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
  2001. data/spec/support/quickcheck.rb +0 -303
  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
@@ -1,2579 +0,0 @@
1
- # frozen_string_literal: true
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- module Stupidedi
3
- using Refinements
4
-
5
- module Guides
6
- module FiftyTen
7
- module X223
8
-
9
- b = GuideBuilder
10
- d = Schema
11
- r = SegmentReqs
12
- e = ElementReqs
13
- s = Versions::FunctionalGroups::FiftyTen::SegmentDefs
14
- t = Versions::FunctionalGroups::FiftyTen::TransactionSetDefs
15
-
16
- loop2300 =
17
- d::LoopDef.build("2300 CLAIM INFORMATION",
18
- d::RepeatCount.bounded(100),
19
- b::Segment(1300, s::CLM, "Claim Information",
20
- r::Required, d::RepeatCount.bounded(1),
21
- b::Element(e::Required, "Patient Control Number", b::MaxLength(20)),
22
- b::Element(e::Required, "Total Claim Charge Amount"),
23
- b::Element(e::NotUsed, "Claim Filing Indicator Code"),
24
- b::Element(e::NotUsed, "Non-Institutional Claim Type Code"),
25
- b::Element(e::Required, "HEALTH CARE SERVICE LOCATION INFORMATION",
26
- b::Element(e::Required, "Facility Type Code"),
27
- b::Element(e::Required, "Facility Code Qualifier", b::Values("A")),
28
- b::Element(e::Required, "Claim Frequency Code")),
29
- b::Element(e::NotUsed, "Yes/No Condition or Response Code"),
30
- b::Element(e::Required, "Assignment or Plan Participation Code", b::Values("A", "B", "C")),
31
- b::Element(e::Required, "Benefits Assignment Certification Indicator", b::Values("N", "W", "Y")),
32
- b::Element(e::Required, "Release of Information Code", b::Values("I", "Y")),
33
- b::Element(e::NotUsed, "Patient Signature Source Code"),
34
- b::Element(e::NotUsed, "RELATED CAUSES INFORMATION"),
35
- b::Element(e::NotUsed, "Special Program Code"),
36
- b::Element(e::NotUsed, "Yes/No Condition or Response Code"),
37
- b::Element(e::NotUsed, "Level of Service Code"),
38
- b::Element(e::NotUsed, "Yes/No Condition or Response Code"),
39
- b::Element(e::NotUsed, "Provider Agreement Code"),
40
- b::Element(e::NotUsed, "Claim Status Code"),
41
- b::Element(e::NotUsed, "Yes/No Condition or Response Code"),
42
- b::Element(e::NotUsed, "Claim Submission Reason Code"),
43
- b::Element(e::Situational, "Delay Reason Code", b::Values("1", "2", "3", "4", "5", "6", "7", "8", "9", "10", "11", "15"))),
44
- b::Segment(1350, s::DTP, "Discharge Hour",
45
- r::Situational, d::RepeatCount.bounded(1),
46
- b::Element(e::Required, "Date Time Qualifier", b::Values("096")),
47
- b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("TM")),
48
- b::Element(e::Required, "Discharge Time")),
49
- b::Segment(1350, s::DTP, "Statement Dates",
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- r::Required, d::RepeatCount.bounded(1),
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- b::Element(e::Required, "Date Time Qualifier", b::Values("434")),
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- b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("RD8")),
53
- b::Element(e::Required, "Statement From and To Date")),
54
- b::Segment(1350, s::DTP, "Admission Date/Hour",
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- r::Situational, d::RepeatCount.bounded(1),
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- b::Element(e::Required, "Date Time Qualifier", b::Values("435")),
57
- b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8", "DT")),
58
- b::Element(e::Required, "Admission Date and Hour")),
59
- b::Segment(1350, s::DTP, "Date - Repricer Received Date",
60
- r::Situational, d::RepeatCount.bounded(1),
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- b::Element(e::Required, "Date Time Qualifier", b::Values("050")),
62
- b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
63
- b::Element(e::Required, "Repricer Received Date")),
64
- b::Segment(1400, s::CL1, "Institutional Claim Code",
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- r::Required, d::RepeatCount.bounded(1),
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- b::Element(e::Situational, "Admission Type Code"),
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- b::Element(e::Situational, "Admission Source Code"),
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- b::Element(e::Required, "Patient Status Code"),
69
- b::Element(e::NotUsed, "Nursing Home Residential Status Code")),
70
- b::Segment(1550, s::PWK, "Claim Supplemental Information",
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- r::Situational, d::RepeatCount.bounded(10),
72
- 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")),
73
- b::Element(e::Required, "Attachment Transmission Code", b::Values("AA", "BM", "EL", "EM", "FT", "FX")),
74
- b::Element(e::NotUsed, "Report Copies Needed"),
75
- b::Element(e::NotUsed, "Entity Identifier Code"),
76
- b::Element(e::Situational, "Identification Code Qualifier", b::Values("AC")),
77
- b::Element(e::Situational, "Attachment Control Number", b::MaxLength(50)),
78
- b::Element(e::NotUsed, "Description"),
79
- b::Element(e::NotUsed, "ACTIONS INDICATED"),
80
- b::Element(e::NotUsed, "Request Category Code")),
81
- b::Segment(1600, s::CN1, "Contract Information",
82
- r::Situational, d::RepeatCount.bounded(1),
83
- b::Element(e::Required, "Contract Type Code", b::Values("01", "02", "03", "04", "05", "06", "09")),
84
- b::Element(e::Situational, "Contract Amount"),
85
- b::Element(e::Situational, "Contract Percentage"),
86
- b::Element(e::Situational, "Contract Code"),
87
- b::Element(e::Situational, "Terms Discount Percentage"),
88
- b::Element(e::Situational, "Contract Version Identifier")),
89
- b::Segment(1750, s::AMT, "Patient Estimated Amount Due",
90
- r::Situational, d::RepeatCount.bounded(1),
91
- b::Element(e::Required, "Amount Qualifier Code", b::Values("F3")),
92
- b::Element(e::Required, "Patient Responsibility Amount"),
93
- b::Element(e::NotUsed, "Credit/Debit Flag Code")),
94
- b::Segment(1800, s::REF, "Service Authorization Exception Code",
95
- r::Situational, d::RepeatCount.bounded(1),
96
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("4N")),
97
- b::Element(e::Required, "Service Authorization Exception Code", b::Values("1", "2", "3", "4", "5", "6", "7")),
98
- b::Element(e::NotUsed, "Description"),
99
- b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
100
- b::Segment(1800, s::REF, "Referral Number",
101
- r::Situational, d::RepeatCount.bounded(1),
102
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("9F")),
103
- b::Element(e::Required, "Referral Number"),
104
- b::Element(e::NotUsed, "Description"),
105
- b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
106
- b::Segment(1800, s::REF, "Prior Authorization",
107
- r::Situational, d::RepeatCount.bounded(1),
108
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("G1")),
109
- b::Element(e::Required, "Prior Authorization Number"),
110
- b::Element(e::NotUsed, "Description"),
111
- b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
112
- b::Segment(1800, s::REF, "Payer Claim Control Number",
113
- r::Situational, d::RepeatCount.bounded(1),
114
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("F8")),
115
- b::Element(e::Required, "Payer Claim Control Number"),
116
- b::Element(e::NotUsed, "Description"),
117
- b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
118
- b::Segment(1800, s::REF, "Repriced Claim Number",
119
- r::Situational, d::RepeatCount.bounded(1),
120
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("9A")),
121
- b::Element(e::Required, "Repriced Claim Reference Number"),
122
- b::Element(e::NotUsed, "Description"),
123
- b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
124
- b::Segment(1800, s::REF, "Adjusted Repriced Claim Number",
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- r::Situational, d::RepeatCount.bounded(1),
126
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("9C")),
127
- b::Element(e::Required, "Adjusted Repriced Claim Reference Number"),
128
- b::Element(e::NotUsed, "Description"),
129
- b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
130
- b::Segment(1800, s::REF, "Investigational Device Exemption Number",
131
- r::Situational, d::RepeatCount.bounded(5),
132
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("LX")),
133
- b::Element(e::Required, "Investigational Device Exemption Identifier"),
134
- b::Element(e::NotUsed, "Description"),
135
- b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
136
- b::Segment(1800, s::REF, "Claim Identifier for Transmission Intermediaries",
137
- r::Situational, d::RepeatCount.bounded(1),
138
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("D9")),
139
- b::Element(e::Required, "Value Added Network Trace Number", b::MaxLength(20)),
140
- b::Element(e::NotUsed, "Description"),
141
- b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
142
- b::Segment(1800, s::REF, "Auto Accident State",
143
- r::Situational, d::RepeatCount.bounded(1),
144
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("LU")),
145
- b::Element(e::Required, "Auto Accident State or Province Code"),
146
- b::Element(e::NotUsed, "Description"),
147
- b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
148
- b::Segment(1800, s::REF, "Medical Record Number",
149
- r::Situational, d::RepeatCount.bounded(1),
150
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("EA")),
151
- b::Element(e::Required, "Medical Record Number"),
152
- b::Element(e::NotUsed, "Description"),
153
- b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
154
- b::Segment(1800, s::REF, "Demonstration Project Identifier",
155
- r::Situational, d::RepeatCount.bounded(1),
156
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("P4")),
157
- b::Element(e::Required, "Demonstration Project Identifier"),
158
- b::Element(e::NotUsed, "Description"),
159
- b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
160
- b::Segment(1800, s::REF, "Peer Review Organization (PRO) Approval Number",
161
- r::Situational, d::RepeatCount.bounded(1),
162
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("G4")),
163
- b::Element(e::Required, "Peer Review Authorization Number"),
164
- b::Element(e::NotUsed, "Description"),
165
- b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
166
- b::Segment(1850, s::K3, "File Information",
167
- r::Situational, d::RepeatCount.bounded(10),
168
- b::Element(e::Required, "Fixed Format Information"),
169
- b::Element(e::NotUsed, "Record Format Code"),
170
- b::Element(e::NotUsed, "COMPOSITE UNIT OF MEASURE")),
171
- b::Segment(1900, s::NTE, "Claim Note",
172
- r::Situational, d::RepeatCount.bounded(10),
173
- b::Element(e::Required, "Note Reference Code", b::Values("ALG", "DCP", "DGN", "DME", "MED", "NTR", "ODT", "RHB", "RLH", "RNH", "SET", "SFM", "SPT", "UPI")),
174
- b::Element(e::Required, "Claim Note Text")),
175
- b::Segment(1900, s::NTE, "Billing Note",
176
- r::Situational, d::RepeatCount.bounded(1),
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- b::Element(e::Required, "Note Reference Code", b::Values("ADD")),
178
- b::Element(e::Required, "Billing Note Text")),
179
- b::Segment(2200, s::CRC, "EPSDT Referral",
180
- r::Situational, d::RepeatCount.bounded(1),
181
- b::Element(e::Required, "Code Category", b::Values("ZZ")),
182
- b::Element(e::Required, "Certification Condition Indicator", b::Values("Y", "N")),
183
- b::Element(e::Required, "Condition Code", b::Values("AV", "NU", "S2", "ST")),
184
- b::Element(e::Situational, "Condition Code", b::Values("AV", "NU", "S2", "ST")),
185
- b::Element(e::Situational, "Condition Code", b::Values("AV", "NU", "S2", "ST")),
186
- b::Element(e::NotUsed, "Condition Indicator"),
187
- b::Element(e::NotUsed, "Condition Indicator")),
188
- b::Segment(2310, s::HI, "Principal Diagnosis",
189
- r::Required, d::RepeatCount.bounded(1),
190
- b::Element(e::Required, "HEALTH CARE CODE INFORMATION",
191
- b::Element(e::Required, "Code List Qualifier", b::Values("ABK", "BK")),
192
- b::Element(e::Required, "Principal Diagnosis Code"),
193
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
194
- b::Element(e::NotUsed, "Date Time Period"),
195
- b::Element(e::NotUsed, "Monetary Amount"),
196
- b::Element(e::NotUsed, "Quantity"),
197
- b::Element(e::NotUsed, "Version Identifier"),
198
- b::Element(e::NotUsed, "Industry Code"),
199
- b::Element(e::Situational, "Yes/No Condition or Response Code", b::Values("N", "U", "W", "Y"))),
200
- b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
201
- b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
202
- b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
203
- b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
204
- b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
205
- b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
206
- b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
207
- b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
208
- b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
209
- b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
210
- b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION")),
211
- b::Segment(2310, s::HI, "Admitting Diagnosis",
212
- r::Situational, d::RepeatCount.bounded(1),
213
- b::Element(e::Required, "HEALTH CARE CODE INFORMATION",
214
- b::Element(e::Required, "Code List Qualifier", b::Values("ABJ", "BJ")),
215
- b::Element(e::Required, "Admitting Diagnosis Code"),
216
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
217
- b::Element(e::NotUsed, "Date Time Period"),
218
- b::Element(e::NotUsed, "Monetary Amount"),
219
- b::Element(e::NotUsed, "Quantity"),
220
- b::Element(e::NotUsed, "Version Identifier"),
221
- b::Element(e::NotUsed, "Industry Code"),
222
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
223
- b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
224
- b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
225
- b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
226
- b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
227
- b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
228
- b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
229
- b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
230
- b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
231
- b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
232
- b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
233
- b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION")),
234
- b::Segment(2310, s::HI, "Patient's Reason For Visit",
235
- r::Situational, d::RepeatCount.bounded(1),
236
- b::Element(e::Required, "HEALTH CARE CODE INFORMATION",
237
- b::Element(e::Required, "Code List Qualifier", b::Values("APR", "PR")),
238
- b::Element(e::Required, "Patient Reason For Visit"),
239
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
240
- b::Element(e::NotUsed, "Date Time Period"),
241
- b::Element(e::NotUsed, "Monetary Amount"),
242
- b::Element(e::NotUsed, "Quantity"),
243
- b::Element(e::NotUsed, "Version Identifier"),
244
- b::Element(e::NotUsed, "Industry Code"),
245
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
246
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
247
- b::Element(e::Required, "Code List Qualifier", b::Values("APR", "PR")),
248
- b::Element(e::Required, "Patient Reason For Visit"),
249
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
250
- b::Element(e::NotUsed, "Date Time Period"),
251
- b::Element(e::NotUsed, "Monetary Amount"),
252
- b::Element(e::NotUsed, "Quantity"),
253
- b::Element(e::NotUsed, "Version Identifier"),
254
- b::Element(e::NotUsed, "Industry Code"),
255
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
256
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
257
- b::Element(e::Required, "Code List Qualifier", b::Values("APR", "PR")),
258
- b::Element(e::Required, "Patient Reason For Visit"),
259
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
260
- b::Element(e::NotUsed, "Date Time Period"),
261
- b::Element(e::NotUsed, "Monetary Amount"),
262
- b::Element(e::NotUsed, "Quantity"),
263
- b::Element(e::NotUsed, "Version Identifier"),
264
- b::Element(e::NotUsed, "Industry Code"),
265
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
266
- b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
267
- b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
268
- b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
269
- b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
270
- b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
271
- b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
272
- b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
273
- b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
274
- b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION")),
275
- b::Segment(2310, s::HI, "External Cause of Injury",
276
- r::Situational, d::RepeatCount.bounded(1),
277
- b::Element(e::Required, "HEALTH CARE CODE INFORMATION",
278
- b::Element(e::Required, "Code List Qualifier Code", b::Values("ABN", "BN")),
279
- b::Element(e::Required, "External Cause of Injury Code"),
280
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
281
- b::Element(e::NotUsed, "Date Time Period"),
282
- b::Element(e::NotUsed, "Monetary Amount"),
283
- b::Element(e::NotUsed, "Quantity"),
284
- b::Element(e::NotUsed, "Version Identifier"),
285
- b::Element(e::NotUsed, "Industry Code"),
286
- b::Element(e::Situational, "Present on Admission Indicator", b::Values("N", "U", "W", "Y"))),
287
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
288
- b::Element(e::Required, "Code List Qualifier Code", b::Values("ABN", "BN")),
289
- b::Element(e::Required, "External Cause of Injury Code"),
290
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
291
- b::Element(e::NotUsed, "Date Time Period"),
292
- b::Element(e::NotUsed, "Monetary Amount"),
293
- b::Element(e::NotUsed, "Quantity"),
294
- b::Element(e::NotUsed, "Version Identifier"),
295
- b::Element(e::NotUsed, "Industry Code"),
296
- b::Element(e::Situational, "Present on Admission Indicator", b::Values("N", "U", "W", "Y"))),
297
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
298
- b::Element(e::Required, "Code List Qualifier Code", b::Values("ABN", "BN")),
299
- b::Element(e::Required, "External Cause of Injury Code"),
300
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
301
- b::Element(e::NotUsed, "Date Time Period"),
302
- b::Element(e::NotUsed, "Monetary Amount"),
303
- b::Element(e::NotUsed, "Quantity"),
304
- b::Element(e::NotUsed, "Version Identifier"),
305
- b::Element(e::NotUsed, "Industry Code"),
306
- b::Element(e::Situational, "Present on Admission Indicator", b::Values("N", "U", "W", "Y"))),
307
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
308
- b::Element(e::Required, "Code List Qualifier Code", b::Values("ABN", "BN")),
