stupidedi 1.3.23 → 1.4.0
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- checksums.yaml +4 -4
- data/README.md +4 -4
- data/Rakefile +17 -92
- data/bin/edi-ed +8 -12
- data/bin/edi-obfuscate +8 -9
- data/bin/edi-pp +31 -25
- data/doc/{Transcribing.md → Defining.md} +0 -0
- data/doc/{unwritten/Parsing.md → Parsing.md} +0 -0
- data/doc/{unwritten/Tokenizing.md → Tokenizing.md} +0 -0
- data/doc/{unwritten/Validating.md → Validating.md} +0 -0
- data/lib/ruby/array.rb +1 -4
- data/lib/ruby/blank.rb +0 -3
- data/lib/ruby/exception.rb +13 -33
- data/lib/ruby/hash.rb +0 -2
- data/lib/ruby/module.rb +1 -3
- data/lib/ruby/object.rb +0 -13
- data/lib/ruby/string.rb +12 -3
- data/lib/ruby/to_d.rb +20 -25
- data/lib/ruby/to_date.rb +0 -3
- data/lib/ruby/to_time.rb +0 -3
- data/lib/ruby/try.rb +0 -3
- data/lib/stupidedi.rb +27 -41
- data/lib/stupidedi/builder.rb +3 -22
- data/lib/stupidedi/color.rb +4 -6
- data/lib/stupidedi/config.rb +77 -69
- data/lib/stupidedi/config/code_list_config.rb +0 -2
- data/lib/stupidedi/config/editor_config.rb +0 -2
- data/lib/stupidedi/config/functional_group_config.rb +3 -2
- data/lib/stupidedi/config/interchange_config.rb +5 -6
- data/lib/stupidedi/config/transaction_set_config.rb +17 -48
- data/lib/stupidedi/contrib.rb +41 -6
- data/lib/stupidedi/editor.rb +0 -3
- data/lib/stupidedi/editor/00401.rb +0 -3
- data/lib/stupidedi/editor/004010.rb +4 -8
- data/lib/stupidedi/editor/004010/N4.rb +0 -4
- data/lib/stupidedi/editor/00501.rb +0 -3
- data/lib/stupidedi/editor/005010.rb +5 -9
- data/lib/stupidedi/editor/005010/N4.rb +0 -4
- data/lib/stupidedi/editor/X12.rb +0 -5
- data/lib/stupidedi/editor/X222-HC837.rb +0 -5
- data/lib/stupidedi/editor/abstract_ed.rb +0 -2
- data/lib/stupidedi/editor/claim_ack.rb +0 -2
- data/lib/stupidedi/editor/implementation_ack.rb +2 -3
- data/lib/stupidedi/editor/interchange_ack.rb +0 -2
- data/lib/stupidedi/editor/result.rb +1 -6
- data/lib/stupidedi/editor/result_set.rb +1 -3
- data/lib/stupidedi/editor/transaction_set_ed.rb +23 -19
- data/lib/stupidedi/editor/transmission_ed.rb +0 -3
- data/lib/stupidedi/either.rb +0 -5
- data/lib/stupidedi/exceptions/invalid_element_error.rb +0 -2
- data/lib/stupidedi/exceptions/invalid_schema_error.rb +0 -2
- data/lib/stupidedi/exceptions/output_error.rb +0 -2
- data/lib/stupidedi/exceptions/parse_error.rb +0 -2
- data/lib/stupidedi/exceptions/stupidedi_error.rb +0 -2
- data/lib/stupidedi/exceptions/tokenize_error.rb +0 -2
- data/lib/stupidedi/exceptions/zipper_error.rb +0 -2
- data/lib/stupidedi/guides.rb +7 -3
- data/lib/stupidedi/inspect.rb +1 -4
- data/lib/stupidedi/interchanges.rb +11 -0
- data/lib/stupidedi/interchanges/00200.rb +12 -0
- data/lib/stupidedi/interchanges/00200/element_defs.rb +104 -0
- data/lib/stupidedi/interchanges/00200/interchange_def.rb +59 -0
- data/lib/stupidedi/interchanges/00200/segment_defs.rb +12 -0
- data/lib/stupidedi/interchanges/00200/segment_defs/IEA.rb +17 -0
- data/lib/stupidedi/interchanges/00200/segment_defs/ISA.rb +31 -0
- data/lib/stupidedi/interchanges/00200/segment_defs/TA1.rb +20 -0
- data/lib/stupidedi/interchanges/00300.rb +12 -0
- data/lib/stupidedi/interchanges/00300/element_defs.rb +105 -0
- data/lib/stupidedi/interchanges/00300/interchange_def.rb +59 -0
- data/lib/stupidedi/interchanges/00300/segment_defs.rb +12 -0
- data/lib/stupidedi/interchanges/00300/segment_defs/IEA.rb +17 -0
- data/lib/stupidedi/interchanges/00300/segment_defs/ISA.rb +31 -0
- data/lib/stupidedi/interchanges/00300/segment_defs/TA1.rb +20 -0
- data/lib/stupidedi/interchanges/00400.rb +12 -0
- data/lib/stupidedi/interchanges/00400/element_defs.rb +97 -0
- data/lib/stupidedi/interchanges/00400/interchange_def.rb +59 -0
- data/lib/stupidedi/interchanges/00400/segment_defs.rb +12 -0
- data/lib/stupidedi/interchanges/00400/segment_defs/IEA.rb +17 -0
- data/lib/stupidedi/interchanges/00400/segment_defs/ISA.rb +31 -0
- data/lib/stupidedi/interchanges/00400/segment_defs/TA1.rb +20 -0
- data/lib/stupidedi/interchanges/00401.rb +12 -0
- data/lib/stupidedi/interchanges/00401/element_defs.rb +96 -0
- data/lib/stupidedi/interchanges/00401/interchange_def.rb +59 -0
- data/lib/stupidedi/interchanges/00401/segment_defs.rb +12 -0
- data/lib/stupidedi/interchanges/00401/segment_defs/IEA.rb +17 -0
- data/lib/stupidedi/interchanges/00401/segment_defs/ISA.rb +31 -0
