ADT Message Delivery to the Indiana Network for Patient...

ADT Message Delivery to theIndiana Network for Patient Care

The Indiana Network for Patient Care (INPC) is a community-wide electronic medical record that was developed in the 1990s, and began to operate in 1995. The Regenstrief Institute, Inc., has developed and implemented all of the software and systems that underpin the INPC, and operates the INPC on behalf of its participants. The participants of the INPC include all five of the major hospital and health care systems in Indianapolis, as well as hospitals in surrounding counties. The participants of the INPC also include several large physician practices, two independent commercial laboratories, public health agencies, payors, and the Indiana State Medicaid program. The number of participants grows as new institutions are added.

The INPC is a centrally-managed, federated clinical data repository. Thus each institution’s data is physically located on separate digital storage media. Each patient’s data is protected in accordance with HIPAA guidelines for privacy and security. Such a uniform, standardized approach allows a physician working in an emergency department to view a patient’s previous care information from all participating institutions as a single virtual medical record.

The primary way that data flows into the INPC is as HL7 messages. HL7 is a standards development organization (http://www.hl7.org). The HL7 messaging standard permits structured and encoded health care information to be exchanged between computer applications. This standard specifies message formats to represent various categories of health information, such as: Order Entry, Financial Management, Observation Reporting. However, in this document we are concerned with the category of Admission, Discharge, Transfer (ADT) messages. HL7 ADT messages are used to represent events relevant to Patient Administration, such as: Admit/Visit Notification; Patient Transfer; Discharge/End Visit; Register a Patient; and more.

Introduction

Briefly, we request that Hendricks Regional Health send an ADT message stream of all patients, in accordance with the HL7 messaging standard version 2.3 or higher, to the INPC. The electronic message should be sent in real time, or within a reasonably short time interval, such as 5 minutes, of the patient’s registration or patient record update. INPC can accept ADT^A01's through ADT^A51.

Requirement Summary

In order to ensure the privacy and confidentiality of data transferred in real time over the Internet, data should be sent through an IPSec VPN tunnel. This requires use of a VPN concentrator, a firewall with VPN capability, or any other device capable of creating a LAN-to-LAN VPN tunnel. This also requires a continuous Internet connection with sufficient bandwidth to support your message volume.

Real Time HL7 using VPN

The preferred format for electronic messaging is the HL7 ADT message. This message will contain the four mandatory segments, namely MSH, PID, PV1 and PV2. It may also contain additional segments when supplemental data is available.

Message Format

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The following ADT message fields are required to send a successful message to the INPC. Segments and fields not marked as required are optional but desirable. Therefore, please send as much data available for each patient.

ADT Message Fields

MSH|^~\|REG|<FACILITY NAME>|INPC|REGEN|200701021300||ADTÂ04|987654321|P|2.3EVN|A04|200701021300PID|1||12345^^^^PI||DOE^JANE^R||19700502|F||W|123 MAIN STÂPT.2ÎNDIANAPOLISÎN^46202||317^1231234||||||123121234PV1|1|O|^^^<FACILITY NAME>|||||||||||||||||||||||||||||||||||||||||200701021300PV2|||^HEAD ACHE

Sample HL7 ADT Message

Field

MSH-1MSH-2MSH-3MSH-4MSH-5MSH-6MSH-7MSH-9MSH-10

PID-3PID-5.1PID-5.2PID-5.3PID-7PID-8PID-10PID-11.1PID-11.3PID-11.4PID-11.5PID-19.1

PV1-2PV1-3.4

PV1-44

PV2-3.2

Description

Field SeparatorEncoding CharactersSending ApplicationSending FacilityReceiving ApplicationReceiving FacilityDate/Time of MessageMessage TypeMessage Control ID

Patient ID (Internal ID)Patient’s Last NamePatient’s First NamePatient’s Middle InitialPatient’s Date of BirthPatient’s SexPatient’s RaceStreet AddressCityStateZipSocial Security Number

Patient ClassAssigned Patient Location

Admit Date / Time

Chief Complaint

Value

|^~\REG<FACILITY NAME>INPCREGENYYYYMMDDHHMMSSex: ADTÂ04(unique alpha-numeric code that uniquely identifies a message)

YYYYMMDD(M=Male, F=Female, O=Other, U=Unknown)

if PV1-2=”E” then “<FACILITY NAME> ED” else “<FACILITY NAME>”YYYYMMDDHHMMSS


The following segments may be included in an ADT message for INPC. All segments not marked "Required" are optional but desirable.

The following is the specification for each segment listed above. Fields not marked "Required" are optional but desirable.

Message Type Segment Required

ADT

MSH

EVN

PID

PD1

NK1

PV1

PV2

DB1

OBX

AL1

DG1

DRG

PR1

ROL

GT1

IN1

IN2

IN3

ACC

UB1

UB2

Segment HL7 Field Description Required

MSHMSH-1.1 Field Separator (ST) Yes

MSH-2.1 Encoding Characters (ST) Yes

MSH-3.1 Sending Application (HD)- Namespace ID (IS) Yes

MSH-3.2 Sending Application (HD)- Universal ID (ST) Yes

MSH-3.3 Sending Application (HD)- Universal ID Type (ID) Yes

MSH-4.1 Sending Facility (HD)- Namespace ID (IS) Yes

MSH-4.2 Sending Facility (HD)- Universal ID (ST) Yes

MSH-4.3 Sending Facility (HD)- Universal ID Type (ID) Yes

MSH-5.1 Receiving Application (HD)- Namespace ID (IS) Yes

MSH-5.2 Receiving Application (HD)- Universal ID (ST) Yes

MSH-5.3 Receiving Application (HD)- Universal ID Type (ID) Yes

MSH-6.1 Receiving Facility (HD)- Namespace ID (IS) Yes

MSH-6.2 Receiving Facility (HD)- Universal ID (ST) Yes

MSH-6.3 Receiving Facility (HD)- Universal ID Type (ID) Yes

MSH-7.1 Date/Time of Message (TS) Yes


MSH-8.1 Security (ST)

MSH-9.1 Message Type (CM)- Message Type (ID) Yes

MSH-9.2 Message Type (CM)- Trigger Event (ID) Yes

MSH-10.1 Message Control ID (ST) Yes

MSH-11.1 Processing ID (PT)- Processing ID (ID) Yes

MSH-11.2 Processing ID (PT)- Processing Mode (ID) Yes

MSH-12.1 Version ID (ID) Yes

MSH-13.1 Sequence Number (NM)

MSH-14.1 Continuation Pointer (ST)

MSH-15.1 Accept Acknowledgment Type (ID)

MSH-16.1 Application Acknowledgment Type (ID)

MSH-17.1 Country Code (ID)

MSH-18.1 Character Set (ID)

MSH-19.1 Principal Language of Message (CE)- Indentifier (ID)

MSH-19.2 Principal Language of Message (CE)- Text (ST)

MSH-19.3 Principal Language of Message (CE)- Name of Coding System (ST)

MSH-19.4 Principal Language of Message (CE)- Alternate Identifier (ID)

MSH-19.5 Principal Language of Message (CE)- Alternate Text (ST)

MSH-19.6 Principal Language of Message (CE)- Name of Alternate Coding Syst

EVNEVN-1.1 Event Type Code (ID)

EVN-2.1 Recoded Date/Time (TS)

EVN-3.1 Date/Time Planned Event (TS)

EVN-4.1 Event Reason Code (IS)

EVN-5.1 Operator ID (XCN)- ID Number (ST)

EVN-5.2 Operator ID (XCN)- Family Name (ST)

EVN-5.3 Operator ID (XCN)- Given Name (ST)

EVN-5.4 Operator ID (XCN)- Middle Initial or Name (ST)

EVN-5.5 Operator ID (XCN)- Suffix (ST)

EVN-5.6 Operator ID (XCN)- Prefix (ST)

EVN-5.7 Operator ID (XCN)- Degree (ST)

EVN-5.8 Operator ID (XCN)- Source Table (IS)

EVN-5.9.1 Operator ID (XCN)- Assigning Authority (HD)- Namespace ID (IS)

EVN-5.9.2 Operator ID (XCN)- Assigning Authority (HD)- Unviersal ID (ST)

EVN-5.9.3 Operator ID (XCN)- Assinging Authority (HD)- Universal ID Type (ID)

EVN-5.10 Operator ID (XCN)- Name Type Code (ID)

EVN-5.11 Operator ID (XCN)- Identifier Check Digit (ST)

EVN-5.12 Operator ID (XCN)- Code Identifying the Check Digit Scheme Employ

EVN-5.13 Operator ID (XCN)- Identifier Type Code (IS)

EVN-5.14.1 Operator ID (XCN)- Assigning Facility (HD)- Namespace ID (IS)

EVN-5.14.2 Operator ID (XCN)- Assigning Facility (HD)- Universal ID (ST)

EVN-5.14.3 Operator ID (XCN)- Assigning Facility (HD)- Universal ID Type (ID)

EVN-6.1 Event Occurred (TS)

PIDPID-1.1 Set ID - Patient ID (SI)

PID-2.1 Patient ID (External ID) (CX) - ID (ST)


PID-2.2 Patient ID (CX) - Check digit (ST)

PID-2.3 Patient ID (CX) - Code identifying the check digit scheme employed (

PID-2.4.1 Patient ID (CX) - Assigning authority (HD) - Namespace ID (IS)

PID-2.4.2 Patient ID (CX) - Assigning authority (HD) - Universal ID (ST)

PID-2.4.3 Patient ID (CX) - Assigning authority (HD) - Universal ID type (ID)

PID-2.5 Patient ID (CX) - identifier type code (IS)

PID-2.6.1 Patient ID (CX) - Assigning facility (HD) - Namespace ID (IS)

PID-2.6.2 Patient ID (CX) - Assigning facility (HD) - Universal ID (ST)

PID-2.6.3 Patient ID (CX) - Assigning facility (HD) - Universal ID type (ID)

PID-3.1 Patient ID (internal ID) (CX) - ID (ST) Yes

PID-3.2 Patient ID (internal ID) (CX) - Check digit (ST) Yes

PID-3.3 Patient ID (internal ID) (CX) - Code identifying the check digit scheme Yes

PID-3.4.1 Patient ID (internal ID) (CX) - Assigning authority (HD) - Namespace I

PID-3.4.2 Patient ID (internal ID) (CX) - Assigning authority (HD) - Universal ID Yes

PID-3.4.3 Patient ID (internal ID) (CX) - Assigning authority (HD) - Universal ID

PID-3.5 Patient ID (internal ID) (CX) - identifier type code (IS)

PID-3.6.1 Patient ID (internal ID) (CX) - Assigning facility (HD) - Namespace ID

PID-3.6.2 Patient ID (internal ID) (CX) - Assigning facility (HD) - Universal ID (S

PID-3.6.3 Patient ID (internal ID) (CX) - Assigning facility (HD) - Universal ID ty

PID-4.1 Alternate Patient ID - PID (CX) - ID (ST)

PID-4.2 Alternate Patient ID (CX) - Check digit (ST)

PID-4.3 Alternate Patient ID (CX) - Code Identifying the Check Digit Scheme

PID-4.4.1 Alternate Patient ID (CX) - Assigning Authority (HD) - Namespace ID

PID-4.4.2 Alternate Patient ID (CX) - Assigning Authority (HD) - Universal ID (S

PID-4.4.3 Alternate Patient ID (CX) - Assigning Authority (HD) - Universal ID Ty

PID-4.5 Alternate Patient ID (CX) - Identifier Type Code (IS)

PID-4.6.1 Alternate Patient ID (CX) - Assigning Facility (HD) - Namespace ID (I

PID-4.6.2 Alternate Patient ID (CX) - Assigning Facility (HD) - Universal ID (ST)

PID-4.6.3 Alternate Patient ID (CX) - Assigning Facility (HD) - Universal ID Typ

PID-5.1 Patient Name (XPN) - Family name (ST) Yes

PID-5.2 Patient Name (XPN)- Given name (ST) Yes

PID-5.3 Patient Name (XPN) - Middle initial or name (ST)

PID-5.4 Patient Name (XPN) - Suffix (ST)

PID-5.5 Patient Name (XPN) - Prefix (ST)

PID-5.6 Patient Name (XPN) - Degree (ST)

PID-5.7 Patient Name (XPN) - Name Type Code (ID)

PID-6.1 Mother's maiden name (XPN) - Family name (ST)

PID-6.2 Mother's maiden name (XPN) - Given name (ST)

PID-6.3 Mother's maiden name (XPN) - Middle initial or name (ST)

PID-6.4 Mothers maiden name (XPN) - Suffix (e.g. JR or III) (ST)

PID-6.5 Mothers maiden name (XPN) - Prefix (e.g. DR) (ST)

PID-6.6 Mothers maiden name (XPN) - Degree (e.g. MD) (ST)

PID-6.7 Mothers maiden name (XPN) - Name type code (ID)

PID-7.1 Patient's Date/Time of birth (TS) Yes

PID-8.1 Sex (IS) Yes

PID-9.1 Patient alias (XPN) - Family name (ST)


PID-9.2 Patient alias (XPN) - Given name (ST)

PID-10.1 Race (IS) Yes

PID-11.1 Patient's Address (XAD) - Street Address (ST) Yes

PID-11.2 Patient's Address (XAD) - Other Designation (ST)

PID-11.3 Patient's Address (XAD) - City (ST) Yes

PID-11.4 Patient's Address (XAD) - State or Province (ST) Yes

PID-11.5 Patient's Address (XAD) - Zip or Postal Code (ST) Yes

PID-11.6 Patient's Address (XAD) - Country (ID)

PID-11.7 Patient's Address (XAD) - Address Type (ID)

PID-11.8 Patient's Address (XAD) - Other Geographic Designation (ST)

PID-11.9 Patient's Address (XAD) - County or Parrish Code (IS) Yes

PID-11.10 Patient's Address (XAD) - Census Track (IS)

PID-12.1 County Code (IS)

PID-13.1 Phone Number - Home (XTN) - [NNN] [(999)]999-9999 [X99999] [B99

PID-13.2 Phone Number - Home (XTN) - Telecommunication Use Code (ID)

PID-13.3 Phone Number -Home (XTN) - Telecommunication Equipment Type (

PID-13.4 Phone Number -Home (XTN) - Email Address (ST)

PID-13.5 Phone Number -Home (XTN) - Country Code (NM)

PID-13.6 Phone Number -Home (XTN) - Area/City Code (NM)

PID-13.7 Phone Number -Home (XTN) - Phone Number (NM)

PID-13.8 Phone Number -Home (XTN) - Extension (NM)

PID-13.9 Phone Number -Home (XTN) - Any Text (ST)

PID-14.1 Business Phone Number (XTN) - [NNN] [(999)]999-9999 [X99999] [B

PID-14.2 Business Phone Number (XTN) - Telecommunication Use Code (ID)

PID-14.3 Business Phone Number (XTN) - Telecommunication Equipment Typ

PID-14.4 Business Phone Number (XTN) - Email Address (ST)

PID-14.5 Business Phone Number (XTN) - Country Code (NM)

PID-14.6 Business Phone Number (XTN) - Area/City Code (NM)

PID-14.7 Business Phone Number (XTN) - Phone Number (NM)

PID-14.8 Business Phone Number (XTN) - Extension (NM)

PID-14.9 Business Phone Number (XTN) - Any Text (ST)

PID-15.1 Primary Language (CE) - Identifier (ST)

PID-15.2 Primary Language (CE) - Text (ST)

PID-15.3 Primary Language (CE) - Name of Coding System (ST)

PID-15.4 Primary Language (CE) - Alternate Identifier (ST)

PID-15.5 Primary Language (CE) - Alternate Text (ST)

PID-15.6 Primary Language (CE) - Name of Alternate Coding System (ST)

PID-16.1 Marital Status (IS)

PID-17.1 Religion (IS)

PID-18.1 Patient Account Number (CX) - ID (ST)

PID-18.2 Patient Account Number (CX) - Check digit (ST)

PID-18.3 Patient Account Number (CX) - Code identifying the check digit sche

PID-18.4.1 Patient Account Number (CX) - Assigning authority (HD) - Namespac

PID-18.4.2 Patient Account Number (CX) - Assigning authority (HD) - Universal I

PID-18.4.3 Patient Account Number (CX) - Assigning authority (HD) - Universal I

PID-18.5 Patient Account Number (CX) - identifier type code (IS)


PID-18.6.1 Patient Account Number (CX) - Assigning facility (HD) - Namespace I

PID-18.6.2 Patient Account Number (CX) - Assigning facility (HD) - Universal ID

PID-18.6.3 Patient Account Number (CX) - Assigning facility (HD) - Universal ID t

PID-19.1 SSN Patient (ST) Yes

PID-20.1 Driver's License Number - Patient (DLN) - License Number (ST)

PID-20.2 Driver's License Number - Patient (DLN) - Issuing State, Province, C

PID-20.3 Driver's License Number - Patient (DLN) - Expiration Date (DT)

PID-21.1 Mother's Identifier (CX) - ID (ST)

PID-21.2 Mother's Identifier (CX) - Check digit (ST)

PID-21.3 Mother's Identifier (CX) - Code identifying the check digit scheme em

PID-21.4.1 Mother's Identifier (CX) - Assigning authority (HD) - Namespace ID (I

PID-21.4.2 Mother's Identifier (CX) - Assigning authority (HD) - Universal ID (ST)

PID-21.4.3 Mother's Identifier (CX) - Assigning authority (HD) - Universal ID type

PID-21.5 Mother's Identifier (CX) - identifier type code (IS)

PID-21.6.1 Mother's Identifier (CX) - Assigning facility (HD) - Namespace ID (IS)

PID-21.6.2 Mother's Identifier (CX) - Assigning facility (HD) - Universal ID (ST)

PID-21.6.3 Mother's Identifier (CX) - Assigning facility (HD) - Universal ID type (I

PID-22.1 Ethnic group (IS)

PID-23.1 Birth place (ST)

PID-24.1 Multiple birth indicator (ID)

PID-25.1 Birth order (NM)

PID-26.1 Citizenship (IS)

PID-27.1 Veterans Military Status (CE) - Identifier (ST)