309
- b::Element(e::Required, "External Cause of Injury Code"),
310
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
311
- b::Element(e::NotUsed, "Date Time Period"),
312
- b::Element(e::NotUsed, "Monetary Amount"),
313
- b::Element(e::NotUsed, "Quantity"),
314
- b::Element(e::NotUsed, "Version Identifier"),
315
- b::Element(e::NotUsed, "Industry Code"),
316
- b::Element(e::Situational, "Present on Admission Indicator", b::Values("N", "U", "W", "Y"))),
317
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
318
- b::Element(e::Required, "Code List Qualifier Code", b::Values("ABN", "BN")),
319
- b::Element(e::Required, "External Cause of Injury Code"),
320
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
321
- b::Element(e::NotUsed, "Date Time Period"),
322
- b::Element(e::NotUsed, "Monetary Amount"),
323
- b::Element(e::NotUsed, "Quantity"),
324
- b::Element(e::NotUsed, "Version Identifier"),
325
- b::Element(e::NotUsed, "Industry Code"),
326
- b::Element(e::Situational, "Present on Admission Indicator", b::Values("N", "U", "W", "Y"))),
327
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
328
- b::Element(e::Required, "Code List Qualifier Code", b::Values("ABN", "BN")),
329
- b::Element(e::Required, "External Cause of Injury Code"),
330
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
331
- b::Element(e::NotUsed, "Date Time Period"),
332
- b::Element(e::NotUsed, "Monetary Amount"),
333
- b::Element(e::NotUsed, "Quantity"),
334
- b::Element(e::NotUsed, "Version Identifier"),
335
- b::Element(e::NotUsed, "Industry Code"),
336
- b::Element(e::Situational, "Present on Admission Indicator", b::Values("N", "U", "W", "Y"))),
337
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
338
- b::Element(e::Required, "Code List Qualifier Code", b::Values("ABN", "BN")),
339
- b::Element(e::Required, "External Cause of Injury Code"),
340
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
341
- b::Element(e::NotUsed, "Date Time Period"),
342
- b::Element(e::NotUsed, "Monetary Amount"),
343
- b::Element(e::NotUsed, "Quantity"),
344
- b::Element(e::NotUsed, "Version Identifier"),
345
- b::Element(e::NotUsed, "Industry Code"),
346
- b::Element(e::Situational, "Present on Admission Indicator", b::Values("N", "U", "W", "Y"))),
347
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
348
- b::Element(e::Required, "Code List Qualifier Code", b::Values("ABN", "BN")),
349
- b::Element(e::Required, "External Cause of Injury Code"),
350
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
351
- b::Element(e::NotUsed, "Date Time Period"),
352
- b::Element(e::NotUsed, "Monetary Amount"),
353
- b::Element(e::NotUsed, "Quantity"),
354
- b::Element(e::NotUsed, "Version Identifier"),
355
- b::Element(e::NotUsed, "Industry Code"),
356
- b::Element(e::Situational, "Present on Admission Indicator", b::Values("N", "U", "W", "Y"))),
357
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
358
- b::Element(e::Required, "Code List Qualifier Code", b::Values("ABN", "BN")),
359
- b::Element(e::Required, "External Cause of Injury Code"),
360
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
361
- b::Element(e::NotUsed, "Date Time Period"),
362
- b::Element(e::NotUsed, "Monetary Amount"),
363
- b::Element(e::NotUsed, "Quantity"),
364
- b::Element(e::NotUsed, "Version Identifier"),
365
- b::Element(e::NotUsed, "Industry Code"),
366
- b::Element(e::Situational, "Present on Admission Indicator", b::Values("N", "U", "W", "Y"))),
367
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
368
- b::Element(e::Required, "Code List Qualifier Code", b::Values("ABN", "BN")),
369
- b::Element(e::Required, "External Cause of Injury Code"),
370
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
371
- b::Element(e::NotUsed, "Date Time Period"),
372
- b::Element(e::NotUsed, "Monetary Amount"),
373
- b::Element(e::NotUsed, "Quantity"),
374
- b::Element(e::NotUsed, "Version Identifier"),
375
- b::Element(e::NotUsed, "Industry Code"),
376
- b::Element(e::Situational, "Present on Admission Indicator", b::Values("N", "U", "W", "Y"))),
377
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
378
- b::Element(e::Required, "Code List Qualifier Code", b::Values("ABN", "BN")),
379
- b::Element(e::Required, "External Cause of Injury Code"),
380
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
381
- b::Element(e::NotUsed, "Date Time Period"),
382
- b::Element(e::NotUsed, "Monetary Amount"),
383
- b::Element(e::NotUsed, "Quantity"),
384
- b::Element(e::NotUsed, "Version Identifier"),
385
- b::Element(e::NotUsed, "Industry Code"),
386
- b::Element(e::Situational, "Present on Admission Indicator", b::Values("N", "U", "W", "Y"))),
387
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
388
- b::Element(e::Required, "Code List Qualifier Code", b::Values("ABN", "BN")),
389
- b::Element(e::Required, "External Cause of Injury Code"),
390
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
391
- b::Element(e::NotUsed, "Date Time Period"),
392
- b::Element(e::NotUsed, "Monetary Amount"),
393
- b::Element(e::NotUsed, "Quantity"),
394
- b::Element(e::NotUsed, "Version Identifier"),
395
- b::Element(e::NotUsed, "Industry Code"),
396
- b::Element(e::Situational, "Present on Admission Indicator", b::Values("N", "U", "W", "Y")))),
397
- b::Segment(2310, s::HI, "Diagnosis Related Group (DRG) Information",
398
- r::Situational, d::RepeatCount.bounded(1),
399
- b::Element(e::Required, "HEALTH CARE CODE INFORMATION",
400
- b::Element(e::Required, "Code List Qualifier Code", b::Values("DR")),
401
- b::Element(e::Required, "Diagnosis Related Group (DRG) Code"),
402
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
403
- b::Element(e::NotUsed, "Date Time Period"),
404
- b::Element(e::NotUsed, "Monetary Amount"),
405
- b::Element(e::NotUsed, "Quantity"),
406
- b::Element(e::NotUsed, "Version Identifier"),
407
- b::Element(e::NotUsed, "Industry Code"),
408
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
409
- b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
410
- b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
411
- b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
412
- b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
413
- b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
414
- b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
415
- b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
416
- b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
417
- b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
418
- b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
419
- b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION")),
420
- b::Segment(2310, s::HI, "Other Diagnosis Information",
421
- r::Situational, d::RepeatCount.bounded(2),
422
- b::Element(e::Required, "HEALTH CARE CODE INFORMATION",
423
- b::Element(e::Required, "Code List Qualifier Code", b::Values("ABF", "BF")),
424
- b::Element(e::Required, "Other Diagnosis"),
425
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
426
- b::Element(e::NotUsed, "Date Time Period"),
427
- b::Element(e::NotUsed, "Monetary Amount"),
428
- b::Element(e::NotUsed, "Quantity"),
429
- b::Element(e::NotUsed, "Version Identifier"),
430
- b::Element(e::NotUsed, "Industry Code"),
431
- b::Element(e::Situational, "Present on Admission Indicator", b::Values("N", "U", "W", "Y"))),
432
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
433
- b::Element(e::Required, "Code List Qualifier Code", b::Values("ABF", "BF")),
434
- b::Element(e::Required, "Other Diagnosis"),
435
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
436
- b::Element(e::NotUsed, "Date Time Period"),
437
- b::Element(e::NotUsed, "Monetary Amount"),
438
- b::Element(e::NotUsed, "Quantity"),
439
- b::Element(e::NotUsed, "Version Identifier"),
440
- b::Element(e::NotUsed, "Industry Code"),
441
- b::Element(e::Situational, "Present on Admission Indicator", b::Values("N", "U", "W", "Y"))),
442
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
443
- b::Element(e::Required, "Code List Qualifier Code", b::Values("ABF", "BF")),
444
- b::Element(e::Required, "Other Diagnosis"),
445
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
446
- b::Element(e::NotUsed, "Date Time Period"),
447
- b::Element(e::NotUsed, "Monetary Amount"),
448
- b::Element(e::NotUsed, "Quantity"),
449
- b::Element(e::NotUsed, "Version Identifier"),
450
- b::Element(e::NotUsed, "Industry Code"),
451
- b::Element(e::Situational, "Present on Admission Indicator", b::Values("N", "U", "W", "Y"))),
452
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
453
- b::Element(e::Required, "Code List Qualifier Code", b::Values("ABF", "BF")),
454
- b::Element(e::Required, "Other Diagnosis"),
455
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
456
- b::Element(e::NotUsed, "Date Time Period"),
457
- b::Element(e::NotUsed, "Monetary Amount"),
458
- b::Element(e::NotUsed, "Quantity"),
459
- b::Element(e::NotUsed, "Version Identifier"),
460
- b::Element(e::NotUsed, "Industry Code"),
461
- b::Element(e::Situational, "Present on Admission Indicator", b::Values("N", "U", "W", "Y"))),
462
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
463
- b::Element(e::Required, "Code List Qualifier Code", b::Values("ABF", "BF")),
464
- b::Element(e::Required, "Other Diagnosis"),
465
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
466
- b::Element(e::NotUsed, "Date Time Period"),
467
- b::Element(e::NotUsed, "Monetary Amount"),
468
- b::Element(e::NotUsed, "Quantity"),
469
- b::Element(e::NotUsed, "Version Identifier"),
470
- b::Element(e::NotUsed, "Industry Code"),
471
- b::Element(e::Situational, "Present on Admission Indicator", b::Values("N", "U", "W", "Y"))),
472
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
473
- b::Element(e::Required, "Code List Qualifier Code", b::Values("ABF", "BF")),
474
- b::Element(e::Required, "Other Diagnosis"),
475
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
476
- b::Element(e::NotUsed, "Date Time Period"),
477
- b::Element(e::NotUsed, "Monetary Amount"),
478
- b::Element(e::NotUsed, "Quantity"),
479
- b::Element(e::NotUsed, "Version Identifier"),
480
- b::Element(e::NotUsed, "Industry Code"),
481
- b::Element(e::Situational, "Present on Admission Indicator", b::Values("N", "U", "W", "Y"))),
482
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
483
- b::Element(e::Required, "Code List Qualifier Code", b::Values("ABF", "BF")),
484
- b::Element(e::Required, "Other Diagnosis"),
485
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
486
- b::Element(e::NotUsed, "Date Time Period"),
487
- b::Element(e::NotUsed, "Monetary Amount"),
488
- b::Element(e::NotUsed, "Quantity"),
489
- b::Element(e::NotUsed, "Version Identifier"),
490
- b::Element(e::NotUsed, "Industry Code"),
491
- b::Element(e::Situational, "Present on Admission Indicator", b::Values("N", "U", "W", "Y"))),
492
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
493
- b::Element(e::Required, "Code List Qualifier Code", b::Values("ABF", "BF")),
494
- b::Element(e::Required, "Other Diagnosis"),
495
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
496
- b::Element(e::NotUsed, "Date Time Period"),
497
- b::Element(e::NotUsed, "Monetary Amount"),
498
- b::Element(e::NotUsed, "Quantity"),
499
- b::Element(e::NotUsed, "Version Identifier"),
500
- b::Element(e::NotUsed, "Industry Code"),
501
- b::Element(e::Situational, "Present on Admission Indicator", b::Values("N", "U", "W", "Y"))),
502
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
503
- b::Element(e::Required, "Code List Qualifier Code", b::Values("ABF", "BF")),
504
- b::Element(e::Required, "Other Diagnosis"),
505
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
506
- b::Element(e::NotUsed, "Date Time Period"),
507
- b::Element(e::NotUsed, "Monetary Amount"),
508
- b::Element(e::NotUsed, "Quantity"),
509
- b::Element(e::NotUsed, "Version Identifier"),
510
- b::Element(e::NotUsed, "Industry Code"),
511
- b::Element(e::Situational, "Present on Admission Indicator", b::Values("N", "U", "W", "Y"))),
512
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
513
- b::Element(e::Required, "Code List Qualifier Code", b::Values("ABF", "BF")),
514
- b::Element(e::Required, "Other Diagnosis"),
515
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
516
- b::Element(e::NotUsed, "Date Time Period"),
517
- b::Element(e::NotUsed, "Monetary Amount"),
518
- b::Element(e::NotUsed, "Quantity"),
519
- b::Element(e::NotUsed, "Version Identifier"),
520
- b::Element(e::NotUsed, "Industry Code"),
521
- b::Element(e::Situational, "Present on Admission Indicator", b::Values("N", "U", "W", "Y"))),
522
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
523
- b::Element(e::Required, "Code List Qualifier Code", b::Values("ABF", "BF")),
524
- b::Element(e::Required, "Other Diagnosis"),
525
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
526
- b::Element(e::NotUsed, "Date Time Period"),
527
- b::Element(e::NotUsed, "Monetary Amount"),
528
- b::Element(e::NotUsed, "Quantity"),
529
- b::Element(e::NotUsed, "Version Identifier"),
530
- b::Element(e::NotUsed, "Industry Code"),
531
- b::Element(e::Situational, "Present on Admission Indicator", b::Values("N", "U", "W", "Y"))),
532
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
533
- b::Element(e::Required, "Code List Qualifier Code", b::Values("ABF", "BF")),
534
- b::Element(e::Required, "Other Diagnosis"),
535
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
536
- b::Element(e::NotUsed, "Date Time Period"),
537
- b::Element(e::NotUsed, "Monetary Amount"),
538
- b::Element(e::NotUsed, "Quantity"),
539
- b::Element(e::NotUsed, "Version Identifier"),
540
- b::Element(e::NotUsed, "Industry Code"),
541
- b::Element(e::Situational, "Present on Admission Indicator", b::Values("N", "U", "W", "Y")))),
542
- b::Segment(2310, s::HI, "Principal Procedure Information",
543
- r::Situational, d::RepeatCount.bounded(1),
544
- b::Element(e::Required, "HEALTH CARE CODE INFORMATION",
545
- b::Element(e::Required, "Code List Qualifier Code", b::Values("BBR", "BR", "CAH")),
546
- b::Element(e::Required, "Principal Procedure Code"),
547
- b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
548
- b::Element(e::Required, "Principal Procedure Date"),
549
- b::Element(e::NotUsed, "Monetary Amount"),
550
- b::Element(e::NotUsed, "Quantity"),
551
- b::Element(e::NotUsed, "Version Identifier"),
552
- b::Element(e::NotUsed, "Industry Code"),
553
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
554
- b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
555
- b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
556
- b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
557
- b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
558
- b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
559
- b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
560
- b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
561
- b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
562
- b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
563
- b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
564
- b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION")),
565
- b::Segment(2310, s::HI, "Other Procedure Information",
566
- r::Situational, d::RepeatCount.bounded(2),
567
- b::Element(e::Required, "HEALTH CARE CODE INFORMATION",
568
- b::Element(e::Required, "Code List Qualifier Code", b::Values("BBQ", "BQ")),
569
- b::Element(e::Required, "Procedure Code"),
570
- b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
571
- b::Element(e::Required, "Procedure Date"),
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 Code", b::Values("BBQ", "BQ")),
579
- b::Element(e::Required, "Procedure Code"),
580
- b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
581
- b::Element(e::Required, "Procedure Date"),
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 Code", b::Values("BBQ", "BQ")),
589
- b::Element(e::Required, "Procedure Code"),
590
- b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
591
- b::Element(e::Required, "Procedure Date"),
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 Code", b::Values("BBQ", "BQ")),
599
- b::Element(e::Required, "Procedure Code"),
600
- b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
601
- b::Element(e::Required, "Procedure Date"),
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::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
608
- b::Element(e::Required, "Code List Qualifier Code", b::Values("BBQ", "BQ")),
609
- b::Element(e::Required, "Procedure Code"),
610
- b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
611
- b::Element(e::Required, "Procedure Date"),
612
- b::Element(e::NotUsed, "Monetary Amount"),
613
- b::Element(e::NotUsed, "Quantity"),
614
- b::Element(e::NotUsed, "Version Identifier"),
615
- b::Element(e::NotUsed, "Industry Code"),
616
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
617
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
618
- b::Element(e::Required, "Code List Qualifier Code", b::Values("BBQ", "BQ")),
619
- b::Element(e::Required, "Procedure Code"),
620
- b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
621
- b::Element(e::Required, "Procedure Date"),
622
- b::Element(e::NotUsed, "Monetary Amount"),
623
- b::Element(e::NotUsed, "Quantity"),
624
- b::Element(e::NotUsed, "Version Identifier"),
625
- b::Element(e::NotUsed, "Industry Code"),
626
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
627
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
628
- b::Element(e::Required, "Code List Qualifier Code", b::Values("BBQ", "BQ")),
629
- b::Element(e::Required, "Procedure Code"),
630
- b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
631
- b::Element(e::Required, "Procedure Date"),
632
- b::Element(e::NotUsed, "Monetary Amount"),
633
- b::Element(e::NotUsed, "Quantity"),
634
- b::Element(e::NotUsed, "Version Identifier"),
635
- b::Element(e::NotUsed, "Industry Code"),
636
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
637
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
638
- b::Element(e::Required, "Code List Qualifier Code", b::Values("BBQ", "BQ")),
639
- b::Element(e::Required, "Procedure Code"),
640
- b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
641
- b::Element(e::Required, "Procedure Date"),
642
- b::Element(e::NotUsed, "Monetary Amount"),
643
- b::Element(e::NotUsed, "Quantity"),
644
- b::Element(e::NotUsed, "Version Identifier"),
645
- b::Element(e::NotUsed, "Industry Code"),
646
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
647
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
648
- b::Element(e::Required, "Code List Qualifier Code", b::Values("BBQ", "BQ")),
649