- data/lib/stupidedi/interchanges/00401/segment_defs/TA1.rb +20 -0
- data/lib/stupidedi/interchanges/00501.rb +12 -0
- data/lib/stupidedi/interchanges/00501/element_defs.rb +130 -0
- data/lib/stupidedi/interchanges/00501/interchange_def.rb +59 -0
- data/lib/stupidedi/interchanges/00501/segment_defs.rb +12 -0
- data/lib/stupidedi/interchanges/00501/segment_defs/IEA.rb +17 -0
- data/lib/stupidedi/interchanges/00501/segment_defs/ISA.rb +31 -0
- data/lib/stupidedi/interchanges/00501/segment_defs/ISB.rb +15 -0
- data/lib/stupidedi/interchanges/00501/segment_defs/ISE.rb +15 -0
- data/lib/stupidedi/interchanges/00501/segment_defs/TA1.rb +20 -0
- data/lib/stupidedi/interchanges/00501/segment_defs/TA3.rb +15 -0
- data/lib/stupidedi/interchanges/element_types.rb +11 -0
- data/lib/stupidedi/interchanges/element_types/separator_val.rb +79 -0
- data/lib/stupidedi/interchanges/element_types/special_val.rb +48 -0
- data/lib/stupidedi/parser.rb +32 -0
- data/lib/stupidedi/parser/builder_dsl.rb +289 -0
- data/lib/stupidedi/parser/constraint_table.rb +488 -0
- data/lib/stupidedi/parser/generation.rb +147 -0
- data/lib/stupidedi/parser/identifier_stack.rb +248 -0
- data/lib/stupidedi/parser/instruction.rb +112 -0
- data/lib/stupidedi/parser/instruction_table.rb +222 -0
- data/lib/stupidedi/parser/navigation.rb +786 -0
- data/lib/stupidedi/parser/state_machine.rb +62 -0
- data/lib/stupidedi/parser/states/abstract_state.rb +325 -0
- data/lib/stupidedi/parser/states/failure_state.rb +69 -0
- data/lib/stupidedi/parser/states/functional_group_state.rb +98 -0
- data/lib/stupidedi/parser/states/initial_state.rb +62 -0
- data/lib/stupidedi/parser/states/interchange_state.rb +93 -0
- data/lib/stupidedi/parser/states/loop_state.rb +80 -0
- data/lib/stupidedi/parser/states/table_state.rb +94 -0
- data/lib/stupidedi/parser/states/transaction_set_state.rb +118 -0
- data/lib/stupidedi/parser/states/transmission_state.rb +59 -0
- data/lib/stupidedi/parser/tokenization.rb +195 -0
- data/lib/stupidedi/reader.rb +0 -2
- data/lib/stupidedi/reader/input.rb +0 -3
- data/lib/stupidedi/reader/input/abstract_input.rb +4 -6
- data/lib/stupidedi/reader/input/delegated_input.rb +0 -5
- data/lib/stupidedi/reader/input/file_input.rb +10 -11
- data/lib/stupidedi/reader/position.rb +13 -8
- data/lib/stupidedi/reader/result.rb +5 -5
- data/lib/stupidedi/reader/segment_dict.rb +0 -3
- data/lib/stupidedi/reader/separators.rb +5 -4
- data/lib/stupidedi/reader/stream_reader.rb +3 -6
- data/lib/stupidedi/reader/token_reader.rb +0 -5
- data/lib/stupidedi/reader/tokens/component_element_tok.rb +4 -4
- data/lib/stupidedi/reader/tokens/composite_element_tok.rb +6 -5
- data/lib/stupidedi/reader/tokens/repeated_element_tok.rb +9 -2
- data/lib/stupidedi/reader/tokens/segment_tok.rb +7 -5
- data/lib/stupidedi/reader/tokens/simple_element_tok.rb +2 -4
- data/lib/stupidedi/schema.rb +17 -20
- data/lib/stupidedi/schema/abstract_def.rb +4 -6
- data/lib/stupidedi/schema/abstract_element_def.rb +35 -0
- data/lib/stupidedi/schema/abstract_element_use.rb +38 -0
- data/lib/stupidedi/schema/abstract_use.rb +6 -4
- data/lib/stupidedi/schema/code_list.rb +6 -5
- data/lib/stupidedi/schema/component_element_use.rb +74 -0
- data/lib/stupidedi/schema/composite_element_def.rb +103 -0
- data/lib/stupidedi/schema/composite_element_use.rb +73 -0
- data/lib/stupidedi/schema/element_req.rb +1 -4
- data/lib/stupidedi/schema/functional_group_def.rb +9 -3
- data/lib/stupidedi/schema/interchange_def.rb +9 -3
- data/lib/stupidedi/schema/loop_def.rb +11 -9
- data/lib/stupidedi/schema/repeat_count.rb +0 -3
- data/lib/stupidedi/schema/segment_def.rb +6 -4
- data/lib/stupidedi/schema/segment_req.rb +2 -3
- data/lib/stupidedi/schema/segment_use.rb +1 -4
- data/lib/stupidedi/schema/simple_element_def.rb +51 -0
- data/lib/stupidedi/schema/simple_element_use.rb +81 -0
- data/lib/stupidedi/schema/syntax_note.rb +1 -12
- data/lib/stupidedi/schema/table_def.rb +55 -18
- data/lib/stupidedi/schema/transaction_set_def.rb +25 -4
- data/lib/stupidedi/sets.rb +0 -3
- data/lib/stupidedi/transaction_sets.rb +14 -0
- data/lib/stupidedi/transaction_sets/002001.rb +11 -0
- data/lib/stupidedi/transaction_sets/002001/implementations.rb +23 -0
- data/lib/stupidedi/transaction_sets/002001/implementations/FA997.rb +66 -0
