
262
+ b::Segment(1900, s::NTE, "Claim Note",
263
+ r::Situational, d::RepeatCount.bounded(1),
264
+ b::Element(e::Required, "Note Reference Code", b::Values("ADD", "CER", "DCP", "DGN", "TPO")),
265
+ b::Element(e::Required, "Claim Note Text")),
266
+ b::Segment(1950, s::CR1, "Ambulance Transportation Information",
267
+ r::Situational, d::RepeatCount.bounded(1),
268
+ b::Element(e::Situational, "Unit or Basis of Measure", b::Values("LB")),
269
+ b::Element(e::Situational, "Patient Weight"),
270
+ b::Element(e::NotUsed, "Ambulance Transport Code"),
271
+ b::Element(e::Required, "Ambulance Transport Reason Code", b::Values("A", "B", "C", "D", "E")),
272
+ b::Element(e::Required, "Unit or Basis for Measurement Code", b::Values("DH")),
273
+ b::Element(e::Required, "Transport Distance"),
274
+ b::Element(e::NotUsed, "Address Information"),
275
+ b::Element(e::NotUsed, "Address Information"),
276
+ b::Element(e::Situational, "Round Trip Purpose Description"),
277
+ b::Element(e::Situational, "Stretcher Purpose Description")),
278
+ b::Segment(2000, s::CR2, "Spinal Manipulation Service Information",
279
+ r::Situational, d::RepeatCount.bounded(1),
280
+ b::Element(e::NotUsed, "Count"),
281
+ b::Element(e::NotUsed, "Quantity"),
282
+ b::Element(e::NotUsed, "Sublaxation Level Code"),
283
+ b::Element(e::NotUsed, "Sublaxation Level Code"),
284
+ b::Element(e::NotUsed, "Unit or Basis for Measurement Code"),
285
+ b::Element(e::NotUsed, "Quantity"),
286
+ b::Element(e::NotUsed, "Quantity"),
287
+ b::Element(e::Required, "Nature of Condition Code", b::Values("A", "C", "D", "E", "F", "G", "M")),
288
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code"),
289
+ b::Element(e::Situational, "Patient Condition Description"),
290
+ b::Element(e::Situational, "Patient Condition Description"),
291
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
292
+ b::Segment(2200, s::CRC, "Ambulance Certification",
293
+ r::Situational, d::RepeatCount.bounded(3),
294
+ b::Element(e::Required, "Code Category", b::Values("07")),
295
+ b::Element(e::Required, "Certification Condition Indicator", b::Values("Y", "N")),
296
+ b::Element(e::Required, "Condition Code", b::Values("01", "04", "05", "06", "07", "08", "09", "12")),
297
+ b::Element(e::Situational, "Condition Code", b::Values("01", "04", "05", "06", "07", "08", "09", "12")),
298
+ b::Element(e::Situational, "Condition Code", b::Values("01", "04", "05", "06", "07", "08", "09", "12")),
299
+ b::Element(e::Situational, "Condition Code", b::Values("01", "04", "05", "06", "07", "08", "09", "12")),
300
+ b::Element(e::Situational, "Condition Code", b::Values("01", "04", "05", "06", "07", "08", "09", "12"))),
301
+ b::Segment(2200, s::CRC, "Patient Condition Information: Vision",
302
+ r::Situational, d::RepeatCount.bounded(3),
303
+ b::Element(e::Required, "Code Category", b::Values("E1", "E2", "E3")),
304
+ b::Element(e::Required, "Certification Condition Indicator", b::Values("Y", "N")),
305
+ b::Element(e::Required, "Condition Code", b::Values("L1", "L2", "L3", "L4", "L5")),
306
+ b::Element(e::Situational, "Condition Code", b::Values("L1", "L2", "L3", "L4", "L5")),
307
+ b::Element(e::Situational, "Condition Code", b::Values("L1", "L2", "L3", "L4", "L5")),
308
+ b::Element(e::Situational, "Condition Code", b::Values("L1", "L2", "L3", "L4", "L5")),
309
+ b::Element(e::Situational, "Condition Code", b::Values("L1", "L2", "L3", "L4", "L5"))),
310
+ b::Segment(2200, s::CRC, "Homebound Indicator",
311
+ r::Situational, d::RepeatCount.bounded(1),
312
+ b::Element(e::Required, "Code Category", b::Values("E1", "E2", "E3")),
313
+ b::Element(e::Required, "Certification Condition Indicator", b::Values("Y")),
314
+ b::Element(e::Required, "Condition Code", b::Values("IH")),
315
+ b::Element(e::NotUsed, "Condition Indicator"),
316
+ b::Element(e::Situational, "Condition Indicator"),
317
+ b::Element(e::Situational, "Condition Indicator"),
318
+ b::Element(e::Situational, "Condition Indicator")),
319
+ b::Segment(2200, s::CRC, "EPSDT Referral",
320
+ r::Situational, d::RepeatCount.bounded(1),
321
+ b::Element(e::Required, "Code Category", b::Values("ZZ")),
322
+ b::Element(e::Required, "Certification Condition Indicator", b::Values("Y", "N")),
323
+ b::Element(e::Required, "Condition Code", b::Values("AV", "NU", "S2", "ST")),
324
+ b::Element(e::Situational, "Condition Code", b::Values("AV", "NU", "S2", "ST")),
325
+ b::Element(e::Situational, "Condition Code", b::Values("AV", "NU", "S2", "ST")),
326
+ b::Element(e::NotUsed, "Condition Indicator"),
327
+ b::Element(e::NotUsed, "Condition Indicator")),
328
+ b::Segment(2310, s::HI, "Health Care Diagnosis Code",
329
+ r::Required, d::RepeatCount.bounded(1),
330
+ b::Element(e::Required, "HEALTH CARE CODE INFORMATION",
331
+ b::Element(e::Required, "Code List Qualifier", b::Values("ABK", "BK")),
332
+ b::Element(e::Required, "Diagnosis Code"),
333
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
334
+ b::Element(e::NotUsed, "Date Time Period"),
335
+ b::Element(e::NotUsed, "Monetary Amount"),
336
+ b::Element(e::NotUsed, "Quantity"),
337
+ b::Element(e::NotUsed, "Version Identifier"),
338
+ b::Element(e::NotUsed, "Industry Code"),
339
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
340
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
341
+ b::Element(e::Required, "Code List Qualifier", b::Values("ABF", "BF")),
342
+ b::Element(e::Required, "Diagnosis Code"),
343
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
344
+ b::Element(e::NotUsed, "Date Time Period"),
345
+ b::Element(e::NotUsed, "Monetary Amount"),
346
+ b::Element(e::NotUsed, "Quantity"),
347
+ b::Element(e::NotUsed, "Version Identifier"),
348
+ b::Element(e::NotUsed, "Industry Code"),
349
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
350
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
351
+ b::Element(e::Required, "Code List Qualifier", b::Values("ABF", "BF")),
352
+ b::Element(e::Required, "Diagnosis Code"),
353
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
354
+ b::Element(e::NotUsed, "Date Time Period"),
355
+ b::Element(e::NotUsed, "Monetary Amount"),
356
+ b::Element(e::NotUsed, "Quantity"),
357
+ b::Element(e::NotUsed, "Version Identifier"),
358
+ b::Element(e::NotUsed, "Industry Code"),
359
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
360
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
361
+ b::Element(e::Required, "Code List Qualifier", b::Values("ABF", "BF")),
362
+ b::Element(e::Required, "Diagnosis Code"),
363
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
364
+ b::Element(e::NotUsed, "Date Time Period"),
365
+ b::Element(e::NotUsed, "Monetary Amount"),
366
+ b::Element(e::NotUsed, "Quantity"),
367
+ b::Element(e::NotUsed, "Version Identifier"),
368
+ b::Element(e::NotUsed, "Industry Code"),
369
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
370
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
371
+ b::Element(e::Required, "Code List Qualifier", b::Values("ABF", "BF")),
372
+ b::Element(e::Required, "Diagnosis Code"),
373
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
374
+ b::Element(e::NotUsed, "Date Time Period"),
375
+ b::Element(e::NotUsed, "Monetary Amount"),
376
+ b::Element(e::NotUsed, "Quantity"),
377
+ b::Element(e::NotUsed, "Version Identifier"),
378
+ b::Element(e::NotUsed, "Industry Code"),
379
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
380
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
381
+ b::Element(e::Required, "Code List Qualifier", b::Values("ABF", "BF")),
382
+ b::Element(e::Required, "Diagnosis Code"),
383
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
384
+ b::Element(e::NotUsed, "Date Time Period"),
385
+ b::Element(e::NotUsed, "Monetary Amount"),
386
+ b::Element(e::NotUsed, "Quantity"),
387
+ b::Element(e::NotUsed, "Version Identifier"),
388
+ b::Element(e::NotUsed, "Industry Code"),
389
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
390
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
391
+ b::Element(e::Required, "Code List Qualifier", b::Values("ABF", "BF")),
392
+ b::Element(e::Required, "Diagnosis Code"),
393
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
394
+ b::Element(e::NotUsed, "Date Time Period"),
395
+ b::Element(e::NotUsed, "Monetary Amount"),
396
+ b::Element(e::NotUsed, "Quantity"),
397
+ b::Element(e::NotUsed, "Version Identifier"),
398
+ b::Element(e::NotUsed, "Industry Code"),
399
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
400
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
401
+ b::Element(e::Required, "Code List Qualifier", b::Values("ABF", "BF")),
402
+ b::Element(e::Required, "Diagnosis Code"),
403
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
404
+ b::Element(e::NotUsed, "Date Time Period"),
405
+ b::Element(e::NotUsed, "Monetary Amount"),
406
+ b::Element(e::NotUsed, "Quantity"),
407
+ b::Element(e::NotUsed, "Version Identifier"),
408
+ b::Element(e::NotUsed, "Industry Code"),
409
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
410
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
411
+ b::Element(e::Required, "Code List Qualifier", b::Values("ABF", "BF")),
412
+ b::Element(e::Required, "Diagnosis Code"),
413
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
414
+ b::Element(e::NotUsed, "Date Time Period"),
415
+ b::Element(e::NotUsed, "Monetary Amount"),
416
+ b::Element(e::NotUsed, "Quantity"),
417
+ b::Element(e::NotUsed, "Version Identifier"),
418
+ b::Element(e::NotUsed, "Industry Code"),
419
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
420
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
421
+ b::Element(e::Required, "Code List Qualifier", b::Values("ABF", "BF")),
422
+ b::Element(e::Required, "Diagnosis Code"),
423
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
424
+ b::Element(e::NotUsed, "Date Time Period"),
425
+ b::Element(e::NotUsed, "Monetary Amount"),
426
+ b::Element(e::NotUsed, "Quantity"),
427
+ b::Element(e::NotUsed, "Version Identifier"),
428
+ b::Element(e::NotUsed, "Industry Code"),
429
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
430
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
431
+ b::Element(e::Required, "Code List Qualifier", b::Values("ABF", "BF")),
432
+ b::Element(e::Required, "Diagnosis Code"),
433
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
434
+ b::Element(e::NotUsed, "Date Time Period"),
435
+ b::Element(e::NotUsed, "Monetary Amount"),
436
+ b::Element(e::NotUsed, "Quantity"),
437
+ b::Element(e::NotUsed, "Version Identifier"),
438
+ b::Element(e::NotUsed, "Industry Code"),
439
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
440
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
441
+ b::Element(e::Required, "Code List Qualifier", b::Values("ABF", "BF")),
442
+ b::Element(e::Required, "Diagnosis Code"),
443
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
444
+ b::Element(e::NotUsed, "Date Time Period"),
445
+ b::Element(e::NotUsed, "Monetary Amount"),
446
+ b::Element(e::NotUsed, "Quantity"),
447
+ b::Element(e::NotUsed, "Version Identifier"),
448
+ b::Element(e::NotUsed, "Industry Code"),
449
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code"))),
450
+ b::Segment(2310, s::HI, "Anesthesia Related Procedure",
451
+ r::Situational, d::RepeatCount.bounded(1),
452
+ b::Element(e::Required, "HEALTH CARE CODE INFORMATION",
453
+ b::Element(e::Required, "Code List Qualifier", b::Values("BP")),
454
+ b::Element(e::Required, "Diagnosis Code"),
455
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
456
+ b::Element(e::NotUsed, "Date Time Period"),
457
+ b::Element(e::NotUsed, "Monetary Amount"),
458
+ b::Element(e::NotUsed, "Quantity"),
459
+ b::Element(e::NotUsed, "Version Identifier"),
460
+ b::Element(e::NotUsed, "Industry Code"),
461
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
462
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
463
+ b::Element(e::Required, "Code List Qualifier", b::Values("BO")),
464
+ b::Element(e::Required, "Diagnosis Code"),
465
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
466
+ b::Element(e::NotUsed, "Date Time Period"),
467
+ b::Element(e::NotUsed, "Monetary Amount"),
468
+ b::Element(e::NotUsed, "Quantity"),
469
+ b::Element(e::NotUsed, "Version Identifier"),
470
+ b::Element(e::NotUsed, "Industry Code"),
471
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
472
+ b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
473
+ b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
474
+ b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
475
+ b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
476
+ b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
477
+ b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
478
+ b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
479
+ b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
480
+ b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
481
+ b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION")),
482
+ b::Segment(2310, s::HI, "Condition Information",
483
+ r::Situational, d::RepeatCount.bounded(1),
484
+ b::Element(e::Required, "HEALTH CARE CODE INFORMATION",
485
+ b::Element(e::Required, "Code List Qualifier", b::Values("BG")),
486
+ b::Element(e::Required, "Diagnosis Code"),
487
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
488
+ b::Element(e::NotUsed, "Date Time Period"),
489
+ b::Element(e::NotUsed, "Monetary Amount"),
490
+ b::Element(e::NotUsed, "Quantity"),
491
+ b::Element(e::NotUsed, "Version Identifier"),
492
+ b::Element(e::NotUsed, "Industry Code"),
493
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
494
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
495
+ b::Element(e::Required, "Code List Qualifier", b::Values("BG")),
496
+ b::Element(e::Required, "Diagnosis Code"),
497
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
498
+ b::Element(e::NotUsed, "Date Time Period"),
499
+ b::Element(e::NotUsed, "Monetary Amount"),
500
+ b::Element(e::NotUsed, "Quantity"),
501
+ b::Element(e::NotUsed, "Version Identifier"),
502
+ b::Element(e::NotUsed, "Industry Code"),
503
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
504
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
505
+ b::Element(e::Required, "Code List Qualifier", b::Values("BG")),
506
+ b::Element(e::Required, "Diagnosis Code"),
507
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
508
+ b::Element(e::NotUsed, "Date Time Period"),
509
+ b::Element(e::NotUsed, "Monetary Amount"),
510
+ b::Element(e::NotUsed, "Quantity"),
511
+ b::Element(e::NotUsed, "Version Identifier"),
512
+ b::Element(e::NotUsed, "Industry Code"),
513
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
514
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
515
+ b::Element(e::Required, "Code List Qualifier", b::Values("BG")),
516
+ b::Element(e::Required, "Diagnosis Code"),
517
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
518
+ b::Element(e::NotUsed, "Date Time Period"),
519
+ b::Element(e::NotUsed, "Monetary Amount"),
520
+ b::Element(e::NotUsed, "Quantity"),
521
+ b::Element(e::NotUsed, "Version Identifier"),
522
+ b::Element(e::NotUsed, "Industry Code"),
523
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
524
