stupidedi 1.3.23 → 1.4.0

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Files changed (2005) hide show
  1. checksums.yaml +4 -4
  2. data/README.md +4 -4
  3. data/Rakefile +17 -92
  4. data/bin/edi-ed +8 -12
  5. data/bin/edi-obfuscate +8 -9
  6. data/bin/edi-pp +31 -25
  7. data/doc/{Transcribing.md → Defining.md} +0 -0
  8. data/doc/{unwritten/Parsing.md → Parsing.md} +0 -0
  9. data/doc/{unwritten/Tokenizing.md → Tokenizing.md} +0 -0
  10. data/doc/{unwritten/Validating.md → Validating.md} +0 -0
  11. data/lib/ruby/array.rb +1 -4
  12. data/lib/ruby/blank.rb +0 -3
  13. data/lib/ruby/exception.rb +13 -33
  14. data/lib/ruby/hash.rb +0 -2
  15. data/lib/ruby/module.rb +1 -3
  16. data/lib/ruby/object.rb +0 -13
  17. data/lib/ruby/string.rb +12 -3
  18. data/lib/ruby/to_d.rb +20 -25
  19. data/lib/ruby/to_date.rb +0 -3
  20. data/lib/ruby/to_time.rb +0 -3
  21. data/lib/ruby/try.rb +0 -3
  22. data/lib/stupidedi.rb +27 -41
  23. data/lib/stupidedi/builder.rb +3 -22
  24. data/lib/stupidedi/color.rb +4 -6
  25. data/lib/stupidedi/config.rb +77 -69
  26. data/lib/stupidedi/config/code_list_config.rb +0 -2
  27. data/lib/stupidedi/config/editor_config.rb +0 -2
  28. data/lib/stupidedi/config/functional_group_config.rb +3 -2
  29. data/lib/stupidedi/config/interchange_config.rb +5 -6
  30. data/lib/stupidedi/config/transaction_set_config.rb +17 -48
  31. data/lib/stupidedi/contrib.rb +41 -6
  32. data/lib/stupidedi/editor.rb +0 -3
  33. data/lib/stupidedi/editor/00401.rb +0 -3
  34. data/lib/stupidedi/editor/004010.rb +4 -8
  35. data/lib/stupidedi/editor/004010/N4.rb +0 -4
  36. data/lib/stupidedi/editor/00501.rb +0 -3
  37. data/lib/stupidedi/editor/005010.rb +5 -9
  38. data/lib/stupidedi/editor/005010/N4.rb +0 -4
  39. data/lib/stupidedi/editor/X12.rb +0 -5
  40. data/lib/stupidedi/editor/X222-HC837.rb +0 -5
  41. data/lib/stupidedi/editor/abstract_ed.rb +0 -2
  42. data/lib/stupidedi/editor/claim_ack.rb +0 -2
  43. data/lib/stupidedi/editor/implementation_ack.rb +2 -3
  44. data/lib/stupidedi/editor/interchange_ack.rb +0 -2
  45. data/lib/stupidedi/editor/result.rb +1 -6
  46. data/lib/stupidedi/editor/result_set.rb +1 -3
  47. data/lib/stupidedi/editor/transaction_set_ed.rb +23 -19
  48. data/lib/stupidedi/editor/transmission_ed.rb +0 -3
  49. data/lib/stupidedi/either.rb +0 -5
  50. data/lib/stupidedi/exceptions/invalid_element_error.rb +0 -2
  51. data/lib/stupidedi/exceptions/invalid_schema_error.rb +0 -2
  52. data/lib/stupidedi/exceptions/output_error.rb +0 -2
  53. data/lib/stupidedi/exceptions/parse_error.rb +0 -2
  54. data/lib/stupidedi/exceptions/stupidedi_error.rb +0 -2
  55. data/lib/stupidedi/exceptions/tokenize_error.rb +0 -2
  56. data/lib/stupidedi/exceptions/zipper_error.rb +0 -2
  57. data/lib/stupidedi/guides.rb +7 -3
  58. data/lib/stupidedi/inspect.rb +1 -4
  59. data/lib/stupidedi/interchanges.rb +11 -0
  60. data/lib/stupidedi/interchanges/00200.rb +12 -0
  61. data/lib/stupidedi/interchanges/00200/element_defs.rb +104 -0
  62. data/lib/stupidedi/interchanges/00200/interchange_def.rb +59 -0
  63. data/lib/stupidedi/interchanges/00200/segment_defs.rb +12 -0
  64. data/lib/stupidedi/interchanges/00200/segment_defs/IEA.rb +17 -0
  65. data/lib/stupidedi/interchanges/00200/segment_defs/ISA.rb +31 -0
  66. data/lib/stupidedi/interchanges/00200/segment_defs/TA1.rb +20 -0
  67. data/lib/stupidedi/interchanges/00300.rb +12 -0
  68. data/lib/stupidedi/interchanges/00300/element_defs.rb +105 -0
  69. data/lib/stupidedi/interchanges/00300/interchange_def.rb +59 -0
  70. data/lib/stupidedi/interchanges/00300/segment_defs.rb +12 -0
  71. data/lib/stupidedi/interchanges/00300/segment_defs/IEA.rb +17 -0
  72. data/lib/stupidedi/interchanges/00300/segment_defs/ISA.rb +31 -0
  73. data/lib/stupidedi/interchanges/00300/segment_defs/TA1.rb +20 -0
  74. data/lib/stupidedi/interchanges/00400.rb +12 -0
  75. data/lib/stupidedi/interchanges/00400/element_defs.rb +97 -0
  76. data/lib/stupidedi/interchanges/00400/interchange_def.rb +59 -0
  77. data/lib/stupidedi/interchanges/00400/segment_defs.rb +12 -0
  78. data/lib/stupidedi/interchanges/00400/segment_defs/IEA.rb +17 -0
  79. data/lib/stupidedi/interchanges/00400/segment_defs/ISA.rb +31 -0
  80. data/lib/stupidedi/interchanges/00400/segment_defs/TA1.rb +20 -0
  81. data/lib/stupidedi/interchanges/00401.rb +12 -0
  82. data/lib/stupidedi/interchanges/00401/element_defs.rb +96 -0
  83. data/lib/stupidedi/interchanges/00401/interchange_def.rb +59 -0
  84. data/lib/stupidedi/interchanges/00401/segment_defs.rb +12 -0
  85. data/lib/stupidedi/interchanges/00401/segment_defs/IEA.rb +17 -0
  86. data/lib/stupidedi/interchanges/00401/segment_defs/ISA.rb +31 -0
  87. data/lib/stupidedi/interchanges/00401/segment_defs/TA1.rb +20 -0
  88. data/lib/stupidedi/interchanges/00501.rb +12 -0
  89. data/lib/stupidedi/interchanges/00501/element_defs.rb +130 -0
  90. data/lib/stupidedi/interchanges/00501/interchange_def.rb +59 -0
  91. data/lib/stupidedi/interchanges/00501/segment_defs.rb +12 -0
  92. data/lib/stupidedi/interchanges/00501/segment_defs/IEA.rb +17 -0
  93. data/lib/stupidedi/interchanges/00501/segment_defs/ISA.rb +31 -0
  94. data/lib/stupidedi/interchanges/00501/segment_defs/ISB.rb +15 -0
  95. data/lib/stupidedi/interchanges/00501/segment_defs/ISE.rb +15 -0
  96. data/lib/stupidedi/interchanges/00501/segment_defs/TA1.rb +20 -0
  97. data/lib/stupidedi/interchanges/00501/segment_defs/TA3.rb +15 -0
  98. data/lib/stupidedi/interchanges/element_types.rb +11 -0
  99. data/lib/stupidedi/interchanges/element_types/separator_val.rb +79 -0
  100. data/lib/stupidedi/interchanges/element_types/special_val.rb +48 -0
  101. data/lib/stupidedi/parser.rb +32 -0
  102. data/lib/stupidedi/parser/builder_dsl.rb +289 -0
  103. data/lib/stupidedi/parser/constraint_table.rb +488 -0
  104. data/lib/stupidedi/parser/generation.rb +147 -0
  105. data/lib/stupidedi/parser/identifier_stack.rb +248 -0
  106. data/lib/stupidedi/parser/instruction.rb +112 -0
  107. data/lib/stupidedi/parser/instruction_table.rb +222 -0
  108. data/lib/stupidedi/parser/navigation.rb +786 -0
  109. data/lib/stupidedi/parser/state_machine.rb +62 -0
  110. data/lib/stupidedi/parser/states/abstract_state.rb +325 -0
  111. data/lib/stupidedi/parser/states/failure_state.rb +69 -0
  112. data/lib/stupidedi/parser/states/functional_group_state.rb +98 -0
  113. data/lib/stupidedi/parser/states/initial_state.rb +62 -0
  114. data/lib/stupidedi/parser/states/interchange_state.rb +93 -0
  115. data/lib/stupidedi/parser/states/loop_state.rb +80 -0
  116. data/lib/stupidedi/parser/states/table_state.rb +94 -0
  117. data/lib/stupidedi/parser/states/transaction_set_state.rb +118 -0
  118. data/lib/stupidedi/parser/states/transmission_state.rb +59 -0
  119. data/lib/stupidedi/parser/tokenization.rb +195 -0
  120. data/lib/stupidedi/reader.rb +0 -2
  121. data/lib/stupidedi/reader/input.rb +0 -3
  122. data/lib/stupidedi/reader/input/abstract_input.rb +4 -6
  123. data/lib/stupidedi/reader/input/delegated_input.rb +0 -5
  124. data/lib/stupidedi/reader/input/file_input.rb +10 -11
  125. data/lib/stupidedi/reader/position.rb +13 -8
  126. data/lib/stupidedi/reader/result.rb +5 -5
  127. data/lib/stupidedi/reader/segment_dict.rb +0 -3
  128. data/lib/stupidedi/reader/separators.rb +5 -4
  129. data/lib/stupidedi/reader/stream_reader.rb +3 -6
  130. data/lib/stupidedi/reader/token_reader.rb +0 -5
  131. data/lib/stupidedi/reader/tokens/component_element_tok.rb +4 -4
  132. data/lib/stupidedi/reader/tokens/composite_element_tok.rb +6 -5
  133. data/lib/stupidedi/reader/tokens/repeated_element_tok.rb +9 -2
  134. data/lib/stupidedi/reader/tokens/segment_tok.rb +7 -5
  135. data/lib/stupidedi/reader/tokens/simple_element_tok.rb +2 -4
  136. data/lib/stupidedi/schema.rb +17 -20
  137. data/lib/stupidedi/schema/abstract_def.rb +4 -6
  138. data/lib/stupidedi/schema/abstract_element_def.rb +35 -0
  139. data/lib/stupidedi/schema/abstract_element_use.rb +38 -0
  140. data/lib/stupidedi/schema/abstract_use.rb +6 -4
  141. data/lib/stupidedi/schema/code_list.rb +6 -5
  142. data/lib/stupidedi/schema/component_element_use.rb +74 -0
  143. data/lib/stupidedi/schema/composite_element_def.rb +103 -0
  144. data/lib/stupidedi/schema/composite_element_use.rb +73 -0
  145. data/lib/stupidedi/schema/element_req.rb +1 -4
  146. data/lib/stupidedi/schema/functional_group_def.rb +9 -3
  147. data/lib/stupidedi/schema/interchange_def.rb +9 -3
  148. data/lib/stupidedi/schema/loop_def.rb +11 -9
  149. data/lib/stupidedi/schema/repeat_count.rb +0 -3
  150. data/lib/stupidedi/schema/segment_def.rb +6 -4
  151. data/lib/stupidedi/schema/segment_req.rb +2 -3
  152. data/lib/stupidedi/schema/segment_use.rb +1 -4
  153. data/lib/stupidedi/schema/simple_element_def.rb +51 -0
  154. data/lib/stupidedi/schema/simple_element_use.rb +81 -0
  155. data/lib/stupidedi/schema/syntax_note.rb +1 -12
  156. data/lib/stupidedi/schema/table_def.rb +55 -18
  157. data/lib/stupidedi/schema/transaction_set_def.rb +25 -4
  158. data/lib/stupidedi/sets.rb +0 -3
  159. data/lib/stupidedi/transaction_sets.rb +14 -0
  160. data/lib/stupidedi/transaction_sets/002001.rb +11 -0
  161. data/lib/stupidedi/transaction_sets/002001/implementations.rb +23 -0
  162. data/lib/stupidedi/transaction_sets/002001/implementations/FA997.rb +66 -0
  163. data/lib/stupidedi/transaction_sets/002001/implementations/PO830.rb +160 -0
  164. data/lib/stupidedi/transaction_sets/002001/implementations/SH856.rb +190 -0
  165. data/lib/stupidedi/transaction_sets/002001/standards.rb +14 -0
  166. data/lib/stupidedi/transaction_sets/002001/standards/FA997.rb +31 -0
  167. data/lib/stupidedi/transaction_sets/002001/standards/PO830.rb +45 -0
  168. data/lib/stupidedi/transaction_sets/002001/standards/SH856.rb +38 -0
  169. data/lib/stupidedi/transaction_sets/003010.rb +11 -0
  170. data/lib/stupidedi/transaction_sets/003010/implementations.rb +24 -0
  171. data/lib/stupidedi/transaction_sets/003010/implementations/PC860.rb +140 -0
  172. data/lib/stupidedi/transaction_sets/003010/implementations/PO850.rb +132 -0
  173. data/lib/stupidedi/transaction_sets/003010/implementations/PS830.rb +150 -0
  174. data/lib/stupidedi/transaction_sets/003010/implementations/RA820.rb +158 -0
  175. data/lib/stupidedi/transaction_sets/003010/standards.rb +15 -0
  176. data/lib/stupidedi/transaction_sets/003010/standards/PC860.rb +49 -0
  177. data/lib/stupidedi/transaction_sets/003010/standards/PO850.rb +49 -0
  178. data/lib/stupidedi/transaction_sets/003010/standards/PS830.rb +49 -0
  179. data/lib/stupidedi/transaction_sets/003010/standards/RA820.rb +40 -0
  180. data/lib/stupidedi/transaction_sets/003040.rb +12 -0
  181. data/lib/stupidedi/transaction_sets/003040/implementations.rb +21 -0
  182. data/lib/stupidedi/transaction_sets/003040/implementations/WA142.rb +153 -0
  183. data/lib/stupidedi/transaction_sets/003040/standards.rb +12 -0
  184. data/lib/stupidedi/transaction_sets/003040/standards/WA142.rb +53 -0
  185. data/lib/stupidedi/transaction_sets/003050.rb +12 -0
  186. data/lib/stupidedi/transaction_sets/003050/implementations.rb +21 -0
  187. data/lib/stupidedi/transaction_sets/003050/implementations/PO850.rb +77 -0
  188. data/lib/stupidedi/transaction_sets/003050/standards.rb +12 -0
  189. data/lib/stupidedi/transaction_sets/003050/standards/PO850.rb +41 -0
  190. data/lib/stupidedi/transaction_sets/004010.rb +12 -0
  191. data/lib/stupidedi/transaction_sets/004010/implementations.rb +38 -0
  192. data/lib/stupidedi/transaction_sets/004010/implementations/AR943.rb +72 -0
  193. data/lib/stupidedi/transaction_sets/004010/implementations/FA997.rb +65 -0
  194. data/lib/stupidedi/transaction_sets/004010/implementations/GF990.rb +40 -0
  195. data/lib/stupidedi/transaction_sets/004010/implementations/IM210.rb +221 -0
  196. data/lib/stupidedi/transaction_sets/004010/implementations/OW940.rb +98 -0
  197. data/lib/stupidedi/transaction_sets/004010/implementations/PO850.rb +108 -0
  198. data/lib/stupidedi/transaction_sets/004010/implementations/PS830.rb +143 -0
  199. data/lib/stupidedi/transaction_sets/004010/implementations/QM214.rb +106 -0
  200. data/lib/stupidedi/transaction_sets/004010/implementations/RE944.rb +63 -0
  201. data/lib/stupidedi/transaction_sets/004010/implementations/SH856.rb +156 -0
  202. data/lib/stupidedi/transaction_sets/004010/implementations/SM204.rb +391 -0
  203. data/lib/stupidedi/transaction_sets/004010/implementations/SQ866.rb +103 -0
  204. data/lib/stupidedi/transaction_sets/004010/implementations/SS862.rb +154 -0
  205. data/lib/stupidedi/transaction_sets/004010/implementations/SW945.rb +99 -0
  206. data/lib/stupidedi/transaction_sets/004010/implementations/X091A1-HP835.rb +481 -0
  207. data/lib/stupidedi/transaction_sets/004010/standards.rb +28 -0
  208. data/lib/stupidedi/transaction_sets/004010/standards/AR943.rb +34 -0
  209. data/lib/stupidedi/transaction_sets/004010/standards/FA997.rb +31 -0
  210. data/lib/stupidedi/transaction_sets/004010/standards/GF990.rb +21 -0
  211. data/lib/stupidedi/transaction_sets/004010/standards/HP835.rb +61 -0
  212. data/lib/stupidedi/transaction_sets/004010/standards/IM210.rb +47 -0
  213. data/lib/stupidedi/transaction_sets/004010/standards/OW940.rb +43 -0
  214. data/lib/stupidedi/transaction_sets/004010/standards/PO850.rb +50 -0
  215. data/lib/stupidedi/transaction_sets/004010/standards/PR855.rb +35 -0
  216. data/lib/stupidedi/transaction_sets/004010/standards/PS830.rb +43 -0
  217. data/lib/stupidedi/transaction_sets/004010/standards/QM214.rb +41 -0
  218. data/lib/stupidedi/transaction_sets/004010/standards/RE944.rb +34 -0
  219. data/lib/stupidedi/transaction_sets/004010/standards/SC832.rb +37 -0
  220. data/lib/stupidedi/transaction_sets/004010/standards/SH856.rb +40 -0
  221. data/lib/stupidedi/transaction_sets/004010/standards/SM204.rb +85 -0
  222. data/lib/stupidedi/transaction_sets/004010/standards/SQ866.rb +32 -0
  223. data/lib/stupidedi/transaction_sets/004010/standards/SS862.rb +42 -0
  224. data/lib/stupidedi/transaction_sets/004010/standards/SW945.rb +43 -0
  225. data/lib/stupidedi/transaction_sets/005010.rb +11 -0
  226. data/lib/stupidedi/transaction_sets/005010/implementations.rb +88 -0
  227. data/lib/stupidedi/transaction_sets/005010/implementations/X212-HR276.rb +329 -0
  228. data/lib/stupidedi/transaction_sets/005010/implementations/X214-HN277.rb +356 -0
  229. data/lib/stupidedi/transaction_sets/005010/implementations/X220-BE834.rb +15 -0
  230. data/lib/stupidedi/transaction_sets/005010/implementations/X220A1-BE834.rb +623 -0
  231. data/lib/stupidedi/transaction_sets/005010/implementations/X221-HP835.rb +15 -0
  232. data/lib/stupidedi/transaction_sets/005010/implementations/X221A1-HP835.rb +556 -0
  233. data/lib/stupidedi/transaction_sets/005010/implementations/X222-HC837.rb +15 -0
  234. data/lib/stupidedi/transaction_sets/005010/implementations/X222-HC837P.rb +15 -0
  235. data/lib/stupidedi/transaction_sets/005010/implementations/X222A1-HC837.rb +2033 -0
  236. data/lib/stupidedi/transaction_sets/005010/implementations/X222A1-HC837P.rb +15 -0
  237. data/lib/stupidedi/transaction_sets/005010/implementations/X223-HC837.rb +15 -0
  238. data/lib/stupidedi/transaction_sets/005010/implementations/X223-HC837I.rb +15 -0
  239. data/lib/stupidedi/transaction_sets/005010/implementations/X223A1-HC837.rb +15 -0
  240. data/lib/stupidedi/transaction_sets/005010/implementations/X223A2-HC837.rb +2390 -0
  241. data/lib/stupidedi/transaction_sets/005010/implementations/X223A3-HC837.rb +2595 -0
  242. data/lib/stupidedi/transaction_sets/005010/implementations/X231-FA999.rb +15 -0
  243. data/lib/stupidedi/transaction_sets/005010/implementations/X231A1-FA999.rb +106 -0
  244. data/lib/stupidedi/transaction_sets/005010/implementations/X279-HB271.rb +749 -0
  245. data/lib/stupidedi/transaction_sets/005010/implementations/X279-HS270.rb +533 -0
  246. data/lib/stupidedi/transaction_sets/005010/implementations/X279A1-HB271.rb +751 -0
  247. data/lib/stupidedi/transaction_sets/005010/implementations/X279A1-HS270.rb +533 -0
  248. data/lib/stupidedi/transaction_sets/005010/standards.rb +22 -0
  249. data/lib/stupidedi/transaction_sets/005010/standards/BE834.rb +171 -0
  250. data/lib/stupidedi/transaction_sets/005010/standards/FA997.rb +31 -0
  251. data/lib/stupidedi/transaction_sets/005010/standards/FA999.rb +35 -0
  252. data/lib/stupidedi/transaction_sets/005010/standards/HB271.rb +95 -0
  253. data/lib/stupidedi/transaction_sets/005010/standards/HC837.rb +161 -0
  254. data/lib/stupidedi/transaction_sets/005010/standards/HI278.rb +62 -0
  255. data/lib/stupidedi/transaction_sets/005010/standards/HN277.rb +71 -0
  256. data/lib/stupidedi/transaction_sets/005010/standards/HP835.rb +65 -0
  257. data/lib/stupidedi/transaction_sets/005010/standards/HR276.rb +54 -0
  258. data/lib/stupidedi/transaction_sets/005010/standards/HS270.rb +50 -0
  259. data/lib/stupidedi/transaction_sets/005010/standards/RA820.rb +238 -0
  260. data/lib/stupidedi/transaction_sets/builder.rb +184 -0
  261. data/lib/stupidedi/transaction_sets/common.rb +8 -0
  262. data/lib/stupidedi/transaction_sets/common/implementations.rb +11 -0
  263. data/lib/stupidedi/transaction_sets/common/implementations/element_reqs.rb +37 -0
  264. data/lib/stupidedi/transaction_sets/common/implementations/segment_reqs.rb +31 -0
  265. data/lib/stupidedi/transaction_sets/validation.rb +9 -0
  266. data/lib/stupidedi/transaction_sets/validation/ambiguity.rb +391 -0
  267. data/lib/stupidedi/transaction_sets/validation/implementation.rb +12 -0
  268. data/lib/stupidedi/values.rb +0 -1
  269. data/lib/stupidedi/values/abstract_element_val.rb +0 -4
  270. data/lib/stupidedi/values/abstract_val.rb +3 -4
  271. data/lib/stupidedi/values/composite_element_val.rb +3 -8
  272. data/lib/stupidedi/values/functional_group_val.rb +3 -4
  273. data/lib/stupidedi/values/interchange_val.rb +3 -4
  274. data/lib/stupidedi/values/invalid_envelope_val.rb +2 -6
  275. data/lib/stupidedi/values/invalid_segment_val.rb +16 -9
  276. data/lib/stupidedi/values/loop_val.rb +3 -4
  277. data/lib/stupidedi/values/repeated_element_val.rb +5 -7
  278. data/lib/stupidedi/values/segment_val.rb +7 -11
  279. data/lib/stupidedi/values/segment_val_group.rb +0 -4
  280. data/lib/stupidedi/values/simple_element_val.rb +2 -7
  281. data/lib/stupidedi/values/table_val.rb +3 -4
  282. data/lib/stupidedi/values/transaction_set_val.rb +3 -4
  283. data/lib/stupidedi/values/transmission_val.rb +5 -5
  284. data/lib/stupidedi/version.rb +1 -2
  285. data/lib/stupidedi/versions.rb +11 -3
  286. data/lib/stupidedi/versions/002001.rb +14 -0
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  2000. data/spec/support/node.rb +0 -41
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  2002. data/spec/support/quickcheck/characters.rb +0 -33
  2003. data/spec/support/quickcheck/property.rb +0 -105
  2004. data/spec/support/quickcheck/serialized_edi.rb +0 -400
  2005. data/spec/support/rcov.rb +0 -41
@@ -1,2294 +0,0 @@
1
- # frozen_string_literal: true
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- module Stupidedi
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- using Refinements
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-
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- module Guides
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- module FiftyTen
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- module X222
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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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- # With only a quick glance at X222, it appears that 2300 is a child of
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- # the 2000C HL loop. But there is a nasty little note that reads:
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- #
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- # For the purposes of this documentation, the claim detail information
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- # is presented only in the dependent level. Specific claim detail
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- # information can be given in either the subscriber or the dependent
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- # hierarchical level. Because of this, the claim information is said
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- # to "float." Claim information is positioned in the same hierarchical
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- # level that describes its owner-participant, either the subscriber or
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- # the dependent. In other words, the claim information, Loop 2300, is
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- # placed in the hierarchical level when the patient is the subscriber,
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- # or it is placed at the patient/dependent hierarchical level when the
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- # patient is the dependent of the subscriber as shown here. When the
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- # patient is the subscriber, loops 2000C and 2010CA are not sent. See
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- # 1.4.3.2.2.1, HL Segment, for details.