- data/lib/stupidedi/transaction_sets/002001/implementations/PO830.rb +160 -0
- data/lib/stupidedi/transaction_sets/002001/implementations/SH856.rb +190 -0
- data/lib/stupidedi/transaction_sets/002001/standards.rb +14 -0
- data/lib/stupidedi/transaction_sets/002001/standards/FA997.rb +31 -0
- data/lib/stupidedi/transaction_sets/002001/standards/PO830.rb +45 -0
- data/lib/stupidedi/transaction_sets/002001/standards/SH856.rb +38 -0
- data/lib/stupidedi/transaction_sets/003010.rb +11 -0
- data/lib/stupidedi/transaction_sets/003010/implementations.rb +24 -0
- data/lib/stupidedi/transaction_sets/003010/implementations/PC860.rb +140 -0
- data/lib/stupidedi/transaction_sets/003010/implementations/PO850.rb +132 -0
- data/lib/stupidedi/transaction_sets/003010/implementations/PS830.rb +150 -0
- data/lib/stupidedi/transaction_sets/003010/implementations/RA820.rb +158 -0
- data/lib/stupidedi/transaction_sets/003010/standards.rb +15 -0
- data/lib/stupidedi/transaction_sets/003010/standards/PC860.rb +49 -0
- data/lib/stupidedi/transaction_sets/003010/standards/PO850.rb +49 -0
- data/lib/stupidedi/transaction_sets/003010/standards/PS830.rb +49 -0
- data/lib/stupidedi/transaction_sets/003010/standards/RA820.rb +40 -0
- data/lib/stupidedi/transaction_sets/003040.rb +12 -0
- data/lib/stupidedi/transaction_sets/003040/implementations.rb +21 -0
- data/lib/stupidedi/transaction_sets/003040/implementations/WA142.rb +153 -0
- data/lib/stupidedi/transaction_sets/003040/standards.rb +12 -0
- data/lib/stupidedi/transaction_sets/003040/standards/WA142.rb +53 -0
- data/lib/stupidedi/transaction_sets/003050.rb +12 -0
- data/lib/stupidedi/transaction_sets/003050/implementations.rb +21 -0
- data/lib/stupidedi/transaction_sets/003050/implementations/PO850.rb +77 -0
- data/lib/stupidedi/transaction_sets/003050/standards.rb +12 -0
- data/lib/stupidedi/transaction_sets/003050/standards/PO850.rb +41 -0
- data/lib/stupidedi/transaction_sets/004010.rb +12 -0
- data/lib/stupidedi/transaction_sets/004010/implementations.rb +38 -0
- data/lib/stupidedi/transaction_sets/004010/implementations/AR943.rb +72 -0
- data/lib/stupidedi/transaction_sets/004010/implementations/FA997.rb +65 -0
- data/lib/stupidedi/transaction_sets/004010/implementations/GF990.rb +40 -0
- data/lib/stupidedi/transaction_sets/004010/implementations/IM210.rb +221 -0
- data/lib/stupidedi/transaction_sets/004010/implementations/OW940.rb +98 -0
- data/lib/stupidedi/transaction_sets/004010/implementations/PO850.rb +108 -0
- data/lib/stupidedi/transaction_sets/004010/implementations/PS830.rb +143 -0
- data/lib/stupidedi/transaction_sets/004010/implementations/QM214.rb +106 -0
- data/lib/stupidedi/transaction_sets/004010/implementations/RE944.rb +63 -0
- data/lib/stupidedi/transaction_sets/004010/implementations/SH856.rb +156 -0
- data/lib/stupidedi/transaction_sets/004010/implementations/SM204.rb +391 -0
- data/lib/stupidedi/transaction_sets/004010/implementations/SQ866.rb +103 -0
- data/lib/stupidedi/transaction_sets/004010/implementations/SS862.rb +154 -0
- data/lib/stupidedi/transaction_sets/004010/implementations/SW945.rb +99 -0
- data/lib/stupidedi/transaction_sets/004010/implementations/X091A1-HP835.rb +481 -0
- data/lib/stupidedi/transaction_sets/004010/standards.rb +28 -0
- data/lib/stupidedi/transaction_sets/004010/standards/AR943.rb +34 -0
- data/lib/stupidedi/transaction_sets/004010/standards/FA997.rb +31 -0
- data/lib/stupidedi/transaction_sets/004010/standards/GF990.rb +21 -0
- data/lib/stupidedi/transaction_sets/004010/standards/HP835.rb +61 -0
- data/lib/stupidedi/transaction_sets/004010/standards/IM210.rb +47 -0
- data/lib/stupidedi/transaction_sets/004010/standards/OW940.rb +43 -0
- data/lib/stupidedi/transaction_sets/004010/standards/PO850.rb +50 -0
- data/lib/stupidedi/transaction_sets/004010/standards/PR855.rb +35 -0
- data/lib/stupidedi/transaction_sets/004010/standards/PS830.rb +43 -0
- data/lib/stupidedi/transaction_sets/004010/standards/QM214.rb +41 -0
- data/lib/stupidedi/transaction_sets/004010/standards/RE944.rb +34 -0
- data/lib/stupidedi/transaction_sets/004010/standards/SC832.rb +37 -0
- data/lib/stupidedi/transaction_sets/004010/standards/SH856.rb +40 -0
- data/lib/stupidedi/transaction_sets/004010/standards/SM204.rb +85 -0
- data/lib/stupidedi/transaction_sets/004010/standards/SQ866.rb +32 -0