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
525
+ b::Element(e::Required, "Code List Qualifier", b::Values("BG")),
526
+ b::Element(e::Required, "Diagnosis Code"),
527
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
528
+ b::Element(e::NotUsed, "Date Time Period"),
529
+ b::Element(e::NotUsed, "Monetary Amount"),
530
+ b::Element(e::NotUsed, "Quantity"),
531
+ b::Element(e::NotUsed, "Version Identifier"),
532
+ b::Element(e::NotUsed, "Industry Code"),
533
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
534
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
535
+ b::Element(e::Required, "Code List Qualifier", b::Values("BG")),
536
+ b::Element(e::Required, "Diagnosis Code"),
537
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
538
+ b::Element(e::NotUsed, "Date Time Period"),
539
+ b::Element(e::NotUsed, "Monetary Amount"),
540
+ b::Element(e::NotUsed, "Quantity"),
541
+ b::Element(e::NotUsed, "Version Identifier"),
542
+ b::Element(e::NotUsed, "Industry Code"),
543
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
544
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
545
+ b::Element(e::Required, "Code List Qualifier", b::Values("BG")),
546
+ b::Element(e::Required, "Diagnosis Code"),
547
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
548
+ b::Element(e::NotUsed, "Date Time Period"),
549
+ b::Element(e::NotUsed, "Monetary Amount"),
550
+ b::Element(e::NotUsed, "Quantity"),
551
+ b::Element(e::NotUsed, "Version Identifier"),
552
+ b::Element(e::NotUsed, "Industry Code"),
553
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
554
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
555
+ b::Element(e::Required, "Code List Qualifier", b::Values("BG")),
556
+ b::Element(e::Required, "Diagnosis Code"),
557
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
558
+ b::Element(e::NotUsed, "Date Time Period"),
559
+ b::Element(e::NotUsed, "Monetary Amount"),
560
+ b::Element(e::NotUsed, "Quantity"),
561
+ b::Element(e::NotUsed, "Version Identifier"),
562
+ b::Element(e::NotUsed, "Industry Code"),
563
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
564
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
565
+ b::Element(e::Required, "Code List Qualifier", b::Values("BG")),
566
+ b::Element(e::Required, "Diagnosis Code"),
567
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
568
+ b::Element(e::NotUsed, "Date Time Period"),
569
+ b::Element(e::NotUsed, "Monetary Amount"),
570
+ b::Element(e::NotUsed, "Quantity"),
571
+ b::Element(e::NotUsed, "Version Identifier"),
572
+ b::Element(e::NotUsed, "Industry Code"),
573
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
574
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
575
+ b::Element(e::Required, "Code List Qualifier", b::Values("BG")),
576
+ b::Element(e::Required, "Diagnosis Code"),
577
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
578
+ b::Element(e::NotUsed, "Date Time Period"),
579
+ b::Element(e::NotUsed, "Monetary Amount"),
580
+ b::Element(e::NotUsed, "Quantity"),
581
+ b::Element(e::NotUsed, "Version Identifier"),
582
+ b::Element(e::NotUsed, "Industry Code"),
583
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
584
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
585
+ b::Element(e::Required, "Code List Qualifier", b::Values("BG")),
586
+ b::Element(e::Required, "Diagnosis Code"),
587
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
588
+ b::Element(e::NotUsed, "Date Time Period"),
589
+ b::Element(e::NotUsed, "Monetary Amount"),
590
+ b::Element(e::NotUsed, "Quantity"),
591
+ b::Element(e::NotUsed, "Version Identifier"),
592
+ b::Element(e::NotUsed, "Industry Code"),
593
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
594
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
595
+ b::Element(e::Required, "Code List Qualifier", b::Values("BG")),
596
+ b::Element(e::Required, "Diagnosis Code"),
597
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
598
+ b::Element(e::NotUsed, "Date Time Period"),
599
+ b::Element(e::NotUsed, "Monetary Amount"),
600
+ b::Element(e::NotUsed, "Quantity"),
601
+ b::Element(e::NotUsed, "Version Identifier"),
602
+ b::Element(e::NotUsed, "Industry Code"),
603
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code"))),
604
+ b::Segment(2410, s::HCP, "Claim Pricing/Repricing Information",
605
+ r::Situational, d::RepeatCount.bounded(1),
606
+ b::Element(e::Required, "Pricing Methodology", b::Values("00", "01", "02", "03", "04", "05", "07", "08", "09", "10", "11", "12", "13", "14")),
607
+ b::Element(e::Required, "Repriced Allowed Amount"),
608
+ b::Element(e::Situational, "Repriced Saving Amount"),
609
+ b::Element(e::Situational, "Repricing Organization Identifier"),
610
+ b::Element(e::Situational, "Repricing Per Diem or Flat Rate Amount"),
611
+ b::Element(e::Situational, "Repriced Approved Ambulatory Patient Group Code"),
612
+ b::Element(e::Situational, "Repriced Approved Ambulatory Patient Group Amount"),
613
+ b::Element(e::NotUsed, "Product/Service ID"),
614
+ b::Element(e::NotUsed, "Product/Service Qualifier"),
615
+ b::Element(e::NotUsed, "Product/Service ID"),
616
+ b::Element(e::NotUsed, "Unit or Basis of Measurement Code"),
617
+ b::Element(e::NotUsed, "Quantity"),
618
+ b::Element(e::Situational, "Reject Reason Code", b::Values("T1", "T2", "T3", "T4", "T5", "T6")),
619
+ b::Element(e::Situational, "Policy Compliance Code", b::Values("1", "2", "3", "4", "5")),
620
+ b::Element(e::Situational, "Exception Code", b::Values("1", "2", "3", "4", "5", "6"))),
621
+
622
+ d::LoopDef.build("2310A REFERRING PROVIDER NAME",
623
+ d::RepeatCount.bounded(2),
624
+ b::Segment(2500, s::NM1, "Referring Provider Name",
625
+ r::Situational, d::RepeatCount.bounded(1),
626
+ b::Element(e::Required, "Entity Identifier Code", b::Values("DN", "P3")),
627
+ b::Element(e::Required, "Entity Type Qualifier", b::Values("1")),
628
+ b::Element(e::Required, "Referring Provider Last Name"),
629
+ b::Element(e::Situational, "Referring Provider First Name"),
630
+ b::Element(e::Situational, "Referring Provider Middle Name or Initial"),
631
+ b::Element(e::NotUsed, "Name Prefix"),
632
+ b::Element(e::Situational, "Referring Provider Name Suffix"),
633
+ b::Element(e::Situational, "Identification Code Qualifier", b::Values("XX")),
634
+ b::Element(e::Situational, "Referring Provider Identifier"),
635
+ b::Element(e::NotUsed, "Entity Relationship Code"),
636
+ b::Element(e::NotUsed, "Entity Identifier Code"),
637
+ b::Element(e::NotUsed, "Name Last or Organization Name")),
638
+ b::Segment(2710, s::REF, "Referring Provider Specialty Information",
639
+ r::Situational, d::RepeatCount.bounded(3),
640
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("0B", "1G", "G2")),
641
+ b::Element(e::Required, "Referring Provider Secondary Identifier"),
642
+ b::Element(e::NotUsed, "Description"),
643
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER"))),
644
+
645
+ d::LoopDef.build("2310B RENDERING PROVIDER NAME",
646
+ d::RepeatCount.bounded(1),
647
+ b::Segment(2500, s::NM1, "Rendering Provider Name",
648
+ r::Situational, d::RepeatCount.bounded(1),
649
+ b::Element(e::Required, "Entity Identifier Code", b::Values("82")),
650
+ b::Element(e::Required, "Entity Type Qualifier", b::Values("1", "2")),
651
+ b::Element(e::Required, "Rendering Provider Last Name"),
652
+ b::Element(e::Situational, "Rendering Provider First Name"),
653
+ b::Element(e::Situational, "Rendering Provider Middle Name or Initial"),
654
+ b::Element(e::NotUsed, "Name Prefix"),
655
+ b::Element(e::Situational, "Rendering Provider Name Suffix"),
656
+ b::Element(e::Situational, "Identification Code Qualifier", b::Values("XX")),
657
+ b::Element(e::Situational, "Rendering Provider Identifier"),
658
+ b::Element(e::NotUsed, "Entity Relationship Code"),
659
+ b::Element(e::NotUsed, "Entity Identifier Code"),
660
+ b::Element(e::NotUsed, "Name Last or Organization Name")),
661
+ b::Segment(2550, s::PRV, "Rendering Provider Specialty Information",
662
+ r::Situational, d::RepeatCount.bounded(1),
663
+ b::Element(e::Required, "Provider Code", b::Values("PE")),
664
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("PXC")),
665
+ b::Element(e::Required, "Provider Taxonomy Code"),
666
+ b::Element(e::NotUsed, "State or Province Code"),
667
+ b::Element(e::NotUsed, "PROVIDER SPECIALTY INFORMATION"),
668
+ b::Element(e::NotUsed, "Provider Organization Code")),
669
+ b::Segment(2710, s::REF, "Rendering Provider Secondary Identification",
670
+ r::Situational, d::RepeatCount.bounded(4),
671
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("0B", "1G", "G2", "LU")),
672
+ b::Element(e::Required, "Reference Identification"),
673
+ b::Element(e::NotUsed, "Description"),
674
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER"))),
675
+
676
+ d::LoopDef.build("2310C SERVICE FACILITY LOCATION NAME",
677
+ d::RepeatCount.bounded(1),
678
+ b::Segment(2500, s::NM1, "Service Facility Location Name",
679
+ r::Situational, d::RepeatCount.bounded(1),
680
+ b::Element(e::Required, "Entity Identifier Code", b::Values("77")),
681
+ b::Element(e::Required, "Entity Type Qualifier", b::Values("2")),
682
+ b::Element(e::Required, "Name Last or Organization Name"),
683
+ b::Element(e::Situational, "Name First"),
684
+ b::Element(e::Situational, "Name Middle"),
685
+ b::Element(e::NotUsed, "Name Prefix"),
686
+ b::Element(e::Situational, "Name Suffix"),
687
+ b::Element(e::Situational, "Identification Code Qualifier", b::Values("XX")),
688
+ b::Element(e::Situational, "Laboratory or Facility Primary Identifier"),
689
+ b::Element(e::NotUsed, "Entity Relationship Code"),
690
+ b::Element(e::NotUsed, "Entity Identifier Code"),
691
+ b::Element(e::NotUsed, "Name Last or Organization Name")),
692
+ b::Segment(2650, s::N3, "Service Facility Location Address",
693
+ r::Required, d::RepeatCount.bounded(2),
694
+ b::Element(e::Required, "Laboratory or Facility Address Line"),
695
+ b::Element(e::Situational, "Laboratory or Facility Address Line")),
696
+ b::Segment(2700, s::N4, "Service Facility Location City, State, ZIP Code",
697
+ r::Required, d::RepeatCount.bounded(1),
698
+ b::Element(e::Required, "Laboratory or Facility City Name"),
699
+ b::Element(e::Situational, "Laboratory or Facility Province Code"),
700
+ b::Element(e::Situational, "Laboratory or Facility Postal Zone or ZIP Code"),
701
+ b::Element(e::Situational, "Country Code"),
702
+ b::Element(e::NotUsed, "Location Qualifier"),
703
+ b::Element(e::NotUsed, "Location Identifier"),
704
+ b::Element(e::Situational, "Country Subdivision Code")),
705
+ b::Segment(2710, s::REF, "Service Facility Location Secondary Identification",
706
+ r::Situational, d::RepeatCount.bounded(3),
707
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("0B", "G2", "LU")),
708
+ b::Element(e::Required, "Laboratory or Facility Secondary Identifier"),
709
+ b::Element(e::NotUsed, "Description"),
710
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
711
+ b::Segment(2750, s::PER, "Service Facility Contact Information",
712
+ r::Situational, d::RepeatCount.bounded(1),
713
+ b::Element(e::Required, "Contact Function Code", b::Values("IC")),
714
+ b::Element(e::Situational, "Name"),
715
+ b::Element(e::Required, "Communication Number Qualifier", b::Values("TE")),
716
+ b::Element(e::Required, "Communication Number"),
717
+ b::Element(e::Situational, "Communication Number Qualifier", b::Values("EX")),
718
+ b::Element(e::Situational, "Communication Number"),
719
+ b::Element(e::NotUsed, "Communication Number Qualifier"),
720
+ b::Element(e::NotUsed, "Communication Number"),
721
+ b::Element(e::NotUsed, "Contact Inquiry Reference"))),
722
+
723
+ d::LoopDef.build("2310D SUPERVISING PROVIDER NAME",
724
+ d::RepeatCount.bounded(1),
725
+ b::Segment(2500, s::NM1, "Supervising Provider Name",
726
+ r::Situational, d::RepeatCount.bounded(1),
727
+ b::Element(e::Required, "Entity Identifier Code", b::Values("DQ")),
728
+ b::Element(e::Required, "Entity Type Qualifier", b::Values("1")),
729
+ b::Element(e::Required, "Supervising Provider Last Name"),
730
+ b::Element(e::Situational, "Supervising Provider First Name"),
731
+ b::Element(e::Situational, "Supervising Provider Middle Name or Initial"),
732
+ b::Element(e::NotUsed, "Name Prefix"),
733
+ b::Element(e::Situational, "Supervising Provider Name Suffix"),
734
+ b::Element(e::Situational, "Identification Code Qualifier", b::Values("XX")),
735
+ b::Element(e::Situational, "Supervising Provider Identifier"),
736
+ b::Element(e::NotUsed, "Entity Relationship Code"),
737
+ b::Element(e::NotUsed, "Entity Identifier Code"),
738
+ b::Element(e::NotUsed, "Name Last or Organization Name")),
739
+ b::Segment(2710, s::REF, "Supervising Provider Secondary Identification",
740
+ r::Situational, d::RepeatCount.bounded(4),
741
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("0B", "1G", "G2", "LU")),
742
+ b::Element(e::Required, "Supervising Provider Secondary Identifier"),
743
+ b::Element(e::NotUsed, "Description"),
744
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER"))),
745
+
746
+ d::LoopDef.build("2310E AMBULANCE PICK-UP LOCATION",
747
+ d::RepeatCount.bounded(1),
748
+ b::Segment(2500, s::NM1, "Ambulance Pick-up Location",
749
+ r::Situational, d::RepeatCount.bounded(1),
750
+ b::Element(e::Required, "Entity Identifier Code", b::Values("PW")),
751
+ b::Element(e::Required, "Entity Type Qualifier", b::Values("2")),
752
+ b::Element(e::NotUsed, "Name Last or Organization Name"),
753
+ b::Element(e::NotUsed, "Name First"),
754
+ b::Element(e::NotUsed, "Name Middle"),
755
+ b::Element(e::NotUsed, "Name Prefix"),
756
+ b::Element(e::NotUsed, "Name Suffix"),
757
+ b::Element(e::NotUsed, "Identification Code Qualifier"),
758
+ b::Element(e::NotUsed, "Identification Code"),
759
+ b::Element(e::NotUsed, "Entity Relationship Code"),
760
+ b::Element(e::NotUsed, "Entity Identifier Code"),
761
+ b::Element(e::NotUsed, "Name Last or Organization Name")),
762
+ b::Segment(2650, s::N3, "Ambulance Pick-up Location Address",
763
+ r::Situational, d::RepeatCount.bounded(2),
764
+ b::Element(e::Required, "Ambulance Pick-up Address Line"),
765
+ b::Element(e::Situational, "Ambulance Pick-up Address Line")),
766
+ b::Segment(2700, s::N4, "Ambulance Pick-up Location City, State, ZIP Code",
767
+ r::Situational, d::RepeatCount.bounded(1),
768
+ b::Element(e::Required, "Ambulance Pick-up City Name"),
769
+ b::Element(e::Situational, "Ambulance Pick-up State or Province Code"),
770
+ b::Element(e::Situational, "Ambulance Pick-up Postal Zone or ZIP Code"),
771
+ b::Element(e::Situational, "Country Code"),
772
+ b::Element(e::NotUsed, "Location Qualifier"),
773
+ b::Element(e::NotUsed, "Location Identifier"),
774
+ b::Element(e::Situational, "Country Subdivision Code"))),
775
+
776
+ d::LoopDef.build("2310F AMBULANCE DROP-OFF LOCATION",
777
+ d::RepeatCount.bounded(1),
778
+ b::Segment(2500, s::NM1, "Ambulance Drop-off Location",
779
+ r::Situational, d::RepeatCount.bounded(1),
780
+ b::Element(e::Required, "Entity Identifier Code", b::Values("45")),
781
+ b::Element(e::Required, "Entity Type Qualifier", b::Values("2")),
782
+ b::Element(e::Situational, "Ambulance Drop-off Location"),
783
+ b::Element(e::NotUsed, "Name First"),
