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
@@ -0,0 +1,15 @@
1
+ # frozen_string_literal: true
2
+ module Stupidedi
3
+ module TransactionSets
4
+ module FiftyTen
5
+ module Implementations
6
+ module X222
7
+ warn "DEPRECATION WARNING: #{self}::HC837 is deprecated, use X222A1::HC837 instead"
8
+
9
+ # @deprecated Use X222A1::HC837 instead
10
+ HC837 = X222A1::HC837
11
+ end
12
+ end
13
+ end
14
+ end
15
+ end
@@ -0,0 +1,15 @@
1
+ # frozen_string_literal: true
2
+ module Stupidedi
3
+ module TransactionSets
4
+ module FiftyTen
5
+ module Implementations
6
+ module X222
7
+ warn "DEPRECATION WARNING: #{self}::HC837P is deprecated, use X22A1::HC837 instead"
8
+
9
+ # @deprecated
10
+ HC837P = X222A1::HC837
11
+ end
12
+ end
13
+ end
14
+ end
15
+ end
@@ -0,0 +1,2033 @@
1
+ # frozen_string_literal: true
2
+ module Stupidedi
3
+ module TransactionSets
4
+ module FiftyTen
5
+ module Implementations
6
+ module X222A1
7
+ b = Builder
8
+ d = Schema
9
+ r = SegmentReqs
10
+ e = ElementReqs
11
+ s = SegmentDefs
12
+
13
+ # With only a quick glance at X222, it appears that 2300 is a child of
14
+ # the 2000C HL loop. But there is a little note that reads:
15
+ #
16
+ # For the purposes of this documentation, the claim detail information
17
+ # is presented only in the dependent level. Specific claim detail
18
+ # information can be given in either the subscriber or the dependent
19
+ # hierarchical level. Because of this, the claim information is said
20
+ # to "float." Claim information is positioned in the same hierarchical
21
+ # level that describes its owner-participant, either the subscriber or
22
+ # the dependent. In other words, the claim information, Loop 2300, is
23
+ # placed in the hierarchical level when the patient is the subscriber,
24
+ # or it is placed at the patient/dependent hierarchical level when the
25
+ # patient is the dependent of the subscriber as shown here. When the
26
+ # patient is the subscriber, loops 2000C and 2010CA are not sent. See
27
+ # 1.4.3.2.2.1, HL Segment, for details.
28
+ #
29
+ # So here we build the 2300 LoopDef and later copy it as a child of the
30
+ # 2000B and 2000C loops. The actual transaction set begins below with
31
+ # the line that starts HC837 = ...
32
+
33
+ loop2300 =
34
+ d::LoopDef.build("2300 CLAIM INFORMATION", d::RepeatCount.bounded(100),
35
+ b::Segment(1300, s::CLM, "Claim Information", r::Situational, d::RepeatCount.bounded(1),
36
+ b::Element(e::Required, "Patient Control Number", b::MaxLength(20)),
37
+ b::Element(e::Required, "Total Claim Charge Amount"),
38
+ b::Element(e::NotUsed, "Claim Filing Indicator Code"),
39
+ b::Element(e::NotUsed, "Non-Institutional Claim Type Code"),
40
+ b::Element(e::Required, "HEALTH CARE SERVICE LOCATION INFORMATION",
41
+ b::Element(e::Required, "Place of Service Code"),
42
+ b::Element(e::Required, "Facility Code Qualifier", b::Values("B")),
43
+ b::Element(e::Required, "Claim Frequency Code")),
44
+ b::Element(e::Required, "Provider or Supplier Signature Indicator", b::Values("N", "Y")),
45
+ b::Element(e::Required, "Assignment or Plan Participation Code", b::Values("A", "B", "C")),
46
+ b::Element(e::Required, "Benefits Assignment Certification Indicator", b::Values("N", "W", "Y")),
47
+ b::Element(e::Required, "Release of Information Code", b::Values("I", "Y")),
48
+ b::Element(e::Situational, "Patient Signature Source Code", b::Values("P")),
49
+ b::Element(e::Situational, "RELATED CAUSES INFORMATION",
50
+ b::Element(e::Required, "Related Causes Code", b::Values("AA", "EM", "OA")),
51
+ b::Element(e::Situational, "Related Causes Code", b::Values("AA", "EM", "OA")),
52
+ b::Element(e::NotUsed, "Related Causes Code"),
53
+ b::Element(e::Situational, "Auto Accident State or Province Code"),
54
+ b::Element(e::Situational, "Country Code")),
55
+ b::Element(e::Situational, "Special Program Indicator", b::Values("02", "03", "05", "09")),
56
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code"),
57
+ b::Element(e::NotUsed, "Level of Service Code"),
58
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code"),
59
+ b::Element(e::NotUsed, "Provider Agreement Code"),
60
+ b::Element(e::NotUsed, "Claim Status Code"),
61
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code"),
62
+ b::Element(e::NotUsed, "Claim Submission Reason Code"),
63
+ b::Element(e::Situational, "Delay Reason Code", b::Values("1", "2", "3", "4", "5", "6", "7", "8", "9", "10", "11", "15"))),
64
+ b::Segment(1350, s::DTP, "Onset of Current Illness or Symptom", r::Situational, d::RepeatCount.bounded(1),
65
+ b::Element(e::Required, "Date Time Qualifier", b::Values("431")),
66
+ b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
67
+ b::Element(e::Required, "Onset of Current Illness or Injury Date")),
68
+ b::Segment(1350, s::DTP, "Initial Treatment Date", r::Situational, d::RepeatCount.bounded(1),
69
+ b::Element(e::Required, "Date Time Qualifier", b::Values("454")),
70
+ b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
71
+ b::Element(e::Required, "Initial Treatment Date")),
72
+ b::Segment(1350, s::DTP, "Last Seen Date", r::Situational, d::RepeatCount.bounded(1),
73
+ b::Element(e::Required, "Date Time Qualifier", b::Values("304")),
74
+ b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
75
+ b::Element(e::Required, "Last Seen Date")),
76
+ b::Segment(1350, s::DTP, "Acute Manifestation Date", r::Situational, d::RepeatCount.bounded(1),
77
+ b::Element(e::Required, "Date Time Qualifier", b::Values("453")),
78
+ b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
79
+ b::Element(e::Required, "Acute Manifestation Date")),
80
+ b::Segment(1350, s::DTP, "Accident Date", r::Situational, d::RepeatCount.bounded(1),
81
+ b::Element(e::Required, "Date Time Qualifier", b::Values("439")),
82
+ b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
83
+ b::Element(e::Required, "Accident Date")),
84
+ b::Segment(1350, s::DTP, "Last Menstrual Period Date", r::Situational, d::RepeatCount.bounded(1),
85
+ b::Element(e::Required, "Date Time Qualifier", b::Values("484")),
86
+ b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
87
+ b::Element(e::Required, "Last Menstrual Period Date")),
88
+ b::Segment(1350, s::DTP, "Last X-ray Date", r::Situational, d::RepeatCount.bounded(1),
89
+ b::Element(e::Required, "Date Time Qualifier", b::Values("455")),
90
+ b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
91
+ b::Element(e::Required, "Last X-ray Date")),
92
+ b::Segment(1350, s::DTP, "Hearing and Vision Prescription Date", r::Situational, d::RepeatCount.bounded(1),
93
+ b::Element(e::Required, "Date Time Qualifier", b::Values("471")),
94
+ b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
95
+ b::Element(e::Required, "Prescription Date")),
96
+ b::Segment(1350, s::DTP, "Disability Dates", r::Situational, d::RepeatCount.bounded(1),
97
+ b::Element(e::Required, "Date Time Qualifier", b::Values("314", "360", "361")),
98
+ b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8", "RD8")),
99
+ b::Element(e::Required, "Disability From Date")),
100
+ b::Segment(1350, s::DTP, "Last Worked Date", r::Situational, d::RepeatCount.bounded(1),
101
+ b::Element(e::Required, "Date Time Qualifier", b::Values("297")),
102
+ b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
103
+ b::Element(e::Required, "Last Worked Date")),
104
+ b::Segment(1350, s::DTP, "Authorized Return to Work Date", r::Situational, d::RepeatCount.bounded(1),
105
+ b::Element(e::Required, "Date Time Qualifier", b::Values("296")),
106
+ b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
107
+ b::Element(e::Required, "Work Return Date")),
108
+ b::Segment(1350, s::DTP, "Admission Date", r::Situational, d::RepeatCount.bounded(1),
109
+ b::Element(e::Required, "Date Time Qualifier", b::Values("435")),
110
+ b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
111
+ b::Element(e::Required, "Related Hospitalization Admission Date")),
112
+ b::Segment(1350, s::DTP, "Discharge Date", r::Situational, d::RepeatCount.bounded(1),
113
+ b::Element(e::Required, "Date Time Qualifier", b::Values("096")),
114
+ b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
115
+ b::Element(e::Required, "Related Hospitalization Discharge Date")),
116
+ b::Segment(1350, s::DTP, "Assumed and Relinquished Care Dates", r::Situational, d::RepeatCount.bounded(2),
117
+ b::Element(e::Required, "Date Time Qualifier", b::Values("090", "091")),
118
+ b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
119
+ b::Element(e::Required, "Asumed or Relinquished Care Date")),
120
+ b::Segment(1350, s::DTP, "Property and Casualty Date of First Contact", r::Situational, d::RepeatCount.bounded(1),
121
+ b::Element(e::Required, "Date Time Qualifier", b::Values("444")),
122
+ b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
123
+ b::Element(e::Required, "Date")),
124
+ b::Segment(1350, s::DTP, "Repricer Received Date", r::Situational, d::RepeatCount.bounded(1),
125
+ b::Element(e::Required, "Date Time Qualifier", b::Values("050")),
126
+ b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
127
+ b::Element(e::Required, "Repricer Received Date")),
128
+ b::Segment(1550, s::PWK, "Claim Supplemental Information", r::Situational, d::RepeatCount.bounded(10),
129
+ 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")),
130
+ b::Element(e::Required, "Attachment Transmission Code", b::Values("AA", "BM", "EL", "EM", "FT", "FX")),
131
+ b::Element(e::NotUsed, "Report Copies Needed"),
132
+ b::Element(e::NotUsed, "Entity Identifier Code"),
133
+ b::Element(e::Situational, "Identification Code Qualifier", b::Values("AC")),
134
+ b::Element(e::Situational, "Attachment Control Number", b::MaxLength(50)),
135
+ b::Element(e::NotUsed, "Description"),
136
+ b::Element(e::NotUsed, "ACTIONS INDICATED"),
137
+ b::Element(e::NotUsed, "Request Category Code")),
138
+ b::Segment(1600, s::CN1, "Contract Information", r::Situational, d::RepeatCount.bounded(1),
139
+ b::Element(e::Required, "Contract Type Code", b::Values("01", "02", "03", "04", "05", "06", "09")),
140
+ b::Element(e::Situational, "Contract Amount"),
141
+ b::Element(e::Situational, "Contract Percentage"),
142
+ b::Element(e::Situational, "Contract Code"),
143
+ b::Element(e::Situational, "Terms Discount Percentage"),
144
+ b::Element(e::Situational, "Contract Version Number")),
145
+ b::Segment(1750, s::AMT, "Patient Amount Paid", r::Situational, d::RepeatCount.bounded(1),
146
+ b::Element(e::Required, "Amount Qualifier Code", b::Values("F5")),
147
+ b::Element(e::Required, "Patient Amount Paid"),
148
+ b::Element(e::NotUsed, "Credit/Debit Flag Code")),
149
+ b::Segment(1800, s::REF, "Service Authorization Exception Code", r::Situational, d::RepeatCount.bounded(1),
150
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("4N")),
151
+ b::Element(e::Required, "Service Authorization Exception Code", b::Values("1", "2", "3", "4", "5", "6", "7")),
152
+ b::Element(e::NotUsed, "Description"),
153
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
154
+ b::Segment(1800, s::REF, "Mandatory Medicare (Section 4081) Crossover Indicator", r::Situational, d::RepeatCount.bounded(1),
155
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("F5")),
156
+ b::Element(e::Required, "Medicare Section 4081 Indicator", b::Values("Y", "N")),
157
+ b::Element(e::NotUsed, "Description"),
158
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
159
+ b::Segment(1800, s::REF, "Mammography Certification Number", r::Situational, d::RepeatCount.bounded(1),
160
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("EW")),
161
+ b::Element(e::Required, "Mammography Certification Number"),
162
+ b::Element(e::NotUsed, "Description"),
163
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
164
+ b::Segment(1800, s::REF, "Referral Number", r::Situational, d::RepeatCount.bounded(1),
165
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("9F")),
166
+ b::Element(e::Required, "Referral Number"),
167
+ b::Element(e::NotUsed, "Description"),
168
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
169
+ b::Segment(1800, s::REF, "Prior Authorization", r::Situational, d::RepeatCount.bounded(1),
170
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("G1")),
171
+ b::Element(e::Required, "Prior Authorization Number"),
172
+ b::Element(e::NotUsed, "Description"),
173
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
174
+ b::Segment(1800, s::REF, "Payer Claim Control Number", r::Situational, d::RepeatCount.bounded(1),
175
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("F8")),
176
+ b::Element(e::Required, "Payer Claim Control Number"),
177
+ b::Element(e::NotUsed, "Description"),
178
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
179
+ b::Segment(1800, s::REF, "Clinical Laboratory Improvement Amendment (CLIA) Number", r::Situational, d::RepeatCount.bounded(1),
180
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("X4")),
181
+ b::Element(e::Required, "Clinical Laboratory Improvement Amendment Number"),
182
+ b::Element(e::NotUsed, "Description"),
183
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
184
+ b::Segment(1800, s::REF, "Repriced Claim Number", r::Situational, d::RepeatCount.bounded(1),
185
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("9A")),
186
+ b::Element(e::Required, "Repriced Claim Reference Number"),
187
+ b::Element(e::NotUsed, "Description"),
188
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
189
+ b::Segment(1800, s::REF, "Adjusted Repriced Claim Number", r::Situational, d::RepeatCount.bounded(1),
190
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("9C")),
191
+ b::Element(e::Required, "Adjusted Repriced Claim Reference Number"),
192
+ b::Element(e::NotUsed, "Description"),
193
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
194
+ b::Segment(1800, s::REF, "Investigational Device Exemption Number", r::Situational, d::RepeatCount.bounded(1),
195
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("LX")),
196
+ b::Element(e::Required, "Investigational Device Exemption Identifier"),
197
+ b::Element(e::NotUsed, "Description"),
198
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
199
+ b::Segment(1800, s::REF, "Claim Identifier for Transmission Intermediaries", r::Situational, d::RepeatCount.bounded(1),
200
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("D9")),
201
+ b::Element(e::Required, "Value Added Network Trace Number", b::MaxLength(20)),
202
+ b::Element(e::NotUsed, "Description"),
203
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
204
+ b::Segment(1800, s::REF, "Medical Record Number", r::Situational, d::RepeatCount.bounded(1),
205
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("EA")),
206
+ b::Element(e::Required, "Medical Record Number"),
207
+ b::Element(e::NotUsed, "Description"),
208
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
209
+ b::Segment(1800, s::REF, "Demonstration Project Identifier", r::Situational, d::RepeatCount.bounded(1),
210
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("P4")),
211
+ b::Element(e::Required, "Demonstration Project Number"),
212
+ b::Element(e::NotUsed, "Description"),
213
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
214
+ b::Segment(1800, s::REF, "Care Plan Oversight", r::Situational, d::RepeatCount.bounded(1),
215
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("1J")),
216
+ b::Element(e::Required, "Care Plan Oversight Number"),
217
+ b::Element(e::NotUsed, "Description"),
218
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
219
+ b::Segment(1850, s::K3, "File Information", r::Situational, d::RepeatCount.bounded(10),
220
+ b::Element(e::Required, "Fixed Format Information"),
221
+ b::Element(e::NotUsed, "Record Format Code"),
222
+ b::Element(e::NotUsed, "COMPOSITE UNIT OF MEASURE")),
223
+ b::Segment(1900, s::NTE, "Claim Note", r::Situational, d::RepeatCount.bounded(1),
224
+ b::Element(e::Required, "Note Reference Code", b::Values("ADD", "CER", "DCP", "DGN", "TPO")),
225
+ b::Element(e::Required, "Claim Note Text")),
226
+ b::Segment(1950, s::CR1, "Ambulance Transportation Information", r::Situational, d::RepeatCount.bounded(1),
227
+ b::Element(e::Situational, "Unit or Basis of Measure", b::Values("LB")),
228
+ b::Element(e::Situational, "Patient Weight"),
229
+ b::Element(e::NotUsed, "Ambulance Transport Code"),
230
+ b::Element(e::Required, "Ambulance Transport Reason Code", b::Values("A", "B", "C", "D", "E")),
231
+ b::Element(e::Required, "Unit or Basis for Measurement Code", b::Values("DH")),
232
+ b::Element(e::Required, "Transport Distance"),
233
+ b::Element(e::NotUsed, "Address Information"),
234
+ b::Element(e::NotUsed, "Address Information"),
235
+ b::Element(e::Situational, "Round Trip Purpose Description"),
236
+ b::Element(e::Situational, "Stretcher Purpose Description")),
237
+ b::Segment(2000, s::CR2, "Spinal Manipulation Service Information", r::Situational, d::RepeatCount.bounded(1),
238