- b::Element(e::Required, "Procedure Code"),
650
- b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
651
- b::Element(e::Required, "Procedure Date"),
652
- b::Element(e::NotUsed, "Monetary Amount"),
653
- b::Element(e::NotUsed, "Quantity"),
654
- b::Element(e::NotUsed, "Version Identifier"),
655
- b::Element(e::NotUsed, "Industry Code"),
656
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
657
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
658
- b::Element(e::Required, "Code List Qualifier Code", b::Values("BBQ", "BQ")),
659
- b::Element(e::Required, "Procedure Code"),
660
- b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
661
- b::Element(e::Required, "Procedure Date"),
662
- b::Element(e::NotUsed, "Monetary Amount"),
663
- b::Element(e::NotUsed, "Quantity"),
664
- b::Element(e::NotUsed, "Version Identifier"),
665
- b::Element(e::NotUsed, "Industry Code"),
666
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
667
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
668
- b::Element(e::Required, "Code List Qualifier Code", b::Values("BBQ", "BQ")),
669
- b::Element(e::Required, "Procedure Code"),
670
- b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
671
- b::Element(e::Required, "Procedure Date"),
672
- b::Element(e::NotUsed, "Monetary Amount"),
673
- b::Element(e::NotUsed, "Quantity"),
674
- b::Element(e::NotUsed, "Version Identifier"),
675
- b::Element(e::NotUsed, "Industry Code"),
676
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
677
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
678
- b::Element(e::Required, "Code List Qualifier Code", b::Values("BBQ", "BQ")),
679
- b::Element(e::Required, "Procedure Code"),
680
- b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
681
- b::Element(e::Required, "Procedure Date"),
682
- b::Element(e::NotUsed, "Monetary Amount"),
683
- b::Element(e::NotUsed, "Quantity"),
684
- b::Element(e::NotUsed, "Version Identifier"),
685
- b::Element(e::NotUsed, "Industry Code"),
686
- b::Element(e::NotUsed, "Yes/No Condition or Response Code"))),
687
- b::Segment(2310, s::HI, "Occurrence Span Information",
688
- r::Situational, d::RepeatCount.bounded(2),
689
- b::Element(e::Required, "HEALTH CLAIM CODE INFORMATION",
690
- b::Element(e::Required, "Code List Qualifier Code", b::Values("BI")),
691
- b::Element(e::Required, "Occurrence Span Code"),
692
- b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("RD8")),
693
- b::Element(e::Required, "Occurrence Span Code Date"),
694
- b::Element(e::NotUsed, "Monetary Amount"),
695
- b::Element(e::NotUsed, "Quantity"),
696
- b::Element(e::NotUsed, "Version Identifier"),
697
- b::Element(e::NotUsed, "Industry Code"),
698
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
699
- b::Element(e::Situational, "HEALTH CLAIM CODE INFORMATION",
700
- b::Element(e::Required, "Code List Qualifier Code", b::Values("BI")),
701
- b::Element(e::Required, "Occurrence Span Code"),
702
- b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("RD8")),
703
- b::Element(e::Required, "Occurrence Span Code Date"),
704
- b::Element(e::NotUsed, "Monetary Amount"),
705
- b::Element(e::NotUsed, "Quantity"),
706
- b::Element(e::NotUsed, "Version Identifier"),
707
- b::Element(e::NotUsed, "Industry Code"),
708
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
709
- b::Element(e::Situational, "HEALTH CLAIM CODE INFORMATION",
710
- b::Element(e::Required, "Code List Qualifier Code", b::Values("BI")),
711
- b::Element(e::Required, "Occurrence Span Code"),
712
- b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("RD8")),
713
- b::Element(e::Required, "Occurrence Span Code Date"),
714
- b::Element(e::NotUsed, "Monetary Amount"),
715
- b::Element(e::NotUsed, "Quantity"),
716
- b::Element(e::NotUsed, "Version Identifier"),
717
- b::Element(e::NotUsed, "Industry Code"),
718
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
719
- b::Element(e::Situational, "HEALTH CLAIM CODE INFORMATION",
720
- b::Element(e::Required, "Code List Qualifier Code", b::Values("BI")),
721
- b::Element(e::Required, "Occurrence Span Code"),
722
- b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("RD8")),
723
- b::Element(e::Required, "Occurrence Span Code Date"),
724
- b::Element(e::NotUsed, "Monetary Amount"),
725
- b::Element(e::NotUsed, "Quantity"),
726
- b::Element(e::NotUsed, "Version Identifier"),
727
- b::Element(e::NotUsed, "Industry Code"),
728
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
729
- b::Element(e::Situational, "HEALTH CLAIM CODE INFORMATION",
730
- b::Element(e::Required, "Code List Qualifier Code", b::Values("BI")),
731
- b::Element(e::Required, "Occurrence Span Code"),
732
- b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("RD8")),
733
- b::Element(e::Required, "Occurrence Span Code Date"),
734
- b::Element(e::NotUsed, "Monetary Amount"),
735
- b::Element(e::NotUsed, "Quantity"),
736
- b::Element(e::NotUsed, "Version Identifier"),
737
- b::Element(e::NotUsed, "Industry Code"),
738
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
739
- b::Element(e::Situational, "HEALTH CLAIM CODE INFORMATION",
740
- b::Element(e::Required, "Code List Qualifier Code", b::Values("BI")),
741
- b::Element(e::Required, "Occurrence Span Code"),
742
- b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("RD8")),
743
- b::Element(e::Required, "Occurrence Span Code Date"),
744
- b::Element(e::NotUsed, "Monetary Amount"),
745
- b::Element(e::NotUsed, "Quantity"),
746
- b::Element(e::NotUsed, "Version Identifier"),
747
- b::Element(e::NotUsed, "Industry Code"),
748
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
749
- b::Element(e::Situational, "HEALTH CLAIM CODE INFORMATION",
750
- b::Element(e::Required, "Code List Qualifier Code", b::Values("BI")),
751
- b::Element(e::Required, "Occurrence Span Code"),
752
- b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("RD8")),
753
- b::Element(e::Required, "Occurrence Span Code Date"),
754
- b::Element(e::NotUsed, "Monetary Amount"),
755
- b::Element(e::NotUsed, "Quantity"),
756
- b::Element(e::NotUsed, "Version Identifier"),
757
- b::Element(e::NotUsed, "Industry Code"),
758
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
759
- b::Element(e::Situational, "HEALTH CLAIM CODE INFORMATION",
760
- b::Element(e::Required, "Code List Qualifier Code", b::Values("BI")),
761
- b::Element(e::Required, "Occurrence Span Code"),
762
- b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("RD8")),
763
- b::Element(e::Required, "Occurrence Span Code Date"),
764
- b::Element(e::NotUsed, "Monetary Amount"),
765
- b::Element(e::NotUsed, "Quantity"),
766
- b::Element(e::NotUsed, "Version Identifier"),
767
- b::Element(e::NotUsed, "Industry Code"),
768
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
769
- b::Element(e::Situational, "HEALTH CLAIM CODE INFORMATION",
770
- b::Element(e::Required, "Code List Qualifier Code", b::Values("BI")),
771
- b::Element(e::Required, "Occurrence Span Code"),
772
- b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("RD8")),
773
- b::Element(e::Required, "Occurrence Span Code Date"),
774
- b::Element(e::NotUsed, "Monetary Amount"),
775
- b::Element(e::NotUsed, "Quantity"),
776
- b::Element(e::NotUsed, "Version Identifier"),
777
- b::Element(e::NotUsed, "Industry Code"),
778
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
779
- b::Element(e::Situational, "HEALTH CLAIM CODE INFORMATION",
780
- b::Element(e::Required, "Code List Qualifier Code", b::Values("BI")),
781
- b::Element(e::Required, "Occurrence Span Code"),
782
- b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("RD8")),
783
- b::Element(e::Required, "Occurrence Span Code Date"),
784
- b::Element(e::NotUsed, "Monetary Amount"),
785
- b::Element(e::NotUsed, "Quantity"),
786
- b::Element(e::NotUsed, "Version Identifier"),
787
- b::Element(e::NotUsed, "Industry Code"),
788
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
789
- b::Element(e::Situational, "HEALTH CLAIM CODE INFORMATION",
790
- b::Element(e::Required, "Code List Qualifier Code", b::Values("BI")),
791
- b::Element(e::Required, "Occurrence Span Code"),
792
- b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("RD8")),
793
- b::Element(e::Required, "Occurrence Span Code Date"),
794
- b::Element(e::NotUsed, "Monetary Amount"),
795
- b::Element(e::NotUsed, "Quantity"),
796
- b::Element(e::NotUsed, "Version Identifier"),
797
- b::Element(e::NotUsed, "Industry Code"),
798
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
799
- b::Element(e::Situational, "HEALTH CLAIM CODE INFORMATION",
800
- b::Element(e::Required, "Code List Qualifier Code", b::Values("BI")),
801
- b::Element(e::Required, "Occurrence Span Code"),
802
- b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("RD8")),
803
- b::Element(e::Required, "Occurrence Span Code Date"),
804
- b::Element(e::NotUsed, "Monetary Amount"),
805
- b::Element(e::NotUsed, "Quantity"),
806
- b::Element(e::NotUsed, "Version Identifier"),
807
- b::Element(e::NotUsed, "Industry Code"),
808
- b::Element(e::NotUsed, "Yes/No Condition or Response Code"))),
809
- b::Segment(2310, s::HI, "Occurrence Information",
810
- r::Situational, d::RepeatCount.bounded(2),
811
- b::Element(e::Required, "HEALTH CARE CODE INFORMATION",
812
- b::Element(e::Required, "Code List Qualifier Code", b::Values("BH")),
813
- b::Element(e::Required, "Occurrence Code"),
814
- b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
815
- b::Element(e::Required, "Occurrence Code Date"),
816
- b::Element(e::NotUsed, "Monetary Amount"),
817
- b::Element(e::NotUsed, "Quantity"),
818
- b::Element(e::NotUsed, "Version Identifier"),
819
- b::Element(e::NotUsed, "Industy Code"),
820
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
821
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
822
- b::Element(e::Required, "Code List Qualifier Code", b::Values("BH")),
823
- b::Element(e::Required, "Occurrence Code"),
824
- b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
825
- b::Element(e::Required, "Occurrence Code Date"),
826
- b::Element(e::NotUsed, "Monetary Amount"),
827
- b::Element(e::NotUsed, "Quantity"),
828
- b::Element(e::NotUsed, "Version Identifier"),
829
- b::Element(e::NotUsed, "Industy Code"),
830
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
831
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
832
- b::Element(e::Required, "Code List Qualifier Code", b::Values("BH")),
833
- b::Element(e::Required, "Occurrence Code"),
834
- b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
835
- b::Element(e::Required, "Occurrence Code Date"),
836
- b::Element(e::NotUsed, "Monetary Amount"),
837
- b::Element(e::NotUsed, "Quantity"),
838
- b::Element(e::NotUsed, "Version Identifier"),
839
- b::Element(e::NotUsed, "Industy Code"),
840
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
841
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
842
- b::Element(e::Required, "Code List Qualifier Code", b::Values("BH")),
843
- b::Element(e::Required, "Occurrence Code"),
844
- b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
845
- b::Element(e::Required, "Occurrence Code Date"),
846
- b::Element(e::NotUsed, "Monetary Amount"),
847
- b::Element(e::NotUsed, "Quantity"),
848
- b::Element(e::NotUsed, "Version Identifier"),
849
- b::Element(e::NotUsed, "Industy Code"),
850
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
851
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
852
- b::Element(e::Required, "Code List Qualifier Code", b::Values("BH")),
853
- b::Element(e::Required, "Occurrence Code"),
854
- b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
855
- b::Element(e::Required, "Occurrence Code Date"),
856
- b::Element(e::NotUsed, "Monetary Amount"),
857
- b::Element(e::NotUsed, "Quantity"),
858
- b::Element(e::NotUsed, "Version Identifier"),
859
- b::Element(e::NotUsed, "Industy Code"),
860
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
861
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
862
- b::Element(e::Required, "Code List Qualifier Code", b::Values("BH")),
863
- b::Element(e::Required, "Occurrence Code"),
864
- b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
865
- b::Element(e::Required, "Occurrence Code Date"),
866
- b::Element(e::NotUsed, "Monetary Amount"),
867
- b::Element(e::NotUsed, "Quantity"),
868
- b::Element(e::NotUsed, "Version Identifier"),
869
- b::Element(e::NotUsed, "Industy Code"),
870
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
871
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
872
- b::Element(e::Required, "Code List Qualifier Code", b::Values("BH")),
873
- b::Element(e::Required, "Occurrence Code"),
874
- b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
875
- b::Element(e::Required, "Occurrence Code Date"),
876
- b::Element(e::NotUsed, "Monetary Amount"),
877
- b::Element(e::NotUsed, "Quantity"),
878
- b::Element(e::NotUsed, "Version Identifier"),
879
- b::Element(e::NotUsed, "Industy Code"),
880
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
881
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
882
- b::Element(e::Required, "Code List Qualifier Code", b::Values("BH")),
883
- b::Element(e::Required, "Occurrence Code"),
884
- b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
885
- b::Element(e::Required, "Occurrence Code Date"),
886
- b::Element(e::NotUsed, "Monetary Amount"),
887
- b::Element(e::NotUsed, "Quantity"),
888
- b::Element(e::NotUsed, "Version Identifier"),
889
- b::Element(e::NotUsed, "Industy Code"),
890
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
891
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
892
- b::Element(e::Required, "Code List Qualifier Code", b::Values("BH")),
893
- b::Element(e::Required, "Occurrence Code"),
894
- b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
895
- b::Element(e::Required, "Occurrence Code Date"),
896
- b::Element(e::NotUsed, "Monetary Amount"),
897
- b::Element(e::NotUsed, "Quantity"),
898
- b::Element(e::NotUsed, "Version Identifier"),
899
- b::Element(e::NotUsed, "Industy Code"),
900
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
901
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
902
- b::Element(e::Required, "Code List Qualifier Code", b::Values("BH")),
903
- b::Element(e::Required, "Occurrence Code"),
904
- b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
905
- b::Element(e::Required, "Occurrence Code Date"),
906
- b::Element(e::NotUsed, "Monetary Amount"),
907
- b::Element(e::NotUsed, "Quantity"),
908
- b::Element(e::NotUsed, "Version Identifier"),
909
- b::Element(e::NotUsed, "Industy Code"),
910
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
911
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
912
- b::Element(e::Required, "Code List Qualifier Code", b::Values("BH")),
913
- b::Element(e::Required, "Occurrence Code"),
914
- b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
915
- b::Element(e::Required, "Occurrence Code Date"),
916
- b::Element(e::NotUsed, "Monetary Amount"),
917
- b::Element(e::NotUsed, "Quantity"),
918
- b::Element(e::NotUsed, "Version Identifier"),
919
- b::Element(e::NotUsed, "Industy Code"),
920
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
921
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
922
- b::Element(e::Required, "Code List Qualifier Code", b::Values("BH")),
923
- b::Element(e::Required, "Occurrence Code"),
924
- b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
925
- b::Element(e::Required, "Occurrence Code Date"),
926
- b::Element(e::NotUsed, "Monetary Amount"),
927
- b::Element(e::NotUsed, "Quantity"),
928
- b::Element(e::NotUsed, "Version Identifier"),
929
- b::Element(e::NotUsed, "Industy Code"),
930
- b::Element(e::NotUsed, "Yes/No Condition or Response Code"))),
931
- b::Segment(2310, s::HI, "Value Information",
932
- r::Situational, d::RepeatCount.bounded(2),
933
- b::Element(e::Required, "HEALTH CARE CODE INFORMATION",
934
- b::Element(e::Required, "Code List Qualifier Code", b::Values("BE")),
935
- b::Element(e::Required, "Value Code"),
936
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
937
- b::Element(e::NotUsed, "Date Time Period"),
938
- b::Element(e::Required, "Value Code Amount"),
939
- b::Element(e::NotUsed, "Quantity"),
940
- b::Element(e::NotUsed, "Version Identifier"),
941
- b::Element(e::NotUsed, "Industry Code"),
942
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
943
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
944
- b::Element(e::Required, "Code List Qualifier Code", b::Values("BE")),
945
- b::Element(e::Required, "Value Code"),
946
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
947
- b::Element(e::NotUsed, "Date Time Period"),
948
- b::Element(e::Required, "Value Code Amount"),
949
- b::Element(e::NotUsed, "Quantity"),
950
- b::Element(e::NotUsed, "Version Identifier"),
951
- b::Element(e::NotUsed, "Industry Code"),
952
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
953
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
954
- b::Element(e::Required, "Code List Qualifier Code", b::Values("BE")),
955
- b::Element(e::Required, "Value Code"),
956
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
957
- b::Element(e::NotUsed, "Date Time Period"),
958
- b::Element(e::Required, "Value Code Amount"),
959
- b::Element(e::NotUsed, "Quantity"),
960
- b::Element(e::NotUsed, "Version Identifier"),
961
- b::Element(e::NotUsed, "Industry Code"),
962
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
963
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
964
- b::Element(e::Required, "Code List Qualifier Code", b::Values("BE")),
965
- b::Element(e::Required, "Value Code"),
966
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
967
- b::Element(e::NotUsed, "Date Time Period"),
968
- b::Element(e::Required, "Value Code Amount"),
969
- b::Element(e::NotUsed, "Quantity"),
970
- b::Element(e::NotUsed, "Version Identifier"),
971
- b::Element(e::NotUsed, "Industry Code"),
972
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
973
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
974
- b::Element(e::Required, "Code List Qualifier Code", b::Values("BE")),
975
- b::Element(e::Required, "Value Code"),
976
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
977
- b::Element(e::NotUsed, "Date Time Period"),
978
- b::Element(e::Required, "Value Code Amount"),
979
- b::Element(e::NotUsed, "Quantity"),
980
- b::Element(e::NotUsed, "Version Identifier"),
981
- b::Element(e::NotUsed, "Industry Code"),
982
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
983
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
984
- b::Element(e::Required, "Code List Qualifier Code", b::Values("BE")),
985
- b::Element(e::Required, "Value Code"),
986
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