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- #
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- # So here we build the 2300 LoopDef and later copy it as a child of the
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- # 2000B and 2000C loops. The actual transaction set begins below with
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- # the line that starts HC837 = ...
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-
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- loop2300 =
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- d::LoopDef.build("2300 CLAIM INFORMATION",
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- d::RepeatCount.bounded(100),
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- b::Segment(1300, s::CLM, "Claim Information",
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- # The spec is Required, but that doesn't seem right. This loop
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- # is not required to occur in both the Subscriber and Patient
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- # tables, it must appear in only one of them.
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- r::Situational, d::RepeatCount.bounded(1),
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- b::Element(e::Required, "Patient Control Number", b::MaxLength(20)),
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- b::Element(e::Required, "Total Claim Charge Amount"),
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- b::Element(e::NotUsed, "Claim Filing Indicator Code"),
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- b::Element(e::NotUsed, "Non-Institutional Claim Type Code"),
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- b::Element(e::Required, "HEALTH CARE SERVICE LOCATION INFORMATION",
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- b::Element(e::Required, "Place of Service Code"),
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- b::Element(e::Required, "Facility Code Qualifier", b::Values("B")),
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- b::Element(e::Required, "Claim Frequency Code")),
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- b::Element(e::Required, "Provider or Supplier Signature Indicator", b::Values("N", "Y")),
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- 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")),
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- b::Element(e::Required, "Release of Information Code", b::Values("I", "Y")),
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- b::Element(e::Situational, "Patient Signature Source Code", b::Values("P")),
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- b::Element(e::Situational, "RELATED CAUSES INFORMATION",
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- b::Element(e::Required, "Related Causes Code", b::Values("AA", "EM", "OA")),
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- b::Element(e::Situational, "Related Causes Code", b::Values("AA", "EM", "OA")),
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- b::Element(e::NotUsed, "Related Causes Code"),
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- b::Element(e::Situational, "Auto Accident State or Province Code"),
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- b::Element(e::Situational, "Country Code")),
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- b::Element(e::Situational, "Special Program Indicator", b::Values("02", "03", "05", "09")),
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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"),
66
- b::Element(e::NotUsed, "Yes/No Condition or Response Code"),
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- b::Element(e::NotUsed, "Provider Agreement Code"),
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- b::Element(e::NotUsed, "Claim Status Code"),
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- 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, "Onset of Current Illness or Symptom",
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- r::Situational, d::RepeatCount.bounded(1),
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- b::Element(e::Required, "Date Time Qualifier", b::Values("431")),
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- b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
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- b::Element(e::Required, "Onset of Current Illness or Injury Date")),
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- b::Segment(1350, s::DTP, "Initial Treatment Date",
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- r::Situational, d::RepeatCount.bounded(1),
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- b::Element(e::Required, "Date Time Qualifier", b::Values("454")),
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- b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
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- b::Element(e::Required, "Initial Treatment Date")),
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- b::Segment(1350, s::DTP, "Last Seen Date",
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- r::Situational, d::RepeatCount.bounded(1),
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- b::Element(e::Required, "Date Time Qualifier", b::Values("304")),
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- b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
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- b::Element(e::Required, "Last Seen Date")),
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- b::Segment(1350, s::DTP, "Acute Manifestation Date",
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- r::Situational, d::RepeatCount.bounded(1),
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- b::Element(e::Required, "Date Time Qualifier", b::Values("453")),
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- b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
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- b::Element(e::Required, "Acute Manifestation Date")),
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- b::Segment(1350, s::DTP, "Accident Date",
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- r::Situational, d::RepeatCount.bounded(1),
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- b::Element(e::Required, "Date Time Qualifier", b::Values("439")),
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- b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
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- b::Element(e::Required, "Accident Date")),
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- b::Segment(1350, s::DTP, "Last Menstrual Period Date",
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- r::Situational, d::RepeatCount.bounded(1),
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- b::Element(e::Required, "Date Time Qualifier", b::Values("484")),
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- b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
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- b::Element(e::Required, "Last Menstrual Period Date")),
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- b::Segment(1350, s::DTP, "Last X-ray Date",
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- r::Situational, d::RepeatCount.bounded(1),
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- b::Element(e::Required, "Date Time Qualifier", b::Values("455")),
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- b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
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- b::Element(e::Required, "Last X-ray Date")),
107
- b::Segment(1350, s::DTP, "Hearing and Vision Prescription Date",
108
- r::Situational, d::RepeatCount.bounded(1),
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- b::Element(e::Required, "Date Time Qualifier", b::Values("471")),
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- b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
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- b::Element(e::Required, "Prescription Date")),
112
- b::Segment(1350, s::DTP, "Disability Dates",
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- r::Situational, d::RepeatCount.bounded(1),
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- b::Element(e::Required, "Date Time Qualifier", b::Values("314", "360", "361")),
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- b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8", "RD8")),
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- b::Element(e::Required, "Disability From Date")),
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- b::Segment(1350, s::DTP, "Last Worked Date",
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- r::Situational, d::RepeatCount.bounded(1),
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- b::Element(e::Required, "Date Time Qualifier", b::Values("297")),
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- b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
121
- b::Element(e::Required, "Last Worked Date")),
122
- b::Segment(1350, s::DTP, "Authorized Return to Work Date",
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- r::Situational, d::RepeatCount.bounded(1),
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- b::Element(e::Required, "Date Time Qualifier", b::Values("296")),
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- b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
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- b::Element(e::Required, "Work Return Date")),
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- b::Segment(1350, s::DTP, "Admission Date",
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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")),
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- b::Element(e::Required, "Related Hospitalization Admission Date")),
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- b::Segment(1350, s::DTP, "Discharge Date",
133
- 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("D8")),
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- b::Element(e::Required, "Related Hospitalization Discharge Date")),
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- b::Segment(1350, s::DTP, "Assumed and Relinquished Care Dates",
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- r::Situational, d::RepeatCount.bounded(2),
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- b::Element(e::Required, "Date Time Qualifier", b::Values("090", "091")),
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- b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
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- b::Element(e::Required, "Asumed or Relinquished Care Date")),
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- b::Segment(1350, s::DTP, "Property and Casualty Date of First Contact",
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- r::Situational, d::RepeatCount.bounded(1),
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- b::Element(e::Required, "Date Time Qualifier", b::Values("444")),
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- b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
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- b::Element(e::Required, "Date")),
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- b::Segment(1350, s::DTP, "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")),
152
- 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"),
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- b::Element(e::NotUsed, "Entity Identifier Code"),
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- b::Element(e::Situational, "Identification Code Qualifier", b::Values("AC")),
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- b::Element(e::Situational, "Attachment Control Number", b::MaxLength(50)),
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- b::Element(e::NotUsed, "Description"),
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- b::Element(e::NotUsed, "ACTIONS INDICATED"),
162
- b::Element(e::NotUsed, "Request Category Code")),
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- 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")),
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- b::Element(e::Situational, "Contract Amount"),
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- 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"),
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- b::Element(e::Situational, "Contract Version Number")),
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- b::Segment(1750, s::AMT, "Patient Amount Paid",
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- r::Situational, d::RepeatCount.bounded(1),
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- b::Element(e::Required, "Amount Qualifier Code", b::Values("F5")),
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- b::Element(e::Required, "Patient Amount Paid"),
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- 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),
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- b::Element(e::Required, "Reference Identification Qualifier", b::Values("4N")),
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- b::Element(e::Required, "Service Authorization Exception Code", b::Values("1", "2", "3", "4", "5", "6", "7")),
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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, "Mandatory Medicare (Section 4081) Crossover Indicator",
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- r::Situational, d::RepeatCount.bounded(1),
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- b::Element(e::Required, "Reference Identification Qualifier", b::Values("F5")),
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- b::Element(e::Required, "Medicare Section 4081 Indicator", b::Values("Y", "N")),
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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, "Mammography Certification Number",
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- r::Situational, d::RepeatCount.bounded(1),
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- b::Element(e::Required, "Reference Identification Qualifier", b::Values("EW")),
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- b::Element(e::Required, "Mammography Certification 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, "Referral Number",
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- r::Situational, d::RepeatCount.bounded(1),
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- b::Element(e::Required, "Reference Identification Qualifier", b::Values("9F")),
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- b::Element(e::Required, "Referral Number"),
198
- b::Element(e::NotUsed, "Description"),
199
- 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),
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- b::Element(e::Required, "Reference Identification Qualifier", b::Values("G1")),
203
- b::Element(e::Required, "Prior Authorization Number"),
204
- b::Element(e::NotUsed, "Description"),
205
- b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
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- b::Segment(1800, s::REF, "Payer Claim Control Number",
207
- r::Situational, d::RepeatCount.bounded(1),
208
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("F8")),
209
- b::Element(e::Required, "Payer Claim Control Number"),
210
- b::Element(e::NotUsed, "Description"),
211
- b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
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- b::Segment(1800, s::REF, "Clinical Laboratory Improvement Amendment (CLIA) Number",
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- r::Situational, d::RepeatCount.bounded(1),
214
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("X4")),
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- b::Element(e::Required, "Clinical Laboratory Improvement Amendment Number"),
216
- b::Element(e::NotUsed, "Description"),
217
- 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")),
221
- b::Element(e::Required, "Repriced Claim Reference Number"),
222
- b::Element(e::NotUsed, "Description"),
223
- 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"),
228
- b::Element(e::NotUsed, "Description"),
229
- b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
230
- b::Segment(1800, s::REF, "Investigational Device Exemption Number",
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- r::Situational, d::RepeatCount.bounded(1),
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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")),
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- b::Element(e::Required, "Value Added Network Trace Number", b::MaxLength(20)),
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- b::Element(e::NotUsed, "Description"),
241
- b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
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- b::Segment(1800, s::REF, "Medical Record Number",
243
- r::Situational, d::RepeatCount.bounded(1),
244
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("EA")),
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- b::Element(e::Required, "Medical Record Number"),
246
- b::Element(e::NotUsed, "Description"),
247
- 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),
250
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("P4")),
251
- b::Element(e::Required, "Demonstration Project Number"),
252
- b::Element(e::NotUsed, "Description"),
253
- b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
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- b::Segment(1800, s::REF, "Care Plan Oversight",
255
- r::Situational, d::RepeatCount.bounded(1),
256
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("1J")),
257
- b::Element(e::Required, "Care Plan Oversight Number"),
258
- b::Element(e::NotUsed, "Description"),
259
- b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
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- b::Segment(1850, s::K3, "File Information",
261
- r::Situational, d::RepeatCount.bounded(10),
262
- b::Element(e::Required, "Fixed Format Information"),
263
- b::Element(e::NotUsed, "Record Format Code"),
264
- b::Element(e::NotUsed, "COMPOSITE UNIT OF MEASURE")),
265
- b::Segment(1900, s::NTE, "Claim Note",
266
- r::Situational, d::RepeatCount.bounded(1),
267
- b::Element(e::Required, "Note Reference Code", b::Values("ADD", "CER", "DCP", "DGN", "TPO")),
268
- b::Element(e::Required, "Claim Note Text")),
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- b::Segment(1950, s::CR1, "Ambulance Transportation Information",
270
- r::Situational, d::RepeatCount.bounded(1),
271
- b::Element(e::Situational, "Unit or Basis of Measure", b::Values("LB")),
272
- b::Element(e::Situational, "Patient Weight"),
273
- b::Element(e::NotUsed, "Ambulance Transport Code"),
274
- b::Element(e::Required, "Ambulance Transport Reason Code", b::Values("A", "B", "C", "D", "E")),
275
- b::Element(e::Required, "Unit or Basis for Measurement Code", b::Values("DH")),
276
- b::Element(e::Required, "Transport Distance"),
277
- b::Element(e::NotUsed, "Address Information"),
278
- b::Element(e::NotUsed, "Address Information"),
279
- b::Element(e::Situational, "Round Trip Purpose Description"),
280
- b::Element(e::Situational, "Stretcher Purpose Description")),
281
- b::Segment(2000, s::CR2, "Spinal Manipulation Service Information",
282
- r::Situational, d::RepeatCount.bounded(1),
283
- b::Element(e::NotUsed, "Count"),
284
- b::Element(e::NotUsed, "Quantity"),
285
- b::Element(e::NotUsed, "Sublaxation Level Code"),
286
- b::Element(e::NotUsed, "Sublaxation Level Code"),
287
- b::Element(e::NotUsed, "Unit or Basis for Measurement Code"),
288