+ b::Element(e::NotUsed, "Count"),
239
+ b::Element(e::NotUsed, "Quantity"),
240
+ b::Element(e::NotUsed, "Sublaxation Level Code"),
241
+ b::Element(e::NotUsed, "Sublaxation Level Code"),
242
+ b::Element(e::NotUsed, "Unit or Basis for Measurement Code"),
243
+ b::Element(e::NotUsed, "Quantity"),
244
+ b::Element(e::NotUsed, "Quantity"),
245
+ b::Element(e::Required, "Nature of Condition Code", b::Values("A", "C", "D", "E", "F", "G", "M")),
246
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code"),
247
+ b::Element(e::Situational, "Patient Condition Description"),
248
+ b::Element(e::Situational, "Patient Condition Description"),
249
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
250
+ b::Segment(2200, s::CRC, "Ambulance Certification", r::Situational, d::RepeatCount.bounded(3),
251
+ b::Element(e::Required, "Code Category", b::Values("07")),
252
+ b::Element(e::Required, "Certification Condition Indicator", b::Values("Y", "N")),
253
+ b::Element(e::Required, "Condition Code", b::Values("01", "04", "05", "06", "07", "08", "09", "12")),
254
+ b::Element(e::Situational, "Condition Code", b::Values("01", "04", "05", "06", "07", "08", "09", "12")),
255
+ b::Element(e::Situational, "Condition Code", b::Values("01", "04", "05", "06", "07", "08", "09", "12")),
256
+ b::Element(e::Situational, "Condition Code", b::Values("01", "04", "05", "06", "07", "08", "09", "12")),
257
+ b::Element(e::Situational, "Condition Code", b::Values("01", "04", "05", "06", "07", "08", "09", "12"))),
258
+ b::Segment(2200, s::CRC, "Patient Condition Information: Vision", r::Situational, d::RepeatCount.bounded(3),
259
+ b::Element(e::Required, "Code Category", b::Values("E1", "E2", "E3")),
260
+ b::Element(e::Required, "Certification Condition Indicator", b::Values("Y", "N")),
261
+ b::Element(e::Required, "Condition Code", b::Values("L1", "L2", "L3", "L4", "L5")),
262
+ b::Element(e::Situational, "Condition Code", b::Values("L1", "L2", "L3", "L4", "L5")),
263
+ b::Element(e::Situational, "Condition Code", b::Values("L1", "L2", "L3", "L4", "L5")),
264
+ b::Element(e::Situational, "Condition Code", b::Values("L1", "L2", "L3", "L4", "L5")),
265
+ b::Element(e::Situational, "Condition Code", b::Values("L1", "L2", "L3", "L4", "L5"))),
266
+ b::Segment(2200, s::CRC, "Homebound Indicator", r::Situational, d::RepeatCount.bounded(1),
267
+ b::Element(e::Required, "Code Category", b::Values("E1", "E2", "E3")),
268
+ b::Element(e::Required, "Certification Condition Indicator", b::Values("Y")),
269
+ b::Element(e::Required, "Condition Code", b::Values("IH")),
270
+ b::Element(e::NotUsed, "Condition Indicator"),
271
+ b::Element(e::Situational, "Condition Indicator"),
272
+ b::Element(e::Situational, "Condition Indicator"),
273
+ b::Element(e::Situational, "Condition Indicator")),
274
+ b::Segment(2200, s::CRC, "EPSDT Referral", r::Situational, d::RepeatCount.bounded(1),
275
+ b::Element(e::Required, "Code Category", b::Values("ZZ")),
276
+ b::Element(e::Required, "Certification Condition Indicator", b::Values("Y", "N")),
277
+ b::Element(e::Required, "Condition Code", b::Values("AV", "NU", "S2", "ST")),
278
+ b::Element(e::Situational, "Condition Code", b::Values("AV", "NU", "S2", "ST")),
279
+ b::Element(e::Situational, "Condition Code", b::Values("AV", "NU", "S2", "ST")),
280
+ b::Element(e::NotUsed, "Condition Indicator"),
281
+ b::Element(e::NotUsed, "Condition Indicator")),
282
+ b::Segment(2310, s::HI, "Health Care Diagnosis Code", r::Required, d::RepeatCount.bounded(1),
283
+ b::Element(e::Required, "HEALTH CARE CODE INFORMATION",
284
+ b::Element(e::Required, "Code List Qualifier", b::Values("ABK", "BK")),
285
+ b::Element(e::Required, "Diagnosis Code"),
286
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
287
+ b::Element(e::NotUsed, "Date Time Period"),
288
+ b::Element(e::NotUsed, "Monetary Amount"),
289
+ b::Element(e::NotUsed, "Quantity"),
290
+ b::Element(e::NotUsed, "Version Identifier"),
291
+ b::Element(e::NotUsed, "Industry Code"),
292
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
293
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
294
+ b::Element(e::Required, "Code List Qualifier", b::Values("ABF", "BF")),
295
+ b::Element(e::Required, "Diagnosis Code"),
296
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
297
+ b::Element(e::NotUsed, "Date Time Period"),
298
+ b::Element(e::NotUsed, "Monetary Amount"),
299
+ b::Element(e::NotUsed, "Quantity"),
300
+ b::Element(e::NotUsed, "Version Identifier"),
301
+ b::Element(e::NotUsed, "Industry Code"),
302
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
303
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
304
+ b::Element(e::Required, "Code List Qualifier", b::Values("ABF", "BF")),
305
+ b::Element(e::Required, "Diagnosis Code"),
306
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
307
+ b::Element(e::NotUsed, "Date Time Period"),
308
+ b::Element(e::NotUsed, "Monetary Amount"),
309
+ b::Element(e::NotUsed, "Quantity"),
310
+ b::Element(e::NotUsed, "Version Identifier"),
311
+ b::Element(e::NotUsed, "Industry Code"),
312
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
313
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
314
+ b::Element(e::Required, "Code List Qualifier", b::Values("ABF", "BF")),
315
+ b::Element(e::Required, "Diagnosis Code"),
316
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
317
+ b::Element(e::NotUsed, "Date Time Period"),
318
+ b::Element(e::NotUsed, "Monetary Amount"),
319
+ b::Element(e::NotUsed, "Quantity"),
320
+ b::Element(e::NotUsed, "Version Identifier"),
321
+ b::Element(e::NotUsed, "Industry Code"),
322
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
323
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
324
+ b::Element(e::Required, "Code List Qualifier", b::Values("ABF", "BF")),
325
+ b::Element(e::Required, "Diagnosis Code"),
326
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
327
+ b::Element(e::NotUsed, "Date Time Period"),
328
+ b::Element(e::NotUsed, "Monetary Amount"),
329
+ b::Element(e::NotUsed, "Quantity"),
330
+ b::Element(e::NotUsed, "Version Identifier"),
331
+ b::Element(e::NotUsed, "Industry Code"),
332
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
333
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
334
+ b::Element(e::Required, "Code List Qualifier", b::Values("ABF", "BF")),
335
+ b::Element(e::Required, "Diagnosis Code"),
336
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
337
+ b::Element(e::NotUsed, "Date Time Period"),
338
+ b::Element(e::NotUsed, "Monetary Amount"),
339
+ b::Element(e::NotUsed, "Quantity"),
340
+ b::Element(e::NotUsed, "Version Identifier"),
341
+ b::Element(e::NotUsed, "Industry Code"),
342
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
343
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
344
+ b::Element(e::Required, "Code List Qualifier", b::Values("ABF", "BF")),
345
+ b::Element(e::Required, "Diagnosis Code"),
346
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
347
+ b::Element(e::NotUsed, "Date Time Period"),
348
+ b::Element(e::NotUsed, "Monetary Amount"),
349
+ b::Element(e::NotUsed, "Quantity"),
350
+ b::Element(e::NotUsed, "Version Identifier"),
351
+ b::Element(e::NotUsed, "Industry Code"),
352
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
353
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
354
+ b::Element(e::Required, "Code List Qualifier", b::Values("ABF", "BF")),
355
+ b::Element(e::Required, "Diagnosis Code"),
356
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
357
+ b::Element(e::NotUsed, "Date Time Period"),
358
+ b::Element(e::NotUsed, "Monetary Amount"),
359
+ b::Element(e::NotUsed, "Quantity"),
360
+ b::Element(e::NotUsed, "Version Identifier"),
361
+ b::Element(e::NotUsed, "Industry Code"),
362
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
363
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
364
+ b::Element(e::Required, "Code List Qualifier", b::Values("ABF", "BF")),
365
+ b::Element(e::Required, "Diagnosis Code"),
366
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
367
+ b::Element(e::NotUsed, "Date Time Period"),
368
+ b::Element(e::NotUsed, "Monetary Amount"),
369
+ b::Element(e::NotUsed, "Quantity"),
370
+ b::Element(e::NotUsed, "Version Identifier"),
371
+ b::Element(e::NotUsed, "Industry Code"),
372
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
373
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
374
+ b::Element(e::Required, "Code List Qualifier", b::Values("ABF", "BF")),
375
+ b::Element(e::Required, "Diagnosis Code"),
376
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
377
+ b::Element(e::NotUsed, "Date Time Period"),
378
+ b::Element(e::NotUsed, "Monetary Amount"),
379
+ b::Element(e::NotUsed, "Quantity"),
380
+ b::Element(e::NotUsed, "Version Identifier"),
381
+ b::Element(e::NotUsed, "Industry Code"),
382
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
383
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
384
+ b::Element(e::Required, "Code List Qualifier", b::Values("ABF", "BF")),
385
+ b::Element(e::Required, "Diagnosis Code"),
386
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
387
+ b::Element(e::NotUsed, "Date Time Period"),
388
+ b::Element(e::NotUsed, "Monetary Amount"),
389
+ b::Element(e::NotUsed, "Quantity"),
390
+ b::Element(e::NotUsed, "Version Identifier"),
391
+ b::Element(e::NotUsed, "Industry Code"),
392
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
393
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
394
+ b::Element(e::Required, "Code List Qualifier", b::Values("ABF", "BF")),
395
+ b::Element(e::Required, "Diagnosis Code"),
396
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
397
+ b::Element(e::NotUsed, "Date Time Period"),
398
+ b::Element(e::NotUsed, "Monetary Amount"),
399
+ b::Element(e::NotUsed, "Quantity"),
400
+ b::Element(e::NotUsed, "Version Identifier"),
401
+ b::Element(e::NotUsed, "Industry Code"),
402
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code"))),
403
+ b::Segment(2310, s::HI, "Anesthesia Related Procedure", r::Situational, d::RepeatCount.bounded(1),
404
+ b::Element(e::Required, "HEALTH CARE CODE INFORMATION",
405
+ b::Element(e::Required, "Code List Qualifier", b::Values("BP")),
406
+ b::Element(e::Required, "Diagnosis Code"),
407
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
408
+ b::Element(e::NotUsed, "Date Time Period"),
409
+ b::Element(e::NotUsed, "Monetary Amount"),
410
+ b::Element(e::NotUsed, "Quantity"),
411
+ b::Element(e::NotUsed, "Version Identifier"),
412
+ b::Element(e::NotUsed, "Industry Code"),
413
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
414
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
415
+ b::Element(e::Required, "Code List Qualifier", b::Values("BO")),
416
+ b::Element(e::Required, "Diagnosis Code"),
417
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
418
+ b::Element(e::NotUsed, "Date Time Period"),
419
+ b::Element(e::NotUsed, "Monetary Amount"),
420
+ b::Element(e::NotUsed, "Quantity"),
421
+ b::Element(e::NotUsed, "Version Identifier"),
422
+ b::Element(e::NotUsed, "Industry Code"),
423
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
424
+ b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
425
+ b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
426
+ b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
427
+ b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
428
+ b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
429
+ b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
430
+ b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
431
+ b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
432
+ b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION"),
433
+ b::Element(e::NotUsed, "HEALTH CARE CODE INFORMATION")),
434
+ b::Segment(2310, s::HI, "Condition Information", r::Situational, d::RepeatCount.bounded(1),
435
+ b::Element(e::Required, "HEALTH CARE CODE INFORMATION",
436
+ b::Element(e::Required, "Code List Qualifier", b::Values("BG")),
437
+ b::Element(e::Required, "Diagnosis Code"),
438
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
439
+ b::Element(e::NotUsed, "Date Time Period"),
440
+ b::Element(e::NotUsed, "Monetary Amount"),
441
+ b::Element(e::NotUsed, "Quantity"),
442
+ b::Element(e::NotUsed, "Version Identifier"),
443
+ b::Element(e::NotUsed, "Industry Code"),
444
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
445
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
446
+ b::Element(e::Required, "Code List Qualifier", b::Values("BG")),
447
+ b::Element(e::Required, "Diagnosis Code"),
448
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
449
+ b::Element(e::NotUsed, "Date Time Period"),
450
+ b::Element(e::NotUsed, "Monetary Amount"),
451
+ b::Element(e::NotUsed, "Quantity"),
452
+ b::Element(e::NotUsed, "Version Identifier"),
453
+ b::Element(e::NotUsed, "Industry Code"),
454
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
455
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
456
+ b::Element(e::Required, "Code List Qualifier", b::Values("BG")),
457
+ b::Element(e::Required, "Diagnosis Code"),
458
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
459
+ b::Element(e::NotUsed, "Date Time Period"),
460
+ b::Element(e::NotUsed, "Monetary Amount"),
461
+ b::Element(e::NotUsed, "Quantity"),
462
+ b::Element(e::NotUsed, "Version Identifier"),
463
+ b::Element(e::NotUsed, "Industry Code"),
464
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
465
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
466
+ b::Element(e::Required, "Code List Qualifier", b::Values("BG")),
467
+ b::Element(e::Required, "Diagnosis Code"),
468
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
469
+ b::Element(e::NotUsed, "Date Time Period"),
470
+ b::Element(e::NotUsed, "Monetary Amount"),
471
+ b::Element(e::NotUsed, "Quantity"),
472
+ b::Element(e::NotUsed, "Version Identifier"),
473
+ b::Element(e::NotUsed, "Industry Code"),
474
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
475
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
476
+ b::Element(e::Required, "Code List Qualifier", b::Values("BG")),
477
+ b::Element(e::Required, "Diagnosis Code"),
478
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
479
+ b::Element(e::NotUsed, "Date Time Period"),
480
+ b::Element(e::NotUsed, "Monetary Amount"),
481
+ b::Element(e::NotUsed, "Quantity"),
482
+ b::Element(e::NotUsed, "Version Identifier"),
483
+ b::Element(e::NotUsed, "Industry Code"),
484
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
485
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
486
+ b::Element(e::Required, "Code List Qualifier", b::Values("BG")),
487
+ b::Element(e::Required, "Diagnosis Code"),
488
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
489
+ b::Element(e::NotUsed, "Date Time Period"),
490
+ b::Element(e::NotUsed, "Monetary Amount"),
491
+ b::Element(e::NotUsed, "Quantity"),
492
+ b::Element(e::NotUsed, "Version Identifier"),
493
+ b::Element(e::NotUsed, "Industry Code"),
494
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
495
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
496
+ b::Element(e::Required, "Code List Qualifier", b::Values("BG")),
497
+ b::Element(e::Required, "Diagnosis Code"),
498
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
499
+ b::Element(e::NotUsed, "Date Time Period"),
500
+ b::Element(e::NotUsed, "Monetary Amount"),
501
+ b::Element(e::NotUsed, "Quantity"),
502
+ b::Element(e::NotUsed, "Version Identifier"),
503
+ b::Element(e::NotUsed, "Industry Code"),
504
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
505
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
506
+ b::Element(e::Required, "Code List Qualifier", b::Values("BG")),
507
+ b::Element(e::Required, "Diagnosis Code"),
508
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
509
+ b::Element(e::NotUsed, "Date Time Period"),
510
+ b::Element(e::NotUsed, "Monetary Amount"),
511
+ b::Element(e::NotUsed, "Quantity"),
512
+ b::Element(e::NotUsed, "Version Identifier"),
513
+ b::Element(e::NotUsed, "Industry Code"),
514
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
515
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
516
+ b::Element(e::Required, "Code List Qualifier", b::Values("BG")),
517
+ b::Element(e::Required, "Diagnosis Code"),
518
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
519
+ b::Element(e::NotUsed, "Date Time Period"),
520
+ b::Element(e::NotUsed, "Monetary Amount"),
521
+ b::Element(e::NotUsed, "Quantity"),
522
+ b::Element(e::NotUsed, "Version Identifier"),
523
+ b::Element(e::NotUsed, "Industry Code"),
524
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
525
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
526
+ b::Element(e::Required, "Code List Qualifier", b::Values("BG")),
527
+ b::Element(e::Required, "Diagnosis Code"),
528
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
529
