Chapter Chair: |
Freida
B. Hall |
Chapter Chair: |
Michael
Hawver |
Editor: |
Klaus
D. Veil |
The
Finance chapter describes patient accounting transactions. Other financial
transactions may be added in the future. Financial transactions can be sent
between applications either in batches or online. As defined in Chapter 2 on
batch segments, multiple transactions may be grouped and sent through all file
transfer media or programs when using the HL7 Encoding Rules.
This chapter defines the transactions that take place at the seventh level,
that is, the abstract messages. The examples included in this chapter were
constructed using the HL7 Encoding Rules.
The
patient accounting message set provides for the entry and manipulation of
information on billing accounts, charges, payments, adjustments, insurance, and
other related patient billing and accounts receivable information.
This Standard includes all of the data defined in the National Uniform Billing
Field Specifications. We have excluded state-specific coding and suggest that,
where required, it be implemented in site-specific "Z" segments.
State-specific fields may be included in the Standard at a later time. In
addition, no attempt has been made to define data that have traditionally been
required for the financial responsibility ("proration") of charges. This
requirement is unique to a billing system and not a part of an interface.
We recognize that a wide variety of billing and accounts receivable systems
exist today. Therefore, in an effort to accommodate the needs of the most
comprehensive systems, we have defined an extensive set of transaction segments.
The
triggering events that follow are served by Detail Financial Transaction (DFT),
Add/Change Billing Account (BAR), and General Acknowledgment (ACK) messages.
Each trigger event is documented below, along with the applicable form of the
message exchange. The notation used to describe the sequence, optionality, and
repetition of segments is described in Chapter 2, "Format for Defining Abstract
Messages."
Data
are sent from some application (usually a Registration or an ADT system) for
example, to the patient accounting or financial system to establish an account
for a patient's billing/accounts receivable record. Many of the segments
associated with this event are optional. This optionality allows those systems
needing these fields to set up transactions that fulfill their requirements and
yet satisfy the HL7 requirements.
When an account's start and end dates span a period greater than any particular
visit, the P01 (add account) event should be used to transmit the opening of an
account. The A01 (admit/visit notification) event can notify systems of the
creation of an account as well as notify them of a patient's arrival in the
healthcare facility. In order to create a new account without notifying
systems of a patient's arrival, use the P01 trigger event.
From Standard Version 2.3 onward, the P01 event should only be used to add a
new account that did not exist before, not to update an existing account. The
new P05 (update account) event should be used to update an existing account.
The new P06 (end account) event should be used to close an account. With the
P01 event, EVN-2 - recorded date/time should contain the account start
date.
BAR^P01^BAR_P01 |
Add Billing Account |
Chapter |
|---|---|---|
MSH |
Message Header |
2 |
EVN |
Event Type |
3 |
PID |
Patient Identification |
3 |
[ PD1 ] |
Additional Demographics |
3 |
[{ ROL }] |
Role |
12 |
{ |
||
[ PV1 ] |
Patient Visit |
3 |
[ PV2 ] |
Patient Visit - Additional Info |
3 |
[{ ROL }] |
Role |
12 |
[{ DB1 }] |
Disability Information |
3 |
[{ OBX }] |
Observation/Result |
7 |
[{ AL1 }] |
Allergy Information |
3 |
[{ DG1 }] |
Diagnosis |
6 |
[ DRG ] |
Diagnosis Related Group |
6 |
[{ |
||
PR1 |
Procedures |
6 |
[{ ROL }] |
Role |
12 |
}] |
||
[{ GT1 }] |
Guarantor |
6 |
[{ NK1 }] |
Next of Kin/Associated Parties |
3 |
[{ |
||
IN1 |
Insurance |
6 |
[ IN2 ] |
Insurance - Additional Info. |
6 |
[{ IN3 }] |
Insurance - Add'l Info. - Cert. |
6 |
[{ ROL }] |
Role |
12 |
}] |
||
[ ACC ] |
Accident Information |
6 |
[ UB1 ] |
Universal Bill Information |
6 |
[ UB2 ] |
Universal Bill 92 Information |
6 |
} |
ACK^P01^ACK |
General Acknowledgment |
Chapter |
|---|---|---|
MSH |
Message Header |
2 |
MSA |
Message Acknowledgment |
2 |
[ ERR ] |
Error |
2 |
The error segment will indicate the fields that caused a transaction to be rejected.
Generally,
the elimination of all billing/accounts receivable records will be an internal
function controlled, for example, by the patient accounting or financial
system. However, on occasion, there will be a need to correct an account, or a
series of accounts, that may require that a notice of account deletion be sent
from another sub-system and processed, for example, by the patient accounting
or financial system. Although a series of accounts may be purged within this
one event, we recommend that only one PID segment be sent per event.
BAR^P02^BAR_P02 |
Purge Billing Account |
Chapter |
|---|---|---|
MSH |
Message Header |
2 |
EVN |
Event Type |
3 |
{ |
||
PID |
Patient Identification |
3 |
[ PD1 ] |
Additional Demographics |
3 |
[ PV1 ] |
Patient Visit |
3 |
[{ DB1 }] |
Disability Information |
3 |
} |
ACK^P02^ACK |
General Acknowledgment |
Chapter |
|---|---|---|
MSH |
Message Header |
2 |
MSA |
Message Acknowledgment |
2 |
[ ERR ] |
Error |
2 |
The error segment indicates the fields that caused a transaction to be rejected.
The
Detail Financial Transaction (DFT) message is used to describe a financial
transaction transmitted between systems, that is, to the billing system for
ancillary charges, ADT to billing system for patient deposits, etc. In HL7
2.4, the message construct for the P03 is expanded to support the use cases
described below.
Use case for adding the INx and GT1 segments inside the FT1 repetition:
If the insurance and/or the guarantor information is specific to a certain
financial transaction of a patient and differs from the patient's regular
insurance and/or guarantor, you may use the INx and GT1 segments related to the
FT1 segment. If being used, the information supersedes the information on the
patient level.
Example: Before being employed by a company, a pre-employment physical is
required. The cost of the examinations is paid by the company, and not by the
person's private health insurance. One of the physicians examining the person
is an eye doctor. For efficiency reasons, the person made an appointment for
these examinations on the same day as he already had an appointment with his
eye doctor in the same hospital. The costs for this eye doctor appointment are
being paid by the patient's private health insurance. Both financial
transactions for the same patient/person could be sent in the same message. To
bill the examination for the future-employer to that organization, you need to
use the GT1 segment that is related to the FT1.
Use case for Post Detail Financial Transaction with related Order:
This information can originate in many ways. For instance, a detailed
financial transaction for an ancillary charge is sent to a billing system that
also tracks the transaction(s) in relation to their order via placer order
number or wishes to post these transactions with the additional order
information. Therefore a service reaches a state where a detailed financial
transaction is created and interfaced to other systems along with optional
associated order information. If the message contains multiple transactions
for the same order such as a test service and venipuncture charge on the same
order the ordering information is entered in the Order segment construct that
precedes the FT1 segments. If a message contains multiple transactions for
disparate orders for the same account each FT1 segment construct may contain
the order related information specific to that transaction within the
message.
* If the common order information is sent, the Order Control Code should
reflect the current state of the common order and is not intended to initiate
any order related triggers on the receiving application. For example if
observations are included along with common order information the order control
code would indicate `RE' as observations to follow.
* If common order information is sent related to the entire message or a
specific financial transaction, the required Order Control Code should reflect
the current state of the common order and is not intended to initiate any order
related triggers on the receiving application. For example if observations are
included along with common order information the order control code would
indicate `RE' as observations to follow.
* If order detail information is sent related to the entire message or a
specific financial transaction, the required fields for that detail segment
must accompany that information.
Use case for adding the DG1 segments inside the FT1 repetition:
If diagnosis information is specific to a certain financial transaction of a
patient and differs from the patient's regular insurance and/or guarantor
diagnosis, you may use the DG1 segment related to the FT1 segment. If used,
the information supersedes the information on the patient level.
Example: A delivery person suffers severe bruising following a fall on an icy
loading dock at a delivery location of a commercial account. The costs of the
accident examination provided by a general practitioner chosen and are paid by
the company owning the loading dock, and not by the person/patient's private
health insurance. On that same day, another physician located within the same
clinic sees the person/patient to provide a flu immunization. For efficiency
reasons, the person/patient made an appointment for these examinations related
to the accident with the general practitioner on the same day as he already had
an appointment with his primary care physician for the immunization. The
immunization cost is paid by the patient's private health insurance.
Both financial transactions for the same patient/person could be sent in the
same message. To bill the examination for the accident to the company owning
the loading dock, you need to use the DG1 segment that is related to the
FT1.
DFT^P03^DFT_P03 |
Detail Financial Transaction |
Chapter |
|---|---|---|
MSH |
Message Header |
2 |
EVN |
Event Type |
3 |
PID |
Patient Identification |
3 |
[ PD1 ] |
Additional Demographics |
3 |
[{ ROL }] |
Role |
12 |
[ PV1 ] |
Patient Visit |
3 |
[ PV2 ] |
Patient Visit - Additional Info |
3 |
[{ ROL }] |
Role |
12 |
[{ DB1 }] |
Disability Information |
3 |
[{[1] |
[ ORC ] |
Common Order (global across all FT1s) |
4 |
[ OBR |
Order Detail Segment |
4 |
[{ NTE }]] |
Notes and Comments (on Order Detail) |
2 |
{ |
||
[ OBX |
Observations / Result |
7 |
[{ NTE }]] |
Notes and Comments (on Result) |
2 |
} |
||
}] |
||
{ |
||
FT1 |
Financial Transaction |
6 |
[{ PR1 |
Procedure |
6 |
[{ ROL }] |
Role |
12 |
}] |
||
[{[2] |
[ ORC ] |
Common Order (specific to above FT1) |
4 |
[ OBR |
Order Detail Segment |
4 |
[{ NTE }]] |
Notes and Comments (on Order Detail) |
2 |
{ |
||
[ OBX |
Observations / Result |
7 |
[{ NTE }]] |
Notes and Comments (on Result) |
2 |
} |
||
}] |
||
[{ DG1 }][3] |
Diagnosis (specific to above FT1) |
6 |
|
[ DRG ] |
Diagnosis Related Group |
6 |
[{ GT1 }][4] |
Guarantor (specific to above FT1) |
6 |
|
[{[5] |
IN1 |
Insurance (specific to above FT1) |
6 |
[ IN2 ] |
Insurance - Additional Info. |
6 |
[{ IN3 }] |
Insurance - Add'l Info. - Cert. |
6 |
[{ ROL }] |
Role |
12 |
}] |
||
} |
||
[{ DG1 }][6] |
Diagnosis (global across all FT1s) |
6 |
|
[ DRG ] |
Diagnosis Related Group |
6 |
[{ GT1 }][7] |
Guarantor (global across all FT1s) |
6 |
|
[{[8] |
IN1 |
Insurance (global across all FT1s) |
6 |
[ IN2 ] |
Insurance - Additional Info. |
6 |
[{ IN3 }] |
Insurance - Add'l Info. - Cert. |
6 |
[{ ROL }] |
Role |
12 |
}] |
||
[ ACC ] |
Accident Information |
6 |
Note:
The ROL segment is optionally included after the PD1 to transmit information
for patient level primary care providers, after the PV2 for additional
information on the physicians whose information is sent there (i.e. Attending
Doctor, Referring Doctor, Consulting Doctor), and within the insurance
construct to transmit information for insurance level primary care
providers.
Note: There is an information overlap between the FT1, DG1 and PR1
segments. If diagnosis information is sent in an FT1 segment, it should be
consistent with the information contained in any DG1 segments present within
its hierarchy. Since the procedure code field within the FT1 does not repeat,
if procedure information is sent on an FT1 it is recommended that the single
occurrence of the code in FT1 equates to the primary procedure (PR1-14 -
Procedure Priority code value 1).
Special codes in the Event Type record are used for updating.
ACK^P03^ACK |
General Acknowledgment |
Chapter |
|---|---|---|
MSH |
Message Header |
2 |
MSA |
Message Acknowledgment |
2 |
[ ERR ] |
Error |
2 |
The error segment indicates the fields that caused a transaction to be rejected.
For
patient accounting systems that support demand billing, the QRY/DSR
transaction, as defined in Chapter 5, will provide the mechanism with which to
request a copy of the bill for printing or viewing by the requesting system.
QRY^P04^QRY_P04 |
Generate Bills and Accounts Receivable Statements |
Chapter |
|---|---|---|
see |
5 |
DSR^P04^DSR_P04 |
Generate Bills and Accounts Receivable Statements |
Chapter |
|---|---|---|
see |
5 |
Note: This is a display-oriented response. That is why the associated messages are defined in Chapter 5.
The
P05 event is sent when an existing account is being updated. From Standard
Version 2.3 onward, the P01 (add account) event should no longer be used for
updating an existing account, but only for creating a new account. With the
addition of P10 (transmit ambulatory payment classification [APC] groups) in
Version 2.4, it is expected that the P05 (update account) will be used to send
inpatient coding information and the P10 (transmit ambulatory payment
classification [APC] groups) will be used to send outpatient coding
information.
BAR^P05^BAR_P05 |
Update Billing Account |
Chapter |
|---|---|---|
MSH |
Message Header |
2 |
EVN |
Event Type |
3 |
PID |
Patient Identification |
3 |
[ PD1 ] |
Additional Demographics |
3 |
[{ ROL }] |
Role |
12 |
{ |
||
[ PV1 ] |
Patient Visit |
3 |
[ PV2 ] |
Patient Visit - Additional Info |
3 |
[{ ROL }] |
Role |
12 |
[{ DB1 }] |
Disability Information |
3 |
[{ OBX }] |
Observation/Result |
7 |
[{ AL1 }] |
Allergy Information |
3 |
[{ DG1 }] |
Diagnosis |
6 |
[ DRG ] |
Diagnosis Related Group |
6 |
[{ PR1 |
Procedures |
6 |
[{ ROL }] |
Role |
12 |
}] |
||
[{ GT1 }] |
Guarantor |
6 |
[{ NK1 }] |
Next of Kin/Associated Parties |
3 |
[{ |
||
IN1 |
Insurance |
6 |
[ IN2 ] |
Insurance - Additional Info. |
6 |
[{IN3}] |
Insurance - Add'l Info. - Cert. |
6 |
[{ROL}] |
Role |
12 |
}] |
||
[ ACC ] |
Accident Information |
6 |
[ UB1 ] |
Universal Bill Information |
6 |
[ UB2 ] |
Universal Bill 92 Information |
6 |
[ ABS ] |
Abstract |
6 |
[{ B LC }] |
Blood Code |
6 |
[ R MI ] |
Risk Management Incident |
6 |
} |
ACK^P05^ACK |
General Acknowledgment |
Chapter |
|---|---|---|
MSH |
Message Header |
2 |
MSA |
Message Acknowledgment |
2 |
[ ERR ] |
Error |
2 |
The error segment indicates the fields that caused a transaction to be rejected.
The
P06 event is a notification that the account is no longer open, that is, no new
charges can accrue to this account. This notification is not related to
whether or not the account is paid in full. EVN-2 - recorded date/time
must contain the account end date.
BAR^P06^BAR_P06 |
End Billing Account |
Chapter |
|---|---|---|
MSH |
Message Header |
2 |
EVN |
Event Type |
3 |
{ |
||
PID |
Patient Identification |
3 |
[ PV1 ] |
Patient Visit |
3 |
} |
ACK^P06^ACK |
General Acknowledgment |
Chapter |
|---|---|---|
MSH |
Message Header |
2 |
MSA |
Message Acknowledgment |
2 |
[ ERR ] |
Error |
2 |
The
error segment indicates the fields that caused a transaction to be rejected.
Note: P07-P09 have been defined by the Orders/Observations Technical
Committee as product experience messages.
The
P10 event is used to communicate Ambulatory Payment Classification (APC)
grouping. The grouping can be estimated or actual, based on the APC status
indictor in GP1-1. This information is mandated in the USA by the Health Care
Financing Administration (HCFA) for reimbursement of outpatient services. The
PID and PV1 segments are included for identification purposes only. When other
important fields change, it is recommended that the A08 (update patient
information) event be used in addition.