784
+ b::Element(e::NotUsed, "Name Middle"),
785
+ b::Element(e::NotUsed, "Name Prefix"),
786
+ b::Element(e::NotUsed, "Name Suffix"),
787
+ b::Element(e::NotUsed, "Identification Code Qualifier", b::Values("XX")),
788
+ b::Element(e::NotUsed, "Identification Code"),
789
+ b::Element(e::NotUsed, "Entity Relationship Code"),
790
+ b::Element(e::NotUsed, "Entity Identifier Code"),
791
+ b::Element(e::NotUsed, "Name Last or Organization Name")),
792
+ b::Segment(2650, s::N3, "Ambulance Drop-off Location Address",
793
+ r::Situational, d::RepeatCount.bounded(1),
794
+ b::Element(e::Required, "Ambulance Drop-off Address Line"),
795
+ b::Element(e::Situational, "Ambulance Drop-off Address Line")),
796
+ b::Segment(2700, s::N4, "Ambulance Drop-off Location City, State, ZIP Code",
797
+ r::Situational, d::RepeatCount.bounded(1),
798
+ b::Element(e::Required, "Ambulance Drop-off City Name"),
799
+ b::Element(e::Situational, "Ambulance Drop-off State or Province Code"),
800
+ b::Element(e::Situational, "Ambulance Drop-off Postal Zone or ZIP Code"),
801
+ b::Element(e::Situational, "Country Code"),
802
+ b::Element(e::NotUsed, "Location Qualifier"),
803
+ b::Element(e::NotUsed, "Location Identifier"),
804
+ b::Element(e::Situational, "Country Subdivision Code"))),
805
+
806
+ d::LoopDef.build("2320 OTHER SUBSCRIBER INFORMATION",
807
+ d::RepeatCount.bounded(10),
808
+ b::Segment(2900, s::SBR, "Other Subscriber Information",
809
+ r::Situational, d::RepeatCount.bounded(1),
810
+ b::Element(e::Required, "Payer Responsibility Sequence Number", b::Values("A", "B", "C", "D", "E", "F", "G", "H", "P", "S", "T", "U")),
811
+ b::Element(e::Required, "Individual Relationship Code", b::Values("01", "18", "19", "20", "21", "39", "40", "53", "G8")),
812
+ b::Element(e::Situational, "Insured Group or Policy Number"),
813
+ b::Element(e::Situational, "Other Insured Group Name"),
814
+ b::Element(e::Situational, "Insurance Type Code", b::Values("12", "13", "14", "15", "16", "41", "42", "43", "47")),
815
+ b::Element(e::NotUsed, "Coordination of Benefits Code"),
816
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code"),
817
+ b::Element(e::NotUsed, "Employment Status Code"),
818
+ b::Element(e::Situational, "Claim Filing Indicator Code", b::Values("11", "12", "13", "14", "15", "16", "17", "AM", "BL", "CH", "CI", "DS", "FI", "HM", "LM", "MA", "MB", "MC", "OF", "TV", "VA", "WC", "ZZ"))),
819
+ b::Segment(2950, s::CAS, "Claim Level Adjustments",
820
+ r::Situational, d::RepeatCount.bounded(5),
821
+ b::Element(e::Required, "Claim Adjustment Group Code", b::Values("CO", "CR", "OA", "PI", "PR")),
822
+ b::Element(e::Required, "Adjustment Reason Code"),
823
+ b::Element(e::Required, "Adjustment Amount"),
824
+ b::Element(e::Situational, "Adjustment Quantity"),
825
+ b::Element(e::Situational, "Adjustment Reason Code"),
826
+ b::Element(e::Situational, "Adjustment Amount"),
827
+ b::Element(e::Situational, "Adjustment Quantity"),
828
+ b::Element(e::Situational, "Adjustment Reason Code"),
829
+ b::Element(e::Situational, "Adjustment Amount"),
830
+ b::Element(e::Situational, "Adjustment Quantity"),
831
+ b::Element(e::Situational, "Adjustment Reason Code"),
832
+ b::Element(e::Situational, "Adjustment Amount"),
833
+ b::Element(e::Situational, "Adjustment Quantity"),
834
+ b::Element(e::Situational, "Adjustment Reason Code"),
835
+ b::Element(e::Situational, "Adjustment Amount"),
836
+ b::Element(e::Situational, "Adjustment Quantity"),
837
+ b::Element(e::Situational, "Adjustment Reason Code"),
838
+ b::Element(e::Situational, "Adjustment Amount"),
839
+ b::Element(e::Situational, "Adjustment Quantity")),
840
+ b::Segment(3000, s::AMT, "Coordination of Benefits (COB) Payer Paid Amount",
841
+ r::Situational, d::RepeatCount.bounded(1),
842
+ b::Element(e::Required, "Amount Qualifier Code", b::Values("D")),
843
+ b::Element(e::Required, "Payer Paid Amount"),
844
+ b::Element(e::NotUsed, "Credit/Debit Flag")),
845
+ b::Segment(3000, s::AMT, "Coordination of Benefits (COB) Total Non-Covered Amount",
846
+ r::Situational, d::RepeatCount.bounded(1),
847
+ b::Element(e::Required, "Amount Qualifier Code", b::Values("A8")),
848
+ b::Element(e::Required, "Non-Covered Charge Amount"),
849
+ b::Element(e::NotUsed, "Credit/Debit Flag")),
850
+ b::Segment(3000, s::AMT, "Remaining Patient Liability",
851
+ r::Situational, d::RepeatCount.bounded(1),
852
+ b::Element(e::Required, "Amount Qualifier Code", b::Values("EAF")),
853
+ b::Element(e::Required, "Remaining Patient Liability"),
854
+ b::Element(e::NotUsed, "Credit/Debit Flag")),
855
+ b::Segment(3100, s::OI, "Other Insurance Coverage Information",
856
+ r::Required, d::RepeatCount.bounded(1),
857
+ b::Element(e::NotUsed, "Claim Filing Indicator Code"),
858
+ b::Element(e::NotUsed, "Claim Submission Reason Code"),
859
+ b::Element(e::Required, "Benefits Assignment Certification Indicator", b::Values("N", "W", "Y")),
860
+ b::Element(e::Situational, "Patient Signature Source Code", b::Values("P")),
861
+ b::Element(e::NotUsed, "Provider Agreement Code"),
862
+ b::Element(e::Required, "Release of Information Code", b::Values("I", "Y"))),
863
+ b::Segment(3200, s::MOA, "Outpatient Adjudication Information",
864
+ r::Situational, d::RepeatCount.bounded(1),
865
+ b::Element(e::Situational, "Reimbursement Rate"),
866
+ b::Element(e::Situational, "HCPCS Payable Amount"),
867
+ b::Element(e::Situational, "Claim Payment Remark Code"),
868
+ b::Element(e::Situational, "Claim Payment Remark Code"),
869
+ b::Element(e::Situational, "Claim Payment Remark Code"),
870
+ b::Element(e::Situational, "Claim Payment Remark Code"),
871
+ b::Element(e::Situational, "Claim Payment Remark Code"),
872
+ b::Element(e::Situational, "End Stage Renal Disease Payment Amount"),
873
+ b::Element(e::Situational, "Non-Payable Professional Component Billed Amount")),
874
+
875
+ d::LoopDef.build("2330A OTHER SUBSCRIBER NAME",
876
+ d::RepeatCount.bounded(1),
877
+ b::Segment(3250, s::NM1, "Other Subscriber Name",
878
+ r::Required, d::RepeatCount.bounded(1),
879
+ b::Element(e::Required, "Entity Identifier Code", b::Values("IL")),
880
+ b::Element(e::Required, "Entity Type Qualifier", b::Values("1", "2")),
881
+ b::Element(e::Required, "Other Insured Last Name"),
882
+ b::Element(e::Situational, "Other Insured First Name"),
883
+ b::Element(e::Situational, "Other Insured Middle Name"),
884
+ b::Element(e::NotUsed, "Name Prefix"),
885
+ b::Element(e::Situational, "Other Insured Name Suffix"),
886
+ b::Element(e::Required, "Identification Code Qualifier", b::Values("II", "MI")),
887
+ b::Element(e::Required, "Other Insured Identifier"),
888
+ b::Element(e::NotUsed, "Entity Relationship Code"),
889
+ b::Element(e::NotUsed, "Entity Identifier Code"),
890
+ b::Element(e::NotUsed, "Name Last or Organization Name")),
891
+ b::Segment(3320, s::N3, "Other Subscriber Address",
892
+ r::Situational, d::RepeatCount.bounded(1),
893
+ b::Element(e::Required, "Other Subscriber Address Line"),
894
+ b::Element(e::Situational, "Other Subscriber Address Line")),
895
+ b::Segment(3400, s::N4, "Other Subscriber City, State, ZIP Code",
896
+ r::Situational, d::RepeatCount.bounded(1),
897
+ b::Element(e::Required, "Other Subscriber City Name"),
898
+ b::Element(e::Situational, "Other Subscriber State or Province Code"),
899
+ b::Element(e::Situational, "Other Subscriber Postal Zone or ZIP Code"),
900
+ b::Element(e::Situational, "Country Code"),
901
+ b::Element(e::NotUsed, "Location Qualifier"),
902
+ b::Element(e::NotUsed, "Location Identifier"),
903
+ b::Element(e::Situational, "Country Subdivision Code")),
904
+ b::Segment(3550, s::REF, "Other Subscriber Secondary Identification",
905
+ r::Situational, d::RepeatCount.bounded(1),
906
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("SY")),
907
+ b::Element(e::Required, "Other Insured Additional Identifier"),
908
+ b::Element(e::NotUsed, "Description"),
909
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER"))),
910
+
911
+ d::LoopDef.build("2330B OTHER PAYER NAME",
912
+ d::RepeatCount.bounded(1),
913
+ b::Segment(3250, s::NM1, "Other Payer Name",
914
+ r::Required, d::RepeatCount.bounded(1),
915
+ b::Element(e::Required, "Entity Identifier Code", b::Values("PR")),
916
+ b::Element(e::Required, "Entity Type Qualifier", b::Values("2")),
917
+ b::Element(e::Required, "Other Payer Organization Name"),
918
+ b::Element(e::NotUsed, "Name First"),
919
+ b::Element(e::NotUsed, "Name Middle"),
920
+ b::Element(e::NotUsed, "Name Prefix"),
921
+ b::Element(e::NotUsed, "Name Suffix"),
922
+ b::Element(e::Required, "Identification Code Qualifier", b::Values("PI", "XV")),
923
+ b::Element(e::Required, "Other Payer Primary Identifier"),
924
+ b::Element(e::NotUsed, "Entity Relationship Code"),
925
+ b::Element(e::NotUsed, "Entity Identifier Code"),
926
+ b::Element(e::NotUsed, "Name Last or Organization Name")),
927
+ b::Segment(3320, s::N3, "Other Payer Address",
928
+ r::Situational, d::RepeatCount.bounded(1),
929
+ b::Element(e::Required, "Other Payer Address Line"),
930
+ b::Element(e::Situational, "Other Payer Address Line")),
931
+ b::Segment(3400, s::N4, "Other Payer City, State, ZIP Code",
932
+ r::Situational, d::RepeatCount.bounded(1),
933
+ b::Element(e::Required, "Other Payer City Name"),
934
+ b::Element(e::Situational, "Other Payer State or Province Code"),
935
+ b::Element(e::Situational, "Other Payer Postal Zone or ZIP Code"),
936
+ b::Element(e::Situational, "Country Code"),
937
+ b::Element(e::NotUsed, "Location Qualifier"),
938
+ b::Element(e::NotUsed, "Location Identifier"),
939
+ b::Element(e::Situational, "Country Subdivision Code")),
940
+ b::Segment(3500, s::DTP, "Claim Check or Remittance Date",
941
+ r::Situational, d::RepeatCount.bounded(1),
942
+ b::Element(e::Required, "Date Time Qualifier", b::Values("573")),
943
+ b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
944
+ b::Element(e::Required, "Adjudication or Payment Date")),
945
+ b::Segment(3550, s::REF, "Other Payer Secondary Identifier",
946
+ r::Situational, d::RepeatCount.bounded(2),
947
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("2U", "EI", "FY", "NF")),
948
+ b::Element(e::Required, "Other Payer Secondary Identifier"),
949
+ b::Element(e::NotUsed, "Description"),
950
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
951
+ b::Segment(3550, s::REF, "Other Payer Prior Authorization Number",
952
+ r::Situational, d::RepeatCount.bounded(1),
953
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("G1")),
954
+ b::Element(e::Required, "Other Payer Prior Authorization Number"),
955
+ b::Element(e::NotUsed, "Description"),
956
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
957
+ b::Segment(3550, s::REF, "Other Payer Referral Number",
958
+ r::Situational, d::RepeatCount.bounded(1),
959
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("9F")),
960
+ b::Element(e::Required, "Other Payer Prior Authorization or Referral Number"),
961
+ b::Element(e::NotUsed, "Description"),
962
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
963
+ b::Segment(3550, s::REF, "Other Payer Claim Adjustment Indicator",
964
+ r::Situational, d::RepeatCount.bounded(1),
965
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("T4")),
966
+ b::Element(e::Required, "Other Payer Claim Adjustment Indicator", b::Values("Y")),
967
+ b::Element(e::NotUsed, "Description"),
968
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
969
+ b::Segment(3550, s::REF, "Other Payer Claim Control Number",
970
+ r::Situational, d::RepeatCount.bounded(1),
971
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("F8")),
972
+ b::Element(e::Required, "Other Payer's Claim Control Number"),
973
+ b::Element(e::NotUsed, "Description"),
974
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER"))),
975
+
976
+ d::LoopDef.build("2330C OTHER PAYER REFERRING PROVIDER",
977
+ d::RepeatCount.bounded(2),
978
+ b::Segment(3250, s::NM1, "Other Payer Referring Provider",
979
+ r::Situational, d::RepeatCount.bounded(1),
980
+ b::Element(e::Required, "Entity Identifier Code", b::Values("DN", "P3")),
981
+ b::Element(e::Required, "Entity Type Qualifier", b::Values("1")),
982
+ b::Element(e::NotUsed, "Name Last"),
983
+ b::Element(e::NotUsed, "Name First"),
984
+ b::Element(e::NotUsed, "Name Middle"),
985
+ b::Element(e::NotUsed, "Name Prefix"),
986
+ b::Element(e::NotUsed, "Name Suffix"),
987
+ b::Element(e::NotUsed, "Identification Code Qualifier"),
988
+ b::Element(e::NotUsed, "Identification Code"),
989
+ b::Element(e::NotUsed, "Entity Relationship Code"),
990
+ b::Element(e::NotUsed, "Entity Identifier Code"),
991
+ b::Element(e::NotUsed, "Name Last or Organization Name")),
992
+ b::Segment(3550, s::REF, "Other Payer Referring Provider Secondary Identification",
993
+ r::Required, d::RepeatCount.bounded(3),
994
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("0B", "1G", "G2")),
995
+ b::Element(e::Required, "Other Payer Referring Provider Identifier"),
996
+ b::Element(e::NotUsed, "Description"),
997
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER"))),
998
+
999
+ d::LoopDef.build("2330D OTHER PAYER RENDERING PROVIDER",
1000
+ d::RepeatCount.bounded(1),
1001
+ b::Segment(3250, s::NM1, "Other Payer Rendering Provider",
1002
+ r::Situational, d::RepeatCount.bounded(1),
1003
+ b::Element(e::Required, "Entity Identifier Code", b::Values("82")),
1004
+ b::Element(e::Required, "Entity Type Qualifier", b::Values("1", "2")),
1005
+ b::Element(e::NotUsed, "Name Last"),
1006
+ b::Element(e::NotUsed, "Name First"),
1007
+ b::Element(e::NotUsed, "Name Middle"),
1008
+ b::Element(e::NotUsed, "Name Prefix"),
1009
+ b::Element(e::NotUsed, "Name Suffix"),
1010
+ b::Element(e::NotUsed, "Identification Code Qualifier"),
1011
+ b::Element(e::NotUsed, "Identification Code"),
1012
+ b::Element(e::NotUsed, "Entity Relationship Code"),
1013
+ b::Element(e::NotUsed, "Entity Identifier Code"),
1014
+ b::Element(e::NotUsed, "Name Last or Organization Name")),
1015
+ b::Segment(3550, s::REF, "Other Payer Rendering Provider Secondary Identification",
1016
+ r::Required, d::RepeatCount.bounded(3),
1017
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("0B", "1G", "G2", "LU")),
1018
+ b::Element(e::Required, "Other Payer Rendering Provider Secondary Identifier"),
1019
+ b::Element(e::NotUsed, "Description"),
1020
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER"))),
1021
+
1022
+ d::LoopDef.build("2330E OTHER PAYER SERVICE FACILITY LOCATION",
1023
+ d::RepeatCount.bounded(1),
1024
+ b::Segment(3250, s::NM1, "Other Payer Service Facility Location",
1025
+ r::Situational, d::RepeatCount.bounded(1),
1026
+ b::Element(e::Required, "Entity Identifier Code", b::Values("77")),
1027
+ b::Element(e::Required, "Entity Type Qualifier", b::Values("2")),
1028
+ b::Element(e::NotUsed, "Name Last"),
1029
+ b::Element(e::NotUsed, "Name First"),
1030
+ b::Element(e::NotUsed, "Name Middle"),
1031
+ b::Element(e::NotUsed, "Name Prefix"),
1032
+ b::Element(e::NotUsed, "Name Suffix"),
1033
+ b::Element(e::NotUsed, "Identification Code Qualifier"),
1034
+ b::Element(e::NotUsed, "Identification Code"),
1035
+ b::Element(e::NotUsed, "Entity Relationship Code"),
1036
+ b::Element(e::NotUsed, "Entity Identifier Code"),
1037