- data/lib/stupidedi/transaction_sets/004010/standards/SS862.rb +42 -0
- data/lib/stupidedi/transaction_sets/004010/standards/SW945.rb +43 -0
- data/lib/stupidedi/transaction_sets/005010.rb +11 -0
- data/lib/stupidedi/transaction_sets/005010/implementations.rb +88 -0
- data/lib/stupidedi/transaction_sets/005010/implementations/X212-HR276.rb +329 -0
- data/lib/stupidedi/transaction_sets/005010/implementations/X214-HN277.rb +356 -0
- data/lib/stupidedi/transaction_sets/005010/implementations/X220-BE834.rb +15 -0
- data/lib/stupidedi/transaction_sets/005010/implementations/X220A1-BE834.rb +623 -0
- data/lib/stupidedi/transaction_sets/005010/implementations/X221-HP835.rb +15 -0
- data/lib/stupidedi/transaction_sets/005010/implementations/X221A1-HP835.rb +556 -0
- data/lib/stupidedi/transaction_sets/005010/implementations/X222-HC837.rb +15 -0
- data/lib/stupidedi/transaction_sets/005010/implementations/X222-HC837P.rb +15 -0
- data/lib/stupidedi/transaction_sets/005010/implementations/X222A1-HC837.rb +2033 -0
- data/lib/stupidedi/transaction_sets/005010/implementations/X222A1-HC837P.rb +15 -0
- data/lib/stupidedi/transaction_sets/005010/implementations/X223-HC837.rb +15 -0
- data/lib/stupidedi/transaction_sets/005010/implementations/X223-HC837I.rb +15 -0
- data/lib/stupidedi/transaction_sets/005010/implementations/X223A1-HC837.rb +15 -0
- data/lib/stupidedi/transaction_sets/005010/implementations/X223A2-HC837.rb +2390 -0
- data/lib/stupidedi/transaction_sets/005010/implementations/X223A3-HC837.rb +2595 -0
- data/lib/stupidedi/transaction_sets/005010/implementations/X231-FA999.rb +15 -0
- data/lib/stupidedi/transaction_sets/005010/implementations/X231A1-FA999.rb +106 -0
- data/lib/stupidedi/transaction_sets/005010/implementations/X279-HB271.rb +749 -0
- data/lib/stupidedi/transaction_sets/005010/implementations/X279-HS270.rb +533 -0
- data/lib/stupidedi/transaction_sets/005010/implementations/X279A1-HB271.rb +751 -0
- data/lib/stupidedi/transaction_sets/005010/implementations/X279A1-HS270.rb +533 -0
- data/lib/stupidedi/transaction_sets/005010/standards.rb +22 -0
- data/lib/stupidedi/transaction_sets/005010/standards/BE834.rb +171 -0
- data/lib/stupidedi/transaction_sets/005010/standards/FA997.rb +31 -0
- data/lib/stupidedi/transaction_sets/005010/standards/FA999.rb +35 -0
- data/lib/stupidedi/transaction_sets/005010/standards/HB271.rb +95 -0
- data/lib/stupidedi/transaction_sets/005010/standards/HC837.rb +161 -0
- data/lib/stupidedi/transaction_sets/005010/standards/HI278.rb +62 -0
- data/lib/stupidedi/transaction_sets/005010/standards/HN277.rb +71 -0
- data/lib/stupidedi/transaction_sets/005010/standards/HP835.rb +65 -0
- data/lib/stupidedi/transaction_sets/005010/standards/HR276.rb +54 -0
- data/lib/stupidedi/transaction_sets/005010/standards/HS270.rb +50 -0
- data/lib/stupidedi/transaction_sets/005010/standards/RA820.rb +238 -0
- data/lib/stupidedi/transaction_sets/builder.rb +184 -0
- data/lib/stupidedi/transaction_sets/common.rb +8 -0
- data/lib/stupidedi/transaction_sets/common/implementations.rb +11 -0
- data/lib/stupidedi/transaction_sets/common/implementations/element_reqs.rb +37 -0
- data/lib/stupidedi/transaction_sets/common/implementations/segment_reqs.rb +31 -0
- data/lib/stupidedi/transaction_sets/validation.rb +9 -0
- data/lib/stupidedi/transaction_sets/validation/ambiguity.rb +391 -0
- data/lib/stupidedi/transaction_sets/validation/implementation.rb +12 -0
- data/lib/stupidedi/values.rb +0 -1
- data/lib/stupidedi/values/abstract_element_val.rb +0 -4
- data/lib/stupidedi/values/abstract_val.rb +3 -4
- data/lib/stupidedi/values/composite_element_val.rb +3 -8
- data/lib/stupidedi/values/functional_group_val.rb +3 -4
- data/lib/stupidedi/values/interchange_val.rb +3 -4
- data/lib/stupidedi/values/invalid_envelope_val.rb +2 -6
- data/lib/stupidedi/values/invalid_segment_val.rb +16 -9
- data/lib/stupidedi/values/loop_val.rb +3 -4
- data/lib/stupidedi/values/repeated_element_val.rb +5 -7
- data/lib/stupidedi/values/segment_val.rb +7 -11
- data/lib/stupidedi/values/segment_val_group.rb +0 -4
- data/lib/stupidedi/values/simple_element_val.rb +2 -7
- data/lib/stupidedi/values/table_val.rb +3 -4
- data/lib/stupidedi/values/transaction_set_val.rb +3 -4
- data/lib/stupidedi/values/transmission_val.rb +5 -5