BAR^P10^BAR_P10 |
Transmit Ambulatory Payment Classification (APC) groups |
Chapter |
|---|---|---|
MSH |
Message Header |
2 |
EVN |
Event Type |
3 |
PID |
Patient Identification |
3 |
PV1 |
Patient Visit |
3 |
[{ DG1 }] |
Diagnosis |
6 |
GP1 |
Grouping/Reimbursement - Visit |
6 |
[{ |
||
PR1 |
Procedures |
6 |
[ GP2 ] |
Grouping/reimbursement - Procedure |
6 |
}] |
ACK^P10^ACK |
General Acknowledgment |
Chapter |
|---|---|---|
MSH |
Message Header |
2 |
MSA |
Message Acknowledgment |
2 |
[ ERR ] |
Error |
2 |
The error segment indicates the fields that caused a transaction to be rejected.
The
FT1 segment contains the detail data necessary to post charges, payments,
adjustments, etc. to patient accounting records.
SEQ |
LEN |
DT |
OPT |
RP/# |
TBL# |
ITEM# |
ELEMENT NAME |
|---|---|---|---|---|---|---|---|
1 |
4 |
SI |
O |
00355 |
Set ID - FT1 |
||
2 |
12 |
ST |
O |
00356 |
Transaction ID |
||
3 |
10 |
ST |
O |
00357 |
Transaction Batch ID |
||
4 |
26 |
TS |
R |
00358 |
Transaction Date |
||
5 |
26 |
TS |
O |
00359 |
Transaction Posting Date |
||
6 |
8 |
IS |
R |
0017 |
00360 |
Transaction Type |
|
7 |
250 |
CE |
R |
0132 |
00361 |
Transaction Code |
|
8 |
40 |
ST |
B |
00362 |
Transaction Description |
||
9 |
40 |
ST |
B |
00363 |
Transaction Description - Alt |
||
10 |
6 |
NM |
O |
00364 |
Transaction Quantity |
||
11 |
12 |
CP |
O |
00365 |
Transaction Amount - Extended |
||
12 |
12 |
CP |
O |
00366 |
Transaction Amount - Unit |
||
13 |
250 |
CE |
O |
0049 |
00367 |
Department Code |
|
14 |
250 |
CE |
O |
0072 |
00368 |
Insurance Plan ID |
|
15 |
12 |
CP |
O |
00369 |
Insurance Amount |
||
16 |
80 |
PL |
O |
00133 |
Assigned Patient Location |
||
17 |
1 |
IS |
O |
0024 |
00370 |
Fee Schedule |
|
18 |
2 |
IS |
O |
0018 |
00148 |
Patient Type |
|
19 |
250 |
CE |
O |
Y |
0051 |
00371 |
Diagnosis Code - FT1 |
20 |
250 |
XCN |
O |
Y |
0084 |
00372 |
Performed By Code |
21 |
250 |
XCN |
O |
Y |
00373 |
Ordered By Code |
|
22 |
12 |
CP |
O |
00374 |
Unit Cost |
||
23 |
22 |
EI |
O |
00217 |
Filler Order Number |
||
24 |
250 |
XCN |
O |
Y |
00765 |
Entered By Code |
|
25 |
250 |
CE |
O |
0088 |
00393 |
Procedure Code |
|
26 |
250 |
CE |
O |
Y |
0340 |
01316 |
Procedure Code Modifier |
Definition: This field contains the number that identifies this transaction. For the first occurrence of the segment the sequence number shall be 1, for the second occurrence it shall be 2, etc.
Definition: This field contains a number assigned by the sending system for control purposes. The number can be returned by the receiving system to identify errors.
Definition: This field uniquely identifies the batch in which this transaction belongs.
Definition: This field contains the date of the transaction. For example, this field would be used to identify the date a procedure, item, or test was conducted or used. It may be defaulted to today's date.
Definition: This field contains the date of the transaction that was sent to the financial system for posting.
Definition:
This field contains the code that identifies the type of transaction. Refer
to User-defined Table 0017 - Transaction type for suggested values.
Values |
Description |
|---|---|
CG |
Charge |
CD |
Credit |
PY |
Payment |
AJ |
Adjustment |
CO |
Co-payment |
Components:
<identifier (ST)> ^ <text (ST)> ^ <name of coding system
(IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^
<name of alternate coding system (IS)>
Definition: This field contains the code assigned by the institution for the
purpose of uniquely identifying the transaction. For example, this field would
be used to uniquely identify a procedure, supply item, or test for charging
purposes. Refer to User-defined Table 0132 - Transaction code for
suggested values. See Chapter 7 for a discussion of the universal service ID.
Value |
Description |
|---|---|
No suggested values defined |
Definition: This field has been retained for backward compatibility only. As of Version 2.3, FT1-7 - transaction code contains a component for the transaction description. When used for backward compatibility, FT1-8 - transaction description contains a description of the transaction associated with the code entered in FT1-7 - transaction code
Definition: This field has been retained for backward compatibility only. As of Version 2.3, FT1-7 - transaction code contains a component for the alternate transaction description. When used for backward compatibility, FT1-9 - transaction description-alt contains an alternate description of the transaction associated with the code entered in FT1-7 - transaction code.
Definition: This field contains the quantity of items associated with this transaction.
Components:
<price (MO)> ^ <price type (ID)> ^ <from value (NM)> ^
<to value (NM)> ^ <range units (CE)> ^ <range type
(ID)>
Subcomponents of price: <quantity (NM)> & <denomination
(ID)>
Subcomponents of range units: <identifier (ST)> & <text
(ST)> & <name of coding system (IS)> & <alternate
identifier (ID)> & <alternate text (ST)> & <name of
alternate coding system (ST)>
Definition: This field contains the amount of a transaction. It may be left
blank if the transaction is automatically priced. Total price for multiple
items.
Components:
<price (MO)> ^ <price type (ID)> ^ <from value (NM)> ^
<to value (NM)> ^ <range units (CE)> ^ <range type
(ID)>
Subcomponents of price: <quantity (NM)> & <denomination
(ID)>
Subcomponents of range units: <identifier (ST)> & <text
(ST)> & <name of coding system (IS)> & <alternate
identifier (ID)> & <alternate text (ST)> & <name of
alternate coding system (ST)>
Definition: This field contains the unit price of a transaction. Price of a
single item.
Components:
<identifier (ST)> ^ <text (ST)> ^ <name of coding system
(IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^
<name of alternate coding system (IS)>
Definition: This field contains the department code that controls the
transaction code described above. Refer to User-defined Table 0049 -
Department code for suggested values.
Value |
Description |
|---|---|
No suggested values defined |
Components:
<identifier (ST)> ^ <text (ST)> ^ <name of coding system
(IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^
<name of alternate coding system (IS)>
Definition: This field contains the identifier of the primary insurance plan
with which this transaction should be associated. Refer to User-defined
Table 0072 - Insurance plan ID for suggested values.
Value |
Description |
|---|---|
No suggested values defined |
Components:
<price (MO)> ^ <price type (ID)> ^ <from value (NM)> ^
<to value (NM)> ^ <range units (CE)> ^ <range type
(ID)>
Subcomponents of price: <quantity (NM)> & <denomination
(ID)>
Subcomponents of range units: <identifier (ST)> & <text
(ST)> & <name of coding system (IS)> & <alternate
identifier (ID)> & <alternate text (ST)> & <name of
alternate coding system (ST)>
Definition: This field contains the amount to be posted to the insurance plan
referenced above.
Components:
<point of care (IS)> ^ <room (IS)> ^ <bed (IS)> ^
<facility (HD)> ^ <location status (IS)> ^ <person location
type (IS)> ^ <building (IS)> ^ <floor (IS)> ^ <location
description (ST)>
Subcomponents of facility: <namespace ID (IS)> & <universal
ID (ST)> & <universal ID type (ID)>
Definition: This field contains the current patient location. This can be the
location of the patient when the charge item was ordered or when the charged
service was rendered. For the current assigned patient location, use PV1-3
- assigned patient location.
Definition:
This field contains the code used to select the appropriate fee schedule to be
used for this transaction posting. Refer to User-defined Table 0024 - Fee
schedule for suggested values.
Value |
Description |
|---|---|
No suggested values defined |
Definition:
This field contains the type code assigned to the patient for this episode of
care (visit or stay). Refer to User-defined Table 0018 - Patient type
for suggested values. This is for use when the patient type for billing
purposes is different than the visit patient type in PV1-18 - patient
type.
Value |
Description |
|---|---|
No suggested values defined |
Components:
<identifier (ST)> ^ <text (ST)> ^ <name of coding system
(IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^
<name of alternate coding system (IS)>
Definition: This field contains the primary diagnosis code for billing
purposes. ICD9-CM is assumed for all diagnosis codes. This is the most
current diagnosis code that has been assigned to the patient. ICD10 can also
be used. The name of coding system (third component) indicates which coding
system is used. Refer to User-defined Table 0051 - Diagnosis code for
suggested values.
Value |
Description |
|---|---|
No suggested values defined |
Components:
<ID number (ST)> ^ <family name (ST)> ^ <given name (ST)> ^
<middle initial or name (ST)> ^ <suffix (e.g., JR or III) (ST)> ^
<prefix (e.g., DR) (ST)> ^ <degree (e.g., MD) (IS)> ^ <source
table (IS)> ^ <assigning authority (HD)> ^ <name type code (ID)>
^ <identifier check digit (ST)> ^ <code identifying the check digit
scheme employed (ID)> ^ <identifier type code (IS)> ^ <assigning
facility (HD)>^ <name representation code (ID)> ^ <name context
(CE)> ^ <name validity range (DR)>
Subcomponents of family name: <family name (ST)> & <own family
name prefix (ST)> & <own family name (ST)> & <family name
prefix from partner/spouse (ST)> & <family name from partner/spouse
(ST)>
Subcomponents of assigning authority: <namespace ID (IS)> &
<universal ID (ST)> & <universal ID type (ID)
Subcomponents of assigning facility: <namespace ID (IS)> &
<universal ID (ST)> & <universal ID type (ID)
Definition: This field contains the composite number/name of the person/group
that performed the test/procedure/transaction, etc. This is the service
provider. Refer to User-defined Table 0084 - Performed by for suggested
values. Multiple names and identifiers for the same practitioner may be sent
in this field, not multiple practitioners. The legal name is assumed to be in
the first repetition. When the legal name is not sent, a repeat delimiter must
be sent first for the first repetition.
Value |
Description |
|---|---|
No suggested values defined |
Components:
<ID number (ST)> ^ <family name (ST)> ^ <given name (ST)> ^
<middle initial or name (ST)> ^ <suffix (e.g., JR or III) (ST)> ^
<prefix (e.g., DR) (ST)> ^ <degree (e.g., MD) (IS)> ^ <source
table (IS)> ^ <assigning authority (HD)> ^ <name type code (ID)>
^ <identifier check digit (ST)> ^ <code identifying the check digit
scheme employed (ID)> ^ <identifier type code (IS)> ^ <assigning
facility (HD)>^ <name representation code (ID)> ^ <name context
(CE)> ^ <name validity range (DR)>
Subcomponents of family name: <family name (ST)> & <own family
name prefix (ST)> & <own family name (ST)> & <family name
prefix from partner/spouse (ST)> & <family name from partner/spouse
(ST)>
Subcomponents of assigning facility: <namespace ID (IS)> &
<universal ID (ST)> & <universal ID type (ID)
Definition: This field contains the composite number/name of the person/group
that ordered the test/ procedure/transaction, etc. Multiple names and
identifiers for the same practitioner may be sent in this field, not multiple
practitioners. The legal name is assumed to be in the first repetition. When
the legal name is not sent, a repeat delimiter must be sent first for the first
repetition.
Components:
<price (MO)> ^ <price type (ID)> ^ <from value (NM)> ^
<to value (NM)> ^ <range units (CE)> ^ <range type
(ID)>
Subcomponents of price: <quantity (NM)> & <denomination
(ID)>
Subcomponents of range units: <identifier (ST)> & <text
(ST)> & <name of coding system (IS)> & <alternate
identifier (ID)> & <alternate text (ST)> & <name of
alternate coding system (ST)>
Definition: This field contains the unit cost of transaction. The cost of a
single item.
Components:
<entity identifier (ST)> ^ <namespace ID (IS)> ^ <universal ID
(ST)> ^ <universal ID type (ID)>
Definition: This field is used when the billing system is requesting
observational reporting justification for a charge. This is the number used by
a filler to uniquely identify a result. See Chapter 4 for a complete
description.
Components:
<ID number (ST)> ^ <family name (ST)> ^ <given name (ST)> ^
<middle initial or name (ST)> ^ <suffix (e.g., JR or III) (ST)> ^
<prefix (e.g., DR) (ST)> ^ <degree (e.g., MD) (IS)> ^ <source
table (IS)> ^ <assigning authority (HD)> ^ <name type code (ID)>
^ <identifier check digit (ST)> ^ <code identifying the check digit
scheme employed (ID)> ^ <identifier type code (IS)> ^ <assigning
facility (HD)>^ <name representation code (ID)> ^ <name context
(CE)> ^ <name validity range (DR)>
Subcomponents of family name: <family name (ST)> & <own family
name prefix (ST)> & <own family name (ST)> & <family name
prefix from partner/spouse (ST)> & <family name from partner/spouse
(ST)>
Subcomponents of assigning authority: <namespace ID (IS)> &
<universal ID (ST)> & <universal ID type (ID)
Subcomponents of assigning facility: <namespace ID (IS)> &
<universal ID (ST)> & <universal ID type (ID)
Definition: This field identifies the composite number/name of the person who
entered the insurance information.
Components:
<identifier (ST)> ^ <text (ST)> ^ <name of coding system
(IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^
<name of alternate coding system (IS)>
Definition: This field contains a unique identifier assigned to the procedure,
if any, associated with the charge. Refer to User-defined Table 0088 -
Procedure code for suggested values. This field is a CE data type for
compatibility with clinical and ancillary systems.
Components:
<identifier (ST)> ^ <text (ST)> ^ <name of coding system
(IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^
<name of alternate coding system (IS)>
Definition: This field contains the procedure code modifier to the procedure
code reported in FT1-25-procedure code, when applicable. Procedure code
modifiers are defined by regulatory agencies such as HCFA and the AMA.
Multiple modifiers may be reported. Refer to User-defined Table 0340 -
Procedure code modifier for suggested values.
The
DG1 segment contains patient diagnosis information of various types, for
example, admitting, primary, etc. The DG1 segment is used to send multiple
diagnoses (for example, for medical records encoding). It is also used when
the FT1-19 - diagnosis code - FT1 does not provide sufficient
information for a billing system. This diagnosis coding should be
distinguished from the clinical problem segment used by caregivers to manage
the patient (see Chapter 12, Patient Care). Coding methodologies are also
defined.
SEQ |
LEN |
DT |
OPT |
RP/# |
TBL# |
ITEM# |
ELEMENT NAME |
|---|---|---|---|---|---|---|---|
1 |
4 |
SI |
R |
00375 |
Set ID - DG1 |
||
2 |
2 |
ID |
(B) R |
0053 |
00376 |
Diagnosis Coding Method |
|
3 |
250 |
CE |
O |
0051 |
00377 |
Diagnosis Code - DG1 |
|
4 |
40 |
ST |
B |
00378 |
Diagnosis Description |
||
5 |
26 |
TS |
O |
00379 |
Diagnosis Date/Time |
||
6 |
2 |
IS |
R |
0052 |
00380 |
Diagnosis Type |
|
7 |
250 |
CE |
B |
0118 |
00381 |
Major Diagnostic Category |
|
8 |
250 |
CE |
B |
0055 |
00382 |
Diagnostic Related Group |
|
9 |
1 |
ID |
B |
0136 |
00383 |
DRG Approval Indicator |
|
10 |
2 |
IS |
B |
0056 |
00384 |
DRG Grouper Review Code |
|
11 |
250 |
CE |
B |
0083 |
00385 |
Outlier Type |
|
12 |
3 |
NM |
B |
00386 |
Outlier Days |
||
13 |
12 |
CP |
B |
00387 |
Outlier Cost |
||
14 |
4 |
ST |
B |
00388 |
Grouper Version And Type |
||
15 |
2 |
ID |
O |
0359 |
00389 |
Diagnosis Priority |
|
16 |
250 |
XCN |
O |
Y |
00390 |
Diagnosing Clinician |
|
17 |
3 |
IS |
O |
0228 |
00766 |
Diagnosis Classification |
|
18 |
1 |
ID |
O |
0136 |
00767 |
Confidential Indicator |
|
19 |
26 |
TS |
O |
00768 |
Attestation Date/Time |
Definition: This field contains the number that identifies this transaction. For the first occurrence of the segment the sequence number shall be 1, for the second occurrence it shall be 2, etc.