- b::Element(e::NotUsed, "Quantity"),
289
- b::Element(e::NotUsed, "Quantity"),
290
- b::Element(e::Required, "Nature of Condition Code", b::Values("A", "C", "D", "E", "F", "G", "M")),
291
- b::Element(e::NotUsed, "Yes/No Condition or Response Code"),
292
- b::Element(e::Situational, "Patient Condition Description"),
293
- b::Element(e::Situational, "Patient Condition Description"),
294
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
295
- b::Segment(2200, s::CRC, "Ambulance Certification",
296
- r::Situational, d::RepeatCount.bounded(3),
297
- b::Element(e::Required, "Code Category", b::Values("07")),
298
- b::Element(e::Required, "Certification Condition Indicator", b::Values("Y", "N")),
299
- b::Element(e::Required, "Condition Code", b::Values("01", "04", "05", "06", "07", "08", "09", "12")),
300
- b::Element(e::Situational, "Condition Code", b::Values("01", "04", "05", "06", "07", "08", "09", "12")),
301
- b::Element(e::Situational, "Condition Code", b::Values("01", "04", "05", "06", "07", "08", "09", "12")),
302
- b::Element(e::Situational, "Condition Code", b::Values("01", "04", "05", "06", "07", "08", "09", "12")),
303
- b::Element(e::Situational, "Condition Code", b::Values("01", "04", "05", "06", "07", "08", "09", "12"))),
304
- b::Segment(2200, s::CRC, "Patient Condition Information: Vision",
305
- r::Situational, d::RepeatCount.bounded(3),
306
- b::Element(e::Required, "Code Category", b::Values("E1", "E2", "E3")),
307
- b::Element(e::Required, "Certification Condition Indicator", b::Values("Y", "N")),
308
- b::Element(e::Required, "Condition Code", b::Values("L1", "L2", "L3", "L4", "L5")),
309
- b::Element(e::Situational, "Condition Code", b::Values("L1", "L2", "L3", "L4", "L5")),
310
- b::Element(e::Situational, "Condition Code", b::Values("L1", "L2", "L3", "L4", "L5")),
311
- b::Element(e::Situational, "Condition Code", b::Values("L1", "L2", "L3", "L4", "L5")),
312
- b::Element(e::Situational, "Condition Code", b::Values("L1", "L2", "L3", "L4", "L5"))),
313
- b::Segment(2200, s::CRC, "Homebound Indicator",
314
- r::Situational, d::RepeatCount.bounded(1),
315
- b::Element(e::Required, "Code Category", b::Values("E1", "E2", "E3")),
316
- b::Element(e::Required, "Certification Condition Indicator", b::Values("Y")),
317
- b::Element(e::Required, "Condition Code", b::Values("IH")),
318
- b::Element(e::NotUsed, "Condition Indicator"),
319
- b::Element(e::Situational, "Condition Indicator"),
320
- b::Element(e::Situational, "Condition Indicator"),
321
- b::Element(e::Situational, "Condition Indicator")),
322
- b::Segment(2200, s::CRC, "EPSDT Referral",
323
- r::Situational, d::RepeatCount.bounded(1),
324
- b::Element(e::Required, "Code Category", b::Values("ZZ")),
325
- b::Element(e::Required, "Certification Condition Indicator", b::Values("Y", "N")),
326
- b::Element(e::Required, "Condition Code", b::Values("AV", "NU", "S2", "ST")),
327
- b::Element(e::Situational, "Condition Code", b::Values("AV", "NU", "S2", "ST")),
328
- b::Element(e::Situational, "Condition Code", b::Values("AV", "NU", "S2", "ST")),
329
- b::Element(e::NotUsed, "Condition Indicator"),
330
- b::Element(e::NotUsed, "Condition Indicator")),
331
- b::Segment(2310, s::HI, "Health Care Diagnosis Code",
332
- r::Required, d::RepeatCount.bounded(1),
333
- b::Element(e::Required, "HEALTH CARE CODE INFORMATION",
334
- b::Element(e::Required, "Code List Qualifier", b::Values("ABK", "BK")),
335
- b::Element(e::Required, "Diagnosis Code"),
336
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
337
- b::Element(e::NotUsed, "Date Time Period"),
338
- b::Element(e::NotUsed, "Monetary Amount"),
339
- b::Element(e::NotUsed, "Quantity"),
340
- b::Element(e::NotUsed, "Version Identifier"),
341
- b::Element(e::NotUsed, "Industry Code"),
342
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
343
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
344
- b::Element(e::Required, "Code List Qualifier", b::Values("ABF", "BF")),
345
- b::Element(e::Required, "Diagnosis Code"),
346
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
347
- b::Element(e::NotUsed, "Date Time Period"),
348
- b::Element(e::NotUsed, "Monetary Amount"),
349
- b::Element(e::NotUsed, "Quantity"),
350
- b::Element(e::NotUsed, "Version Identifier"),
351
- b::Element(e::NotUsed, "Industry Code"),
352
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
353
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
354
- b::Element(e::Required, "Code List Qualifier", b::Values("ABF", "BF")),
355
- b::Element(e::Required, "Diagnosis Code"),
356
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
357
- b::Element(e::NotUsed, "Date Time Period"),
358
- b::Element(e::NotUsed, "Monetary Amount"),
359
- b::Element(e::NotUsed, "Quantity"),
360
- b::Element(e::NotUsed, "Version Identifier"),
361
- b::Element(e::NotUsed, "Industry Code"),
362
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
363
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
364
- b::Element(e::Required, "Code List Qualifier", b::Values("ABF", "BF")),
365
- b::Element(e::Required, "Diagnosis Code"),
366
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
367
- b::Element(e::NotUsed, "Date Time Period"),
368
- b::Element(e::NotUsed, "Monetary Amount"),
369
- b::Element(e::NotUsed, "Quantity"),
370
- b::Element(e::NotUsed, "Version Identifier"),
371
- b::Element(e::NotUsed, "Industry Code"),
372
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
373
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
374
- b::Element(e::Required, "Code List Qualifier", b::Values("ABF", "BF")),
375
- b::Element(e::Required, "Diagnosis Code"),
376
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
377
- b::Element(e::NotUsed, "Date Time Period"),
378
- b::Element(e::NotUsed, "Monetary Amount"),
379
- b::Element(e::NotUsed, "Quantity"),
380
- b::Element(e::NotUsed, "Version Identifier"),
381
- b::Element(e::NotUsed, "Industry Code"),
382
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
383
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
384
- b::Element(e::Required, "Code List Qualifier", b::Values("ABF", "BF")),
385
- b::Element(e::Required, "Diagnosis Code"),
386
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
387
- b::Element(e::NotUsed, "Date Time Period"),
388
- b::Element(e::NotUsed, "Monetary Amount"),
389
- b::Element(e::NotUsed, "Quantity"),
390
- b::Element(e::NotUsed, "Version Identifier"),
391
- b::Element(e::NotUsed, "Industry Code"),
392
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
393
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
394
- b::Element(e::Required, "Code List Qualifier", b::Values("ABF", "BF")),
395
- b::Element(e::Required, "Diagnosis Code"),
396
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
397
- b::Element(e::NotUsed, "Date Time Period"),
398
- b::Element(e::NotUsed, "Monetary Amount"),
399
- b::Element(e::NotUsed, "Quantity"),
400
- b::Element(e::NotUsed, "Version Identifier"),
401
- b::Element(e::NotUsed, "Industry Code"),
402
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
403
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
404
- b::Element(e::Required, "Code List Qualifier", b::Values("ABF", "BF")),
405
- b::Element(e::Required, "Diagnosis Code"),
406
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
407
- b::Element(e::NotUsed, "Date Time Period"),
408
- b::Element(e::NotUsed, "Monetary Amount"),
409
- b::Element(e::NotUsed, "Quantity"),
410
- b::Element(e::NotUsed, "Version Identifier"),
411
- b::Element(e::NotUsed, "Industry Code"),
412
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
413
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
414
- b::Element(e::Required, "Code List Qualifier", b::Values("ABF", "BF")),
415
- b::Element(e::Required, "Diagnosis Code"),
416
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
417
- b::Element(e::NotUsed, "Date Time Period"),
418
- b::Element(e::NotUsed, "Monetary Amount"),
419
- b::Element(e::NotUsed, "Quantity"),
420
- b::Element(e::NotUsed, "Version Identifier"),
421
- b::Element(e::NotUsed, "Industry Code"),
422
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
423
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
424
- b::Element(e::Required, "Code List Qualifier", b::Values("ABF", "BF")),
425
- b::Element(e::Required, "Diagnosis Code"),
426
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
427
- b::Element(e::NotUsed, "Date Time Period"),
428
- b::Element(e::NotUsed, "Monetary Amount"),
429
- b::Element(e::NotUsed, "Quantity"),
430
- b::Element(e::NotUsed, "Version Identifier"),
431
- b::Element(e::NotUsed, "Industry Code"),
432
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
433
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
434
- b::Element(e::Required, "Code List Qualifier", b::Values("ABF", "BF")),
435
- b::Element(e::Required, "Diagnosis Code"),
436
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
437
- b::Element(e::NotUsed, "Date Time Period"),
438
- b::Element(e::NotUsed, "Monetary Amount"),
439
- b::Element(e::NotUsed, "Quantity"),
440
- b::Element(e::NotUsed, "Version Identifier"),
441
- b::Element(e::NotUsed, "Industry Code"),
442
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
443
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
444
- b::Element(e::Required, "Code List Qualifier", b::Values("ABF", "BF")),
445
- b::Element(e::Required, "Diagnosis Code"),
446
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
447
- b::Element(e::NotUsed, "Date Time Period"),
448
- b::Element(e::NotUsed, "Monetary Amount"),
449
- b::Element(e::NotUsed, "Quantity"),
450
- b::Element(e::NotUsed, "Version Identifier"),
451
- b::Element(e::NotUsed, "Industry Code"),
452
- b::Element(e::NotUsed, "Yes/No Condition or Response Code"))),
453
- b::Segment(2310, s::HI, "Anesthesia Related Procedure",
454
- r::Situational, d::RepeatCount.bounded(1),
455
- b::Element(e::Required, "HEALTH CARE CODE INFORMATION",
456
- b::Element(e::Required, "Code List Qualifier", b::Values("BP")),
457
- b::Element(e::Required, "Diagnosis Code"),
458
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
459
- b::Element(e::NotUsed, "Date Time Period"),
460
- b::Element(e::NotUsed, "Monetary Amount"),
461
- b::Element(e::NotUsed, "Quantity"),
462
- b::Element(e::NotUsed, "Version Identifier"),
463
- b::Element(e::NotUsed, "Industry Code"),
464
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
465
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
466
- b::Element(e::Required, "Code List Qualifier", b::Values("BO")),
467
- b::Element(e::Required, "Diagnosis Code"),
468
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
469
- b::Element(e::NotUsed, "Date Time Period"),
470
- b::Element(e::NotUsed, "Monetary Amount"),
471
- b::Element(e::NotUsed, "Quantity"),
472
- b::Element(e::NotUsed, "Version Identifier"),
473
- b::Element(e::NotUsed, "Industry Code"),
474
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
475
- b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
476
- b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
477
- b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
478
- b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
479
- b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
480
- b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
481
- b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
482
- b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
483
- b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
484
- b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION")),
485
- b::Segment(2310, s::HI, "Condition Information",
486
- r::Situational, d::RepeatCount.bounded(1),
487
- b::Element(e::Required, "HEALTH CARE CODE INFORMATION",
488
- b::Element(e::Required, "Code List Qualifier", b::Values("BG")),
489
- b::Element(e::Required, "Diagnosis Code"),
490
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
491
- b::Element(e::NotUsed, "Date Time Period"),
492
- b::Element(e::NotUsed, "Monetary Amount"),
493
- b::Element(e::NotUsed, "Quantity"),
494
- b::Element(e::NotUsed, "Version Identifier"),
495
- b::Element(e::NotUsed, "Industry Code"),
496
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
497
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
498
- b::Element(e::Required, "Code List Qualifier", b::Values("BG")),
499
- b::Element(e::Required, "Diagnosis Code"),
500
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
501
- b::Element(e::NotUsed, "Date Time Period"),
502
- b::Element(e::NotUsed, "Monetary Amount"),
503
- b::Element(e::NotUsed, "Quantity"),
504
- b::Element(e::NotUsed, "Version Identifier"),
505
- b::Element(e::NotUsed, "Industry Code"),
506
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
507
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
508
- b::Element(e::Required, "Code List Qualifier", b::Values("BG")),
509
- b::Element(e::Required, "Diagnosis Code"),
510
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
511
- b::Element(e::NotUsed, "Date Time Period"),
512
- b::Element(e::NotUsed, "Monetary Amount"),
513
- b::Element(e::NotUsed, "Quantity"),
514
- b::Element(e::NotUsed, "Version Identifier"),
515
- b::Element(e::NotUsed, "Industry Code"),
516
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
517
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
518
- b::Element(e::Required, "Code List Qualifier", b::Values("BG")),
519
- b::Element(e::Required, "Diagnosis Code"),
520
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
521
- b::Element(e::NotUsed, "Date Time Period"),
522
- b::Element(e::NotUsed, "Monetary Amount"),
523
- b::Element(e::NotUsed, "Quantity"),
524
- b::Element(e::NotUsed, "Version Identifier"),
525
- b::Element(e::NotUsed, "Industry Code"),
526
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
527
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
528
- b::Element(e::Required, "Code List Qualifier", b::Values("BG")),
529
- b::Element(e::Required, "Diagnosis Code"),
530
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
531
- b::Element(e::NotUsed, "Date Time Period"),
532
- b::Element(e::NotUsed, "Monetary Amount"),
533
- b::Element(e::NotUsed, "Quantity"),
534
- b::Element(e::NotUsed, "Version Identifier"),
535
- b::Element(e::NotUsed, "Industry Code"),
536
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
537
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
538
- b::Element(e::Required, "Code List Qualifier", b::Values("BG")),
539
- b::Element(e::Required, "Diagnosis Code"),
540
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
541
- b::Element(e::NotUsed, "Date Time Period"),
542
- b::Element(e::NotUsed, "Monetary Amount"),
543
- b::Element(e::NotUsed, "Quantity"),
544
- b::Element(e::NotUsed, "Version Identifier"),
545
- b::Element(e::NotUsed, "Industry Code"),
546
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
547
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
548
- b::Element(e::Required, "Code List Qualifier", b::Values("BG")),
549
- b::Element(e::Required, "Diagnosis Code"),
550
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
551
- b::Element(e::NotUsed, "Date Time Period"),
552
- b::Element(e::NotUsed, "Monetary Amount"),
553
- b::Element(e::NotUsed, "Quantity"),
554
- b::Element(e::NotUsed, "Version Identifier"),
555
- b::Element(e::NotUsed, "Industry Code"),
556
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
557
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
558
- b::Element(e::Required, "Code List Qualifier", b::Values("BG")),
559
- b::Element(e::Required, "Diagnosis Code"),
560
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
561
- b::Element(e::NotUsed, "Date Time Period"),
562
- b::Element(e::NotUsed, "Monetary Amount"),
563
- b::Element(e::NotUsed, "Quantity"),
564
- b::Element(e::NotUsed, "Version Identifier"),
565
- b::Element(e::NotUsed, "Industry Code"),
566
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
567
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
568
- b::Element(e::Required, "Code List Qualifier", b::Values("BG")),
569
- b::Element(e::Required, "Diagnosis Code"),
570
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
571
- b::Element(e::NotUsed, "Date Time Period"),
572
- b::Element(e::NotUsed, "Monetary Amount"),
573
- b::Element(e::NotUsed, "Quantity"),
574
- b::Element(e::NotUsed, "Version Identifier"),
575
- b::Element(e::NotUsed, "Industry Code"),
576
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
577
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
578
- b::Element(e::Required, "Code List Qualifier", b::Values("BG")),
579
- b::Element(e::Required, "Diagnosis Code"),
580
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
581
- b::Element(e::NotUsed, "Date Time Period"),
582
- b::Element(e::NotUsed, "Monetary Amount"),
583
- b::Element(e::NotUsed, "Quantity"),
584
- b::Element(e::NotUsed, "Version Identifier"),
585
- b::Element(e::NotUsed, "Industry Code"),
586
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
587
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
588
- b::Element(e::Required, "Code List Qualifier", b::Values("BG")),
589
- b::Element(e::Required, "Diagnosis Code"),
590
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
591
- b::Element(e::NotUsed, "Date Time Period"),
592
- b::Element(e::NotUsed, "Monetary Amount"),
593
- b::Element(e::NotUsed, "Quantity"),
594
- b::Element(e::NotUsed, "Version Identifier"),
595
- b::Element(e::NotUsed, "Industry Code"),
596
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
597
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
598
- b::Element(e::Required, "Code List Qualifier", b::Values("BG")),
599
- b::Element(e::Required, "Diagnosis Code"),
600
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
601
- b::Element(e::NotUsed, "Date Time Period"),
602
- b::Element(e::NotUsed, "Monetary Amount"),
603
- b::Element(e::NotUsed, "Quantity"),
604
- b::Element(e::NotUsed, "Version Identifier"),
605
- b::Element(e::NotUsed, "Industry Code"),
606
- b::Element(e::NotUsed, "Yes/No Condition or Response Code"))),
607
- b::Segment(2410, s::HCP, "Claim Pricing/Repricing Information",
608
- r::Situational, d::RepeatCount.bounded(1),
609
- b::Element(e::Required, "Pricing Methodology", b::Values("00", "01", "02", "03", "04", "05", "07", "08", "09", "10", "11", "12", "13", "14")),
610
- b::Element(e::Required, "Repriced Allowed Amount"),
611
- b::Element(e::Situational, "Repriced Saving Amount"),
612
- b::Element(e::Situational, "Repricing Organization Identifier"),
613
- b::Element(e::Situational, "Repricing Per Diem or Flat Rate Amount"),
614
- b::Element(e::Situational, "Repriced Approved Ambulatory Patient Group Code"),
615
- b::Element(e::Situational, "Repriced Approved Ambulatory Patient Group Amount"),
616
- b::Element(e::NotUsed, "Product/Service ID"),
617
- b::Element(e::NotUsed, "Product/Service Qualifier"),
618
- b::Element(e::NotUsed, "Product/Service ID"),
619
- b::Element(e::NotUsed, "Unit or Basis of Measurement Code"),
620
- b::Element(e::NotUsed, "Quantity"),
621
- b::Element(e::Situational, "Reject Reason Code", b::Values("T1", "T2", "T3", "T4", "T5", "T6")),
622
- b::Element(e::Situational, "Policy Compliance Code", b::Values("1", "2", "3", "4", "5")),
623
- b::Element(e::Situational, "Exception Code", b::Values("1", "2", "3", "4", "5", "6"))),
624
-
625
- d::LoopDef.build("2310A REFERRING PROVIDER NAME",
626
- d::RepeatCount.bounded(2),
627
- b::Segment(2500, s::NM1, "Referring Provider Name",
628
- r::Situational, d::RepeatCount.bounded(1),
629
- b::Element(e::Required, "Entity Identifier Code", b::Values("DN", "P3")),
630
- b::Element(e::Required, "Entity Type Qualifier", b::Values("1")),
631
- b::Element(e::Required, "Referring Provider Last Name"),
632
- b::Element(e::Situational, "Referring Provider First Name"),
633
- b::Element(e::Situational, "Referring Provider Middle Name or Initial"),
634
- b::Element(e::NotUsed, "Name Prefix"),