987
- b::Element(e::NotUsed, "Date Time Period"),
988
- b::Element(e::Required, "Value Code Amount"),
989
- b::Element(e::NotUsed, "Quantity"),
990
- b::Element(e::NotUsed, "Version Identifier"),
991
- b::Element(e::NotUsed, "Industry Code"),
992
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
993
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
994
- b::Element(e::Required, "Code List Qualifier Code", b::Values("BE")),
995
- b::Element(e::Required, "Value Code"),
996
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
997
- b::Element(e::NotUsed, "Date Time Period"),
998
- b::Element(e::Required, "Value Code Amount"),
999
- b::Element(e::NotUsed, "Quantity"),
1000
- b::Element(e::NotUsed, "Version Identifier"),
1001
- b::Element(e::NotUsed, "Industry Code"),
1002
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
1003
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
1004
- b::Element(e::Required, "Code List Qualifier Code", b::Values("BE")),
1005
- b::Element(e::Required, "Value Code"),
1006
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
1007
- b::Element(e::NotUsed, "Date Time Period"),
1008
- b::Element(e::Required, "Value Code Amount"),
1009
- b::Element(e::NotUsed, "Quantity"),
1010
- b::Element(e::NotUsed, "Version Identifier"),
1011
- b::Element(e::NotUsed, "Industry Code"),
1012
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
1013
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
1014
- b::Element(e::Required, "Code List Qualifier Code", b::Values("BE")),
1015
- b::Element(e::Required, "Value Code"),
1016
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
1017
- b::Element(e::NotUsed, "Date Time Period"),
1018
- b::Element(e::Required, "Value Code Amount"),
1019
- b::Element(e::NotUsed, "Quantity"),
1020
- b::Element(e::NotUsed, "Version Identifier"),
1021
- b::Element(e::NotUsed, "Industry Code"),
1022
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
1023
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
1024
- b::Element(e::Required, "Code List Qualifier Code", b::Values("BE")),
1025
- b::Element(e::Required, "Value Code"),
1026
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
1027
- b::Element(e::NotUsed, "Date Time Period"),
1028
- b::Element(e::Required, "Value Code Amount"),
1029
- b::Element(e::NotUsed, "Quantity"),
1030
- b::Element(e::NotUsed, "Version Identifier"),
1031
- b::Element(e::NotUsed, "Industry Code"),
1032
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
1033
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
1034
- b::Element(e::Required, "Code List Qualifier Code", b::Values("BE")),
1035
- b::Element(e::Required, "Value Code"),
1036
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
1037
- b::Element(e::NotUsed, "Date Time Period"),
1038
- b::Element(e::Required, "Value Code Amount"),
1039
- b::Element(e::NotUsed, "Quantity"),
1040
- b::Element(e::NotUsed, "Version Identifier"),
1041
- b::Element(e::NotUsed, "Industry Code"),
1042
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
1043
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
1044
- b::Element(e::Required, "Code List Qualifier Code", b::Values("BE")),
1045
- b::Element(e::Required, "Value Code"),
1046
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
1047
- b::Element(e::NotUsed, "Date Time Period"),
1048
- b::Element(e::Required, "Value Code Amount"),
1049
- b::Element(e::NotUsed, "Quantity"),
1050
- b::Element(e::NotUsed, "Version Identifier"),
1051
- b::Element(e::NotUsed, "Industry Code"),
1052
- b::Element(e::NotUsed, "Yes/No Condition or Response Code"))),
1053
- b::Segment(2310, s::HI, "Condition Information",
1054
- r::Situational, d::RepeatCount.bounded(2),
1055
- b::Element(e::Required, "HEALTH CARE CODE INFORMATION",
1056
- b::Element(e::Required, "Code List Qualifier Code", b::Values("BG")),
1057
- b::Element(e::Required, "Condition Code"),
1058
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
1059
- b::Element(e::NotUsed, "Date Time Period"),
1060
- b::Element(e::NotUsed, "Monetary Amount"),
1061
- b::Element(e::NotUsed, "Quantity"),
1062
- b::Element(e::NotUsed, "Version Identifier"),
1063
- b::Element(e::NotUsed, "Industry Code"),
1064
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
1065
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
1066
- b::Element(e::Required, "Code List Qualifier Code", b::Values("BG")),
1067
- b::Element(e::Required, "Condition Code"),
1068
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
1069
- b::Element(e::NotUsed, "Date Time Period"),
1070
- b::Element(e::NotUsed, "Monetary Amount"),
1071
- b::Element(e::NotUsed, "Quantity"),
1072
- b::Element(e::NotUsed, "Version Identifier"),
1073
- b::Element(e::NotUsed, "Industry Code"),
1074
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
1075
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
1076
- b::Element(e::Required, "Code List Qualifier Code", b::Values("BG")),
1077
- b::Element(e::Required, "Condition Code"),
1078
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
1079
- b::Element(e::NotUsed, "Date Time Period"),
1080
- b::Element(e::NotUsed, "Monetary Amount"),
1081
- b::Element(e::NotUsed, "Quantity"),
1082
- b::Element(e::NotUsed, "Version Identifier"),
1083
- b::Element(e::NotUsed, "Industry Code"),
1084
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
1085
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
1086
- b::Element(e::Required, "Code List Qualifier Code", b::Values("BG")),
1087
- b::Element(e::Required, "Condition Code"),
1088
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
1089
- b::Element(e::NotUsed, "Date Time Period"),
1090
- b::Element(e::NotUsed, "Monetary Amount"),
1091
- b::Element(e::NotUsed, "Quantity"),
1092
- b::Element(e::NotUsed, "Version Identifier"),
1093
- b::Element(e::NotUsed, "Industry Code"),
1094
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
1095
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
1096
- b::Element(e::Required, "Code List Qualifier Code", b::Values("BG")),
1097
- b::Element(e::Required, "Condition Code"),
1098
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
1099
- b::Element(e::NotUsed, "Date Time Period"),
1100
- b::Element(e::NotUsed, "Monetary Amount"),
1101
- b::Element(e::NotUsed, "Quantity"),
1102
- b::Element(e::NotUsed, "Version Identifier"),
1103
- b::Element(e::NotUsed, "Industry Code"),
1104
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
1105
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
1106
- b::Element(e::Required, "Code List Qualifier Code", b::Values("BG")),
1107
- b::Element(e::Required, "Condition Code"),
1108
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
1109
- b::Element(e::NotUsed, "Date Time Period"),
1110
- b::Element(e::NotUsed, "Monetary Amount"),
1111
- b::Element(e::NotUsed, "Quantity"),
1112
- b::Element(e::NotUsed, "Version Identifier"),
1113
- b::Element(e::NotUsed, "Industry Code"),
1114
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
1115
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
1116
- b::Element(e::Required, "Code List Qualifier Code", b::Values("BG")),
1117
- b::Element(e::Required, "Condition Code"),
1118
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
1119
- b::Element(e::NotUsed, "Date Time Period"),
1120
- b::Element(e::NotUsed, "Monetary Amount"),
1121
- b::Element(e::NotUsed, "Quantity"),
1122
- b::Element(e::NotUsed, "Version Identifier"),
1123
- b::Element(e::NotUsed, "Industry Code"),
1124
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
1125
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
1126
- b::Element(e::Required, "Code List Qualifier Code", b::Values("BG")),
1127
- b::Element(e::Required, "Condition Code"),
1128
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
1129
- b::Element(e::NotUsed, "Date Time Period"),
1130
- b::Element(e::NotUsed, "Monetary Amount"),
1131
- b::Element(e::NotUsed, "Quantity"),
1132
- b::Element(e::NotUsed, "Version Identifier"),
1133
- b::Element(e::NotUsed, "Industry Code"),
1134
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
1135
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
1136
- b::Element(e::Required, "Code List Qualifier Code", b::Values("BG")),
1137
- b::Element(e::Required, "Condition Code"),
1138
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
1139
- b::Element(e::NotUsed, "Date Time Period"),
1140
- b::Element(e::NotUsed, "Monetary Amount"),
1141
- b::Element(e::NotUsed, "Quantity"),
1142
- b::Element(e::NotUsed, "Version Identifier"),
1143
- b::Element(e::NotUsed, "Industry Code"),
1144
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
1145
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
1146
- b::Element(e::Required, "Code List Qualifier Code", b::Values("BG")),
1147
- b::Element(e::Required, "Condition Code"),
1148
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
1149
- b::Element(e::NotUsed, "Date Time Period"),
1150
- b::Element(e::NotUsed, "Monetary Amount"),
1151
- b::Element(e::NotUsed, "Quantity"),
1152
- b::Element(e::NotUsed, "Version Identifier"),
1153
- b::Element(e::NotUsed, "Industry Code"),
1154
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
1155
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
1156
- b::Element(e::Required, "Code List Qualifier Code", b::Values("BG")),
1157
- b::Element(e::Required, "Condition Code"),
1158
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
1159
- b::Element(e::NotUsed, "Date Time Period"),
1160
- b::Element(e::NotUsed, "Monetary Amount"),
1161
- b::Element(e::NotUsed, "Quantity"),
1162
- b::Element(e::NotUsed, "Version Identifier"),
1163
- b::Element(e::NotUsed, "Industry Code"),
1164
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
1165
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
1166
- b::Element(e::Required, "Code List Qualifier Code", b::Values("BG")),
1167
- b::Element(e::Required, "Condition Code"),
1168
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
1169
- b::Element(e::NotUsed, "Date Time Period"),
1170
- b::Element(e::NotUsed, "Monetary Amount"),
1171
- b::Element(e::NotUsed, "Quantity"),
1172
- b::Element(e::NotUsed, "Version Identifier"),
1173
- b::Element(e::NotUsed, "Industry Code"),
1174
- b::Element(e::NotUsed, "Yes/No Condition or Response Code"))),
1175
- b::Segment(2310, s::HI, "Treatment Code Information",
1176
- r::Situational, d::RepeatCount.bounded(2),
1177
- b::Element(e::Required, "HEALTH CARE CODE INFORMATION",
1178
- b::Element(e::Required, "Code List Qualifier Code", b::Values("TC")),
1179
- b::Element(e::Required, "Treatment Code"),
1180
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
1181
- b::Element(e::NotUsed, "Date Time Period"),
1182
- b::Element(e::NotUsed, "Monetary Amount"),
1183
- b::Element(e::NotUsed, "Quantity"),
1184
- b::Element(e::NotUsed, "Version Identifier"),
1185
- b::Element(e::NotUsed, "Industry Code"),
1186
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
1187
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
1188
- b::Element(e::Required, "Code List Qualifier Code", b::Values("TC")),
1189
- b::Element(e::Required, "Treatment Code"),
1190
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
1191
- b::Element(e::NotUsed, "Date Time Period"),
1192
- b::Element(e::NotUsed, "Monetary Amount"),
1193
- b::Element(e::NotUsed, "Quantity"),
1194
- b::Element(e::NotUsed, "Version Identifier"),
1195
- b::Element(e::NotUsed, "Industry Code"),
1196
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
1197
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
1198
- b::Element(e::Required, "Code List Qualifier Code", b::Values("TC")),
1199
- b::Element(e::Required, "Treatment Code"),
1200
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
1201
- b::Element(e::NotUsed, "Date Time Period"),
1202
- b::Element(e::NotUsed, "Monetary Amount"),
1203
- b::Element(e::NotUsed, "Quantity"),
1204
- b::Element(e::NotUsed, "Version Identifier"),
1205
- b::Element(e::NotUsed, "Industry Code"),
1206
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
1207
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
1208
- b::Element(e::Required, "Code List Qualifier Code", b::Values("TC")),
1209
- b::Element(e::Required, "Treatment Code"),
1210
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
1211
- b::Element(e::NotUsed, "Date Time Period"),
1212
- b::Element(e::NotUsed, "Monetary Amount"),
1213
- b::Element(e::NotUsed, "Quantity"),
1214
- b::Element(e::NotUsed, "Version Identifier"),
1215
- b::Element(e::NotUsed, "Industry Code"),
1216
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
1217
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
1218
- b::Element(e::Required, "Code List Qualifier Code", b::Values("TC")),
1219
- b::Element(e::Required, "Treatment Code"),
1220
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
1221
- b::Element(e::NotUsed, "Date Time Period"),
1222
- b::Element(e::NotUsed, "Monetary Amount"),
1223
- b::Element(e::NotUsed, "Quantity"),
1224
- b::Element(e::NotUsed, "Version Identifier"),
1225
- b::Element(e::NotUsed, "Industry Code"),
1226
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
1227
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
1228
- b::Element(e::Required, "Code List Qualifier Code", b::Values("TC")),
1229
- b::Element(e::Required, "Treatment Code"),
1230
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
1231
- b::Element(e::NotUsed, "Date Time Period"),
1232
- b::Element(e::NotUsed, "Monetary Amount"),
1233
- b::Element(e::NotUsed, "Quantity"),
1234
- b::Element(e::NotUsed, "Version Identifier"),
1235
- b::Element(e::NotUsed, "Industry Code"),
1236
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
1237
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
1238
- b::Element(e::Required, "Code List Qualifier Code", b::Values("TC")),
1239
- b::Element(e::Required, "Treatment Code"),
1240
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
1241
- b::Element(e::NotUsed, "Date Time Period"),
1242
- b::Element(e::NotUsed, "Monetary Amount"),
1243
- b::Element(e::NotUsed, "Quantity"),
1244
- b::Element(e::NotUsed, "Version Identifier"),
1245
- b::Element(e::NotUsed, "Industry Code"),
1246
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
1247
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
1248
- b::Element(e::Required, "Code List Qualifier Code", b::Values("TC")),
1249
- b::Element(e::Required, "Treatment Code"),
1250
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
1251
- b::Element(e::NotUsed, "Date Time Period"),
1252
- b::Element(e::NotUsed, "Monetary Amount"),
1253
- b::Element(e::NotUsed, "Quantity"),
1254
- b::Element(e::NotUsed, "Version Identifier"),
1255
- b::Element(e::NotUsed, "Industry Code"),
1256
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
1257
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
1258
- b::Element(e::Required, "Code List Qualifier Code", b::Values("TC")),
1259
- b::Element(e::Required, "Treatment Code"),
1260
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
1261
- b::Element(e::NotUsed, "Date Time Period"),
1262
- b::Element(e::NotUsed, "Monetary Amount"),
1263
- b::Element(e::NotUsed, "Quantity"),
1264
- b::Element(e::NotUsed, "Version Identifier"),
1265
- b::Element(e::NotUsed, "Industry Code"),
1266
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
1267
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
1268
- b::Element(e::Required, "Code List Qualifier Code", b::Values("TC")),
1269
- b::Element(e::Required, "Treatment Code"),
1270
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
1271
- b::Element(e::NotUsed, "Date Time Period"),
1272
- b::Element(e::NotUsed, "Monetary Amount"),
1273
- b::Element(e::NotUsed, "Quantity"),
1274
- b::Element(e::NotUsed, "Version Identifier"),
1275
- b::Element(e::NotUsed, "Industry Code"),
1276
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
1277
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
1278
- b::Element(e::Required, "Code List Qualifier Code", b::Values("TC")),
1279
- b::Element(e::Required, "Treatment Code"),
1280
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
1281
- b::Element(e::NotUsed, "Date Time Period"),
1282
- b::Element(e::NotUsed, "Monetary Amount"),
1283
- b::Element(e::NotUsed, "Quantity"),
1284
- b::Element(e::NotUsed, "Version Identifier"),
1285
- b::Element(e::NotUsed, "Industry Code"),
1286
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
1287
- b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
1288
- b::Element(e::Required, "Code List Qualifier Code", b::Values("TC")),
1289
- b::Element(e::Required, "Treatment Code"),
1290
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
1291
- b::Element(e::NotUsed, "Date Time Period"),
1292
- b::Element(e::NotUsed, "Monetary Amount"),
1293
- b::Element(e::NotUsed, "Quantity"),
1294
- b::Element(e::NotUsed, "Version Identifier"),
1295
- b::Element(e::NotUsed, "Industry Code"),
1296
- b::Element(e::NotUsed, "Yes/No Condition or Response Code"))),
1297
- b::Segment(2410, s::HCP, "Claim Pricing/Repricing Information",
1298
- r::Situational, d::RepeatCount.bounded(1),
1299
- b::Element(e::Required, "Pricing Methodology", b::Values("00", "01", "02", "03", "04", "05", "06", "07", "08", "09", "10", "11", "12", "13", "14")),
1300
- b::Element(e::Required, "Repriced Allowed Amount"),
1301
- b::Element(e::Situational, "Repriced Saving Amount"),
1302
- b::Element(e::Situational, "Repricing Organization Identifier"),
1303
- b::Element(e::Situational, "Repricing Per Diem or Flat Rate Amount"),
1304
- b::Element(e::Situational, "Repriced Approved DRG Code"),
1305
- b::Element(e::Situational, "Repriced Approved Amount"),
1306
- b::Element(e::Situational, "Repriced Approved Revenue Code"),
1307
- b::Element(e::NotUsed, "Product/Service Qualifier"),
1308
- b::Element(e::NotUsed, "Product/Service ID"),
1309
- b::Element(e::Situational, "Unit or Basis of Measurement Code", b::Values("DA", "UN")),
1310
- b::Element(e::Situational, "Repriced Approved Service Unit Count"),
1311
- b::Element(e::Situational, "Reject Reason Code", b::Values("T1", "T2", "T3", "T4", "T5", "T6")),
1312
- b::Element(e::Situational, "Policy Compliance Code", b::Values("1", "2", "3", "4", "5")),
1313
- b::Element(e::Situational, "Exception Code", b::Values("1", "2", "3", "4", "5", "6"))),
1314
-
1315
- d::LoopDef.build("2310A ATTENDING PROVIDER NAME",
1316
- d::RepeatCount.bounded(1),
1317
- b::Segment(2500, s::NM1, "Attending Provider Name",
1318
- r::Situational, d::RepeatCount.bounded(1),
1319
- b::Element(e::Required, "Entity Identifier Code", b::Values("71")),
1320
- b::Element(e::Required, "Entity Type Qualifier", b::Values("1")),
1321
- b::Element(e::Required, "Attending Provider Last Name"),
1322