+ b::Element(e::NotUsed, "Date Time Period"),
530
+ b::Element(e::NotUsed, "Monetary Amount"),
531
+ b::Element(e::NotUsed, "Quantity"),
532
+ b::Element(e::NotUsed, "Version Identifier"),
533
+ b::Element(e::NotUsed, "Industry Code"),
534
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
535
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
536
+ b::Element(e::Required, "Code List Qualifier", b::Values("BG")),
537
+ b::Element(e::Required, "Diagnosis Code"),
538
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
539
+ b::Element(e::NotUsed, "Date Time Period"),
540
+ b::Element(e::NotUsed, "Monetary Amount"),
541
+ b::Element(e::NotUsed, "Quantity"),
542
+ b::Element(e::NotUsed, "Version Identifier"),
543
+ b::Element(e::NotUsed, "Industry Code"),
544
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
545
+ b::Element(e::Situational, "HEALTH CARE CODE INFORMATION",
546
+ b::Element(e::Required, "Code List Qualifier", b::Values("BG")),
547
+ b::Element(e::Required, "Diagnosis Code"),
548
+ b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
549
+ b::Element(e::NotUsed, "Date Time Period"),
550
+ b::Element(e::NotUsed, "Monetary Amount"),
551
+ b::Element(e::NotUsed, "Quantity"),
552
+ b::Element(e::NotUsed, "Version Identifier"),
553
+ b::Element(e::NotUsed, "Industry Code"),
554
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code"))),
555
+ b::Segment(2410, s::HCP, "Claim Pricing/Repricing Information", r::Situational, d::RepeatCount.bounded(1),
556
+ b::Element(e::Required, "Pricing Methodology", b::Values("00", "01", "02", "03", "04", "05", "07", "08", "09", "10", "11", "12", "13", "14")),
557
+ b::Element(e::Required, "Repriced Allowed Amount"),
558
+ b::Element(e::Situational, "Repriced Saving Amount"),
559
+ b::Element(e::Situational, "Repricing Organization Identifier"),
560
+ b::Element(e::Situational, "Repricing Per Diem or Flat Rate Amount"),
561
+ b::Element(e::Situational, "Repriced Approved Ambulatory Patient Group Code"),
562
+ b::Element(e::Situational, "Repriced Approved Ambulatory Patient Group Amount"),
563
+ b::Element(e::NotUsed, "Product/Service ID"),
564
+ b::Element(e::NotUsed, "Product/Service Qualifier"),
565
+ b::Element(e::NotUsed, "Product/Service ID"),
566
+ b::Element(e::NotUsed, "Unit or Basis of Measurement Code"),
567
+ b::Element(e::NotUsed, "Quantity"),
568
+ b::Element(e::Situational, "Reject Reason Code", b::Values("T1", "T2", "T3", "T4", "T5", "T6")),
569
+ b::Element(e::Situational, "Policy Compliance Code", b::Values("1", "2", "3", "4", "5")),
570
+ b::Element(e::Situational, "Exception Code", b::Values("1", "2", "3", "4", "5", "6"))),
571
+
572
+ d::LoopDef.build("2310A REFERRING PROVIDER NAME", d::RepeatCount.bounded(2),
573
+ b::Segment(2500, s::NM1, "Referring Provider Name", r::Situational, d::RepeatCount.bounded(1),
574
+ b::Element(e::Required, "Entity Identifier Code", b::Values("DN", "P3")),
575
+ b::Element(e::Required, "Entity Type Qualifier", b::Values("1")),
576
+ b::Element(e::Required, "Referring Provider Last Name"),
577
+ b::Element(e::Situational, "Referring Provider First Name"),
578
+ b::Element(e::Situational, "Referring Provider Middle Name or Initial"),
579
+ b::Element(e::NotUsed, "Name Prefix"),
580
+ b::Element(e::Situational, "Referring Provider Name Suffix"),
581
+ b::Element(e::Situational, "Identification Code Qualifier", b::Values("XX")),
582
+ b::Element(e::Situational, "Referring Provider Identifier"),
583
+ b::Element(e::NotUsed, "Entity Relationship Code"),
584
+ b::Element(e::NotUsed, "Entity Identifier Code"),
585
+ b::Element(e::NotUsed, "Name Last or Organization Name")),
586
+ b::Segment(2710, s::REF, "Referring Provider Specialty Information", r::Situational, d::RepeatCount.bounded(3),
587
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("0B", "1G", "G2")),
588
+ b::Element(e::Required, "Referring Provider Secondary Identifier"),
589
+ b::Element(e::NotUsed, "Description"),
590
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER"))),
591
+
592
+ d::LoopDef.build("2310B RENDERING PROVIDER NAME", d::RepeatCount.bounded(1),
593
+ b::Segment(2500, s::NM1, "Rendering Provider Name", r::Situational, d::RepeatCount.bounded(1),
594
+ b::Element(e::Required, "Entity Identifier Code", b::Values("82")),
595
+ b::Element(e::Required, "Entity Type Qualifier", b::Values("1", "2")),
596
+ b::Element(e::Required, "Rendering Provider Last Name"),
597
+ b::Element(e::Situational, "Rendering Provider First Name"),
598
+ b::Element(e::Situational, "Rendering Provider Middle Name or Initial"),
599
+ b::Element(e::NotUsed, "Name Prefix"),
600
+ b::Element(e::Situational, "Rendering Provider Name Suffix"),
601
+ b::Element(e::Situational, "Identification Code Qualifier", b::Values("XX")),
602
+ b::Element(e::Situational, "Rendering Provider Identifier"),
603
+ b::Element(e::NotUsed, "Entity Relationship Code"),
604
+ b::Element(e::NotUsed, "Entity Identifier Code"),
605
+ b::Element(e::NotUsed, "Name Last or Organization Name")),
606
+ b::Segment(2550, s::PRV, "Rendering Provider Specialty Information", r::Situational, d::RepeatCount.bounded(1),
607
+ b::Element(e::Required, "Provider Code", b::Values("PE")),
608
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("PXC")),
609
+ b::Element(e::Required, "Provider Taxonomy Code"),
610
+ b::Element(e::NotUsed, "State or Province Code"),
611
+ b::Element(e::NotUsed, "PROVIDER SPECIALTY INFORMATION"),
612
+ b::Element(e::NotUsed, "Provider Organization Code")),
613
+ b::Segment(2710, s::REF, "Rendering Provider Secondary Identification", r::Situational, d::RepeatCount.bounded(4),
614
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("0B", "1G", "G2", "LU")),
615
+ b::Element(e::Required, "Reference Identification"),
616
+ b::Element(e::NotUsed, "Description"),
617
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER"))),
618
+
619
+ d::LoopDef.build("2310C SERVICE FACILITY LOCATION NAME", d::RepeatCount.bounded(1),
620
+ b::Segment(2500, s::NM1, "Service Facility Location Name", r::Situational, d::RepeatCount.bounded(1),
621
+ b::Element(e::Required, "Entity Identifier Code", b::Values("77")),
622
+ b::Element(e::Required, "Entity Type Qualifier", b::Values("2")),
623
+ b::Element(e::Required, "Name Last or Organization Name"),
624
+ b::Element(e::Situational, "Name First"),
625
+ b::Element(e::Situational, "Name Middle"),
626
+ b::Element(e::NotUsed, "Name Prefix"),
627
+ b::Element(e::Situational, "Name Suffix"),
628
+ b::Element(e::Situational, "Identification Code Qualifier", b::Values("XX")),
629
+ b::Element(e::Situational, "Laboratory or Facility Primary Identifier"),
630
+ b::Element(e::NotUsed, "Entity Relationship Code"),
631
+ b::Element(e::NotUsed, "Entity Identifier Code"),
632
+ b::Element(e::NotUsed, "Name Last or Organization Name")),
633
+ b::Segment(2650, s::N3, "Service Facility Location Address", r::Required, d::RepeatCount.bounded(2),
634
+ b::Element(e::Required, "Laboratory or Facility Address Line"),
635
+ b::Element(e::Situational, "Laboratory or Facility Address Line")),
636
+ b::Segment(2700, s::N4, "Service Facility Location City, State, ZIP Code", r::Required, d::RepeatCount.bounded(1),
637
+ b::Element(e::Required, "Laboratory or Facility City Name"),
638
+ b::Element(e::Situational, "Laboratory or Facility Province Code"),
639
+ b::Element(e::Situational, "Laboratory or Facility Postal Zone or ZIP Code"),
640
+ b::Element(e::Situational, "Country Code"),
641
+ b::Element(e::NotUsed, "Location Qualifier"),
642
+ b::Element(e::NotUsed, "Location Identifier"),
643
+ b::Element(e::Situational, "Country Subdivision Code")),
644
+ b::Segment(2710, s::REF, "Service Facility Location Secondary Identification", r::Situational, d::RepeatCount.bounded(3),
645
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("0B", "G2", "LU")),
646
+ b::Element(e::Required, "Laboratory or Facility Secondary Identifier"),
647
+ b::Element(e::NotUsed, "Description"),
648
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
649
+ b::Segment(2750, s::PER, "Service Facility Contact Information", r::Situational, d::RepeatCount.bounded(1),
650
+ b::Element(e::Required, "Contact Function Code", b::Values("IC")),
651
+ b::Element(e::Situational, "Name"),
652
+ b::Element(e::Required, "Communication Number Qualifier", b::Values("TE")),
653
+ b::Element(e::Required, "Communication Number"),
654
+ b::Element(e::Situational, "Communication Number Qualifier", b::Values("EX")),
655
+ b::Element(e::Situational, "Communication Number"),
656
+ b::Element(e::NotUsed, "Communication Number Qualifier"),
657
+ b::Element(e::NotUsed, "Communication Number"),
658
+ b::Element(e::NotUsed, "Contact Inquiry Reference"))),
659
+
660
+ d::LoopDef.build("2310D SUPERVISING PROVIDER NAME", d::RepeatCount.bounded(1),
661
+ b::Segment(2500, s::NM1, "Supervising Provider Name", r::Situational, d::RepeatCount.bounded(1),
662
+ b::Element(e::Required, "Entity Identifier Code", b::Values("DQ")),
663
+ b::Element(e::Required, "Entity Type Qualifier", b::Values("1")),
664
+ b::Element(e::Required, "Supervising Provider Last Name"),
665
+ b::Element(e::Situational, "Supervising Provider First Name"),
666
+ b::Element(e::Situational, "Supervising Provider Middle Name or Initial"),
667
+ b::Element(e::NotUsed, "Name Prefix"),
668
+ b::Element(e::Situational, "Supervising Provider Name Suffix"),
669
+ b::Element(e::Situational, "Identification Code Qualifier", b::Values("XX")),
670
+ b::Element(e::Situational, "Supervising Provider Identifier"),
671
+ b::Element(e::NotUsed, "Entity Relationship Code"),
672
+ b::Element(e::NotUsed, "Entity Identifier Code"),
673
+ b::Element(e::NotUsed, "Name Last or Organization Name")),
674
+ b::Segment(2710, s::REF, "Supervising Provider Secondary Identification", r::Situational, d::RepeatCount.bounded(4),
675
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("0B", "1G", "G2", "LU")),
676
+ b::Element(e::Required, "Supervising Provider Secondary Identifier"),
677
+ b::Element(e::NotUsed, "Description"),
678
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER"))),
679
+
680
+ d::LoopDef.build("2310E AMBULANCE PICK-UP LOCATION", d::RepeatCount.bounded(1),
681
+ b::Segment(2500, s::NM1, "Ambulance Pick-up Location", r::Situational, d::RepeatCount.bounded(1),
682
+ b::Element(e::Required, "Entity Identifier Code", b::Values("PW")),
683
+ b::Element(e::Required, "Entity Type Qualifier", b::Values("2")),
684
+ b::Element(e::NotUsed, "Name Last or Organization Name"),
685
+ b::Element(e::NotUsed, "Name First"),
686
+ b::Element(e::NotUsed, "Name Middle"),
687
+ b::Element(e::NotUsed, "Name Prefix"),
688
+ b::Element(e::NotUsed, "Name Suffix"),
689
+ b::Element(e::NotUsed, "Identification Code Qualifier"),
690
+ b::Element(e::NotUsed, "Identification Code"),
691
+ b::Element(e::NotUsed, "Entity Relationship Code"),
692
+ b::Element(e::NotUsed, "Entity Identifier Code"),
693
+ b::Element(e::NotUsed, "Name Last or Organization Name")),
694
+ b::Segment(2650, s::N3, "Ambulance Pick-up Location Address", r::Situational, d::RepeatCount.bounded(2),
695
+ b::Element(e::Required, "Ambulance Pick-up Address Line"),
696
+ b::Element(e::Situational, "Ambulance Pick-up Address Line")),
697
+ b::Segment(2700, s::N4, "Ambulance Pick-up Location City, State, ZIP Code", r::Situational, d::RepeatCount.bounded(1),
698
+ b::Element(e::Required, "Ambulance Pick-up City Name"),
699
+ b::Element(e::Situational, "Ambulance Pick-up State or Province Code"),
700
+ b::Element(e::Situational, "Ambulance Pick-up Postal Zone or ZIP Code"),
701
+ b::Element(e::Situational, "Country Code"),
702
+ b::Element(e::NotUsed, "Location Qualifier"),
703
+ b::Element(e::NotUsed, "Location Identifier"),
704
+ b::Element(e::Situational, "Country Subdivision Code"))),
705
+
706
+ d::LoopDef.build("2310F AMBULANCE DROP-OFF LOCATION", d::RepeatCount.bounded(1),
707
+ b::Segment(2500, s::NM1, "Ambulance Drop-off Location", r::Situational, d::RepeatCount.bounded(1),
708
+ b::Element(e::Required, "Entity Identifier Code", b::Values("45")),
709
+ b::Element(e::Required, "Entity Type Qualifier", b::Values("2")),
710
+ b::Element(e::Situational, "Ambulance Drop-off Location"),
711
+ b::Element(e::NotUsed, "Name First"),
712
+ b::Element(e::NotUsed, "Name Middle"),
713
+ b::Element(e::NotUsed, "Name Prefix"),
714
+ b::Element(e::NotUsed, "Name Suffix"),
715
+ b::Element(e::NotUsed, "Identification Code Qualifier", b::Values("XX")),
716
+ b::Element(e::NotUsed, "Identification Code"),
717
+ b::Element(e::NotUsed, "Entity Relationship Code"),
718
+ b::Element(e::NotUsed, "Entity Identifier Code"),
719
+ b::Element(e::NotUsed, "Name Last or Organization Name")),
720
+ b::Segment(2650, s::N3, "Ambulance Drop-off Location Address", r::Situational, d::RepeatCount.bounded(1),
721
+ b::Element(e::Required, "Ambulance Drop-off Address Line"),
722
+ b::Element(e::Situational, "Ambulance Drop-off Address Line")),
723
+ b::Segment(2700, s::N4, "Ambulance Drop-off Location City, State, ZIP Code", r::Situational, d::RepeatCount.bounded(1),
724
+ b::Element(e::Required, "Ambulance Drop-off City Name"),
725
+ b::Element(e::Situational, "Ambulance Drop-off State or Province Code"),
726
+ b::Element(e::Situational, "Ambulance Drop-off Postal Zone or ZIP Code"),
727
+ b::Element(e::Situational, "Country Code"),
728
+ b::Element(e::NotUsed, "Location Qualifier"),
729
+ b::Element(e::NotUsed, "Location Identifier"),
730
+ b::Element(e::Situational, "Country Subdivision Code"))),
731
+
732
+ d::LoopDef.build("2320 OTHER SUBSCRIBER INFORMATION", d::RepeatCount.bounded(10),
733
+ b::Segment(2900, s::SBR, "Other Subscriber Information", r::Situational, d::RepeatCount.bounded(1),
734
+ b::Element(e::Required, "Payer Responsibility Sequence Number", b::Values("A", "B", "C", "D", "E", "F", "G", "H", "P", "S", "T", "U")),
735
+ b::Element(e::Required, "Individual Relationship Code", b::Values("01", "18", "19", "20", "21", "39", "40", "53", "G8")),
736
+ b::Element(e::Situational, "Insured Group or Policy Number"),
737
+ b::Element(e::Situational, "Other Insured Group Name"),
738
+ b::Element(e::Situational, "Insurance Type Code", b::Values("12", "13", "14", "15", "16", "41", "42", "43", "47")),
739
+ b::Element(e::NotUsed, "Coordination of Benefits Code"),
740
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code"),
741
+ b::Element(e::NotUsed, "Employment Status Code"),
742
+ 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"))),
743
+ b::Segment(2950, s::CAS, "Claim Level Adjustments", r::Situational, d::RepeatCount.bounded(5),
744
+ b::Element(e::Required, "Claim Adjustment Group Code", b::Values("CO", "CR", "OA", "PI", "PR")),
745
+ b::Element(e::Required, "Adjustment Reason Code"),
746
+ b::Element(e::Required, "Adjustment Amount"),
747
+ b::Element(e::Situational, "Adjustment Quantity"),
748
+ b::Element(e::Situational, "Adjustment Reason Code"),
749
+ b::Element(e::Situational, "Adjustment Amount"),
750
+ b::Element(e::Situational, "Adjustment Quantity"),
751
+ b::Element(e::Situational, "Adjustment Reason Code"),
752
+ b::Element(e::Situational, "Adjustment Amount"),
753
+ b::Element(e::Situational, "Adjustment Quantity"),
754
+ b::Element(e::Situational, "Adjustment Reason Code"),
755
+ b::Element(e::Situational, "Adjustment Amount"),
756
+ b::Element(e::Situational, "Adjustment Quantity"),
757
+ b::Element(e::Situational, "Adjustment Reason Code"),
758
+ b::Element(e::Situational, "Adjustment Amount"),
759
+ b::Element(e::Situational, "Adjustment Quantity"),
760
+ b::Element(e::Situational, "Adjustment Reason Code"),
761
+ b::Element(e::Situational, "Adjustment Amount"),
762
+ b::Element(e::Situational, "Adjustment Quantity")),
763
+ b::Segment(3000, s::AMT, "Coordination of Benefits (COB) Payer Paid Amount", r::Situational, d::RepeatCount.bounded(1),
764
+ b::Element(e::Required, "Amount Qualifier Code", b::Values("D")),
765
+ b::Element(e::Required, "Payer Paid Amount"),
766
+ b::Element(e::NotUsed, "Credit/Debit Flag")),
767
+ b::Segment(3000, s::AMT, "Coordination of Benefits (COB) Total Non-Covered Amount", r::Situational, d::RepeatCount.bounded(1),
768
+ b::Element(e::Required, "Amount Qualifier Code", b::Values("A8")),
769
+ b::Element(e::Required, "Non-Covered Charge Amount"),
770
+ b::Element(e::NotUsed, "Credit/Debit Flag")),
771
+ b::Segment(3000, s::AMT, "Remaining Patient Liability", r::Situational, d::RepeatCount.bounded(1),
772
+ b::Element(e::Required, "Amount Qualifier Code", b::Values("EAF")),
773
+ b::Element(e::Required, "Remaining Patient Liability"),
774
+ b::Element(e::NotUsed, "Credit/Debit Flag")),
775
+ b::Segment(3100, s::OI, "Other Insurance Coverage Information", r::Required, d::RepeatCount.bounded(1),
776
+ b::Element(e::NotUsed, "Claim Filing Indicator Code"),
777
+ b::Element(e::NotUsed, "Claim Submission Reason Code"),
778
+ b::Element(e::Required, "Benefits Assignment Certification Indicator", b::Values("N", "W", "Y")),