635
- b::Element(e::Situational, "Referring Provider Name Suffix"),
636
- b::Element(e::Situational, "Identification Code Qualifier", b::Values("XX")),
637
- b::Element(e::Situational, "Referring Provider Identifier"),
638
- b::Element(e::NotUsed, "Entity Relationship Code"),
639
- b::Element(e::NotUsed, "Entity Identifier Code"),
640
- b::Element(e::NotUsed, "Name Last or Organization Name")),
641
- b::Segment(2710, s::REF, "Referring Provider Specialty Information",
642
- r::Situational, d::RepeatCount.bounded(3),
643
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("0B", "1G", "G2")),
644
- b::Element(e::Required, "Referring Provider Secondary Identifier"),
645
- b::Element(e::NotUsed, "Description"),
646
- b::Element(e::NotUsed, "REFERENCE IDENTIFIER"))),
647
-
648
- d::LoopDef.build("2310B RENDERING PROVIDER NAME",
649
- d::RepeatCount.bounded(1),
650
- b::Segment(2500, s::NM1, "Rendering Provider Name",
651
- r::Situational, d::RepeatCount.bounded(1),
652
- b::Element(e::Required, "Entity Identifier Code", b::Values("82")),
653
- b::Element(e::Required, "Entity Type Qualifier", b::Values("1", "2")),
654
- b::Element(e::Required, "Rendering Provider Last Name"),
655
- b::Element(e::Situational, "Rendering Provider First Name"),
656
- b::Element(e::Situational, "Rendering Provider Middle Name or Initial"),
657
- b::Element(e::NotUsed, "Name Prefix"),
658
- b::Element(e::Situational, "Rendering Provider Name Suffix"),
659
- b::Element(e::Situational, "Identification Code Qualifier", b::Values("XX")),
660
- b::Element(e::Situational, "Rendering Provider Identifier"),
661
- b::Element(e::NotUsed, "Entity Relationship Code"),
662
- b::Element(e::NotUsed, "Entity Identifier Code"),
663
- b::Element(e::NotUsed, "Name Last or Organization Name")),
664
- b::Segment(2550, s::PRV, "Rendering Provider Specialty Information",
665
- r::Situational, d::RepeatCount.bounded(1),
666
- b::Element(e::Required, "Provider Code", b::Values("PE")),
667
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("PXC")),
668
- b::Element(e::Required, "Provider Taxonomy Code"),
669
- b::Element(e::NotUsed, "State or Province Code"),
670
- b::Element(e::NotUsed, "PROVIDER SPECIALTY INFORMATION"),
671
- b::Element(e::NotUsed, "Provider Organization Code")),
672
- b::Segment(2710, s::REF, "Rendering Provider Secondary Identification",
673
- r::Situational, d::RepeatCount.bounded(4),
674
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("0B", "1G", "G2", "LU")),
675
- b::Element(e::Required, "Reference Identification"),
676
- b::Element(e::NotUsed, "Description"),
677
- b::Element(e::NotUsed, "REFERENCE IDENTIFIER"))),
678
-
679
- d::LoopDef.build("2310C SERVICE FACILITY LOCATION NAME",
680
- d::RepeatCount.bounded(1),
681
- b::Segment(2500, s::NM1, "Service Facility Location Name",
682
- r::Situational, d::RepeatCount.bounded(1),
683
- b::Element(e::Required, "Entity Identifier Code", b::Values("77")),
684
- b::Element(e::Required, "Entity Type Qualifier", b::Values("2")),
685
- b::Element(e::Required, "Name Last or Organization Name"),
686
- b::Element(e::Situational, "Name First"),
687
- b::Element(e::Situational, "Name Middle"),
688
- b::Element(e::NotUsed, "Name Prefix"),
689
- b::Element(e::Situational, "Name Suffix"),
690
- b::Element(e::Situational, "Identification Code Qualifier", b::Values("XX")),
691
- b::Element(e::Situational, "Laboratory or Facility Primary Identifier"),
692
- b::Element(e::NotUsed, "Entity Relationship Code"),
693
- b::Element(e::NotUsed, "Entity Identifier Code"),
694
- b::Element(e::NotUsed, "Name Last or Organization Name")),
695
- b::Segment(2650, s::N3, "Service Facility Location Address",
696
- r::Required, d::RepeatCount.bounded(2),
697
- b::Element(e::Required, "Laboratory or Facility Address Line"),
698
- b::Element(e::Situational, "Laboratory or Facility Address Line")),
699
- b::Segment(2700, s::N4, "Service Facility Location City, State, ZIP Code",
700
- r::Required, d::RepeatCount.bounded(1),
701
- b::Element(e::Required, "Laboratory or Facility City Name"),
702
- b::Element(e::Situational, "Laboratory or Facility Province Code"),
703
- b::Element(e::Situational, "Laboratory or Facility Postal Zone or ZIP Code"),
704
- b::Element(e::Situational, "Country Code"),
705
- b::Element(e::NotUsed, "Location Qualifier"),
706
- b::Element(e::NotUsed, "Location Identifier"),
707
- b::Element(e::Situational, "Country Subdivision Code")),
708
- b::Segment(2710, s::REF, "Service Facility Location Secondary Identification",
709
- r::Situational, d::RepeatCount.bounded(3),
710
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("0B", "G2", "LU")),
711
- b::Element(e::Required, "Laboratory or Facility Secondary Identifier"),
712
- b::Element(e::NotUsed, "Description"),
713
- b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
714
- b::Segment(2750, s::PER, "Service Facility Contact Information",
715
- r::Situational, d::RepeatCount.bounded(1),
716
- b::Element(e::Required, "Contact Function Code", b::Values("IC")),
717
- b::Element(e::Situational, "Name"),
718
- b::Element(e::Required, "Communication Number Qualifier", b::Values("TE")),
719
- b::Element(e::Required, "Communication Number"),
720
- b::Element(e::Situational, "Communication Number Qualifier", b::Values("EX")),
721
- b::Element(e::Situational, "Communication Number"),
722
- b::Element(e::NotUsed, "Communication Number Qualifier"),
723
- b::Element(e::NotUsed, "Communication Number"),
724
- b::Element(e::NotUsed, "Contact Inquiry Reference"))),
725
-
726
- d::LoopDef.build("2310D SUPERVISING PROVIDER NAME",
727
- d::RepeatCount.bounded(1),
728
- b::Segment(2500, s::NM1, "Supervising Provider Name",
729
- r::Situational, d::RepeatCount.bounded(1),
730
- b::Element(e::Required, "Entity Identifier Code", b::Values("DQ")),
731
- b::Element(e::Required, "Entity Type Qualifier", b::Values("1")),
732
- b::Element(e::Required, "Supervising Provider Last Name"),
733
- b::Element(e::Situational, "Supervising Provider First Name"),
734
- b::Element(e::Situational, "Supervising Provider Middle Name or Initial"),
735
- b::Element(e::NotUsed, "Name Prefix"),
736
- b::Element(e::Situational, "Supervising Provider Name Suffix"),
737
- b::Element(e::Situational, "Identification Code Qualifier", b::Values("XX")),
738
- b::Element(e::Situational, "Supervising Provider Identifier"),
739
- b::Element(e::NotUsed, "Entity Relationship Code"),
740
- b::Element(e::NotUsed, "Entity Identifier Code"),
741
- b::Element(e::NotUsed, "Name Last or Organization Name")),
742
- b::Segment(2710, s::REF, "Supervising Provider Secondary Identification",
743
- r::Situational, d::RepeatCount.bounded(4),
744
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("0B", "1G", "G2", "LU")),
745
- b::Element(e::Required, "Supervising Provider Secondary Identifier"),
746
- b::Element(e::NotUsed, "Description"),
747
- b::Element(e::NotUsed, "REFERENCE IDENTIFIER"))),
748
-
749
- d::LoopDef.build("2310E AMBULANCE PICK-UP LOCATION",
750
- d::RepeatCount.bounded(1),
751
- b::Segment(2500, s::NM1, "Ambulance Pick-up Location",
752
- r::Situational, d::RepeatCount.bounded(1),
753
- b::Element(e::Required, "Entity Identifier Code", b::Values("PW")),
754
- b::Element(e::Required, "Entity Type Qualifier", b::Values("2")),
755
- b::Element(e::NotUsed, "Name Last or Organization Name"),
756
- b::Element(e::NotUsed, "Name First"),
757
- b::Element(e::NotUsed, "Name Middle"),
758
- b::Element(e::NotUsed, "Name Prefix"),
759
- b::Element(e::NotUsed, "Name Suffix"),
760
- b::Element(e::NotUsed, "Identification Code Qualifier"),
761
- b::Element(e::NotUsed, "Identification Code"),
762
- b::Element(e::NotUsed, "Entity Relationship Code"),
763
- b::Element(e::NotUsed, "Entity Identifier Code"),
764
- b::Element(e::NotUsed, "Name Last or Organization Name")),
765
- b::Segment(2650, s::N3, "Ambulance Pick-up Location Address",
766
- r::Situational, d::RepeatCount.bounded(2),
767
- b::Element(e::Required, "Ambulance Pick-up Address Line"),
768
- b::Element(e::Situational, "Ambulance Pick-up Address Line")),
769
- b::Segment(2700, s::N4, "Ambulance Pick-up Location City, State, ZIP Code",
770
- r::Situational, d::RepeatCount.bounded(1),
771
- b::Element(e::Required, "Ambulance Pick-up City Name"),
772
- b::Element(e::Situational, "Ambulance Pick-up State or Province Code"),
773
- b::Element(e::Situational, "Ambulance Pick-up Postal Zone or ZIP Code"),
774
- b::Element(e::Situational, "Country Code"),
775
- b::Element(e::NotUsed, "Location Qualifier"),
776
- b::Element(e::NotUsed, "Location Identifier"),
777
- b::Element(e::Situational, "Country Subdivision Code"))),
778
-
779
- d::LoopDef.build("2310F AMBULANCE DROP-OFF LOCATION",
780
- d::RepeatCount.bounded(1),
781
- b::Segment(2500, s::NM1, "Ambulance Drop-off Location",
782
- r::Situational, d::RepeatCount.bounded(1),
783
- b::Element(e::Required, "Entity Identifier Code", b::Values("45")),
784
- b::Element(e::Required, "Entity Type Qualifier", b::Values("2")),
785
- b::Element(e::Situational, "Ambulance Drop-off Location"),
786
- b::Element(e::NotUsed, "Name First"),
787
- b::Element(e::NotUsed, "Name Middle"),
788
- b::Element(e::NotUsed, "Name Prefix"),
789
- b::Element(e::NotUsed, "Name Suffix"),
790
- b::Element(e::NotUsed, "Identification Code Qualifier", b::Values("XX")),
791
- b::Element(e::NotUsed, "Identification Code"),
792
- b::Element(e::NotUsed, "Entity Relationship Code"),
793
- b::Element(e::NotUsed, "Entity Identifier Code"),
794
- b::Element(e::NotUsed, "Name Last or Organization Name")),
795
- b::Segment(2650, s::N3, "Ambulance Drop-off Location Address",
796
- r::Situational, d::RepeatCount.bounded(1),
797
- b::Element(e::Required, "Ambulance Drop-off Address Line"),
798
- b::Element(e::Situational, "Ambulance Drop-off Address Line")),
799
- b::Segment(2700, s::N4, "Ambulance Drop-off Location City, State, ZIP Code",
800
- r::Situational, d::RepeatCount.bounded(1),
801
- b::Element(e::Required, "Ambulance Drop-off City Name"),
802
- b::Element(e::Situational, "Ambulance Drop-off State or Province Code"),
803
- b::Element(e::Situational, "Ambulance Drop-off Postal Zone or ZIP Code"),
804
- b::Element(e::Situational, "Country Code"),
805
- b::Element(e::NotUsed, "Location Qualifier"),
806
- b::Element(e::NotUsed, "Location Identifier"),
807
- b::Element(e::Situational, "Country Subdivision Code"))),
808
-
809
- d::LoopDef.build("2320 OTHER SUBSCRIBER INFORMATION",
810
- d::RepeatCount.bounded(10),
811
- b::Segment(2900, s::SBR, "Other Subscriber Information",
812
- r::Situational, d::RepeatCount.bounded(1),
813
- b::Element(e::Required, "Payer Responsibility Sequence Number", b::Values("A", "B", "C", "D", "E", "F", "G", "H", "P", "S", "T", "U")),
814
- b::Element(e::Required, "Individual Relationship Code", b::Values("01", "18", "19", "20", "21", "39", "40", "53", "G8")),
815
- b::Element(e::Situational, "Insured Group or Policy Number"),
816
- b::Element(e::Situational, "Other Insured Group Name"),
817
- b::Element(e::Situational, "Insurance Type Code", b::Values("12", "13", "14", "15", "16", "41", "42", "43", "47")),
818
- b::Element(e::NotUsed, "Coordination of Benefits Code"),
819
- b::Element(e::NotUsed, "Yes/No Condition or Response Code"),
820
- b::Element(e::NotUsed, "Employment Status Code"),
821
- 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"))),
822
- b::Segment(2950, s::CAS, "Claim Level Adjustments",
823
- r::Situational, d::RepeatCount.bounded(5),
824
- b::Element(e::Required, "Claim Adjustment Group Code", b::Values("CO", "CR", "OA", "PI", "PR")),
825
- b::Element(e::Required, "Adjustment Reason Code"),
826
- b::Element(e::Required, "Adjustment Amount"),
827
- b::Element(e::Situational, "Adjustment Quantity"),
828
- b::Element(e::Situational, "Adjustment Reason Code"),
829
- b::Element(e::Situational, "Adjustment Amount"),
830
- b::Element(e::Situational, "Adjustment Quantity"),
831
- b::Element(e::Situational, "Adjustment Reason Code"),
832
- b::Element(e::Situational, "Adjustment Amount"),
833
- b::Element(e::Situational, "Adjustment Quantity"),
834
- b::Element(e::Situational, "Adjustment Reason Code"),
835
- b::Element(e::Situational, "Adjustment Amount"),
836
- b::Element(e::Situational, "Adjustment Quantity"),
837
- b::Element(e::Situational, "Adjustment Reason Code"),
838
- b::Element(e::Situational, "Adjustment Amount"),
839
- b::Element(e::Situational, "Adjustment Quantity"),
840
- b::Element(e::Situational, "Adjustment Reason Code"),
841
- b::Element(e::Situational, "Adjustment Amount"),
842
- b::Element(e::Situational, "Adjustment Quantity")),
843
- b::Segment(3000, s::AMT, "Coordination of Benefits (COB) Payer Paid Amount",
844
- r::Situational, d::RepeatCount.bounded(1),
845
- b::Element(e::Required, "Amount Qualifier Code", b::Values("D")),
846
- b::Element(e::Required, "Payer Paid Amount"),
847
- b::Element(e::NotUsed, "Credit/Debit Flag")),
848
- b::Segment(3000, s::AMT, "Coordination of Benefits (COB) Total Non-Covered Amount",
849
- r::Situational, d::RepeatCount.bounded(1),
850
- b::Element(e::Required, "Amount Qualifier Code", b::Values("A8")),
851
- b::Element(e::Required, "Non-Covered Charge Amount"),
852
- b::Element(e::NotUsed, "Credit/Debit Flag")),
853
- b::Segment(3000, s::AMT, "Remaining Patient Liability",
854
- r::Situational, d::RepeatCount.bounded(1),
855
- b::Element(e::Required, "Amount Qualifier Code", b::Values("EAF")),
856
- b::Element(e::Required, "Remaining Patient Liability"),
857
- b::Element(e::NotUsed, "Credit/Debit Flag")),
858
- b::Segment(3100, s::OI, "Other Insurance Coverage Information",
859
- r::Required, d::RepeatCount.bounded(1),
860
- b::Element(e::NotUsed, "Claim Filing Indicator Code"),
861
- b::Element(e::NotUsed, "Claim Submission Reason Code"),
862
- b::Element(e::Required, "Benefits Assignment Certification Indicator", b::Values("N", "W", "Y")),
863
- b::Element(e::Situational, "Patient Signature Source Code", b::Values("P")),
864
- b::Element(e::NotUsed, "Provider Agreement Code"),
865
- b::Element(e::Required, "Release of Information Code", b::Values("I", "Y"))),
866
- b::Segment(3200, s::MOA, "Outpatient Adjudication Information",
867
- r::Situational, d::RepeatCount.bounded(1),
868
- b::Element(e::Situational, "Reimbursement Rate"),
869
- b::Element(e::Situational, "HCPCS Payable Amount"),
870
- b::Element(e::Situational, "Claim Payment Remark Code"),
871
- b::Element(e::Situational, "Claim Payment Remark Code"),
872
- b::Element(e::Situational, "Claim Payment Remark Code"),
873
- b::Element(e::Situational, "Claim Payment Remark Code"),
874
- b::Element(e::Situational, "Claim Payment Remark Code"),
875
- b::Element(e::Situational, "End Stage Renal Disease Payment Amount"),
876
- b::Element(e::Situational, "Non-Payable Professional Component Billed Amount")),
877
-
878
- d::LoopDef.build("2330A OTHER SUBSCRIBER NAME",
879
- d::RepeatCount.bounded(1),
880
- b::Segment(3250, s::NM1, "Other Subscriber Name",
881
- r::Required, d::RepeatCount.bounded(1),
882
- b::Element(e::Required, "Entity Identifier Code", b::Values("IL")),
883
- b::Element(e::Required, "Entity Type Qualifier", b::Values("1", "2")),
884
- b::Element(e::Required, "Other Insured Last Name"),
885
- b::Element(e::Situational, "Other Insured First Name"),
886
- b::Element(e::Situational, "Other Insured Middle Name"),
887
- b::Element(e::NotUsed, "Name Prefix"),
888
- b::Element(e::Situational, "Other Insured Name Suffix"),
889
- b::Element(e::Required, "Identification Code Qualifier", b::Values("II", "MI")),
890
- b::Element(e::Required, "Other Insured Identifier"),
891
- b::Element(e::NotUsed, "Entity Relationship Code"),
892
- b::Element(e::NotUsed, "Entity Identifier Code"),
893
- b::Element(e::NotUsed, "Name Last or Organization Name")),
894
- b::Segment(3320, s::N3, "Other Subscriber Address",
895
- r::Situational, d::RepeatCount.bounded(1),
896
- b::Element(e::Required, "Other Subscriber Address Line"),
897
- b::Element(e::Situational, "Other Subscriber Address Line")),
898
- b::Segment(3400, s::N4, "Other Subscriber City, State, ZIP Code",
899
- r::Required, d::RepeatCount.bounded(1),
900
- b::Element(e::Required, "Other Subscriber City Name"),
901
- b::Element(e::Situational, "Other Subscriber State or Province Code"),
902
- b::Element(e::Situational, "Other Subscriber Postal Zone or ZIP Code"),
903
- b::Element(e::Situational, "Country Code"),
904
- b::Element(e::NotUsed, "Location Qualifier"),
905
- b::Element(e::NotUsed, "Location Identifier"),
906
- b::Element(e::Situational, "Country Subdivision Code")),
907
- b::Segment(3550, s::REF, "Other Subscriber Secondary Identification",
908
- r::Situational, d::RepeatCount.bounded(1),
909
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("SY")),
910
- b::Element(e::Required, "Other Insured Additional Identifier"),
911
- b::Element(e::NotUsed, "Description"),
912
- b::Element(e::NotUsed, "REFERENCE IDENTIFIER"))),
913
-
914
- d::LoopDef.build("2330B OTHER PAYER NAME",
915
- d::RepeatCount.bounded(1),
916
- b::Segment(3250, s::NM1, "Other Payer Name",
917
- r::Required, d::RepeatCount.bounded(1),
918
- b::Element(e::Required, "Entity Identifier Code", b::Values("PR")),
919
- b::Element(e::Required, "Entity Type Qualifier", b::Values("2")),
920
- b::Element(e::Required, "Other Payer Organization Name"),
921
- b::Element(e::NotUsed, "Name First"),
922
- b::Element(e::NotUsed, "Name Middle"),
923
- b::Element(e::NotUsed, "Name Prefix"),
924
- b::Element(e::NotUsed, "Name Suffix"),
925
- b::Element(e::Required, "Identification Code Qualifier", b::Values("PI", "XV")),
926
- b::Element(e::Required, "Other Payer Primary Identifier"),
927
- b::Element(e::NotUsed, "Entity Relationship Code"),
928
- b::Element(e::NotUsed, "Entity Identifier Code"),
929
- b::Element(e::NotUsed, "Name Last or Organization Name")),
930
- b::Segment(3320, s::N3, "Other Payer Address",
931
- r::Situational, d::RepeatCount.bounded(1),
932
- b::Element(e::Required, "Other Payer Address Line"),
933
- b::Element(e::Situational, "Other Payer Address Line")),
934
- b::Segment(3400, s::N4, "Other Payer City, State, ZIP Code",
935
- r::Required, d::RepeatCount.bounded(1),
936
- b::Element(e::Required, "Other Payer City Name"),
937
- b::Element(e::Situational, "Other Payer State or Province Code"),
938
- b::Element(e::Situational, "Other Payer Postal Zone or ZIP Code"),
939
- b::Element(e::Situational, "Country Code"),
940
- b::Element(e::NotUsed, "Location Qualifier"),
941
- b::Element(e::NotUsed, "Location Identifier"),
942
- b::Element(e::Situational, "Country Subdivision Code")),
943
- b::Segment(3500, s::DTP, "Claim Check or Remittance Date",
944
- r::Situational, d::RepeatCount.bounded(1),
945
- b::Element(e::Required, "Date Time Qualifier", b::Values("573")),
946
- b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
947
- b::Element(e::Required, "Adjudication or Payment Date")),
948
- b::Segment(3550, s::REF, "Other Payer Secondary Identifier",
949
- r::Situational, d::RepeatCount.bounded(2),
950
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("2U", "EI", "FY", "NF")),
951
- b::Element(e::Required, "Other Payer Secondary Identifier"),
952
- b::Element(e::NotUsed, "Description"),
953
- b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
954
- b::Segment(3550, s::REF, "Other Payer Prior Authorization Number",
955
- r::Situational, d::RepeatCount.bounded(1),
956
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("G1")),
957
- b::Element(e::Required, "Other Payer Prior Authorization Number"),
958
- b::Element(e::NotUsed, "Description"),
959
- b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
960
- b::Segment(3550, s::REF, "Other Payer Referral Number",
961
- r::Situational, d::RepeatCount.bounded(1),
962
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("9F")),
963
- b::Element(e::Required, "Other Payer Prior Authorization or Referral Number"),
964
- b::Element(e::NotUsed, "Description"),
965
- b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