+ b::Element(e::NotUsed, "Name Last or Organization Name")),
1038
+ b::Segment(3550, s::REF, "Other Payer Service Facility Location Secondary Identification",
1039
+ r::Required, d::RepeatCount.bounded(3),
1040
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("0B", "G2", "LU")),
1041
+ b::Element(e::Required, "Other Payer Service Facility Location Secondary Identifier"),
1042
+ b::Element(e::NotUsed, "Description"),
1043
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER"))),
1044
+
1045
+ d::LoopDef.build("2330F OTHER PAYER SUPERVISING PROVIDER",
1046
+ d::RepeatCount.bounded(1),
1047
+ b::Segment(3250, s::NM1, "Other Payer Supervising Provider",
1048
+ r::Situational, d::RepeatCount.bounded(1),
1049
+ b::Element(e::Required, "Entity Identifier Code", b::Values("DQ")),
1050
+ b::Element(e::Required, "Entity Type Qualifier", b::Values("1")),
1051
+ b::Element(e::NotUsed, "Name Last"),
1052
+ b::Element(e::NotUsed, "Name First"),
1053
+ b::Element(e::NotUsed, "Name Middle"),
1054
+ b::Element(e::NotUsed, "Name Prefix"),
1055
+ b::Element(e::NotUsed, "Name Suffix"),
1056
+ b::Element(e::NotUsed, "Identification Code Qualifier"),
1057
+ b::Element(e::NotUsed, "Identification Code"),
1058
+ b::Element(e::NotUsed, "Entity Relationship Code"),
1059
+ b::Element(e::NotUsed, "Entity Identifier Code"),
1060
+ b::Element(e::NotUsed, "Name Last or Organization Name")),
1061
+ b::Segment(3550, s::REF, "Other Payer Supervising Provider Secondary Identification",
1062
+ r::Required, d::RepeatCount.bounded(3),
1063
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("0B", "1G", "G2", "LU")),
1064
+ b::Element(e::Required, "Other Payer Supervising Provider Identifier"),
1065
+ b::Element(e::NotUsed, "Description"),
1066
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER"))),
1067
+
1068
+ d::LoopDef.build("2330G OTHER PAYER BILLING PROVIDER",
1069
+ d::RepeatCount.bounded(1),
1070
+ b::Segment(3250, s::NM1, "Other Payer Billing Provider",
1071
+ r::Situational, d::RepeatCount.bounded(1),
1072
+ b::Element(e::Required, "Entity Identifier Code", b::Values("85")),
1073
+ b::Element(e::Required, "Entity Type Qualifier", b::Values("1", "2")),
1074
+ b::Element(e::NotUsed, "Name L"),
1075
+ b::Element(e::NotUsed, "Name F"),
1076
+ b::Element(e::NotUsed, "Name M"),
1077
+ b::Element(e::NotUsed, "Name P"),
1078
+ b::Element(e::NotUsed, "Name S"),
1079
+ b::Element(e::NotUsed, "Identification Code Qualifier"),
1080
+ b::Element(e::NotUsed, "Identification Code"),
1081
+ b::Element(e::NotUsed, "Entity Relationship Code"),
1082
+ b::Element(e::NotUsed, "Entity Identifier Code"),
1083
+ b::Element(e::NotUsed, "Name Last or Organization Name")),
1084
+ b::Segment(3550, s::REF, "Other Payer Billing Provider Secondary Identification",
1085
+ r::Required, d::RepeatCount.bounded(2),
1086
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("G2", "LU")),
1087
+ b::Element(e::Required, "Other Payer Billing Provider Identifier"),
1088
+ b::Element(e::NotUsed, "Description"),
1089
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")))),
1090
+
1091
+ d::LoopDef.build("2400 SERVICE LINE NUMBER",
1092
+ d::RepeatCount.bounded(50),
1093
+ b::Segment(3650, s::LX, "Service Line Number",
1094
+ r::Required, d::RepeatCount.bounded(1),
1095
+ b::Element(e::Required, "Assigned Number")),
1096
+ b::Segment(3700, s::SV1, "Professional Service",
1097
+ r::Required, d::RepeatCount.bounded(1),
1098
+ b::Element(e::Required, "COMPOSITE MEDICAL PROCEDURE IDENTIFIER",
1099
+ b::Element(e::Required, "Product or Service ID Qualifier", b::Values("ER", "HC", "IV", "WK")),
1100
+ b::Element(e::Required, "Procedure Code"),
1101
+ b::Element(e::Situational, "Procedure Modifier"),
1102
+ b::Element(e::Situational, "Procedure Modifier"),
1103
+ b::Element(e::Situational, "Procedure Modifier"),
1104
+ b::Element(e::Situational, "Procedure Modifier"),
1105
+ b::Element(e::Situational, "Description"),
1106
+ b::Element(e::NotUsed, "Product/Service ID")),
1107
+ b::Element(e::Required, "Line Item Charge Amount"),
1108
+ b::Element(e::Required, "Unit or Basis for Measurement Code", b::Values("MJ", "UN")),
1109
+ b::Element(e::Required, "Service Unit Count", b::MaxLength(8), b::MaxPrecision(3)),
1110
+ b::Element(e::Situational, "Place of Service Code"),
1111
+ b::Element(e::NotUsed, "Service Type Code"),
1112
+ b::Element(e::Required, "COMPOSITE DIAGNOSIS CODE POINTER",
1113
+ b::Element(e::Required, "Diagnosis Code Pointer"),
1114
+ b::Element(e::Situational, "Diagnosis Code Pointer"),
1115
+ b::Element(e::Situational, "Diagnosis Code Pointer"),
1116
+ b::Element(e::Situational, "Diagnosis Code Pointer")),
1117
+ b::Element(e::NotUsed, "Monetary Amount"),
1118
+ b::Element(e::Situational, "Emergency Indicator", b::Values("Y")),
1119
+ b::Element(e::NotUsed, "Multiple Procedure Code"),
1120
+ b::Element(e::Situational, "EPSDT Indicator", b::Values("Y")),
1121
+ b::Element(e::Situational, "Family Planning Indicator", b::Values("Y")),
1122
+ b::Element(e::NotUsed, "Review Code"),
1123
+ b::Element(e::NotUsed, "National or Local Assigned Review Value"),
1124
+ b::Element(e::Situational, "Co-Pay Status Code", b::Values("0")),
1125
+ b::Element(e::NotUsed, "Health Care Professional Shortage Area Code"),
1126
+ b::Element(e::NotUsed, "Reference Identification"),
1127
+ b::Element(e::NotUsed, "Postal Code"),
1128
+ b::Element(e::NotUsed, "Monetary Amount"),
1129
+ b::Element(e::NotUsed, "Level of Care Code"),
1130
+ b::Element(e::NotUsed, "Provider Agreement Code")),
1131
+ b::Segment(4000, s::SV5, "Durable Medical Equipment Service",
1132
+ r::Situational, d::RepeatCount.bounded(1),
1133
+ b::Element(e::Required, "COMPOSITE MEDICAL PROCEDURE IDENTIFIER",
1134
+ b::Element(e::Required, "Procedure Identifier", b::Values("HC")),
1135
+ b::Element(e::Required, "Procedure Code"),
1136
+ b::Element(e::NotUsed, "Procedure Modifier"),
1137
+ b::Element(e::NotUsed, "Procedure Modifier"),
1138
+ b::Element(e::NotUsed, "Procedure Modifier"),
1139
+ b::Element(e::NotUsed, "Procedure Modifier"),
1140
+ b::Element(e::NotUsed, "Description"),
1141
+ b::Element(e::NotUsed, "Product/Service ID")),
1142
+ b::Element(e::Required, "Unit or Basis for Measurement Code"),
1143
+ b::Element(e::Required, "Length of Medical Necessity"),
1144
+ b::Element(e::Required, "DME Rental Price"),
1145
+ b::Element(e::Required, "DME Purchase Price"),
1146
+ b::Element(e::Required, "Rental Unit Price Indicator", b::Values("1", "4", "6")),
1147
+ b::Element(e::NotUsed, "Prognosis Code")),
1148
+ b::Segment(4200, s::PWK, "Line Supplemental Information",
1149
+ r::Situational, d::RepeatCount.bounded(10),
1150
+ b::Element(e::Required, "Attachment Report Type Code", b::Values("03", "04", "05", "06", "07", "08", "09", "10", "11", "13", "15", "21", "A3", "A4", "AM", "AS", "B2", "B4", "BR", "BS", "BT", "CB", "CK", "CT", "D2", "DA", "DA", "DB", "DG", "DJ", "DS", "EB", "HC", "HR", "I5", "IR", "LA", "M1", "MT", "NN", "OB", "OC", "OD", "OE", "OX", "OZ", "P4", "P5", "PE", "PN", "PO", "PQ", "PY", "PZ", "RB", "RR", "RT", "RX", "SG", "V5", "XP")),
1151
+ b::Element(e::Required, "Attachment Transmission Code", b::Values("AA", "BM", "EL", "EM", "FT", "FX")),
1152
+ b::Element(e::NotUsed, "Report Copies Needed"),
1153
+ b::Element(e::NotUsed, "Entity Identifier Code"),
1154
+ b::Element(e::Situational, "Identification Code Qualifier", b::Values("AC")),
1155
+ b::Element(e::Situational, "Attachment Control Number", b::MaxLength(50)),
1156
+ b::Element(e::NotUsed, "Description"),
1157
+ b::Element(e::NotUsed, "ACTIONS INDICATED"),
1158
+ b::Element(e::NotUsed, "Request Category Code")),
1159
+ b::Segment(4200, s::PWK, "Durable Medical Equipment Certification of Medical Necessity Indicator",
1160
+ r::Situational, d::RepeatCount.bounded(1),
1161
+ b::Element(e::Required, "Attachment Report Type Code", b::Values("CT")),
1162
+ b::Element(e::Required, "Attachment Transmission Code", b::Values("AB", "AD", "AF", "AG", "NS")),
1163
+ b::Element(e::NotUsed, "Report Copies Needed"),
1164
+ b::Element(e::NotUsed, "Entity Identifier Code"),
1165
+ b::Element(e::NotUsed, "Identification Code Qualifier"),
1166
+ b::Element(e::NotUsed, "Identification Code"),
1167
+ b::Element(e::NotUsed, "Description"),
1168
+ b::Element(e::NotUsed, "ACTIONS INDICATED"),
1169
+ b::Element(e::NotUsed, "Request Category Code")),
1170
+ b::Segment(4250, s::CR1, "Ambulance Transport Information",
1171
+ r::Situational, d::RepeatCount.bounded(1),
1172
+ b::Element(e::Situational, "Unit or Basis for Measurement Code", b::Values("LB")),
1173
+ b::Element(e::Situational, "Patient Weight"),
1174
+ b::Element(e::NotUsed, "Ambulance Transport Code"),
1175
+ b::Element(e::Required, "Ambulance Transport Reason Code", b::Values("A", "B", "C", "D", "E")),
1176
+ b::Element(e::Required, "Unit or Basis for Measurement Code", b::Values("DH")),
1177
+ b::Element(e::Required, "Transport Distance"),
1178
+ b::Element(e::NotUsed, "Address Information"),
1179
+ b::Element(e::NotUsed, "Address Information"),
1180
+ b::Element(e::Situational, "Round Trip Purpose Description"),
1181
+ b::Element(e::Situational, "Stretcher Purpose Description")),
1182
+ b::Segment(4350, s::CR3, "Durable Medical Equipment Certification",
1183
+ r::Situational, d::RepeatCount.bounded(1),
1184
+ b::Element(e::Required, "Certification Type Code", b::Values("I", "R", "S")),
1185
+ b::Element(e::Required, "Unit or Basis for Measurement Code", b::Values("MO")),
1186
+ b::Element(e::Required, "Durable Medical Equipment Duration"),
1187
+ b::Element(e::NotUsed, "Insulin Dependent Code"),
1188
+ b::Element(e::NotUsed, "Description")),
1189
+ b::Segment(4500, s::CRC, "Ambulance Certification",
1190
+ r::Situational, d::RepeatCount.bounded(3),
1191
+ b::Element(e::Required, "Code Category", b::Values("07")),
1192
+ b::Element(e::Required, "Certification Condition Indicator", b::Values("N", "Y")),
1193
+ b::Element(e::Required, "Condition Code", b::Values("01", "04", "05", "06", "07", "08", "09", "12")),
1194
+ b::Element(e::Situational, "Condition Code", b::Values("01", "04", "05", "06", "07", "08", "09", "12")),
1195
+ b::Element(e::Situational, "Condition Code", b::Values("01", "04", "05", "06", "07", "08", "09", "12")),
1196
+ b::Element(e::Situational, "Condition Code", b::Values("01", "04", "05", "06", "07", "08", "09", "12")),
1197
+ b::Element(e::Situational, "Condition Code", b::Values("01", "04", "05", "06", "07", "08", "09", "12"))),
1198
+ b::Segment(4500, s::CRC, "Hospice Employee Indicator",
1199
+ r::Situational, d::RepeatCount.bounded(1),
1200
+ b::Element(e::Required, "Code Category", b::Values("70")),
1201
+ b::Element(e::Required, "Hospice Employed Provider Indicator", b::Values("N", "Y")),
1202
+ b::Element(e::Required, "Condition Indicator", b::Values("65")),
1203
+ b::Element(e::NotUsed, "Condition Indicator"),
1204
+ b::Element(e::NotUsed, "Condition Indicator"),
1205
+ b::Element(e::NotUsed, "Condition Indicator"),
1206
+ b::Element(e::NotUsed, "Condition Indicator")),
1207
+ b::Segment(4500, s::CRC, "Condition Indicator/Durable Medical Equipment",
1208
+ r::Situational, d::RepeatCount.bounded(1),
1209
+ b::Element(e::Required, "Code Category", b::Values("09")),
1210
+ b::Element(e::Required, "Certification Condition Indicator", b::Values("Y", "N")),
1211
+ b::Element(e::Required, "Condition Indicator", b::Values("38", "ZV")),
1212
+ b::Element(e::Situational, "Condition Indicator", b::Values("38", "ZV")),
1213
+ b::Element(e::NotUsed, "Condition Indicator"),
1214
+ b::Element(e::NotUsed, "Condition Indicator"),
1215
+ b::Element(e::NotUsed, "Condition Indicator")),
1216
+ b::Segment(4550, s::DTP, "Service Date",
1217
+ r::Required, d::RepeatCount.bounded(1),
1218
+ b::Element(e::Required, "Date Time Qualifier", b::Values("472")),
1219
+ b::Element(e::Required, "Date Time Period Qualifier", b::Values("D8", "RD8")),
1220
+ b::Element(e::Required, "Service Date")),
1221
+ b::Segment(4550, s::DTP, "Prescription Date",
1222
+ r::Situational, d::RepeatCount.bounded(1),
1223
+ b::Element(e::Required, "Date Time Qualifier", b::Values("471")),
1224
+ b::Element(e::Required, "Date Time Period Qualifier", b::Values("D8")),
1225
+ b::Element(e::Required, "Prescription Date")),
1226
+ b::Segment(4550, s::DTP, "Certification Revision/Recertification Date",
1227
+ r::Situational, d::RepeatCount.bounded(1),
1228
+ b::Element(e::Required, "Date Time Qualifier", b::Values("607")),
1229
+ b::Element(e::Required, "Date Time Period Qualifier", b::Values("D8")),
1230
+ b::Element(e::Required, "Certification Revision or Recertification Date")),
1231
+ b::Segment(4550, s::DTP, "Begin Therapy Date",
1232
+ r::Situational, d::RepeatCount.bounded(1),
1233
+ b::Element(e::Required, "Date Time Qualifier", b::Values("463")),
1234
+ b::Element(e::Required, "Date Time Period Qualifier", b::Values("D8")),
1235
+ b::Element(e::Required, "Begin Therapy Date")),
1236
+ b::Segment(4550, s::DTP, "Last Certification Date",
1237
+ r::Situational, d::RepeatCount.bounded(1),
1238
+ b::Element(e::Required, "Date Time Qualifier", b::Values("461")),
1239
+ b::Element(e::Required, "Date Time Period Qualifier", b::Values("D8")),
1240
+ b::Element(e::Required, "Last Certification Date")),
1241
+ b::Segment(4550, s::DTP, "Last Seen Date",
1242
+ r::Situational, d::RepeatCount.bounded(1),
1243
+ b::Element(e::Required, "Date Time Qualifier", b::Values("304")),
1244
+ b::Element(e::Required, "Date Time Period Qualifier", b::Values("D8")),
1245
+ b::Element(e::Required, "Treatment or Therapy Date")),
1246
+ b::Segment(4550, s::DTP, "Test Date",
1247
+ r::Situational, d::RepeatCount.bounded(2),
1248
+ b::Element(e::Required, "Date Time Qualifier", b::Values("738", "739")),
1249
+ b::Element(e::Required, "Date Time Period Qualifier", b::Values("D8")),
1250
+ b::Element(e::Required, "Test Performed Date")),
1251
+ b::Segment(4550, s::DTP, "Shipped Date",
1252
+ r::Situational, d::RepeatCount.bounded(1),
1253
+ b::Element(e::Required, "Date Time Qualifier", b::Values("011")),
1254
+ b::Element(e::Required, "Date Time Period Qualifier", b::Values("D8")),
1255
+ b::Element(e::Required, "Shipped Date")),
1256
+ b::Segment(4550, s::DTP, "Last X-ray Date",
1257
+ r::Situational, d::RepeatCount.bounded(1),
1258
+ b::Element(e::Required, "Date Time Qualifier", b::Values("455")),
1259
+ b::Element(e::Required, "Date Time Period Qualifier", b::Values("D8")),
1260
+ b::Element(e::Required, "Last X-ray Date")),
1261
+ b::Segment(4550, s::DTP, "Initial Treatment Date",
1262
+ r::Situational, d::RepeatCount.bounded(1),
1263
+ b::Element(e::Required, "Date Time Qualifier", b::Values("454")),
1264
+ b::Element(e::Required, "Date Time Period Qualifier", b::Values("D8")),
1265
+ b::Element(e::Required, "Initial Treatment Date")),
1266
+ b::Segment(4600, s::QTY, "Ambulance Patient Count",
1267
+ r::Situational, d::RepeatCount.bounded(1),
1268
+ b::Element(e::Required, "Quantity Qualifier", b::Values("PT")),
1269
+ b::Element(e::Required, "Ambulance Patient Count"),
1270
+ b::Element(e::NotUsed, "COMPOSITE UNIT OF MEASURE"),
1271
+ b::Element(e::NotUsed, "Free-form Information")),
1272
+ b::Segment(4600, s::QTY, "Obstetric Anesthesia Additional Units",
1273
+ r::Situational, d::RepeatCount.bounded(1),
1274