779
+ b::Element(e::Situational, "Patient Signature Source Code", b::Values("P")),
780
+ b::Element(e::NotUsed, "Provider Agreement Code"),
781
+ b::Element(e::Required, "Release of Information Code", b::Values("I", "Y"))),
782
+ b::Segment(3200, s::MOA, "Outpatient Adjudication Information", r::Situational, d::RepeatCount.bounded(1),
783
+ b::Element(e::Situational, "Reimbursement Rate"),
784
+ b::Element(e::Situational, "HCPCS Payable Amount"),
785
+ b::Element(e::Situational, "Claim Payment Remark Code"),
786
+ b::Element(e::Situational, "Claim Payment Remark Code"),
787
+ b::Element(e::Situational, "Claim Payment Remark Code"),
788
+ b::Element(e::Situational, "Claim Payment Remark Code"),
789
+ b::Element(e::Situational, "Claim Payment Remark Code"),
790
+ b::Element(e::Situational, "End Stage Renal Disease Payment Amount"),
791
+ b::Element(e::Situational, "Non-Payable Professional Component Billed Amount")),
792
+
793
+ d::LoopDef.build("2330A OTHER SUBSCRIBER NAME", d::RepeatCount.bounded(1),
794
+ b::Segment(3250, s::NM1, "Other Subscriber Name", r::Required, d::RepeatCount.bounded(1),
795
+ b::Element(e::Required, "Entity Identifier Code", b::Values("IL")),
796
+ b::Element(e::Required, "Entity Type Qualifier", b::Values("1", "2")),
797
+ b::Element(e::Required, "Other Insured Last Name"),
798
+ b::Element(e::Situational, "Other Insured First Name"),
799
+ b::Element(e::Situational, "Other Insured Middle Name"),
800
+ b::Element(e::NotUsed, "Name Prefix"),
801
+ b::Element(e::Situational, "Other Insured Name Suffix"),
802
+ b::Element(e::Required, "Identification Code Qualifier", b::Values("II", "MI")),
803
+ b::Element(e::Required, "Other Insured Identifier"),
804
+ b::Element(e::NotUsed, "Entity Relationship Code"),
805
+ b::Element(e::NotUsed, "Entity Identifier Code"),
806
+ b::Element(e::NotUsed, "Name Last or Organization Name")),
807
+ b::Segment(3320, s::N3, "Other Subscriber Address", r::Situational, d::RepeatCount.bounded(1),
808
+ b::Element(e::Required, "Other Subscriber Address Line"),
809
+ b::Element(e::Situational, "Other Subscriber Address Line")),
810
+ b::Segment(3400, s::N4, "Other Subscriber City, State, ZIP Code", r::Situational, d::RepeatCount.bounded(1),
811
+ b::Element(e::Required, "Other Subscriber City Name"),
812
+ b::Element(e::Situational, "Other Subscriber State or Province Code"),
813
+ b::Element(e::Situational, "Other Subscriber Postal Zone or ZIP Code"),
814
+ b::Element(e::Situational, "Country Code"),
815
+ b::Element(e::NotUsed, "Location Qualifier"),
816
+ b::Element(e::NotUsed, "Location Identifier"),
817
+ b::Element(e::Situational, "Country Subdivision Code")),
818
+ b::Segment(3550, s::REF, "Other Subscriber Secondary Identification", r::Situational, d::RepeatCount.bounded(1),
819
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("SY")),
820
+ b::Element(e::Required, "Other Insured Additional Identifier"),
821
+ b::Element(e::NotUsed, "Description"),
822
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER"))),
823
+
824
+ d::LoopDef.build("2330B OTHER PAYER NAME", d::RepeatCount.bounded(1),
825
+ b::Segment(3250, s::NM1, "Other Payer Name", r::Required, d::RepeatCount.bounded(1),
826
+ b::Element(e::Required, "Entity Identifier Code", b::Values("PR")),
827
+ b::Element(e::Required, "Entity Type Qualifier", b::Values("2")),
828
+ b::Element(e::Required, "Other Payer Organization Name"),
829
+ b::Element(e::NotUsed, "Name First"),
830
+ b::Element(e::NotUsed, "Name Middle"),
831
+ b::Element(e::NotUsed, "Name Prefix"),
832
+ b::Element(e::NotUsed, "Name Suffix"),
833
+ b::Element(e::Required, "Identification Code Qualifier", b::Values("PI", "XV")),
834
+ b::Element(e::Required, "Other Payer Primary Identifier"),
835
+ b::Element(e::NotUsed, "Entity Relationship Code"),
836
+ b::Element(e::NotUsed, "Entity Identifier Code"),
837
+ b::Element(e::NotUsed, "Name Last or Organization Name")),
838
+ b::Segment(3320, s::N3, "Other Payer Address", r::Situational, d::RepeatCount.bounded(1),
839
+ b::Element(e::Required, "Other Payer Address Line"),
840
+ b::Element(e::Situational, "Other Payer Address Line")),
841
+ b::Segment(3400, s::N4, "Other Payer City, State, ZIP Code", r::Situational, d::RepeatCount.bounded(1),
842
+ b::Element(e::Required, "Other Payer City Name"),
843
+ b::Element(e::Situational, "Other Payer State or Province Code"),
844
+ b::Element(e::Situational, "Other Payer Postal Zone or ZIP Code"),
845
+ b::Element(e::Situational, "Country Code"),
846
+ b::Element(e::NotUsed, "Location Qualifier"),
847
+ b::Element(e::NotUsed, "Location Identifier"),
848
+ b::Element(e::Situational, "Country Subdivision Code")),
849
+ b::Segment(3500, s::DTP, "Claim Check or Remittance Date", r::Situational, d::RepeatCount.bounded(1),
850
+ b::Element(e::Required, "Date Time Qualifier", b::Values("573")),
851
+ b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
852
+ b::Element(e::Required, "Adjudication or Payment Date")),
853
+ b::Segment(3550, s::REF, "Other Payer Secondary Identifier", r::Situational, d::RepeatCount.bounded(2),
854
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("2U", "EI", "FY", "NF")),
855
+ b::Element(e::Required, "Other Payer Secondary Identifier"),
856
+ b::Element(e::NotUsed, "Description"),
857
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
858
+ b::Segment(3550, s::REF, "Other Payer Prior Authorization Number", r::Situational, d::RepeatCount.bounded(1),
859
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("G1")),
860
+ b::Element(e::Required, "Other Payer Prior Authorization Number"),
861
+ b::Element(e::NotUsed, "Description"),
862
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
863
+ b::Segment(3550, s::REF, "Other Payer Referral Number", r::Situational, d::RepeatCount.bounded(1),
864
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("9F")),
865
+ b::Element(e::Required, "Other Payer Prior Authorization or Referral Number"),
866
+ b::Element(e::NotUsed, "Description"),
867
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
868
+ b::Segment(3550, s::REF, "Other Payer Claim Adjustment Indicator", r::Situational, d::RepeatCount.bounded(1),
869
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("T4")),
870
+ b::Element(e::Required, "Other Payer Claim Adjustment Indicator", b::Values("Y")),
871
+ b::Element(e::NotUsed, "Description"),
872
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
873
+ b::Segment(3550, s::REF, "Other Payer Claim Control Number", r::Situational, d::RepeatCount.bounded(1),
874
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("F8")),
875
+ b::Element(e::Required, "Other Payer's Claim Control Number"),
876
+ b::Element(e::NotUsed, "Description"),
877
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER"))),
878
+
879
+ d::LoopDef.build("2330C OTHER PAYER REFERRING PROVIDER", d::RepeatCount.bounded(2),
880
+ b::Segment(3250, s::NM1, "Other Payer Referring Provider", r::Situational, d::RepeatCount.bounded(1),
881
+ b::Element(e::Required, "Entity Identifier Code", b::Values("DN", "P3")),
882
+ b::Element(e::Required, "Entity Type Qualifier", b::Values("1")),
883
+ b::Element(e::NotUsed, "Name Last"),
884
+ b::Element(e::NotUsed, "Name First"),
885
+ b::Element(e::NotUsed, "Name Middle"),
886
+ b::Element(e::NotUsed, "Name Prefix"),
887
+ b::Element(e::NotUsed, "Name Suffix"),
888
+ b::Element(e::NotUsed, "Identification Code Qualifier"),
889
+ b::Element(e::NotUsed, "Identification Code"),
890
+ b::Element(e::NotUsed, "Entity Relationship Code"),
891
+ b::Element(e::NotUsed, "Entity Identifier Code"),
892
+ b::Element(e::NotUsed, "Name Last or Organization Name")),
893
+ b::Segment(3550, s::REF, "Other Payer Referring Provider Secondary Identification", r::Required, d::RepeatCount.bounded(3),
894
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("0B", "1G", "G2")),
895
+ b::Element(e::Required, "Other Payer Referring Provider Identifier"),
896
+ b::Element(e::NotUsed, "Description"),
897
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER"))),
898
+
899
+ d::LoopDef.build("2330D OTHER PAYER RENDERING PROVIDER", d::RepeatCount.bounded(1),
900
+ b::Segment(3250, s::NM1, "Other Payer Rendering Provider", r::Situational, d::RepeatCount.bounded(1),
901
+ b::Element(e::Required, "Entity Identifier Code", b::Values("82")),
902
+ b::Element(e::Required, "Entity Type Qualifier", b::Values("1", "2")),
903
+ b::Element(e::NotUsed, "Name Last"),
904
+ b::Element(e::NotUsed, "Name First"),
905
+ b::Element(e::NotUsed, "Name Middle"),
906
+ b::Element(e::NotUsed, "Name Prefix"),
907
+ b::Element(e::NotUsed, "Name Suffix"),
908
+ b::Element(e::NotUsed, "Identification Code Qualifier"),
909
+ b::Element(e::NotUsed, "Identification Code"),
910
+ b::Element(e::NotUsed, "Entity Relationship Code"),
911
+ b::Element(e::NotUsed, "Entity Identifier Code"),
912
+ b::Element(e::NotUsed, "Name Last or Organization Name")),
913
+ b::Segment(3550, s::REF, "Other Payer Rendering Provider Secondary Identification", r::Required, d::RepeatCount.bounded(3),
914
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("0B", "1G", "G2", "LU")),
915
+ b::Element(e::Required, "Other Payer Rendering Provider Secondary Identifier"),
916
+ b::Element(e::NotUsed, "Description"),
917
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER"))),
918
+
919
+ d::LoopDef.build("2330E OTHER PAYER SERVICE FACILITY LOCATION", d::RepeatCount.bounded(1),
920
+ b::Segment(3250, s::NM1, "Other Payer Service Facility Location", r::Situational, d::RepeatCount.bounded(1),
921
+ b::Element(e::Required, "Entity Identifier Code", b::Values("77")),
922
+ b::Element(e::Required, "Entity Type Qualifier", b::Values("2")),
923
+ b::Element(e::NotUsed, "Name Last"),
924
+ b::Element(e::NotUsed, "Name First"),
925
+ b::Element(e::NotUsed, "Name Middle"),
926
+ b::Element(e::NotUsed, "Name Prefix"),
927
+ b::Element(e::NotUsed, "Name Suffix"),
928
+ b::Element(e::NotUsed, "Identification Code Qualifier"),
929
+ b::Element(e::NotUsed, "Identification Code"),
930
+ b::Element(e::NotUsed, "Entity Relationship Code"),
931
+ b::Element(e::NotUsed, "Entity Identifier Code"),
932
+ b::Element(e::NotUsed, "Name Last or Organization Name")),
933
+ b::Segment(3550, s::REF, "Other Payer Service Facility Location Secondary Identification", r::Required, d::RepeatCount.bounded(3),
934
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("0B", "G2", "LU")),
935
+ b::Element(e::Required, "Other Payer Service Facility Location Secondary Identifier"),
936
+ b::Element(e::NotUsed, "Description"),
937
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER"))),
938
+
939
+ d::LoopDef.build("2330F OTHER PAYER SUPERVISING PROVIDER", d::RepeatCount.bounded(1),
940
+ b::Segment(3250, s::NM1, "Other Payer Supervising Provider", r::Situational, d::RepeatCount.bounded(1),
941
+ b::Element(e::Required, "Entity Identifier Code", b::Values("DQ")),
942
+ b::Element(e::Required, "Entity Type Qualifier", b::Values("1")),
943
+ b::Element(e::NotUsed, "Name Last"),
944
+ b::Element(e::NotUsed, "Name First"),
945
+ b::Element(e::NotUsed, "Name Middle"),
946
+ b::Element(e::NotUsed, "Name Prefix"),
947
+ b::Element(e::NotUsed, "Name Suffix"),
948
+ b::Element(e::NotUsed, "Identification Code Qualifier"),
949
+ b::Element(e::NotUsed, "Identification Code"),
950
+ b::Element(e::NotUsed, "Entity Relationship Code"),
951
+ b::Element(e::NotUsed, "Entity Identifier Code"),
952
+ b::Element(e::NotUsed, "Name Last or Organization Name")),
953
+ b::Segment(3550, s::REF, "Other Payer Supervising Provider Secondary Identification", r::Required, d::RepeatCount.bounded(3),
954
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("0B", "1G", "G2", "LU")),
955
+ b::Element(e::Required, "Other Payer Supervising Provider Identifier"),
956
+ b::Element(e::NotUsed, "Description"),
957
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER"))),
958
+
959
+ d::LoopDef.build("2330G OTHER PAYER BILLING PROVIDER", d::RepeatCount.bounded(1),
960
+ b::Segment(3250, s::NM1, "Other Payer Billing Provider", r::Situational, d::RepeatCount.bounded(1),
961
+ b::Element(e::Required, "Entity Identifier Code", b::Values("85")),
962
+ b::Element(e::Required, "Entity Type Qualifier", b::Values("1", "2")),
963
+ b::Element(e::NotUsed, "Name L"),
964
+ b::Element(e::NotUsed, "Name F"),
965
+ b::Element(e::NotUsed, "Name M"),
966
+ b::Element(e::NotUsed, "Name P"),
967
+ b::Element(e::NotUsed, "Name S"),
968
+ b::Element(e::NotUsed, "Identification Code Qualifier"),
969
+ b::Element(e::NotUsed, "Identification Code"),
970
+ b::Element(e::NotUsed, "Entity Relationship Code"),
971
+ b::Element(e::NotUsed, "Entity Identifier Code"),
972
+ b::Element(e::NotUsed, "Name Last or Organization Name")),
973
+ b::Segment(3550, s::REF, "Other Payer Billing Provider Secondary Identification", r::Required, d::RepeatCount.bounded(2),
974
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("G2", "LU")),
975
+ b::Element(e::Required, "Other Payer Billing Provider Identifier"),
976
+ b::Element(e::NotUsed, "Description"),
977
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")))),
978
+
979
+ d::LoopDef.build("2400 SERVICE LINE NUMBER", d::RepeatCount.bounded(50),
980
+ b::Segment(3650, s::LX, "Service Line Number", r::Required, d::RepeatCount.bounded(1),
981
+ b::Element(e::Required, "Assigned Number")),
982
+ b::Segment(3700, s::SV1, "Professional Service", r::Required, d::RepeatCount.bounded(1),
983
+ b::Element(e::Required, "COMPOSITE MEDICAL PROCEDURE IDENTIFIER",
984
+ b::Element(e::Required, "Product or Service ID Qualifier", b::Values("ER", "HC", "IV", "WK")),
985
+ b::Element(e::Required, "Procedure Code"),
986
+ b::Element(e::Situational, "Procedure Modifier"),
987
+ b::Element(e::Situational, "Procedure Modifier"),
988
+ b::Element(e::Situational, "Procedure Modifier"),
989
+ b::Element(e::Situational, "Procedure Modifier"),
990
+ b::Element(e::Situational, "Description"),
991
+ b::Element(e::NotUsed, "Product/Service ID")),
992
+ b::Element(e::Required, "Line Item Charge Amount"),
993
+ b::Element(e::Required, "Unit or Basis for Measurement Code", b::Values("MJ", "UN")),
994
+ b::Element(e::Required, "Service Unit Count", b::MaxLength(8), b::MaxPrecision(3)),
995
+ b::Element(e::Situational, "Place of Service Code"),
996
+ b::Element(e::NotUsed, "Service Type Code"),
997
+ b::Element(e::Required, "COMPOSITE DIAGNOSIS CODE POINTER",
998
+ b::Element(e::Required, "Diagnosis Code Pointer"),
999
+ b::Element(e::Situational, "Diagnosis Code Pointer"),
1000
+ b::Element(e::Situational, "Diagnosis Code Pointer"),
1001
+ b::Element(e::Situational, "Diagnosis Code Pointer")),
1002
+ b::Element(e::NotUsed, "Monetary Amount"),
1003
+ b::Element(e::Situational, "Emergency Indicator", b::Values("Y")),
1004
+ b::Element(e::NotUsed, "Multiple Procedure Code"),
1005
+ b::Element(e::Situational, "EPSDT Indicator", b::Values("Y")),
1006
+ b::Element(e::Situational, "Family Planning Indicator", b::Values("Y")),
1007
+ b::Element(e::NotUsed, "Review Code"),
1008
+ b::Element(e::NotUsed, "National or Local Assigned Review Value"),
1009
+ b::Element(e::Situational, "Co-Pay Status Code", b::Values("0")),
1010
+ b::Element(e::NotUsed, "Health Care Professional Shortage Area Code"),
1011
+ b::Element(e::NotUsed, "Reference Identification"),
1012
+ b::Element(e::NotUsed, "Postal Code"),
1013
+ b::Element(e::NotUsed, "Monetary Amount"),
1014
+ b::Element(e::NotUsed, "Level of Care Code"),
1015
+ b::Element(e::NotUsed, "Provider Agreement Code")),
1016
+ b::Segment(4000, s::SV5, "Durable Medical Equipment Service", r::Situational, d::RepeatCount.bounded(1),
1017
+ b::Element(e::Required, "COMPOSITE MEDICAL PROCEDURE IDENTIFIER",
1018
+ b::Element(e::Required, "Procedure Identifier", b::Values("HC")),
1019
+ b::Element(e::Required, "Procedure Code"),
1020
+ b::Element(e::NotUsed, "Procedure Modifier"),
1021
+ b::Element(e::NotUsed, "Procedure Modifier"),
1022
+ b::Element(e::NotUsed, "Procedure Modifier"),
1023
+ b::Element(e::NotUsed, "Procedure Modifier"),
1024
+ b::Element(e::NotUsed, "Description"),
1025
+ b::Element(e::NotUsed, "Product/Service ID")),
1026
+ b::Element(e::Required, "Unit or Basis for Measurement Code"),
1027
+ b::Element(e::Required, "Length of Medical Necessity"),
1028
+ b::Element(e::Required, "DME Rental Price"),
1029
+ b::Element(e::Required, "DME Purchase Price"),
1030
+ b::Element(e::Required, "Rental Unit Price Indicator", b::Values("1", "4", "6")),
1031
+ b::Element(e::NotUsed, "Prognosis Code")),
1032
+ b::Segment(4200, s::PWK, "Line Supplemental Information", r::Situational, d::RepeatCount.bounded(10),
1033
+ b::Element(e::Required, "Attachment Report Type Code", b::Values("03", "04", "05", "06", "07", "08", "09", "10", "11", "13", "15", "21", "A3", "A4", "AM", "AS", "B2", "B4", "BR", "BS", "BT", "CB", "CK", "CT", "D2", "DA", "DA", "DB", "DG", "DJ", "DS", "EB", "HC", "HR", "I5", "IR", "LA", "M1", "MT", "NN", "OB", "OC", "OD", "OE", "OX", "OZ", "P4", "P5", "PE", "PN", "PO", "PQ", "PY", "PZ", "RB", "RR", "RT", "RX", "SG", "V5", "XP")),