966
- b::Segment(3550, s::REF, "Other Payer Claim Adjustment Indicator",
967
- r::Situational, d::RepeatCount.bounded(1),
968
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("T4")),
969
- b::Element(e::Required, "Other Payer Claim Adjustment Indicator", b::Values("Y")),
970
- b::Element(e::NotUsed, "Description"),
971
- b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
972
- b::Segment(3550, s::REF, "Other Payer Claim Control Number",
973
- r::Situational, d::RepeatCount.bounded(1),
974
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("F8")),
975
- b::Element(e::Required, "Other Payer's Claim Control Number"),
976
- b::Element(e::NotUsed, "Description"),
977
- b::Element(e::NotUsed, "REFERENCE IDENTIFIER"))),
978
-
979
- d::LoopDef.build("2330C OTHER PAYER REFERRING PROVIDER",
980
- d::RepeatCount.bounded(2),
981
- b::Segment(3250, s::NM1, "Other Payer Referring Provider",
982
- r::Situational, d::RepeatCount.bounded(1),
983
- b::Element(e::Required, "Entity Identifier Code", b::Values("DN", "P3")),
984
- b::Element(e::Required, "Entity Type Qualifier", b::Values("1")),
985
- b::Element(e::NotUsed, "Name Last"),
986
- b::Element(e::NotUsed, "Name First"),
987
- b::Element(e::NotUsed, "Name Middle"),
988
- b::Element(e::NotUsed, "Name Prefix"),
989
- b::Element(e::NotUsed, "Name Suffix"),
990
- b::Element(e::NotUsed, "Identification Code Qualifier"),
991
- b::Element(e::NotUsed, "Identification Code"),
992
- b::Element(e::NotUsed, "Entity Relationship Code"),
993
- b::Element(e::NotUsed, "Entity Identifier Code"),
994
- b::Element(e::NotUsed, "Name Last or Organization Name")),
995
- b::Segment(3550, s::REF, "Other Payer Referring Provider Secondary Identification",
996
- r::Required, d::RepeatCount.bounded(3),
997
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("0B", "1G", "G2")),
998
- b::Element(e::Required, "Other Payer Referring Provider Identifier"),
999
- b::Element(e::NotUsed, "Description"),
1000
- b::Element(e::NotUsed, "REFERENCE IDENTIFIER"))),
1001
-
1002
- d::LoopDef.build("2330D OTHER PAYER RENDERING PROVIDER",
1003
- d::RepeatCount.bounded(1),
1004
- b::Segment(3250, s::NM1, "Other Payer Rendering Provider",
1005
- r::Situational, d::RepeatCount.bounded(1),
1006
- b::Element(e::Required, "Entity Identifier Code", b::Values("82")),
1007
- b::Element(e::Required, "Entity Type Qualifier", b::Values("1", "2")),
1008
- b::Element(e::NotUsed, "Name Last"),
1009
- b::Element(e::NotUsed, "Name First"),
1010
- b::Element(e::NotUsed, "Name Middle"),
1011
- b::Element(e::NotUsed, "Name Prefix"),
1012
- b::Element(e::NotUsed, "Name Suffix"),
1013
- b::Element(e::NotUsed, "Identification Code Qualifier"),
1014
- b::Element(e::NotUsed, "Identification Code"),
1015
- b::Element(e::NotUsed, "Entity Relationship Code"),
1016
- b::Element(e::NotUsed, "Entity Identifier Code"),
1017
- b::Element(e::NotUsed, "Name Last or Organization Name")),
1018
- b::Segment(3550, s::REF, "Other Payer Rendering Provider Secondary Identification",
1019
- r::Required, d::RepeatCount.bounded(3),
1020
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("0B", "1G", "G2", "LU")),
1021
- b::Element(e::Required, "Other Payer Rendering Provider Secondary Identifier"),
1022
- b::Element(e::NotUsed, "Description"),
1023
- b::Element(e::NotUsed, "REFERENCE IDENTIFIER"))),
1024
-
1025
- d::LoopDef.build("2330E OTHER PAYER SERVICE FACILITY LOCATION",
1026
- d::RepeatCount.bounded(1),
1027
- b::Segment(3250, s::NM1, "Other Payer Service Facility Location",
1028
- r::Situational, d::RepeatCount.bounded(1),
1029
- b::Element(e::Required, "Entity Identifier Code", b::Values("77")),
1030
- b::Element(e::Required, "Entity Type Qualifier", b::Values("2")),
1031
- b::Element(e::NotUsed, "Name Last"),
1032
- b::Element(e::NotUsed, "Name First"),
1033
- b::Element(e::NotUsed, "Name Middle"),
1034
- b::Element(e::NotUsed, "Name Prefix"),
1035
- b::Element(e::NotUsed, "Name Suffix"),
1036
- b::Element(e::NotUsed, "Identification Code Qualifier"),
1037
- b::Element(e::NotUsed, "Identification Code"),
1038
- b::Element(e::NotUsed, "Entity Relationship Code"),
1039
- b::Element(e::NotUsed, "Entity Identifier Code"),
1040
- b::Element(e::NotUsed, "Name Last or Organization Name")),
1041
- b::Segment(3550, s::REF, "Other Payer Service Facility Location Secondary Identification",
1042
- r::Required, d::RepeatCount.bounded(3),
1043
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("0B", "G2", "LU")),
1044
- b::Element(e::Required, "Other Payer Service Facility Location Secondary Identifier"),
1045
- b::Element(e::NotUsed, "Description"),
1046
- b::Element(e::NotUsed, "REFERENCE IDENTIFIER"))),
1047
-
1048
- d::LoopDef.build("2330F OTHER PAYER SUPERVISING PROVIDER",
1049
- d::RepeatCount.bounded(1),
1050
- b::Segment(3250, s::NM1, "Other Payer Supervising Provider",
1051
- r::Situational, d::RepeatCount.bounded(1),
1052
- b::Element(e::Required, "Entity Identifier Code", b::Values("DQ")),
1053
- b::Element(e::Required, "Entity Type Qualifier", b::Values("1")),
1054
- b::Element(e::NotUsed, "Name Last"),
1055
- b::Element(e::NotUsed, "Name First"),
1056
- b::Element(e::NotUsed, "Name Middle"),
1057
- b::Element(e::NotUsed, "Name Prefix"),
1058
- b::Element(e::NotUsed, "Name Suffix"),
1059
- b::Element(e::NotUsed, "Identification Code Qualifier"),
1060
- b::Element(e::NotUsed, "Identification Code"),
1061
- b::Element(e::NotUsed, "Entity Relationship Code"),
1062
- b::Element(e::NotUsed, "Entity Identifier Code"),
1063
- b::Element(e::NotUsed, "Name Last or Organization Name")),
1064
- b::Segment(3550, s::REF, "Other Payer Supervising Provider Secondary Identification",
1065
- r::Required, d::RepeatCount.bounded(3),
1066
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("0B", "1G", "G2", "LU")),
1067
- b::Element(e::Required, "Other Payer Supervising Provider Identifier"),
1068
- b::Element(e::NotUsed, "Description"),
1069
- b::Element(e::NotUsed, "REFERENCE IDENTIFIER"))),
1070
-
1071
- d::LoopDef.build("2330G OTHER PAYER BILLING PROVIDER",
1072
- d::RepeatCount.bounded(1),
1073
- b::Segment(3250, s::NM1, "Other Payer Billing Provider",
1074
- r::Situational, d::RepeatCount.bounded(1),
1075
- b::Element(e::Required, "Entity Identifier Code", b::Values("85")),
1076
- b::Element(e::Required, "Entity Type Qualifier", b::Values("1", "2")),
1077
- b::Element(e::NotUsed, "Name L"),
1078
- b::Element(e::NotUsed, "Name F"),
1079
- b::Element(e::NotUsed, "Name M"),
1080
- b::Element(e::NotUsed, "Name P"),
1081
- b::Element(e::NotUsed, "Name S"),
1082
- b::Element(e::NotUsed, "Identification Code Qualifier"),
1083
- b::Element(e::NotUsed, "Identification Code"),
1084
- b::Element(e::NotUsed, "Entity Relationship Code"),
1085
- b::Element(e::NotUsed, "Entity Identifier Code"),
1086
- b::Element(e::NotUsed, "Name Last or Organization Name")),
1087
- b::Segment(3550, s::REF, "Other Payer Billing Provider Secondary Identification",
1088
- r::Required, d::RepeatCount.bounded(2),
1089
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("G2", "LU")),
1090
- b::Element(e::Required, "Other Payer Billing Provider Identifier"),
1091
- b::Element(e::NotUsed, "Description"),
1092
- b::Element(e::NotUsed, "REFERENCE IDENTIFIER")))),
1093
-
1094
- d::LoopDef.build("2400 SERVICE LINE NUMBER",
1095
- d::RepeatCount.bounded(50),
1096
- b::Segment(3650, s::LX, "Service Line Number",
1097
- r::Required, d::RepeatCount.bounded(1),
1098
- b::Element(e::Required, "Assigned Number")),
1099
- b::Segment(3700, s::SV1, "Professional Service",
1100
- r::Required, d::RepeatCount.bounded(1),
1101
- b::Element(e::Required, "COMPOSITE MEDICAL PROCEDURE IDENTIFIER",
1102
- b::Element(e::Required, "Product or Service ID Qualifier", b::Values("ER", "HC", "IV", "WK")),
1103
- b::Element(e::Required, "Procedure Code"),
1104
- b::Element(e::Situational, "Procedure Modifier"),
1105
- b::Element(e::Situational, "Procedure Modifier"),
1106
- b::Element(e::Situational, "Procedure Modifier"),
1107
- b::Element(e::Situational, "Procedure Modifier"),
1108
- b::Element(e::Situational, "Description"),
1109
- b::Element(e::NotUsed, "Product/Service ID")),
1110
- b::Element(e::Required, "Line Item Charge Amount"),
1111
- b::Element(e::Required, "Unit or Basis for Measurement Code", b::Values("MJ", "UN")),
1112
- b::Element(e::Required, "Service Unit Count", b::MaxLength(8), b::MaxPrecision(3)),
1113
- b::Element(e::Situational, "Place of Service Code"),
1114
- b::Element(e::NotUsed, "Service Type Code"),
1115
- b::Element(e::Required, "COMPOSITE DIAGNOSIS CODE POINTER",
1116
- b::Element(e::Required, "Diagnosis Code Pointer"),
1117
- b::Element(e::Situational, "Diagnosis Code Pointer"),
1118
- b::Element(e::Situational, "Diagnosis Code Pointer"),
1119
- b::Element(e::Situational, "Diagnosis Code Pointer")),
1120
- b::Element(e::NotUsed, "Monetary Amount"),
1121
- b::Element(e::Situational, "Emergency Indicator", b::Values("Y")),
1122
- b::Element(e::NotUsed, "Multiple Procedure Code"),
1123
- b::Element(e::Situational, "EPSDT Indicator", b::Values("Y")),
1124
- b::Element(e::Situational, "Family Planning Indicator", b::Values("Y")),
1125
- b::Element(e::NotUsed, "Review Code"),
1126
- b::Element(e::NotUsed, "National or Local Assigned Review Value"),
1127
- b::Element(e::Situational, "Co-Pay Status Code", b::Values("0")),
1128
- b::Element(e::NotUsed, "Health Care Professional Shortage Area Code"),
1129
- b::Element(e::NotUsed, "Reference Identification"),
1130
- b::Element(e::NotUsed, "Postal Code"),
1131
- b::Element(e::NotUsed, "Monetary Amount"),
1132
- b::Element(e::NotUsed, "Level of Care Code"),
1133
- b::Element(e::NotUsed, "Provider Agreement Code")),
1134
- b::Segment(4000, s::SV5, "Durable Medical Equipment Service",
1135
- r::Situational, d::RepeatCount.bounded(1),
1136
- b::Element(e::Required, "COMPOSITE MEDICAL PROCEDURE IDENTIFIER",
1137
- b::Element(e::Required, "Procedure Identifier", b::Values("HC")),
1138
- b::Element(e::Required, "Procedure Code"),
1139
- b::Element(e::NotUsed, "Procedure Modifier"),
1140
- b::Element(e::NotUsed, "Procedure Modifier"),
1141
- b::Element(e::NotUsed, "Procedure Modifier"),
1142
- b::Element(e::NotUsed, "Procedure Modifier"),
1143
- b::Element(e::NotUsed, "Description"),
1144
- b::Element(e::NotUsed, "Product/Service ID")),
1145
- b::Element(e::Required, "Unit or Basis for Measurement Code"),
1146
- b::Element(e::Required, "Length of Medical Necessity"),
1147
- b::Element(e::Required, "DME Rental Price"),
1148
- b::Element(e::Required, "DME Purchase Price"),
1149
- b::Element(e::Required, "Rental Unit Price Indicator", b::Values("1", "4", "6")),
1150
- b::Element(e::NotUsed, "Prognosis Code")),
1151
- b::Segment(4200, s::PWK, "Line Supplemental Information",
1152
- r::Situational, d::RepeatCount.bounded(10),
1153
- b::Element(e::Required, "Attachment Report Type Code", b::Values("03", "04", "05", "06", "07", "08", "09", "10", "11", "13", "15", "21", "A3", "A4", "AM", "AS", "B2", "B4", "BR", "BS", "BT", "CB", "CK", "CT", "D2", "DA", "DA", "DB", "DG", "DJ", "DS", "EB", "HC", "HR", "I5", "IR", "LA", "M1", "MT", "NN", "OB", "OC", "OD", "OE", "OX", "OZ", "P4", "P5", "PE", "PN", "PO", "PQ", "PY", "PZ", "RB", "RR", "RT", "RX", "SG", "V5", "XP")),
1154
- b::Element(e::Required, "Attachment Transmission Code", b::Values("AA", "BM", "EL", "EM", "FT", "FX")),
1155
- b::Element(e::NotUsed, "Report Copies Needed"),
1156
- b::Element(e::NotUsed, "Entity Identifier Code"),
1157
- b::Element(e::Situational, "Identification Code Qualifier", b::Values("AC")),
1158
- b::Element(e::Situational, "Attachment Control Number", b::MaxLength(50)),
1159
- b::Element(e::NotUsed, "Description"),
1160
- b::Element(e::NotUsed, "ACTIONS INDICATED"),
1161
- b::Element(e::NotUsed, "Request Category Code")),
1162
- b::Segment(4200, s::PWK, "Durable Medical Equipment Certification of Medical Necessity Indicator",
1163
- r::Situational, d::RepeatCount.bounded(1),
1164
- b::Element(e::Required, "Attachment Report Type Code", b::Values("CT")),
1165
- b::Element(e::Required, "Attachment Transmission Code", b::Values("AB", "AD", "AF", "AG", "NS")),
1166
- b::Element(e::NotUsed, "Report Copies Needed"),
1167
- b::Element(e::NotUsed, "Entity Identifier Code"),
1168
- b::Element(e::NotUsed, "Identification Code Qualifier"),
1169
- b::Element(e::NotUsed, "Identification Code"),
1170
- b::Element(e::NotUsed, "Description"),
1171
- b::Element(e::NotUsed, "ACTIONS INDICATED"),
1172
- b::Element(e::NotUsed, "Request Category Code")),
1173
- b::Segment(4250, s::CR1, "Ambulance Transport Information",
1174
- r::Situational, d::RepeatCount.bounded(1),
1175
- b::Element(e::Situational, "Unit or Basis for Measurement Code", b::Values("LB")),
1176
- b::Element(e::Situational, "Patient Weight"),
1177
- b::Element(e::NotUsed, "Ambulance Transport Code"),
1178
- b::Element(e::Required, "Ambulance Transport Reason Code", b::Values("A", "B", "C", "D", "E")),
1179
- b::Element(e::Required, "Unit or Basis for Measurement Code", b::Values("DH")),
1180
- b::Element(e::Required, "Transport Distance"),
1181
- b::Element(e::NotUsed, "Address Information"),
1182
- b::Element(e::NotUsed, "Address Information"),
1183
- b::Element(e::Situational, "Round Trip Purpose Description"),
1184
- b::Element(e::Situational, "Stretcher Purpose Description")),
1185
- b::Segment(4350, s::CR3, "Durable Medical Equipment Certification",
1186
- r::Situational, d::RepeatCount.bounded(1),
1187
- b::Element(e::Required, "Certification Type Code", b::Values("I", "R", "S")),
1188
- b::Element(e::Required, "Unit or Basis for Measurement Code", b::Values("MO")),
1189
- b::Element(e::Required, "Durable Medical Equipment Duration"),
1190
- b::Element(e::NotUsed, "Insulin Dependent Code"),
1191
- b::Element(e::NotUsed, "Description")),
1192
- b::Segment(4500, s::CRC, "Ambulance Certification",
1193
- r::Situational, d::RepeatCount.bounded(3),
1194
- b::Element(e::Required, "Code Category", b::Values("07")),
1195
- b::Element(e::Required, "Certification Condition Indicator", b::Values("N", "Y")),
1196
- b::Element(e::Required, "Condition Code", b::Values("01", "04", "05", "06", "07", "08", "09", "12")),
1197
- b::Element(e::Situational, "Condition Code", b::Values("01", "04", "05", "06", "07", "08", "09", "12")),
1198
- b::Element(e::Situational, "Condition Code", b::Values("01", "04", "05", "06", "07", "08", "09", "12")),
1199
- b::Element(e::Situational, "Condition Code", b::Values("01", "04", "05", "06", "07", "08", "09", "12")),
1200
- b::Element(e::Situational, "Condition Code", b::Values("01", "04", "05", "06", "07", "08", "09", "12"))),
1201
- b::Segment(4500, s::CRC, "Hospice Employee Indicator",
1202
- r::Situational, d::RepeatCount.bounded(1),
1203
- b::Element(e::Required, "Code Category", b::Values("70")),
1204
- b::Element(e::Required, "Hospice Employed Provider Indicator", b::Values("N", "Y")),
1205
- b::Element(e::Required, "Condition Indicator", b::Values("65")),
1206
- b::Element(e::NotUsed, "Condition Indicator"),
1207
- b::Element(e::NotUsed, "Condition Indicator"),
1208
- b::Element(e::NotUsed, "Condition Indicator"),
1209
- b::Element(e::NotUsed, "Condition Indicator")),
1210
- b::Segment(4500, s::CRC, "Condition Indicator/Durable Medical Equipment",
1211
- r::Situational, d::RepeatCount.bounded(1),
1212
- b::Element(e::Required, "Code Category", b::Values("09")),
1213
- b::Element(e::Required, "Certification Condition Indicator", b::Values("Y", "N")),
1214
- b::Element(e::Required, "Condition Indicator", b::Values("38", "ZV")),
1215
- b::Element(e::Situational, "Condition Indicator", b::Values("38", "ZV")),
1216
- b::Element(e::NotUsed, "Condition Indicator"),
1217
- b::Element(e::NotUsed, "Condition Indicator"),
1218
- b::Element(e::NotUsed, "Condition Indicator")),
1219
- b::Segment(4550, s::DTP, "Service Date",
1220
- r::Required, d::RepeatCount.bounded(1),
1221
- b::Element(e::Required, "Date Time Qualifier", b::Values("472")),
1222
- b::Element(e::Required, "Date Time Period Qualifier", b::Values("D8", "RD8")),
1223
- b::Element(e::Required, "Service Date")),
1224
- b::Segment(4550, s::DTP, "Prescription Date",
1225
- r::Situational, d::RepeatCount.bounded(1),
1226
- b::Element(e::Required, "Date Time Qualifier", b::Values("471")),
1227
- b::Element(e::Required, "Date Time Period Qualifier", b::Values("D8")),
1228
- b::Element(e::Required, "Prescription Date")),
1229
- b::Segment(4550, s::DTP, "Certification Revision/Recertification Date",
1230
- r::Situational, d::RepeatCount.bounded(1),
1231
- b::Element(e::Required, "Date Time Qualifier", b::Values("607")),
1232
- b::Element(e::Required, "Date Time Period Qualifier", b::Values("D8")),
1233
- b::Element(e::Required, "Certification Revision or Recertification Date")),
1234
- b::Segment(4550, s::DTP, "Begin Therapy Date",
1235
- r::Situational, d::RepeatCount.bounded(1),
1236
- b::Element(e::Required, "Date Time Qualifier", b::Values("463")),
1237
- b::Element(e::Required, "Date Time Period Qualifier", b::Values("D8")),
1238
- b::Element(e::Required, "Begin Therapy Date")),
1239
- b::Segment(4550, s::DTP, "Last Certification Date",
1240
- r::Situational, d::RepeatCount.bounded(1),
1241
- b::Element(e::Required, "Date Time Qualifier", b::Values("461")),
1242
- b::Element(e::Required, "Date Time Period Qualifier", b::Values("D8")),
1243
- b::Element(e::Required, "Last Certification Date")),
1244
- b::Segment(4550, s::DTP, "Last Seen Date",
1245
- r::Situational, d::RepeatCount.bounded(1),
1246
- b::Element(e::Required, "Date Time Qualifier", b::Values("304")),
1247
- b::Element(e::Required, "Date Time Period Qualifier", b::Values("D8")),
1248
- b::Element(e::Required, "Treatment or Therapy Date")),
1249
- b::Segment(4550, s::DTP, "Test Date",
1250
- r::Situational, d::RepeatCount.bounded(2),
1251
- b::Element(e::Required, "Date Time Qualifier", b::Values("738", "739")),
1252
- b::Element(e::Required, "Date Time Period Qualifier", b::Values("D8")),
1253
- b::Element(e::Required, "Test Performed Date")),
1254
- b::Segment(4550, s::DTP, "Shipped Date",
1255
- r::Situational, d::RepeatCount.bounded(1),
1256
- b::Element(e::Required, "Date Time Qualifier", b::Values("011")),
1257
- b::Element(e::Required, "Date Time Period Qualifier", b::Values("D8")),
1258
- b::Element(e::Required, "Shipped Date")),
1259
- b::Segment(4550, s::DTP, "Last X-ray Date",
1260
- r::Situational, d::RepeatCount.bounded(1),
1261
- b::Element(e::Required, "Date Time Qualifier", b::Values("455")),
1262
- b::Element(e::Required, "Date Time Period Qualifier", b::Values("D8")),
1263
- b::Element(e::Required, "Last X-ray Date")),
1264
- b::Segment(4550, s::DTP, "Initial Treatment Date",
1265
- r::Situational, d::RepeatCount.bounded(1),
1266
- b::Element(e::Required, "Date Time Qualifier", b::Values("454")),
1267
- b::Element(e::Required, "Date Time Period Qualifier", b::Values("D8")),
1268
- b::Element(e::Required, "Initial Treatment Date")),
1269
- b::Segment(4600, s::QTY, "Ambulance Patient Count",
1270
- r::Situational, d::RepeatCount.bounded(1),
1271
- b::Element(e::Required, "Quantity Qualifier", b::Values("PT")),
1272
- b::Element(e::Required, "Ambulance Patient Count"),
1273
- b::Element(e::NotUsed, "COMPOSITE UNIT OF MEASURE"),
1274
- b::Element(e::NotUsed, "Free-form Information")),
1275
- b::Segment(4600, s::QTY, "Obstetric Anesthesia Additional Units",
1276
- r::Situational, d::RepeatCount.bounded(1),
1277
- b::Element(e::Required, "Quantity Qualifier", b::Values("FL")),
1278
- b::Element(e::Required, "Obstetric Additional Units"),
1279
- b::Element(e::NotUsed, "COMPOSITE UNIT OF MEASURE"),
1280
- b::Element(e::NotUsed, "Free-form Information")),
1281
- b::Segment(4620, s::MEA, "Test Result",
1282
- r::Situational, d::RepeatCount.bounded(5),
1283
- b::Element(e::Required, "Measurement Reference Identification Code", b::Values("OG", "TR")),
1284
- b::Element(e::Required, "Measurement Qualifier", b::Values("HT", "R1", "R2", "R3", "R4")),
