stupidedi 1.2.12 → 1.2.14

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Files changed (34) hide show
  1. checksums.yaml +4 -4
  2. data/README.md +10 -4
  3. data/bin/edi-pp +1 -1
  4. data/doc/Generating.md +1 -1
  5. data/lib/ruby/to_d.rb +23 -20
  6. data/lib/stupidedi/config.rb +4 -0
  7. data/lib/stupidedi/guides/005010.rb +11 -3
  8. data/lib/stupidedi/guides/005010/X220-BE834.rb +709 -0
  9. data/lib/stupidedi/guides/005010/X220A1-BE834.rb +709 -0
  10. data/lib/stupidedi/guides/005010/X223-HC837I.rb +2582 -0
  11. data/lib/stupidedi/schema/table_def.rb +2 -2
  12. data/lib/stupidedi/version.rb +1 -1
  13. data/lib/stupidedi/versions/functional_groups/005010/element_defs.rb +471 -14
  14. data/lib/stupidedi/versions/functional_groups/005010/segment_defs.rb +41 -2
  15. data/lib/stupidedi/versions/functional_groups/005010/segment_defs/ACT.rb +33 -0
  16. data/lib/stupidedi/versions/functional_groups/005010/segment_defs/BGN.rb +31 -0
  17. data/lib/stupidedi/versions/functional_groups/005010/segment_defs/COB.rb +24 -0
  18. data/lib/stupidedi/versions/functional_groups/005010/segment_defs/DSB.rb +30 -0
  19. data/lib/stupidedi/versions/functional_groups/005010/segment_defs/EC.rb +26 -0
  20. data/lib/stupidedi/versions/functional_groups/005010/segment_defs/HD.rb +31 -0
  21. data/lib/stupidedi/versions/functional_groups/005010/segment_defs/HLH.rb +27 -0
  22. data/lib/stupidedi/versions/functional_groups/005010/segment_defs/ICM.rb +26 -0
  23. data/lib/stupidedi/versions/functional_groups/005010/segment_defs/IDC.rb +24 -0
  24. data/lib/stupidedi/versions/functional_groups/005010/segment_defs/INS.rb +39 -0
  25. data/lib/stupidedi/versions/functional_groups/005010/segment_defs/LE.rb +20 -0
  26. data/lib/stupidedi/versions/functional_groups/005010/segment_defs/LS.rb +20 -0
  27. data/lib/stupidedi/versions/functional_groups/005010/segment_defs/LUI.rb +28 -0
  28. data/lib/stupidedi/versions/functional_groups/005010/segment_defs/PLA.rb +25 -0
  29. data/lib/stupidedi/versions/functional_groups/005010/transaction_set_defs.rb +3 -3
  30. data/lib/stupidedi/versions/functional_groups/005010/transaction_set_defs/BE834.rb +163 -0
  31. data/lib/stupidedi/zipper/abstract_cursor.rb +2 -2
  32. data/spec/examples/ruby/symbol.example +22 -18
  33. data/spec/spec_helper.rb +1 -0
  34. metadata +25 -7
data/lib/stupidedi/guides/005010/X223-HC837I.rb ADDED
@@ -0,0 +1,2582 @@
1
+ # frozen_string_literal: true
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+ module Stupidedi
3
+ using Refinements
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+
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+ module Guides
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+ module FiftyTen
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+ module X223
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+
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+ b = GuideBuilder
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+ d = Schema
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+ r = SegmentReqs
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+ e = ElementReqs
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+ s = Versions::FunctionalGroups::FiftyTen::SegmentDefs
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+ t = Versions::FunctionalGroups::FiftyTen::TransactionSetDefs
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+
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+ loop2300 =
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+ d::LoopDef.build("2300 CLAIM INFORMATION",
18
+ d::RepeatCount.bounded(100),
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+ b::Segment(1300, s::CLM, "Claim Information",
20
+ r::Required, d::RepeatCount.bounded(1),
21
+ b::Element(e::Required, "Patient Control Number", b::MaxLength(20)),
22
+ b::Element(e::Required, "Total Claim Charge Amount"),
23
+ b::Element(e::NotUsed, "Claim Filing Indicator Code"),
24
+ b::Element(e::NotUsed, "Non-Institutional Claim Type Code"),
25
+ b::Element(e::Required, "HEALTH CARE SERVICE LOCATION INFORMATION",
26
+ b::Element(e::Required, "Facility Type Code"),
27
+ b::Element(e::Required, "Facility Code Qualifier", b::Values("A")),
28
+ b::Element(e::Required, "Claim Frequency Code")),
29
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code"),
30
+ b::Element(e::Required, "Assignment or Plan Participation Code", b::Values("A", "B", "C")),
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+ b::Element(e::Required, "Benefits Assignment Certification Indicator", b::Values("N", "W", "Y")),
32
+ b::Element(e::Required, "Release of Information Code", b::Values("I", "Y")),
33
+ b::Element(e::NotUsed, "Patient Signature Source Code"),
34
+ b::Element(e::NotUsed, "RELATED CAUSES INFORMATION"),
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+ b::Element(e::NotUsed, "Special Program Code"),
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+ b::Element(e::NotUsed, "Yes/No Condition or Response Code"),
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+ b::Element(e::NotUsed, "Level of Service Code"),
38
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code"),
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+ b::Element(e::NotUsed, "Provider Agreement Code"),
40
+ b::Element(e::NotUsed, "Claim Status Code"),
41
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code"),
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+ b::Element(e::NotUsed, "Claim Submission Reason Code"),
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+ b::Element(e::Situational, "Delay Reason Code", b::Values("1", "2", "3", "4", "5", "6", "7", "8", "9", "10", "11", "15"))),
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+ b::Segment(1350, s::DTP, "Discharge Hour",
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+ r::Situational, d::RepeatCount.bounded(1),
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+ b::Element(e::Required, "Date Time Qualifier", b::Values("096")),
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+ b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("TM")),
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+ b::Element(e::Required, "Discharge Time")),
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+ b::Segment(1350, s::DTP, "Statement Dates",
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+ r::Required, d::RepeatCount.bounded(1),
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+ b::Element(e::Required, "Date Time Qualifier", b::Values("434")),
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+ b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("RD8")),
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+ b::Element(e::Required, "Statement From and To Date")),
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+ b::Segment(1350, s::DTP, "Admission Date/Hour",
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+ r::Situational, d::RepeatCount.bounded(1),
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+ b::Element(e::Required, "Date Time Qualifier", b::Values("435")),
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+ b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8", "DT")),
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+ b::Element(e::Required, "Admission Date and Hour")),
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+ b::Segment(1350, s::DTP, "Date - Repricer Received Date",
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+ r::Situational, d::RepeatCount.bounded(1),
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+ b::Element(e::Required, "Date Time Qualifier", b::Values("050")),
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+ b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
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+ b::Element(e::Required, "Repricer Received Date")),
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+ b::Segment(1400, s::CL1, "Institutional Claim Code",
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+ r::Required, d::RepeatCount.bounded(1),
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+ b::Element(e::Situational, "Admission Type Code"),
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+ b::Element(e::Situational, "Admission Source Code"),
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+ b::Element(e::Required, "Patient Status Code"),
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+ b::Element(e::NotUsed, "Nursing Home Residential Status Code")),
70
+ b::Segment(1550, s::PWK, "Claim Supplemental Information",
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+ r::Situational, d::RepeatCount.bounded(10),
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+ 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")),
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+ b::Element(e::Required, "Attachment Transmission Code", b::Values("AA", "BM", "EL", "EM", "FT", "FX")),
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+ b::Element(e::NotUsed, "Report Copies Needed"),
75
+ b::Element(e::NotUsed, "Entity Identifier Code"),
76
+ b::Element(e::Situational, "Identification Code Qualifier", b::Values("AC")),
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+ b::Element(e::Situational, "Attachment Control Number", b::MaxLength(50)),
78
+ b::Element(e::NotUsed, "Description"),
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+ b::Element(e::NotUsed, "ACTIONS INDICATED"),
80
+ b::Element(e::NotUsed, "Request Category Code")),
81
+ b::Segment(1600, s::CN1, "Contract Information",
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+ r::Situational, d::RepeatCount.bounded(1),
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+ b::Element(e::Required, "Contract Type Code", b::Values("01", "02", "03", "04", "05", "06", "09")),
84
+ b::Element(e::Situational, "Contract Amount"),
85
+ b::Element(e::Situational, "Contract Percentage"),
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+ b::Element(e::Situational, "Contract Code"),
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+ b::Element(e::Situational, "Terms Discount Percentage"),
88
+ b::Element(e::Situational, "Contract Version Identifier")),
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+ b::Segment(1750, s::AMT, "Patient Estimated Amount Due",
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+ r::Situational, d::RepeatCount.bounded(1),
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+ b::Element(e::Required, "Amount Qualifier Code", b::Values("F3")),
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+ b::Element(e::Required, "Patient Responsibility Amount"),
93
+ b::Element(e::NotUsed, "Credit/Debit Flag Code")),
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+ b::Segment(1800, s::REF, "Service Authorization Exception Code",
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+ r::Situational, d::RepeatCount.bounded(1),
96
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("4N")),
97
+ b::Element(e::Required, "Service Authorization Exception Code", b::Values("1", "2", "3", "4", "5", "6", "7")),
98
+ b::Element(e::NotUsed, "Description"),
99
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
100
+ b::Segment(1800, s::REF, "Referral Number",
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+ r::Situational, d::RepeatCount.bounded(1),
102
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("9F")),
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+ b::Element(e::Required, "Referral Number"),
104
+ b::Element(e::NotUsed, "Description"),
105
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
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+ b::Segment(1800, s::REF, "Prior Authorization",
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+ r::Situational, d::RepeatCount.bounded(1),
108
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("G1")),
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+ b::Element(e::Required, "Prior Authorization Number"),
110
+ b::Element(e::NotUsed, "Description"),
111
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
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+ b::Segment(1800, s::REF, "Payer Claim Control Number",
113
+ r::Situational, d::RepeatCount.bounded(1),
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+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("F8")),
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+ b::Element(e::Required, "Payer Claim Control Number"),
116
+ b::Element(e::NotUsed, "Description"),
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+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
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+ b::Segment(1800, s::REF, "Repriced Claim Number",
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+ r::Situational, d::RepeatCount.bounded(1),
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+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("9A")),
121
+ b::Element(e::Required, "Repriced Claim Reference Number"),
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+ b::Element(e::NotUsed, "Description"),
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+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
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+ b::Segment(1800, s::REF, "Adjusted Repriced Claim Number",
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+ r::Situational, d::RepeatCount.bounded(1),
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+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("9C")),
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+ b::Element(e::Required, "Adjusted Repriced Claim Reference Number"),
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+ b::Element(e::NotUsed, "Description"),
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+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
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+ b::Segment(1800, s::REF, "Investigational Device Exemption Number",
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+ r::Situational, d::RepeatCount.bounded(5),
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+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("LX")),
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+ b::Element(e::Required, "Investigational Device Exemption Identifier"),
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+ b::Element(e::NotUsed, "Description"),
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+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
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+ b::Segment(1800, s::REF, "Claim Identifier for Transmission Intermediaries",
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+ r::Situational, d::RepeatCount.bounded(1),
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+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("D9")),
139
+ b::Element(e::Required, "Value Added Network Trace Number", b::MaxLength(20)),
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+ b::Element(e::NotUsed, "Description"),
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+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
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+ b::Segment(1800, s::REF, "Auto Accident State",
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+ r::Situational, d::RepeatCount.bounded(1),
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+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("LU")),
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+ b::Element(e::Required, "Auto Accident State or Province Code"),
146
+ b::Element(e::NotUsed, "Description"),
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+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
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+ b::Segment(1800, s::REF, "Medical Record Number",
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+ r::Situational, d::RepeatCount.bounded(1),
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+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("EA")),
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+ b::Element(e::Required, "Medical Record Number"),
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+ b::Element(e::NotUsed, "Description"),
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+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
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+ b::Segment(1800, s::REF, "Demonstration Project Identifier",
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+ r::Situational, d::RepeatCount.bounded(1),
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+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("P4")),
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+ b::Element(e::Required, "Demonstration Project Identifier"),
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+ b::Element(e::NotUsed, "Description"),
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+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
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+ b::Segment(1800, s::REF, "Peer Review Organization (PRO) Approval Number",
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+ r::Situational, d::RepeatCount.bounded(1),
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+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("G4")),
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+ b::Element(e::Required, "Peer Review Authorization Number"),
164
+ b::Element(e::NotUsed, "Description"),
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+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
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+ b::Segment(1850, s::K3, "File Information",
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+ r::Situational, d::RepeatCount.bounded(10),
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+ b::Element(e::Required, "Fixed Format Information"),
169
+ b::Element(e::NotUsed, "Record Format Code"),
170
+ b::Element(e::NotUsed, "COMPOSITE UNIT OF MEASURE")),
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+ b::Segment(1900, s::NTE, "Claim Note",
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+ r::Situational, d::RepeatCount.bounded(10),
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+ b::Element(e::Required, "Note Reference Code", b::Values("ALG", "DCP", "DGN", "DME", "MED", "NTR", "ODT", "RHB", "RLH", "RNH", "SET", "SFM", "SPT", "UPI")),
174
+ b::Element(e::Required, "Claim Note Text")),
175
+ b::Segment(1900, s::NTE, "Billing Note",
176
+ r::Situational, d::RepeatCount.bounded(1),
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+ b::Element(e::Required, "Note Reference Code", b::Values("ADD")),
178
+ b::Element(e::Required, "Billing Note Text")),
179
+ b::Segment(2200, s::CRC, "EPSDT Referral",
180
+ r::Situational, d::RepeatCount.bounded(1),
181
+ b::Element(e::Required, "Code Category", b::Values("ZZ")),
182
+ b::Element(e::Required, "Certification Condition Indicator", b::Values("Y", "N")),
183
+ b::Element(e::Required, "Condition Code", b::Values("AV", "NU", "S2", "ST")),
184
+ b::Element(e::Situational, "Condition Code", b::Values("AV", "NU", "S2", "ST")),
185
+ b::Element(e::Situational, "Condition Code", b::Values("AV", "NU", "S2", "ST")),
186
+ b::Element(e::NotUsed, "Condition Indicator"),
187
+ b::Element(e::NotUsed, "Condition Indicator")),
188
+ b::Segment(2310, s::HI, "Principal Diagnosis",
189
+ r::Required, d::RepeatCount.bounded(1),
190
+ b::Element(e::Required, "HEALTH CARE CODE INFORMATION",
191
+ b::Element(e::Required, "Code List Qualifier", b::Values("ABK", "BK")),
192