- b::Element(e::Situational, "Attending Provider First Name"),
1323
- b::Element(e::Situational, "Attending Provider Middle Name or Initial"),
1324
- b::Element(e::NotUsed, "Name Prefix"),
1325
- b::Element(e::Situational, "Attending Provider Name Suffix"),
1326
- b::Element(e::Situational, "Identification Code Qualifier", b::Values("XX")),
1327
- b::Element(e::Situational, "Attending Provider Primary Identifier"),
1328
- b::Element(e::NotUsed, "Entity Relationship Code"),
1329
- b::Element(e::NotUsed, "Entity Identifier Code"),
1330
- b::Element(e::NotUsed, "Name Last or Organization Name")),
1331
- b::Segment(2550, s::PRV, "Attending Provider Specialty Information",
1332
- r::Situational, d::RepeatCount.bounded(1),
1333
- b::Element(e::Required, "Provider Code", b::Values("AT")),
1334
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("PXC")),
1335
- b::Element(e::Required, "Provider Taxonomy Code"),
1336
- b::Element(e::NotUsed, "State or Province Code"),
1337
- b::Element(e::NotUsed, "PROVIDER SPECIALITY INFORMATION"),
1338
- b::Element(e::NotUsed, "Provider Organization Code")),
1339
- b::Segment(2710, s::REF, "Attending Provider Secondary Information",
1340
- r::Situational, d::RepeatCount.bounded(3),
1341
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("0B", "1G", "G2")),
1342
- b::Element(e::Required, "Referring Provider Secondary Identifier"),
1343
- b::Element(e::NotUsed, "Description"),
1344
- b::Element(e::NotUsed, "REFERENCE IDENTIFIER"))),
1345
-
1346
- d::LoopDef.build("2310B OPERATING PHYSICIAN NAME",
1347
- d::RepeatCount.bounded(1),
1348
- b::Segment(2500, s::NM1, "Operating Physician Name",
1349
- r::Situational, d::RepeatCount.bounded(1),
1350
- b::Element(e::Required, "Entity Identifier Code", b::Values("72")),
1351
- b::Element(e::Required, "Entity Type Qualifier", b::Values("1")),
1352
- b::Element(e::Required, "Attending Provider Last Name"),
1353
- b::Element(e::Situational, "Attending Provider First Name"),
1354
- b::Element(e::Situational, "Attending Provider Middle Name or Initial"),
1355
- b::Element(e::NotUsed, "Name Prefix"),
1356
- b::Element(e::Situational, "Attending Provider Name Suffix"),
1357
- b::Element(e::Situational, "Identification Code Qualifier", b::Values("XX")),
1358
- b::Element(e::Situational, "Attending Provider Primary Identifier"),
1359
- b::Element(e::NotUsed, "Entity Relationship Code"),
1360
- b::Element(e::NotUsed, "Entity Identifier Code"),
1361
- b::Element(e::NotUsed, "Name Last or Organization Name")),
1362
- b::Segment(2710, s::REF, "Operating Physician Secondary Identification",
1363
- r::Situational, d::RepeatCount.bounded(4),
1364
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("0B", "1G", "G2", "LU")),
1365
- b::Element(e::Required, "Reference Physician Secondary Identifier"),
1366
- b::Element(e::NotUsed, "Description"),
1367
- b::Element(e::NotUsed, "REFERENCE IDENTIFIER"))),
1368
-
1369
- d::LoopDef.build("2310C OTHER OPERATING PHYSICIAN NAME",
1370
- d::RepeatCount.bounded(1),
1371
- b::Segment(2500, s::NM1, "Other Operating Physician Name",
1372
- r::Situational, d::RepeatCount.bounded(1),
1373
- b::Element(e::Required, "Entity Identifier Code", b::Values("ZZ")),
1374
- b::Element(e::Required, "Entity Type Qualifier", b::Values("1")),
1375
- b::Element(e::Required, "Other Operating Physician Last Name"),
1376
- b::Element(e::Situational, "Other Operating Physician First Name"),
1377
- b::Element(e::Situational, "Other Operating Physician Middle Name or Initial"),
1378
- b::Element(e::NotUsed, "Name Prefix"),
1379
- b::Element(e::Situational, "Other Operating Physician Name Suffix"),
1380
- b::Element(e::Situational, "Identification Code Qualifier", b::Values("XX")),
1381
- b::Element(e::Situational, "Other Operating Physician Identifier"),
1382
- b::Element(e::NotUsed, "Entity Relationship Code"),
1383
- b::Element(e::NotUsed, "Entity Identifier Code"),
1384
- b::Element(e::NotUsed, "Name Last or Organization Name")),
1385
- b::Segment(2710, s::REF, "Other Operating Physician Secondary Identification",
1386
- r::Situational, d::RepeatCount.bounded(4),
1387
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("0B", "1G", "G2", "LU")),
1388
- b::Element(e::Required, "Other Provider Secondary Identifier"),
1389
- b::Element(e::NotUsed, "Description"),
1390
- b::Element(e::NotUsed, "REFERENCE IDENTIFIER"))),
1391
-
1392
- d::LoopDef.build("2310D RENDERING PROVIDER NAME",
1393
- d::RepeatCount.bounded(1),
1394
- b::Segment(2500, s::NM1, "Rendering Provider Name",
1395
- r::Situational, d::RepeatCount.bounded(1),
1396
- b::Element(e::Required, "Entity Identifier Code", b::Values("82")),
1397
- b::Element(e::Required, "Entity Type Qualifier", b::Values("1")),
1398
- b::Element(e::Required, "Rendering Provider Last Name"),
1399
- b::Element(e::Situational, "Rendering Provider First Name"),
1400
- b::Element(e::Situational, "Rendering Provider Middle Name or Initial"),
1401
- b::Element(e::NotUsed, "Name Prefix"),
1402
- b::Element(e::Situational, "Rendering Provider Name Suffix"),
1403
- b::Element(e::Situational, "Identification Code Qualifier", b::Values("XX")),
1404
- b::Element(e::Situational, "Rendering Provider Identifier"),
1405
- b::Element(e::NotUsed, "Entity Relationship Code"),
1406
- b::Element(e::NotUsed, "Entity Identifier Code"),
1407
- b::Element(e::NotUsed, "Name Last or Organization Name")),
1408
- b::Segment(2710, s::REF, "Rendering Provider Secondary Identification",
1409
- r::Situational, d::RepeatCount.bounded(4),
1410
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("0B", "1G", "G2", "LU")),
1411
- b::Element(e::Required, "Rendering Provider Secondary Identifier"),
1412
- b::Element(e::NotUsed, "Description"),
1413
- b::Element(e::NotUsed, "REFERENCE IDENTIFIER"))),
1414
-
1415
- d::LoopDef.build("2310E SERVICE FACILITY LOCATION NAME",
1416
- d::RepeatCount.bounded(1),
1417
- b::Segment(2500, s::NM1, "Service Facility Location Name",
1418
- r::Situational, d::RepeatCount.bounded(1),
1419
- b::Element(e::Required, "Entity Identifier Code", b::Values("77")),
1420
- b::Element(e::Required, "Entity Type Qualifier", b::Values("2")),
1421
- b::Element(e::Required, "Laboratory or Facility Name"),
1422
- b::Element(e::NotUsed, "Name First"),
1423
- b::Element(e::NotUsed, "Name Middle"),
1424
- b::Element(e::NotUsed, "Name Prefix"),
1425
- b::Element(e::NotUsed, "Name Suffix"),
1426
- b::Element(e::Situational, "Identification Code Qualifier", b::Values("XX")),
1427
- b::Element(e::Situational, "Laboratory or Facility Primary Identifier"),
1428
- b::Element(e::NotUsed, "Entity Relationship Code"),
1429
- b::Element(e::NotUsed, "Entity Identifier Code"),
1430
- b::Element(e::NotUsed, "Name Last or Organization Name")),
1431
- b::Segment(2650, s::N3, "Service Facility Location Address",
1432
- r::Required, d::RepeatCount.bounded(1),
1433
- b::Element(e::Required, "Laboratory or Facility Address Line"),
1434
- b::Element(e::Situational, "Laboratory or Facility Address Line")),
1435
- b::Segment(2700, s::N4, "Service Facility Location City, State, ZIP Code",
1436
- r::Required, d::RepeatCount.bounded(1),
1437
- b::Element(e::Required, "Laboratory or Facility City Name"),
1438
- b::Element(e::Situational, "Laboratory or Facility State or Province Code"),
1439
- b::Element(e::Situational, "Laboratory or Facility Postal Zone or ZIP Code"),
1440
- b::Element(e::Situational, "Country Code"),
1441
- b::Element(e::NotUsed, "Location Qualifier"),
1442
- b::Element(e::NotUsed, "Location Identifier"),
1443
- b::Element(e::Situational, "Country Subdivision Code")),
1444
- b::Segment(2710, s::REF, "Service Facility Location Secondary Identification",
1445
- r::Situational, d::RepeatCount.bounded(3),
1446
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("0B", "G2", "LU")),
1447
- b::Element(e::Required, "Laboratory or Facility Secondary Identifier"),
1448
- b::Element(e::NotUsed, "Description"),
1449
- b::Element(e::NotUsed, "REFERENCE IDENTIFIER"))),
1450
-
1451
- d::LoopDef.build("2310F REFERRING PROVIDER NAME",
1452
- d::RepeatCount.bounded(1),
1453
- b::Segment(2500, s::NM1, "Referring Provider Name",
1454
- r::Situational, d::RepeatCount.bounded(1),
1455
- b::Element(e::Required, "Entity Identifier Code", b::Values("DN")),
1456
- b::Element(e::Required, "Entity Type Qualifier", b::Values("1")),
1457
- b::Element(e::Required, "Referring Provider Last Name"),
1458
- b::Element(e::Situational, "Referring Provider First Name"),
1459
- b::Element(e::Situational, "Referring Provider Middle Name or Initial"),
1460
- b::Element(e::NotUsed, "Name Prefix"),
1461
- b::Element(e::Situational, "Referring Provider Name Suffix"),
1462
- b::Element(e::Situational, "Identification Code Qualifier", b::Values("XX")),
1463
- b::Element(e::Situational, "Identification Code"),
1464
- b::Element(e::NotUsed, "Entity Relationship Code"),
1465
- b::Element(e::NotUsed, "Entity Identifier Code"),
1466
- b::Element(e::NotUsed, "Name Last or Organization Name")),
1467
- b::Segment(2710, s::REF, "Referring Provider Secondary Identification",
1468
- r::Situational, d::RepeatCount.bounded(3),
1469
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("0B", "1G", "G2")),
1470
- b::Element(e::Required, "Referring Provider Secondary Identifier"),
1471
- b::Element(e::NotUsed, "Description"),
1472
- b::Element(e::NotUsed, "REFERENCE IDENTIFIER"))),
1473
-
1474
- d::LoopDef.build("2320 OTHER SUBSCRIBER INFORMATION",
1475
- d::RepeatCount.bounded(10),
1476
- b::Segment(2900, s::SBR, "Other Subscriber Information",
1477
- r::Situational, d::RepeatCount.bounded(1),
1478
- b::Element(e::Required, "Payer Responsibility Sequence Number", b::Values("A", "B", "C", "D", "E", "F", "G", "H", "P", "S", "T", "U")),
1479
- b::Element(e::Required, "Individual Relationship Code", b::Values("01", "18", "19", "20", "21", "39", "40", "53", "G8")),
1480
- b::Element(e::Situational, "Insured Group or Policy Number"),
1481
- b::Element(e::Situational, "Other Insured Group Name"),
1482
- b::Element(e::NotUsed, "Insurance Type Code"),
1483
- b::Element(e::NotUsed, "Coordination of Benefits Code"),
1484
- b::Element(e::NotUsed, "Yes/No Condition or Response Code"),
1485
- b::Element(e::NotUsed, "Employment Status Code"),
1486
- 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"))),
1487
- b::Segment(2950, s::CAS, "Claim Level Adjustments",
1488
- r::Situational, d::RepeatCount.bounded(5),
1489
- b::Element(e::Required, "Claim Adjustment Group Code", b::Values("CO", "CR", "OA", "PI", "PR")),
1490
- b::Element(e::Required, "Adjustment Reason Code"),
1491
- b::Element(e::Required, "Adjustment Amount"),
1492
- b::Element(e::Situational, "Adjustment Quantity"),
1493
- b::Element(e::Situational, "Adjustment Reason Code"),
1494
- b::Element(e::Situational, "Adjustment Amount"),
1495
- b::Element(e::Situational, "Adjustment Quantity"),
1496
- b::Element(e::Situational, "Adjustment Reason Code"),
1497
- b::Element(e::Situational, "Adjustment Amount"),
1498
- b::Element(e::Situational, "Adjustment Quantity"),
1499
- b::Element(e::Situational, "Adjustment Reason Code"),
1500
- b::Element(e::Situational, "Adjustment Amount"),
1501
- b::Element(e::Situational, "Adjustment Quantity"),
1502
- b::Element(e::Situational, "Adjustment Reason Code"),
1503
- b::Element(e::Situational, "Adjustment Amount"),
1504
- b::Element(e::Situational, "Adjustment Quantity"),
1505
- b::Element(e::Situational, "Adjustment Reason Code"),
1506
- b::Element(e::Situational, "Adjustment Amount"),
1507
- b::Element(e::Situational, "Adjustment Quantity")),
1508
- b::Segment(3000, s::AMT, "Coordination of Benefits (COB) Payer Paid Amount",
1509
- r::Situational, d::RepeatCount.bounded(1),
1510
- b::Element(e::Required, "Amount Qualifier Code", b::Values("D")),
1511
- b::Element(e::Required, "Payer Paid Amount"),
1512
- b::Element(e::NotUsed, "Credit/Debit Flag")),
1513
- b::Segment(3000, s::AMT, "Remaining Patient Liability",
1514
- r::Situational, d::RepeatCount.bounded(1),
1515
- b::Element(e::Required, "Amount Qualifier Code", b::Values("EAF")),
1516
- b::Element(e::Required, "Remaining Patient Liability"),
1517
- b::Element(e::NotUsed, "Credit/Debit Flag")),
1518
- b::Segment(3000, s::AMT, "Coordination of Benefits (COB) Total Non-Covered Amount",
1519
- r::Situational, d::RepeatCount.bounded(1),
1520
- b::Element(e::Required, "Amount Qualifier Code", b::Values("A8")),
1521
- b::Element(e::Required, "Non-Covered Charge Amount"),
1522
- b::Element(e::NotUsed, "Credit/Debit Flag Code")),
1523
- b::Segment(3100, s::OI, "Other Insurance Coverage Information",
1524
- r::Required, d::RepeatCount.bounded(1),
1525
- b::Element(e::NotUsed, "Claim Filing Indicator Code"),
1526
- b::Element(e::NotUsed, "Claim Submission Reason Code"),
1527
- b::Element(e::Required, "Benefits Assignment Certification Indicator", b::Values("N", "W", "Y")),
1528
- b::Element(e::NotUsed, "Patient Signature Source Code"),
1529
- b::Element(e::NotUsed, "Provider Agreement Code"),
1530
- b::Element(e::Required, "Release of Information Code", b::Values("I", "Y"))),
1531
- b::Segment(3150, s::MIA, "Inpatient Adjudication Information",
1532
- r::Situational, d::RepeatCount.bounded(1),
1533
- b::Element(e::Required, "Covered Days or Visits Count"),
1534
- b::Element(e::NotUsed, "Monetary Amount"),
1535
- b::Element(e::Situational, "Lifetime Psychiatric Days Count"),
1536
- b::Element(e::Situational, "Claim DRG Amount"),
1537
- b::Element(e::Situational, "Claim Payment Remark Code"),
1538
- b::Element(e::Situational, "Claim Disproportionate Share Amount"),
1539
- b::Element(e::Situational, "Claim MSP Pass-through Amount"),
1540
- b::Element(e::Situational, "Claim PPS Capital Amount"),
1541
- b::Element(e::Situational, "PPS-Capital FSP DRG Amount"),
1542
- b::Element(e::Situational, "PPS-Capital HSP DRG Amount"),
1543
- b::Element(e::Situational, "PPS-Capital DSH DRG Amount"),
1544
- b::Element(e::Situational, "Old Capital Amount"),
1545
- b::Element(e::Situational, "PPS-Capital IME Amount"),
1546
- b::Element(e::Situational, "PPS-Operating Hospital Specific DRG Amount"),
1547
- b::Element(e::Situational, "Cost Report Day Count"),
1548
- b::Element(e::Situational, "PPS-Operating Federal Specific DRG Amount"),
1549
- b::Element(e::Situational, "Claim PPS Capital Outlier Amount"),
1550
- b::Element(e::Situational, "Claim Indirect Teaching Amount"),
1551
- b::Element(e::Situational, "Non-Payable Professional Component Billed Amount"),
1552
- b::Element(e::Situational, "Claim Payment Remark Code"),
1553
- b::Element(e::Situational, "Claim Payment Remark Code"),
1554
- b::Element(e::Situational, "Claim Payment Remark Code"),
1555
- b::Element(e::Situational, "Claim Payment Remark Code"),
1556
- b::Element(e::Situational, "PPS-Capital Exception Amount")),
1557
- b::Segment(3200, s::MOA, "Outpatient Adjudication Information",
1558
- r::Situational, d::RepeatCount.bounded(1),
1559
- b::Element(e::Situational, "Reimbursement Rate"),
1560
- b::Element(e::Situational, "HCPCS Payable Amount"),
1561
- b::Element(e::Situational, "Claim Payment Remark Code"),
1562
- b::Element(e::Situational, "Claim Payment Remark Code"),
1563
- b::Element(e::Situational, "Claim Payment Remark Code"),
1564
- b::Element(e::Situational, "Claim Payment Remark Code"),
1565
- b::Element(e::Situational, "Claim Payment Remark Code"),
1566
- b::Element(e::Situational, "End Stage Renal Disease Payment Amount"),
1567
- b::Element(e::Situational, "Non-Payable Professional Component Billed Amount")),
1568
-
1569
- d::LoopDef.build("2330A OTHER SUBSCRIBER NAME",
1570
- d::RepeatCount.bounded(1),
1571
- b::Segment(3250, s::NM1, "Other Subscriber Name",
1572
- r::Required, d::RepeatCount.bounded(1),
1573
- b::Element(e::Required, "Entity Identifier Code", b::Values("IL")),
1574
- b::Element(e::Required, "Entity Type Qualifier", b::Values("1", "2")),
1575
- b::Element(e::Required, "Other Insured Last Name"),
1576
- b::Element(e::Situational, "Other Insured First Name"),
1577
- b::Element(e::Situational, "Other Insured Middle Name"),
1578
- b::Element(e::NotUsed, "Name Prefix"),
1579
- b::Element(e::Situational, "Other Insured Name Suffix"),
1580
- b::Element(e::Required, "Identification Code Qualifier", b::Values("II", "MI")),
1581
- b::Element(e::Required, "Other Insured Identifier"),
1582
- b::Element(e::NotUsed, "Entity Relationship Code"),
1583
- b::Element(e::NotUsed, "Entity Identifier Code"),
1584
- b::Element(e::NotUsed, "Name Last or Organization Name")),
1585
- b::Segment(3320, s::N3, "Other Subscriber Address",
1586
- r::Situational, d::RepeatCount.bounded(1),
1587
- b::Element(e::Required, "Other Insured Address Line"),
1588
- b::Element(e::Situational, "Other Insured Address Line")),
1589
- b::Segment(3400, s::N4, "Other Subscriber City, State, ZIP Code",
1590
- r::Required, d::RepeatCount.bounded(1),
1591
- b::Element(e::Required, "Other Insured City Name"),
1592
- b::Element(e::Situational, "Other Insured State or Province Code"),
1593
- b::Element(e::Situational, "Other Insured Postal Zone or ZIP Code"),
1594
- b::Element(e::Situational, "Country Code"),
1595
- b::Element(e::NotUsed, "Location Qualifier"),
1596
- b::Element(e::NotUsed, "Location Identifier"),
1597
- b::Element(e::Situational, "Country Subdivision Code")),
1598
- b::Segment(3550, s::REF, "Other Subscriber Secondary Identification",
1599
- r::Situational, d::RepeatCount.bounded(2),
1600
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("SY")),
1601
- b::Element(e::Required, "Other Insured Additional Identifier"),
1602
- b::Element(e::NotUsed, "Description"),
1603
- b::Element(e::NotUsed, "REFERENCE IDENTIFIER"))),
1604
-
1605
- d::LoopDef.build("2330B OTHER PAYER NAME",
1606
- d::RepeatCount.bounded(1),
1607
- b::Segment(3250, s::NM1, "Other Payer Name",
1608
- r::Required, d::RepeatCount.bounded(1),
1609
- b::Element(e::Required, "Entity Identifier Code", b::Values("PR")),
1610
- b::Element(e::Required, "Entity Type Qualifier", b::Values("2")),
1611
- b::Element(e::Required, "Other Payer Last or Organization Name"),
1612
- b::Element(e::NotUsed, "Name First"),
1613
- b::Element(e::NotUsed, "Name Middle"),
1614
- b::Element(e::NotUsed, "Name Prefix"),
1615
- b::Element(e::NotUsed, "Name Suffix"),
1616
- b::Element(e::Required, "Identification Code Qualifier", b::Values("PI", "XV")),
1617
- b::Element(e::Required, "Other Payer Primary Identifier"),
1618
- b::Element(e::NotUsed, "Entity Relationship Code"),
1619
- b::Element(e::NotUsed, "Entity Identifier Code"),
1620
- b::Element(e::NotUsed, "Name Last or Organization Name")),
1621
- b::Segment(3320, s::N3, "Other Payer Address",
1622
- r::Situational, d::RepeatCount.bounded(1),
1623
- b::Element(e::Required, "Other Payer Address Line"),
1624
- b::Element(e::Situational, "Other Payer Address Line")),