1285
- b::Element(e::Required, "Test Results"),
1286
- b::Element(e::NotUsed, "COMPOSITE UNIT OF MEASURE"),
1287
- b::Element(e::NotUsed, "Range Minimum"),
1288
- b::Element(e::NotUsed, "Range Maximum"),
1289
- b::Element(e::NotUsed, "Measurement Significance Code"),
1290
- b::Element(e::NotUsed, "Measurement Attribute Code"),
1291
- b::Element(e::NotUsed, "Surface/Layer/Position Code"),
1292
- b::Element(e::NotUsed, "Measurement Method or Device"),
1293
- b::Element(e::NotUsed, "Code List Qualifier Code"),
1294
- b::Element(e::NotUsed, "Industry Code")),
1295
- b::Segment(4650, s::CN1, "Contract Information",
1296
- r::Situational, d::RepeatCount.bounded(1),
1297
- b::Element(e::Required, "Contract Type Code", b::Values("01", "02", "03", "04", "05", "06", "09")),
1298
- b::Element(e::Required, "Contract Amount"),
1299
- b::Element(e::Situational, "Contract Percentage"),
1300
- b::Element(e::Situational, "Contract Code"),
1301
- b::Element(e::Situational, "Terms Discount Percentage"),
1302
- b::Element(e::Situational, "Contract Version Identifier")),
1303
- b::Segment(4700, s::REF, "Repriced Line Item Reference Number",
1304
- r::Situational, d::RepeatCount.bounded(1),
1305
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("9B")),
1306
- b::Element(e::Required, "Repriced Line Item Reference Number"),
1307
- b::Element(e::NotUsed, "Description"),
1308
- b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
1309
- b::Segment(4700, s::REF, "Adjusted Repriced Line Item Reference Number",
1310
- r::Situational, d::RepeatCount.bounded(1),
1311
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("9D")),
1312
- b::Element(e::Required, "Adjusted Repriced Line Item Reference Number"),
1313
- b::Element(e::NotUsed, "Description"),
1314
- b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
1315
- b::Segment(4700, s::REF, "Prior Authorization",
1316
- r::Situational, d::RepeatCount.bounded(5),
1317
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("G1")),
1318
- b::Element(e::Required, "Prior Authorization or Referral Number"),
1319
- b::Element(e::NotUsed, "Description"),
1320
- b::Element(e::Situational, "REFERENCE IDENTIFIER",
1321
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("2U")),
1322
- b::Element(e::Required, "Other Payer Primary Identifier"),
1323
- b::Element(e::NotUsed, "Reference Identifier Qualifier"),
1324
- b::Element(e::NotUsed, "Reference Identification"),
1325
- b::Element(e::NotUsed, "Reference Identifier Qualifier"),
1326
- b::Element(e::NotUsed, "Reference Identification"))),
1327
- b::Segment(4700, s::REF, "Line Item Control Number",
1328
- r::Situational, d::RepeatCount.bounded(1),
1329
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("6R")),
1330
- b::Element(e::Required, "Line Item Control Number", b::MaxLength(30)),
1331
- b::Element(e::NotUsed, "Description"),
1332
- b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
1333
- b::Segment(4700, s::REF, "Mammography Certification Number",
1334
- r::Situational, d::RepeatCount.bounded(1),
1335
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("EW")),
1336
- b::Element(e::Required, "Mammography Certification Number"),
1337
- b::Element(e::NotUsed, "Description"),
1338
- b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
1339
- b::Segment(4700, s::REF, "Clinical Laboratory Improvement Amendment (CLIA) Number",
1340
- r::Situational, d::RepeatCount.bounded(1),
1341
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("X4")),
1342
- b::Element(e::Required, "Clinical Laboratory Improvement Amendment Number"),
1343
- b::Element(e::NotUsed, "Description"),
1344
- b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
1345
- b::Segment(4700, s::REF, "Referring Clinical Laboratory Improvement Amendment (CLIA) Number",
1346
- r::Situational, d::RepeatCount.bounded(1),
1347
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("F4")),
1348
- b::Element(e::Required, "Referring CLIA Number"),
1349
- b::Element(e::NotUsed, "Description"),
1350
- b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
1351
- b::Segment(4700, s::REF, "Immunization Batch Number",
1352
- r::Situational, d::RepeatCount.bounded(1),
1353
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("BT")),
1354
- b::Element(e::Required, "Immunization Batch Number"),
1355
- b::Element(e::NotUsed, "Description"),
1356
- b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
1357
- b::Segment(4700, s::REF, "Referral Number",
1358
- r::Situational, d::RepeatCount.bounded(5),
1359
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("9F")),
1360
- b::Element(e::Required, "Referral Number"),
1361
- b::Element(e::NotUsed, "Description"),
1362
- b::Element(e::Situational, "REFERENCE IDENTIFIER",
1363
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("2U")),
1364
- b::Element(e::Required, "Other Payer Primary Identifier"),
1365
- b::Element(e::NotUsed, "Reference Identifier Qualifier"),
1366
- b::Element(e::NotUsed, "Reference Identification"),
1367
- b::Element(e::NotUsed, "Reference Identifier Qualifier"),
1368
- b::Element(e::NotUsed, "Reference Identification"))),
1369
- b::Segment(4750, s::AMT, "Sales Tax Amount",
1370
- r::Situational, d::RepeatCount.bounded(1),
1371
- b::Element(e::Required, "Amount Qualifier Code", b::Values("T")),
1372
- b::Element(e::Required, "Sales Tax Amount"),
1373
- b::Element(e::NotUsed, "Credit/Debit Flag Code")),
1374
- b::Segment(4750, s::AMT, "Postage Claimed Amount",
1375
- r::Situational, d::RepeatCount.bounded(1),
1376
- b::Element(e::Required, "Amount Qualifier Code", b::Values("F4")),
1377
- b::Element(e::Required, "Postage Claimed Amount"),
1378
- b::Element(e::NotUsed, "Credit/Debit Flag Code")),
1379
- b::Segment(4800, s::K3, "File Information",
1380
- r::Situational, d::RepeatCount.bounded(10),
1381
- b::Element(e::Required, "Fixed Format Identification"),
1382
- b::Element(e::NotUsed, "Record Format Code"),
1383
- b::Element(e::NotUsed, "COMPOSITE UNIT OF MEASURE")),
1384
- b::Segment(4850, s::NTE, "Line Note",
1385
- r::Situational, d::RepeatCount.bounded(1),
1386
- b::Element(e::Required, "Note Reference Code", b::Values("ADD", "DCP")),
1387
- b::Element(e::Required, "Line Note Text")),
1388
- b::Segment(4850, s::NTE, "Third Party Organization Notes",
1389
- r::Situational, d::RepeatCount.bounded(1),
1390
- b::Element(e::Required, "Note Reference Code", b::Values("TPO")),
1391
- b::Element(e::Required, "Line Note Text")),
1392
- b::Segment(4880, s::PS1, "Purchased Service Information",
1393
- r::Situational, d::RepeatCount.bounded(1),
1394
- b::Element(e::Required, "Purchased Service Provider Identifier"),
1395
- b::Element(e::Required, "Purchased Service Charge Amount"),
1396
- b::Element(e::NotUsed, "State or Province Code")),
1397
- b::Segment(4920, s::HCP, "Line Pricing/Repricing Information",
1398
- r::Situational, d::RepeatCount.bounded(1),
1399
- b::Element(e::Required, "Pricing Methodology", b::Values("00", "01", "02", "03", "04", "05", "06", "07", "08", "09", "10", "11", "12", "13", "14")),
1400
- b::Element(e::Required, "Repriced Allowed Amount"),
1401
- b::Element(e::Situational, "Repciced Saving Amount"),
1402
- b::Element(e::Situational, "Repricing Organization Identifier"),
1403
- b::Element(e::Situational, "Repricing Per Diem or Flat Rate Amount"),
1404
- b::Element(e::Situational, "Repriced Approved Ambulatory Patient Group Code"),
1405
- b::Element(e::Situational, "Repriced Approved Ambulatory Patient Group Amount"),
1406
- b::Element(e::NotUsed, "Product/Service ID"),
1407
- b::Element(e::Situational, "Product or Service ID", b::Values("ER", "HC", "IV", "WK")),
1408
- b::Element(e::Situational, "Repriced Approved HCPCS Code"),
1409
- b::Element(e::Situational, "Unit or Basis for Measurement Code", b::Values("MJ", "UN")),
1410
- b::Element(e::Situational, "Repriced Approved Service Unit Count", b::MaxLength(8), b::MaxPrecision(3)),
1411
- b::Element(e::Situational, "Reject Reason Code", b::Values("T1", "T2", "T3", "T4", "T5", "T6")),
1412
- b::Element(e::Situational, "Policy Compliance Code", b::Values("1", "2", "3", "4", "5")),
1413
- b::Element(e::Situational, "Exception Code", b::Values("1", "2", "3", "4", "5", "6"))),
1414
-
1415
- d::LoopDef.build("2410 DRUG IDENTIFICATION",
1416
- d::RepeatCount.bounded(1),
1417
- b::Segment(4930, s::LIN, "Drug Identification",
1418
- r::Situational, d::RepeatCount.bounded(1),
1419
- b::Element(e::NotUsed, "Assigned Identification"),
1420
- b::Element(e::Required, "Product or Service ID Qualifier", b::Values("N4")),
1421
- b::Element(e::Required, "National Drug Code"),
1422
- b::Element(e::NotUsed, "Product/Service ID Qualifier"),
1423
- b::Element(e::NotUsed, "Product/Service ID"),
1424
- b::Element(e::NotUsed, "Product/Service ID Qualifier"),
1425
- b::Element(e::NotUsed, "Product/Service ID"),
1426
- b::Element(e::NotUsed, "Product/Service ID Qualifier"),
1427
- b::Element(e::NotUsed, "Product/Service ID"),
1428
- b::Element(e::NotUsed, "Product/Service ID Qualifier"),
1429
- b::Element(e::NotUsed, "Product/Service ID"),
1430
- b::Element(e::NotUsed, "Product/Service ID Qualifier"),
1431
- b::Element(e::NotUsed, "Product/Service ID"),
1432
- b::Element(e::NotUsed, "Product/Service ID Qualifier"),
1433
- b::Element(e::NotUsed, "Product/Service ID"),
1434
- b::Element(e::NotUsed, "Product/Service ID Qualifier"),
1435
- b::Element(e::NotUsed, "Product/Service ID"),
1436
- b::Element(e::NotUsed, "Product/Service ID Qualifier"),
1437
- b::Element(e::NotUsed, "Product/Service ID"),
1438
- b::Element(e::NotUsed, "Product/Service ID Qualifier"),
1439
- b::Element(e::NotUsed, "Product/Service ID"),
1440
- b::Element(e::NotUsed, "Product/Service ID Qualifier"),
1441
- b::Element(e::NotUsed, "Product/Service ID"),
1442
- b::Element(e::NotUsed, "Product/Service ID Qualifier"),
1443
- b::Element(e::NotUsed, "Product/Service ID"),
1444
- b::Element(e::NotUsed, "Product/Service ID Qualifier"),
1445
- b::Element(e::NotUsed, "Product/Service ID"),
1446
- b::Element(e::NotUsed, "Product/Service ID Qualifier"),
1447
- b::Element(e::NotUsed, "Product/Service ID"),
1448
- b::Element(e::NotUsed, "Product/Service ID Qualifier"),
1449
- b::Element(e::NotUsed, "Product/Service ID")),
1450
- b::Segment(4940, s::CTP, "Drug Quantity",
1451
- r::Required, d::RepeatCount.bounded(1),
1452
- b::Element(e::NotUsed, "Class of Trade Code"),
1453
- b::Element(e::NotUsed, "Price Identifier Code"),
1454
- b::Element(e::NotUsed, "Unit Price"),
1455
- b::Element(e::Required, "National Drug Unit Count"),
1456
- b::Element(e::Required, "COMPOSITE UNIT OF MEASURE",
1457
- b::Element(e::Required, "Unit or Basis for Measurement Code", b::Values("F2", "GR", "ME", "ML", "UN")),
1458
- b::Element(e::NotUsed, "Exponent"),
1459
- b::Element(e::NotUsed, "Multiplier"),
1460
- b::Element(e::NotUsed, "Unit or Basis for Measurement Code"),
1461
- b::Element(e::NotUsed, "Exponent"),
1462
- b::Element(e::NotUsed, "Multiplier"),
1463
- b::Element(e::NotUsed, "Unit or Basis for Measurement Code"),
1464
- b::Element(e::NotUsed, "Exponent"),
1465
- b::Element(e::NotUsed, "Multiplier"),
1466
- b::Element(e::NotUsed, "Unit or Basis for Measurement Code"),
1467
- b::Element(e::NotUsed, "Exponent"),
1468
- b::Element(e::NotUsed, "Multiplier"),
1469
- b::Element(e::NotUsed, "Unit or Basis for Measurement Code"),
1470
- b::Element(e::NotUsed, "Exponent"),
1471
- b::Element(e::NotUsed, "Multiplier")),
1472
- b::Element(e::NotUsed, "Price Multiplier Qualifier"),
1473
- b::Element(e::NotUsed, "Multiplier"),
1474
- b::Element(e::NotUsed, "Monetary Amount"),
1475
- b::Element(e::NotUsed, "Basis of Unit Price Code"),
1476
- b::Element(e::NotUsed, "Condition Value"),
1477
- b::Element(e::NotUsed, "Multiple Price Quantity")),
1478
- b::Segment(4950, s::REF, "Rendering Provider Secondary Identification",
1479
- r::Situational, d::RepeatCount.bounded(1),
1480
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("VY", "XZ")),
1481
- b::Element(e::Required, "Prescription Number"),
1482
- b::Element(e::NotUsed, "Description"),
1483
- b::Element(e::NotUsed, "REFERENCE IDENTIFIER"))),
1484
-
1485
- d::LoopDef.build("2420A RENDERING PROVIDER NAME",
1486
- d::RepeatCount.bounded(1),
1487
- b::Segment(5000, s::NM1, "Rendering Provider Name",
1488
- r::Situational, d::RepeatCount.bounded(1),
1489
- b::Element(e::Required, "Entity Identifier Code", b::Values("82")),
1490
- b::Element(e::Required, "Entity Type Qualifier", b::Values("1", "2")),
1491
- b::Element(e::Required, "Rendering Provider Last Name"),
1492
- b::Element(e::Situational, "Rendering Provider First Name"),
1493
- b::Element(e::Situational, "Rendering Provider Middle Name or Initial"),
1494
- b::Element(e::NotUsed, "Name Prefix"),
1495
- b::Element(e::Situational, "Rendering Provider Suffix"),
1496
- b::Element(e::Situational, "Identification Code Qualifier", b::Values("XX")),
1497
- b::Element(e::Situational, "Rendering Provider Identifier"),
1498
- b::Element(e::NotUsed, "Entity Relationship Code"),
1499
- b::Element(e::NotUsed, "Entity Identifier Code"),
1500
- b::Element(e::NotUsed, "Name Last or Organization Name")),
1501
- b::Segment(5050, s::PRV, "Rendering Provider Specialty Information",
1502
- r::Situational, d::RepeatCount.bounded(1),
1503
- b::Element(e::Required, "Provider Code", b::Values("PE")),
1504
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("PXC")),
1505
- b::Element(e::Required, "Provider Taxonmy Code"),
1506
- b::Element(e::NotUsed, "State or Province Code"),
1507
- b::Element(e::NotUsed, "PROVIDER SPECIALTY INFORMATION"),
1508
- b::Element(e::NotUsed, "Provider Organization Code")),
1509
- b::Segment(5250, s::REF, "Rendering Provider Secondary Identification",
1510
- r::Situational, d::RepeatCount.bounded(20),
1511
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("0B", "1G", "G2", "LU")),
1512
- b::Element(e::Required, "Rendering Provider Secondary Identifier"),
1513
- b::Element(e::NotUsed, "Description"),
1514
- b::Element(e::NotUsed, "REFERENCE IDENTIFIER"))),
1515
-
1516
- d::LoopDef.build("2420B PURCHASED SERVICE PROVIDER NAME",
1517
- d::RepeatCount.bounded(1),
1518
- b::Segment(5000, s::NM1, "Purchased Service Provider Name",
1519
- r::Situational, d::RepeatCount.bounded(1),
1520
- b::Element(e::Required, "Entity Identifier Code", b::Values("QB")),
1521
- b::Element(e::Required, "Entity Type Qualifier", b::Values("1", "2")),
1522
- b::Element(e::NotUsed, "Name Last"),
1523
- b::Element(e::NotUsed, "Name First"),
1524
- b::Element(e::NotUsed, "Name Middle"),
1525
- b::Element(e::NotUsed, "Name Prefix"),
1526
- b::Element(e::NotUsed, "Name Suffix"),
1527
- b::Element(e::Situational, "Identification Code Qualifier", b::Values("XX")),
1528
- b::Element(e::Situational, "Purchased Service Provider Identifier"),
1529
- b::Element(e::NotUsed, "Entity Relationship Code"),
1530
- b::Element(e::NotUsed, "Entity Identifier Code"),
1531
- b::Element(e::NotUsed, "Name Last or Organization Name")),
1532
- b::Segment(5250, s::REF, "Purchased Service Provider Secondary Identification",
1533
- r::Situational, d::RepeatCount.bounded(20),
1534
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("0B", "1G", "G2")),
1535
- b::Element(e::Required, "Purchased Service Provider Secondary Identifier"),
1536
- b::Element(e::NotUsed, "Description"),
1537
- b::Element(e::Situational, "REFERENCE IDENTIFIER",
1538
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("2U")),
1539
- b::Element(e::Required, "Other Payer Primary Identifier"),
1540
- b::Element(e::NotUsed, "Reference Identifier Qualifier"),
1541
- b::Element(e::NotUsed, "Reference Identifier"),
1542
- b::Element(e::NotUsed, "Reference Identifier Qualifier"),
1543
- b::Element(e::NotUsed, "Reference Identifier")))),
1544
-
1545
- d::LoopDef.build("2420C SERVICE FACILITY LOCATION NAME",
1546
- d::RepeatCount.bounded(1),
1547
- b::Segment(5000, s::NM1, "Service Facility Location Name",
1548
- r::Situational, d::RepeatCount.bounded(1),
1549
- b::Element(e::Required, "Entity Identifier Code", b::Values("77")),
1550
- b::Element(e::Required, "Entity Type Qualifier", b::Values("2")),
1551
- b::Element(e::Required, "Laboratory or Facility Name"),
1552
- b::Element(e::NotUsed, "Name First"),
1553
- b::Element(e::NotUsed, "Name Middle"),
1554
- b::Element(e::NotUsed, "Name Prefix"),
1555
- b::Element(e::NotUsed, "Name Suffix"),
1556
- b::Element(e::Situational, "Identification Code Qualifier", b::Values("XX")),
1557
- b::Element(e::Situational, "Laboratory or Facility Primary Identifier"),
1558
- b::Element(e::NotUsed, "Entity Relationship Code"),
1559
- b::Element(e::NotUsed, "Entity Identifier Code"),
1560
- b::Element(e::NotUsed, "Name Last or Organization Name")),
1561
- b::Segment(5140, s::N3, "Service Facility Location Address",
1562
- r::Required, d::RepeatCount.bounded(1),
1563
- b::Element(e::Required, "Laboratory or Facility Address Line"),
1564
- b::Element(e::Situational, "Laboratory or Facility Address Line")),
1565
- b::Segment(5200, s::N4, "Service Facility Location City, State, ZIP Code",
1566
- r::Required, d::RepeatCount.bounded(1),
1567
- b::Element(e::Required, "Laboratory or Facility City Name"),
1568
- b::Element(e::Situational, "Laboratory or Facility State or Province Code"),
1569
- b::Element(e::Situational, "Laboratory or Facility Postal Zone or ZIP Code"),
1570
- b::Element(e::Situational, "Country Code"),
1571
- b::Element(e::NotUsed, "Location Qualifier"),
1572
- b::Element(e::NotUsed, "Location Identifier"),
1573
- b::Element(e::Situational, "Country Subdivision Code")),
1574
- b::Segment(5250, s::REF, "Service Facility Location Secondary Identification",
1575
- r::Situational, d::RepeatCount.bounded(3),
1576
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("G2", "LU")),
1577
- b::Element(e::Required, "Service Facility Location Secondary Identifier"),
1578
- b::Element(e::NotUsed, "Description"),
1579
- b::Element(e::Situational, "REFERENCE IDENTIFIER",
1580
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("2U")),
1581
- b::Element(e::Required, "Other Payer Primary Identifier"),
1582
- b::Element(e::NotUsed, "Reference Identification Qualifier"),
1583
- b::Element(e::NotUsed, "Reference Identification"),
1584
- b::Element(e::NotUsed, "Reference Identification Qualifier"),
1585
- b::Element(e::NotUsed, "Reference Identification")))),
1586
-
1587
- d::LoopDef.build("2420D SUPERVISING PROVIDER NAME",
1588
- d::RepeatCount.bounded(1),
1589
- b::Segment(5000, s::NM1, "Supervising Provider Name",
1590
- r::Situational, d::RepeatCount.bounded(1),
1591
- b::Element(e::Required, "Entity Identifier Code", b::Values("DQ")),
1592
- b::Element(e::Required, "Entity Type Qualifier", b::Values("1")),
1593
- b::Element(e::Required, "Supervising Provider Last"),
1594
- b::Element(e::Situational, "Supervising Provider First"),
1595
- b::Element(e::Situational, "Supervising Provider Middle"),
1596
- b::Element(e::NotUsed, "Name Prefix"),
1597
- b::Element(e::Situational, "Supervising Provider Suffix"),
1598
- b::Element(e::Situational, "Identification Code Qualifier", b::Values("XX")),
1599
- b::Element(e::Situational, "Supervising Provider Identifier"),
1600
- b::Element(e::NotUsed, "Entity Relationship Code"),
1601
- b::Element(e::NotUsed, "Entity Identifier Code"),
1602
- b::Element(e::NotUsed, "Name Last or Organization Name")),
1603
- b::Segment(5250, s::REF, "Supervising Provider Secondary Identification",
1604
- r::Situational, d::RepeatCount.bounded(20),
1605
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("0B", "1G", "G2", "LU")),
1606
- b::Element(e::Required, "Supervising Provider Secondary Identifier"),
1607
- b::Element(e::NotUsed, "Description"),
1608
- b::Element(e::Situational, "REFERENCE IDENTIFIER",
1609
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("2U")),
1610
- b::Element(e::Required, "Other Payer Primary Identifier"),
1611
- b::Element(e::Required, "Reference Identification Qualifier"),
1612
- b::Element(e::Required, "Reference Identification"),