Definition:
This field has been retained for backward compatibility only.
Use the components of DG1-3 - diagnosis code-DG1 instead of this
field. When used for backward compatibility, ICD9 is the recommended coding
methodology. Refer to User-de
fined
Table 0053 - Diagnosis coding method for suggested values.
Value |
Description |
|---|---|
No suggested values defined |
Components:
<identifier (ST)> ^ <text (ST)> ^ <name of coding system
(IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^
<name of alternate coding system (IS)>
Definition: Use this field instead of DG1-2 - diagnosis coding method
and DG1-4 - diagnosis description. (Those two fields have been retained
for backward compatibility only.) DG1-3 - diagnosis code DG1 contains
the diagnosis code assigned to this diagnosis. Refer to User-defined Table
0051 - Diagnosis code for suggested values. This field is a CE data type
for compatibility with clinical and ancillary systems.
See Chapter 7 for suggested diagnosis codes. For the name of the coding
system, refer to Chapter 7, Section 7.2.5, "Coding schemes."
Definition: This field has been retained for backward compatibility only. Use the components of DG1-3 - diagnosis code-DG1 field instead of this field. When used for backward compatibility, DG1-4 - diagnosis description contains a description that best describes the diagnosis.
Definition: This field contains the date/time that the diagnosis was determined.
Definition:
This field contains a code that identifies the type of diagnosis being sent.
Refer to User-defined Table 0052 - Diagnosis type for suggested values.
This field should no longer be used to indicate "DRG" because the DRG fields
have moved to the new DRG segment.
Values |
Description |
|---|---|
A |
Admitting |
W |
Working |
F |
Final |
Components:
<identifier (ST)> ^ <text (ST)> ^ <name of coding system
(IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^
<name of alternate coding system (IS)>
Definition: This field has been retained for backward compatibility
only. This field should only be used in a master file transaction.
Refer to User-defined Table 0118 - Major diagnostic category for
suggested values.
Value |
Description |
|---|---|
No suggested values defined |
Components:
<identifier (ST)> ^ <text (ST)> ^ <name of coding system
(IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^
<name of alternate coding system (IS)>
Definition: This field has been retained for backward compatibility
only. This field has moved to the new DRG segment. It contains the
DRG for the transaction. Interim DRGs could be determined for an encounter.
Refer to User-defined Table 0055 - Diagnosis Related Group for suggested
values.
Value |
Description |
|---|---|
No suggested values defined |
Definition: This field has been retained for backward compatibility only. This field has moved to the new DRG segment. This field indicates if the DRG has been approved by a reviewing entity. Refer to HL7 table 0136 - Yes/no indicator for valid values.
Definition:
This field has been retained for backward compatibility only.
This field has moved to the new DRG segment. Refer to User-defined Table
0056 - DRG grouper review code for suggested values. This code indicates
that the grouper results have been reviewed and approved.
Value |
Description |
|---|---|
No suggested values defined |
Components:
<identifier (ST)> ^ <text (ST)> ^ <name of coding system
(IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^
<name of alternate coding system (IS)>
Definition: This field has been retained for backward compatibility
only. This field has moved to the new DRG segment. When used for
backward compatibility, this field contains the type of outlier (i.e. period of
care beyond DRG-standard stay in facility) that has been paid. Refer to
User-defined Table 0083 - Outlier type for suggested values.
Definition: This field has been retained for backward compatibility only. This field has moved to the new DRG segment. When used for backward compatibility, this field contains the number of days that have been approved for an outlier payment.
Components:
<price (MO)> ^ <price type (ID)> ^ <from value (NM)> ^
<to value (NM)> ^ <range units (CE)> ^ <range type
(ID)>
Subcomponents of price: <quantity (NM)> & <denomination
(ID)>
Subcomponents of range units: <identifier (ST)> & <text
(ST)> & <name of coding system (IS)> & <alternate
identifier (ID)> & <alternate text (ST)> & <name of
alternate coding system (ST)>
Definition: This field has been retained for backward compatibility
only. This field has moved to the new DRG segment. When used for
backward compatibility, this field contains the amount of money that has been
approved for an outlier payment.
Definition: This field has been retained for backward compatibility only. This field has moved to the new DRG segment; refer to the field definition in Section <IP_ADDRESS>. When used for backward compatibility, this field contains the grouper version and type.
Definition:
This field contains the number that identifies the significance or priority of
the diagnosis code. Refer to User-defined Table 0359 - Diagnosis
priority for suggested values.
Value |
Description |
|---|---|
0 |
Not included in diagnosis ranking |
1 |
The primary diagnosis |
2 ... |
For ranked secondary diagnoses |
Components:
<ID number (ST)> ^ <family name (ST)> ^ <given name (ST)> ^
<middle initial or name (ST)> ^ <suffix (e.g., JR or III) (ST)> ^
<prefix (e.g., DR) (ST)> ^ <degree (e.g., MD) (IS)> ^ <source
table (IS)> ^ <assigning authority (HD)> ^ <name type code(ID)>
^ <identifier check digit (ST)> ^ <code identifying the check digit
scheme employed (ID)> ^ <identifier type code (IS)> ^ <assigning
facility (HD)>^ <name representation code (ID)> ^ <name context
(CE)> ^ <name validity range (DR)>
Subcomponents of family name: <family name (ST)> & <own family
name prefix (ST)> & <own family name (ST)> & <family name
prefix from partner/spouse (ST)> & <family name from partner/spouse
(ST)>
Subcomponents of assigning authority: <namespace ID (IS)> &
<universal ID (ST)> & <universal ID type (ID)
Subcomponents of assigning facility: <namespace ID (IS)> &
<universal ID (ST)> & <universal ID type (ID)
Definition: This field contains the individual responsible for generating the
diagnosis information. Multiple names and identifiers for the same person may
be sent in this field, not multiple diagnosing clinicians. The legal name is
assumed to be in the first repetition. When the legal name is not sent, a
repeat delimiter must be sent first for the first repetition.
Definition:
This field indicates if the patient information is for a diagnosis or a
non-diagnosis code. Refer to User-defined Table 0228 - Diagnosis
classification for suggested values.
Value |
Description |
|---|---|
C |
Consultation |
D |
Diagnosis |
M |
Medication (antibiotic) |
O |
Other |
R |
Radiological scheduling (not using ICDA codes) |
S |
Sign and symptom |
T |
Tissue diagnosis |
I |
Invasive procedure not classified elsewhere (I.V., catheter, etc.) |
Definition:
This field indicates whether the diagnosis is confidential. Refer to HL7
table 0136 - Yes/no indicator for valid values.
Y the diagnosis is a confidential diagnosis
N the diagnosis does not contain a confidential diagnosis
Definition: This field contains the time stamp that indicates the date and time that the attestation was signed.
The
DRG segment contains diagnoses-related grouping information of various types.
The DRG segment is used to send the DRG information, for example, for billing
and medical records encoding.
SEQ |
LEN |
DT |
OPT |
RP/# |
TBL# |
ITEM# |
ELEMENT NAME |
|---|---|---|---|---|---|---|---|
1 |
250 |
CE |
O |
0055 |
00382 |
Diagnostic Related Group |
|
2 |
26 |
TS |
O |
00769 |
DRG Assigned Date/Time |
||
3 |
1 |
ID |
O |
0136 |
00383 |
DRG Approval Indicator |
|
4 |
2 |
IS |
O |
0056 |
00384 |
DRG Grouper Review Code |
|
5 |
250 |
CE |
O |
0083 |
00385 |
Outlier Type |
|
6 |
3 |
NM |
O |
00386 |
Outlier Days |
||
7 |
12 |
CP |
O |
00387 |
Outlier Cost |
||
8 |
1 |
IS |
O |
0229 |
00770 |
DRG Payor |
|
9 |
9 |
CP |
O |
00771 |
Outlier Reimbursement |
||
10 |
1 |
ID |
O |
0136 |
00767 |
Confidential Indicator |
|
11 |
21 |
IS |
O |
0415 |
01500 |
DRG Transfer Type |
Components:
<identifier (ST)> ^ <text (ST)> ^ <name of coding system
(IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^
<name of alternate coding system (IS)>
Definition: This field contains the DRG for the transaction. Interim DRG's
could be determined for an encounter. Refer to User-defined Table
0055 - DRG for suggested values. For the name of coding system component,
send the grouper version and type.
Definition: This field contains the time stamp to indicate the date and time that the DRG was assigned.
Definition: This field indicates if the DRG has been approved by a reviewing entity. Refer to HL7 table 0136 - Yes/no indicator for valid values.
Definition: This code indicates that the grouper results have been reviewed and approved. Refer to User-defined Table 0056 - DRG grouper review code for suggested values.
Components:
<identifier (ST)> ^ <text (ST)> ^ <name of coding system
(IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^
<name of alternate coding system (IS)>
Definition: Refers to the type of outlier (i.e. period of care beyond
DRG-standard stay in facility) that has been paid. Refer to User-defined
Table 0083 - Outlier type for suggested values.
Values |
Description |
|---|---|
D |
Outlier days |
C |
Outlier cost |
Definition: This field contains the number of days that have been approved as an outlier payment.
Components:
<price (MO)> ^ <price type (ID)> ^ <from value (NM)> ^
<to value (NM)> ^ <range units (CE)> ^ <range type
(ID)>
Subcomponents of price: <quantity (NM)> & <denomination
(ID)>
Subcomponents of range units: <identifier (ST)> & <text
(ST)> & <name of coding system (IS)> & <alternate
identifier (ID)> & <alternate text (ST)> & <name of
alternate coding system (ST)>
Definition: This field contains the amount of money that has been approved for
an outlier payment.
Definition:
This field indicates the associated DRG Payor. Refer to User-defined Table
0229 - DRG payor for suggested values.
Value |
Description |
|---|---|
M |
Medicare |
C |
Champus |
G |
Managed Care Organization |
Components:
<price (MO)> ^ <price type (ID)> ^ <from value (NM)> ^
<to value (NM)> ^ <range units (CE)> ^ <range type
(ID)>
Subcomponents of price: <quantity (NM)> & <denomination
(ID)>
Subcomponents of range units: <identifier (ST)> & <text
(ST)> & <name of coding system (IS)> & <alternate
identifier (ID)> & <alternate text (ST)> & <name of
alternate coding system (ST)>
Definition: Where applicable, the outlier reimbursement amount indicates the
part of the total reimbursement designated for reimbursement of outlier
conditions (day or cost).
Definition:
This field indicates if the DRG contains a confidential diagnosis. Refer to
HL7 table 0136 - Yes/no indicator for valid values.
Y the DRG contains a confidential diagnosis
N the DRG does not contain a confidential diagnosis
Definition:
This field indicates the type of hospital receiving a transfer patient, which
affects how a facility is reimbursed under diagnosis related group (DRGs), for
example, exempt or non-exempt. Refer to User-defined Table 0415 - DRG
transfer type for suggested values.
Value |
Description |
|---|---|
N |
DRG Non Exempt |
E |
DRG Exempt |
The
PR1 segment contains information relative to various types of procedures that
can be performed on a patient. The PR1 segment can be used to send procedure
information, for example: Surgical, Nuclear Medicine, X-ray with contrast, etc.
The PR1 segment is used to send multiple procedures, for example, for medical
records encoding or for billing systems.
SEQ |
LEN |
DT |
OPT |
RP/# |
TBL# |
ITEM# |
ELEMENT NAME |
|---|---|---|---|---|---|---|---|
1 |
4 |
SI |
R |
00391 |
Set ID - PR1 |
||
2 |
3 |
IS |
(B) R |
0089 |
00392 |
Procedure Coding Method |
|
3 |
250 |
CE |
R |
0088 |
00393 |
Procedure Code |
|
4 |
40 |
ST |
B |
00394 |
Procedure Description |
||
5 |
26 |
TS |
R |
00395 |
Procedure Date/Time |
||
6 |
2 |
IS |
O |
0230 |
00396 |
Procedure Functional Type |
|
7 |
4 |
NM |
O |
00397 |
Procedure Minutes |
||
8 |
250 |
XCN |
B |
Y |
0010 |
00398 |
Anesthesiologist |
9 |
2 |
IS |
O |
0019 |
00399 |
Anesthesia Code |
|
10 |
4 |
NM |
O |
00400 |
Anesthesia Minutes |
||
11 |
250 |
XCN |
B |
Y |
0010 |
00401 |
Surgeon |
12 |
250 |
XCN |
B |
Y |
0010 |
00402 |
Procedure Practitioner |
13 |
250 |
CE |
O |
0059 |
00403 |
Consent Code |
|
14 |
2 |
ID |
O |
0418 |
00404 |
Procedure Priority |
|
15 |
250 |
CE |
O |
0051 |
00772 |
Associated Diagnosis Code |
|
16 |
250 |
CE |
O |
Y |
0340 |
01316 |
Procedure Code Modifier |
17 |
20 |
IS |
O |
0416 |
01501 |
Procedure DRG Type |
|
18 |
250 |
CE |
O |
Y |
0417 |
01502 |
Tissue Type Code |
Definition: This field contains the number that identifies this transaction. For the first occurrence of the segment the sequence number shall be 1, for the second occurrence it shall be 2, etc.
Definition:
This field has been retained for backward compatibility only.
Use the components of PR1-3 - procedure code instead of this field.
When used for backward compatibility, PR1-2 - procedure coding method
contains the methodology used to assign a code to the procedure (CPT4, for
example). If more than one coding method is needed for a single procedure,
this field and the associated values in PR1-3 - procedure code and
PR1-4 - procedure description may repeat. In this instance, the three
fields (PR1-2 through PR1-4) are directly associated with one
another. Refer to User-defined Table 0089 - Procedure coding method for
suggested values.
Value |
Description |
|---|---|
No suggested values defined |
Components:
<identifier (ST)> ^ <text (ST)> ^ <name of coding system
(IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^
<name of alternate coding system (IS)>
Definition: Use this field instead of PR1-2 - procedure coding method
and PR1-4 - procedure description. Those two fields have been retained
for backward compatibility only. This field contains a unique identifier
assigned to the procedure. Refer to User-defined Table 0088 - Procedure
code for suggested values. This field is a CE data type for compatibility
with clinical and ancillary systems.
Value |
Description |
|---|---|
No suggested values defined |
Definition: This field has been retained for backward compatibility only. Use the components of PR1-3 - procedure code instead of this field. The field contains a text description that describes the procedure.
Definition: This field contains the date/time that the procedure was performed.
Definition:
This field contains the optional code that further defines the type of
procedure. Refer to User-defined Table 0230 - Procedure functional type
for suggested values.
Value |
Description |
|---|---|
A |
Anesthesia |
P |
Procedure for treatment (therapeutic, including operations) |
I |
Invasive procedure not classified elsewhere (e.g., IV, catheter, etc.) |
D |
Diagnostic procedure |
Definition: This field indicates the length of time in whole minutes that the procedure took to complete.