PID-27.2 Veterans Military Status (CE) - Text (ST)

PID-27.3 Veterans Military Status (CE) - Name of Coding System (ST)

PID-27.4 Veterans Military Status (CE) - Alternate Identifier (ST)

PID-27.5 Veterans Military Status (CE) - Alternate Text (ST)

PID-27.6 Veterans Military Status (CE) - Name of Alternate Coding System (S

PID-28.1 Nationality (CE) - Identifier (ST)

PID-28.2 Nationality (CE) - Text (ST)

PID-28.3 Nationality (CE) - Name of Coding System (ST)

PID-28.4 Nationality (CE) - Alternate Identifier (ST)

PID-28.5 Nationality (CE) - Alternate Text (ST)

PID-28.6 Nationality (CE) - Name of Alternate Coding System (ST)

PID-29.1 Patient Death Date and Time (TS)

PID-30.1 Patient Death Indicator (ID)

PD1PD1-1.1 Living Dependency (IS)

PD1-2.1 Living Arrangement (IS)

PD1-3.1 Patient Primary Facility (XON)- Organization Name (ST)

PD1-3.2 Patient Primary Facility (XON)- Organization Name Type Code (ID)

PD1-3.3 Patient Primary Facility (XON)- ID Number (ID)

PD1-3.4 Patient Primary Facility (XON)- Check Digit (NM)

PD1-3.5 Patient Primary Facility (XON)- Check Digit Scheme (ID)

PD1-3.6.1 Patient Primary Facility (XON)- Assigning Authority (HD)- Namespac

PD1-3.6.2 Patient Primary Facility (XON)- Assigning Authority (HD)- Universal I


PD1-3.6.3 Patient Primary Facility (XON)- Assigning Authority (HD)- Universal I

PD1-3.7 Patient Primary Facility (XON)- Identifier Type Code (ID)

PD1-3.8.1 Patient Primary Facility (XON)- Assigning Facility (HD)- Namespace I

PD1-3.8.2 Patient Primary Facility (XON)- Assigning Facility (HD)- Universal ID (

PD1-3.8.3 Patient Primary Facility (XON)- Assigning Facility (HD)- Universal ID

PD1-4.1 Patient Primary Care Provider Name & ID Number (XCN)- ID Number

PD1-4.2 Patient Primary Care Provider Name & ID Number (XCN)- Family Na

PD1-4.3 Patient Priarmy Care Provider Name & ID Number (XCN)- Given Na

PD1-4.4 Patient Primary Care Provider Name & ID Number (XCN)- Middle Initi

PD1-4.5 Patient Primary Care Provider Name & ID Number (XCN)- Suffix (ST)

PD1-4.6 Patient Primary Care Provider Name & ID Number (XCN)- Prefix (ST)

PD1-4.7 Patient Primary Care Provider Name & ID Number (XCN)- Degree (S

PD1-4.8 Patient Primary Care Provider Name & ID Number (XCN)- Source Ta

PD1-4.9.1 Patient Primary Care Provider Name & ID Number (XCN)- Assigning



PD1-4.10 Patient Primary Care Provider Name & ID Number (XCN)- Name Typ

PD1-4.11 Patient Primary Care Provider Name & ID Number (XCN)- Identifier C

PD1-4.12 Patient Primary Care Provider Name & ID Number (XCN)- Code Iden

PD1-4.13 Patient Primary Care Provider Name & ID Number (XCN)- Identifier T




PD1-5.1 Student Indicator (IS)

PD1-6.1 Handicap (IS)

PD1-7.1 Living Will (IS)

PD1-8.1 Organ Donor (IS)

PD1-9.1 Patient Separate Bill Indicator (ID)

PD1-10.1 Duplicate Patient (CX)

PD1-11.1 Publicit Indicator (IS)

PD1-12.1 Protection Indicator (ID)

NK1NK1-1.1 Set ID - Next of Kin/ Associated Parties (SI)

NK1-2.1 Name (XPN) - Family name (ST)

NK1-2.2 Name (XPN) - Given name (ST)

NK1-2.3 Name (XPN) - Middle initial or name (ST)

NK1-2.4 Name (XPN) - Suffix (e.g., JR or III) (ST)

NK1-2.5 Name (XPN) - Prefix (e.g., DR) (ST)

NK1-2.6 Name (XPN) - Degree (e.g., MD) (ST)

NK1-2.7 Name (XPN) - Name type code (ID)

NK1-3.1 Relationship (CE) - Identifier (ST)

NK1-3.2 Relationship (CE) - Text (ST)

NK1-3.3 Relationship (CE) - Name of coding system (ST)

NK1-3.4 Relationship (CE) - Alternate identifier (ST)

NK1-3.5 Relationship (CE) - Alternate text (ST)

NK1-3.6 Relationship (CE) - Name of alternate coding system (ST)


NK1-4.1 Address (XAD) - Street address (ST)

NK1-4.2 Address (XAD) - Other designation (ST)

NK1-4.3 Address (XAD) - City (ST)

NK1-4.4 Address (XAD) - State or province (ST)

NK1-4.5 Address (XAD) - Zip or postal code(ST)

NK1-4.6 Address (XAD) - Country (ID)

NK1-4.7 Address (XAD) - Address type (ID)

NK1-4.8 Address (XAD) - Other geographic designation (ST)

NK1-4.9 Address (XAD) - County/parish code (IS)

NK1-4.10 Address (XAD) - Census tract (IS)

NK1-5.1 Phone Number (XTN) - [NNN] [(999)]999-9999 [X99999] [B99999] [C

NK1-5.2 Phone Number (XTN) - Telecommunication Use Code (ID)

NK1-5.3 Phone Number (XTN) - Telecommunication Equipment Type (ID)

NK1-5.4 Phone Number (XTN) - Email Address (ST)

NK1-5.5 Phone Number (XTN) - Country Code (NM)

NK1-5.6 Phone Number (XTN) - Area/City Code (NM)

NK1-5.7 Phone Number (XTN) - Phone Number (NM)

NK1-5.8 Phone Number (XTN) - Extension (NM)

NK1-5.9 Phone Number (XTN) - Any Text (ST)

NK1-6.1 Business Phone Number (XTN) - [NNN] [(999)]999-9999 [X99999] [B

NK1-6.2 Business Phone Number (XTN) - Telecommunication Use Code (ID)

NK1-6.3 Business Phone Number (XTN) - Telecommunication Equipment Typ

NK1-6.4 Business Phone Number (XTN) - Email Address (ST)

NK1-6.5 Business Phone Number (XTN) - Country Code (NM)

NK1-6.6 Business Phone Number (XTN) - Area/City Code (NM)

NK1-6.7 Business Phone Number (XTN) - Phone Number (NM)

NK1-6.8 Business Phone Number (XTN) - Extension (NM)

NK1-6.9 Business Phone Number (XTN) - Any Text (ST)

NK1-7.1 Contact Role (CE) - Identifier (ST)

NK1-7.2 Contact Role (CE) - Text (ST)

NK1-7.3 Contact Role (CE) - Name of Coding System (ST)

NK1-7.4 Contact Role (CE) - Alternate Identifier (ST)

NK1-7.5 Contact Role (CE) - Alternate Text (ST)

NK1-7.6 Contact Role (CE) - Name of Alternate Coding System (ST)

NK1-8.1 Start Date (DT)

NK1-9.1 End Date (DT)

NK1-10.1 Next of Kin / Associated Parties Job Title (ST)

NK1-11.1 Next of Kin / Associated Parties Job Code/Class (CM) - Job Code (IS

NK1-11.2 Next of Kin / Associated Parties Job Code/Class (CM) - Employee Cl

NK1-12.1 Next of Kin / Associated Parties Employee Number (CX) - ID (ST)

NK1-12.2 Next of Kin / Associated Parties Employee Number (CX) - Check Digi

NK1-12.3 Next of Kin / Associated Parties Employee Number (CX) - Code Ident

NK1-12.4.1 Next of Kin / Associated Parties Employee Number (CX) - Assigning



NK1-12.5 Next of Kin / Associated Parties Employee Number (CX) - Identifier T





NK1-13.1 Organization Name (XON) - Organization Name (ST)

NK1-13.2 Organization Name (XON) - Organization Name Type Code (ID)

NK1-13.3 Organization Name (XON) - ID Number (ID)

NK1-13.4 Organization Name (XON) - Check Digit (NM)

NK1-13.5 Organization Name (XON) - Check Digit Scheme (ID)

NK1-13.6.1 Organziation Name (XON) - Assigning Authority (HD) - Namespace I

NK1-13.6.2 Organization Name (XON) - Assigning Authority (HD) - Universal ID (

NK1-13.6.3 Organization Name (XON) - Assigning Authority (HD) - Universal ID T

NK1-13.7 Organization Name (XON) - Identifier Type Code (ID)

NK1-13.8.1 Organization Name (XON) - Assigning Facility (HD) - Namespace ID

NK1-13.8.2 Organization Name (XON) - Assigning Facility (HD) - Universal ID (S

NK1-13.8.3 Organization Name (XON) - Assigning Facility (HD) - Universal ID Ty

NK1-14.1 Marital Status (IS)

NK1-15.1 Sex Code (IS)

NK1-16.1 Date/Time of Birth (TS)

NK1-17.1 Living Dependency (IS)

NK1-18.1 Ambulatory Status (IS)

NK1-19.1 Citizenship (IS)

NK1-20.1 Primary Language (CE)

NK1-21.1 Living Arrangement (IS)

NK1-22.1 Publicity Indicator (IS)

NK1-23.1 Protection Indicator (ID)

NK1-24.1 Student Indicatory (IS)

NK1-25.1 Religion (IS)

NK1-26.1 Mother's Maiden Name (XPN) - Family Name (ST)

NK1-26.2 Mother's Maiden Name (XPN) - Given Name (ST)

NK1-26.3 Mother's Maiden Name (XPN) - Middle Initial or Name (ST)

NK1-26.4 Mother's Maiden Name (XPN) - Suffix (ST)

NK1-26.5 Mother's Maiden Name (XPN) - Prefix (ST)

NK1-26.6 Mother's Maiden Name (XPN) - Degree (ST)

NK1-26.7 Mother's Maiden Name (XPN) - Name Type Code (ID)

NK1-27.1 Nationality (CE) - Identifier (ST)

NK1-27.2 Nationality (CE) - Text (ST)

NK1-27.3 Nationality (CE) - Name of Coding System (ST)

NK1-27.4 Nationality (CE) - Alternate Identifier (ST)

NK1-27.5 Nationality (CE) - Alternate Text (ST)

NK1-27.6 Nationality (CE) - Name of Alternate Coding System (ST)

NK1-28.1 Ethinic Group (IS)

NK1-29.1 Contact Reason (CE) - Identifier (ST)

NK1-29.2 Contact Reason (CE) - Text (ST)

NK1-29.3 Contact Reason (CE) - Name of Coding System (ST)

NK1-29.4 Contact Reason (CE) - Alternate Identifier (ST)

NK1-29.5 Contact Reason (CE) - Alternate Text (ST)


NK1-29.6 Contact Reason (CE) - Name of Alternate Coding System (ST)

NK1-30.1 Contact Person's Name (XPN) - Family Name (ST)

NK1-30.2 Contact Person's Name (XPN) - Given Name (ST)

NK1-30.3 Contact Person's Name (XPN) - Middle Initial or Name (ST)

NK1-30.4 Contact Person's Name (XPN) - Suffix (ST)

NK1-30.5 Contact Person's Name (XPN) - Prefix (ST)

NK1-30.6 Contact Person's Name (XPN) - Degree (ST)

NK1-30.7 Contact Person's Name (XPN) - Name Type Code (ID)

NK1-31.1 Contact Person's Telephone Number (XTN) - [NNN] [(999)]999-9999

NK1-31.1 Contact Person Address (XAD) - Street address (ST)

NK1-31.2 Contact Person's Telephone Number (XTN) - Telecommunication Us

NK1-31.3 Contact Person's Telephone Number (XTN) - Telecommunication Eq

NK1-31.4 Contact Person's Telephone Number (XTN) - Email Address (ST)

NK1-31.5 Contact Person's Telephone Number (XTN) - Country Code (NM)

NK1-31.6 Contact Person's Telephone Number (XTN) - Area/City Code (NM)

NK1-31.7 Contact Person's Telephone Number (XTN) - Phone Number (NM)

NK1-31.8 Contact Person's Telephone Number (XTN) - Extension (NM)

NK1-31.9 Contact Person's Telephone Number (XTN) - Any Text (ST)

NK1-32.2 Contact Person Address (XAD) - Other designation (ST)

NK1-32.4 Contact Person Address (XAD) - City (ST)

NK1-32.5 Contact Person Address (XAD) - State or province (ST)

NK1-32.6 Contact Person Address (XAD) - Zip or postal code(ST)

NK1-32.7 Contact Person Address (XAD) - Country (ID)

NK1-32.8 Contact Person Address (XAD) - Address type (ID)

NK1-32.9 Contact Person Address (XAD) - Other geographic designation (ST)

NK1-32.10 Contact Person Address (XAD) - County/parish code (IS)

NK1-32.11 Contact Person Address (XAD) - Census tract (IS)

NK1-33.1 Next of Kin / Associated Party Identifiers (CX) - ID (ST)

NK1-33.2 Next of Kin / Associated Party Identifiers (CX) - Check Digit (ST)

NK1-33.3 Next of Kin / Associated Party Identifiers (CX) - Code Identifying the

NK1-33.4.1 Next of Kin / Associated Party Identifiers (CX) - Assigning Authority (



NK1-33.5 Next of Kin / Associated Party Identifiers (CX) - Identifier Type Code (

NK1-33.6.1 Next of Kin / Associated Party Identifiers (CX) - Assigning Facility (H



NK1-34.1 Job Status (IS)

NK1-35.1 Race (IS)

NK1-36.1 Handicap (IS)

NK1-37.1 Contact Person Social Security Number (ST)

PV1PV1-1.1 Set ID- PV1 (SI)

PV1-2.1 Patient Class (IS) Yes

PV1-3.1 Assigned Patient Location (PL)- Point of Care (IS)

PV1-3.2 Assigned Patient Location (PL)- Room (IS)


PV1-3.3 Assigned Patient Location (PL)- Bed (IS)

PV1-3.4.1 Assigned Pateint Location (PL)- Facility (HD)- Namespace ID (IS) Yes

PV1-3.4.2 Assigned Patient Location (PL)- Facility (HD)- Universal ID (ST) Yes

PV1-3.4.3 Assigned Patient Location (PL)- Facility (HD)- Universal ID Type (ID) Yes

PV1-3.5 Assigned Patient Location (PL)- Location Status (IS)

PV1-3.6 Assigned Patient Location (PL)- Person Location Type (IS)

PV1-3.7 Assigned Patient Location (PL)- Building (IS)

PV1-3.8 Assigned Patient Location (PL)- Floor (IS)

PV1-3.9 Assigned Patient Location (PL)- Location Description (ST)

PV1-4.1 Admission Type (IS)

PV1-5.1 Preadmit Number (CX)- ID (ST)

PV1-5.2 Preadmit Number (CX)- Check Digit (ST)

PV1-5.3 Preadmit Number (CX)- Code Identifying the Check Digit Scheme E

PV1-5.4.1 Preadmit Number (CX)- Assigning Authority (HD)- Namespace ID (IS

PV1-5.4.2 Preadmit Number (CX)- Assigning Authority (HD)- Universal ID (ST)

PV1-5.4.3 Preadmit Number (CX)- Assigning Authority (HD)- Universal ID Type

PV1-5.5 Preadmit Number (CX)- Identifier Type Code (IS)

PV1-5.6.1 Preadmit Number (CX)- Assigning Facility (HD)- Namespace ID (IS)

PV1-5.6.2 Preadmit Number (CX)- Assigning Facility (HD)- Universal ID (ST)

PV1-5.6.3 Preadmit Number (CX)- Assigning Facility (HD)- Universal ID Type (I

PV1-6.1 Prior Patient Location (PL)- Point of Care (IS)

PV1-6.2 Prior Patient Location (PL)- Room (IS)

PV1-6.3 Prior Patient Location (PL)- Bed (IS)

PV1-6.4.1 Prior Patient Location (PL)- Facility (HD)- Namespace ID (IS)

PV1-6.4.2 Prior Patient Location (PL)- Facility (HD)- Universal ID (ST)

PV1-6.4.3 Prior Patient Location (PL)- Facility (HS)- Universal ID Type (ID)

PV1-6.5 Prior Patient Location (PL)- Location Status (IS)

PV1-6.6 Prior Patient Location (PL)- Person Location Type (IS)

PV1-6.7 Prior Patient Location (PL)- Building (IS)

PV1-6.8 Prior Patient Location (PL)- Floor (IS)

PV1-6.9 Prior Patient Location (PL)- Location Description (ST)

PV1-7.1 Attending Doctor (XCN)- ID Number (ST)

PV1-7.2 Attending Doctor (XCN)- Facility Name (ST)

PV1-7.3 Attending Doctor (XCN)- Given Name (ST)

PV1-7.4 Attending Doctor (XCN)- Middle Initial or Name (ST)

PV1-7.5 Attending Doctor (XCN)- Suffix (ST)

PV1-7.6 Attending Doctor (XCN)- Prefix (ST)

PV1-7.7 Attending Doctor (XCN)- Degree (ST)

PV1-7.8 Attending Doctor (XCN)- Source Table (IS)

PV1-7.9.1 Attending Doctor (XCN)- Assigning Authority (HD)- Namespace ID (I

PV1-7.9.2 Attending Doctor (XCN)- Assigning Authority (HD)- Universal ID (ST)

PV1-7.9.3 Attending Doctor (XCN)- Assigning Authority (HD)- Universal ID Type

PV1-7.10 Attending Doctor (HD)- Name Type Code (ID)

PV1-7.11 Attending Doctor (HD)- Identifier Check Digit (ST)

PV1-7.12 Attending Doctor (HD)- Code Identifying the Check Digit Scheme Em

PV1-7.13 Attending Doctor (HD)- Identifier Type Code (IS)


PV1-7.14.1 Attending Doctor (HD)- Assigning Facility (HD)- Namespace ID (IS)