1613
- b::Element(e::Required, "Reference Identification Qualifier"),
1614
- b::Element(e::Required, "Reference Identification")))),
1615
-
1616
- d::LoopDef.build("2420E ORDERING PROVIDER NAME",
1617
- d::RepeatCount.bounded(1),
1618
- b::Segment(5000, s::NM1, "Ordering Provider Name",
1619
- r::Situational, d::RepeatCount.bounded(1),
1620
- b::Element(e::Required, "Entity Identifier Code", b::Values("DK")),
1621
- b::Element(e::Required, "Entity Type Qualifier", b::Values("1")),
1622
- b::Element(e::Required, "Ordering Provider Last"),
1623
- b::Element(e::Situational, "Ordering Provider First"),
1624
- b::Element(e::Situational, "Ordering Provider Middle"),
1625
- b::Element(e::NotUsed, "Name Prefix"),
1626
- b::Element(e::Situational, "Ordering Provider Suffix"),
1627
- b::Element(e::Situational, "Identification Code Qualifier", b::Values("XX")),
1628
- b::Element(e::Situational, "Ordering Provider Identifier"),
1629
- b::Element(e::NotUsed, "Entity Relationship Code"),
1630
- b::Element(e::NotUsed, "Entity Identifier Code"),
1631
- b::Element(e::NotUsed, "Name Last or Organization Name")),
1632
- b::Segment(5140, s::N3, "Ordering Provider Address",
1633
- r::Situational, d::RepeatCount.bounded(1),
1634
- b::Element(e::Required, "Ordering Provider Address Line"),
1635
- b::Element(e::Situational, "Ordering Provider Address Line")),
1636
- b::Segment(5200, s::N4, "Ordering Provider City, State, ZIP Code",
1637
- r::Required, d::RepeatCount.bounded(1),
1638
- b::Element(e::Required, "Ordering Provider City Name"),
1639
- b::Element(e::Situational, "Ordering Provider State or Province Code"),
1640
- b::Element(e::Situational, "Ordering Provider Postal Zone or ZIP Code"),
1641
- b::Element(e::Situational, "Country Code"),
1642
- b::Element(e::NotUsed, "Location Qualifier"),
1643
- b::Element(e::NotUsed, "Location Identifier"),
1644
- b::Element(e::Situational, "Country Subdivision Code")),
1645
- b::Segment(5250, s::REF, "Ordering Provider Secondary Identification",
1646
- r::Situational, d::RepeatCount.bounded(20),
1647
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("0B", "1G", "G2")),
1648
- b::Element(e::Required, "Ordering Provider Secondary Identifier"),
1649
- b::Element(e::NotUsed, "Description"),
1650
- b::Element(e::Situational, "REFERENCE IDENTIFIER",
1651
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("2U")),
1652
- b::Element(e::Required, "Other Payer Primary Identifier"),
1653
- b::Element(e::NotUsed, "Reference Identification Qualifier"),
1654
- b::Element(e::NotUsed, "Reference Identification"),
1655
- b::Element(e::NotUsed, "Reference Identification Qualifier"),
1656
- b::Element(e::NotUsed, "Reference Identification"))),
1657
- b::Segment(5300, s::PER, "Ordering Provider Contact Information",
1658
- r::Situational, d::RepeatCount.bounded(1),
1659
- b::Element(e::Required, "Contact Function Code", b::Values("IC")),
1660
- b::Element(e::Situational, "Ordering Provider Contact Name"),
1661
- b::Element(e::Required, "Communication Number Qualifier", b::Values("EM", "FX", "TE")),
1662
- b::Element(e::Required, "Communication Number"),
1663
- b::Element(e::Situational, "Communication Number Qualifier", b::Values("EM", "EX", "FX", "TE")),
1664
- b::Element(e::Situational, "Communication Number"),
1665
- b::Element(e::Situational, "Communication Number Qualifier", b::Values("EM", "EX", "FX", "TE")),
1666
- b::Element(e::Situational, "Communication Number"),
1667
- b::Element(e::NotUsed, "Contact Inquiry Reference"))),
1668
-
1669
- d::LoopDef.build("2420F REFERRING PROVIDER NAME",
1670
- d::RepeatCount.bounded(2),
1671
- b::Segment(5000, s::NM1, "Referring Provider Name",
1672
- r::Situational, d::RepeatCount.bounded(1),
1673
- b::Element(e::Required, "Entity Identifier Code", b::Values("DN", "P3")),
1674
- b::Element(e::Required, "Entity Type Qualifier", b::Values("1")),
1675
- b::Element(e::Required, "Referring Provider Last"),
1676
- b::Element(e::Situational, "Referring Provider First"),
1677
- b::Element(e::Situational, "Referring Provider Middle"),
1678
- b::Element(e::NotUsed, "Name Prefix"),
1679
- b::Element(e::Situational, "Referring Provider Suffix"),
1680
- b::Element(e::Situational, "Identification Code Qualifier", b::Values("XX")),
1681
- b::Element(e::Situational, "Referring Provider Identifier"),
1682
- b::Element(e::NotUsed, "Entity Relationship Code"),
1683
- b::Element(e::NotUsed, "Entity Identifier Code"),
1684
- b::Element(e::NotUsed, "Name Last or Organization Name")),
1685
- b::Segment(5250, s::REF, "Referring Provider Secondary Identification",
1686
- r::Situational, d::RepeatCount.bounded(20),
1687
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("0B", "1G", "G2")),
1688
- b::Element(e::Required, "Referring Provider Secondary Identifier"),
1689
- b::Element(e::NotUsed, "Description"),
1690
- b::Element(e::Situational, "REFERENCE IDENTIFIER",
1691
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("2U")),
1692
- b::Element(e::Required, "Other Payer Primary Identifier"),
1693
- b::Element(e::NotUsed, "Reference Identification Qualifier"),
1694
- b::Element(e::NotUsed, "Reference Identification"),
1695
- b::Element(e::NotUsed, "Reference Identification Qualifier"),
1696
- b::Element(e::NotUsed, "Reference Identification")))),
1697
-
1698
- d::LoopDef.build("2420G AMBULANCE PICK-UP LOCATION",
1699
- d::RepeatCount.bounded(1),
1700
- b::Segment(5000, s::NM1, "Ambulance Pick-up Location",
1701
- r::Situational, d::RepeatCount.bounded(1),
1702
- b::Element(e::Required, "Entity Identifier Code", b::Values("PW")),
1703
- b::Element(e::Required, "Entity Type Qualifier", b::Values("2")),
1704
- b::Element(e::NotUsed, "Name Last"),
1705
- b::Element(e::NotUsed, "Name First"),
1706
- b::Element(e::NotUsed, "Name Middle"),
1707
- b::Element(e::NotUsed, "Name Prefix"),
1708
- b::Element(e::NotUsed, "Name Suffix"),
1709
- b::Element(e::NotUsed, "Identification Code Qualifier"),
1710
- b::Element(e::NotUsed, "Identification Code"),
1711
- b::Element(e::NotUsed, "Entity Relationship Code"),
1712
- b::Element(e::NotUsed, "Entity Identifier Code"),
1713
- b::Element(e::NotUsed, "Name Last or Organization Name")),
1714
- b::Segment(5140, s::N3, "Ambulance Pick-up Location Address",
1715
- r::Required, d::RepeatCount.bounded(1),
1716
- b::Element(e::Required, "Ambulance Pick-up Address Line"),
1717
- b::Element(e::Situational, "Ambulance Pick-up Address Line")),
1718
- b::Segment(5200, s::N4, "Ambulance Pick-up Location City, State, ZIP Code",
1719
- r::Required, d::RepeatCount.bounded(1),
1720
- b::Element(e::Required, "Ambulance Pick-up City Name"),
1721
- b::Element(e::Situational, "Ambulance Pick-up State or Province Code"),
1722
- b::Element(e::Situational, "Ambulance Pick-up Postal Zone or ZIP Code"),
1723
- b::Element(e::Situational, "Country Code"),
1724
- b::Element(e::NotUsed, "Location Qualifier"),
1725
- b::Element(e::NotUsed, "Location Identifier"),
1726
- b::Element(e::Situational, "Country Subdivision Code"))),
1727
-
1728
- d::LoopDef.build("2420H AMBULANCE DROP-OFF LOCATION",
1729
- d::RepeatCount.bounded(1),
1730
- b::Segment(5000, s::NM1, "Ambulance Drop-off Location",
1731
- r::Situational, d::RepeatCount.bounded(1),
1732
- b::Element(e::Required, "Entity Identifier Code", b::Values("45")),
1733
- b::Element(e::Required, "Entity Type Qualifier", b::Values("2")),
1734
- b::Element(e::Situational, "Ambulance Drop-off Location"),
1735
- b::Element(e::NotUsed, "Name First"),
1736
- b::Element(e::NotUsed, "Name Middle"),
1737
- b::Element(e::NotUsed, "Name Prefix"),
1738
- b::Element(e::NotUsed, "Name Suffix"),
1739
- b::Element(e::NotUsed, "Identification Code Qualifier"),
1740
- b::Element(e::NotUsed, "Identification Code"),
1741
- b::Element(e::NotUsed, "Entity Relationship Code"),
1742
- b::Element(e::NotUsed, "Entity Identifier Code"),
1743
- b::Element(e::NotUsed, "Name Last or Organization Name")),
1744
- b::Segment(5140, s::N3, "Ambulance Drop-off Location Address",
1745
- r::Required, d::RepeatCount.bounded(1),
1746
- b::Element(e::Required, "Ambulance Drop-off Address Line"),
1747
- b::Element(e::Situational, "Ambulance Drop-off Address Line")),
1748
- b::Segment(5200, s::N4, "Ambulance Drop-off Location City, State, ZIP Code",
1749
- r::Required, d::RepeatCount.bounded(1),
1750
- b::Element(e::Required, "Ambulance Drop-off City Name"),
1751
- b::Element(e::Situational, "Ambulance Drop-off State or Province Code"),
1752
- b::Element(e::Situational, "Ambulance Drop-off Postal Zone or ZIP Code"),
1753
- b::Element(e::Situational, "Country Code"),
1754
- b::Element(e::NotUsed, "Location Qualifier"),
1755
- b::Element(e::NotUsed, "Location Identifier"),
1756
- b::Element(e::Situational, "Country Subdivision Code"))),
1757
-
1758
- d::LoopDef.build("2430 LINE ADJUDICATION INFORMATION",
1759
- d::RepeatCount.bounded(15),
1760
- b::Segment(5400, s::SVD, "Line Adjudication Information",
1761
- r::Situational, d::RepeatCount.bounded(1),
1762
- b::Element(e::Required, "Other Payer Primary Identifier"),
1763
- b::Element(e::Required, "Service Line Paid Amount"),
1764
- b::Element(e::Required, "COMPOSITE MEDICAL PROCEDURE IDENTIFIER",
1765
- b::Element(e::Required, "Product or Service ID Qualifier", b::Values("ER", "HC", "IV", "WK")),
1766
- b::Element(e::Required, "Procedure Code"),
1767
- b::Element(e::Situational, "Procedure Modifier"),
1768
- b::Element(e::Situational, "Procedure Modifier"),
1769
- b::Element(e::Situational, "Procedure Modifier"),
1770
- b::Element(e::Situational, "Procedure Modifier"),
1771
- b::Element(e::Situational, "Procedure Code Description"),
1772
- b::Element(e::NotUsed, "Product/Service ID")),
1773
- b::Element(e::NotUsed, "Product/Service ID"),
1774
- b::Element(e::Required, "Paid Service Unit Count", b::MaxLength(8), b::MaxPrecision(3)),
1775
- b::Element(e::Situational, "Bundled or Unbundled Line Number")),
1776
- b::Segment(5450, s::CAS, "Line Adjustment",
1777
- r::Situational, d::RepeatCount.bounded(5),
1778
- b::Element(e::Required, "Claim Adjustment Group Code", b::Values("CO", "CR", "OA", "PI", "PR")),
1779
- b::Element(e::Required, "Adjustment Reason Code"),
1780
- b::Element(e::Required, "Adjustment Amount"),
1781
- b::Element(e::Situational, "Adjustment Quantity"),
1782
- b::Element(e::Situational, "Adjustment Reason Code"),
1783
- b::Element(e::Situational, "Adjustment Amount"),
1784
- b::Element(e::Situational, "Adjustment Quantity"),
1785
- b::Element(e::Situational, "Adjustment Reason Code"),
1786
- b::Element(e::Situational, "Adjustment Amount"),
1787
- b::Element(e::Situational, "Adjustment Quantity"),
1788
- b::Element(e::Situational, "Adjustment Reason Code"),
1789
- b::Element(e::Situational, "Adjustment Amount"),
1790
- b::Element(e::Situational, "Adjustment Quantity"),
1791
- b::Element(e::Situational, "Adjustment Reason Code"),
1792
- b::Element(e::Situational, "Adjustment Amount"),
1793
- b::Element(e::Situational, "Adjustment Quantity"),
1794
- b::Element(e::Situational, "Adjustment Reason Code"),
1795
- b::Element(e::Situational, "Adjustment Amount"),
1796
- b::Element(e::Situational, "Adjustment Quantity")),
1797
- b::Segment(5500, s::DTP, "Line Check or Remittance Date",
1798
- r::Required, d::RepeatCount.bounded(1),
1799
- b::Element(e::Required, "Date Time Qualifier", b::Values("573")),
1800
- b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
1801
- b::Element(e::Required, "Adjudication or Payment Date")),
1802
- b::Segment(5505, s::AMT, "Remaining Patient Liability",
1803
- r::Situational, d::RepeatCount.bounded(1),
1804
- b::Element(e::Required, "Amount Qualifier Code"),
1805
- b::Element(e::Required, "Remaining Patient Liability"),
1806
- b::Element(e::NotUsed, "Credit/Debit Flag Code"))),
1807
-
1808
- d::LoopDef.build("2440 FORM IDENTIFICATION CODE",
1809
- d::RepeatCount.unbounded,
1810
- b::Segment(5510, s::LQ, "Form Identification Code",
1811
- r::Situational, d::RepeatCount.bounded(1),
1812
- b::Element(e::Required, "Code List Qualifier Code", b::Values("AS", "UT")),
1813
- b::Element(e::Required, "Form Identifier")),
1814
- b::Segment(5520, s::FRM, "Supporting Documentation",
1815
- r::Required, d::RepeatCount.bounded(99),
1816
- b::Element(e::Required, "Question Number/Letter"),
1817
- b::Element(e::Situational, "Question Response", b::Values("N", "W", "Y")),
1818
- b::Element(e::Situational, "Question Response"),
1819
- b::Element(e::Situational, "Question Response"),
1820
- b::Element(e::Situational, "Question Response")))))
1821
-
1822
- HC837P = b.build(t::HC837,
1823
- d::TableDef.header("Table 1 - Header",
1824
- b::Segment(50, s::ST, "Transaction Set Header",
1825
- r::Required, d::RepeatCount.bounded(1),
1826
- b::Element(e::Required, "Transaction Set Identifier Code", b::Values("837")),
1827
- b::Element(e::Required, "Transaction Set Control Number"),
1828
- b::Element(e::Required, "Implementation Guide Version Name", b::Values("005010X222"))),
1829
- b::Segment(100, s::BHT, "Beginning of Hierarchical Transaction",
1830
- r::Required, d::RepeatCount.bounded(1),
1831
- b::Element(e::Required, "Hierarchical Structure Code", b::Values("0019")),
1832
- b::Element(e::Required, "Transaction Set Purpose Code", b::Values("00", "18")),
1833
- b::Element(e::Required, "Originator Application Transaction Identifier", b::MaxLength(30)),
1834
- b::Element(e::Required, "Transaction Set Creation Date"),
1835
- b::Element(e::Required, "Transaction Set Creation Time"),
1836
- b::Element(e::Required, "Claim or Encounter Identifier", b::Values("31", "CH", "RP"))),
1837
-
1838
- d::LoopDef.build("1000A SUBMITTER NAME",
1839
- d::RepeatCount.bounded(1),
1840
- b::Segment(200, s::NM1, "Submitter Name",
1841
- r::Required, d::RepeatCount.bounded(1),
1842
- b::Element(e::Required, "Entity Identifier Code", b::Values("41")),
1843
- b::Element(e::Required, "Entity Type Qualifier", b::Values("1", "2")),
1844
- b::Element(e::Required, "Submitter Last or Organization Name"),
1845
- b::Element(e::Situational, "Submitter First Name"),
1846
- b::Element(e::Situational, "Submitter Middle Name or Initial"),
1847
- b::Element(e::NotUsed, "Name Prefix"),
1848
- b::Element(e::NotUsed, "Name Suffix"),
1849
- b::Element(e::Required, "Identification Qualifier Code", b::Values("46")),
1850
- b::Element(e::Required, "Submitter Identifier"),
1851
- b::Element(e::NotUsed, "Entity Relationship Code"),
1852
- b::Element(e::NotUsed, "Entity Identifier Code"),
1853
- b::Element(e::NotUsed, "Name Last or Organization Name")),
1854
- b::Segment(450, s::PER, "Submitter EDI Contact Information",
1855
- r::Required, d::RepeatCount.bounded(2),
1856
- b::Element(e::Required, "Contact Function Code", b::Values("IC")),
1857
- b::Element(e::Situational, "Submitter Contact Name"),
1858
- b::Element(e::Required, "Communication Number Qualifier", b::Values("EM", "FX", "TE")),
1859
- b::Element(e::Required, "Communication Number"),
1860
- b::Element(e::Situational, "Communication Number Qualifier", b::Values("EM", "EX", "FX", "TE")),
1861
- b::Element(e::Situational, "Communication Number"),
1862
- b::Element(e::Situational, "Communication Number Qualifier", b::Values("EM", "EX", "FX", "TE")),
1863
- b::Element(e::Situational, "Communication Number"),
1864
- b::Element(e::NotUsed, "Contact Inquiry Reference"))),
1865
-
1866
- d::LoopDef.build("1000B RECEIVER NAME",
1867
- d::RepeatCount.bounded(1),
1868
- b::Segment(200, s::NM1, "Receiver Name",
1869
- r::Required, d::RepeatCount.bounded(1),
1870
- b::Element(e::Required, "Entity Identifier Code", b::Values("40")),
1871
- b::Element(e::Required, "Entity Type Qualifier", b::Values("2")),
1872
- b::Element(e::Required, "Receiver Name"),
1873
- b::Element(e::NotUsed, "Name First"),
1874
- b::Element(e::NotUsed, "Name Last"),
1875
- b::Element(e::NotUsed, "Name Prefix"),
1876
- b::Element(e::NotUsed, "Name Suffix"),
1877
- b::Element(e::Required, "Identification Code Qualifier", b::Values("46")),
1878
- b::Element(e::Required, "Receiver Primary Identifier"),
1879
- b::Element(e::NotUsed, "Entity Relationship Code"),
1880
- b::Element(e::NotUsed, "Entity Identifier Code"),
1881
- b::Element(e::NotUsed, "Name Last or Organization Name")))),
1882
-
1883
- d::TableDef.detail("Table 2 - Billing Provider Detail",
1884
- d::LoopDef.build("2000A BILLING PROVIDER HIERARCHICAL LEVEL",
1885
- d::RepeatCount.bounded(1),
1886
- b::Segment(10, s::HL, "Billing Provider Hierarchical Level",
1887
- r::Required, d::RepeatCount.bounded(1),
1888
- b::Element(e::Required, "Hierarchical ID Number"),
1889
- b::Element(e::NotUsed, "Hierarchical Parent ID Number"),
1890
- b::Element(e::Required, "Hierarchical Level Code", b::Values("20")),
1891
- b::Element(e::Required, "Hierachical Child Code")),
1892
- b::Segment(30, s::PRV, "Billing Provider Specialty Information",
1893
- r::Situational, d::RepeatCount.bounded(1),
1894
- b::Element(e::Required, "Provider Code", b::Values("BI")),
1895
- b::Element(e::Required, "Reference Identification Number", b::Values("PXC")),
1896
- b::Element(e::Required, "Provider Taxonomy Code"),
1897
- b::Element(e::NotUsed, "State or Province Code"),
1898
- b::Element(e::NotUsed, "PROVIDER SPECIALTY INFORMATION"),
1899
- b::Element(e::NotUsed, "Provider Organization Code")),
1900
- b::Segment(100, s::CUR, "Foreign Currency Information",
1901
- r::Situational, d::RepeatCount.bounded(1),
1902
- b::Element(e::Required, "Entity Identifier Code", b::Values("85")),
1903
- b::Element(e::Required, "Currency Code"),
1904
- b::Element(e::NotUsed, "Exchange Rate"),
1905
- b::Element(e::NotUsed, "Entity Identifier Code"),
1906
- b::Element(e::NotUsed, "Currency Code"),
1907
- b::Element(e::NotUsed, "Currency Market/Exchange Code"),
1908
- b::Element(e::NotUsed, "Date/Time Qualifier"),
1909
- b::Element(e::NotUsed, "Date"),
1910
- b::Element(e::NotUsed, "Time"),
1911
- b::Element(e::NotUsed, "Date/Time Qualifier"),
1912
- b::Element(e::NotUsed, "Date"),
1913
- b::Element(e::NotUsed, "Time"),
1914
- b::Element(e::NotUsed, "Date/Time Qualifier"),
1915
- b::Element(e::NotUsed, "Date"),
1916
- b::Element(e::NotUsed, "Time"),
1917
- b::Element(e::NotUsed, "Date/Time Qualifier"),
1918
- b::Element(e::NotUsed, "Date"),
1919
- b::Element(e::NotUsed, "Time"),
1920
- b::Element(e::NotUsed, "Date/Time Qualifier"),
1921
- b::Element(e::NotUsed, "Date"),
1922
- b::Element(e::NotUsed, "Time")),
1923
-
1924
- d::LoopDef.build("2010AA BILLING PROVIDER NAME",
1925
- d::RepeatCount.bounded(1),
1926
- b::Segment(150, s::NM1, "Billing Provider Name",
1927
- r::Required, d::RepeatCount.bounded(1),
1928
- b::Element(e::Required, "Entity Identifier Code", b::Values("85")),
1929
- b::Element(e::Required, "Entity Type Qualifier", b::Values("1", "2")),
1930
- b::Element(e::Required, "Billing Provider Last or Organizational Name"),
1931
- b::Element(e::Situational, "Billing Provider First Name"),
1932
- b::Element(e::Situational, "Billing Provider Middle Name or Initial"),
1933
- b::Element(e::NotUsed, "Name Prefix"),
1934
- b::Element(e::Situational, "Billing Provider Name Suffix"),
1935
- b::Element(e::Situational, "Identification Code Qualifier", b::Values("XX")),
1936
- b::Element(e::Situational, "Billing Provider Identifier"),
1937
- b::Element(e::NotUsed, "Entity Relationship Code"),
1938
- b::Element(e::NotUsed, "Entity Identifier Code"),
1939
- b::Element(e::NotUsed, "Name Last or Organization Name")),
1940
- b::Segment(250, s::N3, "Billing Provider Address",
1941
- r::Required, d::RepeatCount.bounded(1),
1942
- b::Element(e::Required, "Billing Provider Address Line"),
1943
- b::Element(e::Situational, "Billing Provider Address Line")),
1944
- b::Segment(300, s::N4, "Billing Provider City, State, ZIP Code",
1945
- r::Required, d::RepeatCount.bounded(1),
1946
- b::Element(e::Required, "Billing Provider City Name"),
1947
- b::Element(e::Situational, "Billing Provider State or Province Code"),
1948
- b::Element(e::Situational, "Billing Provider Postal Zone or ZIP Code"),
1949
- b::Element(e::Situational, "Country Code"),