+ b::Element(e::Required, "Quantity Qualifier", b::Values("FL")),
1275
+ b::Element(e::Required, "Obstetric Additional Units"),
1276
+ b::Element(e::NotUsed, "COMPOSITE UNIT OF MEASURE"),
1277
+ b::Element(e::NotUsed, "Free-form Information")),
1278
+ b::Segment(4620, s::MEA, "Test Result",
1279
+ r::Situational, d::RepeatCount.bounded(5),
1280
+ b::Element(e::Required, "Measurement Reference Identification Code", b::Values("OG", "TR")),
1281
+ b::Element(e::Required, "Measurement Qualifier", b::Values("HT", "R1", "R2", "R3", "R4")),
1282
+ b::Element(e::Required, "Test Results"),
1283
+ b::Element(e::NotUsed, "COMPOSITE UNIT OF MEASURE"),
1284
+ b::Element(e::NotUsed, "Range Minimum"),
1285
+ b::Element(e::NotUsed, "Range Maximum"),
1286
+ b::Element(e::NotUsed, "Measurement Significance Code"),
1287
+ b::Element(e::NotUsed, "Measurement Attribute Code"),
1288
+ b::Element(e::NotUsed, "Surface/Layer/Position Code"),
1289
+ b::Element(e::NotUsed, "Measurement Method or Device"),
1290
+ b::Element(e::NotUsed, "Code List Qualifier Code"),
1291
+ b::Element(e::NotUsed, "Industry Code")),
1292
+ b::Segment(4650, s::CN1, "Contract Information",
1293
+ r::Situational, d::RepeatCount.bounded(1),
1294
+ b::Element(e::Required, "Contract Type Code", b::Values("01", "02", "03", "04", "05", "06", "09")),
1295
+ b::Element(e::Required, "Contract Amount"),
1296
+ b::Element(e::Situational, "Contract Percentage"),
1297
+ b::Element(e::Situational, "Contract Code"),
1298
+ b::Element(e::Situational, "Terms Discount Percentage"),
1299
+ b::Element(e::Situational, "Contract Version Identifier")),
1300
+ b::Segment(4700, s::REF, "Repriced Line Item Reference Number",
1301
+ r::Situational, d::RepeatCount.bounded(1),
1302
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("9B")),
1303
+ b::Element(e::Required, "Repriced Line Item Reference Number"),
1304
+ b::Element(e::NotUsed, "Description"),
1305
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
1306
+ b::Segment(4700, s::REF, "Adjusted Repriced Line Item Reference Number",
1307
+ r::Situational, d::RepeatCount.bounded(1),
1308
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("9D")),
1309
+ b::Element(e::Required, "Adjusted Repriced Line Item Reference Number"),
1310
+ b::Element(e::NotUsed, "Description"),
1311
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
1312
+ b::Segment(4700, s::REF, "Prior Authorization",
1313
+ r::Situational, d::RepeatCount.bounded(5),
1314
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("G1")),
1315
+ b::Element(e::Required, "Prior Authorization or Referral Number"),
1316
+ b::Element(e::NotUsed, "Description"),
1317
+ b::Element(e::Situational, "REFERENCE IDENTIFIER",
1318
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("2U")),
1319
+ b::Element(e::Required, "Other Payer Primary Identifier"),
1320
+ b::Element(e::NotUsed, "Reference Identifier Qualifier"),
1321
+ b::Element(e::NotUsed, "Reference Identification"),
1322
+ b::Element(e::NotUsed, "Reference Identifier Qualifier"),
1323
+ b::Element(e::NotUsed, "Reference Identification"))),
1324
+ b::Segment(4700, s::REF, "Line Item Control Number",
1325
+ r::Situational, d::RepeatCount.bounded(1),
1326
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("6R")),
1327
+ b::Element(e::Required, "Line Item Control Number", b::MaxLength(30)),
1328
+ b::Element(e::NotUsed, "Description"),
1329
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
1330
+ b::Segment(4700, s::REF, "Mammography Certification Number",
1331
+ r::Situational, d::RepeatCount.bounded(1),
1332
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("EW")),
1333
+ b::Element(e::Required, "Mammography Certification Number"),
1334
+ b::Element(e::NotUsed, "Description"),
1335
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
1336
+ b::Segment(4700, s::REF, "Clinical Laboratory Improvement Amendment (CLIA) Number",
1337
+ r::Situational, d::RepeatCount.bounded(1),
1338
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("X4")),
1339
+ b::Element(e::Required, "Clinical Laboratory Improvement Amendment Number"),
1340
+ b::Element(e::NotUsed, "Description"),
1341
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
1342
+ b::Segment(4700, s::REF, "Referring Clinical Laboratory Improvement Amendment (CLIA) Number",
1343
+ r::Situational, d::RepeatCount.bounded(1),
1344
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("F4")),
1345
+ b::Element(e::Required, "Referring CLIA Number"),
1346
+ b::Element(e::NotUsed, "Description"),
1347
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
1348
+ b::Segment(4700, s::REF, "Immunization Batch Number",
1349
+ r::Situational, d::RepeatCount.bounded(1),
1350
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("BT")),
1351
+ b::Element(e::Required, "Immunization Batch Number"),
1352
+ b::Element(e::NotUsed, "Description"),
1353
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
1354
+ b::Segment(4700, s::REF, "Referral Number",
1355
+ r::Situational, d::RepeatCount.bounded(5),
1356
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("9F")),
1357
+ b::Element(e::Required, "Referral Number"),
1358
+ b::Element(e::NotUsed, "Description"),
1359
+ b::Element(e::Situational, "REFERENCE IDENTIFIER",
1360
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("2U")),
1361
+ b::Element(e::Required, "Other Payer Primary Identifier"),
1362
+ b::Element(e::NotUsed, "Reference Identifier Qualifier"),
1363
+ b::Element(e::NotUsed, "Reference Identification"),
1364
+ b::Element(e::NotUsed, "Reference Identifier Qualifier"),
1365
+ b::Element(e::NotUsed, "Reference Identification"))),
1366
+ b::Segment(4750, s::AMT, "Sales Tax Amount",
1367
+ r::Situational, d::RepeatCount.bounded(1),
1368
+ b::Element(e::Required, "Amount Qualifier Code", b::Values("T")),
1369
+ b::Element(e::Required, "Sales Tax Amount"),
1370
+ b::Element(e::NotUsed, "Credit/Debit Flag Code")),
1371
+ b::Segment(4750, s::AMT, "Postage Claimed Amount",
1372
+ r::Situational, d::RepeatCount.bounded(1),
1373
+ b::Element(e::Required, "Amount Qualifier Code", b::Values("F4")),
1374
+ b::Element(e::Required, "Postage Claimed Amount"),
1375
+ b::Element(e::NotUsed, "Credit/Debit Flag Code")),
1376
+ b::Segment(4800, s::K3, "File Information",
1377
+ r::Situational, d::RepeatCount.bounded(10),
1378
+ b::Element(e::Required, "Fixed Format Identification"),
1379
+ b::Element(e::NotUsed, "Record Format Code"),
1380
+ b::Element(e::NotUsed, "COMPOSITE UNIT OF MEASURE")),
1381
+ b::Segment(4850, s::NTE, "Line Note",
1382
+ r::Situational, d::RepeatCount.bounded(1),
1383
+ b::Element(e::Required, "Note Reference Code", b::Values("ADD", "DCP")),
1384
+ b::Element(e::Required, "Line Note Text")),
1385
+ b::Segment(4850, s::NTE, "Third Party Organization Notes",
1386
+ r::Situational, d::RepeatCount.bounded(1),
1387
+ b::Element(e::Required, "Note Reference Code", b::Values("TPO")),
1388
+ b::Element(e::Required, "Line Note Text")),
1389
+ b::Segment(4880, s::PS1, "Purchased Service Information",
1390
+ r::Situational, d::RepeatCount.bounded(1),
1391
+ b::Element(e::Required, "Purchased Service Provider Identifier"),
1392
+ b::Element(e::Required, "Purchased Service Charge Amount"),
1393
+ b::Element(e::NotUsed, "State or Province Code")),
1394
+ b::Segment(4920, s::HCP, "Line Pricing/Repricing Information",
1395
+ r::Situational, d::RepeatCount.bounded(1),
1396
+ b::Element(e::Required, "Pricing Methodology", b::Values("00", "01", "02", "03", "04", "05", "06", "07", "08", "09", "10", "11", "12", "13", "14")),
1397
+ b::Element(e::Required, "Repriced Allowed Amount"),
1398
+ b::Element(e::Situational, "Repciced Saving Amount"),
1399
+ b::Element(e::Situational, "Repricing Organization Identifier"),
1400
+ b::Element(e::Situational, "Repricing Per Diem or Flat Rate Amount"),
1401
+ b::Element(e::Situational, "Repriced Approved Ambulatory Patient Group Code"),
1402
+ b::Element(e::Situational, "Repriced Approved Ambulatory Patient Group Amount"),
1403
+ b::Element(e::NotUsed, "Product/Service ID"),
1404
+ b::Element(e::Situational, "Product or Service ID", b::Values("ER", "HC", "IV", "WK")),
1405
+ b::Element(e::Situational, "Repriced Approved HCPCS Code"),
1406
+ b::Element(e::Situational, "Unit or Basis for Measurement Code", b::Values("MJ", "UN")),
1407
+ b::Element(e::Situational, "Repriced Approved Service Unit Count", b::MaxLength(8), b::MaxPrecision(3)),
1408
+ b::Element(e::Situational, "Reject Reason Code", b::Values("T1", "T2", "T3", "T4", "T5", "T6")),
1409
+ b::Element(e::Situational, "Policy Compliance Code", b::Values("1", "2", "3", "4", "5")),
1410
+ b::Element(e::Situational, "Exception Code", b::Values("1", "2", "3", "4", "5", "6"))),
1411
+
1412
+ d::LoopDef.build("2410 DRUG IDENTIFICATION",
1413
+ d::RepeatCount.bounded(1),
1414
+ b::Segment(4930, s::LIN, "Drug Identification",
1415
+ r::Situational, d::RepeatCount.bounded(1),
1416
+ b::Element(e::NotUsed, "Assigned Identification"),
1417
+ b::Element(e::Required, "Product or Service ID Qualifier", b::Values("N4", "EN", "EO", "HI", "ON", "UK", "UP")),
1418
+ b::Element(e::Required, "National Drug Code or Universal Product Number"),
1419
+ b::Element(e::NotUsed, "Product/Service ID Qualifier"),
1420
+ b::Element(e::NotUsed, "Product/Service ID"),
1421
+ b::Element(e::NotUsed, "Product/Service ID Qualifier"),
1422
+ b::Element(e::NotUsed, "Product/Service ID"),
1423
+ b::Element(e::NotUsed, "Product/Service ID Qualifier"),
1424
+ b::Element(e::NotUsed, "Product/Service ID"),
1425
+ b::Element(e::NotUsed, "Product/Service ID Qualifier"),
1426
+ b::Element(e::NotUsed, "Product/Service ID"),
1427
+ b::Element(e::NotUsed, "Product/Service ID Qualifier"),
1428
+ b::Element(e::NotUsed, "Product/Service ID"),
1429
+ b::Element(e::NotUsed, "Product/Service ID Qualifier"),
1430
+ b::Element(e::NotUsed, "Product/Service ID"),
1431
+ b::Element(e::NotUsed, "Product/Service ID Qualifier"),
1432
+ b::Element(e::NotUsed, "Product/Service ID"),
1433
+ b::Element(e::NotUsed, "Product/Service ID Qualifier"),
1434
+ b::Element(e::NotUsed, "Product/Service ID"),
1435
+ b::Element(e::NotUsed, "Product/Service ID Qualifier"),
1436
+ b::Element(e::NotUsed, "Product/Service ID"),
1437
+ b::Element(e::NotUsed, "Product/Service ID Qualifier"),
1438
+ b::Element(e::NotUsed, "Product/Service ID"),
1439
+ b::Element(e::NotUsed, "Product/Service ID Qualifier"),
1440
+ b::Element(e::NotUsed, "Product/Service ID"),
1441
+ b::Element(e::NotUsed, "Product/Service ID Qualifier"),
1442
+ b::Element(e::NotUsed, "Product/Service ID"),
1443
+ b::Element(e::NotUsed, "Product/Service ID Qualifier"),
1444
+ b::Element(e::NotUsed, "Product/Service ID"),
1445
+ b::Element(e::NotUsed, "Product/Service ID Qualifier"),
1446
+ b::Element(e::NotUsed, "Product/Service ID")),
1447
+ b::Segment(4940, s::CTP, "Drug Quantity",
1448
+ r::Required, d::RepeatCount.bounded(1),
1449
+ b::Element(e::NotUsed, "Class of Trade Code"),
1450
+ b::Element(e::NotUsed, "Price Identifier Code"),
1451
+ b::Element(e::NotUsed, "Unit Price"),
1452
+ b::Element(e::Required, "National Drug Unit Count"),
1453
+ b::Element(e::Required, "COMPOSITE UNIT OF MEASURE",
1454
+ b::Element(e::Required, "Unit or Basis for Measurement Code", b::Values("F2", "GR", "ME", "ML", "UN")),
1455
+ b::Element(e::NotUsed, "Exponent"),
1456
+ b::Element(e::NotUsed, "Multiplier"),
1457
+ b::Element(e::NotUsed, "Unit or Basis for Measurement Code"),
1458
+ b::Element(e::NotUsed, "Exponent"),
1459
+ b::Element(e::NotUsed, "Multiplier"),
1460
+ b::Element(e::NotUsed, "Unit or Basis for Measurement Code"),
1461
+ b::Element(e::NotUsed, "Exponent"),
1462
+ b::Element(e::NotUsed, "Multiplier"),
1463
+ b::Element(e::NotUsed, "Unit or Basis for Measurement Code"),
1464
+ b::Element(e::NotUsed, "Exponent"),
1465
+ b::Element(e::NotUsed, "Multiplier"),
1466
+ b::Element(e::NotUsed, "Unit or Basis for Measurement Code"),
1467
+ b::Element(e::NotUsed, "Exponent"),
1468
+ b::Element(e::NotUsed, "Multiplier")),
1469
+ b::Element(e::NotUsed, "Price Multiplier Qualifier"),
1470
+ b::Element(e::NotUsed, "Multiplier"),
1471
+ b::Element(e::NotUsed, "Monetary Amount"),
1472
+ b::Element(e::NotUsed, "Basis of Unit Price Code"),
1473
+ b::Element(e::NotUsed, "Condition Value"),
1474
+ b::Element(e::NotUsed, "Multiple Price Quantity")),
1475
+ b::Segment(4950, s::REF, "Rendering Provider Secondary Identification",
1476
+ r::Situational, d::RepeatCount.bounded(1),
1477
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("VY", "XZ")),
1478
+ b::Element(e::Required, "Prescription Number"),
1479
+ b::Element(e::NotUsed, "Description"),
1480
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER"))),
1481
+
1482
+ d::LoopDef.build("2420A RENDERING PROVIDER NAME",
1483
+ d::RepeatCount.bounded(1),
1484
+ b::Segment(5000, s::NM1, "Rendering Provider Name",
1485
+ r::Situational, d::RepeatCount.bounded(1),
1486
+ b::Element(e::Required, "Entity Identifier Code", b::Values("82")),
1487
+ b::Element(e::Required, "Entity Type Qualifier", b::Values("1", "2")),
1488
+ b::Element(e::Required, "Rendering Provider Last Name"),
1489
+ b::Element(e::Situational, "Rendering Provider First Name"),
1490
+ b::Element(e::Situational, "Rendering Provider Middle Name or Initial"),
1491
+ b::Element(e::NotUsed, "Name Prefix"),
1492
+ b::Element(e::Situational, "Rendering Provider Suffix"),
1493
+ b::Element(e::Situational, "Identification Code Qualifier", b::Values("XX")),
1494
+ b::Element(e::Situational, "Rendering Provider Identifier"),
1495
+ b::Element(e::NotUsed, "Entity Relationship Code"),
1496
+ b::Element(e::NotUsed, "Entity Identifier Code"),
1497
+ b::Element(e::NotUsed, "Name Last or Organization Name")),
1498
+ b::Segment(5050, s::PRV, "Rendering Provider Specialty Information",
1499
+ r::Situational, d::RepeatCount.bounded(1),
1500
+ b::Element(e::Required, "Provider Code", b::Values("PE")),
1501
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("PXC")),
1502
+ b::Element(e::Required, "Provider Taxonmy Code"),
1503
+ b::Element(e::NotUsed, "State or Province Code"),
1504
+ b::Element(e::NotUsed, "PROVIDER SPECIALTY INFORMATION"),
1505
+ b::Element(e::NotUsed, "Provider Organization Code")),
1506
+ b::Segment(5250, s::REF, "Rendering Provider Secondary Identification",
1507
+ r::Situational, d::RepeatCount.bounded(20),
1508
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("0B", "1G", "G2", "LU")),
1509
+ b::Element(e::Required, "Rendering Provider Secondary Identifier"),
1510
+ b::Element(e::NotUsed, "Description"),
1511
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER"))),
1512
+
1513
+ d::LoopDef.build("2420B PURCHASED SERVICE PROVIDER NAME",
1514
+ d::RepeatCount.bounded(1),
1515
+ b::Segment(5000, s::NM1, "Purchased Service Provider Name",
1516
+ r::Situational, d::RepeatCount.bounded(1),
1517
+ b::Element(e::Required, "Entity Identifier Code", b::Values("QB")),
1518
+ b::Element(e::Required, "Entity Type Qualifier", b::Values("1", "2")),
1519
+ b::Element(e::NotUsed, "Name Last"),
1520
+ b::Element(e::NotUsed, "Name First"),
1521
+ b::Element(e::NotUsed, "Name Middle"),
1522
+ b::Element(e::NotUsed, "Name Prefix"),
1523
+ b::Element(e::NotUsed, "Name Suffix"),
1524
+ b::Element(e::Situational, "Identification Code Qualifier", b::Values("XX")),
