ANSI ASC X12 Change Process 101 (.pdf)

ANSI ASC X12 Glossary

Encounter Data System Gap Analysis Guidelines

External Code Maintenance List

Gap Assistss

Tutorial

Related Links

DATA ELEMENTS   Currently Supported in 837I Implementation Guide Submitter Information Object Descriptor         Submitter Name 837A1_1000A_NM103_SubmitterLastorOrganizationName Yes Submitter Identifier 837A1_1000A_NM109_SubmitterIdentifier Yes Submitter Fax 837A1_1000A_PER06_CommicationNumber (??FX Qualifier) Yes Submitter Telephone 837A1_1000A_PER06_CommicationNumber (??TE Qualifier) Yes Test/Production Indicator (?? ISA15 - no OD for that) Yes Processing Date 837A1_BHT04_TransactionSetCreationDate Yes Input/Tape Supplier Number (TSN) 837A1_BHT03_OriginatorApplicationTransactionIdentifier Yes   Receiver Information       Receiver Name 837A1_1000B_NM103_ReceiverName Yes Receiver Identification 837A1_1000B_NM109_ReceiverPrimaryIdentifier Yes   Provider Information       Service Provider Name 837A1_2010AA_NM103_ServiceProviderLastorOrganizationName Yes Service Provider Identification Number 837A1_2010AA_NM109_ServiceProviderIdentifier Yes   Patient Information           Patient's Last Name 837A1_2010CA_NM103_PatientLastName Yes Patient's First Name 837A1_2010CA_NM104_PatientFirstName Yes Patient's Middle Name 837A1_2010CA_NM105_PatientMiddleName Yes Patient Control Number 837A1_2300_CLM01_PatientAccountNumber Yes Medical Record Number 837A1_2300_REF02_MedicalRecordNumber Yes Unique Personal Identifier / Social Security Number 837A1_2010CA_REF02_PatientSecondaryIdentifier Yes Patient's Race 837A1_2010CA_DMG05_C05603_RaceorEthnicityCode (??Composite) No Patient's Ethnicity 837A1_2010CA_DMG05_C05603_RaceorEthnicityCode (??Composite) No Patient Address Line 1 837A1_2010CA_N301_PatientAddressLine No Patient Address Line 2 837A1_2010CA_N302_PatientAddressLine No Patient's City 837A1_2010CA_N401_PatientCityName Yes Patient's County Code 837A1_2010CA_N406_LocationIdentifier Yes Patient's State 837A1_2010CA_N402_PatientStateName Yes Patient's Postal Service Zip Code and Extension Code 837A1_2010CA_N403_PatientPostalXoneorZIPCode Yes Patient Sex 837A1_2010CA_DMG03_PatientGenderCode Yes Patient Birthdate 837A1_2010CA_DMG02_PatientBirthDate Yes Newborn Birth Weight 837A1_2300_HI01_C02205_ValueCodeAssociatedAmount (??Composite) Yes Mother's Medical Record Number for Newborn Child 837A1_2300_REF02_MothersMedicalRecordNumber Yes Expected Patient Responsibility 837A1_2300_AMT02_PatientResponsibilityAmount Yes   Claim Information       Type of Admission 837A1_2300_CL101_AdmissionTypeCode Yes Source of Admission 837A1_2300_CL102_AdmissionSourceCode Yes Admission Date/Start of Care 837A1_2300_DTP03_AdmissionDateandHour Yes Admission Hour 837A1_2300_DTP03_AdmissionDateandHour Yes Statement Covers Period - From Date 837A1_2300_DTP03_StatementFromorToDate Yes Statement Covers Period - Thru Date 837A1_2300_DTP03_StatementFromorToDate Yes Service Date 837A1_2400_DTP02_ServiceDate Yes Discharge Date - Derived from Statement From Date & Type of Bill 837A1_2300_DTP03_StatementFromorToDate Yes Discharge Hour 837A1_2300_DTP03_DischargeHour Yes Patient Status or Disposition 837A1_2300_CL103_PatientStatusCode Yes Type of Bill 837A1_2300_CLM05_FacilityTypeCode (??Composite) Yes Accident Related Codes & Dates 837A1_2300_HI01_C02204_OccurrenceorOccurrenceSpanCodeAssociatedDate (??Composite) Yes ALC Span Dates 837A1_2300_HI01_C02204_OccurrenceorOccurrenceSpanCodeAssociatedDate (??Composite) Yes LOA Span Dates 837A1_2300_HI01_C02204_OccurrenceorOccurrenceSpanCodeAssociatedDate (??Composite) Yes Homeless Patient Indicator 837A1_2300_HI01_C02202_ConditionCode (??Composite) Yes Non-US Resident Patient Indicator 837A1_2300_HI01_C02202_ConditionCode (??Composite) Yes Readmission Code 837A1_2300_HI01_C02202_ConditionCode (??Composite) Yes Medicaid Special Program (PHC) Indicator 837A1_2300_HI01_C02202_ConditionCode (??Composite) Yes Medicaid Special Program (SFP) Indicator 837A1_2300_HI01_C02202_ConditionCode (??Composite) Yes Medicaid Special Program (FP) Indicator 837A1_2300_HI01_C02202_ConditionCode (??Composite) Yes Medicaid Special Program (DIS) Indicator 837A1_2300_HI01_C02202_ConditionCode (??Composite) Yes Workers' Compensation Indicator and Amount 837A1_2300_HI01_C02205_ValueCodeAssociatedAmount (??Composite) Yes No Fault Indicator and Amount 837A1_2300_HI01_C02205_ValueCodeAssociatedAmount (??Composite) Yes Mcaid Surplus, Catastrophic, Recurring Monthly Amount 837A1_2300_HI01_C02205_ValueCodeAssociatedAmount (??Composite) Yes Blood Furnished Indicator and Amount 837A1_2300_HI01_C02205_ValueCodeAssociatedAmount (??Composite) Yes   Note: The above data elements using UB Occurrence Codes, Occurrence Span Code, Condition Codes, and Value Codes are examples of how public health would use the UB code lists, they are not meant to be all inclusive. The Readmission Code is left to describe how maintenance to a UB code list could satisfy a potential public health data need.       Insurance Information       Source of Payment Code 837A1_2000B_SBR09_ClaimFilingIndicatorCode Yes Payer Identification 837A1_2010BC_NM109_PayerIdentifier Yes Policy Number 837A1_2010BA_NM109_SubscriberPrimaryIdentifier Yes Covered Days 837A1_23200_QTY02_ClaimDaysCount Yes Non-Covered Days 837A1_23200_QTY02_ClaimDaysCount Yes Payer Estimated Amount Due 837A1_2300_AMT02_EstimatedClaimDueAmount Yes Payer Prior Payment 837A1_2320_AMT02_OtherPayerPatientPaidAmount Yes   Service Line Information       UB-92 Accommodation Code 837A1_2400_SV201_ServiceLineRevenueCode Yes Accommodations Rate 837A1_2400_SV206_ServiceLineRate Yes Accommodations Days 837A1_2400_SV204_UnitBasisForMeasurementCode Yes Accommodations Total Charges 837A1_2400_SV203_LineItemChargeAmount Yes Accommodations Total Non-Covered Charges 837A1_2400_SV207_LineItemDeniedChargeorNonCoveredChargeAmount Yes Ancillary Revenue Code 837A1_2400_SV201_ServiceLineRevenueCode Yes Ancillary Units of Service 837A1_2400_SV205_ServiceUnitCount Yes Ancillary Total Charges 837A1_2400_SV203_LineItemChargeAmount Yes Ancillary Total Non-Covered Charges 837A1_2400_SV207_LineItemDeniedChargeorNonCoveredChargeAmount Yes Total Charges 837A1_2300_CLM02_TotalClaimChargeAmount Yes Procedure Code - HCPCS or CPT4 837A1_2400_SV202_C00302_ProcedureCode (??Composite) Yes Modifier 1 (HCPC & CPT4) 837A1_2400_SV202_C00303_ProcedureModifier (?? Composite) Yes Modifier 2 (HCPC & CPT4) 837A1_2400_SV202_C00304_ProcedureModifier (?? Composite) Yes   Medical Information       Principal Diagnosis Code 837A1_2300_HI01_C02202_IndustryCode (??Composite) Yes Other Diagnosis Code 837A1_2300_HI01_C02202_IndustryCode (??Composite) Yes Other Diagnosis Emergent Indicator 837A1_2300_HI01_C02209_IndustryCode (??Composite) No Principal Procedure Code 837A1_2300_HI01_C02202_IndustryCode (??Composite) Yes Principal Procedure Date 837A1_2300_HI01_C02204_DateTimePeriod (??Composite) Yes Other Procedure Code 837A1_2300_HI01_C02202_IndustryCode (??Composite) Yes Other Procedure Date 837A1_2300_HI01_C02204_DateTimePeriod (??Composite) Yes Admitting Diagnosis Code 837A1_2300_HI02_C02202_IndustryCode (??Composite) Yes Patient's Reason for Visit 837A1_2300_HI02_C02202_IndustryCode (??Composite) Yes External Cause-of-Injury Code 837A1_2300_HI03_C02202_IndustryCode (??Composite) Yes Place-of-Injury Code 837A1_2300_HI04_C02202_IndustryCode (??Composite) No Other E-Codes 837A1_2300_HI04_C02202_IndustryCode (??Composite) No   Physician Information       Attending Physician License Number 837A1_2310A_NM109_AttendingPhysicianPrimaryIdentifier Yes Operating Physician License Number 837A1_2310B_NM109_OperatingPhysicianPrimaryIdentifier Yes Other Physician License Number 837A1_2310C_NM109_OtherPhysicianIdentifier Yes Referring Physician License Number 837A1_2310D_NM109_ReferringPhysicianIdentifier Yes   Additional Information       State Mandated Information Not Supported by Standard 837A1_2300_NTE02_ClaimNoteText Yes