PV1-7.14.2 Attending Doctor (HD)- Assigning Facility (HD)- Universal ID (ST)

PV1-7.14.3 Attending Doctor (HD)- Assigning Facility (HD)- Universal ID Type (ID

PV1-8.1 Referring Doctor (XCN)- ID Number (ST)

PV1-8.2 Referring Doctor (XCN)- Facility Name (ST)

PV1-8.3 Referring Doctor (XCN)- Given Name (ST)

PV1-8.4 Referring Doctor (XCN)- Middle Initial or Name (ST)

PV1-8.5 Referring Doctor (XCN)- Suffix (ST)

PV1-8.6 Referring Doctor (XCN)- Prefix (ST)

PV1-8.7 Referring Doctor (XCN)- Degree (ST)

PV1-8.8 Referring Doctor (XCN)- Source Table (IS)

PV1-8.9.1 Referring Doctor (XCN)- Assigning Authority (HD)- Namespace ID (IS

PV1-8.9.2 Referring Doctor (XCN)- Assigning Authority (HD)- Universal ID (ST)

PV1-8.9.3 Referring Doctor (XCN)- Assigning Authority (HD)- Universal ID Type

PV1-8.10 Referring Doctor (HD)- Name Type Code (ID)

PV1-8.11 Referring Doctor (HD)- Identifier Check Digit (ST)

PV1-8.12 Referring Doctor (HD)- Code Identifying the Check Digit Scheme Em

PV1-8.13 Referring Doctor (HD)- Identifier Type Code (IS)

PV1-8.14.1 Referring Doctor (HD)- Assigning Facility (HD)- Namespace ID (IS)

PV1-8.14.2 Referring Doctor (HD)- Assigning Facility (HD)- Universal ID (ST)

PV1-8.14.3 Referring Doctor (HD)- Assigning Facility (HD)- Universal ID Type (ID

PV1-9.1 Consulting Doctor (XCN)- ID Number (ST)

PV1-9.2 Consulting Doctor (XCN)- Facility Name (ST)

PV1-9.3 Consulting Doctor (XCN)- Given Name (ST)

PV1-9.4 Consulting Doctor (XCN)- Middle Initial or Name (ST)

PV1-9.5 Consulting Doctor (XCN)- Suffix (ST)

PV1-9.6 Consulting Doctor (XCN)- Prefix (ST)

PV1-9.7 Consulting Doctor (XCN)- Degree (ST)

PV1-9.8 Consulting Doctor (XCN)- Source Table (IS)

PV1-9.9.1 Consulting Doctor (XCN)- Assigning Authority (HD)- Namespace ID (I

PV1-9.9.2 Consulting Doctor (XCN)- Assigning Authority (HD)- Universal ID (ST)

PV1-9.9.3 Consulting Doctor (XCN)- Assigning Authority (HD)- Universal ID Typ

PV1-9.10 Consulting Doctor (HD)- Name Type Code (ID)

PV1-9.11 Consulting Doctor (HD)- Identifier Check Digit (ST)

PV1-9.12 Consulting Doctor (HD)- Code Identifying the Check Digit Scheme E

PV1-9.13 Consulting Doctor (HD)- Identifier Type Code (IS)

PV1-9.14.1 Consulting Doctor (HD)- Assigning Facility (HD)- Namespace ID (IS)

PV1-9.14.2 Consulting Doctor (HD)- Assigning Facility (HD)- Universal ID (ST)

PV1-9.14.3 Consulting Doctor (HD)- Assigning Facility (HD)- Universal ID Type (I

PV1-10.1 Hospital Service (IS)

PV1-11.1 Temporary Location (PL)- Point of Care (IS)

PV1-11.2 Temporary Location (PL)- Room (IS)

PV1-11.3 Temporary Location (PL)- Bed (IS)

PV1-11.4.1 Temporary Location (PL)- Facility (HD)- Namespace ID (IS)

PV1-11.4.2 Temporary Location (PL)- Facility (HD)- Universal ID (ST)

PV1-11.4.3 Temporary Location (PL)- Facility (HD)- Universal ID Type (ID)


PV1-11.5 Temporary Location (PL)- Location Status (IS)

PV1-11.6 Temporary Location (PL)- Person Location Type (IS)

PV1-11.7 Temporary Location (PL)- Building (IS)

PV1-11.8 Temporary Location (PL)- Floor (IS)

PV1-11.9 Temporary Location (PL)- Location Description (ST)

PV1-12.1 Preadmit Test Indicator (IS)

PV1-13.1 Re-Admission Indicator (IS)

PV1-14.1 Admit Source (IS)

PV1-15.1 Ambulatory Status (IS)

PV1-16.1 VIP Indicator (IS)

PV1-17.1 Admitting Doctor (XCN)- ID Number (ST)

PV1-17.2 Admitting Doctor (XCN)- Facility Name (ST)

PV1-17.3 Admitting Doctor (XCN)- Given Name (ST)

PV1-17.4 Admitting Doctor (XCN)- Middle Initial or Name (ST)

PV1-17.5 Admitting Doctor (XCN)- Suffix (ST)

PV1-17.6 Admitting Doctor (XCN)- Prefix (ST)

PV1-17.7 Admitting Doctor (XCN)- Degree (ST)

PV1-17.8 Admitting Doctor (XCN)- Source Table (IS)

PV1-17.9.1 Admitting Doctor (XCN)- Assigning Authority (HD)- Namespace ID (I

PV1-17.9.2 Admitting Doctor (XCN)- Assigning Authority (HD)- Universal ID (ST)

PV1-17.9.3 Admitting Doctor (XCN)- Assigning Authority (HD)- Universal ID Type

PV1-17.10 Admitting Doctor (HD)- Name Type Code (ID)

PV1-17.11 Admitting Doctor (HD)- Identifier Check Digit (ST)

PV1-17.12 Admitting Doctor (HD)- Code Identifying the Check Digit Scheme Em

PV1-17.13 Admitting Doctor (HD)- Identifier Type Code (IS)

PV1-17.14.1 Admitting Doctor (HD)- Assigning Facility (HD)- Namespace ID (IS)

PV1-17.14.2 Admitting Doctor (HD)- Assigning Facility (HD)- Universal ID (ST)

PV1-17.14.3 Admitting Doctor (HD)- Assigning Facility (HD)- Universal ID Type (ID

PV1-18.1 Patient Type (IS)

PV1-19.1 Visit Number (CX)- ID (ST)

PV1-19.2 Visit Number (CX)- Check Digit (ST)

PV1-19.3 Visit Number (CX)- Code Identifying the Check Digit Scheme Employ

PV1-19.4.1 Visit Number (CX)- Assigning Authority (HD)- Namespace ID (IS)

PV1-19.4.2 Visit Number (CX)- Assigning Authority (HD)- Universal ID (ST)

PV1-19.4.3 Visit Number (CX)- Assigning Authority (HD)- Universal ID Type (ID)

PV1-19.5 Visit Number (CX)- Identifier Type Code (IS)

PV1-19.6.1 Visit Number (CX)- Assigning Facility (HD)- Namespace ID (IS)

PV1-19.6.2 Visit Number (CX)- Assigning Facility (HD)- Universal ID (ST)

PV1-19.6.3 Visit Number (CX)- Assigning Facility (HD)- Universal ID Type (ID)

PV1-20.1 Financial Class (CM)- Financial Class (IS)

PV1-20.2 Financial Class (CM)- Effective Date (TS)

PV1-21.1 Charge Price Indicator (IS)

PV1-22.1 Courtesy Code (IS)

PV1-23.1 Credit Rating (IS)

PV1-24.1 Contract Code (IS)

PV1-25.1 Contract Effective Date (DT)


PV1-26.1 Contract Amount (NM)

PV1-27.1 Contract Period (NM)

PV1-28.1 Interest Code (IS)

PV1-29.1 Transfer to Bad Debt Code (IS)

PV1-30.1 Transfer to Bad Debt Date (DT)

PV1-31.1 Bad Debt Agency Code (IS)

PV1-32.1 Bad Debt Transfer Amount (NM)

PV1-33.1 Bad Debt Recovery Amount (NM)

PV1-34.1 Delete Account Indicator (IS)

PV1-35.1 Delete Account Date (DT)

PV1-36.1 Discharge Disposition (IS)

PV1-37.1 Discharged to Location (CM)- Discharge Location (IS)

PV1-37.2 Discharged to Location (CM)- Effective Date (TS)

PV1-38.1 Diet Type (IS)

PV1-39.1 Servicing Facility (IS)

PV1-40.1 Bed Status (IS)

PV1-41.1 Account Status (IS)

PV1-42.1 Pending Location (PL)- Point of Care (IS)

PV1-42.2 Pending Location (PL)- Room (IS)

PV1-42.3 Pending Location (PL)- Bed (IS)

PV1-42.4.1 Pending Location (PL)- Faciilty (HD)- Namespace ID (IS)

PV1-42.4.2 Pending Location (PL)- Facility (HD)- Universal ID (ST)

PV1-42.4.3 Pending Location (PL)- Facility (HD)- Universal ID Type (ID)

PV1-43.1 Prior Temporary Location (PL)- Point of Care (IS)

PV1-43.2 Prior Temporary Location (PL)- Room (IS)

PV1-43.3 Prior Temporary Location (PL)- Bed (IS)

PV1-43.4.1 Prior Temporary Location (PL)- Faciilty (HD)- Namespace ID (IS)

PV1-43.4.2 Prior Temporary Location (PL)- Facility (HD)- Universal ID (ST)

PV1-43.4.3 Prior Temporary Location (PL)- Facility (HD)- Universal ID Type (ID)

PV1-44.1 Admit Date/Time (TS) Yes

PV1-45.1 Discharge Date/Time (TS)

PV1-46.1 Current Patient Balance (NM)

PV1-47.1 Total Charges (NM)

PV1-48.1 Total Adjustments (NM)

PV1-49.1 Total Payments (NM)

PV1-50.1 Alternate Visit ID (CX)- ID (ST)

PV1-50.2 Alternate Visit ID (CX)- Check Digit (ST)

PV1-50.3 Alternate Visit ID (CX)- Code Identifying the Check Digit Scheme Em

PV1-50.4.1 Alternate Visit ID (CX)- Assinging Authority (HD)- Namespace ID (IS)

PV1-50.4.2 Alternate Visit ID (CX)- Assinging Authority (HD)- Universal ID (ST)

PV1-50.4.3 Alternate Visit ID (CX)- Assigning Authority (HD)- Universal ID Type (I

PV1-50.5 Alternate Visit ID (CX)- Identifier Type Code (IS)

PV1-50.6.1 Alternate Visit ID (CX)- Assigning Facility (HD)- Namespace ID (IS)

PV1-50.6.2 Alternate Visit ID (CX)- Assigning Facility (HD)- Universal ID (ST)

PV1-50.6.3 Alternate Visit ID (CX)- Assigning Facility (HD)- Universal ID Type (ID

PV1-51.1 Visit Indicator (IS)


PV1-52.1 Other Healthcare Provider (XCN)- ID Number (ST)

PV1-52.2 Other Healthcare Provider (XCN)- Facility Name (ST)

PV1-52.3 Other Healthcare Provider (XCN)- Given Name (ST)

PV1-52.4 Other Healthcare Provider (XCN)- Middle Initial or Name (ST)

PV1-52.5 Other Healthcare Provider (XCN)- Suffix (ST)

PV1-52.6 Other Healthcare Provider (XCN)- Prefix (ST)

PV1-52.7 Other Healthcare Provider (XCN)- Degree (ST)

PV1-52.8 Other Healthcare Provider (XCN)- Source Table (IS)

PV1-52.9.1 Other Healthcare Provider (XCN)- Assigning Authority (HD)- Namesp

PV1-52.9.2 Other Healthcare Provider (XCN)- Assigning Authority (HD)- Universa

PV1-52.9.3 Other Healthcare Provider (XCN)- Assigning Authority (HD)- Universa

PV1-52.10 Other Healthcare Provider (HD)- Name Type Code (ID)

PV1-52.11 Other Healthcare Provider (HD)- Identifier Check Digit (ST)

PV1-52.12 Other Healthcare Provider (HD)- Code Identifying the Check Digit Sc

PV1-52.13 Other Healthcare Provider (HD)- Identifier Type Code (IS)

PV1-52.14.1 Other Healthcare Provider (HD)- Assigning Facility (HD)- Namespace

PV1-52.14.2 Other Healthcare Provider (HD)- Assigning Facility (HD)- Universal ID

PV1-52.14.3 Other Healthcare Provider (HD)- Assigning Facility (HD)- Universal ID

PV1-53.1 PV1 Usage Notes

PV2PV2-1.1 Prior Pending Location (PL)- Point of Care (IS)

PV2-1.2 Prior Pending Location (PL)- Room (IS)

PV2-1.3 Prior Pending Location (PL)- Bed (IS)

PV2-1.4.1 Prior Pending Location (PL)- Facility (HD)- Namespace ID (IS)

PV2-1.4.2 Prior Pending Location (PL)- Facility (HD)- Universal ID (ST)

PV2-1.4.3 Prior Pending Location (PL)- Facility HD)- Universal ID Type (ID)

PV2-1.5 Prior Pending Location (PL)- Location Status (IS)

PV2-1.6 Prior Pending Location (PL)- Persona Location Type (IS)

PV2-1.7 Prior Pending Location (PL)- Building (IS)

PV2-1.8 Prior Pending Location (PL)- Floor (IS)

PV2-1.9 Prior Pending Location (PL)- Location Description (ST)

PV2-2.1 Accommodation Code (CE)- Identifier (ST)

PV2-2.2 Accommodation Code (CE)- Text (ST)

PV2-2.3 Accommodation Code (CE)- Name of Coding System (ST)

PV2-2.4 Accommodation Code (CE)- Alternate Identifier (ST)

PV2-2.5 Accommodation Code (CE)- Alternate Text (ST)

PV2-2.6 Accommodation Code (CE)- Name of Alternate Coding System (ST)

PV2-3.1 Admit Reason (CE)- Identifier (ST)

PV2-3.2 Admit Reason (CE)- Text (ST) Yes

PV2-3.3 Admit Reason (CE)- Name of Coding System (ST)

PV2-3.4 Admit Reason (CE)- Alternate Identifier (ST)

PV2-3.5 Admit Reason (CE)- Alternate Text (ST)

PV2-3.6 Admit Reason (CE)- Name of Alternate Coding System (ST)

PV2-4.1 Transfer Reason (CE)- Identifier (ST)

PV2-4.2 Transfer Reason (CE)- Text (ST)

PV2-4.3 Transfer Reason (CE)- Name of Coding System (ST)


PV2-4.4 Transfer Reason (CE)- Alternate Identifier (ST)

PV2-4.5 Transfer Reason (CE)- Alternate Text (ST)

PV2-4.6 Transfer Reason (CE)- Name of Alternate Coding System (ST)

PV2-5.1 Patient Valuables (ST)

PV2-6.1 Patient Valuables Location (ST)

PV2-7.1 Visit User Code (IS)

PV2-8.1 Expected Admit Date (DT)

PV2-9.1 Expected Discharge Date (DT)

PV2-10.1 Expected Length of Inpatient Stay (NM)

PV2-11.1 Actual Length of Inpatient Stay (NM)

PV2-12.1 Visit Description (ST)

PV2-13.1 Referral Source (XCN)- ID Number (ST)

PV2-13.2 Referral Source (XCN)- Family Name (ST)

PV2-13.3 Referral Source (XCN)- Given Name (ST)

PV2-13.4 Referral Source (XCN)- Middle Initial or Name (ST)

PV2-13.5 Referral Source (XCN)- Suffix (ST)

PV2-13.6 Referral Source (XCN)- Prefix (ST)

PV2-13.7 Referral Source (XCN)- Degree (ST)

PV2-13.8 Referral Source (XCN)- Source Table (IS)

PV2-13.9.1 Referral Source (XCN)- Assigning Authority (HD)- Namespace ID (IS)

PV2-13.9.2 Referral Source (XCN)- Assigning Authority (HD)- Universal ID (ST)

PV2-13.9.3 Referral Source (XCN)- Assigning Authority (HD)- Universal ID Type (

PV2-13.10 Referral Source (XCN)- Name Type (ID)

PV2-13.11 Referral Source (XCN)- Identifier Check Digit (ST)

PV2-13.12 Referral Source (XCN)- Code Identifying the Check Digit Scheme Em

PV2-13.13 Referral Source (XCN)- Identifier Type Code (IS)

PV2-13.14.1 Referral Source (XCN)- Assigning Facility ID (HD)- Namespace ID (I

PV2-13.14.2 Referral Source (XCN)- Assigning Facility ID (HD)- Universal ID (ST)

PV2-13.14.3 Referral Source (XCN)- Assigning Facility ID (HD)- Universal ID Type

PV2-14.1 Previous Service Date (DT)

PV2-15.1 Employment Illness Related Indicator (ID)

PV2-16.1 Purge Status Code (IS)

PV2-17.1 Purge Status Date (DT)

PV2-18.1 Special Program Code (IS)

PV2-19.1 Retention Indicator (ID)

PV2-20.1 Expected Number of Insurance Plans (NM)

PV2-21.1 Visit Publicity Code (IS)

PV2-22.1 Visit Protection Indicator (ID)

PV2-23.1 Clinic Organization Name (XON)- Organization Name (ST)

PV2-23.2 Clinic Organization Name (XON)- Organization Name Type Code (ID)

PV2-23.3 Clinic Organization Name (XON)- ID Number (ID)

PV2-23.4 Clinic Organization Name (XON)- Check Digit (NM)

PV2-23.5 Clinic Organization Name (XON)- Check Digit Scheme (ID)

PV2-23.6.1 Clinic Organization Name (XON)- Assigning Authority (HD)- Namesp

PV2-23.6.2 Clinic Organization Name (XON)- Assigning Authority (HD)- Universal

PV2-23.6.3 Clinic Organzation Name (XON)- Assigning Authority (HD)- Universal


PV2-23.7 Clinic Organization Name (XON)- Identifier Type Code (ID)