1950
- b::Element(e::NotUsed, "Location Qualifier"),
1951
- b::Element(e::NotUsed, "Location Identifier"),
1952
- b::Element(e::Situational, "Country Subdivision Code")),
1953
- b::Segment(350, s::REF, "Billing Provider Tax Identification",
1954
- r::Required, d::RepeatCount.bounded(1),
1955
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("EI", "SY")),
1956
- b::Element(e::Required, "Billing Provider Tax Identification Number"),
1957
- b::Element(e::NotUsed, "Description"),
1958
- b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
1959
- b::Segment(350, s::REF, "Billing Provider UPIN/License Information",
1960
- r::Situational, d::RepeatCount.bounded(2),
1961
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("0B", "1G")),
1962
- b::Element(e::Required, "Billing Provider License and/or UPIN Information"),
1963
- b::Element(e::NotUsed, "Description"),
1964
- b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
1965
- b::Segment(400, s::PER, "Billing Provider Contact Information",
1966
- r::Situational, d::RepeatCount.bounded(2),
1967
- b::Element(e::Required, "Contact Function Code", b::Values("IC")),
1968
- b::Element(e::Situational, "Billing Provider Contact Name"),
1969
- b::Element(e::Required, "Communication Number Qualifier", b::Values("EM", "FX", "TE")),
1970
- b::Element(e::Required, "Communication Number"),
1971
- b::Element(e::Situational, "Communication Number Qualifier", b::Values("EM", "EX", "FX", "TE")),
1972
- b::Element(e::Situational, "Communication Number"),
1973
- b::Element(e::Situational, "Communication Number Qualifier", b::Values("EM", "EX", "FX", "TE")),
1974
- b::Element(e::Situational, "Communication Number"),
1975
- b::Element(e::NotUsed, "Contact Inquiry Reference"))),
1976
-
1977
- d::LoopDef.build("2010AB PAY-TO ADDRESS NAME",
1978
- d::RepeatCount.bounded(1),
1979
- b::Segment(150, s::NM1, "Pay-to Address Name",
1980
- r::Situational, d::RepeatCount.bounded(1),
1981
- b::Element(e::Required, "Entity Identifier Code", b::Values("87")),
1982
- b::Element(e::Required, "Entity Type Qualifier", b::Values("1", "2")),
1983
- b::Element(e::NotUsed, "Name Last or Organizational Name"),
1984
- b::Element(e::NotUsed, "Name First"),
1985
- b::Element(e::NotUsed, "Name Middle"),
1986
- b::Element(e::NotUsed, "Name Prefix"),
1987
- b::Element(e::NotUsed, "Name Suffix"),
1988
- b::Element(e::NotUsed, "Identification Code Qualifier"),
1989
- b::Element(e::NotUsed, "Identifier Code"),
1990
- b::Element(e::NotUsed, "Entity Relationship Code"),
1991
- b::Element(e::NotUsed, "Entity Identifier Code"),
1992
- b::Element(e::NotUsed, "Name Last or Organization Name")),
1993
- b::Segment(250, s::N3, "Pay-to Address - ADDRESS",
1994
- r::Required, d::RepeatCount.bounded(1),
1995
- b::Element(e::Required, "Pay-To Address Line"),
1996
- b::Element(e::Situational, "Pay-To Address Line")),
1997
- b::Segment(300, s::N4, "Pay-To Address City, State, ZIP Code",
1998
- r::Required, d::RepeatCount.bounded(1),
1999
- b::Element(e::Required, "Pay-to City Name"),
2000
- b::Element(e::Situational, "Pay-to State or Province Code"),
2001
- b::Element(e::Situational, "Pay-to Postal Zone or ZIP Code"),
2002
- b::Element(e::Situational, "Country Code"),
2003
- b::Element(e::NotUsed, "Location Qualifier"),
2004
- b::Element(e::NotUsed, "Location Identifier"),
2005
- b::Element(e::Situational, "Country Subdivision Code"))),
2006
-
2007
- d::LoopDef.build("2010AC PAY-TO PLAN NAME",
2008
- d::RepeatCount.bounded(1),
2009
- b::Segment(150, s::NM1, "Pay-To Plan Name",
2010
- r::Situational, d::RepeatCount.bounded(1),
2011
- b::Element(e::Required, "Entity Identifier Code", b::Values("PE")),
2012
- b::Element(e::Required, "Entity Type Qualifier", b::Values("2")),
2013
- b::Element(e::Required, "Pay-To Plan Organizational Name"),
2014
- b::Element(e::NotUsed, "Name First"),
2015
- b::Element(e::NotUsed, "Name Middle"),
2016
- b::Element(e::NotUsed, "Name Prefix"),
2017
- b::Element(e::NotUsed, "Name Suffix"),
2018
- b::Element(e::Required, "Identification Code Qualifier", b::Values("PI", "XV")),
2019
- b::Element(e::Required, "Pay-To Plan Primary Identifier"),
2020
- b::Element(e::NotUsed, "Entity Relationship Code"),
2021
- b::Element(e::NotUsed, "Entity Identifier Code"),
2022
- b::Element(e::NotUsed, "Name Last or Organization Name")),
2023
- b::Segment(250, s::N3, "Pay-to Plan Address",
2024
- r::Required, d::RepeatCount.bounded(1),
2025
- b::Element(e::Required, "Pay-To Plan Address Line"),
2026
- b::Element(e::Situational, "Pay-To Plan Address Line")),
2027
- b::Segment(300, s::N4, "Pay-To Plan City, State, ZIP Code",
2028
- r::Required, d::RepeatCount.bounded(1),
2029
- b::Element(e::Required, "Pay-to Plan City Name"),
2030
- b::Element(e::Situational, "Pay-to Plan State or Province Code"),
2031
- b::Element(e::Situational, "Pay-to Plan Postal Zone or ZIP Code"),
2032
- b::Element(e::Situational, "Country Code"),
2033
- b::Element(e::NotUsed, "Location Qualifier"),
2034
- b::Element(e::NotUsed, "Location Identifier"),
2035
- b::Element(e::Situational, "Country Subdivision Code")),
2036
- b::Segment(350, s::REF, "Pay-to Plan Secondary Identification",
2037
- r::Situational, d::RepeatCount.bounded(1),
2038
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("2U", "FY", "NF")),
2039
- b::Element(e::Required, "Pay-to Plan Secondary Identifier"),
2040
- b::Element(e::NotUsed, "Description"),
2041
- b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
2042
- b::Segment(350, s::REF, "Pay-to Plan Tax Identification Number",
2043
- r::Required, d::RepeatCount.bounded(1),
2044
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("EI")),
2045
- b::Element(e::Required, "Pay-to Plan Tax Identification Number"),
2046
- b::Element(e::NotUsed, "Description"),
2047
- b::Element(e::NotUsed, "REFERENCE IDENTIFIER"))))),
2048
-
2049
- d::TableDef.detail("Table 2 - Subscriber Detail",
2050
- d::LoopDef.build("2000B SUBSCRIBER HIERARCHICAL LEVEL",
2051
- d::RepeatCount.bounded(1),
2052
- b::Segment(10, s::HL, "Subscriber Hierarchical Level",
2053
- r::Required, d::RepeatCount.bounded(1),
2054
- b::Element(e::Required, "Hierarchical ID Number"),
2055
- b::Element(e::Required, "Hierarchical Parent ID Number"),
2056
- b::Element(e::Required, "Hierarchical Level Code", b::Values("22")),
2057
- b::Element(e::Required, "Hierachical Child values", b::Values("0", "1"))),
2058
- b::Segment(50, s::SBR, "Subscriber Information",
2059
- r::Situational, d::RepeatCount.bounded(1),
2060
- b::Element(e::Required, "Payer Responsibility Sequence Number", b::Values("A", "B", "C", "D", "E", "F", "G", "H", "P", "S", "T", "U")),
2061
- b::Element(e::Situational, "Individual Relationship Code", b::Values("18")),
2062
- b::Element(e::Situational, "Subscriber Group or Policy Number"),
2063
- b::Element(e::Situational, "Subscriber Group Name"),
2064
- b::Element(e::Situational, "Insurance Type Code", b::Values("12", "13", "14", "15", "16", "41", "42", "43", "47")),
2065
- b::Element(e::NotUsed, "Coordination of Benefits Code"),
2066
- b::Element(e::NotUsed, "Yes/No Condition or Response Code"),
2067
- b::Element(e::NotUsed, "Employment Status Code"),
2068
- 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"))),
2069
- b::Segment(70, s::PAT, "Patient Information",
2070
- r::Situational, d::RepeatCount.bounded(1),
2071
- b::Element(e::NotUsed, "Individual Relationship Code"),
2072
- b::Element(e::NotUsed, "Patient Location Code"),
2073
- b::Element(e::NotUsed, "Employment Status Code"),
2074
- b::Element(e::NotUsed, "Student Status Code"),
2075
- b::Element(e::Situational, "Date Time Period Format Qualifier", b::Values("D8")),
2076
- b::Element(e::Situational, "Patient Death Date"),
2077
- b::Element(e::Situational, "Unit or Basis for Measurement Code", b::Values("01")),
2078
- b::Element(e::Situational, "Patient Weight"),
2079
- b::Element(e::Situational, "Pregnancy Indicator", b::Values("Y"))),
2080
-
2081
- d::LoopDef.build("2010BA SUBSCRIBER NAME",
2082
- d::RepeatCount.bounded(1),
2083
- b::Segment(150, s::NM1, "Subscriber Name",
2084
- r::Required, d::RepeatCount.bounded(1),
2085
- b::Element(e::Required, "Entity Identifier Code", b::Values("IL")),
2086
- b::Element(e::Required, "Entity Type Qualifier", b::Values("1", "2")),
2087
- b::Element(e::Situational, "Subscriber Last Name"),
2088
- b::Element(e::Situational, "Subscriber First Name"),
2089
- b::Element(e::Situational, "Subscriber Middle Name or Initial"),
2090
- b::Element(e::NotUsed, "Name Prefix"),
2091
- b::Element(e::Situational, "Subscriber Name Suffix"),
2092
- b::Element(e::Required, "Identification Code Qualifier", b::Values("II", "MI")),
2093
- b::Element(e::Required, "Subscriber Primary Identifier"),
2094
- b::Element(e::NotUsed, "Entity Relationship Code"),
2095
- b::Element(e::NotUsed, "Entity Identifier Code"),
2096
- b::Element(e::NotUsed, "Name Last or Organization Name")),
2097
- b::Segment(250, s::N3, "Subscriber Address",
2098
- r::Situational, d::RepeatCount.bounded(1),
2099
- b::Element(e::Required, "Subscriber Address Line"),
2100
- b::Element(e::Situational, "Subscriber Address Line")),
2101
- b::Segment(300, s::N4, "Subscriber City, State, ZIP Code",
2102
- r::Required, d::RepeatCount.bounded(1),
2103
- b::Element(e::Required, "Subscriber City Name"),
2104
- b::Element(e::Situational, "Subscriber State Code"),
2105
- b::Element(e::Situational, "Subscriber Postal Zone or ZIP Code"),
2106
- b::Element(e::Situational, "Country Code"),
2107
- b::Element(e::NotUsed, "Location Qualifier"),
2108
- b::Element(e::NotUsed, "Location Identifier"),
2109
- b::Element(e::Situational, "Country Subdivision Code")),
2110
- b::Segment(320, s::DMG, "Subscriber Demographic Information",
2111
- r::Situational, d::RepeatCount.bounded(1),
2112
- b::Element(e::Required, "Date Time Period Format Qualifier"),
2113
- b::Element(e::Required, "Subscriber Birth Date"),
2114
- b::Element(e::Required, "Subscriber Gender Code", b::Values("F", "M", "U")),
2115
- b::Element(e::NotUsed, "Marital Status Code"),
2116
- b::Element(e::NotUsed, "COMPOSITE RACE OR ETHNICITY INFORMATION"),
2117
- b::Element(e::NotUsed, "Citizenship Status Code"),
2118
- b::Element(e::NotUsed, "Country Code"),
2119
- b::Element(e::NotUsed, "Basis of Verification Code"),
2120
- b::Element(e::NotUsed, "Quantity"),
2121
- b::Element(e::NotUsed, "Code List Qualifier Code"),
2122
- b::Element(e::NotUsed, "Industry Code")),
2123
- b::Segment(350, s::REF, "Subscriber Secondary Identification",
2124
- r::Situational, d::RepeatCount.bounded(1),
2125
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("SY")),
2126
- b::Element(e::Required, "Subscriber Supplemental Identifier"),
2127
- b::Element(e::NotUsed, "Description"),
2128
- b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
2129
- b::Segment(350, s::REF, "Property and Casualty Claim Number",
2130
- r::Situational, d::RepeatCount.bounded(1),
2131
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("Y4")),
2132
- b::Element(e::Required, "Property Casualty Claim Number"),
2133
- b::Element(e::NotUsed, "Description"),
2134
- b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
2135
- b::Segment(400, s::PER, "Property and Casualty Subscriber Contact Information",
2136
- r::Situational, d::RepeatCount.bounded(1),
2137
- b::Element(e::Required, "Contact Fuction Code", b::Values("IC")),
2138
- b::Element(e::Situational, "Name"),
2139
- b::Element(e::Required, "Communication Qualifier Number", b::Values("TE")),
2140
- b::Element(e::Required, "Communication Number"),
2141
- b::Element(e::Situational, "Communication Qualifier Number", b::Values("TE", "EX")),
2142
- b::Element(e::Situational, "Communication Number"),
2143
- b::Element(e::NotUsed, "Communication Qualifier Number"),
2144
- b::Element(e::NotUsed, "Communication Number"),
2145
- b::Element(e::NotUsed, "Contact Inquiry Reference"))),
2146
-
2147
- d::LoopDef.build("2010BB PAYER NAME",
2148
- d::RepeatCount.bounded(10),
2149
- b::Segment(150, s::NM1, "Payer Name",
2150
- r::Required, d::RepeatCount.bounded(1),
2151
- b::Element(e::Required, "Entity Identifier Code", b::Values("PR")),
2152
- b::Element(e::Required, "Entity Type Qualifier", b::Values("2")),
2153
- b::Element(e::Required, "Payer Name"),
2154
- b::Element(e::NotUsed, "Name Last"),
2155
- b::Element(e::NotUsed, "Name Middle"),
2156
- b::Element(e::NotUsed, "Name Prefix"),
2157
- b::Element(e::NotUsed, "Name Suffix"),
2158
- b::Element(e::Required, "Identification Code Qualifier", b::Values("PI", "XV")),
2159
- b::Element(e::Required, "Payer Identification"),
2160
- b::Element(e::NotUsed, "Entity Relationship Code"),
2161
- b::Element(e::NotUsed, "Entity Identifier Code"),
2162
- b::Element(e::NotUsed, "Name Last or Organization Name")),
2163
- b::Segment(250, s::N3, "Payer Address",
2164
- r::Situational, d::RepeatCount.bounded(2),
2165
- b::Element(e::Required, "Payer Address Line"),
2166
- b::Element(e::Situational, "Payer Address Line")),
2167
- b::Segment(300, s::N4, "Payer City, State, ZIP Code",
2168
- r::Required, d::RepeatCount.bounded(1),
2169
- b::Element(e::Required, "Payer City Name"),
2170
- b::Element(e::Situational, "Payer State or Province Code"),
2171
- b::Element(e::Situational, "Payer Postal Zone or ZIP Code"),
2172
- b::Element(e::Situational, "Country Code"),
2173
- b::Element(e::NotUsed, "Location Qualifier"),
2174
- b::Element(e::NotUsed, "Location Identifier"),
2175
- b::Element(e::Situational, "Country Subdivision Code")),
2176
- b::Segment(350, s::REF, "Payer Secondary Identification",
2177
- r::Situational, d::RepeatCount.bounded(3),
2178
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("2U", "EI", "FY", "NF")),
2179
- b::Element(e::Required, "Payer Secondary Identifier"),
2180
- b::Element(e::NotUsed, "Description"),
2181
- b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
2182
- b::Segment(350, s::REF, "Billing Provider Secondary Identification",
2183
- r::Situational, d::RepeatCount.bounded(2),
2184
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("G2", "LU")),
2185
- b::Element(e::Required, "Billing Provider Secondary Identifier"),
2186
- b::Element(e::NotUsed, "Description"),
2187
- b::Element(e::NotUsed, "REFERENCE IDENTIFIER"))),
2188
-
2189
- loop2300)),
2190
-
2191
- d::TableDef.detail("Table 2 - Patient Detail",
2192
- d::LoopDef.build("2000C PATIENT HIERARCHICAL LEVEL",
2193
- d::RepeatCount.bounded(1),
2194
- b::Segment(10, s::HL, "Patient Hierachical Level",
2195
- r::Situational, d::RepeatCount.bounded(1),
2196
- b::Element(e::Required, "Hierarchical ID Number"),
2197
- b::Element(e::Required, "Hierarchical Parent ID Number"),
2198
- b::Element(e::Required, "Hierarchical Level Code", b::Values("23")),
2199
- b::Element(e::Required, "Hierarchical Child Code", b::Values("0"))),
2200
- b::Segment(70, s::PAT, "Patient Information",
2201
- r::Required, d::RepeatCount.bounded(1),
2202
- b::Element(e::Required, "Individual Relationship Code", b::Values("01", "19", "20", "21", "39", "40", "53", "G8")),
2203
- b::Element(e::NotUsed, "Patient Location Code"),
2204
- b::Element(e::NotUsed, "Employment Status Code"),
2205
- b::Element(e::NotUsed, "Student Status Code"),
2206
- b::Element(e::Situational, "Date Time Period Format Qualifier"),
2207
- b::Element(e::Situational, "Patient Death Date"),
2208
- b::Element(e::Situational, "Unit Basis for Measurement Code", b::Values("01")),
2209
- b::Element(e::Situational, "Patient Weight"),
2210
- b::Element(e::Situational, "Pregnancy Indicator", b::Values("Y"))),
2211
-
2212
- d::LoopDef.build("2010CA PATIENT NAME",
2213
- d::RepeatCount.bounded(1),
2214
- b::Segment(150, s::NM1, "Patient Name",
2215
- r::Required, d::RepeatCount.bounded(1),
2216
- b::Element(e::Required, "Entity Qualifier Code", b::Values("QC")),
2217
- b::Element(e::Required, "Entity Type Qualifier", b::Values("1")),
2218
- b::Element(e::Required, "Patient Last Name"),
2219
- b::Element(e::Situational, "Patient First Name"),
2220
- b::Element(e::Situational, "Patient Middle Name or Initial"),
2221
- b::Element(e::NotUsed, "Name Prefix"),
2222
- b::Element(e::Situational, "Patient Name Suffix"),
2223
- b::Element(e::NotUsed, "Identification Code Qualifier"),
2224
- b::Element(e::NotUsed, "Identification Code"),
2225
- b::Element(e::NotUsed, "Entity Relationship Code"),
2226
- b::Element(e::NotUsed, "Entity Identification Code"),
2227
- b::Element(e::NotUsed, "Name Last or Organization Name")),
2228
- b::Segment(250, s::N3, "Patient Address",
2229
- r::Required, d::RepeatCount.bounded(1),
2230
- b::Element(e::Required, "Patient Address Line"),
2231
- b::Element(e::Situational, "Patient Address Line")),
2232
- b::Segment(300, s::N4, "Patient City, State, ZIP Code",
2233
- r::Required, d::RepeatCount.bounded(1),
2234
- b::Element(e::Required, "Patient City Name"),
2235
- b::Element(e::Situational, "Patient State Code"),
2236
- b::Element(e::Situational, "Patient Postal Zone or ZIP Code"),
2237
- b::Element(e::Situational, "Country Code"),
2238
- b::Element(e::NotUsed, "Location Qualifier"),
2239
- b::Element(e::NotUsed, "Location Identifier"),
2240
- b::Element(e::Situational, "Country Subdivision Code")),
2241
- b::Segment(320, s::DMG, "Patient Demographic Information",
2242
- r::Required, d::RepeatCount.bounded(1),
2243
- b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
2244
- b::Element(e::Required, "Patient Birth Date"),
2245
- b::Element(e::Required, "Patient Gender Code", b::Values("F", "M", "U")),
2246
- b::Element(e::NotUsed, "Marital Status Code"),
2247
- b::Element(e::NotUsed, "COMPOSITE RACE OR ETHNICITY INFORMATION"),
2248
- b::Element(e::NotUsed, "Citizenship Status Code"),
2249
- b::Element(e::NotUsed, "Country Code"),
2250
- b::Element(e::NotUsed, "Basis of Verification Code"),
2251
- b::Element(e::NotUsed, "Quantity"),
2252
- b::Element(e::NotUsed, "Code List Qualifier Code"),
2253
- b::Element(e::NotUsed, "Industry Code")),
2254
- b::Segment(350, s::REF, "Property and Casualty Claim Number",
2255
- r::Situational, d::RepeatCount.bounded(1),
2256
- b::Element(e::Required, "Reference Identifier Qualifier", b::Values("Y4")),
2257
- b::Element(e::Required, "Property Casualty Claim Number"),
2258
- b::Element(e::NotUsed, "Description"),
2259
- b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
2260
- b::Segment(400, s::PER, "Property and Casualty Patient Contact Information",
2261
- r::Situational, d::RepeatCount.bounded(1),
2262
- b::Element(e::Required, "Contact Function Code", b::Values("IC")),
2263
- b::Element(e::Situational, "Name"),
2264
- b::Element(e::Required, "Communication Number Qualifier", b::Values("TE")),
2265
- b::Element(e::Required, "Communication Number"),
2266
- b::Element(e::Situational, "Communication Number Qualifier", b::Values("EX")),
2267
- b::Element(e::Situational, "Communication Number"),
2268
- b::Element(e::NotUsed, "Communication Number Qualifier"),
2269
- b::Element(e::NotUsed, "Communication Number"),
2270
- b::Element(e::NotUsed, "Contact Inquiry Reference"))),
2271
-
2272
- loop2300)),
2273
-
2274
- # The X12 standard and X222 specification place the SE segment at what
2275
- # appears to be the end of Table 2 - Patient Detail. This doesn't make
2276
- # sense because Table 2 - Patient Detail doesn't occur if the patient
2277
- # is the subscriber.
2278
- #
2279
- # If we placed it in both Table 2 - Subscriber Detail and Table 2 -
2280
- # Patient Detail, it would incorrectly allow the segment to occur in
2281
- # each table.
2282
- #
2283
- # This structure doesn't match the specification, but it does ensure
2284
- # that the first occurrence of SE terminates the transaction set.
2285
- d::TableDef.summary("Table 3 - Summary",
2286
- b::Segment(5550, s::SE, "Transaction Set Trailer",
2287
- r::Required, d::RepeatCount.bounded(1),
2288
- b::Element(e::Required, "Number of Included Segments"),
2289
- b::Element(e::Required, "Transaction Set Control Number"))))
2290
-
2291
- end
2292
- end
2293
- end
2294
- end