+ b::Element(e::Required, "Principal Diagnosis Code"),
193
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
194
+ b::Element(e::NotUsed, "Date Time Period"),
195
+ b::Element(e::NotUsed, "Monetary Amount"),
196
+ b::Element(e::NotUsed, "Quantity"),
197
+ b::Element(e::NotUsed, "Version Identifier"),
198
+ b::Element(e::NotUsed, "Industry Code"),
199
+ b::Element(e::Situational, "Yes/No Condition or Response Code", b::Values("N", "U", "W", "Y"))),
200
+ b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
201
+ b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
202
+ b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
203
+ b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
204
+ b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
205
+ b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
206
+ b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
207
+ b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
208
+ b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
209
+ b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
210
+ b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION")),
211
+ b::Segment(2310, s::HI, "Admitting Diagnosis",
212
+ r::Situational, d::RepeatCount.bounded(1),
213
+ b::Element(e::Required, "HEALTH CARE CODE INFORMATION",
214
+ b::Element(e::Required, "Code List Qualifier", b::Values("ABJ", "BJ")),
215
+ b::Element(e::Required, "Admitting Diagnosis Code"),
216
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
217
+ b::Element(e::NotUsed, "Date Time Period"),
218
+ b::Element(e::NotUsed, "Monetary Amount"),
219
+ b::Element(e::NotUsed, "Quantity"),
220
+ b::Element(e::NotUsed, "Version Identifier"),
221
+ b::Element(e::NotUsed, "Industry Code"),
222
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
223
+ b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
224
+ b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
225
+ b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
226
+ b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
227
+ b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
228
+ b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
229
+ b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
230
+ b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
231
+ b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
232
+ b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
233
+ b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION")),
234
+ b::Segment(2310, s::HI, "Patient's Reason For Visit",
235
+ r::Situational, d::RepeatCount.bounded(1),
236
+ b::Element(e::Required, "HEALTH CARE CODE INFORMATION",
237
+ b::Element(e::Required, "Code List Qualifier", b::Values("APR", "PR")),
238
+ b::Element(e::Required, "Patient Reason For Visit"),
239
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
240
+ b::Element(e::NotUsed, "Date Time Period"),
241
+ b::Element(e::NotUsed, "Monetary Amount"),
242
+ b::Element(e::NotUsed, "Quantity"),
243
+ b::Element(e::NotUsed, "Version Identifier"),
244
+ b::Element(e::NotUsed, "Industry Code"),
245
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
246
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
247
+ b::Element(e::Required, "Code List Qualifier", b::Values("APR", "PR")),
248
+ b::Element(e::Required, "Patient Reason For Visit"),
249
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
250
+ b::Element(e::NotUsed, "Date Time Period"),
251
+ b::Element(e::NotUsed, "Monetary Amount"),
252
+ b::Element(e::NotUsed, "Quantity"),
253
+ b::Element(e::NotUsed, "Version Identifier"),
254
+ b::Element(e::NotUsed, "Industry Code"),
255
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
256
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
257
+ b::Element(e::Required, "Code List Qualifier", b::Values("APR", "PR")),
258
+ b::Element(e::Required, "Patient Reason For Visit"),
259
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
260
+ b::Element(e::NotUsed, "Date Time Period"),
261
+ b::Element(e::NotUsed, "Monetary Amount"),
262
+ b::Element(e::NotUsed, "Quantity"),
263
+ b::Element(e::NotUsed, "Version Identifier"),
264
+ b::Element(e::NotUsed, "Industry Code"),
265
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
266
+ b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
267
+ b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
268
+ b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
269
+ b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
270
+ b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
271
+ b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
272
+ b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
273
+ b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
274
+ b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION")),
275
+ b::Segment(2310, s::HI, "External Cause of Injury",
276
+ r::Situational, d::RepeatCount.bounded(1),
277
+ b::Element(e::Required, "HEALTH CARE CODE INFORMATION",
278
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("ABN", "BN")),
279
+ b::Element(e::Required, "External Cause of Injury Code"),
280
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
281
+ b::Element(e::NotUsed, "Date Time Period"),
282
+ b::Element(e::NotUsed, "Monetary Amount"),
283
+ b::Element(e::NotUsed, "Quantity"),
284
+ b::Element(e::NotUsed, "Version Identifier"),
285
+ b::Element(e::NotUsed, "Industry Code"),
286
+ b::Element(e::Situational, "Present on Admission Indicator", b::Values("N", "U", "W", "Y"))),
287
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
288
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("ABN", "BN")),
289
+ b::Element(e::Required, "External Cause of Injury Code"),
290
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
291
+ b::Element(e::NotUsed, "Date Time Period"),
292
+ b::Element(e::NotUsed, "Monetary Amount"),
293
+ b::Element(e::NotUsed, "Quantity"),
294
+ b::Element(e::NotUsed, "Version Identifier"),
295
+ b::Element(e::NotUsed, "Industry Code"),
296
+ b::Element(e::Situational, "Present on Admission Indicator", b::Values("N", "U", "W", "Y"))),
297
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
298
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("ABN", "BN")),
299
+ b::Element(e::Required, "External Cause of Injury Code"),
300
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
301
+ b::Element(e::NotUsed, "Date Time Period"),
302
+ b::Element(e::NotUsed, "Monetary Amount"),
303
+ b::Element(e::NotUsed, "Quantity"),
304
+ b::Element(e::NotUsed, "Version Identifier"),
305
+ b::Element(e::NotUsed, "Industry Code"),
306
+ b::Element(e::Situational, "Present on Admission Indicator", b::Values("N", "U", "W", "Y"))),
307
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
308
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("ABN", "BN")),
309
+ b::Element(e::Required, "External Cause of Injury Code"),
310
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
311
+ b::Element(e::NotUsed, "Date Time Period"),
312
+ b::Element(e::NotUsed, "Monetary Amount"),
313
+ b::Element(e::NotUsed, "Quantity"),
314
+ b::Element(e::NotUsed, "Version Identifier"),
315
+ b::Element(e::NotUsed, "Industry Code"),
316
+ b::Element(e::Situational, "Present on Admission Indicator", b::Values("N", "U", "W", "Y"))),
317
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
318
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("ABN", "BN")),
319
+ b::Element(e::Required, "External Cause of Injury Code"),
320
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
321
+ b::Element(e::NotUsed, "Date Time Period"),
322
+ b::Element(e::NotUsed, "Monetary Amount"),
323
+ b::Element(e::NotUsed, "Quantity"),
324
+ b::Element(e::NotUsed, "Version Identifier"),
325
+ b::Element(e::NotUsed, "Industry Code"),
326
+ b::Element(e::Situational, "Present on Admission Indicator", b::Values("N", "U", "W", "Y"))),
327
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
328
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("ABN", "BN")),
329
+ b::Element(e::Required, "External Cause of Injury Code"),
330
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
331
+ b::Element(e::NotUsed, "Date Time Period"),
332
+ b::Element(e::NotUsed, "Monetary Amount"),
333
+ b::Element(e::NotUsed, "Quantity"),
334
+ b::Element(e::NotUsed, "Version Identifier"),
335
+ b::Element(e::NotUsed, "Industry Code"),
336
+ b::Element(e::Situational, "Present on Admission Indicator", b::Values("N", "U", "W", "Y"))),
337
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
338
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("ABN", "BN")),
339
+ b::Element(e::Required, "External Cause of Injury Code"),
340
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
341
+ b::Element(e::NotUsed, "Date Time Period"),
342
+ b::Element(e::NotUsed, "Monetary Amount"),
343
+ b::Element(e::NotUsed, "Quantity"),
344
+ b::Element(e::NotUsed, "Version Identifier"),
345
+ b::Element(e::NotUsed, "Industry Code"),
346
+ b::Element(e::Situational, "Present on Admission Indicator", b::Values("N", "U", "W", "Y"))),
347
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
348
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("ABN", "BN")),
349
+ b::Element(e::Required, "External Cause of Injury Code"),
350
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
351
+ b::Element(e::NotUsed, "Date Time Period"),
352
+ b::Element(e::NotUsed, "Monetary Amount"),
353
+ b::Element(e::NotUsed, "Quantity"),
354
+ b::Element(e::NotUsed, "Version Identifier"),
355
+ b::Element(e::NotUsed, "Industry Code"),
356
+ b::Element(e::Situational, "Present on Admission Indicator", b::Values("N", "U", "W", "Y"))),
357
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
358
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("ABN", "BN")),
359
+ b::Element(e::Required, "External Cause of Injury Code"),
360
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
361
+ b::Element(e::NotUsed, "Date Time Period"),
362
+ b::Element(e::NotUsed, "Monetary Amount"),
363
+ b::Element(e::NotUsed, "Quantity"),
364
+ b::Element(e::NotUsed, "Version Identifier"),
365
+ b::Element(e::NotUsed, "Industry Code"),
366
+ b::Element(e::Situational, "Present on Admission Indicator", b::Values("N", "U", "W", "Y"))),
367
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
368
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("ABN", "BN")),
369
+ b::Element(e::Required, "External Cause of Injury Code"),
370
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
371
+ b::Element(e::NotUsed, "Date Time Period"),
372
+ b::Element(e::NotUsed, "Monetary Amount"),
373
+ b::Element(e::NotUsed, "Quantity"),
374
+ b::Element(e::NotUsed, "Version Identifier"),
375
+ b::Element(e::NotUsed, "Industry Code"),
376
+ b::Element(e::Situational, "Present on Admission Indicator", b::Values("N", "U", "W", "Y"))),
377
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
378
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("ABN", "BN")),
379
+ b::Element(e::Required, "External Cause of Injury Code"),
380
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
381
+ b::Element(e::NotUsed, "Date Time Period"),
382
+ b::Element(e::NotUsed, "Monetary Amount"),
383
+ b::Element(e::NotUsed, "Quantity"),
384
+ b::Element(e::NotUsed, "Version Identifier"),
385
+ b::Element(e::NotUsed, "Industry Code"),
386
+ b::Element(e::Situational, "Present on Admission Indicator", b::Values("N", "U", "W", "Y"))),
387
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
388
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("ABN", "BN")),
389
+ b::Element(e::Required, "External Cause of Injury Code"),
390
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
391
+ b::Element(e::NotUsed, "Date Time Period"),
392
+ b::Element(e::NotUsed, "Monetary Amount"),
393
+ b::Element(e::NotUsed, "Quantity"),
394
+ b::Element(e::NotUsed, "Version Identifier"),
395
+ b::Element(e::NotUsed, "Industry Code"),
396
+ b::Element(e::Situational, "Present on Admission Indicator", b::Values("N", "U", "W", "Y")))),
397
+ b::Segment(2310, s::HI, "Diagnosis Related Group (DRG) Information",
398
+ r::Situational, d::RepeatCount.bounded(1),
399
+ b::Element(e::Required, "HEALTH CARE CODE INFORMATION",
400
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("DR")),
401
+ b::Element(e::Required, "Diagnosis Related Group (DRG) Code"),
402
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
403
+ b::Element(e::NotUsed, "Date Time Period"),
404
+ b::Element(e::NotUsed, "Monetary Amount"),
405
+ b::Element(e::NotUsed, "Quantity"),
406
+ b::Element(e::NotUsed, "Version Identifier"),
407
+ b::Element(e::NotUsed, "Industry Code"),
408
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
409
+ b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
410
+ b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
411
+ b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
412
+ b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
413
+ b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
414
+ b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
415
+ b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
416
+ b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
417
+ b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
418
+ b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
419
+ b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION")),
420
+ b::Segment(2310, s::HI, "Other Diagnosis Information",
421
+ r::Situational, d::RepeatCount.bounded(2),
422
+ b::Element(e::Required, "HEALTH CARE CODE INFORMATION",
423
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("ABF", "BF")),
424
+ b::Element(e::Required, "Other Diagnosis"),
425
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
426
+ b::Element(e::NotUsed, "Date Time Period"),
427
+ b::Element(e::NotUsed, "Monetary Amount"),
428
+ b::Element(e::NotUsed, "Quantity"),
429
+ b::Element(e::NotUsed, "Version Identifier"),
430
+ b::Element(e::NotUsed, "Industry Code"),
431
+ b::Element(e::Situational, "Present on Admission Indicator", b::Values("N", "U", "W", "Y"))),
432
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
433
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("ABF", "BF")),
434
+ b::Element(e::Required, "Other Diagnosis"),
435
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
436
+ b::Element(e::NotUsed, "Date Time Period"),
437
+ b::Element(e::NotUsed, "Monetary Amount"),
438
+ b::Element(e::NotUsed, "Quantity"),
439
+ b::Element(e::NotUsed, "Version Identifier"),
440
+ b::Element(e::NotUsed, "Industry Code"),
441
+ b::Element(e::Situational, "Present on Admission Indicator", b::Values("N", "U", "W", "Y"))),
442
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
443
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("ABF", "BF")),
444
+ b::Element(e::Required, "Other Diagnosis"),
445
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
446
+ b::Element(e::NotUsed, "Date Time Period"),
447
+ b::Element(e::NotUsed, "Monetary Amount"),
448
+ b::Element(e::NotUsed, "Quantity"),
449
+ b::Element(e::NotUsed, "Version Identifier"),
450
+ b::Element(e::NotUsed, "Industry Code"),
451
+ b::Element(e::Situational, "Present on Admission Indicator", b::Values("N", "U", "W", "Y"))),
452
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
453
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("ABF", "BF")),
454
+ b::Element(e::Required, "Other Diagnosis"),
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::Situational, "Present on Admission Indicator", b::Values("N", "U", "W", "Y"))),
462
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
463
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("ABF", "BF")),
464
+ b::Element(e::Required, "Other Diagnosis"),
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::Situational, "Present on Admission Indicator", b::Values("N", "U", "W", "Y"))),
472
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
473
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("ABF", "BF")),
474
+ b::Element(e::Required, "Other Diagnosis"),
475
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
476
+ b::Element(e::NotUsed, "Date Time Period"),
477
+ b::Element(e::NotUsed, "Monetary Amount"),
478
+ b::Element(e::NotUsed, "Quantity"),
479
+ b::Element(e::NotUsed, "Version Identifier"),
480
+ b::Element(e::NotUsed, "Industry Code"),
481
+ b::Element(e::Situational, "Present on Admission Indicator", b::Values("N", "U", "W", "Y"))),
482
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
483
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("ABF", "BF")),
484
+ b::Element(e::Required, "Other Diagnosis"),
485
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
486
+ b::Element(e::NotUsed, "Date Time Period"),
487
+ b::Element(e::NotUsed, "Monetary Amount"),
488
+ b::Element(e::NotUsed, "Quantity"),
489
+ b::Element(e::NotUsed, "Version Identifier"),
490
+ b::Element(e::NotUsed, "Industry Code"),
491
+ b::Element(e::Situational, "Present on Admission Indicator", b::Values("N", "U", "W", "Y"))),
492
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
493
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("ABF", "BF")),
494
+ b::Element(e::Required, "Other Diagnosis"),
495
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
496
+ b::Element(e::NotUsed, "Date Time Period"),
497
+ b::Element(e::NotUsed, "Monetary Amount"),
498
+ b::Element(e::NotUsed, "Quantity"),
499
+ b::Element(e::NotUsed, "Version Identifier"),
500
+ b::Element(e::NotUsed, "Industry Code"),
501
+ b::Element(e::Situational, "Present on Admission Indicator", b::Values("N", "U", "W", "Y"))),
502
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
503
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("ABF", "BF")),
504
+ b::Element(e::Required, "Other Diagnosis"),
505
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
506
+ b::Element(e::NotUsed, "Date Time Period"),
507
+ b::Element(e::NotUsed, "Monetary Amount"),
508
+ b::Element(e::NotUsed, "Quantity"),
509
+ b::Element(e::NotUsed, "Version Identifier"),
510
+ b::Element(e::NotUsed, "Industry Code"),
511
+ b::Element(e::Situational, "Present on Admission Indicator", b::Values("N", "U", "W", "Y"))),
512
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
513
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("ABF", "BF")),
514
+ b::Element(e::Required, "Other Diagnosis"),
515
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
516
+ b::Element(e::NotUsed, "Date Time Period"),
517
+ b::Element(e::NotUsed, "Monetary Amount"),
518
+ b::Element(e::NotUsed, "Quantity"),
519
+ b::Element(e::NotUsed, "Version Identifier"),
520
+ b::Element(e::NotUsed, "Industry Code"),
521
+ b::Element(e::Situational, "Present on Admission Indicator", b::Values("N", "U", "W", "Y"))),
522
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
523
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("ABF", "BF")),
524
+ b::Element(e::Required, "Other Diagnosis"),
525
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
526
+ b::Element(e::NotUsed, "Date Time Period"),
527
+ b::Element(e::NotUsed, "Monetary Amount"),
528
+ b::Element(e::NotUsed, "Quantity"),
529
+ b::Element(e::NotUsed, "Version Identifier"),
530
+ b::Element(e::NotUsed, "Industry Code"),
531
+ b::Element(e::Situational, "Present on Admission Indicator", b::Values("N", "U", "W", "Y"))),
532
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
533
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("ABF", "BF")),
534
+ b::Element(e::Required, "Other Diagnosis"),
535
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
536
+ b::Element(e::NotUsed, "Date Time Period"),
537
+ b::Element(e::NotUsed, "Monetary Amount"),