PV2-23.8.1 Clinic Organization Name (XON)- Assigning Facility (HD)- Namespac

PV2-23.8.2 Clinic Organization Name (XON)- Assigning Facility (HD)- Universal I

PV2-23.8.3 Clinic Organization Name (XON)- Assigning Facility (HD)- Universal I

PV2-24.1 Patient Status Code (IS)

PV2-25.1 Visit Priority Code (IS)

PV2-26.1 Previous Treatment Date (DT)

PV2-27.1 Expected Discharge Disposition (IS)

PV2-28.1 Signature o File Date (DT)

PV2-29.1 First Similar Illness Date (DT)

PV2-30.1 Patient Charge Adjustment Code (IS)

PV2-31.1 Recurring Service Code (IS)

PV2-32.1 Billing Media Code (ID)

PV2-33.1 Expected Surgery Date and Time (TS)

PV2-34.1 Military Partnership Code (ID)

PV2-35.1 Military Non Availability Code (ID)

PV2-36.1 Newborn Baby Indicatory (ID)

PV2-37.1 Baby Detained Indicatory (ID)

DB1DB1-1.1 Set ID- DBI (SI)

DB1-2.1 Disabled Person Code (IS)

DB1-3.1 Disabled Person Identifier (CX) - ID (ST)

DB1-3.2 Disabled Person Identifier (CX)- Check Digit (ST)

DB1-3.3 Disabled Person Identifier (CX)- Code Identifying the Check Digit Sch

DB1-3.4.1 Disabled Person Identifier (CX)- Assigning Authority (HD)- Namespac

DB1-3.4.2 Disabled Person Identifier (CX)- Assigning Authority (HD)- Universal I

DB1-3.4.3 Disabled Person Identifier (CX)- Assigning Authority (HD)- Universal I

DB1-3.5 Disabled Person Identifier (CX)- Identifier Type Code (IS)

DB1-3.6.1 Disabled Person Identifier (CX)- Assigning Facility (HD)- Namespace

DB1-3.6.2 Disabled Person Identifier (CX)- Assigning Facility (HD)- Universal ID

DB1-3.6.3 Disabled Person Identifier (CX)- Assigning Facility (HD)- Universal ID

DB1-4.1 Disability Indicator

DB1-5.1 Disability Start Date (DT)

DB1-6.1 Disability End Date (DT)

DB1-7.1 Disability Return to Work Date (DT)

DB1-8.1 Disability Unable to Work Date (DT)

OBXOBX-1.1 Set ID - Observation Simple (SI)

OBX-2.1 Value Type (ID)

OBX-3.1 Observation Identifier (CE) - Identifier (ST)

OBX-3.2 Observation Identifier (CE) - Text (ST)

OBX-3.3 Observation Identifier (CE) - Name of coding system (ST)

OBX-3.4 Observation Identifier (CE) - Alternate Identifier (ST)

OBX-3.5 Observation Identifier (CE) - Alternate Text (ST)

OBX-3.6 Observation Identifier (CE) - Name of alternate coding system (ST)

OBX-4.1 Observation sub-ID (ST)


OBX-5.1 Observation value

OBX-6.1 Units (CE) - Identifier (ST)

OBX-6.2 Units (CE) - Text (ST)

OBX-6.3 Units (CE) - Name of coding system (ST)

OBX-6.4 Units (CE) - Alternate Identifier (ST)

OBX-6.5 Units (CE) - Alternate Text (ST)

OBX-6.6 Units (CE) - Name of alternate coding system (ST)

OBX-7.1 References range (ST)

OBX-8.1 Abnormal flags

OBX-9.1 Probability (NM)

OBX-10.1 Nature of abnormal test (ID)

OBX-11.1 Observ result status (ID)

OBX-12.1 Effective date last obs normal value (TS)

OBX-13.1 User defined access checks (ST)

OBX-14.1 Date-time of the observation (TS)

OBX-15.1 Producer's ID (CE) - Identifier (ST)

OBX-15.2 Producer's ID (CE) - Text (ST)

OBX-15.3 Producer's ID (CE) - Name of coding system (ST)

OBX-15.4 Producer's ID (CE) - Alternate identifier (ID)

OBX-15.5 Producer's ID (CE) - Alternate text (ST)

OBX-15.6 Producer's ID (CE) - Name of alternate coding system (ST)

OBX-16.1 Responsible observer (XCN) - ID Number (ST)

OBX-16.2 Responsible observer (XCN) - Family name (ST)

OBX-16.3 Responsible observer (XCN) - Given name (ST)

OBX-16.4 Responsible observer (XCN) - Middle initial or name (ST)

OBX-16.5 Responsible observer (XCN) - Suffix (ST)

OBX-16.6 Responsible observer (XCN) - Prefix (ST)

OBX-16.7 Responsible observer (XCN) - Degree (ST)

OBX-16.8 Responsible observer (XCN) - Source table (IS)

OBX-16.9 Responsible observer (XCN) - Assigning authority (HD)

OBX-16.10 Responsible observer (XCN) - Name type (ID)

OBX-16.11 Responsible observer (XCN) - Identifier check digit (ST)

OBX-16.12 Responsible observer (XCN) - Code identifying the check digit schem

OBX-16.13 Responsible observer (XCN) - Identifier type code (IS)

OBX-16.14 Responsible observer (XCN) - Assigning facility ID (HD)

OBX-17.1 Observation method (CE) - Identifier (ST)

OBX-17.2 Observation method (CE) - Text (ST)

OBX-17.3 Observation method (CE) - Name of coding system (ST)

OBX-17.4 Observation method (CE) - Alternate identifier (ID)

OBX-17.5 Observation method (CE) - Alternate text (ST)

OBX-17.6 Observation method (CE) - Name of alternate coding system (ST)

AL1AL1-1.1 Set ID-AL1 (SI)

AL1-2.1 Allergy Type (IS)

AL1-3.1 Allergy Code/Mnemonic/Description (CE)

AL1-4.1 Allergy Serverity (IS)


AL1-5.1 Allergy Reaction (ST)

AL1-6.1 Identification Date (DT)

DG1DG1-1.1 Set ID- DG1 (SI)

DG1-2.1 Diagnosis Coding Method (ID)

DG1-3.1 Diagnosis Code (CE)- Identifier (ST)

DG1-4.1 Diagnosis Description (ST)

DG1-5.1 Diagnosis Date/Time (TS)

DG1-6.1 Diagnosis Type (IS)

DG1-7.1 Major Diagnostic Category (CE)- Identifier (ST)

DG1-7.2 Major Diagnostic Category (CE)- Text (ST)

DG1-7.3 Major Diagnostic Category (CE)- Name of Coding System (ST)

DG1-7.4 Major Diagnostic Category (CE)- Alternate Identifier (ST)

DG1-7.5 Major Diagnostic Category (CE)- Alternate Text (ST)

DG1-7.6 Major Diagnostic Category (CE)- Name of Alternate Coding System (

DG1-8.1 Diagnostic Related Group (IS)

DG1-9.1 DRG Approval Indicator (ID)

DG1-10.1 DRG Grouper Review Code (IS)

DG1-11.1 Outlier Type (CE)- Identifier (ST)

DG1-11.2 Outlier Type (CE)- Text (ST)

DG1-11.3 Outlier Type (CE)- Name of Coding System (ST)

DG1-11.4 Outlier Type (CE)- Alternate Identifier (ST)

DG1-11.5 Outlier Type (CE)- Alternate Text (ST)

DG1-11.6 Outlier Type (CE)- Name of Alternate Coding System (ST)

DG1-12.1 Outlier Days (NM)

DG1-13.1 Outlier Cost (NM)

DG1-14.1 Grouper Version and Type (ST)

DG1-15.1 Diagnosis Priority (NM)

DG1-16.1 Diagnosing Clinician (XCN)- ID Number (ST)

DG1-16.2 Diagnosing Clinician (XCN)- Family Name (ST)

DG1-16.3 Diagnosing Clinician (XCN)- Given Name (ST)

DG1-16.4 Diagnosing Clinician (XCN)- Middle Initial or Name (ST)

DG1-16.5 Diagnosing Clinician (XCN)- Suffix (ST)

DG1-16.6 Diagnosing Clinician (XCN)- Prefix (ST)

DG1-16.7 Diagnosing Clinician (XCN)- Degree (ST)

DG1-16.8 Diagnosing Clinician (XCN)- Source Table (IS)

DG1-16.9.1 Diagnosing Clinician (XCN)- Assigning Authority (HD)- Namespace I

DG1-16.9.2 Diagnosing Clinician (XCN)- Assigning Authority (HD)- Universal ID (

DG1-16.9.3 Diagnosing Clinician (XCN)- Assigning Authority (HD)- Universal ID T

DG1-16.10 Diagnosing Clinician (XCN)- Name Type Code (ID)

DG1-16.11 Diagnosing Clinician (XCN)- Identifier Check Digit (ST)

DG1-16.12 Diagnosing Clinician (XCN)- Code Identifying the Check Digit Schem

DG1-16.13 Diagnosing Clinician (XCN)- Identifier Type Code (IS)

DG1-16.14.1 Diagnosing Clinician (XCN)- Assigning Facility (HD)- Namespace ID (

DG1-16.14.2 Diagnosing Clinician (XCN)- Assigning Facility (HD)- Universal ID (ST

DG1-16.14.3 Diagnosing Clinician (XCN)- Assigning Facility (HD)- Universal ID Typ


DG1-17.1 Diagnosis Classification (IS)

DG1-18.1 Confidential Indicator (ID)

DG1-19.1 Attestation Date/Time (TS)

DRGDRG-1.1 Diagnostic Related Group (CE)- Identifier (ST)

DRG-1.2 Diagnostic Related Group (CE)- Text (ST)

DRG-1.3 Diagnostic Related Group (CE)- Name of Coding System (ST)

DRG-1.4 Diagnostic Related Group (CE)- Alternate Identifier (ST)

DRG-1.5 Diagnostic Related Group (CE)- Alternate Text (ST)

DRG-1.6 Diagnostic Related Group (CE)- Name of Alternate Coding System (

DRG-2.1 DRG Assign Date/Time (TS)

DRG-3.1 DRG Approval Indicator (ID)

DRG-4.1 DRG Grouper Review Code (IS)

DRG-5.1 Outlier Type (CE)- Identifier (ST)

DRG-5.2 Outlier Type (CE)- Text (ST)

DRG-5.3 Outlier Type (CE)- Name of Coding System (ST)

DRG-5.4 Outlier Type (CE)- Alternate Identifier (ST)

DRG-5.5 Outlier Type (CE)- Alternate Text (ST)

DRG-5.6 Outlier Type (CE)- Name of Alternate Coding System (ST)

DRG-6.1 Outlier Days (CP)- Price (MO)

DRG-6.2 Outlier Days (CP)- Price Type (ID)

DRG-6.3 Outlier Days (CP)- From Value (NM)

DRG-6.4 Outlier Days (CP)- To Value (NM)

DRG-6.5 Outlier Days (CP)- Range Units (CE)

DRG-6.6 Outlier Days (CP)- Range Type (ID)

DRG-7.1 Outlier Cost (CP)- Price (MO)

DRG-7.2 Outlier Cost (CP)- Price Type (ID)

DRG-7.3 Outlier Cost (CP)- From Value (NM)

DRG-7.4 Outlier Cost (CP)- To Value (NM)

DRG-7.5 Outlier Cost (CP)- Range Units (CE)

DRG-7.6 Outlier Cost (CP)- Range Type (ID)

DRG-8.1 DRG Payor (IS)

DRG-9.1 Outlier Reimbursement (CP)- Price (MO)

DRG-9.2 Outlier Reimbursement (CP)- Price Type (ID)

DRG-9.3 Outlier Reimbursement (CP)- From Value (NM)

DRG-9.4 Outlier Reimbursement (CP)- To Value (NM)

DRG-9.5 Outlier Reimbursement (CP)- Range Units (CE)

DRG-9.6 Outlier Reimbursement (CP)- Range Type (ID)

DRG-10.1 Confidential Indicator (ID)

PR1PR1-1.1 Set ID- PRI (SI)

PR1-2.1 Procedure Coding Method (IS)

PR1-3.1 Procedure Code (CE)

PR1-4.1 Procedure Description (ST)

PR1-5.1 Procedure Date/Time (TS)

PR1-6.1 Proceduer Functional Type (IS)


PR1-7.1 Procedure Minutes (NM)

PR1-8.1 Anesthesiologist (XCN)- ID Number (ST)

PR1-8.2 Anesthesiologist (XCN)- Family Name (ST)

PR1-8.3 Anesthesiologist (XCN)- Given Name (ST)

PR1-8.4 Anesthesiologist (XCN)- Middle Initial or Name (ST)

PR1-8.5 Anesthesiologist (XCN)- Suffix (ST)

PR1-8.6 Anesthesiologist (XCN)- Prefix (ST)

PR1-8.7 Anesthesiologist (XCN)- Degree (ST)

PR1-8.8 Anesthesiologist (XCN)- Source Table (IS)

PR1-8.9.1 Anesthesiologist (XCN)- Assigning Authority (HD)- Namespace ID (IS

PR1-8.9.2 Anesthesiologist (XCN)- Assigning Authority (HD)- Universal ID (ST)

PR1-8.9.3 Anesthesiologist (XCN)- Assigning Authority (HD)- Universal ID Type

PR1-8.10 Anesthesiologist (XCN)- Name Type Code (ID)

PR1-8.11 Anesthesiologist (XCN)- Identifier Check Digit (ST)

PR1-8.12 Anesthesiologist (XCN)- Code Identifying the Check Digit Scheme E

PR1-8.13 Anesthesiologist (XCN)- Identifier Type Code (IS)

PR1-8.14.1 Anesthesiologist (XCN)- Assigning Facility (HD)- Namespace ID (IS)

PR1-8.14.2 Anesthesiologist (XCN)- Assigning Facility (HD)- Universal ID (ST)

PR1-8.14.3 Anesthesiologist (XCN)- Assigning Facility (HD)- Universal ID Type (I

PR1-9.1 Anesthesia Code (IS)

PR1-10.1 Anesthesia Minutes (NM)

PR1-11.1 Surgeon (XCN)- ID Number (ST)

PR1-11.2 Surgeon (XCN)- Family Name (ST)

PR1-11.3 Surgeon (XCN)- Given Name (ST)

PR1-11.4 Surgeon (XCN)- Middle Initial or Name (ST)

PR1-11.5 Surgeon (XCN)- Suffix (ST)

PR1-11.6 Surgeon (XCN)- Prefix (ST)

PR1-11.7 Surgeon (XCN)- Degree (ST)

PR1-11.8 Surgeon (XCN)- Source Table (IS)

PR1-11.9.1 Surgeon (XCN)- Assigning Authority (HD)- Namespace ID (IS)

PR1-11.9.2 Surgeon (XCN)- Assigning Authority (HD)- Universal ID (ST)

PR1-11.9.3 Surgeon (XCN)- Assiging Authority (HD)- Universal ID Type (ID)

PR1-11.10 Surgeon (XCN)- Name Type Code (ID)

PR1-11.11 Surgeon (XCN)- Identifier Check Digit (ST)

PR1-11.12 Surgeon (XCN)- Code Identifying the Check Digit Scheme Employed

PR1-11.13 Surgeon (XCN)- Identifier Type Code (IS)

PR1-11.14.1 Surgeon (XCN)- Assigning Facility (HD)- Namespace ID (IS)

PR1-11.14.2 Surgeon (XCN)- Assigning Facility (HD)- Universal ID (ST)

PR1-11.14.3 Surgeon (XCN)- Assigning Facility (HD)- Universal ID Type (ID)

PR1-12.1 Procedure Practitioner (XCN)- ID Number (ST)

PR1-12.2 Procedure Practitioner (XCN)- Family Name (ST)

PR1-12.3 Procedure Practitioner (XCN)- Given Name (ST)

PR1-12.4 Procedure Practitioner (XCN)- Middle Initial or Name (ST)

PR1-12.5 Procedure Practitioner (XCN)- Suffix (ST)

PR1-12.6 Procedure Practitioner (XCN)- Prefix (ST)

PR1-12.7 Procedure Practitioner (XCN)- Degree (ST)


PR1-12.8 Procedure Practitioner (XCN)- Source Table (IS)

PR1-12.9.1 Procedure Practitioner (XCN)- Assigning Authority (HD)- Namespace

PR1-12.9.2 Procedure Practitioner (XCN)- Assigning Authority (HD)- Universal ID

PR1-12.9.3 Procedure Practitioner (XCN)- Assigning Authority (HD)- Universal ID

PR1-12.10 Procedure Practitioner (XCN)- Name Type Code (ID)

PR1-12.11 Procedure Practitioner (XCN)- Identifier Check Digit (ST)

PR1-12.12 Procedure Practitioner (XCN)- Code Identifying the Check Digit Sche

PR1-12.13 Procedure Practitioner (XCN)- Identifier Type Code (IS)

PR1-12.14.1 Procedure Practitioner (XCN)- Assigning Facility (HD)- Namespace I

PR1-12.14.2 Procedure Practitioner (XCN)- Assigning Facility (HD)- Universal ID (

PR1-12.14.3 Procedure Practitioner (XCN)- Assigning Facility (HD)- Universal ID T

PR1-13.1 Consent Code (CE)- Identifier (ST)

PR1-13.2 Consent Code (CE)- Text (ST)

PR1-13.3 Consent Code (CE)- Name of Coding System (ST)

PR1-13.4 Consent Code (CE)- Alternate Identifier (ST)

PR1-13.5 Consent Code (CE)- Alternate Text (ST)

PR1-13.6 Consent Code (CE)- Name of Alternate Coding System (ST)

PR1-14.1 Procedure Priority (NM)

PR1-15.1 Associated Diagnosis Code (CE)- Identifier (ST)

PR1-15.2 Associated Diagnosis Code (CE)- Text (ST)

PR1-15.3 Associated Diagnosis Code (CE)- Name of Coding System (ST)

PR1-15.4 Associated Diagnosis Code (CE)- Alternate Identifier (ST)

PR1-15.5 Associated Diagnosis Code (CE)- Alternate Text (ST)

PR1-15.6 Associated Diagnosis Code (CE)- Name of Alternate Coding System

ROLROL-1.1 Role Instance ID (EI)- Entity Identifier (ST)