1625
- b::Segment(3400, s::N4, "Other Payer City, State, ZIP Code",
1626
- r::Required, d::RepeatCount.bounded(1),
1627
- b::Element(e::Required, "Other Payer City Name"),
1628
- b::Element(e::Situational, "Other Payer State Code"),
1629
- b::Element(e::Situational, "Other Payer Postal Zone or ZIP Code"),
1630
- b::Element(e::Situational, "Country Code"),
1631
- b::Element(e::NotUsed, "Location Qualifier"),
1632
- b::Element(e::NotUsed, "Location Identifier"),
1633
- b::Element(e::Situational, "Country Subdivision Code")),
1634
- b::Segment(3500, s::DTP, "Claim Check or Remittance Date",
1635
- r::Situational, d::RepeatCount.bounded(1),
1636
- b::Element(e::Required, "Date Time Qualifier", b::Values("573")),
1637
- b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
1638
- b::Element(e::Required, "Adjudication or Payment Date")),
1639
- b::Segment(3550, s::REF, "Other Payer Secondary Identifier",
1640
- r::Situational, d::RepeatCount.bounded(2),
1641
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("2U", "EI", "FY", "NF")),
1642
- b::Element(e::Required, "Other Payer Secondary Identifier"),
1643
- b::Element(e::NotUsed, "Description"),
1644
- b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
1645
- b::Segment(3550, s::REF, "Other Payer Prior Authorization Number",
1646
- r::Situational, d::RepeatCount.bounded(1),
1647
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("G1")),
1648
- b::Element(e::Required, "Other Payer Prior Authorization Number"),
1649
- b::Element(e::NotUsed, "Description"),
1650
- b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
1651
- b::Segment(3550, s::REF, "Other Payer Referral Number",
1652
- r::Situational, d::RepeatCount.bounded(1),
1653
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("9F")),
1654
- b::Element(e::Required, "Other Payer Prior Authorization or Referral Number"),
1655
- b::Element(e::NotUsed, "Description"),
1656
- b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
1657
- b::Segment(3550, s::REF, "Other Payer Claim Adjustment Indicator",
1658
- r::Situational, d::RepeatCount.bounded(1),
1659
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("T4")),
1660
- b::Element(e::Required, "Other Payer Claim Adjustment Indicator", b::Values("Y")),
1661
- b::Element(e::NotUsed, "Description"),
1662
- b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
1663
- b::Segment(3550, s::REF, "Other Payer Claim Control Number",
1664
- r::Situational, d::RepeatCount.bounded(1),
1665
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("F8")),
1666
- b::Element(e::Required, "Other Payer's Claim Control Number"),
1667
- b::Element(e::NotUsed, "Description"),
1668
- b::Element(e::NotUsed, "REFERENCE IDENTIFIER"))),
1669
-
1670
- d::LoopDef.build("2330C OTHER PAYER ATTENDING PROVIDER",
1671
- d::RepeatCount.bounded(1),
1672
- b::Segment(3250, s::NM1, "Other Payer Attending Provider",
1673
- r::Situational, d::RepeatCount.bounded(1),
1674
- b::Element(e::Required, "Entity Identifier Code", b::Values("71")),
1675
- b::Element(e::Required, "Entity Type Qualifier", b::Values("1")),
1676
- b::Element(e::NotUsed, "Name Last"),
1677
- b::Element(e::NotUsed, "Name First"),
1678
- b::Element(e::NotUsed, "Name Middle"),
1679
- b::Element(e::NotUsed, "Name Prefix"),
1680
- b::Element(e::NotUsed, "Name Suffix"),
1681
- b::Element(e::NotUsed, "Identification Code Qualifier"),
1682
- b::Element(e::NotUsed, "Identification Code"),
1683
- b::Element(e::NotUsed, "Entity Relationship Code"),
1684
- b::Element(e::NotUsed, "Entity Identifier Code"),
1685
- b::Element(e::NotUsed, "Name Last or Organization Name")),
1686
- b::Segment(3550, s::REF, "Other Payer Attending Provider Secondary Identification",
1687
- r::Required, d::RepeatCount.bounded(4),
1688
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("0B", "1G", "G2", "LU")),
1689
- b::Element(e::Required, "Other Payer Attending Provider Identifier"),
1690
- b::Element(e::NotUsed, "Description"),
1691
- b::Element(e::NotUsed, "REFERENCE IDENTIFIER"))),
1692
-
1693
- d::LoopDef.build("2330D OTHER PAYER OPERATING PHYSICIAN",
1694
- d::RepeatCount.bounded(1),
1695
- b::Segment(3250, s::NM1, "Other Payer Operating Physician",
1696
- r::Situational, d::RepeatCount.bounded(1),
1697
- b::Element(e::Required, "Entity Identifier Code", b::Values("72")),
1698
- b::Element(e::Required, "Entity Type Qualifier", b::Values("1")),
1699
- b::Element(e::NotUsed, "Name Last"),
1700
- b::Element(e::NotUsed, "Name First"),
1701
- b::Element(e::NotUsed, "Name Middle"),
1702
- b::Element(e::NotUsed, "Name Prefix"),
1703
- b::Element(e::NotUsed, "Name Suffix"),
1704
- b::Element(e::NotUsed, "Identification Code Qualifier"),
1705
- b::Element(e::NotUsed, "Identification Code"),
1706
- b::Element(e::NotUsed, "Entity Relationship Code"),
1707
- b::Element(e::NotUsed, "Entity Identifier Code"),
1708
- b::Element(e::NotUsed, "Name Last or Organization Name")),
1709
- b::Segment(3550, s::REF, "Other Payer Operating Physician Secondary Identification",
1710
- r::Required, d::RepeatCount.bounded(4),
1711
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("0B", "1G", "G2", "LU")),
1712
- b::Element(e::Required, "Other Payer Operating Provider Secondary Identifier"),
1713
- b::Element(e::NotUsed, "Description"),
1714
- b::Element(e::NotUsed, "REFERENCE IDENTIFIER"))),
1715
-
1716
- d::LoopDef.build("2330E OTHER PAYER OTHER OPERATING PHYSICIAN",
1717
- d::RepeatCount.bounded(1),
1718
- b::Segment(3250, s::NM1, "Other Payer Other Operating Physician",
1719
- r::Situational, d::RepeatCount.bounded(1),
1720
- b::Element(e::Required, "Entity Identifier Code", b::Values("ZZ")),
1721
- b::Element(e::Required, "Entity Type Qualifier", b::Values("1")),
1722
- b::Element(e::NotUsed, "Name Last"),
1723
- b::Element(e::NotUsed, "Name First"),
1724
- b::Element(e::NotUsed, "Name Middle"),
1725
- b::Element(e::NotUsed, "Name Prefix"),
1726
- b::Element(e::NotUsed, "Name Suffix"),
1727
- b::Element(e::NotUsed, "Identification Code Qualifier"),
1728
- b::Element(e::NotUsed, "Identification Code"),
1729
- b::Element(e::NotUsed, "Entity Relationship Code"),
1730
- b::Element(e::NotUsed, "Entity Identifier Code"),
1731
- b::Element(e::NotUsed, "Name Last or Organization Name")),
1732
- b::Segment(3550, s::REF, "Other Payer Other Operating Physician Secondary Identification",
1733
- r::Required, d::RepeatCount.bounded(4),
1734
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("0B", "1G", "G2", "LU")),
1735
- b::Element(e::Required, "Other Payer Other Operating Physician Secondary Identifier"),
1736
- b::Element(e::NotUsed, "Description"),
1737
- b::Element(e::NotUsed, "REFERENCE IDENTIFIER"))),
1738
-
1739
- d::LoopDef.build("2330F OTHER PAYER SERVICE FACILITY LOCATION",
1740
- d::RepeatCount.bounded(1),
1741
- b::Segment(3250, s::NM1, "Other Payer Service Facility Location",
1742
- r::Situational, d::RepeatCount.bounded(1),
1743
- b::Element(e::Required, "Entity Identifier Code", b::Values("77")),
1744
- b::Element(e::Required, "Entity Type Qualifier", b::Values("2")),
1745
- b::Element(e::NotUsed, "Name Last"),
1746
- b::Element(e::NotUsed, "Name First"),
1747
- b::Element(e::NotUsed, "Name Middle"),
1748
- b::Element(e::NotUsed, "Name Prefix"),
1749
- b::Element(e::NotUsed, "Name Suffix"),
1750
- b::Element(e::NotUsed, "Identification Code Qualifier"),
1751
- b::Element(e::NotUsed, "Identification Code"),
1752
- b::Element(e::NotUsed, "Entity Relationship Code"),
1753
- b::Element(e::NotUsed, "Entity Identifier Code"),
1754
- b::Element(e::NotUsed, "Name Last or Organization Name")),
1755
- b::Segment(3550, s::REF, "Other Payer Supervising Provider Secondary Identification",
1756
- r::Required, d::RepeatCount.bounded(3),
1757
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("0B", "G2", "LU")),
1758
- b::Element(e::Required, "Other Payer Service Facility Location Identifier"),
1759
- b::Element(e::NotUsed, "Description"),
1760
- b::Element(e::NotUsed, "REFERENCE IDENTIFIER"))),
1761
-
1762
- d::LoopDef.build("2330G OTHER PAYER RENDERING PROVIDER NAME",
1763
- d::RepeatCount.bounded(1),
1764
- b::Segment(3250, s::NM1, "Other Payer Rendering Provider Name",
1765
- r::Situational, d::RepeatCount.bounded(1),
1766
- b::Element(e::Required, "Entity Identifier Code", b::Values("82")),
1767
- b::Element(e::Required, "Entity Type Qualifier", b::Values("1")),
1768
- b::Element(e::NotUsed, "Name Last or Organization Name"),
1769
- b::Element(e::NotUsed, "Name First"),
1770
- b::Element(e::NotUsed, "Name Middle"),
1771
- b::Element(e::NotUsed, "Name Prefix"),
1772
- b::Element(e::NotUsed, "Name Suffix"),
1773
- b::Element(e::NotUsed, "Identification Code Qualifier"),
1774
- b::Element(e::NotUsed, "Identification Code"),
1775
- b::Element(e::NotUsed, "Entity Relationship Code"),
1776
- b::Element(e::NotUsed, "Entity Identifier Code"),
1777
- b::Element(e::NotUsed, "Name Last or Organization Name")),
1778
- b::Segment(3550, s::REF, "Other Payer Rendering Provider Secondary Identification",
1779
- r::Required, d::RepeatCount.bounded(4),
1780
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("0B", "1G", "G2", "LU")),
1781
- b::Element(e::Required, "Other Payer Rendering Provider Secondary Identifier"),
1782
- b::Element(e::NotUsed, "Description"),
1783
- b::Element(e::NotUsed, "REFERENCE IDENTIFIER")))),
1784
-
1785
- d::LoopDef.build("2330H OTHER PAYER REFERRING PROVIDER",
1786
- d::RepeatCount.bounded(1),
1787
- b::Segment(3250, s::NM1, "Other Payer Referring Provider",
1788
- r::Situational, d::RepeatCount.bounded(1),
1789
- b::Element(e::Required, "Entity Identifier Code", b::Values("DN")),
1790
- b::Element(e::Required, "Entity Type Qualifier", b::Values("1")),
1791
- b::Element(e::NotUsed, "Name Last or Organization Name"),
1792
- b::Element(e::NotUsed, "Name First"),
1793
- b::Element(e::NotUsed, "Name Middle"),
1794
- b::Element(e::NotUsed, "Name Prefix"),
1795
- b::Element(e::NotUsed, "Name Suffix"),
1796
- b::Element(e::NotUsed, "Identification Code Qualifier"),
1797
- b::Element(e::NotUsed, "Identification Code"),
1798
- b::Element(e::NotUsed, "Entity Relationship Code"),
1799
- b::Element(e::NotUsed, "Entity Identifier Code"),
1800
- b::Element(e::NotUsed, "Name Last or Organization Name")),
1801
- b::Segment(3550, s::REF, "Other Payer Referring Provider Secondary Identification",
1802
- r::Required, d::RepeatCount.bounded(3),
1803
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("0B", "1G", "G2")),
1804
- b::Element(e::Required, "Other Payer Referring Provider Identifier"),
1805
- b::Element(e::NotUsed, "Description"),
1806
- b::Element(e::NotUsed, "REFERENCE IDENTIFIER"))),
1807
-
1808
- d::LoopDef.build("2330I OTHER PAYER BILLING PROVIDER",
1809
- d::RepeatCount.bounded(1),
1810
- b::Segment(3250, s::NM1, "Other Payer Billing Provider",
1811
- r::Situational, d::RepeatCount.bounded(1),
1812
- b::Element(e::Required, "Entity Identifier Code", b::Values("85")),
1813
- b::Element(e::Required, "Entity Type Qualifier", b::Values("2")),
1814
- b::Element(e::NotUsed, "Name Last or Organization Name"),
1815
- b::Element(e::NotUsed, "Name First"),
1816
- b::Element(e::NotUsed, "Name Middle"),
1817
- b::Element(e::NotUsed, "Name Prefix"),
1818
- b::Element(e::NotUsed, "Name Suffix"),
1819
- b::Element(e::NotUsed, "Identification Code Qualifier"),
1820
- b::Element(e::NotUsed, "Identification Code"),
1821
- b::Element(e::NotUsed, "Entity Relationship Code"),
1822
- b::Element(e::NotUsed, "Entity Identifier Code"),
1823
- b::Element(e::NotUsed, "Name Last or Organization Name")),
1824
- b::Segment(3550, s::REF, "Other Payer Billing Provider Secondary Information",
1825
- r::Required, d::RepeatCount.bounded(2),
1826
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("G2", "LU")),
1827
- b::Element(e::Required, "Other Payer Billing Provider Identifier"),
1828
- b::Element(e::NotUsed, "Description"),
1829
- b::Element(e::NotUsed, "REFERENCE IDENTIFIER"))),
1830
-
1831
- d::LoopDef.build("2400 SERVICE LINE NUMBER",
1832
- d::RepeatCount.bounded(999),
1833
- b::Segment(3650, s::LX, "Service Line Number",
1834
- r::Required, d::RepeatCount.bounded(1),
1835
- b::Element(e::Required, "Assigned Number")),
1836
- b::Segment(3750, s::SV2, "Institutional Service Line",
1837
- r::Required, d::RepeatCount.bounded(1),
1838
- b::Element(e::Required, "Service Line Revenue Code"),
1839
- b::Element(e::Situational, "COMPOSITE MEDICAL PROCEDURE IDENTIFIER",
1840
- b::Element(e::Required, "Product or Service ID Qualifier", b::Values("ER", "HC", "HP", "IV", "WK")),
1841
- b::Element(e::Required, "Procedure Code"),
1842
- b::Element(e::Situational, "Procedure Modifier"),
1843
- b::Element(e::Situational, "Procedure Modifier"),
1844
- b::Element(e::Situational, "Procedure Modifier"),
1845
- b::Element(e::Situational, "Procedure Modifier"),
1846
- b::Element(e::Situational, "Description"),
1847
- b::Element(e::NotUsed, "Product/Service ID")),
1848
- b::Element(e::Required, "Line Item Charge Amount"),
1849
- b::Element(e::Required, "Unit or Basis for Measurement Code", b::Values("DA", "UN")),
1850
- b::Element(e::Required, "Service Unit Count"),
1851
- b::Element(e::NotUsed, "Unit Rate"),
1852
- b::Element(e::Situational, "Line Item Denied Charge or Non-Covered Charge Amount"),
1853
- b::Element(e::NotUsed, "Yes/No Condition or Response Code"),
1854
- b::Element(e::NotUsed, "Nursing Home Residential Status Code"),
1855
- b::Element(e::NotUsed, "Level of Care Code")),
1856
- b::Segment(4200, s::PWK, "Line Supplemental Information",
1857
- r::Situational, d::RepeatCount.bounded(10),
1858
- b::Element(e::Required, "Attachment Report Type Code", b::Values("03", "04", "05", "06", "07", "08", "09", "10", "11", "13", "15", "21", "A3", "A4", "AM", "AS", "B2", "B3", "B4", "BR", "BS", "BT", "CB", "CK", "CT", "D2", "DA", "DB", "DG", "DJ", "DS", "EB", "HC", "HR", "I5", "IR", "LA", "M1", "MT", "NN", "OB", "OC", "OD", "OE", "OX", "OZ", "P4", "P5", "PE", "PN", "PO", "PQ", "PY", "PZ", "RB", "RR", "RT", "RX", "SG", "V5", "XP")),
1859
- b::Element(e::Required, "Attachment Transmission Code", b::Values("AA", "BM", "EL", "EM", "FT", "FX")),
1860
- b::Element(e::NotUsed, "Report Copies Needed"),
1861
- b::Element(e::NotUsed, "Entity Identifier Code"),
1862
- b::Element(e::Situational, "Identification Code Qualifier", b::Values("AC")),
1863
- b::Element(e::Situational, "Attachment Control Number", b::MaxLength(50)),
1864
- b::Element(e::NotUsed, "Description"),
1865
- b::Element(e::NotUsed, "ACTIONS INDICATED"),
1866
- b::Element(e::NotUsed, "Request Category Code")),
1867
- b::Segment(4550, s::DTP, "Date - Service Date",
1868
- r::Situational, d::RepeatCount.bounded(1),
1869
- b::Element(e::Required, "Date Time Qualifier", b::Values("472")),
1870
- b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8", "RD8")),
1871
- b::Element(e::Required, "Service Date")),
1872
- b::Segment(4700, s::REF, "Line Item Control Number",
1873
- r::Situational, d::RepeatCount.bounded(1),
1874
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("6R")),
1875
- b::Element(e::Required, "Line Item Control Number", b::MaxLength(30)),
1876
- b::Element(e::NotUsed, "Description"),
1877
- b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
1878
- b::Segment(4700, s::REF, "Repriced Line Item Reference Number",
1879
- r::Situational, d::RepeatCount.bounded(1),
1880
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("9B")),
1881
- b::Element(e::Required, "Repriced Line Item Reference Number"),
1882
- b::Element(e::NotUsed, "Description"),
1883
- b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
1884
- b::Segment(4700, s::REF, "Adjusted Repriced Line Item Reference Number",
1885
- r::Situational, d::RepeatCount.bounded(1),
1886
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("9D")),
1887
- b::Element(e::Required, "Adjusted Repriced Line Item Reference Number"),
1888
- b::Element(e::NotUsed, "Description"),
1889
- b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
1890
- b::Segment(4750, s::AMT, "Service Tax Amount",
1891
- r::Situational, d::RepeatCount.bounded(1),
1892
- b::Element(e::Required, "Amount Qualifier Code", b::Values("GT")),
1893
- b::Element(e::Required, "Service Tax Amount"),
1894
- b::Element(e::NotUsed, "Credit/Debit Flag Code")),
1895
- b::Segment(4750, s::AMT, "Facility Tax Amount",
1896
- r::Situational, d::RepeatCount.bounded(1),
1897
- b::Element(e::Required, "Amount Qualifier Code", b::Values("N8")),
1898
- b::Element(e::Required, "Facility Tax Amount"),
1899
- b::Element(e::NotUsed, "Credit/Debit Flag Code")),
1900
- b::Segment(4850, s::NTE, "Third Party Organization Notes",
1901
- r::Situational, d::RepeatCount.bounded(1),
1902
- b::Element(e::Required, "Note Reference Code", b::Values("TPO")),
1903
- b::Element(e::Required, "Line Note Text")),
1904
- b::Segment(4920, s::HCP, "Line Pricing/Repricing Information",
1905
- r::Situational, d::RepeatCount.bounded(1),
1906
- b::Element(e::Required, "Pricing Methodology", b::Values("00", "01", "02", "03", "04", "05", "06", "07", "08", "09", "10", "11", "12", "13", "14")),
1907
- b::Element(e::Required, "Monetary Amount"),
1908
- b::Element(e::Situational, "Monetary Amount"),
1909
- b::Element(e::Situational, "Reference Identification"),
1910
- b::Element(e::Situational, "Rate"),
1911
- b::Element(e::Situational, "Reference Identification"),
1912
- b::Element(e::Situational, "Monetary Amount"),
1913
- b::Element(e::Situational, "Product/Service ID"),
1914
- b::Element(e::Situational, "Product or Service ID Qualifier", b::Values("ER", "HC", "HP", "IV", "WK")),
1915
- b::Element(e::Situational, "Repriced Approved HCPCS Code"),
1916
- b::Element(e::Situational, "Unit or Basis for Measurement Code", b::Values("DA", "UN")),
1917
- b::Element(e::Situational, "Quantity", b::MaxLength(8), b::MaxPrecision(3)),
1918
- b::Element(e::Situational, "Reject Reason Code", b::Values("T1", "T2", "T3", "T4", "T5", "T6")),
1919
- b::Element(e::Situational, "Policy Compliance Code", b::Values("1", "2", "3", "4", "5")),
1920
- b::Element(e::Situational, "Exception Code", b::Values("1", "2", "3", "4", "5", "6"))),
1921
-
1922
- d::LoopDef.build("2410 DRUG IDENTIFICATION",
1923
- d::RepeatCount.bounded(1),
1924
- b::Segment(4930, s::LIN, "Drug Identification",
1925
- r::Situational, d::RepeatCount.bounded(1),
1926
- b::Element(e::NotUsed, "Assigned Identification"),
1927
- b::Element(e::Required, "Product or Service ID Qualifier", b::Values("N4")),
1928
- b::Element(e::Required, "National Drug Code"),
1929
- b::Element(e::NotUsed, "Product/Service ID Qualifier"),
1930
- b::Element(e::NotUsed, "Product/Service ID"),
1931
- b::Element(e::NotUsed, "Product/Service ID Qualifier"),
1932
- b::Element(e::NotUsed, "Product/Service ID"),
1933