1525
+ b::Element(e::Situational, "Purchased Service Provider Identifier"),
1526
+ b::Element(e::NotUsed, "Entity Relationship Code"),
1527
+ b::Element(e::NotUsed, "Entity Identifier Code"),
1528
+ b::Element(e::NotUsed, "Name Last or Organization Name")),
1529
+ b::Segment(5250, s::REF, "Purchased Service Provider Secondary Identification",
1530
+ r::Situational, d::RepeatCount.bounded(20),
1531
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("0B", "1G", "G2")),
1532
+ b::Element(e::Required, "Purchased Service Provider Secondary Identifier"),
1533
+ b::Element(e::NotUsed, "Description"),
1534
+ b::Element(e::Situational, "REFERENCE IDENTIFIER",
1535
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("2U")),
1536
+ b::Element(e::Required, "Other Payer Primary Identifier"),
1537
+ b::Element(e::NotUsed, "Reference Identifier Qualifier"),
1538
+ b::Element(e::NotUsed, "Reference Identifier"),
1539
+ b::Element(e::NotUsed, "Reference Identifier Qualifier"),
1540
+ b::Element(e::NotUsed, "Reference Identifier")))),
1541
+
1542
+ d::LoopDef.build("2420C SERVICE FACILITY LOCATION NAME",
1543
+ d::RepeatCount.bounded(1),
1544
+ b::Segment(5000, s::NM1, "Service Facility Location Name",
1545
+ r::Situational, d::RepeatCount.bounded(1),
1546
+ b::Element(e::Required, "Entity Identifier Code", b::Values("77")),
1547
+ b::Element(e::Required, "Entity Type Qualifier", b::Values("2")),
1548
+ b::Element(e::Required, "Laboratory or Facility Name"),
1549
+ b::Element(e::NotUsed, "Name First"),
1550
+ b::Element(e::NotUsed, "Name Middle"),
1551
+ b::Element(e::NotUsed, "Name Prefix"),
1552
+ b::Element(e::NotUsed, "Name Suffix"),
1553
+ b::Element(e::Situational, "Identification Code Qualifier", b::Values("XX")),
1554
+ b::Element(e::Situational, "Laboratory or Facility Primary Identifier"),
1555
+ b::Element(e::NotUsed, "Entity Relationship Code"),
1556
+ b::Element(e::NotUsed, "Entity Identifier Code"),
1557
+ b::Element(e::NotUsed, "Name Last or Organization Name")),
1558
+ b::Segment(5140, s::N3, "Service Facility Location Address",
1559
+ r::Required, d::RepeatCount.bounded(1),
1560
+ b::Element(e::Required, "Laboratory or Facility Address Line"),
1561
+ b::Element(e::Situational, "Laboratory or Facility Address Line")),
1562
+ b::Segment(5200, s::N4, "Service Facility Location City, State, ZIP Code",
1563
+ r::Required, d::RepeatCount.bounded(1),
1564
+ b::Element(e::Required, "Laboratory or Facility City Name"),
1565
+ b::Element(e::Situational, "Laboratory or Facility State or Province Code"),
1566
+ b::Element(e::Situational, "Laboratory or Facility Postal Zone or ZIP Code"),
1567
+ b::Element(e::Situational, "Country Code"),
1568
+ b::Element(e::NotUsed, "Location Qualifier"),
1569
+ b::Element(e::NotUsed, "Location Identifier"),
1570
+ b::Element(e::Situational, "Country Subdivision Code")),
1571
+ b::Segment(5250, s::REF, "Service Facility Location Secondary Identification",
1572
+ r::Situational, d::RepeatCount.bounded(3),
1573
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("G2", "LU")),
1574
+ b::Element(e::Required, "Service Facility Location Secondary Identifier"),
1575
+ b::Element(e::NotUsed, "Description"),
1576
+ b::Element(e::Situational, "REFERENCE IDENTIFIER",
1577
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("2U")),
1578
+ b::Element(e::Required, "Other Payer Primary Identifier"),
1579
+ b::Element(e::NotUsed, "Reference Identification Qualifier"),
1580
+ b::Element(e::NotUsed, "Reference Identification"),
1581
+ b::Element(e::NotUsed, "Reference Identification Qualifier"),
1582
+ b::Element(e::NotUsed, "Reference Identification")))),
1583
+
1584
+ d::LoopDef.build("2420D SUPERVISING PROVIDER NAME",
1585
+ d::RepeatCount.bounded(1),
1586
+ b::Segment(5000, s::NM1, "Supervising Provider Name",
1587
+ r::Situational, d::RepeatCount.bounded(1),
1588
+ b::Element(e::Required, "Entity Identifier Code", b::Values("DQ")),
1589
+ b::Element(e::Required, "Entity Type Qualifier", b::Values("1")),
1590
+ b::Element(e::Required, "Supervising Provider Last"),
1591
+ b::Element(e::Situational, "Supervising Provider First"),
1592
+ b::Element(e::Situational, "Supervising Provider Middle"),
1593
+ b::Element(e::NotUsed, "Name Prefix"),
1594
+ b::Element(e::Situational, "Supervising Provider Suffix"),
1595
+ b::Element(e::Situational, "Identification Code Qualifier", b::Values("XX")),
1596
+ b::Element(e::Situational, "Supervising Provider Identifier"),
1597
+ b::Element(e::NotUsed, "Entity Relationship Code"),
1598
+ b::Element(e::NotUsed, "Entity Identifier Code"),
1599
+ b::Element(e::NotUsed, "Name Last or Organization Name")),
1600
+ b::Segment(5250, s::REF, "Supervising Provider Secondary Identification",
1601
+ r::Situational, d::RepeatCount.bounded(20),
1602
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("0B", "1G", "G2", "LU")),
1603
+ b::Element(e::Required, "Supervising Provider Secondary Identifier"),
1604
+ b::Element(e::NotUsed, "Description"),
1605
+ b::Element(e::Situational, "REFERENCE IDENTIFIER",
1606
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("2U")),
1607
+ b::Element(e::Required, "Other Payer Primary Identifier"),
1608
+ b::Element(e::Required, "Reference Identification Qualifier"),
1609
+ b::Element(e::Required, "Reference Identification"),
1610
+ b::Element(e::Required, "Reference Identification Qualifier"),
1611
+ b::Element(e::Required, "Reference Identification")))),
1612
+
1613
+ d::LoopDef.build("2420E ORDERING PROVIDER NAME",
1614
+ d::RepeatCount.bounded(1),
1615
+ b::Segment(5000, s::NM1, "Ordering Provider Name",
1616
+ r::Situational, d::RepeatCount.bounded(1),
1617
+ b::Element(e::Required, "Entity Identifier Code", b::Values("DK")),
1618
+ b::Element(e::Required, "Entity Type Qualifier", b::Values("1")),
1619
+ b::Element(e::Required, "Ordering Provider Last"),
1620
+ b::Element(e::Situational, "Ordering Provider First"),
1621
+ b::Element(e::Situational, "Ordering Provider Middle"),
1622
+ b::Element(e::NotUsed, "Name Prefix"),
1623
+ b::Element(e::Situational, "Ordering Provider Suffix"),
1624
+ b::Element(e::Situational, "Identification Code Qualifier", b::Values("XX")),
1625
+ b::Element(e::Situational, "Ordering Provider Identifier"),
1626
+ b::Element(e::NotUsed, "Entity Relationship Code"),
1627
+ b::Element(e::NotUsed, "Entity Identifier Code"),
1628
+ b::Element(e::NotUsed, "Name Last or Organization Name")),
1629
+ b::Segment(5140, s::N3, "Ordering Provider Address",
1630
+ r::Situational, d::RepeatCount.bounded(1),
1631
+ b::Element(e::Required, "Ordering Provider Address Line"),
1632
+ b::Element(e::Situational, "Ordering Provider Address Line")),
1633
+ b::Segment(5200, s::N4, "Ordering Provider City, State, ZIP Code",
1634
+ r::Situational, d::RepeatCount.bounded(1),
1635
+ b::Element(e::Required, "Ordering Provider City Name"),
1636
+ b::Element(e::Situational, "Ordering Provider State or Province Code"),
1637
+ b::Element(e::Situational, "Ordering Provider Postal Zone or ZIP Code"),
1638
+ b::Element(e::Situational, "Country Code"),
1639
+ b::Element(e::NotUsed, "Location Qualifier"),
1640
+ b::Element(e::NotUsed, "Location Identifier"),
1641
+ b::Element(e::Situational, "Country Subdivision Code")),
1642
+ b::Segment(5250, s::REF, "Ordering Provider Secondary Identification",
1643
+ r::Situational, d::RepeatCount.bounded(20),
1644
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("0B", "1G", "G2")),
1645
+ b::Element(e::Required, "Ordering Provider Secondary Identifier"),
1646
+ b::Element(e::NotUsed, "Description"),
1647
+ b::Element(e::Situational, "REFERENCE IDENTIFIER",
1648
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("2U")),
1649
+ b::Element(e::Required, "Other Payer Primary Identifier"),
1650
+ b::Element(e::NotUsed, "Reference Identification Qualifier"),
1651
+ b::Element(e::NotUsed, "Reference Identification"),
1652
+ b::Element(e::NotUsed, "Reference Identification Qualifier"),
1653
+ b::Element(e::NotUsed, "Reference Identification"))),
1654
+ b::Segment(5300, s::PER, "Ordering Provider Contact Information",
1655
+ r::Situational, d::RepeatCount.bounded(1),
1656
+ b::Element(e::Required, "Contact Function Code", b::Values("IC")),
1657
+ b::Element(e::Situational, "Ordering Provider Contact Name"),
1658
+ b::Element(e::Required, "Communication Number Qualifier", b::Values("EM", "FX", "TE")),
1659
+ b::Element(e::Required, "Communication Number"),
1660
+ b::Element(e::Situational, "Communication Number Qualifier", b::Values("EM", "EX", "FX", "TE")),
1661
+ b::Element(e::Situational, "Communication Number"),
1662
+ b::Element(e::Situational, "Communication Number Qualifier", b::Values("EM", "EX", "FX", "TE")),
1663
+ b::Element(e::Situational, "Communication Number"),
1664
+ b::Element(e::NotUsed, "Contact Inquiry Reference"))),
1665
+
1666
+ d::LoopDef.build("2420F REFERRING PROVIDER NAME",
1667
+ d::RepeatCount.bounded(2),
1668
+ b::Segment(5000, s::NM1, "Referring Provider Name",
1669
+ r::Situational, d::RepeatCount.bounded(1),
1670
+ b::Element(e::Required, "Entity Identifier Code", b::Values("DN", "P3")),
1671
+ b::Element(e::Required, "Entity Type Qualifier", b::Values("1")),
1672
+ b::Element(e::Required, "Referring Provider Last"),
1673
+ b::Element(e::Situational, "Referring Provider First"),
1674
+ b::Element(e::Situational, "Referring Provider Middle"),
1675
+ b::Element(e::NotUsed, "Name Prefix"),
1676
+ b::Element(e::Situational, "Referring Provider Suffix"),
1677
+ b::Element(e::Situational, "Identification Code Qualifier", b::Values("XX")),
1678
+ b::Element(e::Situational, "Referring Provider Identifier"),
1679
+ b::Element(e::NotUsed, "Entity Relationship Code"),
1680
+ b::Element(e::NotUsed, "Entity Identifier Code"),
1681
+ b::Element(e::NotUsed, "Name Last or Organization Name")),
1682
+ b::Segment(5250, s::REF, "Referring Provider Secondary Identification",
1683
+ r::Situational, d::RepeatCount.bounded(20),
1684
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("0B", "1G", "G2")),
1685
+ b::Element(e::Required, "Referring Provider Secondary Identifier"),
1686
+ b::Element(e::NotUsed, "Description"),
1687
+ b::Element(e::Situational, "REFERENCE IDENTIFIER",
1688
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("2U")),
1689
+ b::Element(e::Required, "Other Payer Primary Identifier"),
1690
+ b::Element(e::NotUsed, "Reference Identification Qualifier"),
1691
+ b::Element(e::NotUsed, "Reference Identification"),
1692
+ b::Element(e::NotUsed, "Reference Identification Qualifier"),
1693
+ b::Element(e::NotUsed, "Reference Identification")))),
1694
+
1695
+ d::LoopDef.build("2420G AMBULANCE PICK-UP LOCATION",
1696
+ d::RepeatCount.bounded(1),
1697
+ b::Segment(5000, s::NM1, "Ambulance Pick-up Location",
1698
+ r::Situational, d::RepeatCount.bounded(1),
1699
+ b::Element(e::Required, "Entity Identifier Code", b::Values("PW")),
1700
+ b::Element(e::Required, "Entity Type Qualifier", b::Values("2")),
1701
+ b::Element(e::NotUsed, "Name Last"),
1702
+ b::Element(e::NotUsed, "Name First"),
1703
+ b::Element(e::NotUsed, "Name Middle"),
1704
+ b::Element(e::NotUsed, "Name Prefix"),
1705
+ b::Element(e::NotUsed, "Name Suffix"),
1706
+ b::Element(e::NotUsed, "Identification Code Qualifier"),
1707
+ b::Element(e::NotUsed, "Identification Code"),
1708
+ b::Element(e::NotUsed, "Entity Relationship Code"),
1709
+ b::Element(e::NotUsed, "Entity Identifier Code"),
1710
+ b::Element(e::NotUsed, "Name Last or Organization Name")),
1711
+ b::Segment(5140, s::N3, "Ambulance Pick-up Location Address",
1712
+ r::Required, d::RepeatCount.bounded(1),
1713
+ b::Element(e::Required, "Ambulance Pick-up Address Line"),
1714
+ b::Element(e::Situational, "Ambulance Pick-up Address Line")),
1715
+ b::Segment(5200, s::N4, "Ambulance Pick-up Location City, State, ZIP Code",
1716
+ r::Required, d::RepeatCount.bounded(1),
1717
+ b::Element(e::Required, "Ambulance Pick-up City Name"),
1718
+ b::Element(e::Situational, "Ambulance Pick-up State or Province Code"),
1719
+ b::Element(e::Situational, "Ambulance Pick-up Postal Zone or ZIP Code"),
1720
+ b::Element(e::Situational, "Country Code"),
1721
+ b::Element(e::NotUsed, "Location Qualifier"),
1722
+ b::Element(e::NotUsed, "Location Identifier"),
1723
+ b::Element(e::Situational, "Country Subdivision Code"))),
1724
+
1725
+ d::LoopDef.build("2420H AMBULANCE DROP-OFF LOCATION",
1726
+ d::RepeatCount.bounded(1),
1727
+ b::Segment(5000, s::NM1, "Ambulance Drop-off Location",
1728
+ r::Situational, d::RepeatCount.bounded(1),
1729
+ b::Element(e::Required, "Entity Identifier Code", b::Values("45")),
1730
+ b::Element(e::Required, "Entity Type Qualifier", b::Values("2")),
1731
+ b::Element(e::Situational, "Ambulance Drop-off Location"),
1732
+ b::Element(e::NotUsed, "Name First"),
1733
+ b::Element(e::NotUsed, "Name Middle"),
1734
+ b::Element(e::NotUsed, "Name Prefix"),
1735
+ b::Element(e::NotUsed, "Name Suffix"),
1736
+ b::Element(e::NotUsed, "Identification Code Qualifier"),
1737
+ b::Element(e::NotUsed, "Identification Code"),
1738
+ b::Element(e::NotUsed, "Entity Relationship Code"),
1739
+ b::Element(e::NotUsed, "Entity Identifier Code"),
1740
+ b::Element(e::NotUsed, "Name Last or Organization Name")),
1741
+ b::Segment(5140, s::N3, "Ambulance Drop-off Location Address",
1742
+ r::Required, d::RepeatCount.bounded(1),
1743
+ b::Element(e::Required, "Ambulance Drop-off Address Line"),
1744
+ b::Element(e::Situational, "Ambulance Drop-off Address Line")),
1745
+ b::Segment(5200, s::N4, "Ambulance Drop-off Location City, State, ZIP Code",
1746
+ r::Required, d::RepeatCount.bounded(1),
1747
+ b::Element(e::Required, "Ambulance Drop-off City Name"),
1748
+ b::Element(e::Situational, "Ambulance Drop-off State or Province Code"),
1749
+ b::Element(e::Situational, "Ambulance Drop-off Postal Zone or ZIP Code"),
1750
+ b::Element(e::Situational, "Country Code"),
1751
+ b::Element(e::NotUsed, "Location Qualifier"),
1752
+ b::Element(e::NotUsed, "Location Identifier"),
1753
+ b::Element(e::Situational, "Country Subdivision Code"))),
1754
+
1755
+ d::LoopDef.build("2430 LINE ADJUDICATION INFORMATION",
1756
+ d::RepeatCount.bounded(15),
1757
+ b::Segment(5400, s::SVD, "Line Adjudication Information",
1758
+ r::Situational, d::RepeatCount.bounded(1),
1759
+ b::Element(e::Required, "Other Payer Primary Identifier"),
1760
+ b::Element(e::Required, "Service Line Paid Amount"),
1761
+ b::Element(e::Required, "COMPOSITE MEDICAL PROCEDURE IDENTIFIER",
1762
+ b::Element(e::Required, "Product or Service ID Qualifier", b::Values("ER", "HC", "IV", "WK")),
1763
+ b::Element(e::Required, "Procedure Code"),
1764
+ b::Element(e::Situational, "Procedure Modifier"),
1765
+ b::Element(e::Situational, "Procedure Modifier"),
1766
+ b::Element(e::Situational, "Procedure Modifier"),
1767
+ b::Element(e::Situational, "Procedure Modifier"),
1768
+ b::Element(e::Situational, "Procedure Code Description"),
1769
+ b::Element(e::NotUsed, "Product/Service ID")),
1770
+ b::Element(e::NotUsed, "Product/Service ID"),
1771
+ b::Element(e::Required, "Paid Service Unit Count", b::MaxLength(8), b::MaxPrecision(3)),
1772
+ b::Element(e::Situational, "Bundled or Unbundled Line Number")),
1773
+ b::Segment(5450, s::CAS, "Line Adjustment",
1774