ROL-1.2 Role Instance ID (EI)- Assigning Authority (HD)

ROL-2.1 Action Code (ID)

ROL-3.1 Role (CE)- Identifier (ST)

ROL-3.2 Role (CE)- Text (ST)

ROL-3.3 Role (CE)- Name of Coding System (ST)

ROL-3.4 Role (CE)- Alternate Identifier (ST)

ROL-3.5 Role (CE)- Alternate Text (ST)

ROL-3.6 Role (CE)- Name of Alternate Coding System (ST)

ROL-4.1 Role Person (XCN)- ID Number (ST)

ROL-4.2 Role Person (XCN)- Family Name (ST)

ROL-4.3 Role Person (XCN)- Given Name (ST)

ROL-4.4 Role Person (XCN)- Middle Initial or Name (ST)

ROL-4.5 Role Person (XCN)- Suffix (ST)

ROL-4.6 Role Person (XCN)- Prefix (ST)

ROL-4.7 Role Person (XCN)- Degree (ST)

ROL-4.8 Role Person (XCN)- Source Table (IS)

ROL-4.9 Role Person (XCN)- Assigning Authority (HD)

ROL-4.10 Role Person (XCN)- Name Type Code (ID)

ROL-4.11 Role Person (XCN)- Identifier Check Digit (ST)

ROL-4.12 Role Person (XCN)- Code Identifying the Check Digit Scheme Emplo


ROL-4.13 Role Person (XCN)- Identifier Type Code (IS)

ROL-4.14 Role Person (XCN)- Assigning Facility (HD)

ROL-5.1 Role Begin Date/Time (TS)

ROL-6.1 Role End Date/Time (TS)

ROL-7.1 Role Duration (CE)- Identifier (ST)

ROL-7.2 Role Duration (CE)- Text (ST)

ROL-7.3 Role Duration (CE)- Name of Coding System (ST)

ROL-7.4 Role Duration (CE)- Alternate Identifier (ST)

ROL-7.5 Role Duration (CE)- Alternate Text (ST)

ROL-7.6 Role Duration (CE)- Name of Alternate Coding System (ST)

ROL-8.1 Role Action Reason (CE)- Identifier (ST)

ROL-8.2 Role Action Reason (CE)- Text (ST)

ROL-8.3 Role Action Reason (CE)- Name of Coding System (ST)

ROL-8.4 Role Action Reason (CE)- Alternate Identifier (ST)

ROL-8.5 Role Action Reason (CE)- Alternate Text (ST)

ROL-8.6 Role Action Reason (CE)- Name of Alternate Coding System (ST)

GT1GT1-1.1 Set ID- GT1 (SI)

GT1-2.1 Guarantor Number (CX)- ID (ST)

GT1-2.2 Guarantor Number (CX)- Check Digit (ST)

GT1-2.3 Guarantor Number (CX)- Code Identiftying the Check Digit Scheme E

GT1-2.4.1 Guarantor Number (CX)- Assigning Authority (HD)- Namespace ID (I

GT1-2.4.2 Guarantor Number (CX)- Assigning Authority (HD)- Universal ID (ST)

GT1-2.4.3 Guarantor Number (CX)- Assigning Authority (HD)- Universal ID Type

GT1-2.5 Guarantor Number (CX)- Identifier Type Code (IS)

GT1-2.6.1 Guarantor Number (CX)- Assigning Facility (HD)- Namespace ID (IS)

GT1-2.6.2 Guarantor Number (CX)- Assigning Facility (HD)- Universal ID (ST)

GT1-2.6.3 Guarantor Number (CX)- Assigning Facility (HD)- Universal ID Type (I

GT1-3.1 Guarantor Name (XPN)- Family Name (ST)

GT1-3.2 Guarantor Name (XPN)- Given Name (ST)

GT1-3.3 Guarantor Name (XPN)- Middle Initial or Name (ST)

GT1-3.4 Guarantor Name (XPN)- Suffix (ST)

GT1-3.5 Guarantor Name (XPN)- Prefix (ST)

GT1-3.6 Guarantor Name (XPN)- Degree (ST)

GT1-3.7 Guarantor Name (XPN)- Name Type Code (ID)

GT1-4.1 Guarantor Spouse Name (XPN)- Family Name (ST)

GT1-4.2 Guarantor Spouse Name (XPN)- Given Name (ST)

GT1-4.3 Guarantor Spouse Name (XPN)- Middle Initial or Name (ST)

GT1-4.4 Guarantor Spouse Name (XPN)- Sufix (ST)

GT1-4.5 Guarantor Spouse Name (XPN)- Prefix (ST)

GT1-4.6 Guarantor Spouse Name (XPN)- Degree (ST)

GT1-4.7 Guarantor Spouse Name (XPN)- Name Type Code (ID)

GT1-5.1 Guarantor Address (XAD)- Street Address (ST)

GT1-5.2 Guarantor Address (XAD)- Other Designation (ST)

GT1-5.3 Guarantor Address (XAD)- City (ST)

GT1-5.4 Guarantor Address (XAD)- State or Province (ST)


GT1-5.5 Guarantor Address (XAD)- Zip or Postal Code (ST)

GT1-5.6 Guarantor Address (XAD)-Country (ID)

GT1-5.7 Guarantor Address (XAD)- Address Type (ID)

GT1-5.8 Guarantor Address (XAD)- Other Geographic Designation (ST)

GT1-5.9 Guarantor Address (XAD)- County/Parish Code (IS)

GT1-5.10 Guarantor Address (XAD)- Census Tract (IS)

GT1-6.1 Guarantor Ph Num- Home (XTN)- [NNN] [(999)999-9999 [X99999] [B

GT1-6.2 Guarantor Ph Num- Home (XTN)- Telecommunication Use Code (ID)

GT1-6.3 Guarantor Ph Num- Home (XTN)- Telecommunication Equipment Ty

GT1-6.4 Guarantor Ph Num- Home (XTN)- Email Address (ST)

GT1-6.5 Guarantor Ph Num- Home (XTN)- Country Code (NM)

GT1-6.6 Guarantor Ph Num- Home (XTN)- Area/City Code (NM)

GT1-6.7 Guarantor Ph Num- Home (XTN)- Phone Number (NM)

GT1-6.8 Guarantor Ph Num- Home (XTN)- Extension (NM)

GT1-6.9 Guarantor Ph Num- Home (XTN)- Any Text (ST)

GT1-7.1 Guarantor Ph Num- Business (XTN)- [NNN] [(999)999-9999 [X99999]

GT1-7.2 Guarantor Ph Num- Business (XTN)- Telecommunication Use Code (

GT1-7.3 Guarantor Ph Num- Business (XTN)- Telecommunication Equipment

GT1-7.4 Guarantor Ph Num- Business (XTN)- Email Address (ST)

GT1-7.5 Guarantor Ph Num- Business (XTN)- Country Code (NM)

GT1-7.6 Guarantor Ph Num- Business (XTN)- Area/City Code (NM)

GT1-7.7 Guarantor Ph Num- Business (XTN)- Phone Number (NM)

GT1-7.8 Guarantor Ph Num- Business (XTN)- Extension (NM)

GT1-7.9 Guarantor Ph Num- Business (XTN)- Any Text (ST)

GT1-8.1 Guarantor Date and Time of Birth (TS)

GT1-9.1 Guarantor Type (IS)

GT1-10.1 Guarantor Type (IS)

GT1-11.1 Guarantor Relationship (IS)

GT1-12.1 Guarantor SSN (ST)

GT1-13.1 Guarantor Date- Begin (DT)

GT1-14.1 Guarantor Date- End (DT)

GT1-15.1 Guarantor Priority (NM)

GT1-16.1 Guarantor Employer Name (XPN)- Family Name (ST)

GT1-16.2 Guarantor Employer Name (XPN)- Given Name (ST)

GT1-16.3 Guarantor Employer Name (XPN)- Middle Initial or Name (ST)

GT1-16.4 Guarantor Employer Name (XPN)- Suffix (ST)

GT1-16.5 Guarantor Employer Name (XPN)- Prefix (ST)

GT1-16.6 Guarantor Employer Name (XPN)- Degree (ST)

GT1-16.7 Guarantor Employer Name (XPN)- Name Type Code (ID)

GT1-17.1 Guarantor Employer Address (XAD)- Street Address (ST)

GT1-17.2 Guarantor Employer Address (XAD)- Other Designation (ST)

GT1-17.3 Guarantor Employer Address (XAD)- City (ST)

GT1-17.4 Guarantor Employer Address (XAD)- State or Province (ST)

GT1-17.5 Guarantor Employer Address (XAD)- Zip or Postal Code (ST)

GT1-17.6 Guarantor Employer Address (XAD)- Country (ID)

GT1-17.7 Guarantor Employer Address (XAD)- Address Type (ID)


GT1-17.8 Guarantor Employer Address (XAD)- Other Geographic Designation (

GT1-17.9 Guarantor Employer Address (XAD)- County/ Parish Code (IS)

GT1-17.10 Guarantor Employer Address (XAD)- Census Tract (IS)

GT1-18.1 Guarantor Employer Phone Number (XTN)- [NNN] [(999)999-9999 [X

GT1-18.2 Guarantor Employer Phone Number (XTN)- Telecommunication Use

GT1-18.3 Guarantor Employer Phone Number (XTN)- Telecommunication Equi

GT1-18.4 Guarantor Employer Phone Number (XTN)- Email Address (ST)

GT1-18.5 Guarantor Employer Phone Number (XTN)- Country Code (NM)

GT1-18.6 Guarantor Employer Phone Number (XTN)- Area/City Code (NM)

GT1-18.7 Guarantor Employer Phone Number (XTN)- Phone Number (NM)

GT1-18.8 Guarantor Employer Phone Number (XTN)- Extension (NM)

GT1-18.9 Guarantor Employer Phone Number (XTN)- Any Text (ST)

GT1-19.1 Guarantor Employee ID Number (CX)- ID (ST)

GT1-19.2 Guarantor Employee ID Number (CX)- Check Digit (ST)

GT1-19.3 Guarantor Employee ID Number (CX)- Code Identifying the Check Di

GT1-19.4.1 Guarantor Employee ID Number (CX)- Assigning Authority (HD)- Na

GT1-19.4.2 Guarantor Employee ID Number (CX)- Assigning Authority (HD)- Univ

GT1-19.4.3 Guarantor Employee ID Number (CX)- Assigning Authority (HD)- Univ

GT1-19.5 Guarantor Employee ID Number (CX)- Identifier Type Code (IS)

GT1-19.6.1 Guarantor Employee ID Number (CX)- Assigning Facility (HD)- Name

GT1-19.6.2 Guarantor Employee ID Number (CX)- Assigning Facility (HD)- Unive

GT1-19.6.3 Guarantor Employee ID Number (CX)- Assigning Facility (HD)- Unive

GT1-20.1 Guarantor Employment Status (IS)

GT1-21.1 Guarantor Organization Name (XON)- Organization Name (ST)

GT1-21.2 Guarantor Organization Name (XON)- Organization Name Type Cod

GT1-21.3 Guarantor Organization Name (XON)- ID Number (ID)

GT1-21.4 Guarantor Organization Name (XON)- Check Digit (NM)

GT1-21.5 Guarantor Organization Name (XON)- Check Digit Scheme (ID)

GT1-21.6.1 Guarantor Organization Name (XON)- Assigning Authority (HD)- Nam

GT1-21.6.2 Guarantor Organization Name (XON)- Assigning Authority (HD)- Univ

GT1-21.6.3 Guarantor Organization Name (XON)- Assigning Authority (HD)- Univ

GT1-21.7 Guarantor Organization Name (XON)- Identifier Type Code (ID)

GT1-21.8.1 Guarantor Organization Name (XON)- Assigning Facility ID (HD)- Na

GT1-21.8.2 Guarantor Organization Name (XON)- Assigning Facility ID (HD)- Uni

GT1-21.8.3 Guarantor Organization Name (XON)- Assigning Facility ID (HD)- Uni

GT1-22.1 Guarantor Billing Hold Flag (ID)

GT1-23.1 Guarantor Credit Rating Code (CE)- Identifier (ST)

GT1-23.2 Guarantor Credit Rating Code (CE)- Text (ST)

GT1-23.3 Guarantor Credit Rating Code (CE)- Name of Coding System (ST)

GT1-23.4 Guarantor Credit Rating Code (CE)- Alternate Identifier (ST)

GT1-23.5 Guarantor Credit Rating Code (CE)- Alternate Text (ST)

GT1-23.6 Guarantor Credit Rating Code (CE)- Name of Alternate Coding Syste

GT1-24.1 Guarantor Death Date and Time (TS)

GT1-25.1 Guarantor Death Flag (ID)

GT1-26.1 Guarantor Charge Adjustment Code (CE)- Identifier (ST)

GT1-26.2 Guarantor Charge Adjustment Code (CE)- Text (ST)


GT1-26.3 Guarantor Charge Adjustment Code (CE)- Name of Coding System (

GT1-26.4 Guarantor Charge Adjustment Code (CE)- Alternate Identifier (ST)

GT1-26.5 Guarantor Charge Adjustment Code (CE)- Alternate Text (ST)

GT1-26.6 Guarantor Charge Adjustment Code (CE)- Name of Alternate Coding

GT1-27.1 Guarantor Household Annual Income (CP)- Price (MO)

GT1-27.2 Guarantor Household Annual Income (CE)- Price Type (ID)

GT1-27.3 Guarantor Household Annual Income (CE)- From Value (NM)

GT1-27.4 Guarantor Household Annual Income (CE)- To Value (NM)

GT1-27.5 Guarantor Household Annual Income (CE)- Range Units (CE)

GT1-27.6 Guarantor Household Annual Income (CE)- Range Type (ID)

GT1-28.1 Guarantor Household Size (NM)

GT1-29.1 Guarantor Employer Identification Number (CX)- ID (ST)

GT1-29.2 Guarantor Employer Identification Number (CX)- Check Digit (ST)

GT1-29.3 Guarantor Employer Identification Number (CX)- Code Identifying the

GT1-29.4.1 Guarantor Employer Identification Number (CX)- Assigning Authority



GT1-29.5 Guarantor Employer Identification Number (CX)- Identifier Type Code

GT1-29.6.1 Guarantor Employer Identification Number (CX)- Assigning Facility (H



GT1-30.1 Guarantor Marital Status Code (IS)

GT1-31.1 Guarantor Hire Effective Date (DT)

GT1-32.1 Guarantor Employement Stop Date (DT)

GT1-33.1 Living Dependency (IS)

GT1-34.1 Ambulatory Status Code (IS)

GT1-35.1 Citizenship (IS)

GT1-36.1 Primary Language (CE)- Identifier (ST)

GT1-36.2 Primary Language (CE)- Text (ST)

GT1-36.3 Primary Language (CE)- Name of Coding System (ST)

GT1-36.4 Primary Language (CE)- Alternate Identifier (ST)

GT1-36.5 Primary Language (CE)- Alternate Text (ST)

GT1-36.6 Primary Language (CE)- Name of Alternate Coding System (ST)

GT1-37.1 Living Arrangement (IS)

GT1-38.1 Publicity Indicator (CE)- Identifier (ST)

GT1-38.2 Publicity Indicator (CE)- Text (ST)

GT1-38.3 Publicity Indicator (CE)- Name of Coding System (ST)

GT1-38.4 Publicity Indicator (CE)- Alternate Identifier (ST)

GT1-38.5 Publicity Indicator (CE)- Alternate Text (ST)

GT1-38.6 Publicity Indicator (CE)- Name of Alternate Coding System (ST)

GT1-39.1 Protection Indicator (ID)

GT1-40.1 Student Indicator (IS)

GT1-41.1 Religion (IS)

GT1-42.1 Mother's Maiden Name (XPN)- Family Name (ST)

GT1-42.2 Mother's Maiden Name (XPN)- Given Name (ST)

GT1-42.3 Mother's Maiden Name (XPN)- Middle Initial or Name (ST)


GT1-42.4 Mother's Maiden Name (XPN)- Suffix (ST)

GT1-42.5 Mother's Maiden Name (XPN)- Prefix (ST)

GT1-42.6 Mother's Maiden Name (XPN)- Degree (ST)

GT1-42.7 Mother's Maiden Name (XPN)- Name Type Code (ID)

GT1-43.1 Nationality (CE)- Identifier (ST)

GT1-43.2 Nationality (CE)- Text (ST)

GT1-43.3 Nationality (CE)- Name of Coding System (ST)

GT1-43.4 Nationality (CE)- Alternate Identifier (ST)

GT1-43.5 Nationality (CE)- Alternate Text (ST)

GT1-43.6 Nationality (CE)- Name of Alternate Coding System (ST)

GT1-44.1 Ethnic Group (IS)

GT1-45.1 Contact Person Name (XPN)- Family Name (ST)

GT1-45.2 Contact Person Name (XPN)- Given Name (ST)

GT1-45.3 Contact Person Name (XPN)- Middle Initial or Name (ST)

GT1-45.4 Contact Person Name (XPN)- Suffix (ST)

GT1-45.5 Contact Person Name (XPN)- Prefix (ST)

GT1-45.6 Contact Person Name (XPN)- Degree (ST)

GT1-45.7 Contact Person Name (XPN)- Name Type Code (ID)

GT1-46.1 Contact Person Phone Number (XTN)- [NNN] [(999)999-9999 [X9999

GT1-46.2 Contact Person Phone Number (XTN)- Telecommunication Use Cod

GT1-46.3 Contact Person Phone Number (XTN)- Telecommunication Equipme

GT1-46.4 Contact Person Phone Number (XTN)- Email Address (ST)

GT1-46.5 Contact Person Phone Number (XTN)- Country Code (NM)

GT1-46.6 Contact Person Phone Number (XTN)- Area/City Code (NM)

GT1-46.7 Contact Person Phone Number (XTN)- Phone Number (NM)

GT1-46.8 Contact Person Phone Number (XTN)- Extension (NM)

GT1-46.9 Contact Person Phone Number (XTN)- Any Text (ST)

GT1-47.1 Contact Reason (CE)- Identifier (ST)

GT1-47.2 Contact Reason (CE)- Text (ST)