Components:
<ID number (ST)> ^ <family name (ST)> ^ <given name (ST)> ^
<middle initial or name (ST)> ^ <suffix (e.g., JR or III) (ST)> ^
<prefix (e.g., DR) (ST)> ^ <degree (e.g., MD) (IS)> ^ <source
table (IS)> ^ <assigning authority (HD)> ^ <name type code(ID)>
^ <identifier check digit (ST)> ^ <code identifying the check digit
scheme employed (ID)> ^ <identifier type code (IS)> ^ <assigning
facility (HD)>^ <name representation code (ID)> ^ <name context
(CE)> ^ <name validity range (DR)>
Subcomponents of family name: <family name (ST)> & <own family
name prefix (ST)> & <own family name (ST)> & <family name
prefix from partner/spouse (ST)> & <family name from partner/spouse
(ST)>
Subcomponents of assigning authority: <namespace ID (IS)> &
<universal ID (ST)> & <universal ID type (ID)
Subcomponents of assigning facility: <namespace ID (IS)> &
<universal ID (ST)> & <universal ID type (ID)
Definition: HL7 has introduced the ROL segment to report a wide range of
practitioner roles related to a single procedure. This segment is described in
Chapter 12. When using trigger events introduced in HL7 Version 2.3, it is
recommended that the ROL segment be used to report all practitioner roles
related to the procedure.
However, in order to maintain backward compatibility, the practitioner roles
existing in HL7 Version 2.2 (PR1-8 - anesthesiologist, PR1-11 -
surgeon, and PR1-12 - procedure practitioner) should also be
populated in the PR1 segment as per the HL7 2.2 specifications. You may
additionally report the practitioner information in the ROL segment (See
Chapter 12, Section 12.4.3, "ROL - role segment").
When this field is used for backward compatibility, the XCN data type applies.
It contains the anesthesiologist who administered the anesthesia. Use values
in User-defined Table 0010 - Physician ID for first component. Multiple
names and identifiers for the same person should be sent in this field, not
multiple anesthesiologists. The legal name is assumed to be in the first
repetition. When the legal name is not sent, a repeat delimiter must be sent
first for the first repetition.
Value |
Description |
|---|---|
No suggested values defined |
Definition:
This field contains a unique identifier of the anesthesia used during the
procedure. Refer to User-defined Table 0019 - Anesthesia code for
suggested values.
Value |
Description |
|---|---|
No suggested values defined |
Definition: This field contains the length of time in minutes that the anesthesia was administered.
Components:
<ID number (ST)> ^ <family name (ST)> ^ <given name (ST)> ^
<middle initial or name (ST)> ^ <suffix (e.g., JR or III) (ST)> ^
<prefix (e.g., DR) (ST)> ^ <degree (e.g., MD) (IS)> ^ <source
table (IS)> ^ <assigning authority (HD)> ^ <name type code(ID)>
^ <identifier check digit (ST)> ^ <code identifying the check digit
scheme employed (ID)> ^ <identifier type code (IS)> ^ <assigning
facility (HD)>^ <name representation code (ID)> ^ <name context
(CE)> ^ <name validity range (DR)>
Subcomponents of family name: <family name (ST)> & <own family
name prefix (ST)> & <own family name (ST)> & <family name
prefix from partner/spouse (ST)> & <family name from partner/spouse
(ST)>
Subcomponents of assigning authority: <namespace ID (IS)> &
<universal ID (ST)> & <universal ID type (ID)
Subcomponents of assigning facility: <namespace ID (IS)> &
<universal ID (ST)> & <universal ID type (ID)
Definition: HL7 has introduced the ROL segment to report a wide range of
practitioner roles related to a single procedure. This segment is described in
Chapter 12. When using trigger events introduced in HL7 Version 2.3, it is
recommended that the ROL segment be used to report all practitioner roles
related to the procedure.
However, in order to maintain backward compatibility, the practitioner roles
existing in HL7 Version 2.2 (PR1-8 - anesthesiologist, PR1-11 -
surgeon, and PR1-12 - procedure practitioner) should also be
populated in the PR1 segment as per the HL7 2.2 specifications. You may
additionally report the practitioner information in the ROL segment (See
Chapter 12, Section 12.4.3, "ROL - role segment").
When this field is being used for backward compatibility, the XCN data type
applies. It contains the surgeon who performed the procedure. Use the values
in User-defined Table 0010 - Physician ID for the first component.
Multiple names and identifiers for the same person should be sent in this
field, not multiple surgeons. The legal name is assumed to be in the first
repetition. When the legal name is not sent, a repeat delimiter must be sent
first for the first repetition.
Components:
<ID number (ST)> ^ <family name (ST)> ^ <given name (ST)> ^
<middle initial or name (ST)> ^ <suffix (e.g., JR or III) (ST)> ^
<prefix (e.g., DR) (ST)> ^ <degree (e.g., MD) (IS)> ^ <source
table (IS)> ^ <assigning authority (HD)> ^ <name type code(ID)>
^ <identifier check digit (ST)> ^ <code identifying the check digit
scheme employed (ID)> ^ <identifier type code (IS)> ^ <assigning
facility (HD)>^ <name representation code (ID)> ^ <name context
(CE)> ^ <name validity range (DR)>
Subcomponents of family name: <family name (ST)> & <own family
name prefix (ST)> & <own family name (ST)> & <family name
prefix from partner/spouse (ST)> & <family name from partner/spouse
(ST)>
Subcomponents of assigning authority: <namespace ID (IS)> &
<universal ID (ST)> & <universal ID type (ID)
Subcomponents of assigning facility: <namespace ID (IS)> &
<universal ID (ST)> & <universal ID type (ID)
Definition: HL7 has introduced the ROL segment to report a wide range of
practitioner roles related to a single procedure. This segment is described in
Chapter 12. When using trigger events introduced in HL7 Version 2.3, it is
recommended that the ROL segment be used to report all practitioner roles
related to the procedure.
However, in order to maintain backward compatibility, the practitioner roles
existing in HL7 Version 2.2 (PR1-8 - anesthesiologist, PR1-11 -
surgeon, and PR1-12 - procedure practitioner) should also be
populated in the PR1 segment as per the HL7 2.2 specifications. You may
additionally report the practitioner information in the ROL segment (See
Chapter 12, Section 12.4.3, "ROL - role segment").
This field contains the different types of practitioners associated with this
procedure. The ID and name components follow the standard rules defined for a
composite name (XCN) field. The last component, identifier type code,
indicates which type of procedure practitioner is shown. When the identifier
type component is unvalued, it is assumed that the practitioner identified is a
resident. Use values in User-defined Table 0010 - Physician ID for the
first component. Refer to User-defined Table 0133 - Procedure practitioner
identifier code type for suggested values for the identifier type code
component.
Value |
Description |
|---|---|
AN |
Anesthesiologist/Anesthetist |
PR |
Procedure MD/ Surgeon |
RD |
Radiologist |
RS |
Resident |
NP |
Nurse Practitioner |
CM |
Certified Nurse Midwife |
SN |
Scrub Nurse |
PS |
Primary Surgeon |
AS |
Assistant Surgeon |
Components:
<identifier (ST)> ^ <text (ST)> ^ <name of coding system
(IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^
<name of alternate coding system (IS)>
Definition: This field contains the type of consent that was obtained for
permission to treat the patient. Refer to User-defined Table 0059 - Consent
code for suggested values.
Value |
Description |
|---|---|
No suggested values defined |
Definition:
This field contains a number that identifies the significance or priority of
the procedure code. Refer to HL7 table 0418 - Procedure priority for
valid values.
Value |
Description |
|---|---|
0 |
the admitting procedure |
1 |
the primary procedure |
2 ... |
for ranked secondary procedures |
Components:
<identifier (ST)> ^ <text (ST)> ^ <name of coding system
(IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^
<name of alternate coding system (IS)>
Definition: This field contains the diagnosis that is the primary reason this
procedure was performed, e.g. in the US, Medicare wants to know for which
diagnosis this procedure is submitted for inclusion on HCFA 1500 form. Refer
to User-defined Table 0051 - Diagnosis code for suggested values.
Components:
<identifier (ST)> ^ <text (ST)> ^ <name of coding system
(IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^
<name of alternate coding system (IS)>
Definition: This field contains the procedure code modifier to the procedure
code reported in field 3, when applicable. Procedure code modifiers are
defined by regulatory agencies such as HCFA and the AMA. Multiple modifiers
may be reported. Refer to User-defined Table 0340 - Procedure code
modifier for suggested values.
Value |
Description |
|---|---|
No suggested values defined |
Definition:
This field indicates a procedure's priority ranking relative to its DRG. Refer
to User-defined Table 0416 - Procedure DRG type for suggested values.
Value |
Description |
|---|---|
1 |
1st non-Operative |
2 |
2nd non-Operative |
3 |
Major Operative |
4 |
2nd Operative |
5 |
3rd Operative |
Components:
<identifier (ST)> ^ <text (ST)> ^ <name of coding system
(IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^
<name of alternate coding system (IS)>
Definition: Code representing type of tissue removed from a patient during
this procedure. Refer to User-defined Table 0417 - Tissue type code for
suggested values.
Value |
Description |
|---|---|
1 |
Insufficient Tissue |
2 |
Not abnormal |
3 |
Abnormal-not categorized |
4 |
Mechanical abnormal |
5 |
Growth alteration |
6 |
Degeneration & necrosis |
7 |
Non-acute inflammation |
8 |
Non-malignant neoplasm |
9 |
Malignant neoplasm |
0 |
No tissue expected |
B |
Basal cell carcinoma |
C |
Carcinoma-unspecified type |
G |
Additional tissue required |
The
GT1 segment contains guarantor (e.g., the person or the organization with
financial responsibility for payment of a patient account) data for patient and
insurance billing applications.
SEQ |
LEN |
DT |
OPT |
RP/# |
TBL# |
ITEM# |
ELEMENT NAME |
|---|---|---|---|---|---|---|---|
1 |
4 |
SI |
R |
00405 |
Set ID - GT1 |
||
2 |
250 |
CX |
O |
Y |
00406 |
Guarantor Number |
|
3 |
250 |
XPN |
R |
Y |
00407 |
Guarantor Name |
|
4 |
250 |
XPN |
O |
Y |
00408 |
Guarantor Spouse Name |
|
5 |
250 |
XAD |
O |
Y |
00409 |
Guarantor Address |
|
6 |
250 |
XTN |
O |
Y |
00410 |
Guarantor Ph Num - Home |
|
7 |
250 |
XTN |
O |
Y |
00411 |
Guarantor Ph Num - Business |
|
8 |
26 |
TS |
O |
00412 |
Guarantor Date/Time Of Birth |
||
9 |
1 |
IS |
O |
0001 |
00413 |
Guarantor Administrative Sex |
|
10 |
2 |
IS |
O |
0068 |
00414 |
Guarantor Type |
|
11 |
250 |
CE |
O |
0063 |
00415 |
Guarantor Relationship |
|
12 |
11 |
ST |
O |
00416 |
Guarantor SSN |
||
13 |
8 |
DT |
O |
00417 |
Guarantor Date - Begin |
||
14 |
8 |
DT |
O |
00418 |
Guarantor Date - End |
||
15 |
2 |
NM |
O |
00419 |
Guarantor Priority |
||
16 |
250 |
XPN |
O |
Y |
00420 |
Guarantor Employer Name |
|
17 |
250 |
XAD |
O |
Y |
00421 |
Guarantor Employer Address |
|
18 |
250 |
XTN |
O |
Y |
00422 |
Guarantor Employer Phone Number |
|
19 |
250 |
CX |
O |
Y |
00423 |
Guarantor Employee ID Number |
|
20 |
2 |
IS |
O |
0066 |
00424 |
Guarantor Employment Status |
|
21 |
250 |
XON |
O |
Y |
00425 |
Guarantor Organization Name |
|
22 |
1 |
ID |
O |
0136 |
00773 |
Guarantor Billing Hold Flag |
|
23 |
250 |
CE |
O |
0341 |
00774 |
Guarantor Credit Rating Code |
|
24 |
26 |
TS |
O |
00775 |
Guarantor Death Date And Time |
||
25 |
1 |
ID |
O |
0136 |
00776 |
Guarantor Death Flag |
|
26 |
250 |
CE |
O |
0218 |
00777 |
Guarantor Charge Adjustment Code |
|
27 |
10 |
CP |
O |
00778 |
Guarantor Household Annual Income |
||
28 |
3 |
NM |
O |
00779 |
Guarantor Household Size |
||
29 |
250 |
CX |
O |
Y |
00780 |
Guarantor Employer ID Number |
|
30 |
250 |
CE |
O |
0002 |
00781 |
Guarantor Marital Status Code |
|
31 |
8 |
DT |
O |
00782 |
Guarantor Hire Effective Date |
||
32 |
8 |
DT |
O |
00783 |
Employment Stop Date |
||
33 |
2 |
IS |
O |
0223 |
00755 |
Living Dependency |
|
34 |
2 |
IS |
O |
Y |
0009 |
00145 |
Ambulatory Status |
35 |
250 |
CE |
O |
Y |
0171 |
00129 |
Citizenship |
36 |
250 |
CE |
O |
0296 |
00118 |
Primary Language |
|
37 |
2 |
IS |
O |
0220 |
00742 |
Living Arrangement |
|
38 |
250 |
CE |
O |
0215 |
00743 |
Publicity Code |
|
39 |
1 |
ID |
O |
0136 |
00744 |
Protection Indicator |
|
40 |
2 |
IS |
O |
0231 |
00745 |
Student Indicator |
|
41 |
250 |
CE |
O |
0006 |
00120 |
Religion |
|
42 |
250 |
XPN |
O |
Y |
00109 |
Mother's Maiden Name |
|
43 |
250 |
CE |
O |
0212 |
00739 |
Nationality |
|
44 |
250 |
CE |
O |
Y |
0189 |
00125 |
Ethnic Group |
45 |
250 |
XPN |
O |
Y |
00748 |
Contact Person's Name |
|
46 |
250 |
XTN |
O |
Y |
00749 |
Contact Person's Telephone Number |
|
47 |
250 |
CE |
O |
0222 |
00747 |
Contact Reason |
|
48 |
2 |
IS |
O |
0063 |
00784 |
Contact Relationship |
|
49 |
20 |
ST |
O |
00785 |
Job Title |
||
50 |
20 |
JCC |
O |
0327/ 0328 |
00786 |
Job Code/Class |
|
51 |
250 |
XON |
O |
Y |
01299 |
Guarantor Employer's Organization Name |
|
52 |
2 |
IS |
O |
0295 |
00753 |
Handicap |
|
53 |
2 |
IS |
O |
0311 |
00752 |
Job Status |
|
54 |
50 |
FC |
O |
0064 |
01231 |
Guarantor Financial Class |
|
55 |
250 |
CE |
O |
Y |
0005 |
01291 |
Guarantor Race |
Definition: GT1-1 - set ID contains a number that identifies this transaction. For the first occurrence of the segment the sequence shall be 1, for the second occurrence it shall be 2, etc.
Components:
<ID (ST)> ^ <check digit (ST)> ^ <code identifying the check
digit scheme employed (ID)> ^ < assigning authority (HD)> ^
<identifier type code (ID)> ^ < assigning facility (HD) ^
<effective date (DT)> ^ <expiration date (DT)>
Subcomponents of assigning authority: <namespace ID (IS)> &
<universal ID (ST)> & <universal ID type (ID)
Subcomponents of assigning facility: <namespace ID (IS)> &
<universal ID (ST)> & <universal ID type (ID)
Definition: This field contains the primary identifier, or other identifiers,
assigned to the guarantor. The assigning authority and identifier type code
are strongly recommended for all CX data types.
Components:
In Version 2.3, replaces the PN data type. <family name (FN)> ^
<given name (ST)> ^ <second and further given names or initials
thereof (ST)> ^ <suffix (e.g., JR or III) (ST)> ^ <prefix (e.g.,
DR) (ST)> ^ <degree (e.g., MD) (IS)> ^ <name type code (ID)
> ^ <name representation code (ID)> ^ <name context (CE)> ^
<name validity range (DR)> ^ <name assembly order (ID)>
Subcomponents of family name: <family name (ST)> & <own family
name prefix (ST)> & <own family name (ST)> & <family name
prefix from partner/spouse (ST)> & <family name from partner/spouse
(ST)>
Definition: This field contains the name of the guarantor. Multiple names for
the same guarantor may be sent in this field. The legal name is assumed to be
in the first repetition. When the legal name is not sent, a repeat delimiter
must be sent first for the first repetition.