+ r::Situational, d::RepeatCount.bounded(5),
1775
+ b::Element(e::Required, "Claim Adjustment Group Code", b::Values("CO", "CR", "OA", "PI", "PR")),
1776
+ b::Element(e::Required, "Adjustment Reason Code"),
1777
+ b::Element(e::Required, "Adjustment Amount"),
1778
+ b::Element(e::Situational, "Adjustment Quantity"),
1779
+ b::Element(e::Situational, "Adjustment Reason Code"),
1780
+ b::Element(e::Situational, "Adjustment Amount"),
1781
+ b::Element(e::Situational, "Adjustment Quantity"),
1782
+ b::Element(e::Situational, "Adjustment Reason Code"),
1783
+ b::Element(e::Situational, "Adjustment Amount"),
1784
+ b::Element(e::Situational, "Adjustment Quantity"),
1785
+ b::Element(e::Situational, "Adjustment Reason Code"),
1786
+ b::Element(e::Situational, "Adjustment Amount"),
1787
+ b::Element(e::Situational, "Adjustment Quantity"),
1788
+ b::Element(e::Situational, "Adjustment Reason Code"),
1789
+ b::Element(e::Situational, "Adjustment Amount"),
1790
+ b::Element(e::Situational, "Adjustment Quantity"),
1791
+ b::Element(e::Situational, "Adjustment Reason Code"),
1792
+ b::Element(e::Situational, "Adjustment Amount"),
1793
+ b::Element(e::Situational, "Adjustment Quantity")),
1794
+ b::Segment(5500, s::DTP, "Line Check or Remittance Date",
1795
+ r::Required, d::RepeatCount.bounded(1),
1796
+ b::Element(e::Required, "Date Time Qualifier", b::Values("573")),
1797
+ b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
1798
+ b::Element(e::Required, "Adjudication or Payment Date")),
1799
+ b::Segment(5505, s::AMT, "Remaining Patient Liability",
1800
+ r::Situational, d::RepeatCount.bounded(1),
1801
+ b::Element(e::Required, "Amount Qualifier Code"),
1802
+ b::Element(e::Required, "Remaining Patient Liability"),
1803
+ b::Element(e::NotUsed, "Credit/Debit Flag Code"))),
1804
+
1805
+ d::LoopDef.build("2440 FORM IDENTIFICATION CODE",
1806
+ d::RepeatCount.unbounded,
1807
+ b::Segment(5510, s::LQ, "Form Identification Code",
1808
+ r::Situational, d::RepeatCount.bounded(1),
1809
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("AS", "UT")),
1810
+ b::Element(e::Required, "Form Identifier")),
1811
+ b::Segment(5520, s::FRM, "Supporting Documentation",
1812
+ r::Required, d::RepeatCount.bounded(99),
1813
+ b::Element(e::Required, "Question Number/Letter"),
1814
+ b::Element(e::Situational, "Question Response", b::Values("N", "W", "Y")),
1815
+ b::Element(e::Situational, "Question Response"),
1816
+ b::Element(e::Situational, "Question Response"),
1817
+ b::Element(e::Situational, "Question Response")))))
1818
+
1819
+ HC837P = b.build(t::HC837,
1820
+ d::TableDef.header("Table 1 - Header",
1821
+ b::Segment(50, s::ST, "Transaction Set Header",
1822
+ r::Required, d::RepeatCount.bounded(1),
1823
+ b::Element(e::Required, "Transaction Set Identifier Code", b::Values("837")),
1824
+ b::Element(e::Required, "Transaction Set Control Number"),
1825
+ b::Element(e::Required, "Implementation Guide Version Name", b::Values("005010X222A1"))),
1826
+ b::Segment(100, s::BHT, "Beginning of Hierarchical Transaction",
1827
+ r::Required, d::RepeatCount.bounded(1),
1828
+ b::Element(e::Required, "Hierarchical Structure Code", b::Values("0019")),
1829
+ b::Element(e::Required, "Transaction Set Purpose Code", b::Values("00", "18")),
1830
+ b::Element(e::Required, "Originator Application Transaction Identifier", b::MaxLength(30)),
1831
+ b::Element(e::Required, "Transaction Set Creation Date"),
1832
+ b::Element(e::Required, "Transaction Set Creation Time"),
1833
+ b::Element(e::Required, "Claim or Encounter Identifier", b::Values("31", "CH", "RP"))),
1834
+
1835
+ d::LoopDef.build("1000A SUBMITTER NAME",
1836
+ d::RepeatCount.bounded(1),
1837
+ b::Segment(200, s::NM1, "Submitter Name",
1838
+ r::Required, d::RepeatCount.bounded(1),
1839
+ b::Element(e::Required, "Entity Identifier Code", b::Values("41")),
1840
+ b::Element(e::Required, "Entity Type Qualifier", b::Values("1", "2")),
1841
+ b::Element(e::Required, "Submitter Last or Organization Name"),
1842
+ b::Element(e::Situational, "Submitter First Name"),
1843
+ b::Element(e::Situational, "Submitter Middle Name or Initial"),
1844
+ b::Element(e::NotUsed, "Name Prefix"),
1845
+ b::Element(e::NotUsed, "Name Suffix"),
1846
+ b::Element(e::Required, "Identification Qualifier Code", b::Values("46")),
1847
+ b::Element(e::Required, "Submitter Identifier"),
1848
+ b::Element(e::NotUsed, "Entity Relationship Code"),
1849
+ b::Element(e::NotUsed, "Entity Identifier Code"),
1850
+ b::Element(e::NotUsed, "Name Last or Organization Name")),
1851
+ b::Segment(450, s::PER, "Submitter EDI Contact Information",
1852
+ r::Required, d::RepeatCount.bounded(2),
1853
+ b::Element(e::Required, "Contact Function Code", b::Values("IC")),
1854
+ b::Element(e::Situational, "Submitter Contact Name"),
1855
+ b::Element(e::Required, "Communication Number Qualifier", b::Values("EM", "FX", "TE")),
1856
+ b::Element(e::Required, "Communication Number"),
1857
+ b::Element(e::Situational, "Communication Number Qualifier", b::Values("EM", "EX", "FX", "TE")),
1858
+ b::Element(e::Situational, "Communication Number"),
1859
+ b::Element(e::Situational, "Communication Number Qualifier", b::Values("EM", "EX", "FX", "TE")),
1860
+ b::Element(e::Situational, "Communication Number"),
1861
+ b::Element(e::NotUsed, "Contact Inquiry Reference"))),
1862
+
1863
+ d::LoopDef.build("1000B RECEIVER NAME",
1864
+ d::RepeatCount.bounded(1),
1865
+ b::Segment(200, s::NM1, "Receiver Name",
1866
+ r::Required, d::RepeatCount.bounded(1),
1867
+ b::Element(e::Required, "Entity Identifier Code", b::Values("40")),
1868
+ b::Element(e::Required, "Entity Type Qualifier", b::Values("2")),
1869
+ b::Element(e::Required, "Receiver Name"),
1870
+ b::Element(e::NotUsed, "Name First"),
1871
+ b::Element(e::NotUsed, "Name Last"),
1872
+ b::Element(e::NotUsed, "Name Prefix"),
1873
+ b::Element(e::NotUsed, "Name Suffix"),
1874
+ b::Element(e::Required, "Identification Code Qualifier", b::Values("46")),
1875
+ b::Element(e::Required, "Receiver Primary Identifier"),
1876
+ b::Element(e::NotUsed, "Entity Relationship Code"),
1877
+ b::Element(e::NotUsed, "Entity Identifier Code"),
1878
+ b::Element(e::NotUsed, "Name Last or Organization Name")))),
1879
+
1880
+ d::TableDef.detail("Table 2 - Billing Provider Detail",
1881
+ d::LoopDef.build("2000A BILLING PROVIDER HIERARCHICAL LEVEL",
1882
+ d::RepeatCount.unbounded,
1883
+ b::Segment(10, s::HL, "Billing Provider Hierarchical Level",
1884
+ r::Required, d::RepeatCount.bounded(1),
1885
+ b::Element(e::Required, "Hierarchical ID Number"),
1886
+ b::Element(e::NotUsed, "Hierarchical Parent ID Number"),
1887
+ b::Element(e::Required, "Hierarchical Level Code", b::Values("20")),
1888
+ b::Element(e::Required, "Hierachical Child Code")),
1889
+ b::Segment(30, s::PRV, "Billing Provider Specialty Information",
1890
+ r::Situational, d::RepeatCount.bounded(1),
1891
+ b::Element(e::Required, "Provider Code", b::Values("BI")),
1892
+ b::Element(e::Required, "Reference Identification Number", b::Values("PXC")),
1893
+ b::Element(e::Required, "Provider Taxonomy Code"),
1894
+ b::Element(e::NotUsed, "State or Province Code"),
1895
+ b::Element(e::NotUsed, "PROVIDER SPECIALTY INFORMATION"),
1896
+ b::Element(e::NotUsed, "Provider Organization Code")),
1897
+ b::Segment(100, s::CUR, "Foreign Currency Information",
1898
+ r::Situational, d::RepeatCount.bounded(1),
1899
+ b::Element(e::Required, "Entity Identifier Code", b::Values("85")),
1900
+ b::Element(e::Required, "Currency Code"),
1901
+ b::Element(e::NotUsed, "Exchange Rate"),
1902
+ b::Element(e::NotUsed, "Entity Identifier Code"),
1903
+ b::Element(e::NotUsed, "Currency Code"),
1904
+ b::Element(e::NotUsed, "Currency Market/Exchange Code"),
1905
+ b::Element(e::NotUsed, "Date/Time Qualifier"),
1906
+ b::Element(e::NotUsed, "Date"),
1907
+ b::Element(e::NotUsed, "Time"),
1908
+ b::Element(e::NotUsed, "Date/Time Qualifier"),
1909
+ b::Element(e::NotUsed, "Date"),
1910
+ b::Element(e::NotUsed, "Time"),
1911
+ b::Element(e::NotUsed, "Date/Time Qualifier"),
1912
+ b::Element(e::NotUsed, "Date"),
1913
+ b::Element(e::NotUsed, "Time"),
1914
+ b::Element(e::NotUsed, "Date/Time Qualifier"),
1915
+ b::Element(e::NotUsed, "Date"),
1916
+ b::Element(e::NotUsed, "Time"),
1917
+ b::Element(e::NotUsed, "Date/Time Qualifier"),
1918
+ b::Element(e::NotUsed, "Date"),
1919
+ b::Element(e::NotUsed, "Time")),
1920
+
1921
+ d::LoopDef.build("2010AA BILLING PROVIDER NAME",
1922
+ d::RepeatCount.bounded(1),
1923
+ b::Segment(150, s::NM1, "Billing Provider Name",
1924
+ r::Required, d::RepeatCount.bounded(1),
1925
+ b::Element(e::Required, "Entity Identifier Code", b::Values("85")),
1926
+ b::Element(e::Required, "Entity Type Qualifier", b::Values("1", "2")),
1927
+ b::Element(e::Required, "Billing Provider Last or Organizational Name"),
1928
+ b::Element(e::Situational, "Billing Provider First Name"),
1929
+ b::Element(e::Situational, "Billing Provider Middle Name or Initial"),
1930
+ b::Element(e::NotUsed, "Name Prefix"),
1931
+ b::Element(e::Situational, "Billing Provider Name Suffix"),
1932
+ b::Element(e::Situational, "Identification Code Qualifier", b::Values("XX")),
1933
+ b::Element(e::Situational, "Billing Provider Identifier"),
1934
+ b::Element(e::NotUsed, "Entity Relationship Code"),
1935
+ b::Element(e::NotUsed, "Entity Identifier Code"),
1936
+ b::Element(e::NotUsed, "Name Last or Organization Name")),
1937
+ b::Segment(250, s::N3, "Billing Provider Address",
1938
+ r::Required, d::RepeatCount.bounded(1),
1939
+ b::Element(e::Required, "Billing Provider Address Line"),
1940
+ b::Element(e::Situational, "Billing Provider Address Line")),
1941
+ b::Segment(300, s::N4, "Billing Provider City, State, ZIP Code",
1942
+ r::Required, d::RepeatCount.bounded(1),
1943
+ b::Element(e::Required, "Billing Provider City Name"),
1944
+ b::Element(e::Situational, "Billing Provider State or Province Code"),
1945
+ b::Element(e::Situational, "Billing Provider Postal Zone or ZIP Code"),
1946
+ b::Element(e::Situational, "Country Code"),
1947
+ b::Element(e::NotUsed, "Location Qualifier"),
1948
+ b::Element(e::NotUsed, "Location Identifier"),
1949
+ b::Element(e::Situational, "Country Subdivision Code")),
1950
+ b::Segment(350, s::REF, "Billing Provider Tax Identification",
1951
+ r::Required, d::RepeatCount.bounded(1),
1952
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("EI", "SY")),
1953
+ b::Element(e::Required, "Billing Provider Tax Identification Number"),
1954
+ b::Element(e::NotUsed, "Description"),
1955
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
1956
+ b::Segment(350, s::REF, "Billing Provider UPIN/License Information",
1957
+ r::Situational, d::RepeatCount.bounded(2),
1958
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("0B", "1G")),
1959
+ b::Element(e::Required, "Billing Provider License and/or UPIN Information"),
1960
+ b::Element(e::NotUsed, "Description"),
1961
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
1962
+ b::Segment(400, s::PER, "Billing Provider Contact Information",
1963
+ r::Situational, d::RepeatCount.bounded(2),
1964
+ b::Element(e::Required, "Contact Function Code", b::Values("IC")),
1965
+ b::Element(e::Situational, "Billing Provider Contact Name"),
1966
+ b::Element(e::Required, "Communication Number Qualifier", b::Values("EM", "FX", "TE")),
1967
+ b::Element(e::Required, "Communication Number"),
1968
+ b::Element(e::Situational, "Communication Number Qualifier", b::Values("EM", "EX", "FX", "TE")),
1969
+ b::Element(e::Situational, "Communication Number"),
1970
+ b::Element(e::Situational, "Communication Number Qualifier", b::Values("EM", "EX", "FX", "TE")),
1971
+ b::Element(e::Situational, "Communication Number"),
1972
+ b::Element(e::NotUsed, "Contact Inquiry Reference"))),
1973
+
1974
+ d::LoopDef.build("2010AB PAY-TO ADDRESS NAME",
1975
+ d::RepeatCount.bounded(1),
1976
+ b::Segment(150, s::NM1, "Pay-to Address Name",
1977
+ r::Situational, d::RepeatCount.bounded(1),
1978
+ b::Element(e::Required, "Entity Identifier Code", b::Values("87")),
1979
+ b::Element(e::Required, "Entity Type Qualifier", b::Values("1", "2")),
1980
+ b::Element(e::NotUsed, "Name Last or Organizational Name"),
1981
+ b::Element(e::NotUsed, "Name First"),
1982
+ b::Element(e::NotUsed, "Name Middle"),
1983
+ b::Element(e::NotUsed, "Name Prefix"),
1984
+ b::Element(e::NotUsed, "Name Suffix"),
1985
+ b::Element(e::NotUsed, "Identification Code Qualifier"),
1986
+ b::Element(e::NotUsed, "Identifier Code"),
1987
+ b::Element(e::NotUsed, "Entity Relationship Code"),
1988
+ b::Element(e::NotUsed, "Entity Identifier Code"),
1989
+ b::Element(e::NotUsed, "Name Last or Organization Name")),
1990
+ b::Segment(250, s::N3, "Pay-to Address - ADDRESS",
1991
+ r::Required, d::RepeatCount.bounded(1),
1992
+ b::Element(e::Required, "Pay-To Address Line"),
1993
+ b::Element(e::Situational, "Pay-To Address Line")),
1994
+ b::Segment(300, s::N4, "Pay-To Address City, State, ZIP Code",
1995
+ r::Required, d::RepeatCount.bounded(1),
1996
+ b::Element(e::Required, "Pay-to City Name"),
1997
+ b::Element(e::Situational, "Pay-to State or Province Code"),
1998
+ b::Element(e::Situational, "Pay-to Postal Zone or ZIP Code"),
1999
+ b::Element(e::Situational, "Country Code"),
2000
+ b::Element(e::NotUsed, "Location Qualifier"),
2001
+ b::Element(e::NotUsed, "Location Identifier"),
2002
+ b::Element(e::Situational, "Country Subdivision Code"))),
2003
+
2004
+ d::LoopDef.build("2010AC PAY-TO PLAN NAME",
2005
+ d::RepeatCount.bounded(1),
2006
+ b::Segment(150, s::NM1, "Pay-To Plan Name",
2007
+ r::Situational, d::RepeatCount.bounded(1),
2008
+ b::Element(e::Required, "Entity Identifier Code", b::Values("PE")),
2009
+ b::Element(e::Required, "Entity Type Qualifier", b::Values("2")),
2010
+ b::Element(e::Required, "Pay-To Plan Organizational Name"),
2011
+ b::Element(e::NotUsed, "Name First"),
2012
+ b::Element(e::NotUsed, "Name Middle"),
2013
+ b::Element(e::NotUsed, "Name Prefix"),
2014
+ b::Element(e::NotUsed, "Name Suffix"),
2015
+ b::Element(e::Required, "Identification Code Qualifier", b::Values("PI", "XV")),
2016
+ b::Element(e::Required, "Pay-To Plan Primary Identifier"),
2017
+ b::Element(e::NotUsed, "Entity Relationship Code"),
2018
+ b::Element(e::NotUsed, "Entity Identifier Code"),
2019
+ b::Element(e::NotUsed, "Name Last or Organization Name")),
2020
+ b::Segment(250, s::N3, "Pay-to Plan Address",
2021
+ r::Required, d::RepeatCount.bounded(1),
2022
+ b::Element(e::Required, "Pay-To Plan Address Line"),
2023
+ b::Element(e::Situational, "Pay-To Plan Address Line")),
2024
+ b::Segment(300, s::N4, "Pay-To Plan City, State, ZIP Code",
2025
+ r::Required, d::RepeatCount.bounded(1),
2026
+ b::Element(e::Required, "Pay-to Plan City Name"),
2027
+ b::Element(e::Situational, "Pay-to Plan State or Province Code"),
2028
+ b::Element(e::Situational, "Pay-to Plan Postal Zone or ZIP Code"),
2029
+ b::Element(e::Situational, "Country Code"),
2030
+ b::Element(e::NotUsed, "Location Qualifier"),
2031
+ b::Element(e::NotUsed, "Location Identifier"),
2032
+ b::Element(e::Situational, "Country Subdivision Code")),
2033
+ b::Segment(350, s::REF, "Pay-to Plan Secondary Identification",
2034
+ r::Situational, d::RepeatCount.bounded(1),
2035
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("2U", "FY", "NF")),