GT1-47.3 Contact Reason (CE)- Name of Coding System (ST)

GT1-47.4 Contact Reason (CE)- Alternate Identifier (ST)

GT1-47.5 Contact Reason (CE)- Alternate Text (ST)

GT1-47.6 Contact Reason (CE)- Name of Alternate Coding System (ST)

GT1-48.1 Contact Relationship Code (IS)

GT1-49.1 Job Title (ST)

GT1-50.1 Job Code/Class (JCC)- Job Code (IS)

GT1-50.2 Job Code/Class (JCC)- Job Class (IS)

GT1-51.1 Guarantor Employer's Organization Name (XON)- Organization Nam

GT1-51.2 Guarantor Employer's Organization Name (XON)- Organization Nam

GT1-51.3 Guarantor Employer's Organization Name (XON)- ID Number (ID)

GT1-51.4 Guarantor Employer's Organization Name (XON)- Check Digit (NM)

GT1-51.5 Guarantor Employer's Organization Name (XON)- Check Digit Sche

GT1-51.6.1 Guarantor Employer's Organization Name (XON)- Assigning Authorit

GT1-51.6.2 Guarantor Employer's Organization Name (XON)- Assigning Authorit

GT1-51.6.3 Guarantor Employer's Organization Name (XON)- Assigning Authroit

GT1-51.7 Guarantor Employer's Organization Name (XON)- Identifier Type Cod


GT1-51.8.1 Guarantor Employer's Organization Name (XON)- Assigning Facility I



GT1-52.1 Handicap (IS)

GT1-53.1 Job Status (IS)

GT1-54.1 Guarantor Financial Class (FC)- Financial Class (IS)

GT1-54.2 Guarantor Financial Class (FC)- Effective Date (TS)

GT1-55.1 Guarantor Race (IS)

IN1IN1-1.1 Set ID- IN1 (SI)

IN1-2.1 Insurance Plan ID (CE)- Identifier (ST)

IN1-2.2 Insurance Plan ID (CE)- Text (ST)

IN1-2.3 Insurance Plan ID (CE)- Name of Coding System (ST)

IN1-2.4 Insuance Plan ID (CE)- Alternate Identifier (ST)

IN1-2.5 Insurance Plan ID (CE)- Alternate Text (ST)

IN1-2.6 Insurance Plan ID (CE)- Name of Alternate Coding System (ST)

IN1-3.1 Insurance Company ID (CX)- ID (ST)

IN1-3.2 Insurance Company ID (CX)- Check Digit (ST)

IN1-3.3 Insurance Company ID (CX)- Code Identifying the Check Digit Sche

IN1-3.4.1 Insurance Company ID (CX)- Assigning Authority (HD)- Namespace I

IN1-3.4.2 Insurance Company ID (CX)- Assigning Authority (HD)- Universal ID (

IN1-3.4.3 Insurance Company ID (CX)- Assigning Authority (HD)- Universal ID

IN1-3.5 Insurance Company ID (CX)- Identifier Type Code (IS)

IN1-3.6.1 Insurance Company ID (CX)- Assigning Facility ID (HD)- Namespace

IN1-3.6.2 Insurance Company ID (CX)- Assigning Facility ID (HD)- Universal ID

IN1-3.6.3 Insurance Company ID (CX)- Assigning Facility ID (HD)- Universal ID

IN1-4.1 Insurance Company Name (XON)- Organization Name (ST)

IN1-4.2 Insurance Company Name (XON)- Organization Name Type Code (I

IN1-4.3 Insurance Company Name (XON)- ID Number (ID)

IN1-4.4 Insurnace Company Name (XON)- Check Digit (NM)

IN1-4.5 Insurance Company Name (XON)- Check Digit Scheme (ID)

IN1-4.6.1 Insurance Company Name (XON)- Assigning Authority (HD)- Names

IN1-4.6.2 Insuance Company Name (XON)- Assigning Authority (HD)- Universa

IN1-4.6.3 Insurance Company Name (XON)- Assigning Authority (HD)- Univers

IN1-4.7 Insurance Company Name (XON)- Identifier Type Code (ID)

IN1-4.8.1 Insurance Company Name (XON)- Assigning Facility ID (HD)- Names

IN1-4.8.2 Insurance Company Name (XON)- Assigning Facility ID (HD)- Univer

IN1-4.8.3 Insurance Company Name (XON)- Assigning Facility ID (HD)- Univer

IN1-5.1 Insurance Company Address (XAD)- Street Address (ST)

IN1-5.2 Insurance Company Address (XAD)- Other Designation (ST)

IN1-5.3 Insurance Company Address (XAD)- City (ST)

IN1-5.4 Insurance Company Address (XAD)- State or Province (ST)

IN1-5.5 Insurance Company Address (XAD)- Zip or Postal Code (ST)

IN1-5.6 Insurance Company Address (XAD)- Country (ID)

IN1-5.7 Insurance Company Address (XAD)- Address Type (ID)

IN1-5.8 Insurance Company Address (XAD)- Other Geographic Designation (


IN1-5.9 Insurance Company Address (XAD)- County/Parish Code (IS)

IN1-5.10 Insurance Company Address (XAD)- Census Tract (IS)

IN1-6.1 Insurance Company Contact Person (XPN)- Family Name (ST)

IN1-6.2 Insurance Company Contact Person (XPN)- Given Name (ST)

IN1-6.3 Insurance Company Contact Person (XPN)- Middle Initial or Name (S

IN1-6.4 Insurance Company Contact Person (XPN)- Suffix (ST)

IN1-6.5 Insurance Company Contact Person (XPN)- Prefix (ST)

IN1-6.6 Insurance Company Contact Person (XPN)- Degree (ST)

IN1-6.7 Insurance Company Contact Person (XPN)- Name Type Code (ID)

IN1-7.1 Insurance Co Phone Number (XTN)- [NNN] [(999)999-9999 [X99999]

IN1-7.2 Insurance Co Phone Number (XTN)- Telecommunication Use Code (I

IN1-7.3 Insurance Co Phone Number (XTN)- Telecommunication Equipment

IN1-7.4 Insurance Co Phone Number (XTN)- Email Address (ST)

IN1-7.5 Insurance Co Phone Number (XTN)- Country Code (NM)

IN1-7.6 Insurance Co Phone Number (XTN)- Area/City Code (NM)

IN1-7.7 Insurance Co Phone Number (XTN)- Phone Number (NM)

IN1-7.8 Insurance Co Phone Number (XTN)- Extension (NM)

IN1-7.9 Insurance Co Phone Number (XTN)- Any Text (ST)

IN1-8.1 Group Number (ST)

IN1-9.1 Group Name (XON)- Organization Name (ST)

IN1-9.2 Group Name (XON)- Organization Name Type Code (ID)

IN1-9.3 Group Name (XON)- ID Number (ID)

IN1-9.4 Group Name (XON)- Check Digit (NM)

IN1-9.5 Group Name (XON)- Check Digit Scheme (ID)

IN1-9.6.1 Group Name (XON)- Assigning Authority (HD)- Namespace ID (IS)

IN1-9.6.2 Group Name (XON)- Assigning Authority (HD)- Universal ID (ST)

IN1-9.6.3 Group Name (XON)- Assigning Authority (HD)- Universal ID Type (ID

IN1-9.7 Group Name (XON)- Identifier Type Code (ID)

IN1-9.8.1 Group Name (XON)- Assigning Facility ID (HD)- Namespace ID (IS)

IN1-9.8.2 Group Name (XON)- Assigning Facility ID (HD)- Universal ID (ST)

IN1-9.8.3 Group Name (XON)- Assigning Facility ID (HD)- Universal ID Type (I

IN1-10.1 Insured's Group Empl ID (CX)- ID (ST)

IN1-10.2 Insured's Group Empl ID (CX)- Check Digit (ST)

IN1-10.3 Insured's Group Empl ID (CX)- Code Identifying the Check Digit Sche

IN1-10.4.1 Insured's Group Empl ID (CX)- Assigning Authority (HD)- Namespace

IN1-10.4.2 Insured's Group Empl ID (CX)- Assigning Authority (HD)- Universal I

IN1-10.4.3 Insured' Group Empl ID (CX)- Assinging Authority (HD)- Universal ID

IN1-10.5 Insured's Group Empl ID (CX)- Identifier Type Code (IS)

IN1-10.6.1 Insured's Group Empl ID (CX)- Assigning Facility (HD)- Namespace I

IN1-10.6.2 Insured's Group Empl ID (CX)- Assigning Facility (HD)- Universal ID (

IN1-10.6.3 Insured's Group Empl ID (CX)- Assigning Facility (HD)- Universal ID

IN1-11.1 Insured's Group Emp Name (XON)- Organization Name (ST)

IN1-11.2 Insured's Group Emp Name (XON)- Organization Name Type Code (I

IN1-11.3 Insured's Group Emp Name (XON)- ID Number (ID)

IN1-11.4 Insured's Group Emp Name (XON)- Check Digit (NM)

IN1-11.5 Insured's Group Emp Name (XON)- Check Digit Scheme (ID)


IN1-11.6.1 Insured's Group Emp Name (XON)- Assigning Authority (HD)- Name

IN1-11.6.2 Insured's Group Emp Name (XON)- Assigning Authority (HD)- Univer

IN1-11.6.3 Insured's Group Emp Name (XON)- Assinging Authority (HD)- Univer

IN1-11.7 Insured's Group Emp Name (XON)- Identifier Type Code (IS)

IN1-11.8.1 Insured's Group Emp Name (XON)- Assigning Facility (HD)- Namesp

IN1-11.8.2 Insured's Group Emp Name (XON)- Assigning Facility (HD)- Universa

IN1-11.8.3 Insured's Group Emp Name (XON)- Assigning Facility (HD)- Universa

IN1-12.1 Plan Effective Date (DT)

IN1-13.1 Plan Expiration Date (DT)

IN1-14.1 Authorization Information (CM)- Authorization Number (ST)

IN1-14.2 Authorization Information (CM)- Date (DT)

IN1-14.3 Authorization Information (CM)- Source (ST)

IN1-15.1 Plan Type (IS)

IN1-16.1 Name of Insured (XPN)- Family Name (ST)

IN1-16.2 Name of Insured (XPN)- Given Name (ST)

IN1-16.3 Name of Insured (XPN)- Middle Initial or Name (ST)

IN1-16.4 Name of Insured (XPN)- Sufix (ST)

IN1-16.5 Name of Insured (XPN)- Prefix (ST)

IN1-16.6 Name of Insured (XPN)- Degree (ST)

IN1-16.7 Name of Insured (XPN)- Name Type Code (ID)

IN1-17.1 Insured's Relationship to Patient (IS)

IN1-18.1 Insured's Date of Birth (TS)

IN1-19.1 Insured's Address (XAD)- Street Address (ST)

IN1-19.2 Insured's Address (XAD)- Other Designatino (ST)

IN1-19.3 Insured's Address (XAD)- City (ST)

IN1-19.4 Insured's Address (XAD)- State or Province (ST)

IN1-19.5 Insured's Address (XAD)- Zip or Postal Code (ST)

IN1-19.6 Insured's Address (XAD)- Country (ID)

IN1-19.7 Insured's Address (XAD)- Address Type (ID)

IN1-19.8 Insured's Address (XAD)- Other Geographic Designation (ST)

IN1-19.9 Insured's Address (XAD)- County/Parish Code (IS)

IN1-19.10 Insured's Address (XAD)- Census Tract (IS)

IN1-20.1 Assignment of Benefits (IS)

IN1-21.1 Coordination of Benefits (IS)

IN1-22.1 Coordination of Benefits Priority (ST)

IN1-23.1 Notice of Admission Flag (ID)

IN1-24.1 Notice of Admission Date (DT)

IN1-25.1 Report of Eligibility Flag (ID)

IN1-26.1 Report of Eligibility Date (DT)

IN1-27.1 Release Information Code (IS)

IN1-28.1 Pre-Admit Cert (PAC) (ST)

IN1-29.1 Verification Date/Time (TS)

IN1-30.1 Verification by (XCN)- ID Number (ST)

IN1-30.2 Verification by (XCN)- Family Name (ST)

IN1-30.3 Verification by (XCN)- Given Name (ST)

IN1-30.4 Verification by (XCN)- Middle Initial or Name (ST)


IN1-30.5 Verification by (XCN)- Suffix (ST)

IN1-30.6 Verification by (XCN)- Prefix (ST)

IN1-30.7 Verification by (XCN)- Degree (ST)

IN1-30.8 Verification by (XCN)- Source Table (IS)

IN1-30.9.1 Verification by (XCN)- Assigning Authority (HD)- Namespace ID (IS)

IN1-30.9.2 Verification by (XCN)- Assigning Authority (HD)- Universal ID (ST)

IN1-30.9.3 Verificiation by (XCN)- Assigning Authority (HD)- Universal ID Type (

IN1-30.10 Verification by (XCN)- Name Type Code (ID)

IN1-30.11 Verification by (XCN)- Identifier Check Digit (ST)

IN1-30.12 Verification by (XCN)- Code Identifying the Check Digit Scheme Empl

IN1-30.13 Verification by (XCN)- Identifier Type Code (IS)

IN1-30.14.1 Verification by (XCN)- Assigning Facility (HD)- Namespace ID (IS)

IN1-30.14.2 Verification by (XCN)- Assigning Facility (HD)- Universal ID (ST)

IN1-30.14.3 Verification by (XCN)- Assigning Facility (HD)- Universal ID Type (ID)

IN1-31.1 Type of Agreement Code (IS)

IN1-32.1 Billing Status (IS)

IN1-33.1 Lifetime Reserve Days (NM)

IN1-34.1 Delay Before Lifetime Reserve Day (NM)

IN1-35.1 Company Plan Code (IS)

IN1-36.1 Policy Number (ST)

IN1-37.1 Policy Deductible (CP)- Price (MO)

IN1-37.2 Policy Deductible (CP)- Price Type (ID)

IN1-37.3 Policy Deductible (CP)- From Value (NM)

IN1-37.4 Policy Deductible (CP)- To Value (NM)

IN1-37.5 Policy Deductible (CP)- Range Units (CE)

IN1-37.6 Policy Deductible (CP)- Range Type (ID)

IN1-38.1 Policy Limit- Amount (CP)- Price (MO)

IN1-38.2 Policy Limit- Amount (CP)- Price Type (ID)

IN1-38.3 Policy Limit- Amount (CP)- From Value (NM)

IN1-38.4 Policy Limit- Amount (CP)- To Value (NM)

IN1-38.5 Policy Limit- Amount (CP)- Range Units (CE)

IN1-38.6 Policy Limit- Amount (CP)- Range Type (ID)

IN1-39.1 Policy Limit- Days (NM)

IN1-40.1 Room Rate- Semi-Private (CP)- Price (MO)

IN1-40.2 Room Rate- Semi-Private (CP)- Price Type (ID)

IN1-40.3 Room Rate- Semi-Private (CP)- From Value (NM)

IN1-40.4 Room Rate- Semi-Private (CP)- To Value (NM)

IN1-40.5 Room Rate- Semi-Private (CP)- Range Units (CE)

IN1-40.6 Room Rate- Semi-Private (CP)- Range Type (ID)

IN1-41.1 Room Rate- Private (CP)- Price (MO)

IN1-41.2 Room Rate- Private (CP)- Price Type (ID)

IN1-41.3 Room Rate- Private (CP)- From Value (NM)

IN1-41.4 Room Rate- Private (CP)- To Value (NM)

IN1-41.5 Room Rate- Private (CP)- Range Units (CE)

IN1-41.6 Room Rate- Private (CP)- Range Type (ID)

IN1-42.1 Insured's Employment Status (CE)- Identifier (ST)


IN1-42.2 Insured's Employment Status (CE)- Text (ST)

IN1-42.3 Insured's Employment Status (CE)- Name of Coding System (ST)

IN1-42.4 Insured's Employment Status (CE)- Alternate Identifier (ST)

IN1-42.5 Insured's Employment Status (CE)- Alternate Text (ST)

IN1-42.6 Insured's Employment Status (CE)- Name of Alternate Coding Syste

IN1-43.1 Insured's Sex (IS)

IN1-44.1 Insured's Employer's Address (XAD)- Street Address (ST)

IN1-44.2 Insured's Employer's Address (XAD)- Other Designation (ST)

IN1-44.3 Insured's Employer's Address (XAD)- City (ST)

IN1-44.4 Insured's Employer's Address (XAD)- State or Province (ST)

IN1-44.5 Insured's Employer's Address (XAD)- Zip or Postal Code (ST)

IN1-44.6 Insured's Employer's Address (XAD)- Country (ID)

IN1-44.7 Insured's Employer's Address (XAD)- Address Type (ID)

IN1-44.8 Insured's Employer's Address (XAD)- Other Geographic Designation

IN1-44.9 Insured's Employer's Address (XAD)- County/Parish Code (IS)

IN1-44.10 Insured's Employer's Address (XAD)- Census Tract (IS)

IN1-45.1 Verificaion Status (ST)

IN1-46.1 Prior Insurance Plan ID (IS)

IN1-47.1 Coverage Type (IS)

IN1-48.1 Handicap Code (IS)

IN1-49.1 Insured's ID Number (CX)- ID (ST)

IN1-49.2 Insured's ID Number (CX)- Check Digit (ST)

IN1-49.3 Insured's ID Number (CX)- Code Identifying the Check Digit Scheme

IN1-49.4.1 Insured's ID Number (CX)- Assigning Authority (HD)- Namespace ID

IN1-49.4.2 Insured's ID Number (CX)- Assigning Authority (HD)- Universal ID (S

IN1-49.4.3 Insured's ID Number (CX)- Assigning Authority (HD)- Universal ID Ty

IN1-49.5 Insured's ID Number (CX)- Identifier Type Code (IS)

IN1-49.6.1 Insured's ID Number (CX)- Assigning Facility (HD)- Namespace ID (I

IN1-49.6.2 Insured's ID Number (CX)- Assigning Facility (HD)- Universal ID (ST)

IN1-49.6.3 Insured's ID Number (CX)- Assigning Facility (HD)- Universal ID Type

IN2IN2-1.1 Insured's Employee ID (CX)- ID (ST)