- b::Element(e::NotUsed, "Product/Service ID Qualifier"),
1934
- b::Element(e::NotUsed, "Product/Service ID"),
1935
- b::Element(e::NotUsed, "Product/Service ID Qualifier"),
1936
- b::Element(e::NotUsed, "Product/Service ID"),
1937
- b::Element(e::NotUsed, "Product/Service ID Qualifier"),
1938
- b::Element(e::NotUsed, "Product/Service ID"),
1939
- b::Element(e::NotUsed, "Product/Service ID Qualifier"),
1940
- b::Element(e::NotUsed, "Product/Service ID"),
1941
- b::Element(e::NotUsed, "Product/Service ID Qualifier"),
1942
- b::Element(e::NotUsed, "Product/Service ID"),
1943
- b::Element(e::NotUsed, "Product/Service ID Qualifier"),
1944
- b::Element(e::NotUsed, "Product/Service ID"),
1945
- b::Element(e::NotUsed, "Product/Service ID Qualifier"),
1946
- b::Element(e::NotUsed, "Product/Service ID"),
1947
- b::Element(e::NotUsed, "Product/Service ID Qualifier"),
1948
- b::Element(e::NotUsed, "Product/Service ID"),
1949
- b::Element(e::NotUsed, "Product/Service ID Qualifier"),
1950
- b::Element(e::NotUsed, "Product/Service ID"),
1951
- b::Element(e::NotUsed, "Product/Service ID Qualifier"),
1952
- b::Element(e::NotUsed, "Product/Service ID"),
1953
- b::Element(e::NotUsed, "Product/Service ID Qualifier"),
1954
- b::Element(e::NotUsed, "Product/Service ID"),
1955
- b::Element(e::NotUsed, "Product/Service ID Qualifier"),
1956
- b::Element(e::NotUsed, "Product/Service ID")),
1957
- b::Segment(4940, s::CTP, "Drug Quantity",
1958
- r::Required, d::RepeatCount.bounded(1),
1959
- b::Element(e::NotUsed, "Class of Trade Code"),
1960
- b::Element(e::NotUsed, "Price Identifier Code"),
1961
- b::Element(e::NotUsed, "Unit Price"),
1962
- b::Element(e::Required, "National Drug Unit Count"),
1963
- b::Element(e::Required, "COMPOSITE UNIT OF MEASURE",
1964
- b::Element(e::Required, "Code Qualifier", b::Values("F2", "GR", "ME", "ML", "UN")),
1965
- b::Element(e::NotUsed, "Exponent"),
1966
- b::Element(e::NotUsed, "Multiplier"),
1967
- b::Element(e::NotUsed, "Unit or Basis for Measurement Code"),
1968
- b::Element(e::NotUsed, "Exponent"),
1969
- b::Element(e::NotUsed, "Multiplier"),
1970
- b::Element(e::NotUsed, "Unit or Basis for Measurement Code"),
1971
- b::Element(e::NotUsed, "Exponent"),
1972
- b::Element(e::NotUsed, "Multiplier"),
1973
- b::Element(e::NotUsed, "Unit or Basis for Measurement Code"),
1974
- b::Element(e::NotUsed, "Exponent"),
1975
- b::Element(e::NotUsed, "Multiplier"),
1976
- b::Element(e::NotUsed, "Unit or Basis for Measurement Code"),
1977
- b::Element(e::NotUsed, "Exponent"),
1978
- b::Element(e::NotUsed, "Multiplier")),
1979
- b::Element(e::NotUsed, "Price Multiplier Qualifier"),
1980
- b::Element(e::NotUsed, "Multiplier"),
1981
- b::Element(e::NotUsed, "Monetary Amount"),
1982
- b::Element(e::NotUsed, "Basis of Unit Price Code"),
1983
- b::Element(e::NotUsed, "Condition Value"),
1984
- b::Element(e::NotUsed, "Multiple Price Quantity")),
1985
- b::Segment(4950, s::REF, "Prescription or Compound Drug Association Number",
1986
- r::Situational, d::RepeatCount.bounded(1),
1987
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("VY", "XZ")),
1988
- b::Element(e::Required, "Prescription Number"),
1989
- b::Element(e::NotUsed, "Description"),
1990
- b::Element(e::NotUsed, "REFERENCE IDENTIFIER"))),
1991
-
1992
- d::LoopDef.build("2420A OPERATING PHYSICIAN NAME",
1993
- d::RepeatCount.bounded(1),
1994
- b::Segment(5000, s::NM1, "Operating Physician Name",
1995
- r::Situational, d::RepeatCount.bounded(1),
1996
- b::Element(e::Required, "Entity Identifier Code", b::Values("72")),
1997
- b::Element(e::Required, "Entity Type Qualifier", b::Values("1")),
1998
- b::Element(e::Required, "Operating Physician Last Name"),
1999
- b::Element(e::Situational, "Operating Physician First Name"),
2000
- b::Element(e::Situational, "Operating Physician Middle Name or Initial"),
2001
- b::Element(e::NotUsed, "Name Prefix"),
2002
- b::Element(e::Situational, "Operating Physician Suffix"),
2003
- b::Element(e::Situational, "Identification Code Qualifier", b::Values("XX")),
2004
- b::Element(e::Situational, "Operating Physician Primary Identifier"),
2005
- b::Element(e::NotUsed, "Entity Relationship Code"),
2006
- b::Element(e::NotUsed, "Entity Identifier Code"),
2007
- b::Element(e::NotUsed, "Name Last or Organization Name")),
2008
- b::Segment(5250, s::REF, "Operating Physician Secondary Identification",
2009
- r::Situational, d::RepeatCount.bounded(20),
2010
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("0B", "1G", "G2", "LU")),
2011
- b::Element(e::Required, "Operating Physician Secondary Identifier"),
2012
- b::Element(e::NotUsed, "Description"),
2013
- b::Element(e::Situational, "REFERENCE IDENTIFIER",
2014
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("2U")),
2015
- b::Element(e::Required, "Other Payer Primary Identifier"),
2016
- b::Element(e::NotUsed, "Reference Identification Qualifier"),
2017
- b::Element(e::NotUsed, "Reference Identification"),
2018
- b::Element(e::NotUsed, "Reference Identification Qualifier"),
2019
- b::Element(e::NotUsed, "Reference Identification")))),
2020
-
2021
- d::LoopDef.build("2420B OTHER OPERATING PHYSICIAN NAME",
2022
- d::RepeatCount.bounded(1),
2023
- b::Segment(5000, s::NM1, "Other Operating Physician Name",
2024
- r::Situational, d::RepeatCount.bounded(1),
2025
- b::Element(e::Required, "Entity Identifier Code", b::Values("ZZ")),
2026
- b::Element(e::Required, "Entity Type Qualifier", b::Values("1")),
2027
- b::Element(e::Required, "Other Operating Physician Last Name"),
2028
- b::Element(e::Situational, "Other Operating Physician First Name"),
2029
- b::Element(e::Situational, "Other Operating Physician Middle Name or Initial"),
2030
- b::Element(e::NotUsed, "Name Prefix"),
2031
- b::Element(e::Situational, "Other Operating Physician Name Suffix"),
2032
- b::Element(e::Situational, "Identification Code Qualifier", b::Values("XX")),
2033
- b::Element(e::Situational, "Other Operating Physician Identifier"),
2034
- b::Element(e::NotUsed, "Entity Relationship Code"),
2035
- b::Element(e::NotUsed, "Entity Identifier Code"),
2036
- b::Element(e::NotUsed, "Name Last or Organization Name")),
2037
- b::Segment(5250, s::REF, "Other Operating Physician Secondary Identification",
2038
- r::Situational, d::RepeatCount.bounded(20),
2039
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("0B", "1G", "G2", "LU")),
2040
- b::Element(e::Required, "Other Provider Secondary Identifier"),
2041
- b::Element(e::NotUsed, "Description"),
2042
- b::Element(e::Situational, "REFERENCE IDENTIFIER",
2043
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("2U")),
2044
- b::Element(e::Required, "Other Payer Primary Identifier"),
2045
- b::Element(e::NotUsed, "Reference Identifier Qualifier"),
2046
- b::Element(e::NotUsed, "Reference Identifier"),
2047
- b::Element(e::NotUsed, "Reference Identifier Qualifier"),
2048
- b::Element(e::NotUsed, "Reference Identifier")))),
2049
-
2050
- d::LoopDef.build("2420C RENDERING PROVIDER NAME",
2051
- d::RepeatCount.bounded(1),
2052
- b::Segment(5000, s::NM1, "Rendering Provider Name",
2053
- r::Situational, d::RepeatCount.bounded(1),
2054
- b::Element(e::Required, "Entity Identifier Code", b::Values("82")),
2055
- b::Element(e::Required, "Entity Type Qualifier", b::Values("1")),
2056
- b::Element(e::Required, "Rendering Provider Last Name"),
2057
- b::Element(e::Situational, "Rendering Provider First Name"),
2058
- b::Element(e::Situational, "Rendering Provider Middle Name or Initial"),
2059
- b::Element(e::NotUsed, "Name Prefix"),
2060
- b::Element(e::Situational, "Rendering Provider Name Suffix"),
2061
- b::Element(e::Situational, "Identification Code Qualifier", b::Values("XX")),
2062
- b::Element(e::Situational, "Rendering Provider Identifier"),
2063
- b::Element(e::NotUsed, "Entity Relationship Code"),
2064
- b::Element(e::NotUsed, "Entity Identifier Code"),
2065
- b::Element(e::NotUsed, "Name Last or Organization Name")),
2066
- b::Segment(5250, s::REF, "Rendering Provider Secondary Identification",
2067
- r::Situational, d::RepeatCount.bounded(20),
2068
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("0B", "1G", "G2", "LU")),
2069
- b::Element(e::Required, "Rendering Provider Secondary Identifier"),
2070
- b::Element(e::NotUsed, "Description"),
2071
- b::Element(e::Situational, "REFERENCE IDENTIFIER",
2072
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("2U")),
2073
- b::Element(e::Required, "Other Payer Primary Identifier"),
2074
- b::Element(e::NotUsed, "Reference Identification Qualifier"),
2075
- b::Element(e::NotUsed, "Reference Identification"),
2076
- b::Element(e::NotUsed, "Reference Identification Qualifier"),
2077
- b::Element(e::NotUsed, "Reference Identification")))),
2078
-
2079
- d::LoopDef.build("2420D REFERRING PROVIDER NAME",
2080
- d::RepeatCount.bounded(1),
2081
- b::Segment(5000, s::NM1, "Referring Provider Name",
2082
- r::Situational, d::RepeatCount.bounded(1),
2083
- b::Element(e::Required, "Entity Identifier Code", b::Values("DN")),
2084
- b::Element(e::Required, "Entity Type Qualifier", b::Values("1")),
2085
- b::Element(e::Required, "Referring Provider Last Name"),
2086
- b::Element(e::Situational, "Referring Provider First Name"),
2087
- b::Element(e::Situational, "Referring Provider Middle Name or Initial"),
2088
- b::Element(e::NotUsed, "Name Prefix"),
2089
- b::Element(e::Situational, "Referring Provider Name Suffix"),
2090
- b::Element(e::Situational, "Identification Code Qualifier", b::Values("XX")),
2091
- b::Element(e::Situational, "Referring Provider Identifier"),
2092
- b::Element(e::NotUsed, "Entity Relationship Code"),
2093
- b::Element(e::NotUsed, "Entity Identifier Code"),
2094
- b::Element(e::NotUsed, "Name Last or Organization Name")),
2095
- b::Segment(5250, s::REF, "Referring Provider Secondary Identification",
2096
- r::Situational, d::RepeatCount.bounded(20),
2097
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("0B", "1G", "G2")),
2098
- b::Element(e::Required, "Referring Provider Secondary Identifier"),
2099
- b::Element(e::NotUsed, "Description"),
2100
- b::Element(e::Situational, "REFERENCE IDENTIFIER",
2101
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("2U")),
2102
- b::Element(e::Required, "Other Payer Primary Identifier"),
2103
- b::Element(e::NotUsed, "Reference Identification Qualifier"),
2104
- b::Element(e::NotUsed, "Reference Identification"),
2105
- b::Element(e::NotUsed, "Reference Identification Qualifier"),
2106
- b::Element(e::NotUsed, "Reference Identification")))),
2107
-
2108
- d::LoopDef.build("2430 LINE ADJUDICATION INFORMATION",
2109
- d::RepeatCount.bounded(15),
2110
- b::Segment(5400, s::SVD, "Line Adjudication Information",
2111
- r::Situational, d::RepeatCount.bounded(1),
2112
- b::Element(e::Required, "Other Payer Primary Identifier"),
2113
- b::Element(e::Required, "Service Line Paid Amount"),
2114
- b::Element(e::Required, "COMPOSITE MEDICAL PROCEDURE IDENTIFIER",
2115
- b::Element(e::Required, "Product or Service ID Qualifier", b::Values("ER", "HC", "HP", "IV", "WK")),
2116
- b::Element(e::Required, "Procedure Code"),
2117
- b::Element(e::Situational, "Procedure Modifier"),
2118
- b::Element(e::Situational, "Procedure Modifier"),
2119
- b::Element(e::Situational, "Procedure Modifier"),
2120
- b::Element(e::Situational, "Procedure Modifier"),
2121
- b::Element(e::Situational, "Procedure Code Description"),
2122
- b::Element(e::NotUsed, "Product/Service ID")),
2123
- b::Element(e::NotUsed, "Product/Service ID"),
2124
- b::Element(e::Required, "Paid Service Unit Count", b::MaxLength(8), b::MaxPrecision(3)),
2125
- b::Element(e::Situational, "Bundled Line Number")),
2126
- b::Segment(5450, s::CAS, "Line Adjustment",
2127
- r::Situational, d::RepeatCount.bounded(5),
2128
- b::Element(e::Required, "Claim Adjustment Group Code", b::Values("CO", "CR", "OA", "PI", "PR")),
2129
- b::Element(e::Required, "Adjustment Reason Code"),
2130
- b::Element(e::Required, "Adjustment Amount"),
2131
- b::Element(e::Situational, "Adjustment Quantity"),
2132
- b::Element(e::Situational, "Adjustment Reason Code"),
2133
- b::Element(e::Situational, "Adjustment Amount"),
2134
- b::Element(e::Situational, "Adjustment Quantity"),
2135
- b::Element(e::Situational, "Adjustment Reason Code"),
2136
- b::Element(e::Situational, "Adjustment Amount"),
2137
- b::Element(e::Situational, "Adjustment Quantity"),
2138
- b::Element(e::Situational, "Adjustment Reason Code"),
2139
- b::Element(e::Situational, "Adjustment Amount"),
2140
- b::Element(e::Situational, "Adjustment Quantity"),
2141
- b::Element(e::Situational, "Adjustment Reason Code"),
2142
- b::Element(e::Situational, "Adjustment Amount"),
2143
- b::Element(e::Situational, "Adjustment Quantity"),
2144
- b::Element(e::Situational, "Adjustment Reason Code"),
2145
- b::Element(e::Situational, "Adjustment Amount"),
2146
- b::Element(e::Situational, "Adjustment Quantity")),
2147
- b::Segment(5500, s::DTP, "Line Check or Remittance Date",
2148
- r::Required, d::RepeatCount.bounded(1),
2149
- b::Element(e::Required, "Date Time Qualifier", b::Values("573")),
2150
- b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
2151
- b::Element(e::Required, "Adjudication or Payment Date")),
2152
- b::Segment(5505, s::AMT, "Remaining Patient Liability",
2153
- r::Situational, d::RepeatCount.bounded(1),
2154
- b::Element(e::Required, "Amount Qualifier Code", b::Values("EAF")),
2155
- b::Element(e::Required, "Remaining Patient Liability"),
2156
- b::Element(e::NotUsed, "Credit/Debit Flag Code")))))
2157
-
2158
- HC837I = b.build(t::HC837,
2159
- d::TableDef.header("Table 1 - Header",
2160
- b::Segment(50, s::ST, "Transaction Set Header",
2161
- r::Required, d::RepeatCount.bounded(1),
2162
- b::Element(e::Required, "Transaction Set Identifier Code", b::Values("837")),
2163
- b::Element(e::Required, "Transaction Set Control Number"),
2164
- b::Element(e::Required, "Version, Release or Industry Identifier")),
2165
- b::Segment(100, s::BHT, "Beginning of Hierarchical Transaction",
2166
- r::Required, d::RepeatCount.bounded(1),
2167
- b::Element(e::Required, "Hierarchical Structure Code", b::Values("0019")),
2168
- b::Element(e::Required, "Transaction Set Purpose Code", b::Values("00", "18")),
2169
- b::Element(e::Required, "Originator Application Transaction Identifier", b::MaxLength(30)),
2170
- b::Element(e::Required, "Transaction Set Creation Date"),
2171
- b::Element(e::Required, "Transaction Set Creation Time"),
2172
- b::Element(e::Required, "Claim Identifier", b::Values("31", "CH", "RP"))),
2173
-
2174
- d::LoopDef.build("1000A SUBMITTER NAME",
2175
- d::RepeatCount.bounded(1),
2176
- b::Segment(200, s::NM1, "Submitter Name",
2177
- r::Required, d::RepeatCount.bounded(1),
2178
- b::Element(e::Required, "Entity Identifier Code", b::Values("41")),
2179
- b::Element(e::Required, "Entity Type Qualifier", b::Values("1", "2")),
2180
- b::Element(e::Required, "Submitter Last or Organization Name"),
2181
- b::Element(e::Situational, "Submitter First Name"),
2182
- b::Element(e::Situational, "Submitter Middle Name or Initial"),
2183
- b::Element(e::NotUsed, "Name Prefix"),
2184
- b::Element(e::NotUsed, "Name Suffix"),
2185
- b::Element(e::Required, "Identification Qualifier Code", b::Values("46")),
2186
- b::Element(e::Required, "Submitter Identifier"),
2187
- b::Element(e::NotUsed, "Entity Relationship Code"),
2188
- b::Element(e::NotUsed, "Entity Identifier Code"),
2189
- b::Element(e::NotUsed, "Name Last or Organization Name")),
2190
- b::Segment(450, s::PER, "Submitter EDI Contact Information",
2191
- r::Required, d::RepeatCount.bounded(2),
2192
- b::Element(e::Required, "Contact Function Code", b::Values("IC")),
2193
- b::Element(e::Situational, "Submitter Contact Name"),
2194
- b::Element(e::Required, "Communication Number Qualifier", b::Values("EM", "FX", "TE")),
2195
- b::Element(e::Required, "Communication Number"),
2196
- b::Element(e::Situational, "Communication Number Qualifier", b::Values("EM", "EX", "FX", "TE")),
2197
- b::Element(e::Situational, "Communication Number"),
2198
- b::Element(e::Situational, "Communication Number Qualifier", b::Values("EM", "EX", "FX", "TE")),
2199
- b::Element(e::Situational, "Communication Number"),
2200
- b::Element(e::NotUsed, "Contact Inquiry Reference"))),
2201
-
2202
- d::LoopDef.build("1000B RECEIVER NAME",
2203
- d::RepeatCount.bounded(1),
2204
- b::Segment(200, s::NM1, "Receiver Name",
2205
- r::Required, d::RepeatCount.bounded(1),
2206
- b::Element(e::Required, "Entity Identifier Code", b::Values("40")),
2207
- b::Element(e::Required, "Entity Type Qualifier", b::Values("2")),
2208
- b::Element(e::Required, "Receiver Name"),
2209
- b::Element(e::NotUsed, "Name First"),
2210
- b::Element(e::NotUsed, "Name Last"),
2211
- b::Element(e::NotUsed, "Name Prefix"),
2212
- b::Element(e::NotUsed, "Name Suffix"),
2213
- b::Element(e::Required, "Identification Code Qualifier", b::Values("46")),
2214
- b::Element(e::Required, "Receiver Primary Identifier"),
2215
- b::Element(e::NotUsed, "Entity Relationship Code"),
2216
- b::Element(e::NotUsed, "Entity Identifier Code"),
2217
- b::Element(e::NotUsed, "Name Last or Organization Name")))),
2218
-
2219
- d::TableDef.detail("Table 2 - Billing Provider Detail",
2220
- d::LoopDef.build("2000A BILLING PROVIDER HIERARCHICAL LEVEL",
2221
- d::RepeatCount.bounded(1),
2222
- b::Segment(10, s::HL, "Billing Provider Hierarchical Level",
2223
- r::Required, d::RepeatCount.bounded(1),
2224
- b::Element(e::Required, "Hierarchical ID Number"),
2225
- b::Element(e::NotUsed, "Hierarchical Parent ID Number"),
2226
- b::Element(e::Required, "Hierarchical Level Code", b::Values("20")),
2227
- b::Element(e::Required, "Hierachical Child Code", b::Values("1"))),
2228
- b::Segment(30, s::PRV, "Billing Provider Specialty Information",
2229
- r::Situational, d::RepeatCount.bounded(1),
2230
- b::Element(e::Required, "Provider Code", b::Values("BI")),
2231
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("PXC")),
2232
- b::Element(e::Required, "Provider Taxonomy Code"),
2233
- b::Element(e::NotUsed, "State or Province Code"),
2234
- b::Element(e::NotUsed, "PROVIDER SPECIALTY INFORMATION"),
2235
- b::Element(e::NotUsed, "Provider Organization Code")),
2236
- b::Segment(100, s::CUR, "Foreign Currency Information",
2237
- r::Situational, d::RepeatCount.bounded(1),
2238
- b::Element(e::Required, "Entity Identifier Code", b::Values("85")),
2239
- b::Element(e::Required, "Currency Code"),
2240
- b::Element(e::NotUsed, "Exchange Rate"),
2241
- b::Element(e::NotUsed, "Entity Identifier Code"),
2242
- b::Element(e::NotUsed, "Currency Code"),
2243
- b::Element(e::NotUsed, "Currency Market/Exchange Code"),
2244
- b::Element(e::NotUsed, "Date/Time Qualifier"),
2245
- b::Element(e::NotUsed, "Date"),
2246
- b::Element(e::NotUsed, "Time"),