1034
+ b::Element(e::Required, "Attachment Transmission Code", b::Values("AA", "BM", "EL", "EM", "FT", "FX")),
1035
+ b::Element(e::NotUsed, "Report Copies Needed"),
1036
+ b::Element(e::NotUsed, "Entity Identifier Code"),
1037
+ b::Element(e::Situational, "Identification Code Qualifier", b::Values("AC")),
1038
+ b::Element(e::Situational, "Attachment Control Number", b::MaxLength(50)),
1039
+ b::Element(e::NotUsed, "Description"),
1040
+ b::Element(e::NotUsed, "ACTIONS INDICATED"),
1041
+ b::Element(e::NotUsed, "Request Category Code")),
1042
+ b::Segment(4200, s::PWK, "Durable Medical Equipment Certification of Medical Necessity Indicator", r::Situational, d::RepeatCount.bounded(1),
1043
+ b::Element(e::Required, "Attachment Report Type Code", b::Values("CT")),
1044
+ b::Element(e::Required, "Attachment Transmission Code", b::Values("AB", "AD", "AF", "AG", "NS")),
1045
+ b::Element(e::NotUsed, "Report Copies Needed"),
1046
+ b::Element(e::NotUsed, "Entity Identifier Code"),
1047
+ b::Element(e::NotUsed, "Identification Code Qualifier"),
1048
+ b::Element(e::NotUsed, "Identification Code"),
1049
+ b::Element(e::NotUsed, "Description"),
1050
+ b::Element(e::NotUsed, "ACTIONS INDICATED"),
1051
+ b::Element(e::NotUsed, "Request Category Code")),
1052
+ b::Segment(4250, s::CR1, "Ambulance Transport Information", r::Situational, d::RepeatCount.bounded(1),
1053
+ b::Element(e::Situational, "Unit or Basis for Measurement Code", b::Values("LB")),
1054
+ b::Element(e::Situational, "Patient Weight"),
1055
+ b::Element(e::NotUsed, "Ambulance Transport Code"),
1056
+ b::Element(e::Required, "Ambulance Transport Reason Code", b::Values("A", "B", "C", "D", "E")),
1057
+ b::Element(e::Required, "Unit or Basis for Measurement Code", b::Values("DH")),
1058
+ b::Element(e::Required, "Transport Distance"),
1059
+ b::Element(e::NotUsed, "Address Information"),
1060
+ b::Element(e::NotUsed, "Address Information"),
1061
+ b::Element(e::Situational, "Round Trip Purpose Description"),
1062
+ b::Element(e::Situational, "Stretcher Purpose Description")),
1063
+ b::Segment(4350, s::CR3, "Durable Medical Equipment Certification", r::Situational, d::RepeatCount.bounded(1),
1064
+ b::Element(e::Required, "Certification Type Code", b::Values("I", "R", "S")),
1065
+ b::Element(e::Required, "Unit or Basis for Measurement Code", b::Values("MO")),
1066
+ b::Element(e::Required, "Durable Medical Equipment Duration"),
1067
+ b::Element(e::NotUsed, "Insulin Dependent Code"),
1068
+ b::Element(e::NotUsed, "Description")),
1069
+ b::Segment(4500, s::CRC, "Ambulance Certification", r::Situational, d::RepeatCount.bounded(3),
1070
+ b::Element(e::Required, "Code Category", b::Values("07")),
1071
+ b::Element(e::Required, "Certification Condition Indicator", b::Values("N", "Y")),
1072
+ b::Element(e::Required, "Condition Code", b::Values("01", "04", "05", "06", "07", "08", "09", "12")),
1073
+ b::Element(e::Situational, "Condition Code", b::Values("01", "04", "05", "06", "07", "08", "09", "12")),
1074
+ b::Element(e::Situational, "Condition Code", b::Values("01", "04", "05", "06", "07", "08", "09", "12")),
1075
+ b::Element(e::Situational, "Condition Code", b::Values("01", "04", "05", "06", "07", "08", "09", "12")),
1076
+ b::Element(e::Situational, "Condition Code", b::Values("01", "04", "05", "06", "07", "08", "09", "12"))),
1077
+ b::Segment(4500, s::CRC, "Hospice Employee Indicator", r::Situational, d::RepeatCount.bounded(1),
1078
+ b::Element(e::Required, "Code Category", b::Values("70")),
1079
+ b::Element(e::Required, "Hospice Employed Provider Indicator", b::Values("N", "Y")),
1080
+ b::Element(e::Required, "Condition Indicator", b::Values("65")),
1081
+ b::Element(e::NotUsed, "Condition Indicator"),
1082
+ b::Element(e::NotUsed, "Condition Indicator"),
1083
+ b::Element(e::NotUsed, "Condition Indicator"),
1084
+ b::Element(e::NotUsed, "Condition Indicator")),
1085
+ b::Segment(4500, s::CRC, "Condition Indicator/Durable Medical Equipment", r::Situational, d::RepeatCount.bounded(1),
1086
+ b::Element(e::Required, "Code Category", b::Values("09")),
1087
+ b::Element(e::Required, "Certification Condition Indicator", b::Values("Y", "N")),
1088
+ b::Element(e::Required, "Condition Indicator", b::Values("38", "ZV")),
1089
+ b::Element(e::Situational, "Condition Indicator", b::Values("38", "ZV")),
1090
+ b::Element(e::NotUsed, "Condition Indicator"),
1091
+ b::Element(e::NotUsed, "Condition Indicator"),
1092
+ b::Element(e::NotUsed, "Condition Indicator")),
1093
+ b::Segment(4550, s::DTP, "Service Date", r::Required, d::RepeatCount.bounded(1),
1094
+ b::Element(e::Required, "Date Time Qualifier", b::Values("472")),
1095
+ b::Element(e::Required, "Date Time Period Qualifier", b::Values("D8", "RD8")),
1096
+ b::Element(e::Required, "Service Date")),
1097
+ b::Segment(4550, s::DTP, "Prescription Date", r::Situational, d::RepeatCount.bounded(1),
1098
+ b::Element(e::Required, "Date Time Qualifier", b::Values("471")),
1099
+ b::Element(e::Required, "Date Time Period Qualifier", b::Values("D8")),
1100
+ b::Element(e::Required, "Prescription Date")),
1101
+ b::Segment(4550, s::DTP, "Certification Revision/Recertification Date", r::Situational, d::RepeatCount.bounded(1),
1102
+ b::Element(e::Required, "Date Time Qualifier", b::Values("607")),
1103
+ b::Element(e::Required, "Date Time Period Qualifier", b::Values("D8")),
1104
+ b::Element(e::Required, "Certification Revision or Recertification Date")),
1105
+ b::Segment(4550, s::DTP, "Begin Therapy Date", r::Situational, d::RepeatCount.bounded(1),
1106
+ b::Element(e::Required, "Date Time Qualifier", b::Values("463")),
1107
+ b::Element(e::Required, "Date Time Period Qualifier", b::Values("D8")),
1108
+ b::Element(e::Required, "Begin Therapy Date")),
1109
+ b::Segment(4550, s::DTP, "Last Certification Date", r::Situational, d::RepeatCount.bounded(1),
1110
+ b::Element(e::Required, "Date Time Qualifier", b::Values("461")),
1111
+ b::Element(e::Required, "Date Time Period Qualifier", b::Values("D8")),
1112
+ b::Element(e::Required, "Last Certification Date")),
1113
+ b::Segment(4550, s::DTP, "Last Seen Date", r::Situational, d::RepeatCount.bounded(1),
1114
+ b::Element(e::Required, "Date Time Qualifier", b::Values("304")),
1115
+ b::Element(e::Required, "Date Time Period Qualifier", b::Values("D8")),
1116
+ b::Element(e::Required, "Treatment or Therapy Date")),
1117
+ b::Segment(4550, s::DTP, "Test Date", r::Situational, d::RepeatCount.bounded(2),
1118
+ b::Element(e::Required, "Date Time Qualifier", b::Values("738", "739")),
1119
+ b::Element(e::Required, "Date Time Period Qualifier", b::Values("D8")),
1120
+ b::Element(e::Required, "Test Performed Date")),
1121
+ b::Segment(4550, s::DTP, "Shipped Date", r::Situational, d::RepeatCount.bounded(1),
1122
+ b::Element(e::Required, "Date Time Qualifier", b::Values("011")),
1123
+ b::Element(e::Required, "Date Time Period Qualifier", b::Values("D8")),
1124
+ b::Element(e::Required, "Shipped Date")),
1125
+ b::Segment(4550, s::DTP, "Last X-ray Date", r::Situational, d::RepeatCount.bounded(1),
1126
+ b::Element(e::Required, "Date Time Qualifier", b::Values("455")),
1127
+ b::Element(e::Required, "Date Time Period Qualifier", b::Values("D8")),
1128
+ b::Element(e::Required, "Last X-ray Date")),
1129
+ b::Segment(4550, s::DTP, "Initial Treatment Date", r::Situational, d::RepeatCount.bounded(1),
1130
+ b::Element(e::Required, "Date Time Qualifier", b::Values("454")),
1131
+ b::Element(e::Required, "Date Time Period Qualifier", b::Values("D8")),
1132
+ b::Element(e::Required, "Initial Treatment Date")),
1133
+ b::Segment(4600, s::QTY, "Ambulance Patient Count", r::Situational, d::RepeatCount.bounded(1),
1134
+ b::Element(e::Required, "Quantity Qualifier", b::Values("PT")),
1135
+ b::Element(e::Required, "Ambulance Patient Count"),
1136
+ b::Element(e::NotUsed, "COMPOSITE UNIT OF MEASURE"),
1137
+ b::Element(e::NotUsed, "Free-form Information")),
1138
+ b::Segment(4600, s::QTY, "Obstetric Anesthesia Additional Units", r::Situational, d::RepeatCount.bounded(1),
1139
+ b::Element(e::Required, "Quantity Qualifier", b::Values("FL")),
1140
+ b::Element(e::Required, "Obstetric Additional Units"),
1141
+ b::Element(e::NotUsed, "COMPOSITE UNIT OF MEASURE"),
1142
+ b::Element(e::NotUsed, "Free-form Information")),
1143
+ b::Segment(4620, s::MEA, "Test Result", r::Situational, d::RepeatCount.bounded(5),
1144
+ b::Element(e::Required, "Measurement Reference Identification Code", b::Values("OG", "TR")),
1145
+ b::Element(e::Required, "Measurement Qualifier", b::Values("HT", "R1", "R2", "R3", "R4")),
1146
+ b::Element(e::Required, "Test Results"),
1147
+ b::Element(e::NotUsed, "COMPOSITE UNIT OF MEASURE"),
1148
+ b::Element(e::NotUsed, "Range Minimum"),
1149
+ b::Element(e::NotUsed, "Range Maximum"),
1150
+ b::Element(e::NotUsed, "Measurement Significance Code"),
1151
+ b::Element(e::NotUsed, "Measurement Attribute Code"),
1152
+ b::Element(e::NotUsed, "Surface/Layer/Position Code"),
1153
+ b::Element(e::NotUsed, "Measurement Method or Device"),
1154
+ b::Element(e::NotUsed, "Code List Qualifier Code"),
1155
+ b::Element(e::NotUsed, "Industry Code")),
1156
+ b::Segment(4650, s::CN1, "Contract Information", r::Situational, d::RepeatCount.bounded(1),
1157
+ b::Element(e::Required, "Contract Type Code", b::Values("01", "02", "03", "04", "05", "06", "09")),
1158
+ b::Element(e::Required, "Contract Amount"),
1159
+ b::Element(e::Situational, "Contract Percentage"),
1160
+ b::Element(e::Situational, "Contract Code"),
1161
+ b::Element(e::Situational, "Terms Discount Percentage"),
1162
+ b::Element(e::Situational, "Contract Version Identifier")),
1163
+ b::Segment(4700, s::REF, "Repriced Line Item Reference Number", r::Situational, d::RepeatCount.bounded(1),
1164
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("9B")),
1165
+ b::Element(e::Required, "Repriced Line Item Reference Number"),
1166
+ b::Element(e::NotUsed, "Description"),
1167
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
1168
+ b::Segment(4700, s::REF, "Adjusted Repriced Line Item Reference Number", r::Situational, d::RepeatCount.bounded(1),
1169
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("9D")),
1170
+ b::Element(e::Required, "Adjusted Repriced Line Item Reference Number"),
1171
+ b::Element(e::NotUsed, "Description"),
1172
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
1173
+ b::Segment(4700, s::REF, "Prior Authorization", r::Situational, d::RepeatCount.bounded(5),
1174
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("G1")),
1175
+ b::Element(e::Required, "Prior Authorization or Referral Number"),
1176
+ b::Element(e::NotUsed, "Description"),
1177
+ b::Element(e::Situational, "REFERENCE IDENTIFIER",
1178
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("2U")),
1179
+ b::Element(e::Required, "Other Payer Primary Identifier"),
1180
+ b::Element(e::NotUsed, "Reference Identifier Qualifier"),
1181
+ b::Element(e::NotUsed, "Reference Identification"),
1182
+ b::Element(e::NotUsed, "Reference Identifier Qualifier"),
1183
+ b::Element(e::NotUsed, "Reference Identification"))),
1184
+ b::Segment(4700, s::REF, "Line Item Control Number", r::Situational, d::RepeatCount.bounded(1),
1185
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("6R")),
1186
+ b::Element(e::Required, "Line Item Control Number", b::MaxLength(30)),
1187
+ b::Element(e::NotUsed, "Description"),
1188
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
1189
+ b::Segment(4700, s::REF, "Mammography Certification Number", r::Situational, d::RepeatCount.bounded(1),
1190
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("EW")),
1191
+ b::Element(e::Required, "Mammography Certification Number"),
1192
+ b::Element(e::NotUsed, "Description"),
1193
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
1194
+ b::Segment(4700, s::REF, "Clinical Laboratory Improvement Amendment (CLIA) Number", r::Situational, d::RepeatCount.bounded(1),
1195
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("X4")),
1196
+ b::Element(e::Required, "Clinical Laboratory Improvement Amendment Number"),
1197
+ b::Element(e::NotUsed, "Description"),
1198
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
1199
+ b::Segment(4700, s::REF, "Referring Clinical Laboratory Improvement Amendment (CLIA) Number", r::Situational, d::RepeatCount.bounded(1),
1200
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("F4")),
1201
+ b::Element(e::Required, "Referring CLIA Number"),
1202
+ b::Element(e::NotUsed, "Description"),
1203
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
1204
+ b::Segment(4700, s::REF, "Immunization Batch Number", r::Situational, d::RepeatCount.bounded(1),
1205
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("BT")),
1206
+ b::Element(e::Required, "Immunization Batch Number"),
1207
+ b::Element(e::NotUsed, "Description"),
1208
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
1209
+ b::Segment(4700, s::REF, "Referral Number", r::Situational, d::RepeatCount.bounded(5),
1210
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("9F")),
1211
+ b::Element(e::Required, "Referral Number"),
1212
+ b::Element(e::NotUsed, "Description"),
1213
+ b::Element(e::Situational, "REFERENCE IDENTIFIER",
1214
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("2U")),
1215
+ b::Element(e::Required, "Other Payer Primary Identifier"),
1216
+ b::Element(e::NotUsed, "Reference Identifier Qualifier"),
1217
+ b::Element(e::NotUsed, "Reference Identification"),
1218
+ b::Element(e::NotUsed, "Reference Identifier Qualifier"),
1219
+ b::Element(e::NotUsed, "Reference Identification"))),
1220
+ b::Segment(4750, s::AMT, "Sales Tax Amount", r::Situational, d::RepeatCount.bounded(1),
1221
+ b::Element(e::Required, "Amount Qualifier Code", b::Values("T")),
1222
+ b::Element(e::Required, "Sales Tax Amount"),
1223
+ b::Element(e::NotUsed, "Credit/Debit Flag Code")),
1224
+ b::Segment(4750, s::AMT, "Postage Claimed Amount", r::Situational, d::RepeatCount.bounded(1),
1225
+ b::Element(e::Required, "Amount Qualifier Code", b::Values("F4")),
1226
+ b::Element(e::Required, "Postage Claimed Amount"),
1227
+ b::Element(e::NotUsed, "Credit/Debit Flag Code")),
1228
+ b::Segment(4800, s::K3, "File Information", r::Situational, d::RepeatCount.bounded(10),
1229
+ b::Element(e::Required, "Fixed Format Identification"),
1230
+ b::Element(e::NotUsed, "Record Format Code"),
1231
+ b::Element(e::NotUsed, "COMPOSITE UNIT OF MEASURE")),
1232
+ b::Segment(4850, s::NTE, "Line Note", r::Situational, d::RepeatCount.bounded(1),
1233
+ b::Element(e::Required, "Note Reference Code", b::Values("ADD", "DCP")),
1234
+ b::Element(e::Required, "Line Note Text")),
1235
+ b::Segment(4850, s::NTE, "Third Party Organization Notes", r::Situational, d::RepeatCount.bounded(1),
1236
+ b::Element(e::Required, "Note Reference Code", b::Values("TPO")),
1237
+ b::Element(e::Required, "Line Note Text")),
1238
+ b::Segment(4880, s::PS1, "Purchased Service Information", r::Situational, d::RepeatCount.bounded(1),
1239
+ b::Element(e::Required, "Purchased Service Provider Identifier"),
1240
+ b::Element(e::Required, "Purchased Service Charge Amount"),
1241
+ b::Element(e::NotUsed, "State or Province Code")),
1242
+ b::Segment(4920, s::HCP, "Line Pricing/Repricing Information", r::Situational, d::RepeatCount.bounded(1),
1243
+ b::Element(e::Required, "Pricing Methodology", b::Values("00", "01", "02", "03", "04", "05", "06", "07", "08", "09", "10", "11", "12", "13", "14")),
1244
+ b::Element(e::Required, "Repriced Allowed Amount"),
1245
+ b::Element(e::Situational, "Repciced Saving Amount"),
1246
+ b::Element(e::Situational, "Repricing Organization Identifier"),
1247
+ b::Element(e::Situational, "Repricing Per Diem or Flat Rate Amount"),
1248
+ b::Element(e::Situational, "Repriced Approved Ambulatory Patient Group Code"),
1249
+ b::Element(e::Situational, "Repriced Approved Ambulatory Patient Group Amount"),
1250
+ b::Element(e::NotUsed, "Product/Service ID"),
1251
+ b::Element(e::Situational, "Product or Service ID", b::Values("ER", "HC", "IV", "WK")),
1252
+ b::Element(e::Situational, "Repriced Approved HCPCS Code"),
1253
+ b::Element(e::Situational, "Unit or Basis for Measurement Code", b::Values("MJ", "UN")),
1254
+ b::Element(e::Situational, "Repriced Approved Service Unit Count", b::MaxLength(8), b::MaxPrecision(3)),
1255
+ b::Element(e::Situational, "Reject Reason Code", b::Values("T1", "T2", "T3", "T4", "T5", "T6")),
1256
+ b::Element(e::Situational, "Policy Compliance Code", b::Values("1", "2", "3", "4", "5")),
1257
+ b::Element(e::Situational, "Exception Code", b::Values("1", "2", "3", "4", "5", "6"))),
1258
+
1259
+ d::LoopDef.build("2410 DRUG IDENTIFICATION", d::RepeatCount.bounded(1),
1260
+ b::Segment(4930, s::LIN, "Drug Identification", r::Situational, d::RepeatCount.bounded(1),
1261