538
+ b::Element(e::NotUsed, "Quantity"),
539
+ b::Element(e::NotUsed, "Version Identifier"),
540
+ b::Element(e::NotUsed, "Industry Code"),
541
+ b::Element(e::Situational, "Present on Admission Indicator", b::Values("N", "U", "W", "Y")))
542
+ ),
543
+ b::Segment(2310, s::HI, "Principal Procedure Information",
544
+ r::Situational, d::RepeatCount.bounded(1),
545
+ b::Element(e::Required, "HEALTH CARE CODE INFORMATION",
546
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("BBR", "BR", "CAH")),
547
+ b::Element(e::Required, "Principal Procedure Code"),
548
+ b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
549
+ b::Element(e::Required, "Principal Procedure Date"),
550
+ b::Element(e::NotUsed, "Monetary Amount"),
551
+ b::Element(e::NotUsed, "Quantity"),
552
+ b::Element(e::NotUsed, "Version Identifier"),
553
+ b::Element(e::NotUsed, "Industry Code"),
554
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
555
+ b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
556
+ b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
557
+ b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
558
+ b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
559
+ b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
560
+ b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
561
+ b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
562
+ b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
563
+ b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
564
+ b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
565
+ b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION")
566
+ ),
567
+ b::Segment(2310, s::HI, "Other Procedure Information",
568
+ r::Situational, d::RepeatCount.bounded(2),
569
+ b::Element(e::Required, "HEALTH CARE CODE INFORMATION",
570
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("BBQ", "BQ")),
571
+ b::Element(e::Required, "Procedure Code"),
572
+ b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
573
+ b::Element(e::Required, "Procedure Date"),
574
+ b::Element(e::NotUsed, "Monetary Amount"),
575
+ b::Element(e::NotUsed, "Quantity"),
576
+ b::Element(e::NotUsed, "Version Identifier"),
577
+ b::Element(e::NotUsed, "Industry Code"),
578
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
579
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
580
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("BBQ", "BQ")),
581
+ b::Element(e::Required, "Procedure Code"),
582
+ b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
583
+ b::Element(e::Required, "Procedure Date"),
584
+ b::Element(e::NotUsed, "Monetary Amount"),
585
+ b::Element(e::NotUsed, "Quantity"),
586
+ b::Element(e::NotUsed, "Version Identifier"),
587
+ b::Element(e::NotUsed, "Industry Code"),
588
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
589
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
590
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("BBQ", "BQ")),
591
+ b::Element(e::Required, "Procedure Code"),
592
+ b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
593
+ b::Element(e::Required, "Procedure Date"),
594
+ b::Element(e::NotUsed, "Monetary Amount"),
595
+ b::Element(e::NotUsed, "Quantity"),
596
+ b::Element(e::NotUsed, "Version Identifier"),
597
+ b::Element(e::NotUsed, "Industry Code"),
598
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
599
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
600
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("BBQ", "BQ")),
601
+ b::Element(e::Required, "Procedure Code"),
602
+ b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
603
+ b::Element(e::Required, "Procedure Date"),
604
+ b::Element(e::NotUsed, "Monetary Amount"),
605
+ b::Element(e::NotUsed, "Quantity"),
606
+ b::Element(e::NotUsed, "Version Identifier"),
607
+ b::Element(e::NotUsed, "Industry Code"),
608
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
609
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
610
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("BBQ", "BQ")),
611
+ b::Element(e::Required, "Procedure Code"),
612
+ b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
613
+ b::Element(e::Required, "Procedure Date"),
614
+ b::Element(e::NotUsed, "Monetary Amount"),
615
+ b::Element(e::NotUsed, "Quantity"),
616
+ b::Element(e::NotUsed, "Version Identifier"),
617
+ b::Element(e::NotUsed, "Industry Code"),
618
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
619
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
620
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("BBQ", "BQ")),
621
+ b::Element(e::Required, "Procedure Code"),
622
+ b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
623
+ b::Element(e::Required, "Procedure Date"),
624
+ b::Element(e::NotUsed, "Monetary Amount"),
625
+ b::Element(e::NotUsed, "Quantity"),
626
+ b::Element(e::NotUsed, "Version Identifier"),
627
+ b::Element(e::NotUsed, "Industry Code"),
628
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
629
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
630
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("BBQ", "BQ")),
631
+ b::Element(e::Required, "Procedure Code"),
632
+ b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
633
+ b::Element(e::Required, "Procedure Date"),
634
+ b::Element(e::NotUsed, "Monetary Amount"),
635
+ b::Element(e::NotUsed, "Quantity"),
636
+ b::Element(e::NotUsed, "Version Identifier"),
637
+ b::Element(e::NotUsed, "Industry Code"),
638
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
639
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
640
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("BBQ", "BQ")),
641
+ b::Element(e::Required, "Procedure Code"),
642
+ b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
643
+ b::Element(e::Required, "Procedure Date"),
644
+ b::Element(e::NotUsed, "Monetary Amount"),
645
+ b::Element(e::NotUsed, "Quantity"),
646
+ b::Element(e::NotUsed, "Version Identifier"),
647
+ b::Element(e::NotUsed, "Industry Code"),
648
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
649
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
650
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("BBQ", "BQ")),
651
+ b::Element(e::Required, "Procedure Code"),
652
+ b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
653
+ b::Element(e::Required, "Procedure Date"),
654
+ b::Element(e::NotUsed, "Monetary Amount"),
655
+ b::Element(e::NotUsed, "Quantity"),
656
+ b::Element(e::NotUsed, "Version Identifier"),
657
+ b::Element(e::NotUsed, "Industry Code"),
658
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
659
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
660
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("BBQ", "BQ")),
661
+ b::Element(e::Required, "Procedure Code"),
662
+ b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
663
+ b::Element(e::Required, "Procedure Date"),
664
+ b::Element(e::NotUsed, "Monetary Amount"),
665
+ b::Element(e::NotUsed, "Quantity"),
666
+ b::Element(e::NotUsed, "Version Identifier"),
667
+ b::Element(e::NotUsed, "Industry Code"),
668
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
669
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
670
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("BBQ", "BQ")),
671
+ b::Element(e::Required, "Procedure Code"),
672
+ b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
673
+ b::Element(e::Required, "Procedure Date"),
674
+ b::Element(e::NotUsed, "Monetary Amount"),
675
+ b::Element(e::NotUsed, "Quantity"),
676
+ b::Element(e::NotUsed, "Version Identifier"),
677
+ b::Element(e::NotUsed, "Industry Code"),
678
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
679
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
680
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("BBQ", "BQ")),
681
+ b::Element(e::Required, "Procedure Code"),
682
+ b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
683
+ b::Element(e::Required, "Procedure Date"),
684
+ b::Element(e::NotUsed, "Monetary Amount"),
685
+ b::Element(e::NotUsed, "Quantity"),
686
+ b::Element(e::NotUsed, "Version Identifier"),
687
+ b::Element(e::NotUsed, "Industry Code"),
688
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code"))),
689
+ b::Segment(2310, s::HI, "Occurrence Span Information",
690
+ r::Situational, d::RepeatCount.bounded(2),
691
+ b::Element(e::Required, "HEALTH CLAIM CODE INFORMATION",
692
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("BI")),
693
+ b::Element(e::Required, "Occurrence Span Code"),
694
+ b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("RD8")),
695
+ b::Element(e::Required, "Occurrence Span Code Date"),
696
+ b::Element(e::NotUsed, "Monetary Amount"),
697
+ b::Element(e::NotUsed, "Quantity"),
698
+ b::Element(e::NotUsed, "Version Identifier"),
699
+ b::Element(e::NotUsed, "Industry Code"),
700
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
701
+ b::Element(e::Situational, "HEALTH CLAIM CODE INFORMATION",
702
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("BI")),
703
+ b::Element(e::Required, "Occurrence Span Code"),
704
+ b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("RD8")),
705
+ b::Element(e::Required, "Occurrence Span Code Date"),
706
+ b::Element(e::NotUsed, "Monetary Amount"),
707
+ b::Element(e::NotUsed, "Quantity"),
708
+ b::Element(e::NotUsed, "Version Identifier"),
709
+ b::Element(e::NotUsed, "Industry Code"),
710
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
711
+ b::Element(e::Situational, "HEALTH CLAIM CODE INFORMATION",
712
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("BI")),
713
+ b::Element(e::Required, "Occurrence Span Code"),
714
+ b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("RD8")),
715
+ b::Element(e::Required, "Occurrence Span Code Date"),
716
+ b::Element(e::NotUsed, "Monetary Amount"),
717
+ b::Element(e::NotUsed, "Quantity"),
718
+ b::Element(e::NotUsed, "Version Identifier"),
719
+ b::Element(e::NotUsed, "Industry Code"),
720
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
721
+ b::Element(e::Situational, "HEALTH CLAIM CODE INFORMATION",
722
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("BI")),
723
+ b::Element(e::Required, "Occurrence Span Code"),
724
+ b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("RD8")),
725
+ b::Element(e::Required, "Occurrence Span Code Date"),
726
+ b::Element(e::NotUsed, "Monetary Amount"),
727
+ b::Element(e::NotUsed, "Quantity"),
728
+ b::Element(e::NotUsed, "Version Identifier"),
729
+ b::Element(e::NotUsed, "Industry Code"),
730
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
731
+ b::Element(e::Situational, "HEALTH CLAIM CODE INFORMATION",
732
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("BI")),
733
+ b::Element(e::Required, "Occurrence Span Code"),
734
+ b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("RD8")),
735
+ b::Element(e::Required, "Occurrence Span Code Date"),
736
+ b::Element(e::NotUsed, "Monetary Amount"),
737
+ b::Element(e::NotUsed, "Quantity"),
738
+ b::Element(e::NotUsed, "Version Identifier"),
739
+ b::Element(e::NotUsed, "Industry Code"),
740
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
741
+ b::Element(e::Situational, "HEALTH CLAIM CODE INFORMATION",
742
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("BI")),
743
+ b::Element(e::Required, "Occurrence Span Code"),
744
+ b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("RD8")),
745
+ b::Element(e::Required, "Occurrence Span Code Date"),
746
+ b::Element(e::NotUsed, "Monetary Amount"),
747
+ b::Element(e::NotUsed, "Quantity"),
748
+ b::Element(e::NotUsed, "Version Identifier"),
749
+ b::Element(e::NotUsed, "Industry Code"),
750
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
751
+ b::Element(e::Situational, "HEALTH CLAIM CODE INFORMATION",
752
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("BI")),
753
+ b::Element(e::Required, "Occurrence Span Code"),
754
+ b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("RD8")),
755
+ b::Element(e::Required, "Occurrence Span Code Date"),
756
+ b::Element(e::NotUsed, "Monetary Amount"),
757
+ b::Element(e::NotUsed, "Quantity"),
758
+ b::Element(e::NotUsed, "Version Identifier"),
759
+ b::Element(e::NotUsed, "Industry Code"),
760
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
761
+ b::Element(e::Situational, "HEALTH CLAIM CODE INFORMATION",
762
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("BI")),
763
+ b::Element(e::Required, "Occurrence Span Code"),
764
+ b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("RD8")),
765
+ b::Element(e::Required, "Occurrence Span Code Date"),
766
+ b::Element(e::NotUsed, "Monetary Amount"),
767
+ b::Element(e::NotUsed, "Quantity"),
768
+ b::Element(e::NotUsed, "Version Identifier"),
769
+ b::Element(e::NotUsed, "Industry Code"),
770
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
771
+ b::Element(e::Situational, "HEALTH CLAIM CODE INFORMATION",
772
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("BI")),
773
+ b::Element(e::Required, "Occurrence Span Code"),
774
+ b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("RD8")),
775
+ b::Element(e::Required, "Occurrence Span Code Date"),
776
+ b::Element(e::NotUsed, "Monetary Amount"),
777
+ b::Element(e::NotUsed, "Quantity"),
778
+ b::Element(e::NotUsed, "Version Identifier"),
779
+ b::Element(e::NotUsed, "Industry Code"),
780
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
781
+ b::Element(e::Situational, "HEALTH CLAIM CODE INFORMATION",
782
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("BI")),
783
+ b::Element(e::Required, "Occurrence Span Code"),
784
+ b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("RD8")),
785
+ b::Element(e::Required, "Occurrence Span Code Date"),
786
+ b::Element(e::NotUsed, "Monetary Amount"),
787
+ b::Element(e::NotUsed, "Quantity"),
788
+ b::Element(e::NotUsed, "Version Identifier"),
789
+ b::Element(e::NotUsed, "Industry Code"),
790
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
791
+ b::Element(e::Situational, "HEALTH CLAIM CODE INFORMATION",
792
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("BI")),
793
+ b::Element(e::Required, "Occurrence Span Code"),
794
+ b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("RD8")),
795
+ b::Element(e::Required, "Occurrence Span Code Date"),
796
+ b::Element(e::NotUsed, "Monetary Amount"),
797
+ b::Element(e::NotUsed, "Quantity"),
798
+ b::Element(e::NotUsed, "Version Identifier"),
799
+ b::Element(e::NotUsed, "Industry Code"),
800
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
801
+ b::Element(e::Situational, "HEALTH CLAIM CODE INFORMATION",
802
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("BI")),
803
+ b::Element(e::Required, "Occurrence Span Code"),
804
+ b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("RD8")),
805
+ b::Element(e::Required, "Occurrence Span Code Date"),
806
+ b::Element(e::NotUsed, "Monetary Amount"),
807
+ b::Element(e::NotUsed, "Quantity"),
808
+ b::Element(e::NotUsed, "Version Identifier"),
809
+ b::Element(e::NotUsed, "Industry Code"),
810
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code"))),
811
+ b::Segment(2310, s::HI, "Occurrence Information",
812
+ r::Situational, d::RepeatCount.bounded(2),
813
+ b::Element(e::Required, "HEALTH CARE CODE INFORMATION",
814
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("BH")),
815
+ b::Element(e::Required, "Occurrence Code"),
816
+ b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
817
+ b::Element(e::Required, "Occurrence Code Date"),
818
+ b::Element(e::NotUsed, "Monetary Amount"),
819
+ b::Element(e::NotUsed, "Quantity"),
820
+ b::Element(e::NotUsed, "Version Identifier"),
821
+ b::Element(e::NotUsed, "Industy Code"),
822
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
823
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
824
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("BH")),
825
+ b::Element(e::Required, "Occurrence Code"),
826
+ b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
827
+ b::Element(e::Required, "Occurrence Code Date"),
828
+ b::Element(e::NotUsed, "Monetary Amount"),
829
+ b::Element(e::NotUsed, "Quantity"),
830
+ b::Element(e::NotUsed, "Version Identifier"),
831
+ b::Element(e::NotUsed, "Industy Code"),
832
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
833
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
834
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("BH")),
835
+ b::Element(e::Required, "Occurrence Code"),
836
+ b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
837
+ b::Element(e::Required, "Occurrence Code Date"),
838
+ b::Element(e::NotUsed, "Monetary Amount"),
839
+ b::Element(e::NotUsed, "Quantity"),
840
+ b::Element(e::NotUsed, "Version Identifier"),
841
+ b::Element(e::NotUsed, "Industy Code"),
842
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
843
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
844
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("BH")),
845
+ b::Element(e::Required, "Occurrence Code"),
846
+ b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
847
+ b::Element(e::Required, "Occurrence Code Date"),
848
+ b::Element(e::NotUsed, "Monetary Amount"),
849
+ b::Element(e::NotUsed, "Quantity"),
850
+ b::Element(e::NotUsed, "Version Identifier"),
851
+ b::Element(e::NotUsed, "Industy Code"),
852
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
853
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
854
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("BH")),
855
+ b::Element(e::Required, "Occurrence Code"),
856
+ b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
857
+ b::Element(e::Required, "Occurrence Code Date"),
858
+ b::Element(e::NotUsed, "Monetary Amount"),
859
+ b::Element(e::NotUsed, "Quantity"),
860
+ b::Element(e::NotUsed, "Version Identifier"),
861
+ b::Element(e::NotUsed, "Industy Code"),
862
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
863
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
864
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("BH")),
865
+ b::Element(e::Required, "Occurrence Code"),
866
+ b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
867
+ b::Element(e::Required, "Occurrence Code Date"),
868
+ b::Element(e::NotUsed, "Monetary Amount"),
869
+ b::Element(e::NotUsed, "Quantity"),
870
+ b::Element(e::NotUsed, "Version Identifier"),
871
+ b::Element(e::NotUsed, "Industy Code"),
872
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
873
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
874
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("BH")),
875
+ b::Element(e::Required, "Occurrence Code"),
876
+ b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
877
+ b::Element(e::Required, "Occurrence Code Date"),
878
+ b::Element(e::NotUsed, "Monetary Amount"),
879
+ b::Element(e::NotUsed, "Quantity"),
880
+ b::Element(e::NotUsed, "Version Identifier"),
881
+ b::Element(e::NotUsed, "Industy Code"),
882
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
883
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
884
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("BH")),
885
+ b::Element(e::Required, "Occurrence Code"),
886
+ b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
887
+ b::Element(e::Required, "Occurrence Code Date"),
888
+ b::Element(e::NotUsed, "Monetary Amount"),
889
+ b::Element(e::NotUsed, "Quantity"),
890
+ b::Element(e::NotUsed, "Version Identifier"),
891
+ b::Element(e::NotUsed, "Industy Code"),
892
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
893
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
894
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("BH")),
895
+ b::Element(e::Required, "Occurrence Code"),