IN2-1.2 Insured's Employee ID (CX)- Check Digit (ST)

IN2-1.3 Insured's Employee ID (CX)- Code Identifying the Check Digit Schem

IN2-1.4.1 Insured's Employee ID (CX)- Assigning Authority (HD)- Namespace I

IN2-1.4.2 Insured's Empoyee ID (CX)- Assigning Authority (HD)- Universal ID (

IN2-1.4.3 Insured's Employee ID (CX)- Assigning Authority (HD)- Universal ID

IN2-1.5 Insured's Employee ID (CX)- Identifier Type Code (IS)

IN2-1.6.1 Insured's Employee ID (CX)- Assigning Facility (HD)- Namespace ID

IN2-1.6.2 Insured's Employee ID (CX)- Assigning Facility (HD)- Universal ID (S

IN2-1.6.3 Insured's Employee ID (CX)- Assigning Facility (HD)- Universal ID Ty

IN2-2.1 Insured's Social Security Number (ST)

IN2-3.1 Insured's Employer Name (XCN)- ID Number (ST)

IN2-3.2 Insured's Employer Name (XCN)- Family Name (ST)

IN2-3.3 Insured's Employer Name (XCN)- Given Name (ST)

IN2-3.4 Insured's Employer Name (XCN)- Middle Initial or Name (ST)


IN2-3.5 Insured's Employer Name (XCN)- Suffix (ST)

IN2-3.6 Insured's Employer Name (XCN)- Prefix (ST)

IN2-3.7 Insured's Employer Name (XCN)- Degree (ST)

IN2-3.8 Insured's Employer Name (XCN)- Source Table (IS)

IN2-3.9.1 Insured's Employer Name (XCN)- Assigning Authority (HD)- Namesp

IN2-3.9.2 Insured's Employer Name (XCN)- Assigning Authority (HD)- Universa

IN2-3.9.3 Insured's Employer Name (XCN)- Assigning Authority (HD)- Universa

IN2-3.10 Insured's Employer Name (XCN)- Name Type Code (ID)

IN2-3.11 Insured's Employer Name (XCN)- Identifier Check Digit (ST)

IN2-3.12 Insured's Employer Name (XCN)- Code Identifying the Check Digit S

IN2-3.13 Insured's Employer Name (XCN)- Identifier Type Code (IS)

IN2-3.14.1 Insured's Employer Name (XCN)- Assigning Facility (HD)- Namespac

IN2-3.14.2 Insured's Employer Name (XCN)- Assigning Facility (HD)- Universal I

IN2-3.14.3 Insured's Employer Name (XCN)- Assigning Facility (HD)- Universal I

IN2-4.1 Employer Information Data (IS)

IN2-5.1 Mail Claim Party (IS)

IN2-6.1 Medicare Health Ins Card Number (ST)

IN2-7.1 Medicaid Case Name (XPN)- Family Name (ST)

IN2-7.2 Medicaid Case Name (XPN)- Given Name (ST)

IN2-7.3 Medicaid Case Name (XPN)- Middle Initial or Name (ST)

IN2-7.4 Medicaid Case Name (XPN)- Suffix (ST)

IN2-7.5 Medicaid Case Name (XPN)- Prefix (ST)

IN2-7.6 Medicaid Case Name (XPN)- Degere (ST)

IN2-7.7 Medicaid Case Name (XPN)- Name Type Code (ID)

IN2-8.1 Medicaid Case Number (ST)

IN2-9.1 Champus Sponsor Name (XPN)- Family Name (ST)

IN2-9.2 Champus Sponsor Name (XPN)- Given Name (ST)

IN2-9.3 Champus Sponsor Name (XPN)- Middle Initial or Name (ST)

IN2-9.4 Champus Sponsor Name (XPN)- Suffix (ST)

IN2-9.5 Champus Sponsor Name (XPN)- Prefix (ST)

IN2-9.6 Champus Sponsor Name (XPN)- Degree (ST)

IN2-9.7 Champus Sponsor Name (XPN)- Name Type Code (ID)

IN2-10.1 Champus ID Number (ST)

IN2-11.1 Dependent of Champus Recipient (CE)- Identifier (ST)

IN2-11.2 Dependent of Champus Recipient (CE)- Text (ST)

IN2-11.3 Dependent of Champus Recipient (CE)- Name of Coding System (ST

IN2-11.4 Dependent of Champus Recipient (CE)- Alternate Identifier (ST)

IN2-11.5 Dependent of Champus Recipient (CE)- Alternate Text (ST)

IN2-11.6 Dependent of Champus Recipient (CE)- Name of Alternate Coding S

IN2-12.1 Champus Organization (ST)

IN2-13.1 Champus Station (ST)

IN2-14.1 Champus Service (IS)

IN2-15.1 Champus Rank/Grade (IS)

IN2-16.1 Champus Status (IS)

IN2-17.1 Champus Retire Date (DT)

IN2-18.1 Champus Non-Avail Cert on File (ID)


IN2-19.1 Baby Coverage (ID)

IN2-20.1 Combine Baby Bill (ID)

IN2-21.1 Blood Deductible (ST)

IN2-22.1 Special Coverage Approval Name (XPN)- Family Name (ST)

IN2-22.2 Special Coverage Approval Name (XPN)- Given Name (ST)

IN2-22.3 Speical Coverage Approval Name (XPN)- Middle Initial or Name (ST)

IN2-22.4 Special Coverage Approval Name (XPN)- Suffix (ST)

IN2-22.5 Speical Coverage Approval Name (XPN)- Prefix (ST)

IN2-22.6 Special Coverage Approval Name (XPN)- Degree (ST)

IN2-22.7 Special Coverage Approval Name (XPN)- Name Type Code (ID)

IN2-23.1 Speical Coverage Approval Title (ST)

IN2-24.1 Non-Covered Insurance Code (IS)

IN2-25.1 Payor ID (CX)- ID (ST)

IN2-25.2 Payor ID (CX)- Check Digit (ST)

IN2-25.3 Payor ID (CX)- Code Identifying the Check Digit Scheme Employed (I

IN2-25.4.1 Payor ID (CX)- Assigning Authority (HD)- Namespace ID (IS)

IN2-25.4.2 Payor ID (CX)- Assigning Authority (HD)- Universal ID (ST)

IN2-25.4.3 Payor ID (CX)- Assigning Authority (HD)- Universal ID Type (ID)

IN2-26.1 Payor Subscriber ID (CX)- ID (ST)

IN2-26.2 Payor Subscriber ID (CX)- Check Digit (ST)

IN2-26.3 Payor Subscriber ID (CX)- Code Identifiying the Check Digit Scheme

IN2-26.4.1 Payor Subscriber ID (CX)- Assigning Authority (HD)- Namespace ID (

IN2-26.4.2 Payor Subscriber ID (CX)- Assigning Authority (HD)- Universal ID (ST

IN2-26.4.3 Payor Subscriber ID (CX)- Assigning Authority (HD)- Universal ID Typ

IN2-26.5 Payor Subscriber ID (CX)- Identifier Type Code (IS)

IN2-26.6.1 Payor Subscriber ID (CX)- Assigning Facility (HD)- Namespace ID (IS

IN2-26.6.2 Payor Subscriber ID (CX)- Assigning Facility (HD)- Universal ID (ST)

IN2-26.6.3 Payor Subscriber ID (CX)- Assigning Facility (HD)- Universal ID Type

IN2-27.1 Eligibility Source (IS)

IN2-28.1 Room Coverage Type/Amount (CM)- Room Type (IS)

IN2-28.2 Room Coverage Type/Amount (CM)- Amount Type (IS)

IN2-28.3 Room Coverage Type/Amount (CM)- Coverage Amount (NM)

IN2-29.1 Policy Type/Amount (CM)- Policy Type (IS)

IN2-29.2 Policy Type/Amount (CM)- Amount Class (IS)

IN2-29.3 Policy Type/Amount (CM)- Amount (NM)

IN2-30.1 Daily Deductible (CM)- Delay Days (NM)

IN2-30.2 Daily Deductible (CM)- Amount (NM)

IN2-30.3 Daily Deductible (CM)- Number of Days (NM)

IN2-31.1 Living Dependency (IS)

IN2-32.1 Ambulatory Status (IS)

IN2-33.1 Citizenship (IS)

IN2-34.1 Primary Language (CE)- Identifier (ST)

IN2-34.2 Primary Language (CE)- Text (ST)

IN2-34.3 Primary Language (CE)- Name of Coding System (ST)

IN2-34.4 Primary Language (CE)- Alternate Identifier (ST)

IN2-34.5 Primary Language (CE)- Alternate Text (ST)


IN2-34.6 Primary Language (CE)- Name of Alternate Coding System (ST)

IN2-35.1 Living Arrangement (IS)

IN2-36.1 Publicity Indicator (IS)

IN2-37.1 Protection Indicator (IS)

IN2-38.1 Student Indicator (IS)

IN2-39.1 Religion (IS)

IN2-40.1 Mother's Maiden Name (XPN)- Family Name (ST)

IN2-40.2 Mother's Maiden Name (XPN)- Given Name (ST)

IN2-40.3 Mother's Maiden Name (XPN)- Middle Initial or Name (ST)

IN2-40.4 Mother's Maiden Name (XPN)- Suffix (ST)

IN2-40.5 Mother's Maiden Name (XPN)- Prefix (ST)

IN2-40.6 Mother's Maiden Name (XPN)- Degree (ST)

IN2-40.7 Mother's Maiden Name (XPN)- Name Type Code (ID)

IN2-41.1 Nationality (CE)- Identifier (ST)

IN2-41.2 Nationality (CE)- Text (ST)

IN2-41.3 Nationality (CE)- Name of Coding System (ST)

IN2-41.4 Nationality (CE)- Alternate Identifier (ST)

IN2-41.5 Nationality (CE)- Altnernate Text (ST)

IN2-41.6 Nationality (CE)- Name of Alternate Coding System (ST)

IN2-42.1 Ethnic Group (IS)

IN2-43.1 Marital Status (IS)

IN2-44.1 Insured's Employment Start Date (DT)

IN2-45.1 Insured's Employment Stop Date (DT)

IN2-46.1 Job Title (ST)

IN2-47.1 Job Code/Class (JCC)- Job Code (IS)

IN2-47.2 Job Code/Class (JCC)- Job Class (IS)

IN2-48.1 Job Status (IS)

IN2-49.1 Employer Contact Person Name (XPN)- Family Name (ST)

IN2-49.2 Employer Contact Person Name (XPN)- Given Name (ST)

IN2-49.3 Employer Contact Person Name (XPN)- Middle Initial or Name (ST)

IN2-49.4 Employer Contact Person Name (XPN)- Suffix (ST)

IN2-49.5 Employer Contact Person Name (XPN)- Prefix (ST)

IN2-49.6 Employer Contact Person Name (XPN)- Degree (ST)

IN2-49.7 Employer Contact Person Name (XPN)- Name Type Code (ID)

IN2-50.1 Employer Contact Person Telephone Number (XTN)- [NNN] [(999)]99

IN2-50.2 Employer Contact Person Telephone Number (XTN)- Telecommunic

IN2-50.3 Employer Contact Person Telephone Number (XTN)- Telecommunic

IN2-50.4 Employer Contact Person Telephone Number (XTN)- Email Address

IN2-50.5 Employer Contact Person Telephone Number (XTN)- Country Code (

IN2-50.6 Employer Contact Person Telephone Number (XTN)- Area/City Code

IN2-50.7 Employer Contact Person Telephone Number (XTN)- Phone Number

IN2-50.8 Employer Contact Person Telephone Number (XTN)- Extension (NM)

IN2-50.9 Employer Contact Person Telephone Number (XTN)- Any Text (ST)

IN2-51.1 Employer Contact Reason Code (IS)

IN2-52.1 Insured's Contact Person Name (XPN)- Family Name (ST)

IN2-52.2 Insured's Contact Person Name (XPN)- Given Name (ST)


IN2-52.3 Insured's Contact Person Name (XPN)- Middle Initial or Name (ST)

IN2-52.4 Insured's Contact Person Name (XPN)- Suffix (ST)

IN2-52.5 Insured's Contact Person Name (XPN)- Prefix (ST)

IN2-52.6 Insured's Contact Person Name (XPN)- Degree (ST)

IN2-52.7 Insured's Contact Person Name (XPN)- Name Type Code (ID)

IN2-53.1 Insured's Contact Person Telephone Number (XTN)- [NNN] [(999)]99

IN2-53.2 Insured's Contact Person Telephone Number (XTN)- Telecommunica

IN2-53.3 Insured's Contact Person Telephone Number (XTN)- Telecommunica

IN2-53.4 Insured's Contact Person Telephone Number (XTN)- Email Address (

IN2-53.5 Insured's Contact Person Telephone Number (XTN)- Country Code (

IN2-53.6 Insured's Contact Person Telephone Number (XTN)- Area/City Code

IN2-53.7 Insured's Contact Person Telephone Number (XTN)- Phone Number

IN2-53.8 Insured's Contact Person Telephone Number (XTN)- Extension (NM)

IN2-53.9 Insured's Contact Person Telephone Number (XTN)- Any Text (ST)

IN2-54.1 Insured's Contact Reason Code (IS)

IN2-55.1 Relationship to the Patient Start Date (DT)

IN2-56.1 Relationship to the Patient Stop Date (DT)

IN2-57.1 Insurance Company Contact Reason (IS)

IN2-58.1 Insurance Company Contact Phone Number (XTN)- [NNN] [(999)]999

IN2-58.2 Insurance Company Contact Phone Number (XTN)- Telecommunicat

IN2-58.3 Insurance Company Contact Phone Number (XTN)- Telecommunicat

IN2-58.4 Insurance Company Contact Phone Number (XTN)- Email Address (

IN2-58.5 Insurance Company Contact Phone Number (XTN)- Country Code (N

IN2-58.6 Insurance Company Contact Phone Number (XTN)- Area/City Code (

IN2-58.7 Insurance Company Contact Phone Number (XTN)- Phone Number (

IN2-58.8 Insurance Company Contact Phone Number (XTN)- Extension (NM)

IN2-58.9 Insurance Company Contact Phone Number (XTN)- Any Text (ST)

IN2-59.1 Policy Scope (IS)

IN2-60.1 Policy Source (IS)

IN2-61.1 Pateint Member Number (CX)- ID (ST)

IN2-61.2 Patient Member Number (CX)- Check Digit (ST)

IN2-61.3 Patient Member Number (CX)- Code Identifying the Check Digit Sche

IN2-61.4.1 Patient Member Number (CX)- Assigning Authority (HD)- Namespace

IN2-61.4.2 Patient Member Number (CX)- Assigning Authority (HD)- Universal I

IN2-61.4.3 Patient Member Number (CX)- Assigning Authority (HD)- Universal I

IN2-61.5 Patient Member Number (CX)- Identifier Type Code (IS)

IN2-61.6.1 Patient Member Number (CX)- Assigning Facility (HD)- Namespace I

IN2-61.6.2 Patient Member Number (CX)- Assigning Facility (HD)- Universal ID (

IN2-61.6.3 Patient Member Number (CX)- Assigning Facility (HD)- Universal ID

IN2-62.1 Guarantor's Relationship to Insured (ID)

IN2-63.1 Insured's Telephone Number- Home (XTN)- [NNN] [(999)]999-9999 [

IN2-63.2 Insured's Telephone Number- Home (XTN)- Telecommunication Use

IN2-63.3 Insured's Telephone Number- Home (XTN)- Telecommunication Equi

IN2-63.4 Insured's Telephone Number- Home (XTN)- Email Address (ST)

IN2-63.5 Insured's Telephone Number- Home (XTN)- Country Code (NM)

IN2-63.6 Insured's Telephone Number- Home (XTN)- Area/City Code (NM)


IN2-63.7 Insured's Telephone Number- Home (XTN)- Phone Number (NM)

IN2-63.8 Insured's Telephone Number-Home (XTN)- Extension (NM)

IN2-63.9 Insured's Telephone Number- Home (XTN)- Any Text (ST)

IN2-64.1 Insured's Employer Telephone Number (XTN)- [NNN] [(999)]999-999

IN2-64.2 Insured's Employer Telephone Number (XTN)- Telecommunication U

IN2-64.3 Insured's Employer Telephone Number (XTN)- Telecommunication E

IN2-64.4 Insured's Employer Telephone Number (XTN)- Email Address (ST)

IN2-64.5 Insured's Employer Telephone Number (XTN)- Country Code (NM)

IN2-64.6 Insured's Employer Telephone Number (XTN)- Area/City Code (NM)

IN2-64.7 Insured's Employer Telephone Number (XTN)- Phone Number (NM)

IN2-64.8 Insured's Employer Telephone Number (XTN)- Extension (NM)

IN2-64.9 Insured's Employer Telephone Number (XTN)- Any Text (ST)

IN2-65.1 Military Handicapped Program Code (CE)- Identifier (ST)

IN2-65.2 Military Handicapped Program Code (CE)- Text (ST)

IN2-65.3 Military Handicapped Program Code (CE)- Name of Coding System (

IN2-65.4 Military Handicapped Program Code (CE)- Alternate Identifier (ST)

IN2-65.5 Military Handicapped Program Code (CE)- Alternate Text (ST)

IN2-65.6 Military Handicapped Program Code (CE)- Name of Alternate Coding

IN2-66.1 Suspend Flag (ID)

IN2-67.1 Co-Pay Limit Flag (ID)

IN2-68.1 Stoploss Limit Flag (ID)

IN2-69.1 Insured Organization Name and ID (XON)- Organization Name (ST)

IN2-69.2 Insured Organization Name and ID (XON)- Organization Name Type

IN2-69.3 Insured Organziation Name and ID (XON)- ID Number (ID)

IN2-69.4 Insured Organization Name and ID (XON)- Check Digit (NM)

IN2-69.5 Insured Organization Name and ID (XON)- Check Digit Scheme (ID)

IN2-69.6.1 Insured Organization Name and ID (XON)- Assigning Authority (HD)-

IN2-69.6.2 Insured Organization Name and ID (XON)- Assigning Authority (HD)-

IN2-69.6.3 Insured Organizatino Name and ID (XON)- Assigning Authority (HD)-

IN2-69.7 Insured Organization Name and ID (XON)- Identifier Type Code (ID)

IN2-69.8.1 Insured Organization Name and ID (XON)- Assigning Facility ID (HD)



IN2-70.1 Insured Employer Organization Name and ID (XON)- Organization N

IN2-70.2 Insured Employer Organization Name and ID (XON)- Organization N

IN2-70.3 Insured Employer Organization Name and ID (XON)- ID Number (ID)

IN2-70.4 Insured Employer Organization Name and ID (XON)- Check Digit (N

IN2-70.5 Insured Employer Organization Name and ID (XON)- Check Digit Sch

IN2-70.6.1 Insured Employer Organization Name and ID (XON)- Assigning Auth

IN2-70.6.2 Insured Employer Organization Name and ID (XON)- Assigning Auth

IN2-70.6.3 Insured Employer Oganization Name and ID (XON)- Assigning Autho

IN2-70.7 Insured Employer Organization Name and ID (XON)- Identifier Type

IN2-70.8.1 Insured Employer Organization Name and ID (XON)- Assigning Facili



IN2-71.1 Race (IS)


IN2-72.1 HCFA Patient Relationship to Insured (CE)- Indentifier (ST)

IN2-72.2 HCFA Patient Relationship to Insured (CE)- Text (ST)

IN2-72.3 HCFA Patient Relationship to Insured (CE)- Name of Coding System

IN2-72.4 HCFA Patient Relationship to Insured (CE)- Alternate Identifier (ST)

IN2-72.5 HCFA Patient Relationship to Insured (CE)- Alternate Text (ST)

IN2-72.6 HCFA Patient Relatinship to Insured (CE)- Name of Alternate Coding

IN3IN3-1.1 Set ID- IN3 (SI)

IN3-2.1 Certification Number (CX)- ID (ST)

IN3-2.2 Certification Number (CX)- Check Digit (ST)

IN3-2.3 Certification Number (CX)- Code Identifiying the Check Digit Scheme

IN3-2.4.1 Certification Number (CX)- Assigning Authority (HD)- Namespace ID

IN3-2.4.2 Certification Number (CX)- Assigning Authority (HD)- Universal ID (S

IN3-2.4.3 Certication Number (CX)- Assigning Authority (HD)- Universal ID Typ

IN3-2.5 Certification Number (CX)- Identifier Type Code (IS)

IN3-2.6.1 Certification Number (CX)- Assigning Facility (HD)- Namespace ID (I

IN3-2.6.2 Certification Number (CX)- Assigning Facility (HD)- Universal ID (ST)

IN3-2.6.3 Certification Number (CX)- Assigning Facility (HD)- Universal ID Type

IN3-3.1 Certified by (XCN)- ID Number (ST)

IN3-3.2 Certified by (XCN)- Family Name (ST)

IN3-3.3 Certified by (XCN)- Given Name (ST)

IN3-3.4 Certified by (XCN)- Middle Initial or Name (ST)

IN3-3.5 Certified by (XCN)- Suffix (ST)

IN3-3.6 Certified by (XCN)- Prefix (ST)

IN3-3.7 Certified by (XCN)- Degree (ST)

IN3-3.8 Certified by (XCN)- Source Table (IS)

IN3-3.9.1 Certified by (XCN)- Assigning Authority (HD)- Namespace ID (IS)

IN3-3.9.2 Certified by (XCN)- Assigning Authority (HD)- Universal ID (ST)

IN3-3.9.3 Certified by (XCN)- Assigning Authority (HD)- Universal ID Type (ID)

IN3-3.10 Certified by (XCN)- Name Type Code (ID)

IN3-3.11 Certified by (XCN)- Identifier Check Digit (ST)

IN3-3.12 Certified by (XCN)- Code Identifyingthe Check Digit Scheme Employ

IN3-3.13 Certified by (XCN)- Identifier Type Code (IS)

IN3-3.14.1 Certified by (XCN)- Assigning Facility (HD)- Namespace ID (IS)

IN3-3.14.2 Certified by (XCN)- Assigning Facility (HD)- Universal ID (ST)

IN3-3.14.3 Certified by (XCN)- Assigning Facility (HD)- Universal ID Type (ID)

IN3-4.1 Certification Required (ID)

IN3-5.1 Penalty (CM)- Penalty Type (IS)

IN3-5.2 Penalty (CM)- Penalty Amount (NM)

IN3-6.1 Certification Date/Time (TS)

IN3-7.1 Certification Modify Date/Time (TS)

IN3-8.1 Operator (XCN)- ID Number (ST)

IN3-8.2 Operator (XCN)- Family Name (ST)

IN3-8.3 Operator (XCN)- Given Name (ST)

IN3-8.4 Operator (XCN)- Middle Initial or Name (ST)

IN3-8.5 Operator (XCN)- Suffix (ST)


IN3-8.6 Operator (XCN)- Prefix (ST)

IN3-8.7 Operator (XCN)- Degree (ST)

IN3-8.8 Operator (XCN)- Source Table (IS)

IN3-8.9.1 Operator (XCN)- Assigning Authority (HD)- Namespace ID (IS)

IN3-8.9.2 Operator (XCN)- Assigning Authority (HD)- Universal ID (ST)

IN3-8.9.3 Operator (XCN)- Assigning Authority (HD)- Universal ID Type (ID)

IN3-8.10 Operator (XCN)- Name Type Code (ID)

IN3-8.11 Operator (XCN)- Identifier Check Digit (ST)

IN3-8.12 Operator (XCN)- Code Identifying the Check Digit Scheme Employed

IN3-8.13.1 Operator (XCN)- Assigning Facility (HD)- Namespace ID (IS)

IN3-8.13.2 Operator (XCN)- Assigning Facility (HD)- Universal ID (ST)

IN3-8.13.3 Operator (XCN)- Assigning Facility (HD)- Universal ID Type (ID)

IN3-9.1 Certification Begin Date (DT)

IN3-10.1 Certification End Date (DT)

IN3-11.1 Days (CM)- Day Type (IS)

IN3-11.2 Days (CM)- Number of Days (NM)

IN3-12.1 Non-Concur Code/Description (CE)- Identifier (ST)

IN3-12.2 Non-Concur Code/Description (CE)- Text (ST)

IN3-12.3 Non-Concur Code/Description (CE)- Name of Coding System (ST)

IN3-12.4 Non-Concur Code/Description (CE)- Alternate Identifier (ST)

IN3-12.5 Non-Concur Code/Description (CE)- Alternate Text (ST)

IN3-12.6 Non-Concur Code/Description (CE)- Name of Alternate Coding Syste

IN3-13.1 Non-Concur Effective Date/Time (TS)

IN3-14.1 Physician Reviewer (XCN)- ID Number (ST)

IN3-14.2 Physician Reviewer (XCN)- Family Name (ST)

IN3-14.3 Physician Reviewer (XCN)- Given Name (ST)

IN3-14.4 Physician Reviewer (XCN)- Middle Initial or Name (ST)

IN3-14.5 Physician Reviewer (XCN)- Suffix (ST)

IN3-14.6 Physician Reviewer (XCN)- Prefix (ST)

IN3-14.7 Physician Reviewer (XCN)- Degree (ST)

IN3-14.8 Physician Reviewer (XCN)- Source Table (IS)

IN3-14.9 Physician Reviewer (XCN)- Assigning Authority (HD)- Namespace ID

IN3-14.10 Physician Reviewer (XCN)- Assigning Authority (HD)- Universal ID (S

IN3-14.11 Physician Reviewer (XCN)- Assigning Authority (HD)- Universal ID Ty

IN3-14.12 Physician Reviewer (XCN)- Name Type Code (ID)

IN3-14.13 Physician Reviewer (XCN)- Identifier Check Digit (ST)

IN3-14.14 Physician Reviewer (XCN)- Code Identifying the Check Digit Scheme

IN3-14.15 Physician Reviewer (XCN)- Identifier Type Code (IS)

IN3-14.16.1 Physician Reviewer (XCN)- Assigning Facility (HD)- Namespace ID (I

IN3-14.16.2 Physician Reviewer (XCN)- Assigning Facility (HD)- Universal ID (ST)

IN3-14.16.3 Physician Reviewer (XCN)- Assigning Facility (HD)- Universal ID Typ

IN3-15.1 Certification Contact (ST)

IN3-16.1 Certification Contact Phone Number (XTN)- [NNN] [(999)]999-9999 [

IN3-16.2 Certification Contact Phone Number (XTN)- Telecommunication Use

IN3-16.3 Certifiaction Contact Phone Number (XTN)- Telecommunication Equi

IN3-16.4 Certification Contact Phone Number (XTN)- Email Address (ST)


IN3-16.5 Certification Contact Phone Number (XTN)- Country Code (NM)

IN3-16.6 Certification Contact Phone Number (XTN)- Area/City Code (NM)

IN3-16.7 Certification Contact Phone Number (XTN)- Phone Number (NM)

IN3-16.8 Certification Contact Phone Number (XTN)- Extension (NM)

IN3-16.9 Certification Contact Phone Number (XTN)- Any Text (ST)

IN3-17.1 Appeal Reason (CE)- Identifier (ST)

IN3-17.2 Appeal Reason (CE)- Text (ST)

IN3-17.3 Appeal Reason (CE)- Name of Coding System (ST)

IN3-17.4 Appeal Reason (CE)- Alternate Identifier (ST)

IN3-17.5 Appeal Reason (CE)- Alternate Text (ST)

IN3-17.6 Appeal Reason (CE)- Name of Alternate Coding System (ST)

IN3-18.1 Certification Agency (CE)- Identifier (ST)

IN3-18.2 Certification Agency (CE)- Text (ST)

IN3-18.3 Certification Agency (CE)- Name of Coding System (ST)

IN3-18.4 Certification Agency (CE)- Alternate Identifier (ST)

IN3-18.5 Certification Agency (CE)- Alternate Text (ST)

IN3-18.6 Certification Agency (CE)- Name of Alternate Coding System (ST)

IN3-19.1 Certification Agency Phone Number (XTN)- [NNN] [(999)]999-9999 [X

IN3-19.2 Certification Agency Phone Number (XTN)- Telecommunication Use

IN3-19.3 Certification Agency Phone Number (XTN)- Telecommunication Equi

IN3-19.4 Certification Agency Phone Number (XTN)- Email Address (ST)

IN3-19.5 Certification Agency Phone Number (XTN)- Country Code (NM)

IN3-19.6 Certification Agency Phone Number (XTN)- Area/City Code (NM)

IN3-19.7 Certification Agency Phone Number (XTN)- Phone Number (NM)

IN3-19.8 Certification Agency Phone Number (XTN)- Extension (NM)

IN3-19.9 Certification Agency Phone Number (XTN)- Any Text (ST)

IN3-20.1 Pre-Certification Req/Window (CM)- Pre-Certifcation Patient Type (IS

IN3-20.2 Pre-Certification Req/Window (CM)- Pre-Certification Required (ID)

IN3-20.3 Pre-Certification Req/Window (CM)- Pre-Certification Window (TS)

IN3-21.1 Case Manager (ST)

IN3-22.1 Second Opinion Date (DT)

IN3-23.1 Second Opinion Status (IS)

IN3-24.1 Second Opinion Documentation Received (IS)

IN3-25.1 Second Opinion Practitioner (XCN)- ID Number (ST)

IN3-25.2 Second Opinion Practitioner (XCN)- Family Name (ST)

IN3-25.3 Second Opinion Practitioner (XCN)- Given Name (ST)

IN3-25.4 Second Opinion Practitioner (XCN)- Middle Initial or Name (ST)

IN3-25.5 Second Opinion Practitioner (XCN)- Suffix (ST)

IN3-25.6 Second Opinion Practitioner (XCN)- Prefix (ST)

IN3-25.7 Second Opinion Practitioner (XCN)- Degree (ST)

IN3-25.8 Second Opinion Practitioner (XCN)- Source Table (IS)

IN3-25.9.1 Second Opinion Practitioner (XCN)- Assigning Authority (HD)- Name

IN3-25.9.2 Second Opinion Practitioner (XCN)- Assigning Authority (HD)- Univer

IN3-25.9.3 Second Opinion Practitioner (XCN)- Assigning Authority (HD)- Univer

ACCACC-1.1 Accident Date/Time (TS)


ACC-2.1 Accident Code (CE)- Identifier (ST)

ACC-2.2 Accident Code (CE)- Text (ST)

ACC-2.3 Accident Code (CE)- Name of Coding System (ST)

ACC-2.4 Accident Code (CE)- Alternate Identifier (ST)

ACC-2.5 Accident Code (CE)- Alternate Text (ST)

ACC-2.6 Accident Code (CE)- Name of Alternate Coding System (ST)

ACC-3.1 Accident Location (ST)

ACC-4.1 Auto Accident State (CE)- Identifier (ST)

ACC-4.2 Auto Accident State (CE)- Text (ST)

ACC-4.3 Auto Accident State (CE)- Name of Coding System (ST)

ACC-4.4 Auto Accident State (CE)- Alternate Identifier (ST)

ACC-4.5 Auto Accident State (CE)- Alternate Text (ST)

ACC-4.6 Auto Accident State (CE)- Name of Alternate Coding System (ST)

ACC-5.1 Accident Job Related Indicator (ID)

ACC-6.1 Accident Death Indicator (ID)

UB1UB1-1.1 Set ID- UB1 (SI)

UB1-2.1 Blood Deductible (NM)

UB1-3.1 Blood Furnished-Pints of (40) (NM)

UB1-4.1 Blood Replaced- Pints (41) (NM)

UB1-5.1 Blood Not Replaced- Pints (42) (NM)

UB1-6.1 Co-Insurance Days (25) (NM)

UB1-7.1 Condition Code (IS)

UB1-8.1 Covered Days (23) (NM)

UB1-9.1 Non Covered Days (24) (NM)

UB1-10.1 Value Amount and Code (CM)- Value Code (IS)

UB1-10.2 Value Amount and Code (CM)- Value Amount (NM)

UB1-11.1 Number of Grace Days (90) (NM)

UB1-12.1 Spec Program Indicator (44) (CE)- Identifier (ST)

UB1-12.2 Spec Program Indicator (44) (CE)- Text (ST)

UB1-12.3 Spec Program Indicator (44) (CE)- Name of Coding System (ST)

UB1-12.4 Spec Program Indicator (44) (CE)- Alternate Identifier (ST)

UB1-12.5 Spec Program Indicator (44) (CE)- Alternate Text (ST)

UB1-12.6 Spec Program Indicator (44) (CE)- Name of Alternate Coding System

UB1-13.1 PSRO/UR Approval Indicator (87) (CE)- Identifier (ST)

UB1-13.2 PSRO/UR Approval Indicator (87) (CE)- Text (ST)

UB1-13.3 PSRO/UR Approval Indicator (87) (CE)- Name of Coding System (ST

UB1-13.4 PSRO/UR Approval Indicator (87) (CE)- Alternate Identifier (ST)

UB1-13.5 PSRO/UR Approval Indicator (87) (CE)- Alternate Text (ST)

UB1-13.6 PSRO/UR Approval Indicator (87) (CE)- Name of Alternate Coding S

UB1-14.1 PSRO/UR Approved Stay-fm (88) (DT)

UB1-15.1 PSRO/UR Approved Stay-To (89) (DT)

UB1-16.1 Occurrence (28-32) (CM)- Occurrence Code (IS)

UB1-16.2 Occurrence (28-32) (CM)- Occurrence Date (DT)

UB1-17.1 Occurrence Span (33) (CE)- Identifier (ST)

UB1-17.2 Occurrence Span (33) (CE)- Text (ST)


UB1-17.3 Occurrence Span (33) (CE)- Name of Coding System (ST)

UB1-17.4 Occurrence Span (33) (CE)- Alternate Identifier (ST)

UB1-17.5 Occurrence Span (33) (CE)- Alternate Text (ST)

UB1-17.6 Occurrence Span (33) (CE)- Name of Alternate Coding System (ST)

UB1-18.1 Occur Span Start Date (33) (DT)

UB1-19.1 Occur Span End Date (33) (DT)

UB1-20.1 UB-82 Locator 2 (ST)




UB2UB2-1.1 Set ID- UB2 (SI)

UB2-2.1 Co-Insurance Days (ST)

UB2-3.1 Condition Code (IS)

UB2-4.1 Covered Days (ST)

UB2-5.1 Non-Covered Days (ST)

UB2-6.1 Value Amount and Code (CM)- Value Code (IS)

UB2-6.2 Value Amount and Code (CM)- Value Amount (NM)

UB2-7.1 Occurrence Code & Date (CM)- Identifier (ST)

UB2-7.2 Occurrence Code & Date (CM)- Text (ST)

UB2-7.3 Occurrence Code & Date (CM)- Name of Coding System (ST)

UB2-7.4 Occurrence Code & Date (CM)- Alternate Identifier (ST)

UB2-7.5 Occurrence Code & Date (CM)- Alternate Text (ST)

UB2-7.6 Occurrence Code & Date (CM)- Name of Alternate Coding System (S

UB2-7.7 Occurrence Code & Date (CM)- Occurrence Date (DT)

UB2-8.1 Occurrence Span Code and Dates (CM)- Identifier (ST)

UB2-8.2 Occurrence Span Code and Dates (CM)- Text (ST)

UB2-8.3 Occurrence Span Code and Dates (CM)- Name of Coding System (S

UB2-8.4 Occurrence Span Code and Dates (CM)- Alternate Identifier (ST)

UB2-8.5 Occurrence Span Code and Dates (CM)- Alternate Text (ST)

UB2-8.6 Occurrence Span Code and Dates (CM)- Name of Alternate Coding

UB2-8.7 Occurrence Span Code and Dates (CM)- Occurrence Span Start Dat

UB2-8.8 Occurrence Span Code and Dates (CM)- Occurrence Span Stop Dat

UB2-9.1 UB92 Field 2, Designated for State Use (ST)


UB2-11.1 UB92 Field 31, Designated for National Use (ST)

UB2-12.1 Document Control Number (ST)





UB2-17.1 Speical Visit Count (NM)


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