2247
- b::Element(e::NotUsed, "Date/Time Qualifier"),
2248
- b::Element(e::NotUsed, "Date"),
2249
- b::Element(e::NotUsed, "Time"),
2250
- b::Element(e::NotUsed, "Date/Time Qualifier"),
2251
- b::Element(e::NotUsed, "Date"),
2252
- b::Element(e::NotUsed, "Time"),
2253
- b::Element(e::NotUsed, "Date/Time Qualifier"),
2254
- b::Element(e::NotUsed, "Date"),
2255
- b::Element(e::NotUsed, "Time"),
2256
- b::Element(e::NotUsed, "Date/Time Qualifier"),
2257
- b::Element(e::NotUsed, "Date"),
2258
- b::Element(e::NotUsed, "Time")),
2259
-
2260
- d::LoopDef.build("2010AA BILLING PROVIDER NAME",
2261
- d::RepeatCount.bounded(1),
2262
- b::Segment(150, s::NM1, "Billing Provider Name",
2263
- r::Required, d::RepeatCount.bounded(1),
2264
- b::Element(e::Required, "Entity Identifier Code", b::Values("85")),
2265
- b::Element(e::Required, "Entity Type Qualifier", b::Values("2")),
2266
- b::Element(e::Required, "Billing Provider Organizational Name"),
2267
- b::Element(e::NotUsed, "Name First"),
2268
- b::Element(e::NotUsed, "Name Middle"),
2269
- b::Element(e::NotUsed, "Name Prefix"),
2270
- b::Element(e::NotUsed, "Name Suffix"),
2271
- b::Element(e::Situational, "Identification Code Qualifier", b::Values("XX")),
2272
- b::Element(e::Situational, "Billing Provider Identifier"),
2273
- b::Element(e::NotUsed, "Entity Relationship Code"),
2274
- b::Element(e::NotUsed, "Entity Identifier Code"),
2275
- b::Element(e::NotUsed, "Name Last or Organization Name")),
2276
- b::Segment(250, s::N3, "Billing Provider Address",
2277
- r::Required, d::RepeatCount.bounded(1),
2278
- b::Element(e::Required, "Billing Provider Address Line"),
2279
- b::Element(e::Situational, "Billing Provider Address Line")),
2280
- b::Segment(300, s::N4, "Billing Provider City, State, ZIP Code",
2281
- r::Required, d::RepeatCount.bounded(1),
2282
- b::Element(e::Required, "Billing Provider City Name"),
2283
- b::Element(e::Situational, "Billing Provider State or Province Code"),
2284
- b::Element(e::Situational, "Billing Provider Postal Zone or ZIP Code"),
2285
- b::Element(e::Situational, "Country Code"),
2286
- b::Element(e::NotUsed, "Location Qualifier"),
2287
- b::Element(e::NotUsed, "Location Identifier"),
2288
- b::Element(e::Situational, "Country Subdivision Code")),
2289
- b::Segment(350, s::REF, "Billing Provider Tax Identification",
2290
- r::Required, d::RepeatCount.bounded(1),
2291
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("EI")),
2292
- b::Element(e::Required, "Billing Provider Tax Identification Number"),
2293
- b::Element(e::NotUsed, "Description"),
2294
- b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
2295
- b::Segment(400, s::PER, "Billing Provider Contact Information",
2296
- r::Situational, d::RepeatCount.bounded(2),
2297
- b::Element(e::Required, "Contact Function Code", b::Values("IC")),
2298
- b::Element(e::Situational, "Billing Provider Contact Name"),
2299
- b::Element(e::Required, "Communication Number Qualifier", b::Values("EM", "FX", "TE")),
2300
- b::Element(e::Required, "Communication Number"),
2301
- b::Element(e::Situational, "Communication Number Qualifier", b::Values("EM", "EX", "FX", "TE")),
2302
- b::Element(e::Situational, "Communication Number"),
2303
- b::Element(e::Situational, "Communication Number Qualifier", b::Values("EM", "EX", "FX", "TE")),
2304
- b::Element(e::Situational, "Communication Number"),
2305
- b::Element(e::NotUsed, "Contact Inquiry Reference"))),
2306
-
2307
- d::LoopDef.build("2010AB PAY-TO ADDRESS NAME",
2308
- d::RepeatCount.bounded(1),
2309
- b::Segment(150, s::NM1, "Pay-to Address Name",
2310
- r::Situational, d::RepeatCount.bounded(1),
2311
- b::Element(e::Required, "Entity Identifier Code", b::Values("87")),
2312
- b::Element(e::Required, "Entity Type Qualifier", b::Values("2")),
2313
- b::Element(e::NotUsed, "Name Last or Organizational Name"),
2314
- b::Element(e::NotUsed, "Name First"),
2315
- b::Element(e::NotUsed, "Name Middle"),
2316
- b::Element(e::NotUsed, "Name Prefix"),
2317
- b::Element(e::NotUsed, "Name Suffix"),
2318
- b::Element(e::NotUsed, "Identification Code Qualifier"),
2319
- b::Element(e::NotUsed, "Identifier Code"),
2320
- b::Element(e::NotUsed, "Entity Relationship Code"),
2321
- b::Element(e::NotUsed, "Entity Identifier Code"),
2322
- b::Element(e::NotUsed, "Name Last or Organization Name")),
2323
- b::Segment(250, s::N3, "Pay-to Address - ADDRESS",
2324
- r::Required, d::RepeatCount.bounded(1),
2325
- b::Element(e::Required, "Pay-To Address Line"),
2326
- b::Element(e::Situational, "Pay-To Address Line")),
2327
- b::Segment(300, s::N4, "Pay-To Address City, State, ZIP Code",
2328
- r::Required, d::RepeatCount.bounded(1),
2329
- b::Element(e::Required, "Pay-to Address City Name"),
2330
- b::Element(e::Situational, "Pay-to Address State Code"),
2331
- b::Element(e::Situational, "Pay-to Address Postal Zone or ZIP Code"),
2332
- b::Element(e::Situational, "Country Code"),
2333
- b::Element(e::NotUsed, "Location Qualifier"),
2334
- b::Element(e::NotUsed, "Location Identifier"),
2335
- b::Element(e::Situational, "Country Subdivision Code"))),
2336
-
2337
- d::LoopDef.build("2010AC PAY-TO PLAN NAME",
2338
- d::RepeatCount.bounded(1),
2339
- b::Segment(150, s::NM1, "Pay-To Plan Name",
2340
- r::Situational, d::RepeatCount.bounded(1),
2341
- b::Element(e::Required, "Entity Identifier Code", b::Values("PE")),
2342
- b::Element(e::Required, "Entity Type Qualifier", b::Values("2")),
2343
- b::Element(e::Required, "Pay-To Plan Organizational Name"),
2344
- b::Element(e::NotUsed, "Name First"),
2345
- b::Element(e::NotUsed, "Name Middle"),
2346
- b::Element(e::NotUsed, "Name Prefix"),
2347
- b::Element(e::NotUsed, "Name Suffix"),
2348
- b::Element(e::Required, "Identification Code Qualifier", b::Values("PI", "XV")),
2349
- b::Element(e::Required, "Pay-To Plan Primary Identifier"),
2350
- b::Element(e::NotUsed, "Entity Relationship Code"),
2351
- b::Element(e::NotUsed, "Entity Identifier Code"),
2352
- b::Element(e::NotUsed, "Name Last or Organization Name")),
2353
- b::Segment(250, s::N3, "Pay-to Plan Address",
2354
- r::Required, d::RepeatCount.bounded(1),
2355
- b::Element(e::Required, "Pay-To Plan Address Line"),
2356
- b::Element(e::Situational, "Pay-To Plan Address Line")),
2357
- b::Segment(300, s::N4, "Pay-To Plan City, State, ZIP Code",
2358
- r::Required, d::RepeatCount.bounded(1),
2359
- b::Element(e::Required, "Pay-to Plan City Name"),
2360
- b::Element(e::Situational, "Pay-to Plan State or Province Code"),
2361
- b::Element(e::Situational, "Pay-to Plan Postal Zone or ZIP Code"),
2362
- b::Element(e::Situational, "Country Code"),
2363
- b::Element(e::NotUsed, "Location Qualifier"),
2364
- b::Element(e::NotUsed, "Location Identifier"),
2365
- b::Element(e::Situational, "Country Subdivision Code")),
2366
- b::Segment(350, s::REF, "Pay-to Plan Secondary Identification",
2367
- r::Situational, d::RepeatCount.bounded(1),
2368
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("2U", "FY", "NF")),
2369
- b::Element(e::Required, "Pay-to Plan Secondary Identifier"),
2370
- b::Element(e::NotUsed, "Description"),
2371
- b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
2372
- b::Segment(350, s::REF, "Pay-to Plan Tax Identification Number",
2373
- r::Required, d::RepeatCount.bounded(1),
2374
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("EI")),
2375
- b::Element(e::Required, "Pay-to Plan Tax Identification Number"),
2376
- b::Element(e::NotUsed, "Description"),
2377
- b::Element(e::NotUsed, "REFERENCE IDENTIFIER"))))),
2378
-
2379
- d::TableDef.detail("Table 2 - Subscriber Detail",
2380
- d::LoopDef.build("2000B SUBSCRIBER HIERARCHICAL LEVEL",
2381
- d::RepeatCount.bounded(1),
2382
- b::Segment(10, s::HL, "Subscriber Hierarchical Level",
2383
- r::Required, d::RepeatCount.bounded(1),
2384
- b::Element(e::Required, "Hierarchical ID Number"),
2385
- b::Element(e::Required, "Hierarchical Parent ID Number"),
2386
- b::Element(e::Required, "Hierarchical Level Code", b::Values("22")),
2387
- b::Element(e::Required, "Hierachical Child Code", b::Values("0", "1"))),
2388
- b::Segment(50, s::SBR, "Subscriber Information",
2389
- r::Required, d::RepeatCount.bounded(1),
2390
- b::Element(e::Required, "Payer Responsibility Sequence Number Code", b::Values("A", "B", "C", "D", "E", "F", "G", "H", "P", "S", "T", "U")),
2391
- b::Element(e::Situational, "Individual Relationship Code", b::Values("18")),
2392
- b::Element(e::Situational, "Subscriber Group or Policy Number"),
2393
- b::Element(e::Situational, "Subscriber Group Name"),
2394
- b::Element(e::NotUsed, "Insurance Type Code"),
2395
- b::Element(e::NotUsed, "Coordination of Benefits Code"),
2396
- b::Element(e::NotUsed, "Yes/No Condition or Response Code"),
2397
- b::Element(e::NotUsed, "Employment Status Code"),
2398
- 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"))),
2399
-
2400
- d::LoopDef.build("2010BA SUBSCRIBER NAME",
2401
- d::RepeatCount.bounded(1),
2402
- b::Segment(150, s::NM1, "Subscriber Name",
2403
- r::Required, d::RepeatCount.bounded(1),
2404
- b::Element(e::Required, "Entity Identifier Code", b::Values("IL")),
2405
- b::Element(e::Required, "Entity Type Qualifier", b::Values("1", "2")),
2406
- b::Element(e::Required, "Subscriber Last Name"),
2407
- b::Element(e::Situational, "Subscriber First Name"),
2408
- b::Element(e::Situational, "Subscriber Middle Name or Initial"),
2409
- b::Element(e::NotUsed, "Name Prefix"),
2410
- b::Element(e::Situational, "Subscriber Name Suffix"),
2411
- b::Element(e::Required, "Identification Code Qualifier", b::Values("II", "MI")),
2412
- b::Element(e::Required, "Subscriber Primary Identifier"),
2413
- b::Element(e::NotUsed, "Entity Relationship Code"),
2414
- b::Element(e::NotUsed, "Entity Identifier Code"),
2415
- b::Element(e::NotUsed, "Name Last or Organization Name")),
2416
- b::Segment(250, s::N3, "Subscriber Address",
2417
- r::Situational, d::RepeatCount.bounded(1),
2418
- b::Element(e::Required, "Subscriber Address Line"),
2419
- b::Element(e::Situational, "Subscriber Address Line")),
2420
- b::Segment(300, s::N4, "Subscriber City, State, ZIP Code",
2421
- r::Required, d::RepeatCount.bounded(1),
2422
- b::Element(e::Required, "Subscriber City Name"),
2423
- b::Element(e::Situational, "Subscriber State Code"),
2424
- b::Element(e::Situational, "Subscriber Postal Zone or ZIP Code"),
2425
- b::Element(e::Situational, "Country Code"),
2426
- b::Element(e::NotUsed, "Location Qualifier"),
2427
- b::Element(e::NotUsed, "Location Identifier"),
2428
- b::Element(e::Situational, "Country Subdivision Code")),
2429
- b::Segment(320, s::DMG, "Subscriber Demographic Information",
2430
- r::Situational, d::RepeatCount.bounded(1),
2431
- b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
2432
- b::Element(e::Required, "Subscriber Birth Date"),
2433
- b::Element(e::Required, "Subscriber Gender Code", b::Values("F", "M", "U")),
2434
- b::Element(e::NotUsed, "Marital Status Code"),
2435
- b::Element(e::NotUsed, "COMPOSITE RACE OR ETHNICITY INFORMATION"),
2436
- b::Element(e::NotUsed, "Citizenship Status Code"),
2437
- b::Element(e::NotUsed, "Country Code"),
2438
- b::Element(e::NotUsed, "Basis of Verification Code"),
2439
- b::Element(e::NotUsed, "Quantity"),
2440
- b::Element(e::NotUsed, "Code List Qualifier Code"),
2441
- b::Element(e::NotUsed, "Industry Code")),
2442
- b::Segment(350, s::REF, "Subscriber Secondary Identification",
2443
- r::Situational, d::RepeatCount.bounded(1),
2444
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("SY")),
2445
- b::Element(e::Required, "Subscriber Supplemental Identifier"),
2446
- b::Element(e::NotUsed, "Description"),
2447
- b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
2448
- b::Segment(350, s::REF, "Property and Casualty Claim Number",
2449
- r::Situational, d::RepeatCount.bounded(1),
2450
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("Y4")),
2451
- b::Element(e::Required, "Property Casualty Claim Number"),
2452
- b::Element(e::NotUsed, "Description"),
2453
- b::Element(e::NotUsed, "REFERENCE IDENTIFIER"))),
2454
-
2455
- d::LoopDef.build("2010BB PAYER NAME",
2456
- d::RepeatCount.bounded(10),
2457
- b::Segment(150, s::NM1, "Payer Name",
2458
- r::Required, d::RepeatCount.bounded(1),
2459
- b::Element(e::Required, "Entity Identifier Code", b::Values("PR")),
2460
- b::Element(e::Required, "Entity Type Qualifier", b::Values("2")),
2461
- b::Element(e::Required, "Payer Name"),
2462
- b::Element(e::NotUsed, "Name First"),
2463
- b::Element(e::NotUsed, "Name Middle"),
2464
- b::Element(e::NotUsed, "Name Prefix"),
2465
- b::Element(e::NotUsed, "Name Suffix"),
2466
- b::Element(e::Required, "Identification Code Qualifier", b::Values("PI", "XV")),
2467
- b::Element(e::Required, "Payer Identifier"),
2468
- b::Element(e::NotUsed, "Entity Relationship Code"),
2469
- b::Element(e::NotUsed, "Entity Identifier Code"),
2470
- b::Element(e::NotUsed, "Name Last or Organization Name")),
2471
- b::Segment(250, s::N3, "Payer Address",
2472
- r::Situational, d::RepeatCount.bounded(1),
2473
- b::Element(e::Required, "Payer Address Line"),
2474
- b::Element(e::Situational, "Payer Address Line")),
2475
- b::Segment(300, s::N4, "Payer City, State, ZIP Code",
2476
- r::Required, d::RepeatCount.bounded(1),
2477
- b::Element(e::Required, "Payer City Name"),
2478
- b::Element(e::Situational, "Payer State Code"),
2479
- b::Element(e::Situational, "Payer Postal Zone or ZIP Code"),
2480
- b::Element(e::Situational, "Country Code"),
2481
- b::Element(e::NotUsed, "Location Qualifier"),
2482
- b::Element(e::NotUsed, "Location Identifier"),
2483
- b::Element(e::Situational, "Country Subdivision Code")),
2484
- b::Segment(350, s::REF, "Payer Secondary Identification",
2485
- r::Situational, d::RepeatCount.bounded(3),
2486
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("2U", "EI", "FY", "NF")),
2487
- b::Element(e::Required, "Payer Additional Identifier"),
2488
- b::Element(e::NotUsed, "Description"),
2489
- b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
2490
- b::Segment(350, s::REF, "Billing Provider Secondary Identification",
2491
- r::Situational, d::RepeatCount.bounded(1),
2492
- b::Element(e::Required, "Reference Identification Qualifier", b::Values("G2", "LU")),
2493
- b::Element(e::Required, "Billing Provider Secondary Identifier"),
2494
- b::Element(e::NotUsed, "Description"),
2495
- b::Element(e::NotUsed, "REFERENCE IDENTIFIER"))),
2496
-
2497
- loop2300)),
2498
-
2499
- d::TableDef.detail("Table 2 - Patient Detail",
2500
- d::LoopDef.build("2000C PATIENT HIERARCHICAL LEVEL",
2501
- d::RepeatCount.bounded(1),
2502
- b::Segment(10, s::HL, "Patient Hierachical Level",
2503
- r::Situational, d::RepeatCount.bounded(1),
2504
- b::Element(e::Required, "Hierarchical ID Number"),
2505
- b::Element(e::Required, "Hierarchical Parent ID Number"),
2506
- b::Element(e::Required, "Hierarchical Level Code", b::Values("23")),
2507
- b::Element(e::Required, "Hierarchical Child Code", b::Values("0"))),
2508
- b::Segment(70, s::PAT, "Patient Information",
2509
- r::Required, d::RepeatCount.bounded(1),
2510
- b::Element(e::Required, "Individual Relationship Code", b::Values("01", "19", "20", "21", "39", "40", "53", "G8")),
2511
- b::Element(e::NotUsed, "Patient Location Code"),
2512
- b::Element(e::NotUsed, "Employment Status Code"),
2513
- b::Element(e::NotUsed, "Student Status Code"),
2514
- b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
2515
- b::Element(e::NotUsed, "Date Time Period"),
2516
- b::Element(e::NotUsed, "Unit Basis for Measurement Code"),
2517
- b::Element(e::NotUsed, "Weight"),
2518
- b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
2519
-
2520
- d::LoopDef.build("2010CA PATIENT NAME",
2521
- d::RepeatCount.bounded(1),
2522
- b::Segment(150, s::NM1, "Patient Name",
2523
- r::Required, d::RepeatCount.bounded(1),
2524
- b::Element(e::Required, "Entity Qualifier Code", b::Values("QC")),
2525
- b::Element(e::Required, "Entity Type Qualifier", b::Values("1")),
2526
- b::Element(e::Required, "Patient Last Name"),
2527
- b::Element(e::Situational, "Patient First Name"),
2528
- b::Element(e::Situational, "Patient Middle Name or Initial"),
2529
- b::Element(e::NotUsed, "Name Prefix"),
2530
- b::Element(e::Situational, "Patient Name Suffix"),
2531
- b::Element(e::NotUsed, "Identification Code Qualifier"),
2532
- b::Element(e::NotUsed, "Identification Code"),
2533
- b::Element(e::NotUsed, "Entity Relationship Code"),
2534
- b::Element(e::NotUsed, "Entity Identifier Code"),
2535
- b::Element(e::NotUsed, "Name Last or Organization Name")),
2536
- b::Segment(250, s::N3, "Patient Address",
2537
- r::Required, d::RepeatCount.bounded(1),
2538
- b::Element(e::Required, "Patient Address Line"),
2539
- b::Element(e::Situational, "Patient Address Line")),
2540
- b::Segment(300, s::N4, "Patient City, State, ZIP Code",
2541
- r::Required, d::RepeatCount.bounded(1),
2542
- b::Element(e::Required, "Patient City Name"),
2543
- b::Element(e::Situational, "Patient State Code"),
2544
- b::Element(e::Situational, "Patient Postal Zone or ZIP Code"),
2545
- b::Element(e::Situational, "Country Code"),
2546
- b::Element(e::NotUsed, "Location Qualifier"),
2547
- b::Element(e::NotUsed, "Location Identifier"),
2548
- b::Element(e::Situational, "Country Subdivision Code")),
2549
- b::Segment(320, s::DMG, "Patient Demographic Information",
2550
- r::Required, d::RepeatCount.bounded(1),
2551
- b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
2552
- b::Element(e::Required, "Patient Birth Date"),
2553
- b::Element(e::Required, "Patient Gender Code", b::Values("F", "M", "U")),
2554
- b::Element(e::NotUsed, "Marital Status Code"),
2555
- b::Element(e::NotUsed, "COMPOSITE RACE OR ETHNICITY INFORMATION"),
2556
- b::Element(e::NotUsed, "Citizenship Status Code"),
2557
- b::Element(e::NotUsed, "Country Code"),
2558
- b::Element(e::NotUsed, "Basis of Verification Code"),
2559
- b::Element(e::NotUsed, "Quantity"),
2560
- b::Element(e::NotUsed, "Code List Qualifier Code"),
2561
- b::Element(e::NotUsed, "Industry Code")),
2562
- b::Segment(350, s::REF, "Property and Casualty Claim Number",
2563
- r::Situational, d::RepeatCount.bounded(1),
2564
- b::Element(e::Required, "Reference Identifier Qualifier", b::Values("Y4")),
2565
- b::Element(e::Required, "Property Casualty Claim Number"),
2566
- b::Element(e::NotUsed, "Description"),
2567
- b::Element(e::NotUsed, "REFERENCE IDENTIFIER"))),
2568
-
2569
- loop2300)),
2570
-
2571
- d::TableDef.summary("Table 3 - Summary",
2572
- b::Segment(5550, s::SE, "Transaction Set Trailer",
2573
- r::Required, d::RepeatCount.bounded(1),
2574
- b::Element(e::Required, "Transaction Segment Count"),
2575
- b::Element(e::Required, "Transaction Set Control Number"))))
2576
- end
2577
- end
2578
- end
2579
- end