896
+ b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
897
+ b::Element(e::Required, "Occurrence Code Date"),
898
+ b::Element(e::NotUsed, "Monetary Amount"),
899
+ b::Element(e::NotUsed, "Quantity"),
900
+ b::Element(e::NotUsed, "Version Identifier"),
901
+ b::Element(e::NotUsed, "Industy Code"),
902
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
903
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
904
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("BH")),
905
+ b::Element(e::Required, "Occurrence Code"),
906
+ b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
907
+ b::Element(e::Required, "Occurrence Code Date"),
908
+ b::Element(e::NotUsed, "Monetary Amount"),
909
+ b::Element(e::NotUsed, "Quantity"),
910
+ b::Element(e::NotUsed, "Version Identifier"),
911
+ b::Element(e::NotUsed, "Industy Code"),
912
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
913
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
914
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("BH")),
915
+ b::Element(e::Required, "Occurrence Code"),
916
+ b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
917
+ b::Element(e::Required, "Occurrence Code Date"),
918
+ b::Element(e::NotUsed, "Monetary Amount"),
919
+ b::Element(e::NotUsed, "Quantity"),
920
+ b::Element(e::NotUsed, "Version Identifier"),
921
+ b::Element(e::NotUsed, "Industy Code"),
922
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
923
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
924
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("BH")),
925
+ b::Element(e::Required, "Occurrence Code"),
926
+ b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
927
+ b::Element(e::Required, "Occurrence Code Date"),
928
+ b::Element(e::NotUsed, "Monetary Amount"),
929
+ b::Element(e::NotUsed, "Quantity"),
930
+ b::Element(e::NotUsed, "Version Identifier"),
931
+ b::Element(e::NotUsed, "Industy Code"),
932
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
933
+ ),
934
+ b::Segment(2310, s::HI, "Value Information",
935
+ r::Situational, d::RepeatCount.bounded(2),
936
+ b::Element(e::Required, "HEALTH CARE CODE INFORMATION",
937
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("BE")),
938
+ b::Element(e::Required, "Value Code"),
939
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
940
+ b::Element(e::NotUsed, "Date Time Period"),
941
+ b::Element(e::Required, "Value Code Amount"),
942
+ b::Element(e::NotUsed, "Quantity"),
943
+ b::Element(e::NotUsed, "Version Identifier"),
944
+ b::Element(e::NotUsed, "Industry Code"),
945
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
946
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
947
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("BE")),
948
+ b::Element(e::Required, "Value Code"),
949
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
950
+ b::Element(e::NotUsed, "Date Time Period"),
951
+ b::Element(e::Required, "Value Code Amount"),
952
+ b::Element(e::NotUsed, "Quantity"),
953
+ b::Element(e::NotUsed, "Version Identifier"),
954
+ b::Element(e::NotUsed, "Industry Code"),
955
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
956
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
957
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("BE")),
958
+ b::Element(e::Required, "Value Code"),
959
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
960
+ b::Element(e::NotUsed, "Date Time Period"),
961
+ b::Element(e::Required, "Value Code Amount"),
962
+ b::Element(e::NotUsed, "Quantity"),
963
+ b::Element(e::NotUsed, "Version Identifier"),
964
+ b::Element(e::NotUsed, "Industry Code"),
965
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
966
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
967
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("BE")),
968
+ b::Element(e::Required, "Value Code"),
969
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
970
+ b::Element(e::NotUsed, "Date Time Period"),
971
+ b::Element(e::Required, "Value Code Amount"),
972
+ b::Element(e::NotUsed, "Quantity"),
973
+ b::Element(e::NotUsed, "Version Identifier"),
974
+ b::Element(e::NotUsed, "Industry Code"),
975
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
976
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
977
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("BE")),
978
+ b::Element(e::Required, "Value Code"),
979
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
980
+ b::Element(e::NotUsed, "Date Time Period"),
981
+ b::Element(e::Required, "Value Code Amount"),
982
+ b::Element(e::NotUsed, "Quantity"),
983
+ b::Element(e::NotUsed, "Version Identifier"),
984
+ b::Element(e::NotUsed, "Industry Code"),
985
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
986
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
987
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("BE")),
988
+ b::Element(e::Required, "Value Code"),
989
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
990
+ b::Element(e::NotUsed, "Date Time Period"),
991
+ b::Element(e::Required, "Value Code Amount"),
992
+ b::Element(e::NotUsed, "Quantity"),
993
+ b::Element(e::NotUsed, "Version Identifier"),
994
+ b::Element(e::NotUsed, "Industry Code"),
995
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
996
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
997
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("BE")),
998
+ b::Element(e::Required, "Value Code"),
999
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
1000
+ b::Element(e::NotUsed, "Date Time Period"),
1001
+ b::Element(e::Required, "Value Code Amount"),
1002
+ b::Element(e::NotUsed, "Quantity"),
1003
+ b::Element(e::NotUsed, "Version Identifier"),
1004
+ b::Element(e::NotUsed, "Industry Code"),
1005
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
1006
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
1007
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("BE")),
1008
+ b::Element(e::Required, "Value Code"),
1009
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
1010
+ b::Element(e::NotUsed, "Date Time Period"),
1011
+ b::Element(e::Required, "Value Code Amount"),
1012
+ b::Element(e::NotUsed, "Quantity"),
1013
+ b::Element(e::NotUsed, "Version Identifier"),
1014
+ b::Element(e::NotUsed, "Industry Code"),
1015
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
1016
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
1017
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("BE")),
1018
+ b::Element(e::Required, "Value Code"),
1019
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
1020
+ b::Element(e::NotUsed, "Date Time Period"),
1021
+ b::Element(e::Required, "Value Code Amount"),
1022
+ b::Element(e::NotUsed, "Quantity"),
1023
+ b::Element(e::NotUsed, "Version Identifier"),
1024
+ b::Element(e::NotUsed, "Industry Code"),
1025
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
1026
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
1027
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("BE")),
1028
+ b::Element(e::Required, "Value Code"),
1029
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
1030
+ b::Element(e::NotUsed, "Date Time Period"),
1031
+ b::Element(e::Required, "Value Code Amount"),
1032
+ b::Element(e::NotUsed, "Quantity"),
1033
+ b::Element(e::NotUsed, "Version Identifier"),
1034
+ b::Element(e::NotUsed, "Industry Code"),
1035
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
1036
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
1037
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("BE")),
1038
+ b::Element(e::Required, "Value Code"),
1039
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
1040
+ b::Element(e::NotUsed, "Date Time Period"),
1041
+ b::Element(e::Required, "Value Code Amount"),
1042
+ b::Element(e::NotUsed, "Quantity"),
1043
+ b::Element(e::NotUsed, "Version Identifier"),
1044
+ b::Element(e::NotUsed, "Industry Code"),
1045
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
1046
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
1047
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("BE")),
1048
+ b::Element(e::Required, "Value Code"),
1049
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
1050
+ b::Element(e::NotUsed, "Date Time Period"),
1051
+ b::Element(e::Required, "Value Code Amount"),
1052
+ b::Element(e::NotUsed, "Quantity"),
1053
+ b::Element(e::NotUsed, "Version Identifier"),
1054
+ b::Element(e::NotUsed, "Industry Code"),
1055
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code"))),
1056
+ b::Segment(2310, s::HI, "Condition Information",
1057
+ r::Situational, d::RepeatCount.bounded(2),
1058
+ b::Element(e::Required, "HEALTH CARE CODE INFORMATION",
1059
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("BG")),
1060
+ b::Element(e::Required, "Condition Code"),
1061
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
1062
+ b::Element(e::NotUsed, "Date Time Period"),
1063
+ b::Element(e::NotUsed, "Monetary Amount"),
1064
+ b::Element(e::NotUsed, "Quantity"),
1065
+ b::Element(e::NotUsed, "Version Identifier"),
1066
+ b::Element(e::NotUsed, "Industry Code"),
1067
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
1068
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
1069
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("BG")),
1070
+ b::Element(e::Required, "Condition Code"),
1071
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
1072
+ b::Element(e::NotUsed, "Date Time Period"),
1073
+ b::Element(e::NotUsed, "Monetary Amount"),
1074
+ b::Element(e::NotUsed, "Quantity"),
1075
+ b::Element(e::NotUsed, "Version Identifier"),
1076
+ b::Element(e::NotUsed, "Industry Code"),
1077
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
1078
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
1079
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("BG")),
1080
+ b::Element(e::Required, "Condition Code"),
1081
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
1082
+ b::Element(e::NotUsed, "Date Time Period"),
1083
+ b::Element(e::NotUsed, "Monetary Amount"),
1084
+ b::Element(e::NotUsed, "Quantity"),
1085
+ b::Element(e::NotUsed, "Version Identifier"),
1086
+ b::Element(e::NotUsed, "Industry Code"),
1087
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
1088
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
1089
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("BG")),
1090
+ b::Element(e::Required, "Condition Code"),
1091
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
1092
+ b::Element(e::NotUsed, "Date Time Period"),
1093
+ b::Element(e::NotUsed, "Monetary Amount"),
1094
+ b::Element(e::NotUsed, "Quantity"),
1095
+ b::Element(e::NotUsed, "Version Identifier"),
1096
+ b::Element(e::NotUsed, "Industry Code"),
1097
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
1098
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
1099
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("BG")),
1100
+ b::Element(e::Required, "Condition Code"),
1101
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
1102
+ b::Element(e::NotUsed, "Date Time Period"),
1103
+ b::Element(e::NotUsed, "Monetary Amount"),
1104
+ b::Element(e::NotUsed, "Quantity"),
1105
+ b::Element(e::NotUsed, "Version Identifier"),
1106
+ b::Element(e::NotUsed, "Industry Code"),
1107
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
1108
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
1109
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("BG")),
1110
+ b::Element(e::Required, "Condition Code"),
1111
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
1112
+ b::Element(e::NotUsed, "Date Time Period"),
1113
+ b::Element(e::NotUsed, "Monetary Amount"),
1114
+ b::Element(e::NotUsed, "Quantity"),
1115
+ b::Element(e::NotUsed, "Version Identifier"),
1116
+ b::Element(e::NotUsed, "Industry Code"),
1117
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
1118
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
1119
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("BG")),
1120
+ b::Element(e::Required, "Condition Code"),
1121
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
1122
+ b::Element(e::NotUsed, "Date Time Period"),
1123
+ b::Element(e::NotUsed, "Monetary Amount"),
1124
+ b::Element(e::NotUsed, "Quantity"),
1125
+ b::Element(e::NotUsed, "Version Identifier"),
1126
+ b::Element(e::NotUsed, "Industry Code"),
1127
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
1128
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
1129
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("BG")),
1130
+ b::Element(e::Required, "Condition Code"),
1131
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
1132
+ b::Element(e::NotUsed, "Date Time Period"),
1133
+ b::Element(e::NotUsed, "Monetary Amount"),
1134
+ b::Element(e::NotUsed, "Quantity"),
1135
+ b::Element(e::NotUsed, "Version Identifier"),
1136
+ b::Element(e::NotUsed, "Industry Code"),
1137
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
1138
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
1139
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("BG")),
1140
+ b::Element(e::Required, "Condition Code"),
1141
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
1142
+ b::Element(e::NotUsed, "Date Time Period"),
1143
+ b::Element(e::NotUsed, "Monetary Amount"),
1144
+ b::Element(e::NotUsed, "Quantity"),
1145
+ b::Element(e::NotUsed, "Version Identifier"),
1146
+ b::Element(e::NotUsed, "Industry Code"),
1147
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
1148
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
1149
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("BG")),
1150
+ b::Element(e::Required, "Condition Code"),
1151
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
1152
+ b::Element(e::NotUsed, "Date Time Period"),
1153
+ b::Element(e::NotUsed, "Monetary Amount"),
1154
+ b::Element(e::NotUsed, "Quantity"),
1155
+ b::Element(e::NotUsed, "Version Identifier"),
1156
+ b::Element(e::NotUsed, "Industry Code"),
1157
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
1158
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
1159
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("BG")),
1160
+ b::Element(e::Required, "Condition Code"),
1161
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
1162
+ b::Element(e::NotUsed, "Date Time Period"),
1163
+ b::Element(e::NotUsed, "Monetary Amount"),
1164
+ b::Element(e::NotUsed, "Quantity"),
1165
+ b::Element(e::NotUsed, "Version Identifier"),
1166
+ b::Element(e::NotUsed, "Industry Code"),
1167
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
1168
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
1169
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("BG")),
1170
+ b::Element(e::Required, "Condition Code"),
1171
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
1172
+ b::Element(e::NotUsed, "Date Time Period"),
1173
+ b::Element(e::NotUsed, "Monetary Amount"),
1174
+ b::Element(e::NotUsed, "Quantity"),
1175
+ b::Element(e::NotUsed, "Version Identifier"),
1176
+ b::Element(e::NotUsed, "Industry Code"),
1177
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code"))),
1178
+ b::Segment(2310, s::HI, "Treatment Code Information",
1179
+ r::Situational, d::RepeatCount.bounded(2),
1180
+ b::Element(e::Required, "HEALTH CARE CODE INFORMATION",
1181
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("TC")),
1182
+ b::Element(e::Required, "Treatment Code"),
1183
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
1184
+ b::Element(e::NotUsed, "Date Time Period"),
1185
+ b::Element(e::NotUsed, "Monetary Amount"),
1186
+ b::Element(e::NotUsed, "Quantity"),
1187
+ b::Element(e::NotUsed, "Version Identifier"),
1188
+ b::Element(e::NotUsed, "Industry Code"),
1189
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
1190
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
1191
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("TC")),
1192
+ b::Element(e::Required, "Treatment Code"),
1193
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
1194
+ b::Element(e::NotUsed, "Date Time Period"),
1195
+ b::Element(e::NotUsed, "Monetary Amount"),
1196
+ b::Element(e::NotUsed, "Quantity"),
1197
+ b::Element(e::NotUsed, "Version Identifier"),
1198
+ b::Element(e::NotUsed, "Industry Code"),
1199
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
1200
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
1201
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("TC")),
1202
+ b::Element(e::Required, "Treatment Code"),
1203
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
1204
+ b::Element(e::NotUsed, "Date Time Period"),
1205
+ b::Element(e::NotUsed, "Monetary Amount"),
1206
+ b::Element(e::NotUsed, "Quantity"),
1207
+ b::Element(e::NotUsed, "Version Identifier"),
1208
+ b::Element(e::NotUsed, "Industry Code"),
1209
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
1210
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
1211
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("TC")),
1212
+ b::Element(e::Required, "Treatment Code"),
1213
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
1214
+ b::Element(e::NotUsed, "Date Time Period"),
1215
+ b::Element(e::NotUsed, "Monetary Amount"),
1216
+ b::Element(e::NotUsed, "Quantity"),
1217
+ b::Element(e::NotUsed, "Version Identifier"),
1218
+ b::Element(e::NotUsed, "Industry Code"),
1219
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
1220
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
1221
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("TC")),
1222
+ b::Element(e::Required, "Treatment Code"),
1223
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
1224
+ b::Element(e::NotUsed, "Date Time Period"),
1225
+ b::Element(e::NotUsed, "Monetary Amount"),
1226
+ b::Element(e::NotUsed, "Quantity"),
1227
+ b::Element(e::NotUsed, "Version Identifier"),
1228
+ b::Element(e::NotUsed, "Industry Code"),
1229
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
1230
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
1231
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("TC")),
1232
+ b::Element(e::Required, "Treatment Code"),
1233
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
1234
+ b::Element(e::NotUsed, "Date Time Period"),
1235
+ b::Element(e::NotUsed, "Monetary Amount"),
1236
+ b::Element(e::NotUsed, "Quantity"),
1237
+ b::Element(e::NotUsed, "Version Identifier"),
1238
+ b::Element(e::NotUsed, "Industry Code"),
1239
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
1240
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
1241
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("TC")),
1242
+ b::Element(e::Required, "Treatment Code"),
1243
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
1244
+ b::Element(e::NotUsed, "Date Time Period"),
1245
+ b::Element(e::NotUsed, "Monetary Amount"),
1246
+ b::Element(e::NotUsed, "Quantity"),
1247
+ b::Element(e::NotUsed, "Version Identifier"),
1248
+ b::Element(e::NotUsed, "Industry Code"),
1249
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
1250
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
1251
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("TC")),
1252
+ b::Element(e::Required, "Treatment Code"),
1253
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
1254
+ b::Element(e::NotUsed, "Date Time Period"),
1255
+ b::Element(e::NotUsed, "Monetary Amount"),
1256
+ b::Element(e::NotUsed, "Quantity"),
1257
+ b::Element(e::NotUsed, "Version Identifier"),
1258
+ b::Element(e::NotUsed, "Industry Code"),
1259
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
1260
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
1261
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("TC")),
1262
+ b::Element(e::Required, "Treatment Code"),
1263
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
1264
+ b::Element(e::NotUsed, "Date Time Period"),
1265
+ b::Element(e::NotUsed, "Monetary Amount"),
1266
+ b::Element(e::NotUsed, "Quantity"),
1267
+ b::Element(e::NotUsed, "Version Identifier"),
1268
+ b::Element(e::NotUsed, "Industry Code"),
1269
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
1270
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
1271
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("TC")),
1272
+ b::Element(e::Required, "Treatment Code"),
1273
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
1274
+ b::Element(e::NotUsed, "Date Time Period"),
1275
+ b::Element(e::NotUsed, "Monetary Amount"),
1276
+ b::Element(e::NotUsed, "Quantity"),
1277
+ b::Element(e::NotUsed, "Version Identifier"),
1278
+ b::Element(e::NotUsed, "Industry Code"),
1279
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
1280
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
1281
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("TC")),
1282
+ b::Element(e::Required, "Treatment Code"),
1283
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
1284
+ b::Element(e::NotUsed, "Date Time Period"),
1285
+ b::Element(e::NotUsed, "Monetary Amount"),
1286
+ b::Element(e::NotUsed, "Quantity"),
1287
+ b::Element(e::NotUsed, "Version Identifier"),
1288
+ b::Element(e::NotUsed, "Industry Code"),
1289
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
1290
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
1291
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("TC")),
1292
+ b::Element(e::Required, "Treatment Code"),
1293
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
1294
+ b::Element(e::NotUsed, "Date Time Period"),
1295
+ b::Element(e::NotUsed, "Monetary Amount"),
1296
+ b::Element(e::NotUsed, "Quantity"),
1297
+ b::Element(e::NotUsed, "Version Identifier"),
1298
+ b::Element(e::NotUsed, "Industry Code"),
1299
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code"))),
1300
+ b::Segment(2410, s::HCP, "Claim Pricing/Repricing Information",
1301
+ r::Situational, d::RepeatCount.bounded(1),
1302
+ b::Element(e::Required, "Pricing Methodology", b::Values("00", "01", "02", "03", "04", "05", "06", "07", "08", "09", "10", "11", "12", "13", "14")),
1303
+ b::Element(e::Required, "Repriced Allowed Amount"),
1304
+ b::Element(e::Situational, "Repriced Saving Amount"),
1305
+ b::Element(e::Situational, "Repricing Organization Identifier"),
1306
+ b::Element(e::Situational, "Repricing Per Diem or Flat Rate Amount"),
1307
+ b::Element(e::Situational, "Repriced Approved DRG Code"),
1308
+ b::Element(e::Situational, "Repriced Approved Amount"),
1309
+ b::Element(e::Situational, "Repriced Approved Revenue Code"),
1310
+ b::Element(e::NotUsed, "Product/Service Qualifier"),
1311
+ b::Element(e::NotUsed, "Product/Service ID"),
1312
+ b::Element(e::Situational, "Unit or Basis of Measurement Code", b::Values("DA", "UN")),
1313
+ b::Element(e::Situational, "Repriced Approved Service Unit Count"),
1314
+ b::Element(e::Situational, "Reject Reason Code", b::Values("T1", "T2", "T3", "T4", "T5", "T6")),
1315
+ b::Element(e::Situational, "Policy Compliance Code", b::Values("1", "2", "3", "4", "5")),
1316
+ b::Element(e::Situational, "Exception Code", b::Values("1", "2", "3", "4", "5", "6"))),
1317
+
1318
+ d::LoopDef.build("2310A ATTENDING PROVIDER NAME",
1319
+ d::RepeatCount.bounded(1),
1320
+ b::Segment(2500, s::NM1, "Attending Provider Name",
1321
+ r::Situational, d::RepeatCount.bounded(1),
1322
+ b::Element(e::Required, "Entity Identifier Code", b::Values("71")),
1323
+ b::Element(e::Required, "Entity Type Qualifier", b::Values("1")),
1324
+ b::Element(e::Required, "Attending Provider Last Name"),
1325
+ b::Element(e::Situational, "Attending Provider First Name"),
1326
+ b::Element(e::Situational, "Attending Provider Middle Name or Initial"),
1327
+ b::Element(e::NotUsed, "Name Prefix"),
1328
+ b::Element(e::Situational, "Attending Provider Name Suffix"),
1329
+ b::Element(e::Situational, "Identification Code Qualifier", b::Values("XX")),
1330
+ b::Element(e::Situational, "Attending Provider Primary Identifier"),
1331
+ b::Element(e::NotUsed, "Entity Relationship Code"),
1332
+ b::Element(e::NotUsed, "Entity Identifier Code"),
1333
+ b::Element(e::NotUsed, "Name Last or Organization Name")),
1334
+ b::Segment(2550, s::PRV, "Attending Provider Specialty Information",
1335
+ r::Situational, d::RepeatCount.bounded(1),
1336
+ b::Element(e::Required, "Provider Code", b::Values("AT")),
1337
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("PXC")),
1338
+ b::Element(e::Required, "Provider Taxonomy Code"),
1339
+ b::Element(e::NotUsed, "State or Province Code"),
1340
+ b::Element(e::NotUsed, "PROVIDER SPECIALITY INFORMATION"),
1341
+ b::Element(e::NotUsed, "Provider Organization Code")),
1342
+ b::Segment(2710, s::REF, "Attending Provider Secondary Information",
1343
+ r::Situational, d::RepeatCount.bounded(3),
1344
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("0B", "1G", "G2")),
1345
+ b::Element(e::Required, "Referring Provider Secondary Identifier"),
1346
+ b::Element(e::NotUsed, "Description"),
1347
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER"))),
1348
+
1349
+ d::LoopDef.build("2310B OPERATING PHYSICIAN NAME",
1350
+ d::RepeatCount.bounded(1),
1351
+ b::Segment(2500, s::NM1, "Operating Physician Name",
1352
+ r::Situational, d::RepeatCount.bounded(1),
1353
+ b::Element(e::Required, "Entity Identifier Code", b::Values("72")),
1354
+ b::Element(e::Required, "Entity Type Qualifier", b::Values("1")),
1355
+ b::Element(e::Required, "Attending Provider Last Name"),
1356
+ b::Element(e::Situational, "Attending Provider First Name"),
1357
+ b::Element(e::Situational, "Attending Provider Middle Name or Initial"),
1358
+ b::Element(e::NotUsed, "Name Prefix"),
1359
+ b::Element(e::Situational, "Attending Provider Name Suffix"),
1360
+ b::Element(e::Situational, "Identification Code Qualifier", b::Values("XX")),
1361
+ b::Element(e::Situational, "Attending Provider Primary Identifier"),
1362
+ b::Element(e::NotUsed, "Entity Relationship Code"),
1363
+ b::Element(e::NotUsed, "Entity Identifier Code"),
1364
+ b::Element(e::NotUsed, "Name Last or Organization Name")),
1365
+ b::Segment(2710, s::REF, "Operating Physician Secondary Identification",
1366
+ r::Situational, d::RepeatCount.bounded(4),
1367
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("0B", "1G", "G2", "LU")),
1368
+ b::Element(e::Required, "Reference Physician Secondary Identifier"),
1369
+ b::Element(e::NotUsed, "Description"),
1370
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER"))),
1371
+
1372
+ d::LoopDef.build("2310C OTHER OPERATING PHYSICIAN NAME",
1373
+ d::RepeatCount.bounded(1),
1374
+ b::Segment(2500, s::NM1, "Other Operating Physician Name",
1375
+ r::Situational, d::RepeatCount.bounded(1),
1376
+ b::Element(e::Required, "Entity Identifier Code", b::Values("ZZ")),
1377
+ b::Element(e::Required, "Entity Type Qualifier", b::Values("1")),
1378
+ b::Element(e::Required, "Other Operating Physician Last Name"),
1379
+ b::Element(e::Situational, "Other Operating Physician First Name"),
1380
+ b::Element(e::Situational, "Other Operating Physician Middle Name or Initial"),
1381
+ b::Element(e::NotUsed, "Name Prefix"),
1382
+ b::Element(e::Situational, "Other Operating Physician Name Suffix"),
1383
+ b::Element(e::Situational, "Identification Code Qualifier", b::Values("XX")),
1384
+ b::Element(e::Situational, "Other Operating Physician Identifier"),
1385
+ b::Element(e::NotUsed, "Entity Relationship Code"),
1386
+ b::Element(e::NotUsed, "Entity Identifier Code"),
1387
+ b::Element(e::NotUsed, "Name Last or Organization Name")),
1388
+ b::Segment(2710, s::REF, "Other Operating Physician Secondary Identification",
1389
+ r::Situational, d::RepeatCount.bounded(4),
1390
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("0B", "1G", "G2", "LU")),
1391
+ b::Element(e::Required, "Other Provider Secondary Identifier"),
1392
+ b::Element(e::NotUsed, "Description"),
1393
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER"))),
1394
+
1395
+ d::LoopDef.build("2310D RENDERING PROVIDER NAME",
1396
+ d::RepeatCount.bounded(1),
1397
+ b::Segment(2500, s::NM1, "Rendering Provider Name",
1398
+ r::Situational, d::RepeatCount.bounded(1),
1399
+ b::Element(e::Required, "Entity Identifier Code", b::Values("82")),
1400
+ b::Element(e::Required, "Entity Type Qualifier", b::Values("1")),
1401
+ b::Element(e::Required, "Rendering Provider Last Name"),
1402
+ b::Element(e::Situational, "Rendering Provider First Name"),
1403
+ b::Element(e::Situational, "Rendering Provider Middle Name or Initial"),
1404
+ b::Element(e::NotUsed, "Name Prefix"),
1405
+ b::Element(e::Situational, "Rendering Provider Name Suffix"),
1406
+ b::Element(e::Situational, "Identification Code Qualifier", b::Values("XX")),
1407
+ b::Element(e::Situational, "Rendering Provider Identifier"),
1408
+ b::Element(e::NotUsed, "Entity Relationship Code"),
1409
+ b::Element(e::NotUsed, "Entity Identifier Code"),
1410
+ b::Element(e::NotUsed, "Name Last or Organization Name")),
1411
+ b::Segment(2710, s::REF, "Rendering Provider Secondary Identification",
1412
+ r::Situational, d::RepeatCount.bounded(4),
1413
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("0B", "1G", "G2", "LU")),
1414
+ b::Element(e::Required, "Rendering Provider Secondary Identifier"),
1415
+ b::Element(e::NotUsed, "Description"),
1416
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER"))),
1417
+
1418
+ d::LoopDef.build("2310E SERVICE FACILITY LOCATION NAME",
1419
+ d::RepeatCount.bounded(1),
1420
+ b::Segment(2500, s::NM1, "Service Facility Location Name",
1421
+ r::Situational, d::RepeatCount.bounded(1),
1422
+ b::Element(e::Required, "Entity Identifier Code", b::Values("77")),
1423
+ b::Element(e::Required, "Entity Type Qualifier", b::Values("2")),
1424
+ b::Element(e::Required, "Laboratory or Facility Name"),
1425
+ b::Element(e::NotUsed, "Name First"),
1426
+ b::Element(e::NotUsed, "Name Middle"),
1427
+ b::Element(e::NotUsed, "Name Prefix"),
1428
+ b::Element(e::NotUsed, "Name Suffix"),
1429
+ b::Element(e::Situational, "Identification Code Qualifier", b::Values("XX")),
1430
+ b::Element(e::Situational, "Laboratory or Facility Primary Identifier"),
1431
+ b::Element(e::NotUsed, "Entity Relationship Code"),
1432
+ b::Element(e::NotUsed, "Entity Identifier Code"),
1433
+ b::Element(e::NotUsed, "Name Last or Organization Name")),
1434
+ b::Segment(2650, s::N3, "Service Facility Location Address",
1435
+ r::Required, d::RepeatCount.bounded(1),
1436
+ b::Element(e::Required, "Laboratory or Facility Address Line"),
1437
+ b::Element(e::Situational, "Laboratory or Facility Address Line")),
1438
+ b::Segment(2700, s::N4, "Service Facility Location City, State, ZIP Code",
1439
+ r::Required, d::RepeatCount.bounded(1),
1440
+ b::Element(e::Required, "Laboratory or Facility City Name"),
1441
+ b::Element(e::Situational, "Laboratory or Facility State or Province Code"),
1442
+ b::Element(e::Situational, "Laboratory or Facility Postal Zone or ZIP Code"),
1443
+ b::Element(e::Situational, "Country Code"),
1444
+ b::Element(e::NotUsed, "Location Qualifier"),
1445
+ b::Element(e::NotUsed, "Location Identifier"),
1446
+ b::Element(e::Situational, "Country Subdivision Code")),
1447
+ b::Segment(2710, s::REF, "Service Facility Location Secondary Identification",
1448
+ r::Situational, d::RepeatCount.bounded(3),
1449
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("0B", "G2", "LU")),
1450
+ b::Element(e::Required, "Laboratory or Facility Secondary Identifier"),
1451
+ b::Element(e::NotUsed, "Description"),
1452
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER"))),
1453
+
1454
+ d::LoopDef.build("2310F REFERRING PROVIDER NAME",
1455
+ d::RepeatCount.bounded(1),
1456
+ b::Segment(2500, s::NM1, "Referring Provider Name",
1457
+ r::Situational, d::RepeatCount.bounded(2),
1458
+ b::Element(e::Required, "Entity Identifier Code", b::Values("DN")),
1459
+ b::Element(e::Required, "Entity Type Qualifier", b::Values("1")),
1460
+ b::Element(e::Required, "Referring Provider Last Name"),
1461
+ b::Element(e::Situational, "Referring Provider First Name"),
1462
+ b::Element(e::Situational, "Referring Provider Middle Name or Initial"),
1463
+ b::Element(e::NotUsed, "Name Prefix"),
1464
+ b::Element(e::Situational, "Referring Provider Name Suffix"),
1465
+ b::Element(e::Situational, "Identification Code Qualifier", b::Values("XX")),
1466
+ b::Element(e::Situational, "Identification Code"),
1467
+ b::Element(e::NotUsed, "Entity Relationship Code"),
1468
+ b::Element(e::NotUsed, "Entity Identifier Code"),
1469
+ b::Element(e::NotUsed, "Name Last or Organization Name")),
1470
+ b::Segment(2710, s::REF, "Referring Provider Secondary Identification",
1471
+ r::Situational, d::RepeatCount.bounded(3),
1472
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("0B", "1G", "G2")),
1473
+ b::Element(e::Required, "Referring Provider Secondary Identifier"),
1474
+ b::Element(e::NotUsed, "Description"),
1475
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER"))),
1476
+
1477
+ d::LoopDef.build("2320 OTHER SUBSCRIBER INFORMATION",
1478
+ d::RepeatCount.bounded(10),
1479
+ b::Segment(2900, s::SBR, "Other Subscriber Information",
1480
+ r::Situational, d::RepeatCount.bounded(1),
1481
+ b::Element(e::Required, "Payer Responsibility Sequence Number", b::Values("A", "B", "C", "D", "E", "F", "G", "H", "P", "S", "T", "U")),
1482
+ b::Element(e::Required, "Individual Relationship Code", b::Values("01", "18", "19", "20", "21", "39", "40", "53", "G8")),
1483
+ b::Element(e::Situational, "Insured Group or Policy Number"),
1484
+ b::Element(e::Situational, "Other Insured Group Name"),
1485
+ b::Element(e::NotUsed, "Insurance Type Code"),
1486
+ b::Element(e::NotUsed, "Coordination of Benefits Code"),
1487
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code"),
1488
+ b::Element(e::NotUsed, "Employment Status Code"),
1489
+ 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"))),
1490
+ b::Segment(2950, s::CAS, "Claim Level Adjustments",
1491
+ r::Situational, d::RepeatCount.bounded(5),
1492
+ b::Element(e::Required, "Claim Adjustment Group Code", b::Values("CO", "CR", "OA", "PI", "PR")),
1493
+ b::Element(e::Required, "Adjustment Reason Code"),
1494
+ b::Element(e::Required, "Adjustment Amount"),
1495
+ b::Element(e::Situational, "Adjustment Quantity"),
1496
+ b::Element(e::Situational, "Adjustment Reason Code"),
1497
+ b::Element(e::Situational, "Adjustment Amount"),
1498
+ b::Element(e::Situational, "Adjustment Quantity"),
1499
+ b::Element(e::Situational, "Adjustment Reason Code"),
1500
+ b::Element(e::Situational, "Adjustment Amount"),
1501
+ b::Element(e::Situational, "Adjustment Quantity"),
1502
+ b::Element(e::Situational, "Adjustment Reason Code"),
1503
+ b::Element(e::Situational, "Adjustment Amount"),
1504
+ b::Element(e::Situational, "Adjustment Quantity"),
1505
+ b::Element(e::Situational, "Adjustment Reason Code"),
1506
+ b::Element(e::Situational, "Adjustment Amount"),
1507
+ b::Element(e::Situational, "Adjustment Quantity"),
1508
+ b::Element(e::Situational, "Adjustment Reason Code"),
1509
+ b::Element(e::Situational, "Adjustment Amount"),
1510
+ b::Element(e::Situational, "Adjustment Quantity")),
1511
+ b::Segment(3000, s::AMT, "Coordination of Benefits (COB) Payer Paid Amount",
1512
+ r::Situational, d::RepeatCount.bounded(1),
1513
+ b::Element(e::Required, "Amount Qualifier Code", b::Values("D")),
1514
+ b::Element(e::Required, "Payer Paid Amount"),
1515
+ b::Element(e::NotUsed, "Credit/Debit Flag")),
1516
+ b::Segment(3000, s::AMT, "Remaining Patient Liability",
1517
+ r::Situational, d::RepeatCount.bounded(1),
1518
+ b::Element(e::Required, "Amount Qualifier Code", b::Values("EAF")),
1519
+ b::Element(e::Required, "Remaining Patient Liability"),
1520
+ b::Element(e::NotUsed, "Credit/Debit Flag")),
1521
+ b::Segment(3000, s::AMT, "Coordination of Benefits (COB) Total Non-Covered Amount",
1522
+ r::Situational, d::RepeatCount.bounded(1),
1523
+ b::Element(e::Required, "Amount Qualifier Code", b::Values("A8")),
1524
+ b::Element(e::Required, "Non-Covered Charge Amount"),
1525
+ b::Element(e::NotUsed, "Credit/Debit Flag Code")),
1526
+ b::Segment(3100, s::OI, "Other Insurance Coverage Information",
1527
+ r::Required, d::RepeatCount.bounded(1),
1528
+ b::Element(e::NotUsed, "Claim Filing Indicator Code"),
1529
+ b::Element(e::NotUsed, "Claim Submission Reason Code"),
1530
+ b::Element(e::Required, "Benefits Assignment Certification Indicator", b::Values("N", "W", "Y")),
1531
+ b::Element(e::NotUsed, "Patient Signature Source Code"),
1532
+ b::Element(e::NotUsed, "Provider Agreement Code"),
1533
+ b::Element(e::Required, "Release of Information Code", b::Values("I", "Y"))),
1534
+ b::Segment(3150, s::MIA, "Inpatient Adjudication Information",
1535
+ r::Situational, d::RepeatCount.bounded(1),
1536
+ b::Element(e::Required, "Covered Days or Visits Count"),
1537
+ b::Element(e::NotUsed, "Monetary Amount"),
1538
+ b::Element(e::Situational, "Lifetime Psychiatric Days Count"),
1539
+ b::Element(e::Situational, "Claim DRG Amount"),
1540
+ b::Element(e::Situational, "Claim Payment Remark Code"),
1541
+ b::Element(e::Situational, "Claim Disproportionate Share Amount"),
1542
+ b::Element(e::Situational, "Claim MSP Pass-through Amount"),
1543
+ b::Element(e::Situational, "Claim PPS Capital Amount"),
1544
+ b::Element(e::Situational, "PPS-Capital FSP DRG Amount"),
1545
+ b::Element(e::Situational, "PPS-Capital HSP DRG Amount"),
1546
+ b::Element(e::Situational, "PPS-Capital DSH DRG Amount"),
1547
+ b::Element(e::Situational, "Old Capital Amount"),
1548
+ b::Element(e::Situational, "PPS-Capital IME Amount"),
1549
+ b::Element(e::Situational, "PPS-Operating Hospital Specific DRG Amount"),
1550
+ b::Element(e::Situational, "Cost Report Day Count"),
1551
+ b::Element(e::Situational, "PPS-Operating Federal Specific DRG Amount"),
1552
+ b::Element(e::Situational, "Claim PPS Capital Outlier Amount"),
1553
+ b::Element(e::Situational, "Claim Indirect Teaching Amount"),
1554
+ b::Element(e::Situational, "Non-Payable Professional Component Billed Amount"),
1555
+ b::Element(e::Situational, "Claim Payment Remark Code"),
1556
+ b::Element(e::Situational, "Claim Payment Remark Code"),
1557
+ b::Element(e::Situational, "Claim Payment Remark Code"),
1558
+ b::Element(e::Situational, "Claim Payment Remark Code"),
1559
+ b::Element(e::Situational, "PPS-Capital Exception Amount")),
1560
+ b::Segment(3200, s::MOA, "Outpatient Adjudication Information",
1561
+ r::Situational, d::RepeatCount.bounded(1),
1562
+ b::Element(e::Situational, "Reimbursement Rate"),
1563
+ b::Element(e::Situational, "HCPCS Payable Amount"),
1564
+ b::Element(e::Situational, "Claim Payment Remark Code"),
1565
+ b::Element(e::Situational, "Claim Payment Remark Code"),
1566
+ b::Element(e::Situational, "Claim Payment Remark Code"),
1567
+ b::Element(e::Situational, "Claim Payment Remark Code"),
1568
+ b::Element(e::Situational, "Claim Payment Remark Code"),
1569
+ b::Element(e::Situational, "End Stage Renal Disease Payment Amount"),
1570
+ b::Element(e::Situational, "Non-Payable Professional Component Billed Amount")),
1571
+
1572
+ d::LoopDef.build("2330A OTHER SUBSCRIBER NAME",
1573
+ d::RepeatCount.bounded(1),
1574
+ b::Segment(3250, s::NM1, "Other Subscriber Name",
1575
+ r::Required, d::RepeatCount.bounded(1),
1576
+ b::Element(e::Required, "Entity Identifier Code", b::Values("IL")),
1577
+ b::Element(e::Required, "Entity Type Qualifier", b::Values("1", "2")),
1578
+ b::Element(e::Required, "Other Insured Last Name"),
1579
+ b::Element(e::Situational, "Other Insured First Name"),
1580
+ b::Element(e::Situational, "Other Insured Middle Name"),
1581
+ b::Element(e::NotUsed, "Name Prefix"),
1582
+ b::Element(e::Situational, "Other Insured Name Suffix"),
1583
+ b::Element(e::Required, "Identification Code Qualifier", b::Values("II", "MI")),
1584
+ b::Element(e::Required, "Other Insured Identifier"),
1585
+ b::Element(e::NotUsed, "Entity Relationship Code"),
1586
+ b::Element(e::NotUsed, "Entity Identifier Code"),
1587
+ b::Element(e::NotUsed, "Name Last or Organization Name")),
1588
+ b::Segment(3320, s::N3, "Other Subscriber Address",
1589
+ r::Situational, d::RepeatCount.bounded(1),
1590
+ b::Element(e::Required, "Other Insured Address Line"),
1591
+ b::Element(e::Situational, "Other Insured Address Line")),
1592
+ b::Segment(3400, s::N4, "Other Subscriber City, State, ZIP Code",
1593
+ r::Required, d::RepeatCount.bounded(1),
1594
+ b::Element(e::Required, "Other Insured City Name"),
1595
+ b::Element(e::Situational, "Other Insured State or Province Code"),
1596
+ b::Element(e::Situational, "Other Insured Postal Zone or ZIP Code"),
1597
+ b::Element(e::Situational, "Country Code"),
1598
+ b::Element(e::NotUsed, "Location Qualifier"),
1599
+ b::Element(e::NotUsed, "Location Identifier"),
1600
+ b::Element(e::Situational, "Country Subdivision Code")),
1601
+ b::Segment(3550, s::REF, "Other Subscriber Secondary Identification",
1602
+ r::Situational, d::RepeatCount.bounded(2),
1603
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("SY")),
1604
+ b::Element(e::Required, "Other Insured Additional Identifier"),
1605
+ b::Element(e::NotUsed, "Description"),
1606
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER"))),
1607
+
1608
+ d::LoopDef.build("2330B OTHER PAYER NAME",
1609
+ d::RepeatCount.bounded(1),
1610
+ b::Segment(3250, s::NM1, "Other Payer Name",
1611
+ r::Required, d::RepeatCount.bounded(1),
1612
+ b::Element(e::Required, "Entity Identifier Code", b::Values("PR")),
1613
+ b::Element(e::Required, "Entity Type Qualifier", b::Values("2")),
1614
+ b::Element(e::Required, "Other Payer Last or Organization Name"),
1615
+ b::Element(e::NotUsed, "Name First"),
1616
+ b::Element(e::NotUsed, "Name Middle"),
1617
+ b::Element(e::NotUsed, "Name Prefix"),
1618
+ b::Element(e::NotUsed, "Name Suffix"),
1619
+ b::Element(e::Required, "Identification Code Qualifier", b::Values("PI", "XV")),
1620
+ b::Element(e::Required, "Other Payer Primary Identifier"),
1621
+ b::Element(e::NotUsed, "Entity Relationship Code"),
1622
+ b::Element(e::NotUsed, "Entity Identifier Code"),
1623
+ b::Element(e::NotUsed, "Name Last or Organization Name")),
1624
+ b::Segment(3320, s::N3, "Other Payer Address",
1625
+ r::Situational, d::RepeatCount.bounded(1),
1626
+ b::Element(e::Required, "Other Payer Address Line"),
1627
+ b::Element(e::Situational, "Other Payer Address Line")),
1628
+ b::Segment(3400, s::N4, "Other Payer City, State, ZIP Code",
1629
+ r::Required, d::RepeatCount.bounded(1),
1630
+ b::Element(e::Required, "Other Payer City Name"),
1631
+ b::Element(e::Situational, "Other Payer State Code"),
1632
+ b::Element(e::Situational, "Other Payer Postal Zone or ZIP Code"),
1633
+ b::Element(e::Situational, "Country Code"),
1634
+ b::Element(e::NotUsed, "Location Qualifier"),
1635
+ b::Element(e::NotUsed, "Location Identifier"),
1636
+ b::Element(e::Situational, "Country Subdivision Code")),
1637
+ b::Segment(3500, s::DTP, "Claim Check or Remittance Date",
1638
+ r::Situational, d::RepeatCount.bounded(1),
1639
+ b::Element(e::Required, "Date Time Qualifier", b::Values("573")),
1640
+ b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
1641
+ b::Element(e::Required, "Adjudication or Payment Date")),
1642
+ b::Segment(3550, s::REF, "Other Payer Secondary Identifier",
1643
+ r::Situational, d::RepeatCount.bounded(2),
1644
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("2U", "EI", "FY", "NF")),
1645
+ b::Element(e::Required, "Other Payer Secondary Identifier"),
1646
+ b::Element(e::NotUsed, "Description"),
1647
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
1648
+ b::Segment(3550, s::REF, "Other Payer Prior Authorization Number",
1649
+ r::Situational, d::RepeatCount.bounded(1),
1650
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("G1")),
1651
+ b::Element(e::Required, "Other Payer Prior Authorization Number"),
1652
+ b::Element(e::NotUsed, "Description"),
1653
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
1654
+ b::Segment(3550, s::REF, "Other Payer Referral Number",
1655
+ r::Situational, d::RepeatCount.bounded(1),
1656
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("9F")),
1657
+ b::Element(e::Required, "Other Payer Prior Authorization or Referral Number"),
1658
+ b::Element(e::NotUsed, "Description"),
1659
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
1660
+ b::Segment(3550, s::REF, "Other Payer Claim Adjustment Indicator",
1661
+ r::Situational, d::RepeatCount.bounded(1),
1662
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("T4")),
1663
+ b::Element(e::Required, "Other Payer Claim Adjustment Indicator", b::Values("Y")),
1664
+ b::Element(e::NotUsed, "Description"),
1665
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
1666
+ b::Segment(3550, s::REF, "Other Payer Claim Control Number",
1667
+ r::Situational, d::RepeatCount.bounded(1),
1668
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("F8")),
1669
+ b::Element(e::Required, "Other Payer's Claim Control Number"),
1670
+ b::Element(e::NotUsed, "Description"),
1671
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER"))),
1672
+
1673
+ d::LoopDef.build("2330C OTHER PAYER ATTENDING PROVIDER",
1674
+ d::RepeatCount.bounded(1),
1675
+ b::Segment(3250, s::NM1, "Other Payer Attending Provider",
1676
+ r::Situational, d::RepeatCount.bounded(1),
1677
+ b::Element(e::Required, "Entity Identifier Code", b::Values("71")),
1678
+ b::Element(e::Required, "Entity Type Qualifier", b::Values("1")),
1679
+ b::Element(e::NotUsed, "Name Last"),
1680
+ b::Element(e::NotUsed, "Name First"),
1681
+ b::Element(e::NotUsed, "Name Middle"),
1682
+ b::Element(e::NotUsed, "Name Prefix"),
1683
+ b::Element(e::NotUsed, "Name Suffix"),
1684
+ b::Element(e::NotUsed, "Identification Code Qualifier"),
1685
+ b::Element(e::NotUsed, "Identification Code"),
1686
+ b::Element(e::NotUsed, "Entity Relationship Code"),
1687
+ b::Element(e::NotUsed, "Entity Identifier Code"),
1688
+ b::Element(e::NotUsed, "Name Last or Organization Name")),
1689
+ b::Segment(3550, s::REF, "Other Payer Attending Provider Secondary Identification",
1690
+ r::Required, d::RepeatCount.bounded(4),
1691
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("0B", "1G", "G2", "LU")),
1692
+ b::Element(e::Required, "Other Payer Attending Provider Identifier"),
1693
+ b::Element(e::NotUsed, "Description"),
1694
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER"))),
1695
+
1696
+ d::LoopDef.build("2330D OTHER PAYER OPERATING PHYSICIAN",
1697
+ d::RepeatCount.bounded(1),
1698
+ b::Segment(3250, s::NM1, "Other Payer Operating Physician",
1699
+ r::Situational, d::RepeatCount.bounded(1),
1700
+ b::Element(e::Required, "Entity Identifier Code", b::Values("72")),
1701
+ b::Element(e::Required, "Entity Type Qualifier", b::Values("1")),
1702
+ b::Element(e::NotUsed, "Name Last"),
1703
+ b::Element(e::NotUsed, "Name First"),
1704
+ b::Element(e::NotUsed, "Name Middle"),
1705
+ b::Element(e::NotUsed, "Name Prefix"),
1706
+ b::Element(e::NotUsed, "Name Suffix"),
1707
+ b::Element(e::NotUsed, "Identification Code Qualifier"),
1708
+ b::Element(e::NotUsed, "Identification Code"),
1709
+ b::Element(e::NotUsed, "Entity Relationship Code"),
1710
+ b::Element(e::NotUsed, "Entity Identifier Code"),
1711
+ b::Element(e::NotUsed, "Name Last or Organization Name")),
1712
+ b::Segment(3550, s::REF, "Other Payer Operating Physician Secondary Identification",
1713
+ r::Required, d::RepeatCount.bounded(4),
1714
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("0B", "1G", "G2", "LU")),
1715
+ b::Element(e::Required, "Other Payer Operating Provider Secondary Identifier"),
1716
+ b::Element(e::NotUsed, "Description"),
1717
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER"))),
1718
+
1719
+ d::LoopDef.build("2330E OTHER PAYER OTHER OPERATING PHYSICIAN",
1720
+ d::RepeatCount.bounded(1),
1721
+ b::Segment(3250, s::NM1, "Other Payer Other Operating Physician",
1722
+ r::Situational, d::RepeatCount.bounded(1),
1723
+ b::Element(e::Required, "Entity Identifier Code", b::Values("ZZ")),
1724
+ b::Element(e::Required, "Entity Type Qualifier", b::Values("1")),
1725
+ b::Element(e::NotUsed, "Name Last"),
1726
+ b::Element(e::NotUsed, "Name First"),
1727
+ b::Element(e::NotUsed, "Name Middle"),
1728
+ b::Element(e::NotUsed, "Name Prefix"),
1729
+ b::Element(e::NotUsed, "Name Suffix"),
1730
+ b::Element(e::NotUsed, "Identification Code Qualifier"),
1731
+ b::Element(e::NotUsed, "Identification Code"),
1732
+ b::Element(e::NotUsed, "Entity Relationship Code"),
1733
+ b::Element(e::NotUsed, "Entity Identifier Code"),
1734
+ b::Element(e::NotUsed, "Name Last or Organization Name")),
1735
+ b::Segment(3550, s::REF, "Other Payer Other Operating Physician Secondary Identification",
1736
+ r::Required, d::RepeatCount.bounded(4),
1737
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("0B", "1G", "G2", "LU")),
1738
+ b::Element(e::Required, "Other Payer Other Operating Physician Secondary Identifier"),
1739
+ b::Element(e::NotUsed, "Description"),
1740
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER"))),
1741
+
1742
+ d::LoopDef.build("2330F OTHER PAYER SERVICE FACILITY LOCATION",
1743
+ d::RepeatCount.bounded(1),
1744
+ b::Segment(3250, s::NM1, "Other Payer Service Facility Location",
1745
+ r::Situational, d::RepeatCount.bounded(1),
1746
+ b::Element(e::Required, "Entity Identifier Code", b::Values("77")),
1747
+ b::Element(e::Required, "Entity Type Qualifier", b::Values("2")),
1748
+ b::Element(e::NotUsed, "Name Last"),
1749
+ b::Element(e::NotUsed, "Name First"),
1750
+ b::Element(e::NotUsed, "Name Middle"),
1751
+ b::Element(e::NotUsed, "Name Prefix"),
1752
+ b::Element(e::NotUsed, "Name Suffix"),
1753
+ b::Element(e::NotUsed, "Identification Code Qualifier"),
1754
+ b::Element(e::NotUsed, "Identification Code"),
1755
+ b::Element(e::NotUsed, "Entity Relationship Code"),
1756
+ b::Element(e::NotUsed, "Entity Identifier Code"),
1757
+ b::Element(e::NotUsed, "Name Last or Organization Name")),
1758
+ b::Segment(3550, s::REF, "Other Payer Supervising Provider Secondary Identification",
1759
+ r::Required, d::RepeatCount.bounded(3),
1760
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("0B", "G2", "LU")),
1761
+ b::Element(e::Required, "Other Payer Service Facility Location Identifier"),
1762
+ b::Element(e::NotUsed, "Description"),
1763
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER"))),
1764
+
1765
+ d::LoopDef.build("2330G OTHER PAYER RENDERING PROVIDER NAME",
1766
+ d::RepeatCount.bounded(1),
1767
+ b::Segment(3250, s::NM1, "Other Payer Rendering Provider Name",
1768
+ r::Situational, d::RepeatCount.bounded(1),
1769
+ b::Element(e::Required, "Entity Identifier Code", b::Values("82")),
1770
+ b::Element(e::Required, "Entity Type Qualifier", b::Values("1")),
1771
+ b::Element(e::NotUsed, "Name Last or Organization Name"),
1772
+ b::Element(e::NotUsed, "Name First"),
1773
+ b::Element(e::NotUsed, "Name Middle"),
1774
+ b::Element(e::NotUsed, "Name Prefix"),
1775
+ b::Element(e::NotUsed, "Name Suffix"),
1776
+ b::Element(e::NotUsed, "Identification Code Qualifier"),
1777
+ b::Element(e::NotUsed, "Identification Code"),
1778
+ b::Element(e::NotUsed, "Entity Relationship Code"),
1779
+ b::Element(e::NotUsed, "Entity Identifier Code"),
1780
+ b::Element(e::NotUsed, "Name Last or Organization Name")),
1781
+ b::Segment(3550, s::REF, "Other Payer Rendering Provider Secondary Identification",
1782
+ r::Required, d::RepeatCount.bounded(4),
1783
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("0B", "1G", "G2", "LU")),
1784
+ b::Element(e::Required, "Other Payer Rendering Provider Secondary Identifier"),
1785
+ b::Element(e::NotUsed, "Description"),
1786
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")))),
1787
+
1788
+ d::LoopDef.build("2330H OTHER PAYER REFERRING PROVIDER",
1789
+ d::RepeatCount.bounded(1),
1790
+ b::Segment(3250, s::NM1, "Other Payer Referring Provider",
1791
+ r::Situational, d::RepeatCount.bounded(1),
1792
+ b::Element(e::Required, "Entity Identifier Code", b::Values("DN")),
1793
+ b::Element(e::Required, "Entity Type Qualifier", b::Values("1")),
1794
+ b::Element(e::NotUsed, "Name Last or Organization Name"),
1795
+ b::Element(e::NotUsed, "Name First"),
1796
+ b::Element(e::NotUsed, "Name Middle"),
1797
+ b::Element(e::NotUsed, "Name Prefix"),
1798
+ b::Element(e::NotUsed, "Name Suffix"),
1799
+ b::Element(e::NotUsed, "Identification Code Qualifier"),
1800
+ b::Element(e::NotUsed, "Identification Code"),
1801
+ b::Element(e::NotUsed, "Entity Relationship Code"),
1802
+ b::Element(e::NotUsed, "Entity Identifier Code"),
1803
+ b::Element(e::NotUsed, "Name Last or Organization Name")),
1804
+ b::Segment(3550, s::REF, "Other Payer Referring Provider Secondary Identification",
1805
+ r::Required, d::RepeatCount.bounded(3),
1806
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("0B", "1G", "G2")),
1807
+ b::Element(e::Required, "Other Payer Referring Provider Identifier"),
1808
+ b::Element(e::NotUsed, "Description"),
1809
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER"))),
1810
+
1811
+ d::LoopDef.build("2330I OTHER PAYER BILLING PROVIDER",
1812
+ d::RepeatCount.bounded(1),
1813
+ b::Segment(3250, s::NM1, "Other Payer Billing Provider",
1814
+ r::Situational, d::RepeatCount.bounded(1),
1815
+ b::Element(e::Required, "Entity Identifier Code", b::Values("85")),
1816
+ b::Element(e::Required, "Entity Type Qualifier", b::Values("2")),
1817
+ b::Element(e::NotUsed, "Name Last or Organization Name"),
1818
+ b::Element(e::NotUsed, "Name First"),
1819
+ b::Element(e::NotUsed, "Name Middle"),
1820
+ b::Element(e::NotUsed, "Name Prefix"),
1821
+ b::Element(e::NotUsed, "Name Suffix"),
1822
+ b::Element(e::NotUsed, "Identification Code Qualifier"),
1823
+ b::Element(e::NotUsed, "Identification Code"),
1824
+ b::Element(e::NotUsed, "Entity Relationship Code"),
1825
+ b::Element(e::NotUsed, "Entity Identifier Code"),
1826
+ b::Element(e::NotUsed, "Name Last or Organization Name")),
1827
+ b::Segment(3550, s::REF, "Other Payer Billing Provider Secondary Information",
1828
+ r::Required, d::RepeatCount.bounded(2),
1829
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("G2", "LU")),
1830
+ b::Element(e::Required, "Other Payer Billing Provider Identifier"),
1831
+ b::Element(e::NotUsed, "Description"),
1832
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER"))),
1833
+
1834
+ d::LoopDef.build("2400 SERVICE LINE NUMBER",
1835
+ d::RepeatCount.bounded(999),
1836
+ b::Segment(3650, s::LX, "Service Line Number",
1837
+ r::Required, d::RepeatCount.bounded(1),
1838
+ b::Element(e::Required, "Assigned Number")),
1839
+ b::Segment(3750, s::SV2, "Institutional Service Line",
1840
+ r::Required, d::RepeatCount.bounded(1),
1841
+ b::Element(e::Required, "Service Line Revenue Code"),
1842
+ b::Element(e::Situational, "COMPOSITE MEDICAL PROCEDURE IDENTIFIER",
1843
+ b::Element(e::Required, "Product or Service ID Qualifier", b::Values("ER", "HC", "HP", "IV", "WK")),
1844
+ b::Element(e::Required, "Procedure Code"),
1845
+ b::Element(e::Situational, "Procedure Modifier"),
1846
+ b::Element(e::Situational, "Procedure Modifier"),
1847
+ b::Element(e::Situational, "Procedure Modifier"),
1848
+ b::Element(e::Situational, "Procedure Modifier"),
1849
+ b::Element(e::Situational, "Description"),
1850
+ b::Element(e::NotUsed, "Product/Service ID")),
1851
+ b::Element(e::Required, "Line Item Charge Amount"),
1852
+ b::Element(e::Required, "Unit or Basis for Measurement Code", b::Values("DA", "UN")),
1853
+ b::Element(e::Required, "Service Unit Count"),
1854
+ b::Element(e::NotUsed, "Unit Rate"),
1855
+ b::Element(e::Situational, "Line Item Denied Charge or Non-Covered Charge Amount"),
1856
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code"),
1857
+ b::Element(e::NotUsed, "Nursing Home Residential Status Code"),
1858
+ b::Element(e::NotUsed, "Level of Care Code")),
1859
+ b::Segment(4200, s::PWK, "Line Supplemental Information",
1860
+ r::Situational, d::RepeatCount.bounded(10),
1861
+ 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", "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")),
1862
+ b::Element(e::Required, "Attachment Transmission Code", b::Values("AA", "BM", "EL", "EM", "FT", "FX")),
1863
+ b::Element(e::NotUsed, "Report Copies Needed"),
1864
+ b::Element(e::NotUsed, "Entity Identifier Code"),
1865
+ b::Element(e::Situational, "Identification Code Qualifier", b::Values("AC")),
1866
+ b::Element(e::Situational, "Attachment Control Number", b::MaxLength(50)),
1867
+ b::Element(e::NotUsed, "Description"),
1868
+ b::Element(e::NotUsed, "ACTIONS INDICATED"),
1869
+ b::Element(e::NotUsed, "Request Category Code")),
1870
+ b::Segment(4550, s::DTP, "Date - Service Date",
1871
+ r::Situational, d::RepeatCount.bounded(1),
1872
+ b::Element(e::Required, "Date Time Qualifier", b::Values("472")),
1873
+ b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8", "RD8")),
1874
+ b::Element(e::Required, "Service Date")),
1875
+ b::Segment(4700, s::REF, "Line Item Control Number",
1876
+ r::Situational, d::RepeatCount.bounded(1),
1877
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("6R")),
1878
+ b::Element(e::Required, "Line Item Control Number", b::MaxLength(30)),
1879
+ b::Element(e::NotUsed, "Description"),
1880
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
1881
+ b::Segment(4700, s::REF, "Repriced Line Item Reference Number",
1882
+ r::Situational, d::RepeatCount.bounded(1),
1883
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("9B")),
1884
+ b::Element(e::Required, "Repriced Line Item Reference Number"),
1885
+ b::Element(e::NotUsed, "Description"),
1886
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
1887
+ b::Segment(4700, s::REF, "Adjusted Repriced Line Item Reference Number",
1888
+ r::Situational, d::RepeatCount.bounded(1),
1889
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("9D")),
1890
+ b::Element(e::Required, "Adjusted Repriced Line Item Reference Number"),
1891
+ b::Element(e::NotUsed, "Description"),
1892
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
1893
+ b::Segment(4750, s::AMT, "Service Tax Amount",
1894
+ r::Situational, d::RepeatCount.bounded(1),
1895
+ b::Element(e::Required, "Amount Qualifier Code", b::Values("GT")),
1896
+ b::Element(e::Required, "Service Tax Amount"),
1897
+ b::Element(e::NotUsed, "Credit/Debit Flag Code")),
1898
+ b::Segment(4750, s::AMT, "Facility Tax Amount",
1899
+ r::Situational, d::RepeatCount.bounded(1),
1900
+ b::Element(e::Required, "Amount Qualifier Code", b::Values("N8")),
1901
+ b::Element(e::Required, "Facility Tax Amount"),
1902
+ b::Element(e::NotUsed, "Credit/Debit Flag Code")),
1903
+ b::Segment(4850, s::NTE, "Third Party Organization Notes",
1904
+ r::Situational, d::RepeatCount.bounded(1),
1905
+ b::Element(e::Required, "Note Reference Code", b::Values("TPO")),
1906
+ b::Element(e::Required, "Line Note Text")),
1907
+ b::Segment(4920, s::HCP, "Line Pricing/Repricing Information",
1908
+ r::Situational, d::RepeatCount.bounded(1),
1909