Beginning with Version 2.3, if the guarantor is an organization, send a null
value ("") in GT1-3 - guarantor name and put the organization name in
GT1-21 - guarantor organization name. Either guarantor name or
guarantor organization name is required.
Components:
In Version 2.3, replaces the PN data type. <family name (FN)> ^
<given name (ST)> ^ <second and further given names or initials
thereof (ST)> ^ <suffix (e.g., JR or III) (ST)> ^ <prefix (e.g.,
DR) (ST)> ^ <degree (e.g., MD) (IS)> ^ <name type code (ID)
> ^ <name representation code (ID)> ^ <name context (CE)> ^
<name validity range (DR)> ^ <name assembly order (ID)>
Subcomponents of family name: <family name (ST)> & <own family
name prefix (ST)> & <own family name (ST)> & <family name
prefix from partner/spouse (ST)> & <family name from partner/spouse
(ST)>
Definition: This field contains the name of the guarantor's spouse. Multiple
names for the same guarantor spouse may be sent in this field. The legal name
is assumed to be in the first repetition. When the legal name is not sent, a
repeat delimiter must be sent first for the first repetition.
Components:
In Version 2.3 and later, replaces the AD data type. <street address
(ST)> ^ <other designation (ST)> ^ <city (ST)> ^ <state or
province (ST)> ^ <zip or postal code (ST)> ^ <country (ID)> ^
< address type (ID)> ^ <other geographic designation (ST)>
^ <county/parish code (IS)> ^ <census tract (IS)> ^
<address representation code (ID)> ^ <address validity range
(DR)>
Subcomponents of street address: <street address (ST)> &
<street name (ST)> & <dwelling number (ST)>
Definition: This field contains the guarantor's address. Multiple addresses
for the same person may be sent in this field. The mailing address is assumed
to be in the first repetition. When the mailing address is not sent, a repeat
delimiter must be sent first for the first repetition.
components:
[NNN] [(999)]999-9999 [X99999] [B99999] [C any text] ^
<telecommunication use code (ID)> ^ <telecommunication equipment type
(ID)> ^ <email address (ST)> ^ <country code (NM)> ^
<area/city code (NM)> ^ <phone number (NM)> ^ <extension
(NM)> ^ <any text (ST)>
Definition: This field contains the guarantor's home phone number. All
personal phone numbers for the guarantor may be sent in this field. The
primary telephone number is assumed to be in the first repetition. When the
primary telephone number is not sent, a repeat delimiter must be sent first for
the first repetition.
Components:
[NNN] [(999)]999-9999 [X99999] [B99999] [C any text] ^
<telecommunication use code (ID)> ^ <telecommunication equipment type
(ID)> ^ <email address (ST)> ^ <country code (NM)> ^
<area/city code (NM)> ^ <phone number (NM)> ^ <extension
(NM)> ^ <any text (ST)>
Definition: This field contains the guarantor's business phone number. All
business phone numbers for the guarantor may be sent in this field. The
primary telephone number is assumed to be in the first repetition. When the
primary telephone number is not sent, a repeat delimiter must be sent first for
the first repetition.
Definition: This field contains the guarantor's date of birth.
Definition: This field contains the guarantor's gender. Refer to User-defined Table 0001 - Administrative sex for suggested values.
Definition:
This field indicates the type of guarantor, e.g., individual, institution,
etc. Refer to User-defined Table 0068 - Guarantor type for suggested
values.
Value |
Description |
|---|---|
No suggested values defined |
Components:
<identifier (ST)> ^ <text (ST)> ^ <name of coding system
(IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^
<name of alternate coding system (IS)>
Definition: This field indicates the relationship of the guarantor with the
patient, e.g., parent, child, etc. Refer to User-defined Table 0063 -
Relationship for suggested values.
Definition: This field contains the guarantor's social security number.
Definition: This field contains the date that the guarantor becomes responsible for the patient's account.
Definition: This field contains the date that the guarantor stops being responsible for the patient's account.
Definition:
This field is used to determine the order in which the guarantors are
responsible for the patient's account.
"1" = primary guarantor
"2" = secondary guarantor, etc.
Components:
In Version 2.3, replaces the PN data type. <family name (FN)> ^
<given name (ST)> ^ <second and further given names or initials
thereof (ST)> ^ <suffix (e.g., JR or III) (ST)> ^ <prefix (e.g.,
DR) (ST)> ^ <degree (e.g., MD) (IS)> ^ <name type code (ID)
> ^ <name representation code (ID)> ^ <name context (CE)> ^
<name validity range (DR)> ^ <name assembly order (ID)>
Subcomponents of family name: <family name (ST)> & <own family
name prefix (ST)> & <own family name (ST)> & <family name
prefix from partner/spouse (ST)> & <family name from partner/spouse
(ST)>
Definition: This field contains the name of the guarantor's employer, if the
employer is a person. When the guarantor's employer is an organization, use
GT1-51 - guarantor employer's organization name. Multiple names for the
same person may be sent in this field, not multiple employers. The legal name
must be sent first in the repetition. When the legal name is not sent, a
repeat delimiter must be sent first for the first repetition.
Components:
In Version 2.3 and later, replaces the AD data type. <street address
(ST)> ^ <other designation (ST)> ^ <city (ST)> ^ <state or
province (ST)> ^ <zip or postal code (ST)> ^ <country (ID)> ^
< address type (ID)> ^ <other geographic designation (ST)>
^ <county/parish code (IS)> ^ <census tract (IS)> ^
<address representation code (ID)> ^ <address validity range
(DR)>
Subcomponents of street address: <street address (ST)> &
<street name (ST)> & <dwelling number (ST)>
Definition: This field contains the guarantor's employer's address. Multiple
addresses for the same employer may be sent in this field. The mailing address
must be sent first in the repetition. When the mailing address is not sent, a
repeat delimiter must be sent first for the first repetition.
Components:
[NNN] [(999)]999-9999 [X99999] [B99999] [C any text] ^ <telecommunication
use code (ID)> ^ <telecommunication equipment type (ID)> ^ <email
address (ST)> ^ <country code (NM)> ^ <area/city code (NM)> ^
<phone number (NM)> ^ <extension (NM)> ^ <any text
(ST)>
Definition: This field contains the guarantor's employer's phone number.
Multiple phone numbers for the same employer may be sent in this field. The
primary telephone number must be sent first in the sequence. When the primary
telephone number is not sent, a repeat delimiter must be sent first for the
first repetition.
Components:
<ID (ST)> ^ <check digit (ST)> ^ <code identifying the check
digit scheme employed (ID)> ^ < assigning authority (HD)> ^
<identifier type code (ID)> ^ < assigning facility (HD) ^
<effective date (DT)> ^ <expiration date (DT)>
Subcomponents of assigning authority: <namespace ID (IS)> &
<universal ID (ST)> & <universal ID type (ID)
Subcomponents of assigning facility: <namespace ID (IS)> &
<universal ID (ST)> & <universal ID type (ID)
Definition: This field contains the guarantor's employee number. The
assigning authority and identifier type code are strongly recommended for all
CX data types.
Definition:
This field contains the code that indicates the guarantor's employment status.
Refer to User-defined Table 0066 - Employment status for suggested
values.
Value |
Description |
|---|---|
No suggested values defined |
Components:
<organization name (ST)> ^ <organization name type code (ID)> ^
<ID number (ID)> ^ <check digit (NM)> ^ < check digit scheme
(ID)> ^ <assigning authority (HD)> ^ <identifier type code (ID)>
^ <assigning facility ID (HD)> ^ <name representation code
(ID)>
Subcomponents of assigning authority: <namespace ID (IS)> &
<universal ID (ST)> & <universal ID type (ID)
Subcomponents of assigning facility: <namespace ID (IS)> &
<universal ID (ST)> & <universal ID type (ID)
Definition: This field contains the name of the guarantor when the guarantor
is an organization. Multiple names for the same guarantor may be sent in this
field, not multiple guarantors. The legal name is assumed to be in the first
repetition. When the legal name is not sent, a repeat delimiter must be sent
first for the first repetition.
Beginning with Version 2.3, if the guarantor is a person, send a null value
("") in GT1-21 - guarantor organization name and put the person name in
GT1-3 - guarantor name. Either guarantor person name or guarantor
organization name is required.
Definition:
Refer to HL7 table 0136 - Yes/no indicator for valid values. This
field indicates whether or not a system should suppress printing of the
guarantor's bills.
Y a system should suppress printing of guarantor's bills
N a system should not suppress printing of guarantor's bills
Components:
<identifier (ST)> ^ <text (ST)> ^ <name of coding system
(IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^
<name of alternate coding system (IS)>
Definition: This field contains the guarantor's credit rating. Refer to
User-defined Table 0341 - Guarantor credit rating code for suggested
values.
Value |
Description |
|---|---|
No suggested values defined |
Definition: This field is used to indicate the date and time at which the guarantor's death occurred.
Definition:
This field indicates whether or not the guarantor is deceased. Refer to
HL7 table 0136 - Yes/no indicator for valid values.
Y the guarantor is deceased
N the guarantor is living
Components:
<identifier (ST)> ^ <text (ST)> ^ <name of coding system
(IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^
<name of alternate coding system (IS)>
Definition: This field contains user-defined codes that indicate which
adjustments should be made to this guarantor's charges. For example, when the
hospital agrees to adjust this guarantor's charges to a sliding scale. Refer
to User-defined Table 0218 - Patient charge adjustment for suggested
values.
Example: This field would contain the value used for sliding-fee scale
processing.
Value |
Description |
|---|---|
No suggested values defined |
Components:
<price (MO)> ^ <price type (ID)> ^ <from value (NM)> ^
<to value (NM)> ^ <range units (CE)> ^ <range type
(ID)>
Subcomponents of price: <quantity (NM)> & <denomination
(ID)>
Subcomponents of range units: <identifier (ST)> & <text
(ST)> & <name of coding system (IS)> & <alternate
identifier (ID)> & <alternate text (ST)> & <name of
alternate coding system (ST)>
Definition: This field contains the combined annual income of all members of
the guarantor's household.
Definition: This field specifies the number of people living at the guarantor's primary residence.
Components:
<ID (ST)> ^ <check digit (ST)> ^ <code identifying the check
digit scheme employed (ID)> ^ < assigning authority (HD)> ^
<identifier type code (ID)> ^ < assigning facility (HD) ^
<effective date (DT)> ^ <expiration date (DT)>
Subcomponents of assigning authority: <namespace ID (IS)> &
<universal ID (ST)> & <universal ID type (ID)
Subcomponents of assigning facility: <namespace ID (IS)> &
<universal ID (ST)> & <universal ID type (ID)
Definition: This is a code that uniquely identifies the guarantor's employer
when the employer is a person. It may be a user-defined code or a code defined
by a government agency (Federal Tax ID#).
When further breakdowns of employer information are needed, such as a division
or plant, it is recommended that the coding scheme incorporate the
relationships (e.g., define separate codes for each division). The assigning
authority and identifier type code are strongly recommended for all CX data
types.
Components:
<identifier (ST)> ^ <text (ST)> ^ <name of coding system
(IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^
<name of alternate coding system (IS)>
Definition: This field contains the marital status of the guarantor. Refer
to User-defined Table 0002 - Marital status for suggested values.
Definition: This field contains the date that the guarantor's employment began.
Definition: This field indicates the date on which the guarantor's employment with a particular employer ended.
Definition:
Identifies the specific living conditions of the guarantor. Refer to
User-defined Table 0223 - Living dependency for suggested values.
Value |
Description |
|---|---|
D |
Spouse dependent |
M |
Medical Supervision Required |
S |
Small children |
WU |
Walk up |
CB |
Common Bath |
Definition: Identifies the transient state of mobility for the guarantor. Refer to User-defined Table 0009 - Ambulatory status for suggested values.
Components:
<identifier (ST)> ^ <text (ST)> ^ <name of coding system
(IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^
<name of alternate coding system (IS)>
Definition: This field contains the code to identify the guarantor's
citizenship. HL7 recommends using ISO table 3166 as the suggested values in
User-defined Table 0171 - Citizenship.
Value |
Description |
|---|---|
No suggested values defined |
Components:
<identifier (ST)> ^ <text (ST)> ^ <name of coding system
(IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^
<name of alternate coding system (IS)>
Definition: This field identifies the guarantor's primary speaking language.
HL7 recommends using ISO table 639 as the suggested values in User-defined
Table 0296 - Primary language.
Value |
Description |
|---|---|
No suggested values defined |
Definition:
This field identifies the situation in which the person lives at his
residential address. Refer to User-defined Table 0220 - Living
arrangement for suggested values.
Value |
Description |
|---|---|
A |
Alone |
F |
Family |
I |
Institution |
R |
Relative |
U |
Unknown |
S |
Spouse Only |
Components:
<identifier (ST)> ^ <text (ST)> ^ <name of coding system
(IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^
<name of alternate coding system (IS)>
Definition: This field contains a user-defined code indicating what level of
publicity is allowed (e.g., No Publicity, Family Only) for a guarantor. Refer
to User-defined Table 0215 - Publicity code for suggested values.
Value |
Description |
|---|---|
No suggested values defined |
Definition:
This field identifies the guarantor's protection, which determines whether or
not access to information about this enrollee should be restricted from users
who do not have adequate authority. Refer to HL7 table 0136 - Yes/no
indicator for valid values.
Y restrict access
N do not restrict access
Definition:
This field indicates whether the guarantor is currently a student, and whether
the guarantor is a full-time or part-time student. This field does not
indicate the degree level (high school, college) of the student, or his/her
field of study (accounting, engineering, etc.). Refer to
User-defined Table 0231- Student status for suggested values.
Values |
Description |
|---|---|
F |
Full-time student |
P |
Part-time student |
N |
Not a student |
Components:
<identifier (ST)> ^ <text (ST)> ^ <name of coding system
(IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^
<name of alternate coding system (IS)>
Definition: This field indicates the type of religion practiced by the
guarantor. Refer to User-defined Table 0006 - Religion for suggested
values.
Components:
In Version 2.3, replaces the PN data type. <family name (FN)> ^
<given name (ST)> ^ <second and further given names or initials
thereof (ST)> ^ <suffix (e.g., JR or III) (ST)> ^ <prefix (e.g.,
DR) (ST)> ^ <degree (e.g., MD) (IS)> ^ <name type code (ID)
> ^ <name representation code (ID)> ^ <name context (CE)> ^
<name validity range (DR)> ^ <name assembly order (ID)>
Subcomponents of family name: <family name (ST)> & <own family
name prefix (ST)> & <own family name (ST)> & <family name
prefix from partner/spouse (ST)> & <family name from partner/spouse
(ST)>
Definition: This field indicates the guarantor's mother's maiden name.
Components:
<identifier (ST)> ^ <text (ST)> ^ <name of coding system
(IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^
<name of alternate coding system (IS)>
Definition: This field contains a code that identifies the nation or national
grouping to which the person belongs. This may be different from a person's
citizenship in countries in which multiple nationalities are recognized (for
example, Spain: Basque, Catalan, etc.). HL7 recommends using ISO table 3166 as
suggested values in User-defined Table 0212 - Nationality.
Value |
Description |
|---|---|
No suggested values defined |
Components:
<identifier (ST)> ^ <text (ST)> ^ <name of coding system
(IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^
<name of alternate coding system (IS)>
Definition: This field contains the guarantor's ethnic group. Refer to
User-defined Table 0189 - Ethnic group for suggested values. The second
triplet of the CE data type for ethnic group (alternate identifier, alternate
text, and name of alternate coding system) is reserved for governmentally
assigned codes. In the US, a current use is to report ethnicity in line with US
federal standards for Hispanic origin.
Components:
In Version 2.3, replaces the PN data type. <family name (FN)> ^
<given name (ST)> ^ <second and further given names or initials
thereof (ST)> ^ <suffix (e.g., JR or III) (ST)> ^ <prefix (e.g.,
DR) (ST)> ^ <degree (e.g., MD) (IS)> ^ <name type code (ID)
> ^ <name representation code (ID)> ^ <name context (CE)> ^
<name validity range (DR)> ^ <name assembly order (ID)>
Subcomponents of family name: <family name (ST)> & <own family
name prefix (ST)> & <own family name (ST)> & <family name
prefix from partner/spouse (ST)> & <family name from partner/spouse
(ST)>
Definition: This field contains the name of the person who should be contacted
regarding the guarantor bills, etc. This may be someone other than the
guarantor. (Contact guarantor's wife regarding all bills - guarantor lives out
of country).