+ b::Element(e::NotUsed, "Assigned Identification"),
1262
+ b::Element(e::Required, "Product or Service ID Qualifier", b::Values("N4", "EN", "EO", "HI", "ON", "UK", "UP")),
1263
+ b::Element(e::Required, "National Drug Code or Universal Product Number"),
1264
+ b::Element(e::NotUsed, "Product/Service ID Qualifier"),
1265
+ b::Element(e::NotUsed, "Product/Service ID"),
1266
+ b::Element(e::NotUsed, "Product/Service ID Qualifier"),
1267
+ b::Element(e::NotUsed, "Product/Service ID"),
1268
+ b::Element(e::NotUsed, "Product/Service ID Qualifier"),
1269
+ b::Element(e::NotUsed, "Product/Service ID"),
1270
+ b::Element(e::NotUsed, "Product/Service ID Qualifier"),
1271
+ b::Element(e::NotUsed, "Product/Service ID"),
1272
+ b::Element(e::NotUsed, "Product/Service ID Qualifier"),
1273
+ b::Element(e::NotUsed, "Product/Service ID"),
1274
+ b::Element(e::NotUsed, "Product/Service ID Qualifier"),
1275
+ b::Element(e::NotUsed, "Product/Service ID"),
1276
+ b::Element(e::NotUsed, "Product/Service ID Qualifier"),
1277
+ b::Element(e::NotUsed, "Product/Service ID"),
1278
+ b::Element(e::NotUsed, "Product/Service ID Qualifier"),
1279
+ b::Element(e::NotUsed, "Product/Service ID"),
1280
+ b::Element(e::NotUsed, "Product/Service ID Qualifier"),
1281
+ b::Element(e::NotUsed, "Product/Service ID"),
1282
+ b::Element(e::NotUsed, "Product/Service ID Qualifier"),
1283
+ b::Element(e::NotUsed, "Product/Service ID"),
1284
+ b::Element(e::NotUsed, "Product/Service ID Qualifier"),
1285
+ b::Element(e::NotUsed, "Product/Service ID"),
1286
+ b::Element(e::NotUsed, "Product/Service ID Qualifier"),
1287
+ b::Element(e::NotUsed, "Product/Service ID"),
1288
+ b::Element(e::NotUsed, "Product/Service ID Qualifier"),
1289
+ b::Element(e::NotUsed, "Product/Service ID"),
1290
+ b::Element(e::NotUsed, "Product/Service ID Qualifier"),
1291
+ b::Element(e::NotUsed, "Product/Service ID")),
1292
+ b::Segment(4940, s::CTP, "Drug Quantity", r::Required, d::RepeatCount.bounded(1),
1293
+ b::Element(e::NotUsed, "Class of Trade Code"),
1294
+ b::Element(e::NotUsed, "Price Identifier Code"),
1295
+ b::Element(e::NotUsed, "Unit Price"),
1296
+ b::Element(e::Required, "National Drug Unit Count"),
1297
+ b::Element(e::Required, "COMPOSITE UNIT OF MEASURE",
1298
+ b::Element(e::Required, "Unit or Basis for Measurement Code", b::Values("F2", "GR", "ME", "ML", "UN")),
1299
+ b::Element(e::NotUsed, "Exponent"),
1300
+ b::Element(e::NotUsed, "Multiplier"),
1301
+ b::Element(e::NotUsed, "Unit or Basis for Measurement Code"),
1302
+ b::Element(e::NotUsed, "Exponent"),
1303
+ b::Element(e::NotUsed, "Multiplier"),
1304
+ b::Element(e::NotUsed, "Unit or Basis for Measurement Code"),
1305
+ b::Element(e::NotUsed, "Exponent"),
1306
+ b::Element(e::NotUsed, "Multiplier"),
1307
+ b::Element(e::NotUsed, "Unit or Basis for Measurement Code"),
1308
+ b::Element(e::NotUsed, "Exponent"),
1309
+ b::Element(e::NotUsed, "Multiplier"),
1310
+ b::Element(e::NotUsed, "Unit or Basis for Measurement Code"),
1311
+ b::Element(e::NotUsed, "Exponent"),
1312
+ b::Element(e::NotUsed, "Multiplier")),
1313
+ b::Element(e::NotUsed, "Price Multiplier Qualifier"),
1314
+ b::Element(e::NotUsed, "Multiplier"),
1315
+ b::Element(e::NotUsed, "Monetary Amount"),
1316
+ b::Element(e::NotUsed, "Basis of Unit Price Code"),
1317
+ b::Element(e::NotUsed, "Condition Value"),
1318
+ b::Element(e::NotUsed, "Multiple Price Quantity")),
1319
+ b::Segment(4950, s::REF, "Rendering Provider Secondary Identification", r::Situational, d::RepeatCount.bounded(1),
1320
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("VY", "XZ")),
1321
+ b::Element(e::Required, "Prescription Number"),
1322
+ b::Element(e::NotUsed, "Description"),
1323
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER"))),
1324
+
1325
+ d::LoopDef.build("2420A RENDERING PROVIDER NAME", d::RepeatCount.bounded(1),
1326
+ b::Segment(5000, s::NM1, "Rendering Provider Name", r::Situational, d::RepeatCount.bounded(1),
1327
+ b::Element(e::Required, "Entity Identifier Code", b::Values("82")),
1328
+ b::Element(e::Required, "Entity Type Qualifier", b::Values("1", "2")),
1329
+ b::Element(e::Required, "Rendering Provider Last Name"),
1330
+ b::Element(e::Situational, "Rendering Provider First Name"),
1331
+ b::Element(e::Situational, "Rendering Provider Middle Name or Initial"),
1332
+ b::Element(e::NotUsed, "Name Prefix"),
1333
+ b::Element(e::Situational, "Rendering Provider Suffix"),
1334
+ b::Element(e::Situational, "Identification Code Qualifier", b::Values("XX")),
1335
+ b::Element(e::Situational, "Rendering Provider Identifier"),
1336
+ b::Element(e::NotUsed, "Entity Relationship Code"),
1337
+ b::Element(e::NotUsed, "Entity Identifier Code"),
1338
+ b::Element(e::NotUsed, "Name Last or Organization Name")),
1339
+ b::Segment(5050, s::PRV, "Rendering Provider Specialty Information", r::Situational, d::RepeatCount.bounded(1),
1340
+ b::Element(e::Required, "Provider Code", b::Values("PE")),
1341
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("PXC")),
1342
+ b::Element(e::Required, "Provider Taxonmy Code"),
1343
+ b::Element(e::NotUsed, "State or Province Code"),
1344
+ b::Element(e::NotUsed, "PROVIDER SPECIALTY INFORMATION"),
1345
+ b::Element(e::NotUsed, "Provider Organization Code")),
1346
+ b::Segment(5250, s::REF, "Rendering Provider Secondary Identification", r::Situational, d::RepeatCount.bounded(20),
1347
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("0B", "1G", "G2", "LU")),
1348
+ b::Element(e::Required, "Rendering Provider Secondary Identifier"),
1349
+ b::Element(e::NotUsed, "Description"),
1350
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER"))),
1351
+
1352
+ d::LoopDef.build("2420B PURCHASED SERVICE PROVIDER NAME", d::RepeatCount.bounded(1),
1353
+ b::Segment(5000, s::NM1, "Purchased Service Provider Name", r::Situational, d::RepeatCount.bounded(1),
1354
+ b::Element(e::Required, "Entity Identifier Code", b::Values("QB")),
1355
+ b::Element(e::Required, "Entity Type Qualifier", b::Values("1", "2")),
1356
+ b::Element(e::NotUsed, "Name Last"),
1357
+ b::Element(e::NotUsed, "Name First"),
1358
+ b::Element(e::NotUsed, "Name Middle"),
1359
+ b::Element(e::NotUsed, "Name Prefix"),
1360
+ b::Element(e::NotUsed, "Name Suffix"),
1361
+ b::Element(e::Situational, "Identification Code Qualifier", b::Values("XX")),
1362
+ b::Element(e::Situational, "Purchased Service Provider Identifier"),
1363
+ b::Element(e::NotUsed, "Entity Relationship Code"),
1364
+ b::Element(e::NotUsed, "Entity Identifier Code"),
1365
+ b::Element(e::NotUsed, "Name Last or Organization Name")),
1366
+ b::Segment(5250, s::REF, "Purchased Service Provider Secondary Identification", r::Situational, d::RepeatCount.bounded(20),
1367
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("0B", "1G", "G2")),
1368
+ b::Element(e::Required, "Purchased Service Provider Secondary Identifier"),
1369
+ b::Element(e::NotUsed, "Description"),
1370
+ b::Element(e::Situational, "REFERENCE IDENTIFIER",
1371
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("2U")),
1372
+ b::Element(e::Required, "Other Payer Primary Identifier"),
1373
+ b::Element(e::NotUsed, "Reference Identifier Qualifier"),
1374
+ b::Element(e::NotUsed, "Reference Identifier"),
1375
+ b::Element(e::NotUsed, "Reference Identifier Qualifier"),
1376
+ b::Element(e::NotUsed, "Reference Identifier")))),
1377
+
1378
+ d::LoopDef.build("2420C SERVICE FACILITY LOCATION NAME", d::RepeatCount.bounded(1),
1379
+ b::Segment(5000, s::NM1, "Service Facility Location Name", r::Situational, d::RepeatCount.bounded(1),
1380
+ b::Element(e::Required, "Entity Identifier Code", b::Values("77")),
1381
+ b::Element(e::Required, "Entity Type Qualifier", b::Values("2")),
1382
+ b::Element(e::Required, "Laboratory or Facility Name"),
1383
+ b::Element(e::NotUsed, "Name First"),
1384
+ b::Element(e::NotUsed, "Name Middle"),
1385
+ b::Element(e::NotUsed, "Name Prefix"),
1386
+ b::Element(e::NotUsed, "Name Suffix"),
1387
+ b::Element(e::Situational, "Identification Code Qualifier", b::Values("XX")),
1388
+ b::Element(e::Situational, "Laboratory or Facility Primary Identifier"),
1389
+ b::Element(e::NotUsed, "Entity Relationship Code"),
1390
+ b::Element(e::NotUsed, "Entity Identifier Code"),
1391
+ b::Element(e::NotUsed, "Name Last or Organization Name")),
1392
+ b::Segment(5140, s::N3, "Service Facility Location Address", r::Required, d::RepeatCount.bounded(1),
1393
+ b::Element(e::Required, "Laboratory or Facility Address Line"),
1394
+ b::Element(e::Situational, "Laboratory or Facility Address Line")),
1395
+ b::Segment(5200, s::N4, "Service Facility Location City, State, ZIP Code", r::Required, d::RepeatCount.bounded(1),
1396
+ b::Element(e::Required, "Laboratory or Facility City Name"),
1397
+ b::Element(e::Situational, "Laboratory or Facility State or Province Code"),
1398
+ b::Element(e::Situational, "Laboratory or Facility Postal Zone or ZIP Code"),
1399
+ b::Element(e::Situational, "Country Code"),
1400
+ b::Element(e::NotUsed, "Location Qualifier"),
1401
+ b::Element(e::NotUsed, "Location Identifier"),
1402
+ b::Element(e::Situational, "Country Subdivision Code")),
1403
+ b::Segment(5250, s::REF, "Service Facility Location Secondary Identification", r::Situational, d::RepeatCount.bounded(3),
1404
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("G2", "LU")),
1405
+ b::Element(e::Required, "Service Facility Location Secondary Identifier"),
1406
+ b::Element(e::NotUsed, "Description"),
1407
+ b::Element(e::Situational, "REFERENCE IDENTIFIER",
1408
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("2U")),
1409
+ b::Element(e::Required, "Other Payer Primary Identifier"),
1410
+ b::Element(e::NotUsed, "Reference Identification Qualifier"),
1411
+ b::Element(e::NotUsed, "Reference Identification"),
1412
+ b::Element(e::NotUsed, "Reference Identification Qualifier"),
1413
+ b::Element(e::NotUsed, "Reference Identification")))),
1414
+
1415
+ d::LoopDef.build("2420D SUPERVISING PROVIDER NAME", d::RepeatCount.bounded(1),
1416
+ b::Segment(5000, s::NM1, "Supervising Provider Name", r::Situational, d::RepeatCount.bounded(1),
1417
+ b::Element(e::Required, "Entity Identifier Code", b::Values("DQ")),
1418
+ b::Element(e::Required, "Entity Type Qualifier", b::Values("1")),
1419
+ b::Element(e::Required, "Supervising Provider Last"),
1420
+ b::Element(e::Situational, "Supervising Provider First"),
1421
+ b::Element(e::Situational, "Supervising Provider Middle"),
1422
+ b::Element(e::NotUsed, "Name Prefix"),
1423
+ b::Element(e::Situational, "Supervising Provider Suffix"),
1424
+ b::Element(e::Situational, "Identification Code Qualifier", b::Values("XX")),
1425
+ b::Element(e::Situational, "Supervising Provider Identifier"),
1426
+ b::Element(e::NotUsed, "Entity Relationship Code"),
1427
+ b::Element(e::NotUsed, "Entity Identifier Code"),
1428
+ b::Element(e::NotUsed, "Name Last or Organization Name")),
1429
+ b::Segment(5250, s::REF, "Supervising Provider Secondary Identification", r::Situational, d::RepeatCount.bounded(20),
1430
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("0B", "1G", "G2", "LU")),
1431
+ b::Element(e::Required, "Supervising Provider Secondary Identifier"),
1432
+ b::Element(e::NotUsed, "Description"),
1433
+ b::Element(e::Situational, "REFERENCE IDENTIFIER",
1434
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("2U")),
1435
+ b::Element(e::Required, "Other Payer Primary Identifier"),
1436
+ b::Element(e::Required, "Reference Identification Qualifier"),
1437
+ b::Element(e::Required, "Reference Identification"),
1438
+ b::Element(e::Required, "Reference Identification Qualifier"),
1439
+ b::Element(e::Required, "Reference Identification")))),
1440
+
1441
+ d::LoopDef.build("2420E ORDERING PROVIDER NAME", d::RepeatCount.bounded(1),
1442
+ b::Segment(5000, s::NM1, "Ordering Provider Name", r::Situational, d::RepeatCount.bounded(1),
1443
+ b::Element(e::Required, "Entity Identifier Code", b::Values("DK")),
1444
+ b::Element(e::Required, "Entity Type Qualifier", b::Values("1")),
1445
+ b::Element(e::Required, "Ordering Provider Last"),
1446
+ b::Element(e::Situational, "Ordering Provider First"),
1447
+ b::Element(e::Situational, "Ordering Provider Middle"),
1448
+ b::Element(e::NotUsed, "Name Prefix"),
1449
+ b::Element(e::Situational, "Ordering Provider Suffix"),
1450
+ b::Element(e::Situational, "Identification Code Qualifier", b::Values("XX")),
1451
+ b::Element(e::Situational, "Ordering Provider Identifier"),
1452
+ b::Element(e::NotUsed, "Entity Relationship Code"),
1453
+ b::Element(e::NotUsed, "Entity Identifier Code"),
1454
+ b::Element(e::NotUsed, "Name Last or Organization Name")),
1455
+ b::Segment(5140, s::N3, "Ordering Provider Address", r::Situational, d::RepeatCount.bounded(1),
1456
+ b::Element(e::Required, "Ordering Provider Address Line"),
1457
+ b::Element(e::Situational, "Ordering Provider Address Line")),
1458
+ b::Segment(5200, s::N4, "Ordering Provider City, State, ZIP Code", r::Situational, d::RepeatCount.bounded(1),
1459
+ b::Element(e::Required, "Ordering Provider City Name"),
1460
+ b::Element(e::Situational, "Ordering Provider State or Province Code"),
1461
+ b::Element(e::Situational, "Ordering Provider Postal Zone or ZIP Code"),
1462
+ b::Element(e::Situational, "Country Code"),
1463
+ b::Element(e::NotUsed, "Location Qualifier"),
1464
+ b::Element(e::NotUsed, "Location Identifier"),
1465
+ b::Element(e::Situational, "Country Subdivision Code")),
1466
+ b::Segment(5250, s::REF, "Ordering Provider Secondary Identification", r::Situational, d::RepeatCount.bounded(20),
1467
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("0B", "1G", "G2")),
1468
+ b::Element(e::Required, "Ordering Provider Secondary Identifier"),
1469
+ b::Element(e::NotUsed, "Description"),
1470
+ b::Element(e::Situational, "REFERENCE IDENTIFIER",
1471
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("2U")),
1472
+ b::Element(e::Required, "Other Payer Primary Identifier"),
1473
+ b::Element(e::NotUsed, "Reference Identification Qualifier"),
1474
+ b::Element(e::NotUsed, "Reference Identification"),
1475
+ b::Element(e::NotUsed, "Reference Identification Qualifier"),
1476
+ b::Element(e::NotUsed, "Reference Identification"))),
1477
+ b::Segment(5300, s::PER, "Ordering Provider Contact Information", r::Situational, d::RepeatCount.bounded(1),
1478
+ b::Element(e::Required, "Contact Function Code", b::Values("IC")),
1479
+ b::Element(e::Situational, "Ordering Provider Contact Name"),
1480
+ b::Element(e::Required, "Communication Number Qualifier", b::Values("EM", "FX", "TE")),
1481
+ b::Element(e::Required, "Communication Number"),
1482
+ b::Element(e::Situational, "Communication Number Qualifier", b::Values("EM", "EX", "FX", "TE")),
1483
+ b::Element(e::Situational, "Communication Number"),
1484
+ b::Element(e::Situational, "Communication Number Qualifier", b::Values("EM", "EX", "FX", "TE")),
1485
+ b::Element(e::Situational, "Communication Number"),
1486
+ b::Element(e::NotUsed, "Contact Inquiry Reference"))),
1487
+
1488
+ d::LoopDef.build("2420F REFERRING PROVIDER NAME", d::RepeatCount.bounded(2),
1489
+ b::Segment(5000, s::NM1, "Referring Provider Name", r::Situational, d::RepeatCount.bounded(1),
1490
+ b::Element(e::Required, "Entity Identifier Code", b::Values("DN", "P3")),
1491
+ b::Element(e::Required, "Entity Type Qualifier", b::Values("1")),
1492
+ b::Element(e::Required, "Referring Provider Last"),
1493
+ b::Element(e::Situational, "Referring Provider First"),
1494
+ b::Element(e::Situational, "Referring Provider Middle"),
1495
+ b::Element(e::NotUsed, "Name Prefix"),
1496
+ b::Element(e::Situational, "Referring Provider Suffix"),
1497
+ b::Element(e::Situational, "Identification Code Qualifier", b::Values("XX")),
1498
+ b::Element(e::Situational, "Referring Provider Identifier"),
1499
+ b::Element(e::NotUsed, "Entity Relationship Code"),
1500
+ b::Element(e::NotUsed, "Entity Identifier Code"),
1501
+ b::Element(e::NotUsed, "Name Last or Organization Name")),
1502
+ b::Segment(5250, s::REF, "Referring Provider Secondary Identification", r::Situational, d::RepeatCount.bounded(20),
1503
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("0B", "1G", "G2")),
1504
+ b::Element(e::Required, "Referring Provider Secondary Identifier"),
1505
+ b::Element(e::NotUsed, "Description"),
1506
+ b::Element(e::Situational, "REFERENCE IDENTIFIER",
1507
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("2U")),
1508
+ b::Element(e::Required, "Other Payer Primary Identifier"),
1509
+ b::Element(e::NotUsed, "Reference Identification Qualifier"),
1510
+ b::Element(e::NotUsed, "Reference Identification"),
1511
+ b::Element(e::NotUsed, "Reference Identification Qualifier"),
1512
+ b::Element(e::NotUsed, "Reference Identification")))),
1513
+
1514
+ d::LoopDef.build("2420G AMBULANCE PICK-UP LOCATION", d::RepeatCount.bounded(1),
1515
+ b::Segment(5000, s::NM1, "Ambulance Pick-up Location", r::Situational, d::RepeatCount.bounded(1),