2036
+ b::Element(e::Required, "Pay-to Plan Secondary Identifier"),
2037
+ b::Element(e::NotUsed, "Description"),
2038
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
2039
+ b::Segment(350, s::REF, "Pay-to Plan Tax Identification Number",
2040
+ r::Required, d::RepeatCount.bounded(1),
2041
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("EI")),
2042
+ b::Element(e::Required, "Pay-to Plan Tax Identification Number"),
2043
+ b::Element(e::NotUsed, "Description"),
2044
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER"))))),
2045
+
2046
+ d::TableDef.detail("Table 2 - Subscriber Detail",
2047
+ d::LoopDef.build("2000B SUBSCRIBER HIERARCHICAL LEVEL",
2048
+ d::RepeatCount.unbounded,
2049
+ b::Segment(10, s::HL, "Subscriber Hierarchical Level",
2050
+ r::Required, d::RepeatCount.bounded(1),
2051
+ b::Element(e::Required, "Hierarchical ID Number"),
2052
+ b::Element(e::Required, "Hierarchical Parent ID Number"),
2053
+ b::Element(e::Required, "Hierarchical Level Code", b::Values("22")),
2054
+ b::Element(e::Required, "Hierachical Child values", b::Values("0", "1"))),
2055
+ b::Segment(50, s::SBR, "Subscriber Information",
2056
+ r::Situational, d::RepeatCount.bounded(1),
2057
+ b::Element(e::Required, "Payer Responsibility Sequence Number", b::Values("A", "B", "C", "D", "E", "F", "G", "H", "P", "S", "T", "U")),
2058
+ b::Element(e::Situational, "Individual Relationship Code", b::Values("18")),
2059
+ b::Element(e::Situational, "Subscriber Group or Policy Number"),
2060
+ b::Element(e::Situational, "Subscriber Group Name"),
2061
+ b::Element(e::Situational, "Insurance Type Code", b::Values("12", "13", "14", "15", "16", "41", "42", "43", "47")),
2062
+ b::Element(e::NotUsed, "Coordination of Benefits Code"),
2063
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code"),
2064
+ b::Element(e::NotUsed, "Employment Status Code"),
2065
+ b::Element(e::Situational, "Claim Filing Indicator Code", b::Values("11", "12", "13", "14", "15", "16", "17", "AM", "BL", "CH", "CI", "DS", "FI", "HM", "LM", "MA", "MB", "MC", "OF", "TV", "VA", "WC", "ZZ"))),
2066
+ b::Segment(70, s::PAT, "Patient Information",
2067
+ r::Situational, d::RepeatCount.bounded(1),
2068
+ b::Element(e::NotUsed, "Individual Relationship Code"),
2069
+ b::Element(e::NotUsed, "Patient Location Code"),
2070
+ b::Element(e::NotUsed, "Employment Status Code"),
2071
+ b::Element(e::NotUsed, "Student Status Code"),
2072
+ b::Element(e::Situational, "Date Time Period Format Qualifier", b::Values("D8")),
2073
+ b::Element(e::Situational, "Patient Death Date"),
2074
+ b::Element(e::Situational, "Unit or Basis for Measurement Code", b::Values("01")),
2075
+ b::Element(e::Situational, "Patient Weight"),
2076
+ b::Element(e::Situational, "Pregnancy Indicator", b::Values("Y"))),
2077
+
2078
+ d::LoopDef.build("2010BA SUBSCRIBER NAME",
2079
+ d::RepeatCount.bounded(1),
2080
+ b::Segment(150, s::NM1, "Subscriber Name",
2081
+ r::Required, d::RepeatCount.bounded(1),
2082
+ b::Element(e::Required, "Entity Identifier Code", b::Values("IL")),
2083
+ b::Element(e::Required, "Entity Type Qualifier", b::Values("1", "2")),
2084
+ b::Element(e::Situational, "Subscriber Last Name"),
2085
+ b::Element(e::Situational, "Subscriber First Name"),
2086
+ b::Element(e::Situational, "Subscriber Middle Name or Initial"),
2087
+ b::Element(e::NotUsed, "Name Prefix"),
2088
+ b::Element(e::Situational, "Subscriber Name Suffix"),
2089
+ b::Element(e::Situational, "Identification Code Qualifier", b::Values("II", "MI")),
2090
+ b::Element(e::Situational, "Subscriber Primary Identifier"),
2091
+ b::Element(e::NotUsed, "Entity Relationship Code"),
2092
+ b::Element(e::NotUsed, "Entity Identifier Code"),
2093
+ b::Element(e::NotUsed, "Name Last or Organization Name")),
2094
+ b::Segment(250, s::N3, "Subscriber Address",
2095
+ r::Situational, d::RepeatCount.bounded(1),
2096
+ b::Element(e::Required, "Subscriber Address Line"),
2097
+ b::Element(e::Situational, "Subscriber Address Line")),
2098
+ b::Segment(300, s::N4, "Subscriber City, State, ZIP Code",
2099
+ r::Situational, d::RepeatCount.bounded(1),
2100
+ b::Element(e::Required, "Subscriber City Name"),
2101
+ b::Element(e::Situational, "Subscriber State Code"),
2102
+ b::Element(e::Situational, "Subscriber Postal Zone or ZIP Code"),
2103
+ b::Element(e::Situational, "Country Code"),
2104
+ b::Element(e::NotUsed, "Location Qualifier"),
2105
+ b::Element(e::NotUsed, "Location Identifier"),
2106
+ b::Element(e::Situational, "Country Subdivision Code")),
2107
+ b::Segment(320, s::DMG, "Subscriber Demographic Information",
2108
+ r::Situational, d::RepeatCount.bounded(1),
2109
+ b::Element(e::Required, "Date Time Period Format Qualifier"),
2110
+ b::Element(e::Required, "Subscriber Birth Date"),
2111
+ b::Element(e::Required, "Subscriber Gender Code", b::Values("F", "M", "U")),
2112
+ b::Element(e::NotUsed, "Marital Status Code"),
2113
+ b::Element(e::NotUsed, "COMPOSITE RACE OR ETHNICITY INFORMATION"),
2114
+ b::Element(e::NotUsed, "Citizenship Status Code"),
2115
+ b::Element(e::NotUsed, "Country Code"),
2116
+ b::Element(e::NotUsed, "Basis of Verification Code"),
2117
+ b::Element(e::NotUsed, "Quantity"),
2118
+ b::Element(e::NotUsed, "Code List Qualifier Code"),
2119
+ b::Element(e::NotUsed, "Industry Code")),
2120
+ b::Segment(350, s::REF, "Subscriber Secondary Identification",
2121
+ r::Situational, d::RepeatCount.bounded(1),
2122
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("SY")),
2123
+ b::Element(e::Required, "Subscriber Supplemental Identifier"),
2124
+ b::Element(e::NotUsed, "Description"),
2125
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
2126
+ b::Segment(350, s::REF, "Property and Casualty Claim Number",
2127
+ r::Situational, d::RepeatCount.bounded(1),
2128
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("Y4")),
2129
+ b::Element(e::Required, "Property Casualty Claim Number"),
2130
+ b::Element(e::NotUsed, "Description"),
2131
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
2132
+ b::Segment(400, s::PER, "Property and Casualty Subscriber Contact Information",
2133
+ r::Situational, d::RepeatCount.bounded(1),
2134
+ b::Element(e::Required, "Contact Fuction Code", b::Values("IC")),
2135
+ b::Element(e::Situational, "Name"),
2136
+ b::Element(e::Required, "Communication Qualifier Number", b::Values("TE")),
2137
+ b::Element(e::Required, "Communication Number"),
2138
+ b::Element(e::Situational, "Communication Qualifier Number", b::Values("TE", "EX")),
2139
+ b::Element(e::Situational, "Communication Number"),
2140
+ b::Element(e::NotUsed, "Communication Qualifier Number"),
2141
+ b::Element(e::NotUsed, "Communication Number"),
2142
+ b::Element(e::NotUsed, "Contact Inquiry Reference"))),
2143
+
2144
+ d::LoopDef.build("2010BB PAYER NAME",
2145
+ d::RepeatCount.bounded(10),
2146
+ b::Segment(150, s::NM1, "Payer Name",
2147
+ r::Required, d::RepeatCount.bounded(1),
2148
+ b::Element(e::Required, "Entity Identifier Code", b::Values("PR")),
2149
+ b::Element(e::Required, "Entity Type Qualifier", b::Values("2")),
2150
+ b::Element(e::Required, "Payer Name"),
2151
+ b::Element(e::NotUsed, "Name Last"),
2152
+ b::Element(e::NotUsed, "Name Middle"),
2153
+ b::Element(e::NotUsed, "Name Prefix"),
2154
+ b::Element(e::NotUsed, "Name Suffix"),
2155
+ b::Element(e::Required, "Identification Code Qualifier", b::Values("PI", "XV")),
2156
+ b::Element(e::Required, "Payer Identification"),
2157
+ b::Element(e::NotUsed, "Entity Relationship Code"),
2158
+ b::Element(e::NotUsed, "Entity Identifier Code"),
2159
+ b::Element(e::NotUsed, "Name Last or Organization Name")),
2160
+ b::Segment(250, s::N3, "Payer Address",
2161
+ r::Situational, d::RepeatCount.bounded(2),
2162
+ b::Element(e::Required, "Payer Address Line"),
2163
+ b::Element(e::Situational, "Payer Address Line")),
2164
+ b::Segment(300, s::N4, "Payer City, State, ZIP Code",
2165
+ r::Situational, d::RepeatCount.bounded(1),
2166
+ b::Element(e::Required, "Payer City Name"),
2167
+ b::Element(e::Situational, "Payer State or Province Code"),
2168
+ b::Element(e::Situational, "Payer Postal Zone or ZIP Code"),
2169
+ b::Element(e::Situational, "Country Code"),
2170
+ b::Element(e::NotUsed, "Location Qualifier"),
2171
+ b::Element(e::NotUsed, "Location Identifier"),
2172
+ b::Element(e::Situational, "Country Subdivision Code")),
2173
+ b::Segment(350, s::REF, "Payer Secondary Identification",
2174
+ r::Situational, d::RepeatCount.bounded(3),
2175
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("2U", "EI", "FY", "NF")),
2176
+ b::Element(e::Required, "Payer Secondary Identifier"),
2177
+ b::Element(e::NotUsed, "Description"),
2178
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
2179
+ b::Segment(350, s::REF, "Billing Provider Secondary Identification",
2180
+ r::Situational, d::RepeatCount.bounded(2),
2181
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("G2", "LU")),
2182
+ b::Element(e::Required, "Billing Provider Secondary Identifier"),
2183
+ b::Element(e::NotUsed, "Description"),
2184
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER"))),
2185
+
2186
+ loop2300)),
2187
+
2188
+ d::TableDef.detail("Table 2 - Patient Detail",
2189
+ d::LoopDef.build("2000C PATIENT HIERARCHICAL LEVEL",
2190
+ d::RepeatCount.unbounded,
2191
+ b::Segment(10, s::HL, "Patient Hierachical Level",
2192
+ r::Situational, d::RepeatCount.bounded(1),
2193
+ b::Element(e::Required, "Hierarchical ID Number"),
2194
+ b::Element(e::Required, "Hierarchical Parent ID Number"),
2195
+ b::Element(e::Required, "Hierarchical Level Code", b::Values("23")),
2196
+ b::Element(e::Required, "Hierarchical Child Code", b::Values("0"))),
2197
+ b::Segment(70, s::PAT, "Patient Information",
2198
+ r::Required, d::RepeatCount.bounded(1),
2199
+ b::Element(e::Required, "Individual Relationship Code", b::Values("01", "19", "20", "21", "39", "40", "53", "G8")),
2200
+ b::Element(e::NotUsed, "Patient Location Code"),
2201
+ b::Element(e::NotUsed, "Employment Status Code"),
2202
+ b::Element(e::NotUsed, "Student Status Code"),
2203
+ b::Element(e::Situational, "Date Time Period Format Qualifier"),
2204
+ b::Element(e::Situational, "Patient Death Date"),
2205
+ b::Element(e::Situational, "Unit Basis for Measurement Code", b::Values("01")),
2206
+ b::Element(e::Situational, "Patient Weight"),
2207
+ b::Element(e::Situational, "Pregnancy Indicator", b::Values("Y"))),
2208
+
2209
+ d::LoopDef.build("2010CA PATIENT NAME",
2210
+ d::RepeatCount.bounded(1),
2211
+ b::Segment(150, s::NM1, "Patient Name",
2212
+ r::Required, d::RepeatCount.bounded(1),
2213
+ b::Element(e::Required, "Entity Qualifier Code", b::Values("QC")),
2214
+ b::Element(e::Required, "Entity Type Qualifier", b::Values("1")),
2215
+ b::Element(e::Required, "Patient Last Name"),
2216
+ b::Element(e::Situational, "Patient First Name"),
2217
+ b::Element(e::Situational, "Patient Middle Name or Initial"),
2218
+ b::Element(e::NotUsed, "Name Prefix"),
2219
+ b::Element(e::Situational, "Patient Name Suffix"),
2220
+ b::Element(e::NotUsed, "Identification Code Qualifier"),
2221
+ b::Element(e::NotUsed, "Identification Code"),
2222
+ b::Element(e::NotUsed, "Entity Relationship Code"),
2223
+ b::Element(e::NotUsed, "Entity Identification Code"),
2224
+ b::Element(e::NotUsed, "Name Last or Organization Name")),
2225
+ b::Segment(250, s::N3, "Patient Address",
2226
+ r::Required, d::RepeatCount.bounded(1),
2227
+ b::Element(e::Required, "Patient Address Line"),
2228
+ b::Element(e::Situational, "Patient Address Line")),
2229
+ b::Segment(300, s::N4, "Patient City, State, ZIP Code",
2230
+ r::Required, d::RepeatCount.bounded(1),
2231
+ b::Element(e::Required, "Patient City Name"),
2232
+ b::Element(e::Situational, "Patient State Code"),
2233
+ b::Element(e::Situational, "Patient Postal Zone or ZIP Code"),
2234
+ b::Element(e::Situational, "Country Code"),
2235
+ b::Element(e::NotUsed, "Location Qualifier"),
2236
+ b::Element(e::NotUsed, "Location Identifier"),
2237
+ b::Element(e::Situational, "Country Subdivision Code")),
2238
+ b::Segment(320, s::DMG, "Patient Demographic Information",
2239
+ r::Required, d::RepeatCount.bounded(1),
2240
+ b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
2241
+ b::Element(e::Required, "Patient Birth Date"),
2242
+ b::Element(e::Required, "Patient Gender Code", b::Values("F", "M", "U")),
2243
+ b::Element(e::NotUsed, "Marital Status Code"),
2244
+ b::Element(e::NotUsed, "COMPOSITE RACE OR ETHNICITY INFORMATION"),
2245
+ b::Element(e::NotUsed, "Citizenship Status Code"),
2246
+ b::Element(e::NotUsed, "Country Code"),
2247
+ b::Element(e::NotUsed, "Basis of Verification Code"),
2248
+ b::Element(e::NotUsed, "Quantity"),
2249
+ b::Element(e::NotUsed, "Code List Qualifier Code"),
2250
+ b::Element(e::NotUsed, "Industry Code")),
2251
+ b::Segment(350, s::REF, "Property and Casualty Claim Number",
2252
+ r::Situational, d::RepeatCount.bounded(1),
2253
+ b::Element(e::Required, "Reference Identifier Qualifier", b::Values("Y4")),
2254
+ b::Element(e::Required, "Property Casualty Claim Number"),
2255
+ b::Element(e::NotUsed, "Description"),
2256
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
2257
+ b::Segment(350, s::REF, "Property and Casualty Patient Identifier",
2258
+ r::Situational, d::RepeatCount.bounded(1),
2259
+ b::Element(e::Required, "Reference Identifier Qualifier", b::Values("1W", "SY")),
2260
+ b::Element(e::Required, "Property Casualty Patient Identifier"),
2261
+ b::Element(e::NotUsed, "Description"),
2262
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
2263
+ b::Segment(400, s::PER, "Property and Casualty Patient Contact Information",
2264
+ r::Situational, d::RepeatCount.bounded(1),
2265
+ b::Element(e::Required, "Contact Function Code", b::Values("IC")),
2266
+ b::Element(e::Situational, "Name"),
2267
+ b::Element(e::Required, "Communication Number Qualifier", b::Values("TE")),
2268
+ b::Element(e::Required, "Communication Number"),
2269
+ b::Element(e::Situational, "Communication Number Qualifier", b::Values("EX")),
2270
+ b::Element(e::Situational, "Communication Number"),
2271
+ b::Element(e::NotUsed, "Communication Number Qualifier"),
2272
+ b::Element(e::NotUsed, "Communication Number"),
2273
+ b::Element(e::NotUsed, "Contact Inquiry Reference"))),
2274
+
2275
+ loop2300)),
2276
+
2277
+ # The X12 standard and X222 specification place the SE segment at what
2278
+ # appears to be the end of Table 2 - Patient Detail. This doesn't make
2279
+ # sense because Table 2 - Patient Detail doesn't occur if the patient
2280
+ # is the subscriber.
2281
+ #
2282
+ # If we placed it in both Table 2 - Subscriber Detail and Table 2 -
2283
+ # Patient Detail, it would incorrectly allow the segment to occur in
2284
+ # each table.
2285
+ #
2286
+ # This structure doesn't match the specification, but it does ensure
2287
+ # that the first occurrence of SE terminates the transaction set.
2288
+ d::TableDef.summary("Table 3 - Summary",
2289
+ b::Segment(5550, s::SE, "Transaction Set Trailer",
2290
+ r::Required, d::RepeatCount.bounded(1),
2291
+ b::Element(e::Required, "Number of Included Segments"),
2292
+ b::Element(e::Required, "Transaction Set Control Number"))))
2293
+
2294
+ end
2295
+ end
2296
+ end
2297
+ end