- data/lib/stupidedi/version.rb +1 -2
- data/lib/stupidedi/versions.rb +11 -3
- data/lib/stupidedi/versions/002001.rb +14 -0
- data/lib/stupidedi/versions/002001/element_defs.rb +10576 -0
- data/lib/stupidedi/versions/002001/element_reqs.rb +12 -0
- data/lib/stupidedi/versions/002001/element_types.rb +28 -0
- data/lib/stupidedi/versions/002001/element_types/an.rb +11 -0
- data/lib/stupidedi/versions/002001/element_types/dt.rb +11 -0
- data/lib/stupidedi/versions/002001/element_types/float_val.rb +11 -0
- data/lib/stupidedi/versions/002001/element_types/id.rb +11 -0
- data/lib/stupidedi/versions/002001/element_types/nn.rb +11 -0
- data/lib/stupidedi/versions/002001/element_types/tm.rb +11 -0
- data/lib/stupidedi/versions/002001/functional_group_def.rb +24 -0
- data/lib/stupidedi/versions/002001/segment_defs.rb +88 -0
- data/lib/stupidedi/versions/002001/segment_defs/AK1.rb +17 -0
- data/lib/stupidedi/versions/002001/segment_defs/AK2.rb +17 -0
- data/lib/stupidedi/versions/002001/segment_defs/AK3.rb +18 -0
- data/lib/stupidedi/versions/002001/segment_defs/AK4.rb +20 -0
- data/lib/stupidedi/versions/002001/segment_defs/AK5.rb +22 -0
- data/lib/stupidedi/versions/002001/segment_defs/AK9.rb +23 -0
- data/lib/stupidedi/versions/002001/segment_defs/AT7.rb +29 -0
- data/lib/stupidedi/versions/002001/segment_defs/AT8.rb +25 -0
- data/lib/stupidedi/versions/002001/segment_defs/ATH.rb +21 -0
- data/lib/stupidedi/versions/002001/segment_defs/B1.rb +20 -0
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- data/spec/fixtures/X217-HI278/Sample_278_Response_5010X217-3r.txt +0 -44
- data/spec/fixtures/X217-HI278/Sample_278_Response_5010X217-3r_Clean.txt +0 -26
- data/spec/fixtures/X217-HI278/Sample_278_Response_5010X217-4ar_Clean.txt +0 -28
- data/spec/fixtures/X217-HI278/Sample_278_Response_5010X217-4br_Clean.txt +0 -35
- data/spec/fixtures/X217-HI278/Sample_278_Response_5010X217-5r.txt +0 -60
- data/spec/fixtures/X217-HI278/Sample_278_Response_5010X217-5r_Clean.txt +0 -42
- data/spec/fixtures/X217-HI278/Sample_278_Response_5010X217-6r.txt +0 -40
- data/spec/fixtures/X217-HI278/Sample_278_Response_5010X217-6r_Clean.txt +0 -24
- data/spec/fixtures/X218-RA820/1-bad.txt +0 -31
- data/spec/fixtures/X218-RA820/1-good.txt +0 -25
- data/spec/fixtures/X218-RA820/2-bad.txt +0 -37
- data/spec/fixtures/X218-RA820/2-good.txt +0 -29
- data/spec/fixtures/X218-RA820/3-bad.txt +0 -29
- data/spec/fixtures/X218-RA820/3-good.txt +0 -23
- data/spec/fixtures/X218-RA820/4-bad.txt +0 -36
- data/spec/fixtures/X218-RA820/4-good.txt +0 -27
- data/spec/fixtures/X220-BE834/1-bad.txt +0 -35
- data/spec/fixtures/X220-BE834/1-good.txt +0 -29
- data/spec/fixtures/X220-BE834/10-bad.txt +0 -26
- data/spec/fixtures/X220-BE834/10-good.txt +0 -19
- data/spec/fixtures/X220-BE834/2-bad.txt +0 -31
- data/spec/fixtures/X220-BE834/2-good.txt +0 -23
- data/spec/fixtures/X220-BE834/3-bad.txt +0 -36
- data/spec/fixtures/X220-BE834/3-good.txt +0 -26
- data/spec/fixtures/X220-BE834/4-bad.txt +0 -27
- data/spec/fixtures/X220-BE834/4-good.txt +0 -21
- data/spec/fixtures/X220-BE834/5-bad.txt +0 -26
- data/spec/fixtures/X220-BE834/5-good.txt +0 -17
- data/spec/fixtures/X220-BE834/6-bad.txt +0 -25
- data/spec/fixtures/X220-BE834/6-good.txt +0 -20
- data/spec/fixtures/X220-BE834/7-bad.txt +0 -25
- data/spec/fixtures/X220-BE834/7-good.txt +0 -20
- data/spec/fixtures/X220-BE834/8-bad.txt +0 -25
- data/spec/fixtures/X220-BE834/8-good.txt +0 -20
- data/spec/fixtures/X220-BE834/9-bad.txt +0 -27
- data/spec/fixtures/X220-BE834/9-good.txt +0 -21
- data/spec/fixtures/X221-HP835/1-bad.txt +0 -58
- data/spec/fixtures/X221-HP835/1-good.txt +0 -40
- data/spec/fixtures/X221-HP835/2-bad.txt +0 -51
- data/spec/fixtures/X221-HP835/2-good.txt +0 -40
- data/spec/fixtures/X221-HP835/3a-bad.txt +0 -78
- data/spec/fixtures/X221-HP835/3a-good.txt +0 -49
- data/spec/fixtures/X221-HP835/3b-bad.txt +0 -60
- data/spec/fixtures/X221-HP835/3b-good.txt +0 -32
- data/spec/fixtures/X221-HP835/3c-bad.txt +0 -55
- data/spec/fixtures/X221-HP835/3c-good.txt +0 -34
- data/spec/fixtures/X222-HC837/1-bad.txt +0 -60
- data/spec/fixtures/X222-HC837/1-good.txt +0 -53
- data/spec/fixtures/X222-HC837/10a-bad.txt +0 -52
- data/spec/fixtures/X222-HC837/10a-good.txt +0 -40
- data/spec/fixtures/X222-HC837/10b-bad.txt +0 -99