This is a repeating field that allows for multiple names for the same person.
The legal name is assumed to be in the first repetition. When the legal name
is not sent, a repeat delimiter must be sent first for the first repetition.
Components:
[NNN] [(999)]999-9999 [X99999] [B99999] [C any text] ^
<telecommunication use code (ID)> ^ <telecommunication equipment type
(ID)> ^ <email address (ST)> ^ <country code (NM)> ^
<area/city code (NM)> ^ <phone number (NM)> ^ <extension
(NM)> ^ <any text (ST)>
Definition: This field contains the telephone number of the guarantor (person)
to contact regarding guarantor bills, etc. Multiple phone numbers for that
person may be sent in this sequence. The primary telephone number is assumed
to be in the first repetition. When the primary telephone number is not sent,
a repeat delimiter must be sent first for the first repetition.
Components:
<identifier (ST)> ^ <text (ST)> ^ <name of coding system
(IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^
<name of alternate coding system (IS)>
Definition: This field contains a user-defined code that identifies the reason
for contacting the guarantor, for example, to phone the guarantor if payments
are late. Refer to User-defined Table 0222 - Contact reason for
suggested values.
Value |
Description |
|---|---|
No suggested values defined |
Definition: Identifies the guarantor relationship to the contact person specified above. Refer to User-defined Table 0063 - Relationship for suggested values. Examples include wife, attorney, power of attorney, self, and organization.
Definition: This field contains a descriptive name of the guarantor's occupation (e.g., Sr. Systems Analyst, Sr. Accountant).
Components:
<job code (IS)> ^ <job class (IS)>
Definition: This field contains the guarantor's job code and employee
classification. Refer to User-defined Table 0327 - Job code/class and
User-defined Table 0328 - Employee classification for suggested values.
Value |
Description |
|---|---|
No suggested values defined |
Value |
Description |
|---|---|
No suggested values defined |
Components:
<organization name (ST)> ^ <organization name type code (ID)> ^
<ID number (ID)> ^ <check digit (NM)> ^ < check digit scheme
(ID)> ^ <assigning authority (HD)> ^ <identifier type code (ID)>
^ <assigning facility ID (HD)> ^ <name representation code
(ID)>
Subcomponents of assigning authority: <namespace ID (IS)> &
<universal ID (ST)> & <universal ID type (ID)
Subcomponents of assigning facility: <namespace ID (IS)> &
<universal ID (ST)> & <universal ID type (ID)
Definition: This field contains the name of the guarantor's employer when the
guarantor's employer is an organization. When the guarantor's employer is a
person, use GT1-16 - guarantor employer name. Multiple names for the
same guarantor may be sent in this field. The legal name is assumed to be in
the first repetition. When the legal name is not sent, a repeat delimiter must
be sent first for the first repetition.
Definition:
This field contains a code to describe the guarantor's disability. Refer to
User-defined Table 0295 - Handicap for suggested values.
Value |
Description |
|---|---|
No suggested values defined |
Definition:
This field contains a code that identifies the guarantor's current job status.
Refer to User-defined Table 0311 - Job status for suggested values.
Values |
Description |
|---|---|
P |
Permanent |
T |
Temporary |
O |
Other |
U |
Unknown |
Components:
<financial class (IS)> ^ <effective date (TS)>
Definition: This field contains
the
financial class (FC) assigned to the guarantor for the purpose of identifying
sources of reimbursement. It can be different than that of the patient. When
the FC of the guarantor is different than the FC of the patient, and the
guarantor's coverage for that patient has been exhausted, the source of
reimbursement falls back onto the FC of the patient. Refer to User-defined
Table 0064 - Financial class for suggested values.
Components:
<identifier (ST)> ^ <text (ST)> ^ <name of coding system
(IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^
<name of alternate coding system (IS)>
Definition: This field refers to the guarantor's race. Refer to
User-defined Table 0005 - Race for suggested values. The second triplet
of the CE data type for race (alternate identifier, alternate text, and name of
alternate coding system) is reserved for governmentally assigned codes.
The
IN1 segment contains insurance policy coverage information necessary to produce
properly pro-rated patient and insurance bills.
SEQ |
LEN |
DT |
OPT |
RP/# |
TBL# |
ITEM# |
ELEMENT NAME |
|---|---|---|---|---|---|---|---|
1 |
4 |
SI |
R |
00426 |
Set ID - IN1 |
||
2 |
250 |
CE |
R |
0072 |
00368 |
Insurance Plan ID |
|
3 |
250 |
CX |
R |
Y |
00428 |
Insurance Company ID |
|
4 |
250 |
XON |
O |
Y |
00429 |
Insurance Company Name |
|
5 |
250 |
XAD |
O |
Y |
00430 |
Insurance Company Address |
|
6 |
250 |
XPN |
O |
Y |
00431 |
Insurance Co Contact Person |
|
7 |
250 |
XTN |
O |
Y |
00432 |
Insurance Co Phone Number |
|
8 |
12 |
ST |
O |
00433 |
Group Number |
||
9 |
250 |
XON |
O |
Y |
00434 |
Group Name |
|
10 |
250 |
CX |
O |
Y |
00435 |
Insured's Group Emp ID |
|
11 |
250 |
XON |
O |
Y |
00436 |
Insured's Group Emp Name |
|
12 |
8 |
DT |
O |
00437 |
Plan Effective Date |
||
13 |
8 |
DT |
O |
00438 |
Plan Expiration Date |
||
14 |
250 |
CM |
O |
00439 |
Authorization Information |
||
15 |
3 |
IS |
O |
0086 |
00440 |
Plan Type |
|
16 |
250 |
XPN |
O |
Y |
00441 |
Name Of Insured |
|
17 |
250 |
CE |
O |
0063 |
00442 |
Insured's Relationship To Patient |
|
18 |
26 |
TS |
O |
00443 |
Insured's Date Of Birth |
||
19 |
250 |
XAD |
O |
Y |
00444 |
Insured's Address |
|
20 |
2 |
IS |
O |
0135 |
00445 |
Assignment Of Benefits |
|
21 |
2 |
IS |
O |
0173 |
00446 |
Coordination Of Benefits |
|
22 |
2 |
ST |
O |
00447 |
Coord Of Ben. Priority |
||
23 |
1 |
ID |
O |
0136 |
00448 |
Notice Of Admission Flag |
|
24 |
8 |
DT |
O |
00449 |
Notice Of Admission Date |
||
25 |
1 |
ID |
O |
0136 |
00450 |
Report Of Eligibility Flag |
|
26 |
8 |
DT |
O |
00451 |
Report Of Eligibility Date |
||
27 |
2 |
IS |
O |
0093 |
00452 |
Release Information Code |
|
28 |
15 |
ST |
O |
00453 |
Pre-Admit Cert (PAC) |
||
29 |
26 |
TS |
O |
00454 |
Verification Date/Time |
||
30 |
250 |
XCN |
O |
Y |
00455 |
Verification By |
|
31 |
2 |
IS |
O |
0098 |
00456 |
Type Of Agreement Code |
|
32 |
2 |
IS |
O |
0022 |
00457 |
Billing Status |
|
33 |
4 |
NM |
O |
00458 |
Lifetime Reserve Days |
||
34 |
4 |
NM |
O |
00459 |
Delay Before L.R. Day |
||
35 |
8 |
IS |
O |
0042 |
00460 |
Company Plan Code |
|
36 |
15 |
ST |
O |
00461 |
Policy Number |
||
37 |
12 |
CP |
O |
00462 |
Policy Deductible |
||
38 |
12 |
CP |
B |
00463 |
Policy Limit - Amount |
||
39 |
4 |
NM |
O |
00464 |
Policy Limit - Days |
||
40 |
12 |
CP |
B |
00465 |
Room Rate - Semi-Private |
||
41 |
12 |
CP |
B |
00466 |
Room Rate - Private |
||
42 |
250 |
CE |
O |
0066 |
00467 |
Insured's Employment Status |
|
43 |
1 |
IS |
O |
0001 |
00468 |
Insured's Administrative Sex |
|
44 |
250 |
XAD |
O |
Y |
00469 |
Insured's Employer's Address |
|
45 |
2 |
ST |
O |
00470 |
Verification Status |
||
46 |
8 |
IS |
O |
0072 |
00471 |
Prior Insurance Plan ID |
|
47 |
3 |
IS |
O |
0309 |
01227 |
Coverage Type |
|
48 |
2 |
IS |
O |
0295 |
00753 |
Handicap |
|
49 |
250 |
CX |
O |
Y |
01230 |
Insured's ID Number |
Definition: IN1-1 - set ID contains the number that identifies this transaction. For the first occurrence the sequence number shall be 1, for the second occurrence it shall be 2, etc. The Set ID in the IN1 segment is used to aggregate the grouping of insurance segments. For example, a patient with two insurance plans would have two groupings of insurance segments. IN1, IN2, and IN3 segments for Insurance Plan A with set ID 1, followed by IN1, IN2, and IN3 segments for Insurance Plan B, with set ID 2. There is no set ID in the IN2 segment because it is contained in the IN1, IN2, IN3 grouping, and is therefore not needed. The set ID in the IN3 segment is provided because there can be multiple repetitions of the IN3 segment if there are multiple certifications for the same insurance plan, e.g., IN1 (Set ID 1), IN2, IN3 (Set ID 1), IN3 (Set ID 2), IN3 (Set ID 3)
Components:
<identifier (ST)> ^ <text (ST)> ^ <name of coding system
(IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^
<name of alternate coding system (IS)>
Definition: This field contains a unique identifier for the insurance plan.
Refer to User-defined Table 0072 - Insurance plan ID for suggested
values. To eliminate a plan, the plan could be sent with null values in each
subsequent element. If the respective systems can support it, a null value can
be sent in the plan field.
Components:
<ID (ST)> ^ <check digit (ST)> ^ <code identifying the check
digit scheme employed (ID)> ^ < assigning authority (HD)> ^
<identifier type code (ID)> ^ < assigning facility (HD) ^
<effective date (DT)> ^ <expiration date (DT)>
Subcomponents of assigning authority: <namespace ID (IS)> &
<universal ID (ST)> & <universal ID type (ID)
Subcomponents of assigning facility: <namespace ID (IS)> &
<universal ID (ST)> & <universal ID type (ID)
Definition: This field contains unique identifiers for the insurance company.
The assigning authority and identifier type code are strongly recommended for
all CX data types.
Components:
<organization name (ST)> ^ <organization name type code (ID)> ^
<ID number (ID)> ^ <check digit (NM)> ^ < check digit scheme
(ID)> ^ <assigning authority (HD)> ^ <identifier type code (ID)>
^ <assigning facility ID (HD)> ^ <name representation code
(ID)>
Subcomponents of assigning authority: <namespace ID (IS)> &
<universal ID (ST)> & <universal ID type (ID)
Subcomponents of assigning facility: <namespace ID (IS)> &
<universal ID (ST)> & <universal ID type (ID)
Definition: This field contains the name of the insurance company. Multiple
names for the same insurance company may be sent in this field. The legal name
is assumed to be in the first repetition. When the legal name is not sent, a
repeat delimiter must be sent first for the first repetition.
Components:
In Version 2.3 and later, replaces the AD data type. <street address
(ST)> ^ <other designation (ST)> ^ <city (ST)> ^ <state or
province (ST)> ^ <zip or postal code (ST)> ^ <country (ID)> ^
< address type (ID)> ^ <other geographic designation (ST)>
^ <county/parish code (IS)> ^ <census tract (IS)> ^
<address representation code (ID)> ^ <address validity range
(DR)>
Subcomponents of street address: <street address (ST)> &
<street name (ST)> & <dwelling number (ST)>
Definition: This field contains the address of the insurance company.
Multiple addresses for the same insurance company may be sent in this field.
The mailing address is assumed to be in the first repetition. When the mailing
address is not sent, a repeat delimiter must be sent first for the first
repetition.
Components:
In Version 2.3, replaces the PN data type. <family name (FN)> ^
<given name (ST)> ^ <second and further given names or initials
thereof (ST)> ^ <suffix (e.g., JR or III) (ST)> ^ <prefix (e.g.,
DR) (ST)> ^ <degree (e.g., MD) (IS)> ^ <name type code (ID)
> ^ <name representation code (ID)> ^ <name context (CE)> ^
<name validity range (DR)> ^ <name assembly order (ID)>
Subcomponents of family name: <family name (ST)> & <own family
name prefix (ST)> & <own family name (ST)> & <family name
prefix from partner/spouse (ST)> & <family name from partner/spouse
(ST)>
Definition: This field contains the name of the person who should be contacted
at the insurance company. Multiple names for the same contact person may be
sent in this field. The legal name is assumed to be in the first repetition.
When the legal name is not sent, a repeat delimiter must be sent first for the
first repetition.
Components:
[NNN] [(999)]999-9999 [X99999] [B99999] [C any text] ^ <telecommunication
use code (ID)> ^ <telecommunication equipment type (ID)> ^ <email
address (ST)> ^ <country code (NM)> ^ <area/city code (NM)> ^
<phone number (NM)> ^ <extension (NM)> ^ <any text
(ST)>
Definition: This field contains the phone number of the insurance company.
Multiple phone numbers for the same insurance company may be sent in this
field. The primary phone number is assumed to be in the first repetition.
When the primary phone number is not sent, a repeat delimiter must be sent
first for the first repetition.
Definition: This field contains the group number of the insured's insurance.
Components:
<organization name (ST)> ^ <organization name type code (ID)> ^
<ID number (ID)> ^ <check digit (NM)> ^ < check digit scheme
(ID)> ^ <assigning authority (HD)> ^ <identifier type code (ID)>
^ <assigning facility ID (HD)> ^ <name representation code
(ID)>
Subcomponents of assigning authority: <namespace ID (IS)> &
<universal ID (ST)> & <universal ID type (ID)
Subcomponents of assigning facility: <namespace ID (IS)> &
<universal ID (ST)> & <universal ID type (ID)
Definition: This field contains the group name of the insured's insurance.
Components:
<ID (ST)> ^ <check digit (ST)> ^ <code identifying the check
digit scheme employed (ID)> ^ < assigning authority (HD)> ^
<identifier type code (ID)> ^ < assigning facility (HD) ^
<effective date (DT)> ^ <expiration date (DT)>
Subcomponents of assigning authority: <namespace ID (IS)> &
<universal ID (ST)> & <universal ID type (ID)
Subcomponents of assigning facility: <namespace ID (IS)> &
<universal ID (ST)> & <universal ID type (ID)
Definition: This field holds the group employer ID for the insured's
insurance. The assigning authority and identifier type code are strongly
recommended for all CX data types.
Components:
<organization name (ST)> ^ <organization name type code (ID)> ^
<ID number (ID)> ^ <check digit (NM)> ^ < check digit scheme
(ID)> ^ <assigning authority (HD)> ^ <identifier type code (ID)>
^ <assigning facility ID (HD)> ^ <name representation code
(ID)>
Subcomponents of assigning authority: <namespace ID (IS)> &
<universal ID (ST)> & <universal ID type (ID)
Subcomponents of assigning facility: <namespace ID (IS)> &
<universal ID (ST)> & <universal ID type (ID)
Definition: This field contains the name of the employer that provides the
employee's insurance. Multiple names for the same employer may be sent in this
sequence. The legal name must be sent first. When the legal name is not sent,
a repeat delimiter must be sent first for the first repetition.
Definition: This field contains the date that the insurance goes into effect.
Definition: This field indicates the last date of service that the insurance will cover or be responsible for.
Components:
<authorization number (ST)> ^ <date (DT)> ^ <source
(ST)>
Definition: Based on the type of insurance, some coverage plans require that
an authorization number or code be obtained prior to all non-emergency
admissions, and within 48 hours of an emergency admission. Insurance billing
would not be permitted without this number. The date and source of
authorization are the components of this field.