+ b::Element(e::Required, "Pricing Methodology", b::Values("00", "01", "02", "03", "04", "05", "06", "07", "08", "09", "10", "11", "12", "13", "14")),
1910
+ b::Element(e::Required, "Monetary Amount"),
1911
+ b::Element(e::Situational, "Monetary Amount"),
1912
+ b::Element(e::Situational, "Reference Identification"),
1913
+ b::Element(e::Situational, "Rate"),
1914
+ b::Element(e::Situational, "Reference Identification"),
1915
+ b::Element(e::Situational, "Monetary Amount"),
1916
+ b::Element(e::Situational, "Product/Service ID"),
1917
+ b::Element(e::Situational, "Product or Service ID Qualifier", b::Values("ER", "HC", "HP", "IV", "WK")),
1918
+ b::Element(e::Situational, "Repriced Approved HCPCS Code"),
1919
+ b::Element(e::Situational, "Unit or Basis for Measurement Code", b::Values("DA", "UN")),
1920
+ b::Element(e::Situational, "Quantity", b::MaxLength(8), b::MaxPrecision(3)),
1921
+ b::Element(e::Situational, "Reject Reason Code", b::Values("T1", "T2", "T3", "T4", "T5", "T6")),
1922
+ b::Element(e::Situational, "Policy Compliance Code", b::Values("1", "2", "3", "4", "5")),
1923
+ b::Element(e::Situational, "Exception Code", b::Values("1", "2", "3", "4", "5", "6"))),
1924
+
1925
+ d::LoopDef.build("2410 DRUG IDENTIFICATION",
1926
+ d::RepeatCount.bounded(1),
1927
+ b::Segment(4930, s::LIN, "Drug Identification",
1928
+ r::Situational, d::RepeatCount.bounded(1),
1929
+ b::Element(e::NotUsed, "Assigned Identification"),
1930
+ b::Element(e::Required, "Product or Service ID Qualifier", b::Values("N4")),
1931
+ b::Element(e::Required, "National Drug Code"),
1932
+ b::Element(e::NotUsed, "Product/Service ID Qualifier"),
1933
+ b::Element(e::NotUsed, "Product/Service ID"),
1934
+ b::Element(e::NotUsed, "Product/Service ID Qualifier"),
1935
+ b::Element(e::NotUsed, "Product/Service ID"),
1936
+ b::Element(e::NotUsed, "Product/Service ID Qualifier"),
1937
+ b::Element(e::NotUsed, "Product/Service ID"),
1938
+ b::Element(e::NotUsed, "Product/Service ID Qualifier"),
1939
+ b::Element(e::NotUsed, "Product/Service ID"),
1940
+ b::Element(e::NotUsed, "Product/Service ID Qualifier"),
1941
+ b::Element(e::NotUsed, "Product/Service ID"),
1942
+ b::Element(e::NotUsed, "Product/Service ID Qualifier"),
1943
+ b::Element(e::NotUsed, "Product/Service ID"),
1944
+ b::Element(e::NotUsed, "Product/Service ID Qualifier"),
1945
+ b::Element(e::NotUsed, "Product/Service ID"),
1946
+ b::Element(e::NotUsed, "Product/Service ID Qualifier"),
1947
+ b::Element(e::NotUsed, "Product/Service ID"),
1948
+ b::Element(e::NotUsed, "Product/Service ID Qualifier"),
1949
+ b::Element(e::NotUsed, "Product/Service ID"),
1950
+ b::Element(e::NotUsed, "Product/Service ID Qualifier"),
1951
+ b::Element(e::NotUsed, "Product/Service ID"),
1952
+ b::Element(e::NotUsed, "Product/Service ID Qualifier"),
1953
+ b::Element(e::NotUsed, "Product/Service ID"),
1954
+ b::Element(e::NotUsed, "Product/Service ID Qualifier"),
1955
+ b::Element(e::NotUsed, "Product/Service ID"),
1956
+ b::Element(e::NotUsed, "Product/Service ID Qualifier"),
1957
+ b::Element(e::NotUsed, "Product/Service ID"),
1958
+ b::Element(e::NotUsed, "Product/Service ID Qualifier"),
1959
+ b::Element(e::NotUsed, "Product/Service ID")),
1960
+ b::Segment(4940, s::CTP, "Drug Quantity",
1961
+ r::Required, d::RepeatCount.bounded(1),
1962
+ b::Element(e::NotUsed, "Class of Trade Code"),
1963
+ b::Element(e::NotUsed, "Price Identifier Code"),
1964
+ b::Element(e::NotUsed, "Unit Price"),
1965
+ b::Element(e::Required, "National Drug Unit Count"),
1966
+ b::Element(e::Required, "COMPOSITE UNIT OF MEASURE",
1967
+ b::Element(e::Required, "Code Qualifier", b::Values("F2", "GR", "ME", "ML", "UN")),
1968
+ b::Element(e::NotUsed, "Exponent"),
1969
+ b::Element(e::NotUsed, "Multiplier"),
1970
+ b::Element(e::NotUsed, "Unit or Basis for Measurement Code"),
1971
+ b::Element(e::NotUsed, "Exponent"),
1972
+ b::Element(e::NotUsed, "Multiplier"),
1973
+ b::Element(e::NotUsed, "Unit or Basis for Measurement Code"),
1974
+ b::Element(e::NotUsed, "Exponent"),
1975
+ b::Element(e::NotUsed, "Multiplier"),
1976
+ b::Element(e::NotUsed, "Unit or Basis for Measurement Code"),
1977
+ b::Element(e::NotUsed, "Exponent"),
1978
+ b::Element(e::NotUsed, "Multiplier"),
1979
+ b::Element(e::NotUsed, "Unit or Basis for Measurement Code"),
1980
+ b::Element(e::NotUsed, "Exponent"),
1981
+ b::Element(e::NotUsed, "Multiplier")),
1982
+ b::Element(e::NotUsed, "Price Multiplier Qualifier"),
1983
+ b::Element(e::NotUsed, "Multiplier"),
1984
+ b::Element(e::NotUsed, "Monetary Amount"),
1985
+ b::Element(e::NotUsed, "Basis of Unit Price Code"),
1986
+ b::Element(e::NotUsed, "Condition Value"),
1987
+ b::Element(e::NotUsed, "Multiple Price Quantity")),
1988
+ b::Segment(4950, s::REF, "Prescription or Compound Drug Association Number",
1989
+ r::Situational, d::RepeatCount.bounded(1),
1990
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("VY", "XZ")),
1991
+ b::Element(e::Required, "Prescription Number"),
1992
+ b::Element(e::NotUsed, "Description"),
1993
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER"))),
1994
+
1995
+ d::LoopDef.build("2420A OPERATING PHYSICIAN NAME",
1996
+ d::RepeatCount.bounded(1),
1997
+ b::Segment(5000, s::NM1, "Operating Physician Name",
1998
+ r::Situational, d::RepeatCount.bounded(1),
1999
+ b::Element(e::Required, "Entity Identifier Code", b::Values("72")),
2000
+ b::Element(e::Required, "Entity Type Qualifier", b::Values("1")),
2001
+ b::Element(e::Required, "Operating Physician Last Name"),
2002
+ b::Element(e::Situational, "Operating Physician First Name"),
2003
+ b::Element(e::Situational, "Operating Physician Middle Name or Initial"),
2004
+ b::Element(e::NotUsed, "Name Prefix"),
2005
+ b::Element(e::Situational, "Operating Physician Suffix"),
2006
+ b::Element(e::Situational, "Identification Code Qualifier", b::Values("XX")),
2007
+ b::Element(e::Situational, "Operating Physician Primary Identifier"),
2008
+ b::Element(e::NotUsed, "Entity Relationship Code"),
2009
+ b::Element(e::NotUsed, "Entity Identifier Code"),
2010
+ b::Element(e::NotUsed, "Name Last or Organization Name")),
2011
+ b::Segment(5250, s::REF, "Operating Physician Secondary Identification",
2012
+ r::Situational, d::RepeatCount.bounded(20),
2013
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("0B", "1G", "G2", "LU")),
2014
+ b::Element(e::Required, "Operating Physician Secondary Identifier"),
2015
+ b::Element(e::NotUsed, "Description"),
2016
+ b::Element(e::Situational, "REFERENCE IDENTIFIER",
2017
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("2U")),
2018
+ b::Element(e::Required, "Other Payer Primary Identifier"),
2019
+ b::Element(e::NotUsed, "Reference Identification Qualifier"),
2020
+ b::Element(e::NotUsed, "Reference Identification"),
2021
+ b::Element(e::NotUsed, "Reference Identification Qualifier"),
2022
+ b::Element(e::NotUsed, "Reference Identification")))),
2023
+
2024
+ d::LoopDef.build("2420B OTHER OPERATING PHYSICIAN NAME",
2025
+ d::RepeatCount.bounded(1),
2026
+ b::Segment(5000, s::NM1, "Other Operating Physician Name",
2027
+ r::Situational, d::RepeatCount.bounded(1),
2028
+ b::Element(e::Required, "Entity Identifier Code", b::Values("ZZ")),
2029
+ b::Element(e::Required, "Entity Type Qualifier", b::Values("1")),
2030
+ b::Element(e::Required, "Other Operating Physician Last Name"),
2031
+ b::Element(e::Situational, "Other Operating Physician First Name"),
2032
+ b::Element(e::Situational, "Other Operating Physician Middle Name or Initial"),
2033
+ b::Element(e::NotUsed, "Name Prefix"),
2034
+ b::Element(e::Situational, "Other Operating Physician Name Suffix"),
2035
+ b::Element(e::Situational, "Identification Code Qualifier", b::Values("XX")),
2036
+ b::Element(e::Situational, "Other Operating Physician Identifier"),
2037
+ b::Element(e::NotUsed, "Entity Relationship Code"),
2038
+ b::Element(e::NotUsed, "Entity Identifier Code"),
2039
+ b::Element(e::NotUsed, "Name Last or Organization Name")),
2040
+ b::Segment(5250, s::REF, "Other Operating Physician Secondary Identification",
2041
+ r::Situational, d::RepeatCount.bounded(20),
2042
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("0B", "1G", "G2", "LU")),
2043
+ b::Element(e::Required, "Other Provider Secondary Identifier"),
2044
+ b::Element(e::NotUsed, "Description"),
2045
+ b::Element(e::Situational, "REFERENCE IDENTIFIER",
2046
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("2U")),
2047
+ b::Element(e::Required, "Other Payer Primary Identifier"),
2048
+ b::Element(e::NotUsed, "Reference Identifier Qualifier"),
2049
+ b::Element(e::NotUsed, "Reference Identifier"),
2050
+ b::Element(e::NotUsed, "Reference Identifier Qualifier"),
2051
+ b::Element(e::NotUsed, "Reference Identifier")))),
2052
+
2053
+ d::LoopDef.build("2420C RENDERING PROVIDER NAME",
2054
+ d::RepeatCount.bounded(1),
2055
+ b::Segment(5000, s::NM1, "Rendering Provider Name",
2056
+ r::Situational, d::RepeatCount.bounded(1),
2057
+ b::Element(e::Required, "Entity Identifier Code", b::Values("82")),
2058
+ b::Element(e::Required, "Entity Type Qualifier", b::Values("1")),
2059
+ b::Element(e::Required, "Rendering Provider Last Name"),
2060
+ b::Element(e::Situational, "Rendering Provider First Name"),
2061
+ b::Element(e::Situational, "Rendering Provider Middle Name or Initial"),
2062
+ b::Element(e::NotUsed, "Name Prefix"),
2063
+ b::Element(e::Situational, "Rendering Provider Name Suffix"),
2064
+ b::Element(e::Situational, "Identification Code Qualifier", b::Values("XX")),
2065
+ b::Element(e::Situational, "Rendering Provider Identifier"),
2066
+ b::Element(e::NotUsed, "Entity Relationship Code"),
2067
+ b::Element(e::NotUsed, "Entity Identifier Code"),
2068
+ b::Element(e::NotUsed, "Name Last or Organization Name")),
2069
+ b::Segment(5250, s::REF, "Rendering Provider Secondary Identification",
2070
+ r::Situational, d::RepeatCount.bounded(20),
2071
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("0B", "1G", "G2", "LU")),
2072
+ b::Element(e::Required, "Rendering Provider Secondary Identifier"),
2073
+ b::Element(e::NotUsed, "Description"),
2074
+ b::Element(e::Situational, "REFERENCE IDENTIFIER",
2075
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("2U")),
2076
+ b::Element(e::Required, "Other Payer Primary Identifier"),
2077
+ b::Element(e::NotUsed, "Reference Identification Qualifier"),
2078
+ b::Element(e::NotUsed, "Reference Identification"),
2079
+ b::Element(e::NotUsed, "Reference Identification Qualifier"),
2080
+ b::Element(e::NotUsed, "Reference Identification")))),
2081
+
2082
+ d::LoopDef.build("2420D REFERRING PROVIDER NAME",
2083
+ d::RepeatCount.bounded(1),
2084
+ b::Segment(5000, s::NM1, "Referring Provider Name",
2085
+ r::Situational, d::RepeatCount.bounded(1),
2086
+ b::Element(e::Required, "Entity Identifier Code", b::Values("DN")),
2087
+ b::Element(e::Required, "Entity Type Qualifier", b::Values("1")),
2088
+ b::Element(e::Required, "Referring Provider Last Name"),
2089
+ b::Element(e::Situational, "Referring Provider First Name"),
2090
+ b::Element(e::Situational, "Referring Provider Middle Name or Initial"),
2091
+ b::Element(e::NotUsed, "Name Prefix"),
2092
+ b::Element(e::Situational, "Referring Provider Name Suffix"),
2093
+ b::Element(e::Situational, "Identification Code Qualifier", b::Values("XX")),
2094
+ b::Element(e::Situational, "Referring Provider Identifier"),
2095
+ b::Element(e::NotUsed, "Entity Relationship Code"),
2096
+ b::Element(e::NotUsed, "Entity Identifier Code"),
2097
+ b::Element(e::NotUsed, "Name Last or Organization Name")),
2098
+ b::Segment(5250, s::REF, "Referring Provider Secondary Identification",
2099
+ r::Situational, d::RepeatCount.bounded(20),
2100
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("0B", "1G", "G2")),
2101
+ b::Element(e::Required, "Referring Provider Secondary Identifier"),
2102
+ b::Element(e::NotUsed, "Description"),
2103
+ b::Element(e::Situational, "REFERENCE IDENTIFIER",
2104
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("2U")),
2105
+ b::Element(e::Required, "Other Payer Primary Identifier"),
2106
+ b::Element(e::NotUsed, "Reference Identification Qualifier"),
2107
+ b::Element(e::NotUsed, "Reference Identification"),
2108
+ b::Element(e::NotUsed, "Reference Identification Qualifier"),
2109
+ b::Element(e::NotUsed, "Reference Identification")))),
2110
+
2111
+ d::LoopDef.build("2430 LINE ADJUDICATION INFORMATION",
2112
+ d::RepeatCount.bounded(15),
2113
+ b::Segment(5400, s::SVD, "Line Adjudication Information",
2114
+ r::Situational, d::RepeatCount.bounded(1),
2115
+ b::Element(e::Required, "Other Payer Primary Identifier"),
2116
+ b::Element(e::Required, "Service Line Paid Amount"),
2117
+ b::Element(e::Required, "COMPOSITE MEDICAL PROCEDURE IDENTIFIER",
2118
+ b::Element(e::Required, "Product or Service ID Qualifier", b::Values("ER", "HC", "HP", "IV", "WK")),
2119
+ b::Element(e::Required, "Procedure Code"),
2120
+ b::Element(e::Situational, "Procedure Modifier"),
2121
+ b::Element(e::Situational, "Procedure Modifier"),
2122
+ b::Element(e::Situational, "Procedure Modifier"),
2123
+ b::Element(e::Situational, "Procedure Modifier"),
2124
+ b::Element(e::Situational, "Procedure Code Description"),
2125
+ b::Element(e::NotUsed, "Product/Service ID")),
2126
+ b::Element(e::NotUsed, "Product/Service ID"),
2127
+ b::Element(e::Required, "Paid Service Unit Count", b::MaxLength(8), b::MaxPrecision(3)),
2128
+ b::Element(e::Situational, "Bundled Line Number")),
2129
+ b::Segment(5450, s::CAS, "Line Adjustment",
2130
+ r::Situational, d::RepeatCount.bounded(5),
2131
+ b::Element(e::Required, "Claim Adjustment Group Code", b::Values("CO", "CR", "OA", "PI", "PR")),
2132
+ b::Element(e::Required, "Adjustment Reason Code"),
2133
+ b::Element(e::Required, "Adjustment Amount"),
2134
+ b::Element(e::Situational, "Adjustment Quantity"),
2135
+ b::Element(e::Situational, "Adjustment Reason Code"),
2136
+ b::Element(e::Situational, "Adjustment Amount"),
2137
+ b::Element(e::Situational, "Adjustment Quantity"),
2138
+ b::Element(e::Situational, "Adjustment Reason Code"),
2139
+ b::Element(e::Situational, "Adjustment Amount"),
2140
+ b::Element(e::Situational, "Adjustment Quantity"),
2141
+ b::Element(e::Situational, "Adjustment Reason Code"),
2142
+ b::Element(e::Situational, "Adjustment Amount"),
2143
+ b::Element(e::Situational, "Adjustment Quantity"),
2144
+ b::Element(e::Situational, "Adjustment Reason Code"),
2145
+ b::Element(e::Situational, "Adjustment Amount"),
2146
+ b::Element(e::Situational, "Adjustment Quantity"),
2147
+ b::Element(e::Situational, "Adjustment Reason Code"),
2148
+ b::Element(e::Situational, "Adjustment Amount"),
2149
+ b::Element(e::Situational, "Adjustment Quantity")),
2150
+ b::Segment(5500, s::DTP, "Line Check or Remittance Date",
2151
+ r::Required, d::RepeatCount.bounded(1),
2152
+ b::Element(e::Required, "Date Time Qualifier", b::Values("573")),
2153
+ b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
2154
+ b::Element(e::Required, "Adjudication or Payment Date")),
2155
+ b::Segment(5505, s::AMT, "Remaining Patient Liability",
2156
+ r::Situational, d::RepeatCount.bounded(1),
2157
+ b::Element(e::Required, "Amount Qualifier Code", b::Values("EAF")),
2158
+ b::Element(e::Required, "Remaining Patient Liability"),
2159
+ b::Element(e::NotUsed, "Credit/Debit Flag Code")))))
2160
+
2161
+ HC837I = b.build(t::HC837,
2162
+ d::TableDef.header("Table 1 - Header",
2163
+ b::Segment(50, s::ST, "Transaction Set Header",
2164
+ r::Required, d::RepeatCount.bounded(1),
2165
+ b::Element(e::Required, "Transaction Set Identifier Code", b::Values("837")),
2166
+ b::Element(e::Required, "Transaction Set Control Number"),
2167
+ b::Element(e::Required, "Version, Release or Industry Identifier")),
2168
+ b::Segment(100, s::BHT, "Beginning of Hierarchical Transaction",
2169
+ r::Required, d::RepeatCount.bounded(1),
2170
+ b::Element(e::Required, "Hierarchical Structure Code", b::Values("0019")),
2171
+ b::Element(e::Required, "Transaction Set Purpose Code", b::Values("00", "18")),
2172
+ b::Element(e::Required, "Originator Application Transaction Identifier", b::MaxLength(30)),
2173
+ b::Element(e::Required, "Transaction Set Creation Date"),
2174
+ b::Element(e::Required, "Transaction Set Creation Time"),
2175
+ b::Element(e::Required, "Claim Identifier", b::Values("31", "CH", "RP"))),
2176
+
2177
+ d::LoopDef.build("1000A SUBMITTER NAME",
2178
+ d::RepeatCount.bounded(1),
2179
+ b::Segment(200, s::NM1, "Submitter Name",
2180
+ r::Required, d::RepeatCount.bounded(1),
2181
+ b::Element(e::Required, "Entity Identifier Code", b::Values("41")),
2182
+ b::Element(e::Required, "Entity Type Qualifier", b::Values("1", "2")),
2183
+ b::Element(e::Required, "Submitter Last or Organization Name"),
2184
+ b::Element(e::Situational, "Submitter First Name"),
2185
+ b::Element(e::Situational, "Submitter Middle Name or Initial"),
2186
+ b::Element(e::NotUsed, "Name Prefix"),
2187
+ b::Element(e::NotUsed, "Name Suffix"),
2188
+ b::Element(e::Required, "Identification Qualifier Code", b::Values("46")),
2189
+ b::Element(e::Required, "Submitter Identifier"),
2190
+ b::Element(e::NotUsed, "Entity Relationship Code"),
2191
+ b::Element(e::NotUsed, "Entity Identifier Code"),
2192
+ b::Element(e::NotUsed, "Name Last or Organization Name")),
2193
+ b::Segment(450, s::PER, "Submitter EDI Contact Information",
2194
+ r::Required, d::RepeatCount.bounded(2),
2195
+ b::Element(e::Required, "Contact Function Code", b::Values("IC")),
2196
+ b::Element(e::Situational, "Submitter Contact Name"),
2197
+ b::Element(e::Required, "Communication Number Qualifier", b::Values("EM", "FX", "TE")),
2198
+ b::Element(e::Required, "Communication Number"),
2199
+ b::Element(e::Situational, "Communication Number Qualifier", b::Values("EM", "EX", "FX", "TE")),
2200
+ b::Element(e::Situational, "Communication Number"),
2201
+ b::Element(e::Situational, "Communication Number Qualifier", b::Values("EM", "EX", "FX", "TE")),
2202
+ b::Element(e::Situational, "Communication Number"),
2203
+ b::Element(e::NotUsed, "Contact Inquiry Reference"))),
2204
+
2205
+ d::LoopDef.build("1000B RECEIVER NAME",
2206
+ d::RepeatCount.bounded(1),
2207
+ b::Segment(200, s::NM1, "Receiver Name",
2208
+ r::Required, d::RepeatCount.bounded(1),
2209
+ b::Element(e::Required, "Entity Identifier Code", b::Values("40")),
2210
+ b::Element(e::Required, "Entity Type Qualifier", b::Values("2")),
2211
+ b::Element(e::Required, "Receiver Name"),
2212
+ b::Element(e::NotUsed, "Name First"),
2213
+ b::Element(e::NotUsed, "Name Last"),
2214
+ b::Element(e::NotUsed, "Name Prefix"),
2215
+ b::Element(e::NotUsed, "Name Suffix"),
2216
+ b::Element(e::Required, "Identification Code Qualifier", b::Values("46")),
2217
+ b::Element(e::Required, "Receiver Primary Identifier"),
2218
+ b::Element(e::NotUsed, "Entity Relationship Code"),
2219
+ b::Element(e::NotUsed, "Entity Identifier Code"),
2220
+ b::Element(e::NotUsed, "Name Last or Organization Name")))),
2221
+
2222
+ d::TableDef.detail("Table 2 - Billing Provider Detail",
2223
+ d::LoopDef.build("2000A BILLING PROVIDER HIERARCHICAL LEVEL",
2224
+ d::RepeatCount.bounded(1),
2225
+ b::Segment(10, s::HL, "Billing Provider Hierarchical Level",
2226
+ r::Required, d::RepeatCount.bounded(1),
2227
+ b::Element(e::Required, "Hierarchical ID Number"),
2228
+ b::Element(e::NotUsed, "Hierarchical Parent ID Number"),
2229
+ b::Element(e::Required, "Hierarchical Level Code", b::Values("20")),
2230
+ b::Element(e::Required, "Hierachical Child Code", b::Values("1"))),
2231
+ b::Segment(30, s::PRV, "Billing Provider Specialty Information",
2232
+ r::Situational, d::RepeatCount.bounded(1),
2233
+ b::Element(e::Required, "Provider Code", b::Values("BI")),
2234
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("PXC")),
2235
+ b::Element(e::Required, "Provider Taxonomy Code"),
2236
+ b::Element(e::NotUsed, "State or Province Code"),
2237
+ b::Element(e::NotUsed, "PROVIDER SPECIALTY INFORMATION"),
2238
+ b::Element(e::NotUsed, "Provider Organization Code")),
2239
+ b::Segment(100, s::CUR, "Foreign Currency Information",
2240
+ r::Situational, d::RepeatCount.bounded(1),
2241
+ b::Element(e::Required, "Entity Identifier Code", b::Values("85")),
2242
+ b::Element(e::Required, "Currency Code"),
2243
+ b::Element(e::NotUsed, "Exchange Rate"),
2244
+ b::Element(e::NotUsed, "Entity Identifier Code"),
2245
+ b::Element(e::NotUsed, "Currency Code"),
2246
+ b::Element(e::NotUsed, "Currency Market/Exchange Code"),
2247
+ b::Element(e::NotUsed, "Date/Time Qualifier"),
2248
+ b::Element(e::NotUsed, "Date"),
2249
+ b::Element(e::NotUsed, "Time"),
2250
+ b::Element(e::NotUsed, "Date/Time Qualifier"),
2251
+ b::Element(e::NotUsed, "Date"),
2252
+ b::Element(e::NotUsed, "Time"),
2253
+ b::Element(e::NotUsed, "Date/Time Qualifier"),
2254
+ b::Element(e::NotUsed, "Date"),
2255
+ b::Element(e::NotUsed, "Time"),
2256
+ b::Element(e::NotUsed, "Date/Time Qualifier"),
2257
+ b::Element(e::NotUsed, "Date"),
2258
+ b::Element(e::NotUsed, "Time"),
2259
+ b::Element(e::NotUsed, "Date/Time Qualifier"),
2260
+ b::Element(e::NotUsed, "Date"),
2261
+ b::Element(e::NotUsed, "Time")),
2262
+
2263
+ d::LoopDef.build("2010AA BILLING PROVIDER NAME",
2264
+ d::RepeatCount.bounded(1),
2265
+ b::Segment(150, s::NM1, "Billing Provider Name",
2266
+ r::Required, d::RepeatCount.bounded(1),
2267
+ b::Element(e::Required, "Entity Identifier Code", b::Values("85")),
2268
+ b::Element(e::Required, "Entity Type Qualifier", b::Values("2")),
2269
+ b::Element(e::Required, "Billing Provider Organizational Name"),
2270
+ b::Element(e::NotUsed, "Name First"),
2271
+ b::Element(e::NotUsed, "Name Middle"),
2272
+ b::Element(e::NotUsed, "Name Prefix"),
2273
+ b::Element(e::NotUsed, "Name Suffix"),
2274
+ b::Element(e::Situational, "Identification Code Qualifier", b::Values("XX")),
2275
+ b::Element(e::Situational, "Billing Provider Identifier"),
2276
+ b::Element(e::NotUsed, "Entity Relationship Code"),
2277
+ b::Element(e::NotUsed, "Entity Identifier Code"),
2278
+ b::Element(e::NotUsed, "Name Last or Organization Name")),
2279
+ b::Segment(250, s::N3, "Billing Provider Address",
2280
+ r::Required, d::RepeatCount.bounded(1),
2281
+ b::Element(e::Required, "Billing Provider Address Line"),
2282
+ b::Element(e::Situational, "Billing Provider Address Line")),
2283
+ b::Segment(300, s::N4, "Billing Provider City, State, ZIP Code",
2284
+ r::Required, d::RepeatCount.bounded(1),
2285
+ b::Element(e::Required, "Billing Provider City Name"),
2286
+ b::Element(e::Situational, "Billing Provider State or Province Code"),
2287
+ b::Element(e::Situational, "Billing Provider Postal Zone or ZIP Code"),
2288
+ b::Element(e::Situational, "Country Code"),
2289
+ b::Element(e::NotUsed, "Location Qualifier"),
2290
+ b::Element(e::NotUsed, "Location Identifier"),
2291
+ b::Element(e::Situational, "Country Subdivision Code")),
2292
+ b::Segment(350, s::REF, "Billing Provider Tax Identification",
2293
+ r::Required, d::RepeatCount.bounded(1),
2294
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("EI")),
2295
+ b::Element(e::Required, "Billing Provider Tax Identification Number"),
2296
+ b::Element(e::NotUsed, "Description"),
2297
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
2298
+ b::Segment(400, s::PER, "Billing Provider Contact Information",
2299
+ r::Situational, d::RepeatCount.bounded(2),
2300
+ b::Element(e::Required, "Contact Function Code", b::Values("IC")),
2301
+ b::Element(e::Situational, "Billing Provider Contact Name"),
2302
+ b::Element(e::Required, "Communication Number Qualifier", b::Values("EM", "FX", "TE")),
2303
+ b::Element(e::Required, "Communication Number"),
2304
+ b::Element(e::Situational, "Communication Number Qualifier", b::Values("EM", "EX", "FX", "TE")),
2305
+ b::Element(e::Situational, "Communication Number"),
2306
+ b::Element(e::Situational, "Communication Number Qualifier", b::Values("EM", "EX", "FX", "TE")),
2307
+ b::Element(e::Situational, "Communication Number"),
2308
+ b::Element(e::NotUsed, "Contact Inquiry Reference"))),
2309
+
2310
+ d::LoopDef.build("2010AB PAY-TO ADDRESS NAME",
2311
+ d::RepeatCount.bounded(1),
2312
+ b::Segment(150, s::NM1, "Pay-to Address Name",
2313
+ r::Situational, d::RepeatCount.bounded(1),
2314
+ b::Element(e::Required, "Entity Identifier Code", b::Values("87")),
2315
+ b::Element(e::Required, "Entity Type Qualifier", b::Values("2")),
2316
+ b::Element(e::NotUsed, "Name Last or Organizational Name"),
2317
+ b::Element(e::NotUsed, "Name First"),
2318
+ b::Element(e::NotUsed, "Name Middle"),
2319
+ b::Element(e::NotUsed, "Name Prefix"),
2320
+ b::Element(e::NotUsed, "Name Suffix"),
2321
+ b::Element(e::NotUsed, "Identification Code Qualifier"),
2322
+ b::Element(e::NotUsed, "Identifier Code"),
2323
+ b::Element(e::NotUsed, "Entity Relationship Code"),
2324
+ b::Element(e::NotUsed, "Entity Identifier Code"),
2325
+ b::Element(e::NotUsed, "Name Last or Organization Name")),
2326
+ b::Segment(250, s::N3, "Pay-to Address - ADDRESS",
2327
+ r::Required, d::RepeatCount.bounded(1),
2328
+ b::Element(e::Required, "Pay-To Address Line"),
2329
+ b::Element(e::Situational, "Pay-To Address Line")),
2330
+ b::Segment(300, s::N4, "Pay-To Address City, State, ZIP Code",
2331
+ r::Required, d::RepeatCount.bounded(1),
2332
+ b::Element(e::Required, "Pay-to Address City Name"),
2333
+ b::Element(e::Situational, "Pay-to Address State Code"),
2334
+ b::Element(e::Situational, "Pay-to Address Postal Zone or ZIP Code"),
2335
+ b::Element(e::Situational, "Country Code"),
2336
+ b::Element(e::NotUsed, "Location Qualifier"),
2337
+ b::Element(e::NotUsed, "Location Identifier"),
2338
+ b::Element(e::Situational, "Country Subdivision Code"))),
2339
+
2340
+ d::LoopDef.build("2010AC PAY-TO PLAN NAME",
2341
+ d::RepeatCount.bounded(1),
2342
+ b::Segment(150, s::NM1, "Pay-To Plan Name",
2343
+ r::Situational, d::RepeatCount.bounded(1),
2344
+ b::Element(e::Required, "Entity Identifier Code", b::Values("PE")),
2345
+ b::Element(e::Required, "Entity Type Qualifier", b::Values("2")),
2346
+ b::Element(e::Required, "Pay-To Plan Organizational Name"),
2347
+ b::Element(e::NotUsed, "Name First"),
2348
+ b::Element(e::NotUsed, "Name Middle"),
2349
+ b::Element(e::NotUsed, "Name Prefix"),
2350
+ b::Element(e::NotUsed, "Name Suffix"),
2351
+ b::Element(e::Required, "Identification Code Qualifier", b::Values("PI", "XV")),
2352
+ b::Element(e::Required, "Pay-To Plan Primary Identifier"),
2353
+ b::Element(e::NotUsed, "Entity Relationship Code"),
2354
+ b::Element(e::NotUsed, "Entity Identifier Code"),
2355
+ b::Element(e::NotUsed, "Name Last or Organization Name")),
2356
+ b::Segment(250, s::N3, "Pay-to Plan Address",
2357
+ r::Required, d::RepeatCount.bounded(1),
2358
+ b::Element(e::Required, "Pay-To Plan Address Line"),
2359
+ b::Element(e::Situational, "Pay-To Plan Address Line")),
2360
+ b::Segment(300, s::N4, "Pay-To Plan City, State, ZIP Code",
2361
+ r::Required, d::RepeatCount.bounded(1),
2362
+ b::Element(e::Required, "Pay-to Plan City Name"),
2363
+ b::Element(e::Situational, "Pay-to Plan State or Province Code"),
2364
+ b::Element(e::Situational, "Pay-to Plan Postal Zone or ZIP Code"),
2365
+ b::Element(e::Situational, "Country Code"),
2366
+ b::Element(e::NotUsed, "Location Qualifier"),
2367
+ b::Element(e::NotUsed, "Location Identifier"),
2368
+ b::Element(e::Situational, "Country Subdivision Code")),
2369
+ b::Segment(350, s::REF, "Pay-to Plan Secondary Identification",
2370
+ r::Situational, d::RepeatCount.bounded(1),
2371
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("2U", "FY", "NF")),
2372
+ b::Element(e::Required, "Pay-to Plan Secondary Identifier"),
2373
+ b::Element(e::NotUsed, "Description"),
2374
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
2375
+ b::Segment(350, s::REF, "Pay-to Plan Tax Identification Number",
2376
+ r::Required, d::RepeatCount.bounded(1),
2377
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("EI")),
2378
+ b::Element(e::Required, "Pay-to Plan Tax Identification Number"),
2379
+ b::Element(e::NotUsed, "Description"),
2380
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER"))))),
2381
+
2382
+ d::TableDef.detail("Table 2 - Subscriber Detail",
2383
+ d::LoopDef.build("2000B SUBSCRIBER HIERARCHICAL LEVEL",
2384
+ d::RepeatCount.bounded(1),
2385
+ b::Segment(10, s::HL, "Subscriber Hierarchical Level",
2386
+ r::Required, d::RepeatCount.bounded(1),
2387
+ b::Element(e::Required, "Hierarchical ID Number"),
2388
+ b::Element(e::Required, "Hierarchical Parent ID Number"),
2389
+ b::Element(e::Required, "Hierarchical Level Code", b::Values("22")),
2390
+ b::Element(e::Required, "Hierachical Child Code", b::Values("0", "1"))),
2391
+ b::Segment(50, s::SBR, "Subscriber Information",
2392
+ r::Required, d::RepeatCount.bounded(1),
2393
+ b::Element(e::Required, "Payer Responsibility Sequence Number Code", b::Values("A", "B", "C", "D", "E", "F", "G", "H", "P", "S", "T", "U")),
2394
+ b::Element(e::Situational, "Individual Relationship Code", b::Values("18")),
2395
+ b::Element(e::Situational, "Subscriber Group or Policy Number"),
2396
+ b::Element(e::Situational, "Subscriber Group Name"),
2397
+ b::Element(e::NotUsed, "Insurance Type Code"),
2398
+ b::Element(e::NotUsed, "Coordination of Benefits Code"),
2399
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code"),
2400
+ b::Element(e::NotUsed, "Employment Status Code"),
2401
+ 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"))),
2402
+
2403
+ d::LoopDef.build("2010BA SUBSCRIBER NAME",
2404
+ d::RepeatCount.bounded(1),
2405
+ b::Segment(150, s::NM1, "Subscriber Name",
2406
+ r::Required, d::RepeatCount.bounded(1),
2407
+ b::Element(e::Required, "Entity Identifier Code", b::Values("IL")),
2408
+ b::Element(e::Required, "Entity Type Qualifier", b::Values("1", "2")),
2409
+ b::Element(e::Required, "Subscriber Last Name"),
2410
+ b::Element(e::Situational, "Subscriber First Name"),
2411
+ b::Element(e::Situational, "Subscriber Middle Name or Initial"),
2412
+ b::Element(e::NotUsed, "Name Prefix"),
2413
+ b::Element(e::Situational, "Subscriber Name Suffix"),
2414
+ b::Element(e::Required, "Identification Code Qualifier", b::Values("II", "MI")),
2415
+ b::Element(e::Required, "Subscriber Primary Identifier"),
2416
+ b::Element(e::NotUsed, "Entity Relationship Code"),
2417
+ b::Element(e::NotUsed, "Entity Identifier Code"),
2418
+ b::Element(e::NotUsed, "Name Last or Organization Name")),
2419
+ b::Segment(250, s::N3, "Subscriber Address",
2420
+ r::Situational, d::RepeatCount.bounded(1),
2421
+ b::Element(e::Required, "Subscriber Address Line"),
2422
+ b::Element(e::Situational, "Subscriber Address Line")),
2423
+ b::Segment(300, s::N4, "Subscriber City, State, ZIP Code",
2424
+ r::Required, d::RepeatCount.bounded(1),
2425
+ b::Element(e::Required, "Subscriber City Name"),
2426
+ b::Element(e::Situational, "Subscriber State Code"),
2427
+ b::Element(e::Situational, "Subscriber Postal Zone or ZIP Code"),
2428
+ b::Element(e::Situational, "Country Code"),
2429
+ b::Element(e::NotUsed, "Location Qualifier"),
2430
+ b::Element(e::NotUsed, "Location Identifier"),
2431
+ b::Element(e::Situational, "Country Subdivision Code")),
2432
+ b::Segment(320, s::DMG, "Subscriber Demographic Information",
2433
+ r::Situational, d::RepeatCount.bounded(1),
2434
+ b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
2435
+ b::Element(e::Required, "Subscriber Birth Date"),
2436
+ b::Element(e::Required, "Subscriber Gender Code", b::Values("F", "M", "U")),
2437
+ b::Element(e::NotUsed, "Marital Status Code"),
2438
+ b::Element(e::NotUsed, "COMPOSITE RACE OR ETHNICITY INFORMATION"),
2439
+ b::Element(e::NotUsed, "Citizenship Status Code"),
2440
+ b::Element(e::NotUsed, "Country Code"),
2441
+ b::Element(e::NotUsed, "Basis of Verification Code"),
2442
+ b::Element(e::NotUsed, "Quantity"),
2443
+ b::Element(e::NotUsed, "Code List Qualifier Code"),
2444
+ b::Element(e::NotUsed, "Industry Code")),
2445
+ b::Segment(350, s::REF, "Subscriber Secondary Identification",
2446
+ r::Situational, d::RepeatCount.bounded(1),
2447
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("SY")),
2448
+ b::Element(e::Required, "Subscriber Supplemental Identifier"),
2449
+ b::Element(e::NotUsed, "Description"),
2450
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
2451
+ b::Segment(350, s::REF, "Property and Casualty Claim Number",
2452
+ r::Situational, d::RepeatCount.bounded(1),
2453
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("Y4")),
2454
+ b::Element(e::Required, "Property Casualty Claim Number"),
2455
+ b::Element(e::NotUsed, "Description"),
2456
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER"))),
2457
+
2458
+ d::LoopDef.build("2010BB PAYER NAME",
2459
+ d::RepeatCount.bounded(10),
2460
+ b::Segment(150, s::NM1, "Payer Name",
2461
+ r::Required, d::RepeatCount.bounded(1),
2462
+ b::Element(e::Required, "Entity Identifier Code", b::Values("PR")),
2463
+ b::Element(e::Required, "Entity Type Qualifier", b::Values("2")),
2464
+ b::Element(e::Required, "Payer Name"),
2465
+ b::Element(e::NotUsed, "Name First"),
2466
+ b::Element(e::NotUsed, "Name Middle"),
2467
+ b::Element(e::NotUsed, "Name Prefix"),
2468
+ b::Element(e::NotUsed, "Name Suffix"),
2469
+ b::Element(e::Required, "Identification Code Qualifier", b::Values("PI", "XV")),
2470
+ b::Element(e::Required, "Payer Identifier"),
2471
+ b::Element(e::NotUsed, "Entity Relationship Code"),
2472
+ b::Element(e::NotUsed, "Entity Identifier Code"),
2473
+ b::Element(e::NotUsed, "Name Last or Organization Name")),
2474
+ b::Segment(250, s::N3, "Payer Address",
2475
+ r::Situational, d::RepeatCount.bounded(1),
2476
+ b::Element(e::Required, "Payer Address Line"),
2477
+ b::Element(e::Situational, "Payer Address Line")),
2478
+ b::Segment(300, s::N4, "Payer City, State, ZIP Code",
2479
+ r::Required, d::RepeatCount.bounded(1),
2480
+ b::Element(e::Required, "Payer City Name"),
2481
+ b::Element(e::Situational, "Payer State Code"),
2482
+ b::Element(e::Situational, "Payer Postal Zone or ZIP Code"),
2483
+ b::Element(e::Situational, "Country Code"),
2484
+ b::Element(e::NotUsed, "Location Qualifier"),
2485
+ b::Element(e::NotUsed, "Location Identifier"),
2486
+ b::Element(e::Situational, "Country Subdivision Code")),
2487
+ b::Segment(350, s::REF, "Payer Secondary Identification",
2488
+ r::Situational, d::RepeatCount.bounded(3),
2489
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("2U", "EI", "FY", "NF")),
2490
+ b::Element(e::Required, "Payer Additional Identifier"),
2491
+ b::Element(e::NotUsed, "Description"),
2492
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
2493
+ b::Segment(350, s::REF, "Billing Provider Secondary Identification",
2494
+ r::Situational, d::RepeatCount.bounded(1),
2495
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("G2", "LU")),
2496
+ b::Element(e::Required, "Billing Provider Secondary Identifier"),
2497
+ b::Element(e::NotUsed, "Description"),
2498
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER"))),
2499
+
2500
+ loop2300)),
2501
+
2502
+ d::TableDef.detail("Table 2 - Patient Detail",
2503
+ d::LoopDef.build("2000C PATIENT HIERARCHICAL LEVEL",
2504
+ d::RepeatCount.bounded(1),
2505
+ b::Segment(10, s::HL, "Patient Hierachical Level",
2506
+ r::Situational, d::RepeatCount.bounded(1),
2507
+ b::Element(e::Required, "Hierarchical ID Number"),
2508
+ b::Element(e::Required, "Hierarchical Parent ID Number"),
2509
+ b::Element(e::Required, "Hierarchical Level Code", b::Values("23")),
2510
+ b::Element(e::Required, "Hierarchical Child Code", b::Values("0"))),
2511
+ b::Segment(70, s::PAT, "Patient Information",
2512
+ r::Required, d::RepeatCount.bounded(1),
2513
+ b::Element(e::Required, "Individual Relationship Code", b::Values("01", "19", "20", "21", "39", "40", "53", "G8")),
2514
+ b::Element(e::NotUsed, "Patient Location Code"),
2515
+ b::Element(e::NotUsed, "Employment Status Code"),
2516
+ b::Element(e::NotUsed, "Student Status Code"),
2517
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
2518
+ b::Element(e::NotUsed, "Date Time Period"),
2519
+ b::Element(e::NotUsed, "Unit Basis for Measurement Code"),
2520
+ b::Element(e::NotUsed, "Weight"),
2521
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
2522
+
2523
+ d::LoopDef.build("2010CA PATIENT NAME",
2524
+ d::RepeatCount.bounded(1),
2525
+ b::Segment(150, s::NM1, "Patient Name",
2526
+ r::Required, d::RepeatCount.bounded(1),
2527
+ b::Element(e::Required, "Entity Qualifier Code", b::Values("QC")),
2528
+ b::Element(e::Required, "Entity Type Qualifier", b::Values("1")),
2529
+ b::Element(e::Required, "Patient Last Name"),
2530
+ b::Element(e::Situational, "Patient First Name"),
2531
+ b::Element(e::Situational, "Patient Middle Name or Initial"),
2532
+ b::Element(e::NotUsed, "Name Prefix"),
2533
+ b::Element(e::Situational, "Patient Name Suffix"),
2534
+ b::Element(e::NotUsed, "Identification Code Qualifier"),
2535
+ b::Element(e::NotUsed, "Identification Code"),
2536
+ b::Element(e::NotUsed, "Entity Relationship Code"),
2537
+ b::Element(e::NotUsed, "Entity Identifier Code"),
2538
+ b::Element(e::NotUsed, "Name Last or Organization Name")),
2539
+ b::Segment(250, s::N3, "Patient Address",
2540
+ r::Required, d::RepeatCount.bounded(1),
2541
+ b::Element(e::Required, "Patient Address Line"),
2542
+ b::Element(e::Situational, "Patient Address Line")),
2543
+ b::Segment(300, s::N4, "Patient City, State, ZIP Code",
2544
+ r::Required, d::RepeatCount.bounded(1),
2545
+ b::Element(e::Required, "Patient City Name"),
2546
+ b::Element(e::Situational, "Patient State Code"),
2547
+ b::Element(e::Situational, "Patient Postal Zone or ZIP Code"),
2548
+ b::Element(e::Situational, "Country Code"),
2549
+ b::Element(e::NotUsed, "Location Qualifier"),
2550
+ b::Element(e::NotUsed, "Location Identifier"),
2551
+ b::Element(e::Situational, "Country Subdivision Code")),
2552
+ b::Segment(320, s::DMG, "Patient Demographic Information",
2553
+ r::Required, d::RepeatCount.bounded(1),
2554
+ b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
2555
+ b::Element(e::Required, "Patient Birth Date"),
2556
+ b::Element(e::Required, "Patient Gender Code", b::Values("F", "M", "U")),
2557
+ b::Element(e::NotUsed, "Marital Status Code"),
2558
+ b::Element(e::NotUsed, "COMPOSITE RACE OR ETHNICITY INFORMATION"),
2559
+ b::Element(e::NotUsed, "Citizenship Status Code"),
2560
+ b::Element(e::NotUsed, "Country Code"),
2561
+ b::Element(e::NotUsed, "Basis of Verification Code"),
2562
+ b::Element(e::NotUsed, "Quantity"),
2563
+ b::Element(e::NotUsed, "Code List Qualifier Code"),
2564
+ b::Element(e::NotUsed, "Industry Code")),
2565
+ b::Segment(350, s::REF, "Property and Casualty Claim Number",
2566
+ r::Situational, d::RepeatCount.bounded(1),
2567
+ b::Element(e::Required, "Reference Identifier Qualifier", b::Values("Y4")),
2568
+ b::Element(e::Required, "Property Casualty Claim Number"),
2569
+ b::Element(e::NotUsed, "Description"),
2570
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER"))),
2571
+
2572
+ loop2300)),
2573
+
2574
+ d::TableDef.summary("Table 3 - Summary",
2575
+ b::Segment(5550, s::SE, "Transaction Set Trailer",
2576
+ r::Required, d::RepeatCount.bounded(1),
2577
+ b::Element(e::Required, "Transaction Segment Count"),
2578
+ b::Element(e::Required, "Transaction Set Control Number"))))
2579
+ end
2580
+ end
2581
+ end
2582
+ end