- data/spec/fixtures/X222-HC837/10b-good.txt +0 -80
- data/spec/fixtures/X222-HC837/10c-bad.txt +0 -105
- data/spec/fixtures/X222-HC837/10c-good.txt +0 -80
- data/spec/fixtures/X222-HC837/11-bad.txt +0 -69
- data/spec/fixtures/X222-HC837/11-good.txt +0 -45
- data/spec/fixtures/X222-HC837/12-bad.txt +0 -73
- data/spec/fixtures/X222-HC837/12-good.txt +0 -51
- data/spec/fixtures/X222-HC837/13-bad.txt +0 -64
- data/spec/fixtures/X222-HC837/13-good.txt +0 -46
- data/spec/fixtures/X222-HC837/3a-bad.txt +0 -83
- data/spec/fixtures/X222-HC837/3a-good.txt +0 -59
- data/spec/fixtures/X222-HC837/3b-bad.txt +0 -97
- data/spec/fixtures/X222-HC837/3b-good.txt +0 -70
- data/spec/fixtures/X222-HC837/3c-bad.txt +0 -95
- data/spec/fixtures/X222-HC837/3c-good.txt +0 -74
- data/spec/fixtures/X222-HC837/4-bad.txt +0 -67
- data/spec/fixtures/X222-HC837/4-good.txt +0 -48
- data/spec/fixtures/X222-HC837/5-bad.txt +0 -73
- data/spec/fixtures/X222-HC837/5-good.txt +0 -60
- data/spec/fixtures/X222-HC837/6-bad.txt +0 -50
- data/spec/fixtures/X222-HC837/6-good.txt +0 -39
- data/spec/fixtures/X222-HC837/7-bad.txt +0 -93
- data/spec/fixtures/X222-HC837/7-good.txt +0 -78
- data/spec/fixtures/X222-HC837/8-bad.txt +0 -64
- data/spec/fixtures/X222-HC837/8-good.txt +0 -52
- data/spec/fixtures/X222-HC837/9-bad.txt +0 -56
- data/spec/fixtures/X222-HC837/9-good.txt +0 -38
- data/spec/fixtures/X223-HC837/1-bad.txt +0 -66
- data/spec/fixtures/X223-HC837/1-good.txt +0 -53
- data/spec/fixtures/X223-HC837/2-bad.txt +0 -69
- data/spec/fixtures/X223-HC837/2-good.txt +0 -60
- data/spec/fixtures/X223-HC837/3-bad.txt +0 -89
- data/spec/fixtures/X223-HC837/3-good.txt +0 -61
- data/spec/fixtures/X223-HC837/4-bad.txt +0 -60
- data/spec/fixtures/X223-HC837/4-good.txt +0 -40
- data/spec/fixtures/X223-HC837/5-bad.txt +0 -75
- data/spec/fixtures/X223-HC837/5-good.txt +0 -58
- data/spec/fixtures/X224-HC837/1-bad.txt +0 -54
- data/spec/fixtures/X224-HC837/1-good.txt +0 -44
- data/spec/fixtures/X224-HC837/2a-bad.txt +0 -52
- data/spec/fixtures/X224-HC837/2a-good.txt +0 -42
- data/spec/fixtures/X224-HC837/2b-bad.txt +0 -67
- data/spec/fixtures/X224-HC837/2b-good.txt +0 -52
- data/spec/fixtures/X224-HC837/3-bad.txt +0 -67
- data/spec/fixtures/X224-HC837/3-good.txt +0 -51
- data/spec/fixtures/X224-HC837/4-bad.txt +0 -49
- data/spec/fixtures/X224-HC837/4-good.txt +0 -40
- data/spec/fixtures/X230-FA997/1-bad.txt +0 -19
- data/spec/fixtures/X230-FA997/1-good.txt +0 -16
- data/spec/fixtures/X231-FA999/1-bad.txt +0 -20
- data/spec/fixtures/X231-FA999/1-good.txt +0 -20
- data/spec/fixtures/X279-HB271/1-bad.txt +0 -36
- data/spec/fixtures/X279-HB271/1-good.txt +0 -30
- data/spec/fixtures/X279-HB271/2-bad.txt +0 -22
- data/spec/fixtures/X279-HB271/2-good.txt +0 -16
- data/spec/fixtures/X279-HB271/3-bad.txt +0 -44
- data/spec/fixtures/X279-HB271/3-good.txt +0 -36
- data/spec/fixtures/X279-HS270/1-bad.txt +0 -29
- data/spec/fixtures/X279-HS270/1-good.txt +0 -23
- data/spec/fixtures/X279-HS270/2-bad.txt +0 -32
- data/spec/fixtures/X279-HS270/2-good.txt +0 -25
- data/spec/spec_helper.rb +0 -55
- data/spec/support/fixtures.rb +0 -26
- data/spec/support/matchers/either_matchers.rb +0 -53
- data/spec/support/matchers/navigation_matchers.rb +0 -247
- data/spec/support/node.rb +0 -41
- data/spec/support/quickcheck.rb +0 -303
- data/spec/support/quickcheck/characters.rb +0 -33
- data/spec/support/quickcheck/property.rb +0 -105
- data/spec/support/quickcheck/serialized_edi.rb +0 -400
- data/spec/support/rcov.rb +0 -41
@@ -0,0 +1,15 @@
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# frozen_string_literal: true
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module Stupidedi
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module TransactionSets
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module FiftyTen
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module Implementations
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module X222
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warn "DEPRECATION WARNING: #{self}::HC837 is deprecated, use X222A1::HC837 instead"
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# @deprecated Use X222A1::HC837 instead
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HC837 = X222A1::HC837
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end
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end
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end
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end
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end
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@@ -0,0 +1,15 @@
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# frozen_string_literal: true
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module Stupidedi
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module TransactionSets
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module FiftyTen
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module Implementations
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module X222
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warn "DEPRECATION WARNING: #{self}::HC837P is deprecated, use X22A1::HC837 instead"
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# @deprecated
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HC837P = X222A1::HC837
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end
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end
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end
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end
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end
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@@ -0,0 +1,2033 @@
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# frozen_string_literal: true
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module Stupidedi
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module TransactionSets
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module FiftyTen
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module Implementations
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module X222A1
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b = Builder
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d = Schema
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r = SegmentReqs
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e = ElementReqs
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s = SegmentDefs
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# With only a quick glance at X222, it appears that 2300 is a child of
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# the 2000C HL loop. But there is a little note that reads:
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#
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# For the purposes of this documentation, the claim detail information
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# is presented only in the dependent level. Specific claim detail
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# information can be given in either the subscriber or the dependent
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# hierarchical level. Because of this, the claim information is said
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# to "float." Claim information is positioned in the same hierarchical
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# level that describes its owner-participant, either the subscriber or
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# the dependent. In other words, the claim information, Loop 2300, is
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# placed in the hierarchical level when the patient is the subscriber,
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# or it is placed at the patient/dependent hierarchical level when the
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# patient is the dependent of the subscriber as shown here. When the
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# patient is the subscriber, loops 2000C and 2010CA are not sent. See
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# 1.4.3.2.2.1, HL Segment, for details.
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#
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# So here we build the 2300 LoopDef and later copy it as a child of the
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# 2000B and 2000C loops. The actual transaction set begins below with
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# the line that starts HC837 = ...