Definition:
This field contains the coding structure that identifies the various plan
types, for example, Medicare, Medicaid, Blue Cross, HMO, etc. Refer to
User-defined Table 0086 - Plan ID for suggested values.
Value |
Description |
|---|---|
No suggested values defined |
Components:
In Version 2.3, replaces the PN data type. <family name (FN)> ^
<given name (ST)> ^ <second and further given names or initials
thereof (ST)> ^ <suffix (e.g., JR or III) (ST)> ^ <prefix (e.g.,
DR) (ST)> ^ <degree (e.g., MD) (IS)> ^ <name type code (ID)
> ^ <name representation code (ID)> ^ <name context (CE)> ^
<name validity range (DR)> ^ <name assembly order (ID)>
Subcomponents of family name: <family name (ST)> & <own family
name prefix (ST)> & <own family name (ST)> & <family name
prefix from partner/spouse (ST)> & <family name from partner/spouse
(ST)>
Definition: This field contains the name of the insured person. The insured
is the person who has an agreement with the insurance company to provide
healthcare services to persons covered by the insurance policy. Multiple names
for the same insured person may be sent in this field. The legal name is
assumed to be in the first repetition. When the legal name is not sent, a
repeat delimiter must be sent first for the first repetition.
Components:
<identifier (ST)> ^ <text (ST)> ^ <name of coding system
(IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^
<name of alternate coding system (IS)>
Definition: This field indicates the insured's relationship to the patient.
Refer to User-defined Table 0063 - Relationship for suggested values.
Definition: This field contains the date of birth of the insured.
Components:
<street address (ST)> ^ <other designation (ST)> ^ <city
(ST)> ^ <state or province (ST)> ^ <zip or postal code(ST)> ^
<country (ID)> ^ < address type (ID)> ^ <other
geographic designation (ST)> ^ <county/parish code (IS)> ^
<census tract (IS)> ^ <address representation code (ID)> ^
<address validity range (DR)>
Subcomponents of street address: <street address (ST)> &
<street name (ST)> & <dwelling number (ST)>
Definition: This field contains the address of the insured person. The
insured is the person who has an agreement with the insurance company to
provide healthcare services to persons covered by an insurance policy.
Multiple addresses for the same insured person may be in this field. The
mailing address must be sent in the first repetition. When the legal name is
not sent, a repeat delimiter must be sent first for the first repetition.
Definition:
This field indicates whether the insured agreed to assign the insurance
benefits to the healthcare provider. If so, the insurance will pay the
provider directly. Refer to User-defined Table 0135 - Assignment of
benefits for suggested values.
Value |
Description |
|---|---|
Y |
Yes |
N |
No |
M |
Modified assignment |
Definition:
This field indicates whether this insurance works in conjunction with other
insurance plans, or if it provides independent coverage and payment of benefits
regardless of other insurance that might be available to the patient. Refer to
User-defined Table 0173 - Coordination of benefits for suggested values.
Value |
Description |
|---|---|
CO |
Coordination |
IN |
Independent |
Definition: If the insurance works in conjunction with other insurance plans, this field contains priority sequence. Values are: 1, 2, 3, etc.
Definition: This field indicates whether the insurance company requires a written notice of admission from the healthcare provider. Refer to HL7 table 0136 - Yes/no indicator for valid values.
Definition: If a notice is required, this field indicates the date that it was sent.
Definition: This field indicates whether this insurance carrier sends a report that indicates that the patient is eligible for benefits and whether it identifies those benefits. Refer to HL7 table 0136 - Yes/no indicator for valid values.
Definition: This field indicates whether a report of eligibility (ROE) was received, and also indicates the date that it was received.
Definition:
This field indicates whether the healthcare provider can release information
about the patient, and what information can be released. Refer to
User-defined Table 0093 - Release information for suggested values.
Value |
Description |
|---|---|
Y |
Yes |
N |
No |
... |
user-defined codes |
Definition: This field contains the pre-admission certification code. If the admission must be certified before the admission, this is the code associated with the admission.
Definition: This field contains the date/time that the healthcare provider verified that the patient has the indicated benefits.
Components:
<ID number (ST)> ^ <family name (ST)> ^ <given name (ST)> ^
<middle initial or name (ST)> ^ <suffix (e.g., JR or III) (ST)> ^
<prefix (e.g., DR) (ST)> ^ <degree (e.g., MD) (IS)> ^ <source
table (IS)> ^ <assigning authority (HD)> ^ <name type code(ID)>
^ <identifier check digit (ST)> ^ <code identifying the check digit
scheme employed (ID)> ^ <identifier type code (IS)> ^ <assigning
facility (HD)>^ <name representation code (ID)> ^ <name context
(CE)> ^ <name validity range (DR)>
Subcomponents of family name: <family name (ST)> & <own family
name prefix (ST)> & <own family name (ST)> & <family name
prefix from partner/spouse (ST)> & <family name from partner/spouse
(ST)>
Subcomponents of assigning authority: <namespace ID (IS)> &
<universal ID (ST)> & <universal ID type (ID)
Subcomponents of assigning facility: <namespace ID (IS)> &
<universal ID (ST)> & <universal ID type (ID)
Definition: Refers to the person who verified the benefits. Multiple names
for the same insured person may be sent in this field. The legal name is
assumed to be in the first repetition. When the legal name is not sent, a
repeat delimiter must be sent first for the first repetition.
Definition:
This field is used to further identify an insurance plan. Refer to
User-defined Table 0098 - Type of agreement for suggested values.
Value |
Description |
|---|---|
S |
Standard |
U |
Unified |
M |
Maternity |
Definition:
This field indicates whether the particular insurance has been billed and, if
so, the type of bill. Refer to User-defined Table 0022 - Billing status
for suggested values.
Value |
Description |
|---|---|
No suggested values defined |
Definition: This field contains the number of days left for a certain service to be provided or covered under an insurance policy.
Definition: This field indicates the delay before lifetime reserve days.
Definition:
This field contains optional information to further define the data in IN1-3
- insurance company ID. Refer to User-defined Table 0042 - Company plan
code for suggested values. This table contains codes used to identify an
insurance company plan uniquely.
Value |
Description |
|---|---|
No suggested values defined |
Definition: This field contains the individual policy number of the insured to uniquely identify this patient's plan. For special types of insurance numbers, there are also special fields in the IN2 segment for Medicaid, Medicare, Champus (i.e., IN2-8 - Medicaid case number, IN2-6 - Medicare health ins card number, IN2-10 - Military ID number). But we recommend that this field (IN1-36 - policy number) be filled even when the patient's insurance number is also passed in one of these other fields.
Components:
<price (MO)> ^ <price type (ID)> ^ <from value (NM)> ^
<to value (NM)> ^ <range units (CE)> ^ <range type
(ID)>
Subcomponents of price: <quantity (NM)> & <denomination
(ID)>
Subcomponents of range units: <identifier (ST)> & <text
(ST)> & <name of coding system (IS)> & <alternate
identifier (ID)> & <alternate text (ST)> & <name of
alternate coding system (ST)>
Definition: This field contains the amount specified by the insurance plan
that is the responsibility of the guarantor (i.e. deductible, excess, etc.).
Components:
<price (MO)> ^ <price type (ID)> ^ <from value (NM)> ^
<to value (NM)> ^ <range units (CE)> ^ <range type
(ID)>
Subcomponents of price: <quantity (NM)> & <denomination
(ID)>
Subcomponents of range units: <identifier (ST)> & <text
(ST)> & <name of coding system (IS)> & <alternate
identifier (ID)> & <alternate text (ST)> & <name of
alternate coding system (ST)>
Definition: This field has been retained for backward compatibility
only. Use IN2-29 policy type/amount instead of this field. This field
contains the maximum amount that the insurance policy will pay. In some cases,
the limit may be for a single encounter.
Definition: This field contains the maximum number of days that the insurance policy will cover.
Components:
<price (MO)> ^ <price type (ID)> ^ <from value (NM)> ^
<to value (NM)> ^ <range units (CE)> ^ <range type
(ID)>
Subcomponents of price: <quantity (NM)> & <denomination
(ID)>
Subcomponents of range units: <identifier (ST)> & <text
(ST)> & <name of coding system (IS)> & <alternate
identifier (ID)> & <alternate text (ST)> & <name of
alternate coding system (ST)>
Definition: This field has been retained for backward compatibility
only. Use IN2-28 - room coverage type/amount instead of this
field. When used for backward compatibility, IN1-40 - room
rate-semi-private contains the average room rate that the policy covers.
Components:
<price (MO)> ^ <price type (ID)> ^ <from value (NM)> ^
<to value (NM)> ^ <range units (CE)> ^ <range type
(ID)>
Subcomponents of price: <quantity (NM)> & <denomination
(ID)>
Subcomponents of range units: <identifier (ST)> & <text
(ST)> & <name of coding system (IS)> & <alternate
identifier (ID)> & <alternate text (ST)> & <name of
alternate coding system (ST)>
Definition: This field has been retained for backward compatibility
only. Use IN2-28 - room coverage type/amount instead of this
field. When used for backward compatibility IN1-41 - room rate-private
contains the maximum private room rate that the policy covers.
Components:
<identifier (ST)> ^ <text (ST)> ^ <name of coding system
(IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^
<name of alternate coding system (IS)>
Definition: This field holds the employment status of the insured. Refer to
User-defined Table 0066 - Employment status for suggested values. This
field contains UB92 field 64. For this field element, values from the US HCFA
UB92 and others are used.
Value |
Description |
|---|---|
1 |
Full time employed |
2 |
Part time employed |
4 |
Self-employed, |
C |
Contract, per diem |
L |
Leave of absence (e.g. Family leave, sabbatical, etc.) |
T |
Temporarily unemployed |
3 |
Unemployed |
5 |
Retired |
6 |
On active military duty |
O |
Other |
9 |
Unknown |
Definition: This field contains the gender of the insured. Refer to User-defined Table 0001 - Administrative sex for suggested values.
Components:
<street address (ST)> ^ <other designation (ST)> ^ <city
(ST)> ^ <state or province (ST)> ^ <zip or postal code(ST)> ^
<country (ID)> ^ < address type (ID)> ^ <other
geographic designation (ST)> ^ <county/parish code (IS)> ^
<census tract (IS)> ^ <address representation code (ID)> ^
<address validity range (DR)>
Subcomponents of street address: <street address (ST)> &
<street name (ST)> & <dwelling number (ST)>
Definition: This field contains the address of the insured employee's
employer. Multiple addresses for the same employer may be sent in this field.
The mailing address must be sent first. When the mailing address is not sent,
a repeat delimiter must be sent first for the first repetition.
Definition: This field contains the status of this patient's relationship with this insurance carrier.
Definition: This field uniquely identifies the prior insurance plan when the plan ID changes. Refer to User-defined Table 0072 - Insurance plan ID for suggested values.
Definition:
This field contains the coding structure that identifies the type of insurance
coverage, or what types of services are covered for the purposes of a billing
system. For example, a physician billing system will only want to receive
insurance information for plans that cover physician/professional charges.
Refer to User-defined Table 0309 - Coverage type for suggested values.
Value |
Description |
|---|---|
H |
Hospital/institutional |
P |
Physician/professional |
B |
Both hospital and physician |
Definition: This field contains a code to describe the insured's disability. Refer to User-defined Table 0295 - Handicap for suggested values.
Components:
<ID (ST)> ^ <check digit (ST)> ^ <code identifying the check
digit scheme employed (ID)> ^ < assigning authority (HD)> ^
<identifier type code (ID)> ^ < assigning facility (HD) ^
<effective date (DT)> ^ <expiration date (DT)>
Subcomponents of assigning authority: <namespace ID (IS)> &
<universal ID (ST)> & <universal ID type (ID)
Subcomponents of assigning facility: <namespace ID (IS)> &
<universal ID (ST)> & <universal ID type (ID)
Definition: This data element contains a healthcare institution's identifiers
for the insured. The assigning authority and identifier type code are strongly
recommended for all CX data types.
The
IN2 segment contains additional insurance policy coverage and benefit
information necessary for proper billing and reimbursement. Fields used by
this segment are defined by HCFA or other regulatory agencies.
SEQ |
LEN |
DT |
OPT |
RP/# |
TBL# |
ITEM# |
ELEMENT NAME |
|---|---|---|---|---|---|---|---|
1 |
250 |
CX |
O |
Y |
00472 |
Insured's Employee ID |
|
2 |
11 |
ST |
O |
00473 |
Insured's Social Security Number |
||
3 |
250 |
XCN |
O |
Y |
00474 |
Insured's Employer's Name and ID |
|
4 |
1 |
IS |
O |
0139 |
00475 |
Employer Information Data |
|
5 |
1 |
IS |
O |
Y |
0137 |
00476 |
Mail Claim Party |
6 |
15 |
ST |
O |
00477 |
Medicare Health Ins Card Number |
||
7 |
250 |
XPN |
O |
Y |
00478 |
Medicaid Case Name |
|
8 |
15 |
ST |
O |
00479 |
Medicaid Case Number |
||
9 |
250 |
XPN |
O |
Y |
00480 |
Military Sponsor Name |
|
10 |
20 |
ST |
O |
00481 |
Military ID Number |
||
11 |
250 |
CE |
O |
0342 |
00482 |
Dependent Of Military Recipient |
|
12 |
25 |
ST |
O |
00483 |
Military Organization |
||
13 |
25 |
ST |
O |
00484 |
Military Station |
||
14 |
14 |
IS |
O |
0140 |
00485 |
Military Service |
|
15 |
2 |
IS |
O |
0141 |
00486 |
Military Rank/Grade |
|
16 |
3 |
IS |
O |
0142 |
00487 |
Military Status |
|
17 |
8 |
DT |
O |
00488 |
Military Retire Date |
||
18 |
1 |
ID |
O |
0136 |
00489 |
Military Non-Avail Cert On File |
|
19 |
1 |
ID |
O |
0136 |
00490 |
Baby Coverage |
|
20 |
1 |
ID |
O |
0136 |
00491 |
Combine Baby Bill |
|
21 |
1 |
ST |
O |
00492 |
Blood Deductible |
||
22 |
250 |
XPN |
O |
Y |
00493 |
Special Coverage Approval Name |
|
23 |
30 |
ST |
O |
00494 |
Special Coverage Approval Title |
||
24 |
8 |
IS |
O |
Y |
0143 |
00495 |
Non-Covered Insurance Code |
25 |
250 |
CX |
O |
Y |
00496 |
Payor ID |
|
26 |
250 |
CX |
O |
Y |
00497 |
Payor Subscriber ID |
|
27 |
1 |
IS |
O |
0144 |
00498 |
Eligibility Source |
|
28 |
250 |
CM |
O |
Y |
0145/ 0146 |
00499 |
Room Coverage Type/Amount |
29 |
250 |
CM |
O |
Y |
0147/ 0193 |
00500 |
Policy Type/Amount |
30 |
250 |
CM |
O |
00501 |
Daily Deductible |
||
31 |
2 |
IS |
O |
0223 |
00755 |
Living Dependency |
|
32 |
2 |
IS |
O |
Y |
0009 |
00145 |
Ambulatory Status |
33 |
250 |
CE |
O |
Y |
0171 |
00129 |
Citizenship |
34 |
250 |
CE |
O |
0296 |
00118 |
Primary Language |
|
35 |
2 |
IS |
O |
0220 |
00742 |
Living Arrangement |
|
36 |
250 |
CE |
O |
0215 |
00743 |
Publicity Code |
|
37 |
1 |
ID |
O |
0136 |
00744 |
Protection Indicator |
|
38 |
2 |
IS |
O |
0231 |
00745 |
Student Indicator |
|
39 |
250 |
CE |
O |
0006 |
00120 |
Religion |
|
40 |
250 |
XPN |
O |
Y |
00109 |
Mother's Maiden Name |
|
41 |
250 |
CE |
O |
0212 |
00739 |
Nationality |
|
42 |
250 |
CE |
O |
Y |
0189 |
00125 |
Ethnic Group |
43 |
250 |
CE |
O |
Y |
0002 |
00119 |
Marital Status |
44 |
8 |
DT |
O |
00787 |
Insured's Employment Start Date |
||
45 |
8 |
DT |
O |
00783 |
Employment Stop Date |
||
46 |
20 |
ST |
O |
00785 |
Job Title |
||
47 |
20 |
JCC |
O |
0327/ 0328 |
00786 |
Job Code/Class |
|
48 |
2 |
IS |
O |
0311 |
00752 |
Job Status |
|
49 |
250 |
XPN |
O |
Y |
00789 |
Employer Contact Person Name |
|
50 |
250 |
XTN |
O |
Y |
00790 |
Employer Contact Person Phone Number |
|
51 |
2 |
IS |
O |
0222 |
00791 |
Employer Contact Reason |
|
52 |
250 |
XPN |
O |
Y |
00792 |
Insured's Contact Person's Name |
|
53 |
250 |
XTN |
O |
Y |
00793 |
Insured's Contact Person Phone Number |
|
54 |
2 |
IS |
O |
Y |
0222 |
00794 |
Insured's Contact Person Reason |
55 |
8 |
DT |
O |
00795 |
Relationship To The Patient Start Date |
||
56 |
8 |
DT |
O |
Y |
00796 |
Relationship To The Patient Stop Date |
|
57 |
2 |
IS |
O |
0232 |
00797 |
Insurance Co. Contact Reason |
|
58 |
250 |
XTN |
O |
00798 |
Insurance Co Contact Phone Number |
||
59 |
2 |
IS |
O |
0312 |
00799 |
Policy Scope |
|
60 |
2 |
IS |
O |
0313 |
00800 |
Policy Source |
|
61 |
250 |
CX |
O |
00801 |
Patient Member Number |
||
62 |
250 |
CE |
O |
0063 |
00802 |
Guarantor's Relationship To Insured |
|
63 |
250 |
XTN |
O |
Y |
00803 |
Insured's Phone Number - Home |
|
64 |
250 |
XTN |
O |
Y |
00804 |
Insured's Employer Phone Number |
|
65 |
250 |
CE |
O |
0343 |
00805 |
Military Handicapped Program |
|
66 |
1 |
ID |
O |
0136 |
00806 |
Suspend Flag |
|
67 |
1 |
ID |
O |
0136 |
00807 |
Copay Limit Flag |
|
68 |
1 |
ID |
O |
0136 |
00808 |
Stoploss Limit Flag |
|
69 |
250 |
XON |
O |
Y |
00809 |
Insured Organization Name And ID |
|
70 |
250 |
XON |
O |
Y |
00810 |
Insured Employer Organization Name And ID |
|
71 |
250 |
CE |
O |
Y |
0005 |
00113 |
Race |
72 |
250 |
CE |
O |
0344 |
00811 |
HCFA Patient's Relationship to Insured |
Components:
<ID (ST)> ^ <check digit (ST)> ^ <code identifying the check
digit scheme employed (ID)> ^ < assigning authority (HD)> ^
<identifier type code (ID)> ^ < assigning facility (HD) ^
<effective date (DT)> ^ <expiration date (DT)>
Subcomponents of assigning authority: <namespace ID (IS)> &
<universal ID (ST)> & <universal ID type (ID)
Subcomponents of assigning facility: <namespace ID (IS)> &
<universal ID (ST)> & <universal ID type (ID)
Definition: This field contains the employee ID of the insured. The assigning
authority and identifier type code are strongly recommended for all CX data
types.