1516
+ b::Element(e::Required, "Entity Identifier Code", b::Values("PW")),
1517
+ b::Element(e::Required, "Entity Type Qualifier", b::Values("2")),
1518
+ b::Element(e::NotUsed, "Name Last"),
1519
+ b::Element(e::NotUsed, "Name First"),
1520
+ b::Element(e::NotUsed, "Name Middle"),
1521
+ b::Element(e::NotUsed, "Name Prefix"),
1522
+ b::Element(e::NotUsed, "Name Suffix"),
1523
+ b::Element(e::NotUsed, "Identification Code Qualifier"),
1524
+ b::Element(e::NotUsed, "Identification Code"),
1525
+ b::Element(e::NotUsed, "Entity Relationship Code"),
1526
+ b::Element(e::NotUsed, "Entity Identifier Code"),
1527
+ b::Element(e::NotUsed, "Name Last or Organization Name")),
1528
+ b::Segment(5140, s::N3, "Ambulance Pick-up Location Address", r::Required, d::RepeatCount.bounded(1),
1529
+ b::Element(e::Required, "Ambulance Pick-up Address Line"),
1530
+ b::Element(e::Situational, "Ambulance Pick-up Address Line")),
1531
+ b::Segment(5200, s::N4, "Ambulance Pick-up Location City, State, ZIP Code", r::Required, d::RepeatCount.bounded(1),
1532
+ b::Element(e::Required, "Ambulance Pick-up City Name"),
1533
+ b::Element(e::Situational, "Ambulance Pick-up State or Province Code"),
1534
+ b::Element(e::Situational, "Ambulance Pick-up Postal Zone or ZIP Code"),
1535
+ b::Element(e::Situational, "Country Code"),
1536
+ b::Element(e::NotUsed, "Location Qualifier"),
1537
+ b::Element(e::NotUsed, "Location Identifier"),
1538
+ b::Element(e::Situational, "Country Subdivision Code"))),
1539
+
1540
+ d::LoopDef.build("2420H AMBULANCE DROP-OFF LOCATION", d::RepeatCount.bounded(1),
1541
+ b::Segment(5000, s::NM1, "Ambulance Drop-off Location", r::Situational, d::RepeatCount.bounded(1),
1542
+ b::Element(e::Required, "Entity Identifier Code", b::Values("45")),
1543
+ b::Element(e::Required, "Entity Type Qualifier", b::Values("2")),
1544
+ b::Element(e::Situational, "Ambulance Drop-off Location"),
1545
+ b::Element(e::NotUsed, "Name First"),
1546
+ b::Element(e::NotUsed, "Name Middle"),
1547
+ b::Element(e::NotUsed, "Name Prefix"),
1548
+ b::Element(e::NotUsed, "Name Suffix"),
1549
+ b::Element(e::NotUsed, "Identification Code Qualifier"),
1550
+ b::Element(e::NotUsed, "Identification Code"),
1551
+ b::Element(e::NotUsed, "Entity Relationship Code"),
1552
+ b::Element(e::NotUsed, "Entity Identifier Code"),
1553
+ b::Element(e::NotUsed, "Name Last or Organization Name")),
1554
+ b::Segment(5140, s::N3, "Ambulance Drop-off Location Address", r::Required, d::RepeatCount.bounded(1),
1555
+ b::Element(e::Required, "Ambulance Drop-off Address Line"),
1556
+ b::Element(e::Situational, "Ambulance Drop-off Address Line")),
1557
+ b::Segment(5200, s::N4, "Ambulance Drop-off Location City, State, ZIP Code", r::Required, d::RepeatCount.bounded(1),
1558
+ b::Element(e::Required, "Ambulance Drop-off City Name"),
1559
+ b::Element(e::Situational, "Ambulance Drop-off State or Province Code"),
1560
+ b::Element(e::Situational, "Ambulance Drop-off Postal Zone or ZIP Code"),
1561
+ b::Element(e::Situational, "Country Code"),
1562
+ b::Element(e::NotUsed, "Location Qualifier"),
1563
+ b::Element(e::NotUsed, "Location Identifier"),
1564
+ b::Element(e::Situational, "Country Subdivision Code"))),
1565
+
1566
+ d::LoopDef.build("2430 LINE ADJUDICATION INFORMATION", d::RepeatCount.bounded(15),
1567
+ b::Segment(5400, s::SVD, "Line Adjudication Information", r::Situational, d::RepeatCount.bounded(1),
1568
+ b::Element(e::Required, "Other Payer Primary Identifier"),
1569
+ b::Element(e::Required, "Service Line Paid Amount"),
1570
+ b::Element(e::Required, "COMPOSITE MEDICAL PROCEDURE IDENTIFIER",
1571
+ b::Element(e::Required, "Product or Service ID Qualifier", b::Values("ER", "HC", "IV", "WK")),
1572
+ b::Element(e::Required, "Procedure Code"),
1573
+ b::Element(e::Situational, "Procedure Modifier"),
1574
+ b::Element(e::Situational, "Procedure Modifier"),
1575
+ b::Element(e::Situational, "Procedure Modifier"),
1576
+ b::Element(e::Situational, "Procedure Modifier"),
1577
+ b::Element(e::Situational, "Procedure Code Description"),
1578
+ b::Element(e::NotUsed, "Product/Service ID")),
1579
+ b::Element(e::NotUsed, "Product/Service ID"),
1580
+ b::Element(e::Required, "Paid Service Unit Count", b::MaxLength(8), b::MaxPrecision(3)),
1581
+ b::Element(e::Situational, "Bundled or Unbundled Line Number")),
1582
+ b::Segment(5450, s::CAS, "Line Adjustment", r::Situational, d::RepeatCount.bounded(5),
1583
+ b::Element(e::Required, "Claim Adjustment Group Code", b::Values("CO", "CR", "OA", "PI", "PR")),
1584
+ b::Element(e::Required, "Adjustment Reason Code"),
1585
+ b::Element(e::Required, "Adjustment Amount"),
1586
+ b::Element(e::Situational, "Adjustment Quantity"),
1587
+ b::Element(e::Situational, "Adjustment Reason Code"),
1588
+ b::Element(e::Situational, "Adjustment Amount"),
1589
+ b::Element(e::Situational, "Adjustment Quantity"),
1590
+ b::Element(e::Situational, "Adjustment Reason Code"),
1591
+ b::Element(e::Situational, "Adjustment Amount"),
1592
+ b::Element(e::Situational, "Adjustment Quantity"),
1593
+ b::Element(e::Situational, "Adjustment Reason Code"),
1594
+ b::Element(e::Situational, "Adjustment Amount"),
1595
+ b::Element(e::Situational, "Adjustment Quantity"),
1596
+ b::Element(e::Situational, "Adjustment Reason Code"),
1597
+ b::Element(e::Situational, "Adjustment Amount"),
1598
+ b::Element(e::Situational, "Adjustment Quantity"),
1599
+ b::Element(e::Situational, "Adjustment Reason Code"),
1600
+ b::Element(e::Situational, "Adjustment Amount"),
1601
+ b::Element(e::Situational, "Adjustment Quantity")),
1602
+ b::Segment(5500, s::DTP, "Line Check or Remittance Date", r::Required, d::RepeatCount.bounded(1),
1603
+ b::Element(e::Required, "Date Time Qualifier", b::Values("573")),
1604
+ b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
1605
+ b::Element(e::Required, "Adjudication or Payment Date")),
1606
+ b::Segment(5505, s::AMT, "Remaining Patient Liability", r::Situational, d::RepeatCount.bounded(1),
1607
+ b::Element(e::Required, "Amount Qualifier Code"),
1608
+ b::Element(e::Required, "Remaining Patient Liability"),
1609
+ b::Element(e::NotUsed, "Credit/Debit Flag Code"))),
1610
+
1611
+ d::LoopDef.build("2440 FORM IDENTIFICATION CODE", d::RepeatCount.unbounded,
1612
+ b::Segment(5510, s::LQ, "Form Identification Code", r::Situational, d::RepeatCount.bounded(1),
1613
+ b::Element(e::Required, "Code List Qualifier Code", b::Values("AS", "UT")),
1614
+ b::Element(e::Required, "Form Identifier")),
1615
+ b::Segment(5520, s::FRM, "Supporting Documentation", r::Required, d::RepeatCount.bounded(99),
1616
+ b::Element(e::Required, "Question Number/Letter"),
1617
+ b::Element(e::Situational, "Question Response", b::Values("N", "W", "Y")),
1618
+ b::Element(e::Situational, "Question Response"),
1619
+ b::Element(e::Situational, "Question Response"),
1620
+ b::Element(e::Situational, "Question Response")))))
1621
+
1622
+ HC837 = b.build("HC", "837", "",
1623
+ d::TableDef.header("1 - Header",
1624
+ b::Segment(50, s::ST, "Transaction Set Header", r::Required, d::RepeatCount.bounded(1),
1625
+ b::Element(e::Required, "Transaction Set Identifier Code", b::Values("837")),
1626
+ b::Element(e::Required, "Transaction Set Control Number"),
1627
+ b::Element(e::Required, "Implementation Guide Version Name", b::Values("005010X222A1"))),
1628
+ b::Segment(100, s::BHT, "Beginning of Hierarchical Transaction", r::Required, d::RepeatCount.bounded(1),
1629
+ b::Element(e::Required, "Hierarchical Structure Code", b::Values("0019")),
1630
+ b::Element(e::Required, "Transaction Set Purpose Code", b::Values("00", "18")),
1631
+ b::Element(e::Required, "Originator Application Transaction Identifier", b::MaxLength(30)),
1632
+ b::Element(e::Required, "Transaction Set Creation Date"),
1633
+ b::Element(e::Required, "Transaction Set Creation Time"),
1634
+ b::Element(e::Required, "Claim or Encounter Identifier", b::Values("31", "CH", "RP"))),
1635
+
1636
+ d::LoopDef.build("1000A SUBMITTER NAME", d::RepeatCount.bounded(1),
1637
+ b::Segment(200, s::NM1, "Submitter Name", r::Required, d::RepeatCount.bounded(1),
1638
+ b::Element(e::Required, "Entity Identifier Code", b::Values("41")),
1639
+ b::Element(e::Required, "Entity Type Qualifier", b::Values("1", "2")),
1640
+ b::Element(e::Required, "Submitter Last or Organization Name"),
1641
+ b::Element(e::Situational, "Submitter First Name"),
1642
+ b::Element(e::Situational, "Submitter Middle Name or Initial"),
1643
+ b::Element(e::NotUsed, "Name Prefix"),
1644
+ b::Element(e::NotUsed, "Name Suffix"),
1645
+ b::Element(e::Required, "Identification Qualifier Code", b::Values("46")),
1646
+ b::Element(e::Required, "Submitter Identifier"),
1647
+ b::Element(e::NotUsed, "Entity Relationship Code"),
1648
+ b::Element(e::NotUsed, "Entity Identifier Code"),
1649
+ b::Element(e::NotUsed, "Name Last or Organization Name")),
1650
+ b::Segment(450, s::PER, "Submitter EDI Contact Information", r::Required, d::RepeatCount.bounded(2),
1651
+ b::Element(e::Required, "Contact Function Code", b::Values("IC")),
1652
+ b::Element(e::Situational, "Submitter Contact Name"),
1653
+ b::Element(e::Required, "Communication Number Qualifier", b::Values("EM", "FX", "TE")),
1654
+ b::Element(e::Required, "Communication Number"),
1655
+ b::Element(e::Situational, "Communication Number Qualifier", b::Values("EM", "EX", "FX", "TE")),
1656
+ b::Element(e::Situational, "Communication Number"),
1657
+ b::Element(e::Situational, "Communication Number Qualifier", b::Values("EM", "EX", "FX", "TE")),
1658
+ b::Element(e::Situational, "Communication Number"),
1659
+ b::Element(e::NotUsed, "Contact Inquiry Reference"))),
1660
+
1661
+ d::LoopDef.build("1000B RECEIVER NAME", d::RepeatCount.bounded(1),
1662
+ b::Segment(200, s::NM1, "Receiver Name", r::Required, d::RepeatCount.bounded(1),
1663
+ b::Element(e::Required, "Entity Identifier Code", b::Values("40")),
1664
+ b::Element(e::Required, "Entity Type Qualifier", b::Values("2")),
1665
+ b::Element(e::Required, "Receiver Name"),
1666
+ b::Element(e::NotUsed, "Name First"),
1667
+ b::Element(e::NotUsed, "Name Last"),
1668
+ b::Element(e::NotUsed, "Name Prefix"),
1669
+ b::Element(e::NotUsed, "Name Suffix"),
1670
+ b::Element(e::Required, "Identification Code Qualifier", b::Values("46")),
1671
+ b::Element(e::Required, "Receiver Primary Identifier"),
1672
+ b::Element(e::NotUsed, "Entity Relationship Code"),
1673
+ b::Element(e::NotUsed, "Entity Identifier Code"),
1674
+ b::Element(e::NotUsed, "Name Last or Organization Name")))),
1675
+
1676
+ d::TableDef.detail("2 - Billing Provider Detail",
1677
+ d::LoopDef.build("2000A BILLING PROVIDER HIERARCHICAL LEVEL", d::RepeatCount.unbounded,
1678
+ b::Segment(10, s::HL, "Billing Provider Hierarchical Level", r::Required, d::RepeatCount.bounded(1),
1679
+ b::Element(e::Required, "Hierarchical ID Number"),
1680
+ b::Element(e::NotUsed, "Hierarchical Parent ID Number"),
1681
+ b::Element(e::Required, "Hierarchical Level Code", b::Values("20")),
1682
+ b::Element(e::Required, "Hierachical Child Code")),
1683
+ b::Segment(30, s::PRV, "Billing Provider Specialty Information", r::Situational, d::RepeatCount.bounded(1),
1684
+ b::Element(e::Required, "Provider Code", b::Values("BI")),
1685
+ b::Element(e::Required, "Reference Identification Number", b::Values("PXC")),
1686
+ b::Element(e::Required, "Provider Taxonomy Code"),
1687
+ b::Element(e::NotUsed, "State or Province Code"),
1688
+ b::Element(e::NotUsed, "PROVIDER SPECIALTY INFORMATION"),
1689
+ b::Element(e::NotUsed, "Provider Organization Code")),
1690
+ b::Segment(100, s::CUR, "Foreign Currency Information", r::Situational, d::RepeatCount.bounded(1),
1691
+ b::Element(e::Required, "Entity Identifier Code", b::Values("85")),
1692
+ b::Element(e::Required, "Currency Code"),
1693
+ b::Element(e::NotUsed, "Exchange Rate"),
1694
+ b::Element(e::NotUsed, "Entity Identifier Code"),
1695
+ b::Element(e::NotUsed, "Currency Code"),
1696
+ b::Element(e::NotUsed, "Currency Market/Exchange Code"),
1697
+ b::Element(e::NotUsed, "Date/Time Qualifier"),
1698
+ b::Element(e::NotUsed, "Date"),
1699
+ b::Element(e::NotUsed, "Time"),
1700
+ b::Element(e::NotUsed, "Date/Time Qualifier"),
1701
+ b::Element(e::NotUsed, "Date"),
1702
+ b::Element(e::NotUsed, "Time"),
1703
+ b::Element(e::NotUsed, "Date/Time Qualifier"),
1704
+ b::Element(e::NotUsed, "Date"),
1705
+ b::Element(e::NotUsed, "Time"),
1706
+ b::Element(e::NotUsed, "Date/Time Qualifier"),
1707
+ b::Element(e::NotUsed, "Date"),
1708
+ b::Element(e::NotUsed, "Time"),
1709
+ b::Element(e::NotUsed, "Date/Time Qualifier"),
1710
+ b::Element(e::NotUsed, "Date"),
1711
+ b::Element(e::NotUsed, "Time")),
1712
+
1713
+ d::LoopDef.build("2010AA BILLING PROVIDER NAME", d::RepeatCount.bounded(1),
1714
+ b::Segment(150, s::NM1, "Billing Provider Name", r::Required, d::RepeatCount.bounded(1),
1715
+ b::Element(e::Required, "Entity Identifier Code", b::Values("85")),
1716
+ b::Element(e::Required, "Entity Type Qualifier", b::Values("1", "2")),
1717
+ b::Element(e::Required, "Billing Provider Last or Organizational Name"),
1718
+ b::Element(e::Situational, "Billing Provider First Name"),
1719
+ b::Element(e::Situational, "Billing Provider Middle Name or Initial"),
1720
+ b::Element(e::NotUsed, "Name Prefix"),
1721
+ b::Element(e::Situational, "Billing Provider Name Suffix"),
1722
+ b::Element(e::Situational, "Identification Code Qualifier", b::Values("XX")),
1723
+ b::Element(e::Situational, "Billing Provider Identifier"),
1724
+ b::Element(e::NotUsed, "Entity Relationship Code"),
1725
+ b::Element(e::NotUsed, "Entity Identifier Code"),
1726
+ b::Element(e::NotUsed, "Name Last or Organization Name")),
1727
+ b::Segment(250, s::N3, "Billing Provider Address", r::Required, d::RepeatCount.bounded(1),
1728
+ b::Element(e::Required, "Billing Provider Address Line"),
1729
+ b::Element(e::Situational, "Billing Provider Address Line")),
1730
+ b::Segment(300, s::N4, "Billing Provider City, State, ZIP Code", r::Required, d::RepeatCount.bounded(1),
1731
+ b::Element(e::Required, "Billing Provider City Name"),
1732
+ b::Element(e::Situational, "Billing Provider State or Province Code"),
1733
+ b::Element(e::Situational, "Billing Provider Postal Zone or ZIP Code"),
1734
+ b::Element(e::Situational, "Country Code"),
1735
+ b::Element(e::NotUsed, "Location Qualifier"),
1736
+ b::Element(e::NotUsed, "Location Identifier"),
1737
+ b::Element(e::Situational, "Country Subdivision Code")),
1738
+ b::Segment(350, s::REF, "Billing Provider Tax Identification", r::Required, d::RepeatCount.bounded(1),
1739
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("EI", "SY")),
1740
+ b::Element(e::Required, "Billing Provider Tax Identification Number"),
1741
+ b::Element(e::NotUsed, "Description"),
1742
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
1743
+ b::Segment(350, s::REF, "Billing Provider UPIN/License Information", r::Situational, d::RepeatCount.bounded(2),
1744
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("0B", "1G")),
1745
+ b::Element(e::Required, "Billing Provider License and/or UPIN Information"),
1746
+ b::Element(e::NotUsed, "Description"),
1747
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
1748
+ b::Segment(400, s::PER, "Billing Provider Contact Information", r::Situational, d::RepeatCount.bounded(2),
1749
+ b::Element(e::Required, "Contact Function Code", b::Values("IC")),
1750
+ b::Element(e::Situational, "Billing Provider Contact Name"),
1751
+ b::Element(e::Required, "Communication Number Qualifier", b::Values("EM", "FX", "TE")),
1752
+ b::Element(e::Required, "Communication Number"),
1753
+ b::Element(e::Situational, "Communication Number Qualifier", b::Values("EM", "EX", "FX", "TE")),
1754
+ b::Element(e::Situational, "Communication Number"),
1755
+ b::Element(e::Situational, "Communication Number Qualifier", b::Values("EM", "EX", "FX", "TE")),
1756
+ b::Element(e::Situational, "Communication Number"),
1757
+ b::Element(e::NotUsed, "Contact Inquiry Reference"))),
1758
+
1759
+ d::LoopDef.build("2010AB PAY-TO ADDRESS NAME", d::RepeatCount.bounded(1),
1760
+ b::Segment(150, s::NM1, "Pay-to Address Name", r::Situational, d::RepeatCount.bounded(1),
1761
+ b::Element(e::Required, "Entity Identifier Code", b::Values("87")),
1762
+ b::Element(e::Required, "Entity Type Qualifier", b::Values("1", "2")),
1763
+ b::Element(e::NotUsed, "Name Last or Organizational Name"),
1764
+ b::Element(e::NotUsed, "Name First"),
1765
+ b::Element(e::NotUsed, "Name Middle"),
1766
+ b::Element(e::NotUsed, "Name Prefix"),
1767
+ b::Element(e::NotUsed, "Name Suffix"),
1768
+ b::Element(e::NotUsed, "Identification Code Qualifier"),
1769
+ b::Element(e::NotUsed, "Identifier Code"),
1770
+ b::Element(e::NotUsed, "Entity Relationship Code"),
1771
+ b::Element(e::NotUsed, "Entity Identifier Code"),
1772
+ b::Element(e::NotUsed, "Name Last or Organization Name")),
1773
+ b::Segment(250, s::N3, "Pay-to Address - ADDRESS", r::Required, d::RepeatCount.bounded(1),
1774
+ b::Element(e::Required, "Pay-To Address Line"),
1775
+ b::Element(e::Situational, "Pay-To Address Line")),
1776
+ b::Segment(300, s::N4, "Pay-To Address City, State, ZIP Code", r::Required, d::RepeatCount.bounded(1),
1777
+ b::Element(e::Required, "Pay-to City Name"),
1778
+ b::Element(e::Situational, "Pay-to State or Province Code"),
1779
+ b::Element(e::Situational, "Pay-to Postal Zone or ZIP Code"),
1780
+ b::Element(e::Situational, "Country Code"),
1781
+ b::Element(e::NotUsed, "Location Qualifier"),
1782
+ b::Element(e::NotUsed, "Location Identifier"),
1783
+ b::Element(e::Situational, "Country Subdivision Code"))),
1784
+
1785
+ d::LoopDef.build("2010AC PAY-TO PLAN NAME", d::RepeatCount.bounded(1),
1786
+ b::Segment(150, s::NM1, "Pay-To Plan Name", r::Situational, d::RepeatCount.bounded(1),
1787
+ b::Element(e::Required, "Entity Identifier Code", b::Values("PE")),
1788
+ b::Element(e::Required, "Entity Type Qualifier", b::Values("2")),
1789
+ b::Element(e::Required, "Pay-To Plan Organizational Name"),
1790
+ b::Element(e::NotUsed, "Name First"),
1791
+ b::Element(e::NotUsed, "Name Middle"),
1792
+ b::Element(e::NotUsed, "Name Prefix"),
1793
+ b::Element(e::NotUsed, "Name Suffix"),
1794
+ b::Element(e::Required, "Identification Code Qualifier", b::Values("PI", "XV")),
1795
+ b::Element(e::Required, "Pay-To Plan Primary Identifier"),
1796
+ b::Element(e::NotUsed, "Entity Relationship Code"),
1797
+ b::Element(e::NotUsed, "Entity Identifier Code"),
1798
+ b::Element(e::NotUsed, "Name Last or Organization Name")),
1799
+ b::Segment(250, s::N3, "Pay-to Plan Address", r::Required, d::RepeatCount.bounded(1),
1800
+ b::Element(e::Required, "Pay-To Plan Address Line"),
1801
+ b::Element(e::Situational, "Pay-To Plan Address Line")),
1802
+ b::Segment(300, s::N4, "Pay-To Plan City, State, ZIP Code", r::Required, d::RepeatCount.bounded(1),
1803
+ b::Element(e::Required, "Pay-to Plan City Name"),
1804
+ b::Element(e::Situational, "Pay-to Plan State or Province Code"),
1805
+ b::Element(e::Situational, "Pay-to Plan Postal Zone or ZIP Code"),
1806
+ b::Element(e::Situational, "Country Code"),
1807
+ b::Element(e::NotUsed, "Location Qualifier"),
1808
+ b::Element(e::NotUsed, "Location Identifier"),
1809
+ b::Element(e::Situational, "Country Subdivision Code")),
1810
+ b::Segment(350, s::REF, "Pay-to Plan Secondary Identification", r::Situational, d::RepeatCount.bounded(1),
1811
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("2U", "FY", "NF")),
1812
+ b::Element(e::Required, "Pay-to Plan Secondary Identifier"),
1813
+ b::Element(e::NotUsed, "Description"),
1814
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
1815
+ b::Segment(350, s::REF, "Pay-to Plan Tax Identification Number", r::Required, d::RepeatCount.bounded(1),
1816
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("EI")),
1817
+ b::Element(e::Required, "Pay-to Plan Tax Identification Number"),
1818
+ b::Element(e::NotUsed, "Description"),
1819
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER"))))),
1820
+
1821
+ d::TableDef.detail("2 - Subscriber Detail",
1822
+ d::LoopDef.build("2000B SUBSCRIBER HIERARCHICAL LEVEL", d::RepeatCount.unbounded,
1823
+ b::Segment(10, s::HL, "Subscriber Hierarchical Level", r::Required, d::RepeatCount.bounded(1),
1824
+ b::Element(e::Required, "Hierarchical ID Number"),
1825
+ b::Element(e::Required, "Hierarchical Parent ID Number"),
1826
+ b::Element(e::Required, "Hierarchical Level Code", b::Values("22")),
1827
+ b::Element(e::Required, "Hierachical Child values", b::Values("0", "1"))),
1828
+ b::Segment(50, s::SBR, "Subscriber Information", r::Situational, d::RepeatCount.bounded(1),
1829
+ b::Element(e::Required, "Payer Responsibility Sequence Number", b::Values("A", "B", "C", "D", "E", "F", "G", "H", "P", "S", "T", "U")),
1830
+ b::Element(e::Situational, "Individual Relationship Code", b::Values("18")),
1831
+ b::Element(e::Situational, "Subscriber Group or Policy Number"),
1832
+ b::Element(e::Situational, "Subscriber Group Name"),
1833
+ b::Element(e::Situational, "Insurance Type Code", b::Values("12", "13", "14", "15", "16", "41", "42", "43", "47")),
1834
+ b::Element(e::NotUsed, "Coordination of Benefits Code"),
1835
+ b::Element(e::NotUsed, "Yes/No Condition or Response Code"),
1836
+ b::Element(e::NotUsed, "Employment Status Code"),
1837
+ 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"))),
1838
+ b::Segment(70, s::PAT, "Patient Information", r::Situational, d::RepeatCount.bounded(1),
1839
+ b::Element(e::NotUsed, "Individual Relationship Code"),
1840
+ b::Element(e::NotUsed, "Patient Location Code"),
1841
+ b::Element(e::NotUsed, "Employment Status Code"),
1842
+ b::Element(e::NotUsed, "Student Status Code"),
1843
+ b::Element(e::Situational, "Date Time Period Format Qualifier", b::Values("D8")),
1844
+ b::Element(e::Situational, "Patient Death Date"),
1845
+ b::Element(e::Situational, "Unit or Basis for Measurement Code", b::Values("01")),
1846
+ b::Element(e::Situational, "Patient Weight"),
1847
+ b::Element(e::Situational, "Pregnancy Indicator", b::Values("Y"))),
1848
+
1849
+ d::LoopDef.build("2010BA SUBSCRIBER NAME", d::RepeatCount.bounded(1),
1850
+ b::Segment(150, s::NM1, "Subscriber Name", r::Required, d::RepeatCount.bounded(1),
1851
+ b::Element(e::Required, "Entity Identifier Code", b::Values("IL")),
1852
+ b::Element(e::Required, "Entity Type Qualifier", b::Values("1", "2")),
1853
+ b::Element(e::Situational, "Subscriber Last Name"),
1854
+ b::Element(e::Situational, "Subscriber First Name"),
1855
+ b::Element(e::Situational, "Subscriber Middle Name or Initial"),
1856
+ b::Element(e::NotUsed, "Name Prefix"),
1857
+ b::Element(e::Situational, "Subscriber Name Suffix"),
1858
+ b::Element(e::Situational, "Identification Code Qualifier", b::Values("II", "MI")),
1859
+ b::Element(e::Situational, "Subscriber Primary Identifier"),
1860
+ b::Element(e::NotUsed, "Entity Relationship Code"),
1861
+ b::Element(e::NotUsed, "Entity Identifier Code"),
1862
+ b::Element(e::NotUsed, "Name Last or Organization Name")),
1863
+ b::Segment(250, s::N3, "Subscriber Address", r::Situational, d::RepeatCount.bounded(1),
1864
+ b::Element(e::Required, "Subscriber Address Line"),
1865
+ b::Element(e::Situational, "Subscriber Address Line")),
1866
+ b::Segment(300, s::N4, "Subscriber City, State, ZIP Code", r::Situational, d::RepeatCount.bounded(1),
1867
+ b::Element(e::Required, "Subscriber City Name"),
1868
+ b::Element(e::Situational, "Subscriber State Code"),
1869
+ b::Element(e::Situational, "Subscriber Postal Zone or ZIP Code"),
1870
+ b::Element(e::Situational, "Country Code"),
1871
+ b::Element(e::NotUsed, "Location Qualifier"),
1872
+ b::Element(e::NotUsed, "Location Identifier"),
1873
+ b::Element(e::Situational, "Country Subdivision Code")),
1874
+ b::Segment(320, s::DMG, "Subscriber Demographic Information", r::Situational, d::RepeatCount.bounded(1),
1875
+ b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
1876
+ b::Element(e::Required, "Subscriber Birth Date"),
1877
+ b::Element(e::Required, "Subscriber Gender Code", b::Values("F", "M", "U")),
1878
+ b::Element(e::NotUsed, "Marital Status Code"),
1879
+ b::Element(e::NotUsed, "COMPOSITE RACE OR ETHNICITY INFORMATION"),
1880
+ b::Element(e::NotUsed, "Citizenship Status Code"),
1881
+ b::Element(e::NotUsed, "Country Code"),
1882
+ b::Element(e::NotUsed, "Basis of Verification Code"),
1883
+ b::Element(e::NotUsed, "Quantity"),
1884
+ b::Element(e::NotUsed, "Code List Qualifier Code"),
1885
+ b::Element(e::NotUsed, "Industry Code")),
1886
+ b::Segment(350, s::REF, "Subscriber Secondary Identification", r::Situational, d::RepeatCount.bounded(1),
1887
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("SY")),
1888
+ b::Element(e::Required, "Subscriber Supplemental Identifier"),
1889
+ b::Element(e::NotUsed, "Description"),
1890
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
1891
+ b::Segment(350, s::REF, "Property and Casualty Claim Number", r::Situational, d::RepeatCount.bounded(1),
1892
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("Y4")),
1893
+ b::Element(e::Required, "Property Casualty Claim Number"),
1894
+ b::Element(e::NotUsed, "Description"),
1895
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
1896
+ b::Segment(400, s::PER, "Property and Casualty Subscriber Contact Information", r::Situational, d::RepeatCount.bounded(1),
1897
+ b::Element(e::Required, "Contact Fuction Code", b::Values("IC")),
1898
+ b::Element(e::Situational, "Name"),
1899
+ b::Element(e::Required, "Communication Qualifier Number", b::Values("TE")),
1900
+ b::Element(e::Required, "Communication Number"),
1901
+ b::Element(e::Situational, "Communication Qualifier Number", b::Values("TE", "EX")),
1902
+ b::Element(e::Situational, "Communication Number"),
1903
+ b::Element(e::NotUsed, "Communication Qualifier Number"),
1904
+ b::Element(e::NotUsed, "Communication Number"),
1905
+ b::Element(e::NotUsed, "Contact Inquiry Reference"))),
1906
+
1907
+ d::LoopDef.build("2010BB PAYER NAME", d::RepeatCount.bounded(10),
1908
+ b::Segment(150, s::NM1, "Payer Name", r::Required, d::RepeatCount.bounded(1),
1909
+ b::Element(e::Required, "Entity Identifier Code", b::Values("PR")),
1910
+ b::Element(e::Required, "Entity Type Qualifier", b::Values("2")),
1911
+ b::Element(e::Required, "Payer Name"),
1912
+ b::Element(e::NotUsed, "Name Last"),
1913
+ b::Element(e::NotUsed, "Name Middle"),
1914
+ b::Element(e::NotUsed, "Name Prefix"),
1915
+ b::Element(e::NotUsed, "Name Suffix"),
1916
+ b::Element(e::Required, "Identification Code Qualifier", b::Values("PI", "XV")),
1917
+ b::Element(e::Required, "Payer Identification"),
1918
+ b::Element(e::NotUsed, "Entity Relationship Code"),
1919
+ b::Element(e::NotUsed, "Entity Identifier Code"),
1920
+ b::Element(e::NotUsed, "Name Last or Organization Name")),
1921
+ b::Segment(250, s::N3, "Payer Address", r::Situational, d::RepeatCount.bounded(2),
1922
+ b::Element(e::Required, "Payer Address Line"),
1923
+ b::Element(e::Situational, "Payer Address Line")),
1924
+ b::Segment(300, s::N4, "Payer City, State, ZIP Code", r::Situational, d::RepeatCount.bounded(1),
1925
+ b::Element(e::Required, "Payer City Name"),
1926
+ b::Element(e::Situational, "Payer State or Province Code"),
1927
+ b::Element(e::Situational, "Payer Postal Zone or ZIP Code"),
1928
+ b::Element(e::Situational, "Country Code"),
1929
+ b::Element(e::NotUsed, "Location Qualifier"),
1930
+ b::Element(e::NotUsed, "Location Identifier"),
1931
+ b::Element(e::Situational, "Country Subdivision Code")),
1932
+ b::Segment(350, s::REF, "Payer Secondary Identification", r::Situational, d::RepeatCount.bounded(3),
1933
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("2U", "EI", "FY", "NF")),
1934
+ b::Element(e::Required, "Payer Secondary Identifier"),
1935
+ b::Element(e::NotUsed, "Description"),
1936
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
1937
+ b::Segment(350, s::REF, "Billing Provider Secondary Identification", r::Situational, d::RepeatCount.bounded(2),
1938
+ b::Element(e::Required, "Reference Identification Qualifier", b::Values("G2", "LU")),
1939
+ b::Element(e::Required, "Billing Provider Secondary Identifier"),
1940
+ b::Element(e::NotUsed, "Description"),
1941
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER"))),
1942
+
1943
+ loop2300)),
1944
+
1945
+ d::TableDef.detail("2 - Patient Detail",
1946
+ d::LoopDef.build("2000C PATIENT HIERARCHICAL LEVEL", d::RepeatCount.unbounded,
1947
+ b::Segment(10, s::HL, "Patient Hierachical Level", r::Situational, d::RepeatCount.bounded(1),
1948
+ b::Element(e::Required, "Hierarchical ID Number"),
1949
+ b::Element(e::Required, "Hierarchical Parent ID Number"),
1950
+ b::Element(e::Required, "Hierarchical Level Code", b::Values("23")),
1951
+ b::Element(e::Required, "Hierarchical Child Code", b::Values("0"))),
1952
+ b::Segment(70, s::PAT, "Patient Information", r::Required, d::RepeatCount.bounded(1),
1953
+ b::Element(e::Required, "Individual Relationship Code", b::Values("01", "19", "20", "21", "39", "40", "53", "G8")),
1954
+ b::Element(e::NotUsed, "Patient Location Code"),
1955
+ b::Element(e::NotUsed, "Employment Status Code"),
1956
+ b::Element(e::NotUsed, "Student Status Code"),
1957
+ b::Element(e::Situational, "Date Time Period Format Qualifier"),
1958
+ b::Element(e::Situational, "Patient Death Date"),
1959
+ b::Element(e::Situational, "Unit Basis for Measurement Code", b::Values("01")),
1960
+ b::Element(e::Situational, "Patient Weight"),
1961
+ b::Element(e::Situational, "Pregnancy Indicator", b::Values("Y"))),
1962
+
1963
+ d::LoopDef.build("2010CA PATIENT NAME", d::RepeatCount.bounded(1),
1964
+ b::Segment(150, s::NM1, "Patient Name", r::Required, d::RepeatCount.bounded(1),
1965
+ b::Element(e::Required, "Entity Qualifier Code", b::Values("QC")),
1966
+ b::Element(e::Required, "Entity Type Qualifier", b::Values("1")),
1967
+ b::Element(e::Required, "Patient Last Name"),
1968
+ b::Element(e::Situational, "Patient First Name"),
1969
+ b::Element(e::Situational, "Patient Middle Name or Initial"),
1970
+ b::Element(e::NotUsed, "Name Prefix"),
1971
+ b::Element(e::Situational, "Patient Name Suffix"),
1972
+ b::Element(e::NotUsed, "Identification Code Qualifier"),
1973
+ b::Element(e::NotUsed, "Identification Code"),
1974
+ b::Element(e::NotUsed, "Entity Relationship Code"),
1975
+ b::Element(e::NotUsed, "Entity Identification Code"),
1976
+ b::Element(e::NotUsed, "Name Last or Organization Name")),
1977
+ b::Segment(250, s::N3, "Patient Address", r::Required, d::RepeatCount.bounded(1),
1978
+ b::Element(e::Required, "Patient Address Line"),
1979
+ b::Element(e::Situational, "Patient Address Line")),
1980
+ b::Segment(300, s::N4, "Patient City, State, ZIP Code", r::Required, d::RepeatCount.bounded(1),
1981
+ b::Element(e::Required, "Patient City Name"),
1982
+ b::Element(e::Situational, "Patient State Code"),
1983
+ b::Element(e::Situational, "Patient Postal Zone or ZIP Code"),
1984
+ b::Element(e::Situational, "Country Code"),
1985
+ b::Element(e::NotUsed, "Location Qualifier"),
1986
+ b::Element(e::NotUsed, "Location Identifier"),
1987
+ b::Element(e::Situational, "Country Subdivision Code")),
1988
+ b::Segment(320, s::DMG, "Patient Demographic Information", r::Required, d::RepeatCount.bounded(1),
1989
+ b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
1990
+ b::Element(e::Required, "Patient Birth Date"),
1991
+ b::Element(e::Required, "Patient Gender Code", b::Values("F", "M", "U")),
1992
+ b::Element(e::NotUsed, "Marital Status Code"),
1993
+ b::Element(e::NotUsed, "COMPOSITE RACE OR ETHNICITY INFORMATION"),
1994
+ b::Element(e::NotUsed, "Citizenship Status Code"),
1995
+ b::Element(e::NotUsed, "Country Code"),
1996
+ b::Element(e::NotUsed, "Basis of Verification Code"),
1997
+ b::Element(e::NotUsed, "Quantity"),
1998
+ b::Element(e::NotUsed, "Code List Qualifier Code"),
1999
+ b::Element(e::NotUsed, "Industry Code")),
2000
+ b::Segment(350, s::REF, "Property and Casualty Claim Number", r::Situational, d::RepeatCount.bounded(1),
2001
+ b::Element(e::Required, "Reference Identifier Qualifier", b::Values("Y4")),
2002
+ b::Element(e::Required, "Property Casualty Claim Number"),
2003
+ b::Element(e::NotUsed, "Description"),
2004
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
2005
+ b::Segment(350, s::REF, "Property and Casualty Patient Identifier", r::Situational, d::RepeatCount.bounded(1),
2006
+ b::Element(e::Required, "Reference Identifier Qualifier", b::Values("1W", "SY")),
2007
+ b::Element(e::Required, "Property Casualty Patient Identifier"),
2008
+ b::Element(e::NotUsed, "Description"),
2009
+ b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
2010
+ b::Segment(400, s::PER, "Property and Casualty Patient Contact Information", r::Situational, d::RepeatCount.bounded(1),
2011
+ b::Element(e::Required, "Contact Function Code", b::Values("IC")),
2012
+ b::Element(e::Situational, "Name"),
2013
+ b::Element(e::Required, "Communication Number Qualifier", b::Values("TE")),
2014
+ b::Element(e::Required, "Communication Number"),
2015
+ b::Element(e::Situational, "Communication Number Qualifier", b::Values("EX")),
2016
+ b::Element(e::Situational, "Communication Number"),
2017
+ b::Element(e::NotUsed, "Communication Number Qualifier"),
2018
+ b::Element(e::NotUsed, "Communication Number"),
2019
+ b::Element(e::NotUsed, "Contact Inquiry Reference"))),
2020
+
2021
+ loop2300)),
2022
+
2023
+ # This structure doesn't match the specification, but it does ensure
2024
+ # that the first occurrence of SE terminates the transaction set.
2025
+ d::TableDef.summary("3 - Summary",
2026
+ b::Segment(5550, s::SE, "Transaction Set Trailer", r::Required, d::RepeatCount.bounded(1),
2027
+ b::Element(e::Required, "Number of Included Segments"),
2028
+ b::Element(e::Required, "Transaction Set Control Number"))))
2029
+ end
2030
+ end
2031
+ end
2032
+ end
2033
+ end