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loop2300 =
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d::LoopDef.build("2300 CLAIM INFORMATION", d::RepeatCount.bounded(100),
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b::Segment(1300, s::CLM, "Claim Information", r::Situational, d::RepeatCount.bounded(1),
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b::Element(e::Required, "Patient Control Number", b::MaxLength(20)),
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b::Element(e::Required, "Total Claim Charge Amount"),
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b::Element(e::NotUsed, "Claim Filing Indicator Code"),
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b::Element(e::NotUsed, "Non-Institutional Claim Type Code"),
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b::Element(e::Required, "HEALTH CARE SERVICE LOCATION INFORMATION",
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41
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b::Element(e::Required, "Place of Service Code"),
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42
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b::Element(e::Required, "Facility Code Qualifier", b::Values("B")),
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43
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b::Element(e::Required, "Claim Frequency Code")),
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44
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b::Element(e::Required, "Provider or Supplier Signature Indicator", b::Values("N", "Y")),
|
45
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+
b::Element(e::Required, "Assignment or Plan Participation Code", b::Values("A", "B", "C")),
|
46
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+
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
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+
b::Element(e::Required, "Related Causes Code", b::Values("AA", "EM", "OA")),
|
51
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+
b::Element(e::Situational, "Related Causes Code", b::Values("AA", "EM", "OA")),
|
52
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+
b::Element(e::NotUsed, "Related Causes Code"),
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53
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+
b::Element(e::Situational, "Auto Accident State or Province Code"),
|
54
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+
b::Element(e::Situational, "Country Code")),
|
55
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+
b::Element(e::Situational, "Special Program Indicator", b::Values("02", "03", "05", "09")),
|
56
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+
b::Element(e::NotUsed, "Yes/No Condition or Response Code"),
|
57
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+
b::Element(e::NotUsed, "Level of Service Code"),
|
58
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+
b::Element(e::NotUsed, "Yes/No Condition or Response Code"),
|
59
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+
b::Element(e::NotUsed, "Provider Agreement Code"),
|
60
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+
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
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+
b::Element(e::Situational, "Delay Reason Code", b::Values("1", "2", "3", "4", "5", "6", "7", "8", "9", "10", "11", "15"))),
|
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
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+
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
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+
b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
|
71
|
+
b::Element(e::Required, "Initial Treatment Date")),
|
72
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+
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
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+
b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
|
75
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+
b::Element(e::Required, "Last Seen Date")),
|
76
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+
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
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+
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
|