Definition: This field contains the social security number of the insured.
Components:
<ID number (ST)> ^ <family name (ST)> ^ <given name (ST)> ^
<middle initial or name (ST)> ^ <suffix (e.g., JR or III) (ST)> ^
<prefix (e.g., DR) (ST)> ^ <degree (e.g., MD) (IS)> ^ <source
table (IS)> ^ <assigning authority (HD)> ^ <name type code(ID)>
^ <identifier check digit (ST)> ^ <code identifying the check digit
scheme employed (ID)> ^ <identifier type code (IS)> ^ <assigning
facility (HD)>^ <name representation code (ID)> ^ <name context
(CE)> ^ <name validity range (DR)>
Subcomponents of family name: <family name (ST)> & <own family
name prefix (ST)> & <own family name (ST)> & <family name
prefix from partner/spouse (ST)> & <family name from partner/spouse
(ST)>
Subcomponents of assigning authority: <namespace ID (IS)> &
<universal ID (ST)> & <universal ID type (ID)
Subcomponents of assigning facility: <namespace ID (IS)> &
<universal ID (ST)> & <universal ID type (ID)
Definition: This field contains the name and ID of the insured's employer or
the person who purchased the insurance for the insured, if the employer is a
person. Multiple names and identifiers for the same person may be sent in this
field, not multiple persons. The legal name is assumed to be in the first
repetition. When the legal name is not sent, a repeat delimiter must be sent
first for the first repetition. When the employer is an organization use
IN2-70 - Insured employer organization name and ID.
Definition:
This field contains the required employer information data for UB82 form
locator 71. Refer to User-defined Table 0139 - Employer information
data for suggested values.
Value |
Description |
|---|---|
No suggested values defined |
Definition:
This field contains the party to which the claim should be mailed. Refer to
User-defined Table 0137 - Mail claim party for suggested values.
Value |
Description |
|---|---|
E |
Employer |
G |
Guarantor |
I |
Insurance company |
O |
Other |
P |
Patient |
Definition: This field contains the Medicare Health Insurance Number (HIN), defined by HCFA or other regulatory agencies.
Components:
In Version 2.3, replaces the PN data type. <family name (FN)> ^
<given name (ST)> ^ <second and further given names or initials
thereof (ST)> ^ <suffix (e.g., JR or III) (ST)> ^ <prefix (e.g.,
DR) (ST)> ^ <degree (e.g., MD) (IS)> ^ <name type code (ID)
> ^ <name representation code (ID)> ^ <name context (CE)> ^
<name validity range (DR)> ^ <name assembly order (ID)>
Subcomponents of family name: <family name (ST)> & <own family
name prefix (ST)> & <own family name (ST)> & <family name
prefix from partner/spouse (ST)> & <family name from partner/spouse
(ST)>
Definition: This field contains the Medicaid case name, defined by HCFA or
other regulatory agencies. Multiple names for the same person may be sent in
this field. The legal name is assumed to be in the first repetition. When the
legal name is not sent, a repeat delimiter must be sent first for the first
repetition.
Definition: This field contains the Medicaid case number, defined by HCFA or other regulatory agencies, which uniquely identifies a patient's Medicaid policy.
Components:
In Version 2.3, replaces the PN data type. <family name (FN)> ^
<given name (ST)> ^ <second and further given names or initials
thereof (ST)> ^ <suffix (e.g., JR or III) (ST)> ^ <prefix (e.g.,
DR) (ST)> ^ <degree (e.g., MD) (IS)> ^ <name type code (ID)
> ^ <name representation code (ID)> ^ <name context (CE)> ^
<name validity range (DR)> ^ <name assembly order (ID)>
Subcomponents of family name: <family name (ST)> & <own family
name prefix (ST)> & <own family name (ST)> & <family name
prefix from partner/spouse (ST)> & <family name from partner/spouse
(ST)>
Definition: This field is defined by HCFA or other regulatory agencies.
Multiple names for the same person may be sent in this field. The legal name
is assumed to be in the first repetition. When the legal name is not sent, a
repeat delimiter must be sent first for the first repetition.
Definition: This field contains the military ID number, defined by HCFA or other regulatory agencies, which uniquely identifies a patient's military policy.
Components:
<identifier (ST)> ^ <text (ST)> ^ <name of coding system
(IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^
<name of alternate coding system (IS)>
Definition: This field is defined by HCFA or other regulatory agencies. Refer
to User-defined Table 0342 - Military recipient for suggested
values.
Value |
Description |
|---|---|
No suggested values defined |
Definition: This field is defined by HCFA or other regulatory agencies.
Definition: This field is defined by HCFA or other regulatory agencies.
Definition:
This field is defined by HCFA or other regulatory agencies and refers to the
military branch of service. Refer to User-defined Table 0140 - Military
service for suggested values. The UB codes listed may not represent a
complete list; refer to a UB specification for additional information.
Value |
Description |
|---|---|
USA |
U.S. Army |
USN |
U.S. Navy |
USAF |
U.S. Air Force |
USMC |
U.S. Marines |
USCG |
U.S. Coast Guard |
USPHS |
U.S. Public Health Service |
NOAA |
National Oceanic and Atmospheric Administration |
NATO |
North Atlantic Treaty Organization |
AUSA |
Australian Army |
AUSN |
Australian Navy |
AUSAF |
Australian Air Force |
Definition:
This user-defined field identifies the military rank/grade of the insured.
Refer to User-defined Table 0141 - Military rank/grade for suggested
values. The UB codes listed may not represent a complete list; refer to a UB
specification for additional information
Value |
Description |
|---|---|
E1 ... E9 |
Enlisted |
O1 ... O10 |
Officers |
W1 ... W4 |
Warrant Officers |
Definition:
This field is defined by HCFA or other regulatory agencies. Refer to
User-defined Table 0142 - Military status for suggested values. The UB
codes listed may not represent a complete list; refer to a UB specification for
additional information
Value |
Description |
|---|---|
ACT |
Active duty |
RET |
Retired |
DEC |
Deceased |
Definition: This field is defined by HCFA or other regulatory agencies.
Definition: Refer to HL7 table 0136 - Yes/no indicator for valid values.
Definition: Refer to HL7 table 0136 - Yes/no indicator for valid values.
Definition: Refer to HL7 table 0136 - Yes/no indicator for valid values.
Definition: Use this field instead of UB1-2 - blood deductible, as the blood deductible can be associated with the specific insurance plan via this field.
Components:
In Version 2.3, replaces the PN data type. <family name (FN)> ^
<given name (ST)> ^ <second and further given names or initials
thereof (ST)> ^ <suffix (e.g., JR or III) (ST)> ^ <prefix (e.g.,
DR) (ST)> ^ <degree (e.g., MD) (IS)> ^ <name type code (ID)
> ^ <name representation code (ID)> ^ <name context (CE)> ^
<name validity range (DR)> ^ <name assembly order (ID)>
Subcomponents of family name: <family name (ST)> & <own family
name prefix (ST)> & <own family name (ST)> & <family name
prefix from partner/spouse (ST)> & <family name from partner/spouse
(ST)>
Definition: This field contains the name of the individual who approves any
special coverage. Multiple names for the same person may be sent in this
field. The legal name is assumed to be in the first repetition. When the
legal name is not sent, a repeat delimiter must be sent first for the first
repetition.
Definition: This field contains the title of the person who approves special coverage.
Definition:
This field contains the code that describes why a service is not covered.
Refer to User-defined Table 0143 - Non-covered insu
rance
code for suggested values.
Value |
Description |
|---|---|
No suggested values defined |
Components:
<ID (ST)> ^ <check digit (ST)> ^ <code identifying the check
digit scheme employed (ID)> ^ < assigning authority (HD)> ^
<identifier type code (ID)> ^ < assigning facility (HD) ^
<effective date (DT)> ^ <expiration date (DT)>
Subcomponents of assigning authority: <namespace ID (IS)> &
<universal ID (ST)> & <universal ID type (ID)
Subcomponents of assigning facility: <namespace ID (IS)> &
<universal ID (ST)> & <universal ID type (ID)
Definition: In the US this field is required for ENVOY Corporation (a US
claims clearing house) processing, and it identifies the organization from
which reimbursement is expected. This field can also be used to report the
National Health Plan ID. The assigning authority and identifier type code are
strongly recommended for all CX data types.
Components:
<ID (ST)> ^ <check digit (ST)> ^ <code identifying the check
digit scheme employed (ID)> ^ < assigning authority (HD)> ^
<identifier type code (ID)> ^ < assigning facility (HD) ^
<effective date (DT)> ^ <expiration date (DT)>
Subcomponents of assigning authority: <namespace ID (IS)> &
<universal ID (ST)> & <universal ID type (ID)
Subcomponents of assigning facility: <namespace ID (IS)> &
<universal ID (ST)> & <universal ID type (ID)
Definition: In the US this field is required for ENVOY Corporation processing,
and it identifies the specific office within the insurance carrier that is
designated as responsible for the claim. The assigning authority and
identifier type code are strongly recommended for all CX data types.
Definition:
In the US this field is required for ENVOY Corporation processing, and it
identifies the source of information about the insured's eligibility for
benefits. Refer to User-defined Table 0144 - Eligibility source for
suggested values.
Value |
Description |
|---|---|
1 |
Insurance company |
2 |
Employer |
3 |
Insured presented policy |
4 |
Insured presented card |
5 |
Signed statement on file |
6 |
Verbal information |
7 |
None |
Components:
<room type (IS)> ^ <amount type (IS)> ^ <coverage
amount(NM)>
Definition: Use this field instead of IN1-40 - room rate-semi-private
and IN1-41 - room rate-private. This field contains room type (e.g.,
private, semi-private), amount type (e.g., limit, percentage) and amount
covered by the insurance. Refer to User-defined Table 0145 - Room type
and User-defined Table 0146 - Amount type for suggested values.
Value |
Description |
|---|---|
PRI |
Private room |
2PRI |
Second private room |
SPR |
Semi-private room |
2SPR |
Second semi-private room |
ICU |
Intensive care unit |
2ICU |
Second intensive care unit |
Value |
Description |
|---|---|
DF |
Differential |
LM |
Limit |
PC |
Percentage |
RT |
Rate |
UL |
Unlimited |
Components:
<policy type (IS)> ^ <amount class (IS)> ^ <amount
(NM)>
Definition: This field contains the policy type (e.g., ancillary, major
medical) and amount (e.g., amount, percentage, limit) covered by the insurance.
Use this field instead of IN1-38 - policy limit-amount. Refer to
User-defined Table 0147 - Policy type and User-defined Table 0193 -
Amount class for suggested values.
Value |
Description |
|---|---|
ANC |
Ancillary |
2ANC |
Second ancillary |
MMD |
Major medical |
2MMD |
Second major medical |
3MMD |
Third major medical |
Value |
Description |
|---|---|
AT |
Amount |
LM |
Limit |
PC |
Percentage |
UL |
Unlimited |
Components:
<delay days (NM)> ^ <amount (NM)> ^ <number of days
(NM)>
Definition: This field contains the number of days after which the daily
deductible begins, the amount of the deductible, and the number of days to
apply the deductible.
Definition: This field identifies the specific living conditions for the insured. Refer to User-defined Table 0223 - Living dependency for suggested values.
Definition: This field identifies the insured's state of mobility. Refer to User-defined Table 0009 - Ambulatory status for suggested values.
Components:
<identifier (ST)> ^ <text (ST)> ^ <name of coding system
(IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^
<name of alternate coding system (IS)>
Definition: This field contains the code that identifies the insured's
citizenship. HL7 recommends using ISO table 3166 as the suggested values in
User-defined Table 0171 - Citizenship.
Components:
<identifier (ST)> ^ <text (ST)> ^ <name of coding system
(IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^
<name of alternate coding system (IS)>
Definition: This field identifies the insured's primary speaking language.
HL7 recommends using ISO table 639 as the suggested values in User-defined
Table 0296 - Primary language.
Definition: This field indicates the situation in which the insured person lives at his primary residence. Refer to User-defined Table 0220 - Living arrangement for suggested values.
Components:
<identifier (ST)> ^ <text (ST)> ^ <name of coding system
(IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^
<name of alternate coding system (IS)>
Definition: This field contains a user-defined code indicating what level of
publicity is allowed (e.g., No Publicity, Family Only) for the insured. Refer
to User-defined Table 0215 - Publicity code for suggested values.
Definition:
This field identifies the insured's protection, which determines whether or
not access to information about this enrollee should be restricted from users
who do not have adequate authority. Refer to HL7 table 0136 - Yes/no
indicator for valid values.
Y restrict access
N do not restrict access
Definition: This field identifies whether the insured is currently a student or not, and whether the insured is a full-time or a part-time student. This field does not indicate the degree level (high school, college) of student, or his/her field of study (accounting, engineering, etc.). Refer to User-defined Table 0231 - Student status for suggested values.
Components: