OptumDeveloper

Insitutional Claims

commercialv1

The ASC X12N Health Care Claim: Institutional (837i) transaction enables institutional healthcare providers to submit healthcare claims for a service or encounter. A healthcare claim includes patient information, related diagnoses, procedures performed or services provided, and any related charges. This API also translates standard X12 EDI 837i transactions to JSON so that it is more accessible to claim readers and developers.

All endpoints
POST/medicalnetwork/institutionalclaims/v1/validation

validateClaim

Claim Validation

Query Parameters

NameTypeDescription
USERNAME*string—

Header Parameters

NameTypeDescription
x-chng-trace-idstring—
Authorization*stringBearer Your-Access-Token<br/>Example: <b>Bearer eyJraWQiOiIxIiwid…</b>

Request Body*

application/json

object

InstitutionalClaimsRequest

controlNumber*string

Interchange Control Number ISA13 GS06 ST02

tradingPartnerServiceIdstring

Loop: 2010BB NM109 where NM108=PI

submitter*object

Loop: 1000A

organizationName*string

Loop: 1000A, Segment: NM1, Element: NM103, Notes: NM103 where NM102=2

taxIdstring

Loop: 1000A, Segment: NM1, Element:NM109, Notes:NM109 where NM108=46

contactInformation*object

PER

name*string

Loop: 1000A, Segment: PER, Element: PER02

phoneNumberstring

Loop: 1000A, Segment: PER, Element: PER04, Notes: PER04-6-8 where PER03-5-7=TE

faxNumberstring

Loop: 1000A, Segment: PER, Element: PER04, Notes:PER04-6-8 where PER03-5-7=FX

emailstring

Loop: 1000A, Segment: PER, Element: PER04, Notes:PER04-6-8 where PER03-5-7=EM

validContactboolean
receiver*object

Loop: 1000B

organizationName*string

Segment: NM1, Element:NM103 where NM102=2

taxIdstring

Segment: NM1, Element: NM109 where NM108=46

subscriber*object

Loop: 2000B, used in 2000C when dependent not present

memberIdstring

Loop: 2010BA, Segment: NM1, Element: NM109, Notes:NM109 where NM108=MI

standardHealthIdstring

Loop: 2010BA, Segment: NM1, Element: NM109, Notes:NM109 where NM108=II

ssnstring

Loop: 2010BA, Segment: REF, Element: REF02, Notes: REF02 where REF01=SY

paymentResponsibilityLevelCode*string

Loop: 2000B, Segment: SBR, Element:SBR01, Notes: Allowed Values are 'A' Payer Responsibility Four, 'B' Payer Responsibility Five, 'C' Payer Responsibility Six, 'D' Payer Responsibility Seven, 'E' Payer Responsibility Eight, 'F' Payer Responsibility Nine, 'G' Payer Responsibility Ten, 'H' Payer Responsibility Eleven, 'P' Primary, 'S' Secondary, 'T' Tertiary, 'U' Unknown

Enum: ABCDEFGHPSTU

firstName*string

Loop: 2010BA, Segment: NM1, Element:NM104

lastName*string

Loop: 2010BA, Segment: NM1, Element:NM103, Notes: NM103 where NM102=1

middleNamestring

Loop: 2010BA, Segment: NM1, Element:NM105

suffixstring

Loop: 2010BA, Segment: NM1, Element: NM107

genderstring

Loop: 2010BA, Segment: DMG, Element:DMG03

Enum: FMU

dateOfBirthstring

Loop: 2010BA, Segment: DMG, Element:DMG02, Notes: DMG02 YYYYMMDD

policyNumberstring

Loop: 2000B, Segment: SBR, Element:SBR03, Notes: Deprecated see otherSubscriberInformation.policyNumber

groupNumberstring

Loop: 2000B, Segment: SBR, Element:SBR03

addressobject

N3 and N4

address1*string

N301

address2string

N302

city*string

N401

statestring

N402

postalCodestring

N403

countryCodestring

N404

countrySubDivisionCodestring

N407

dependentobject

Loop: 2000B and 2000C

firstName*string

Loop: 2010CA, Segment: NM1, Element: NM104

lastName*string

Loop: 2010CA, Segment: NM1, Element: NM103 where NM102=1

middleNamestring

Loop: 2010CA, Segment: NM1, Element: NM105

suffixstring

Loop: 2010CA, Segment: NM1, Element: NM107

gender*string

Loop: 2010CA, Segment: DMG, Element: DMG03, Notes: Allowed Values are: 'M' Male, 'F' Female, 'U' Unknown.

Enum: MFU

dateOfBirth*string

Loop: 2010CA, Segment: DMG, Element: DMG02 where DMG01=D8 YYYYMMDD

ssnstring

Loop: 2010CA, Segment: REF, Element: REF02 where REF01=SY

relationshipToSubscriberCode*string

Loop: 2000C, Segment: PAT, Element: PAT01, Notes: Allowed Values are: '01' Spouse, '19' Child, '20' Employee, '21' Unknown, '39' Organ Donor, '40' Cadaver Donor, '53' Life Partner, 'G8' Other Relationship.

Enum: 011920394053G8

addressobject

N3 and N4

address1*string

N301

address2string

N302

city*string

N401

statestring

N402

postalCodestring

N403

countryCodestring

N404

countrySubDivisionCodestring

N407

providersarray

Another way to set billing, referring, rendering and attending provider, this will overwrite anything you send in billing, referring, rendering, attending. Loop: 2000A,2310F,2310D,2310A

billingPayToPlanNameobject

Loop: 2010AC

addressobject

N3 and N4

address1*string

N301

address2string

N302

city*string

N401

statestring

N402

postalCodestring

N403

countryCodestring

N404

countrySubDivisionCodestring

N407

organizationNamestring

Loop: 2010AC, Segment: NM1, Element: NM103 where NM102=2

identificationCodeQualifierstring

Loop: 2010AC, Segment: NM1, Element: NM108, Notes: Allowed Values are: 'PI' Payor Identification, 'XV' Centers for Medicare and Medicaid Services PlanID.

Enum: PIXV

identificationCodestring

Loop: 2010AC, Segment: NM1, Element: NM109

payerIdentificationNumberstring

Loop: 2010AC, Segment: NM1, Element: REF02 where REF01=2U

claimOfficeNumberstring

Loop: 2010AC, Segment: NM1, Element: REF02 where REF01=FY

taxId*string

Loop: 2010AC, Segment: NM1, Element: REF02 where REF01=EI Employer's Identification Number

naicstring
billingPayToAddressNameobject

Loop: 2010AB Billing Provider Pay To Address Name

addressobject

N3 and N4

address1*string

N301

address2string

N302

city*string

N401

statestring

N402

postalCodestring

N403

countryCodestring

N404

countrySubDivisionCodestring

N407

entityTypeQualifierstring

Loop: 2010AB, Segment: NM1: Element: NM102, Notes: Used when NM101 is set to 87 - qualifier of entity type, Allowed Values: '2' Non-Person Entity

Enum: 2

operatingPhysicianobject

Loop 2310B

organizationNamestring

Loop: 2310B, Segment: NM1, Element: NM103 where NM102=1 and NM101=72

identificationQualifierCodestring

Loop: 2310B, Segment: REF, Element: REF01, Notes: Allowable values: '0B' State License Number, '1G' Provider UPIN Number, 'G2' Provider Commercial Number, 'LU' Location Number

Enum: 0B1GG2LU

secondaryIdentifierstring

Loop: 2310B, Segment: REF, Element: REF02

firstNamestring

Loop: 2310B, Segment: NM1, Element: NM104

lastName*string

Loop: 2310B, Segment: NM1, Element: NM103 where NM102=1

middleNamestring

Loop: 2310B, Segment: NM1, Element: NM105

suffixstring

Loop: 2310B, Segment: NM1, Element: NM107

npistring

Loop: 2310B, Segment: NM1, Element: NM109 when NM108=XX

otherOperatingPhysicianobject

LOOP: 2310C

organizationNamestring

Loop: 2310B, Segment: NM1, Element: NM103 where NM102=1 and NM101=72

identificationQualifierCodestring

Loop: 2310B, Segment: REF, Element: REF01, Notes: Allowable values: '0B' State License Number, '1G' Provider UPIN Number, 'G2' Provider Commercial Number, 'LU' Location Number

Enum: 0B1GG2LU

secondaryIdentifierstring

Loop: 2310B, Segment: REF, Element: REF02

firstNamestring

Loop: 2310B, Segment: NM1, Element: NM104

lastName*string

Loop: 2310B, Segment: NM1, Element: NM103 where NM102=1

middleNamestring

Loop: 2310B, Segment: NM1, Element: NM105

suffixstring

Loop: 2310B, Segment: NM1, Element: NM107

npistring

Loop: 2310B, Segment: NM1, Element: NM109 when NM108=XX

claimInformation*object

Loop: 2000B, 2000C and 2300

claimFilingCode*string

Loop 2000B, Segment: SBR, Element: SBR09, Notes: Claim filing indicator code, Allowed Values are: '11' Other Non-Federal Programs, '12' Preferred Provider Organization (PPO), '13' Point of Service (POS), '14' Exclusive Provider Organization (EPO), '15' Indemnity Insurance, '16' Health Maintenance Organization (HMO) Medicare Risk, '17' Dental Maintenance Organization, 'AM' Automobile Medical, 'BL' Blue Cross/Blue Shield, 'CH' Champus, 'CI' Commercial Insurance Co., 'DS' Disability, 'FI' Federal Employees Program, 'HM' Health Maintenance Organization, 'LM' Liability Medical, 'MA' Medicare Part A, 'MB' Medicare Part B, 'MC' Medicaid, 'OF' Other Federal Program, 'TV' Title V, 'VA' Veterans Affairs Plan, 'WC' Workers' Compensation Health Claim, 'ZZ' Mutually Defined.

Enum: 11121314151617AMBLCHCIDSFIHMLMMAMBMCOFTVVAWCZZ

propertyCasualtyClaimNumberstring

Loop: 2000C Segment: REF, Element: REF02 where REF01=Y4

patientWeightstring

Deprecated PAT08

patientControlNumber*string

Loop: 2300, Segment: CLM, Element: CLM01, Notes: Used to track claim by the healthcare provider through payment. Also known as Claim Submitter's Identifier

claimChargeAmount*string

Loop: 2300, Segment: CLM, Element: CLM02, Notes: Total amount of all submitted charges of service segments. Must balance to the sum of all service line charge amounts (line SV2)

placeOfServiceCode*string

Loop: 2300, Segment: CLM, Element: CLM05-01, Notes: Code identifying where services were, or may be, performed.

claimFrequencyCode*string

Loop: 2300, Segment: CLM, Element: CLM05-03, Notes: Specifies the frequency of the claim.

signatureIndicatorstring
planParticipationCode*string

Loop: 2300, Segment: CLM, Element: CLM07, Notes: Code indicating whether the provider accepts assignment.Allowed Values are: 'A' Assigned, 'B' Assignment Accepted on Clinical Lab Services Only, 'C' Not Assigned.

Enum: ABC

benefitsAssignmentCertificationIndicator*string

Loop: 2300, Segment: CLM, Element: CLM08, Notes: Code indicating a Yes/No Response, Allowed Values are: 'N' No, 'W' Assignment Not Applicable, 'Y' Yes.

Enum: NWY

releaseInformationCode*string

Loop: 2300, Segment: CLM, Element: CLM09, Notes: Indicates whether the provider has on file a signed statement by patient authorizing the release of medical data to other organizations. Allowable Values are: 'I' Informed Consent to Release Medical Information for Conditions or Diagnoses Regulated by Federal Statutes, 'Y' Yes, Provider has a Signed Statement Permitting Release of Medical Billing Data Related to a Claim.

Enum: I, Y

delayReasonCodestring

Loop: 2300, Segment: CLM, Element: CLM20, Notes: Required when the claim is submitted late. If not required by this guide, do not send. Allowable Values are: '1' Proof of Eligibility Unknown or Unavailable, '2' Litigation, '3' Authorization Delays, '4' Delay in Certifying Provider, '5' Delay in Supplying Billing Forms, '6' Delay in Delivery of Custom-made Appliances, '7' Third Party Processing Delay, '8' Delay in Eligibility Determination, '9' Original Claim Rejected or Denied Due to a Reason Unrelated to the Billing Limitation Rules, '10' Administration Delay in the Prior Approval Process, '11' Other, '15 Natural Disaster

Enum: 123456789101115

patientAmountPaidstring

Deprecated AMT02

patientEstimatedAmountDuestring

Loop 2300, Segment: AMT, Element: AMT02 where AMT01=F3, Notes: Estimated patient responsibility amount due.

fileInformationarray
billingNotestring

Loop 2300, Segment: NTE, Element: NTE02 where NTE01=ADD

claimNotesobject

Loop 2300; Segment: NTE

goalRehabOrDischargePlansarray
diagnosisDescriptionarray
allergiesarray
dmearray
medicationsarray
nutritionalRequirmentsarray
ordersForDiscipLinesAndTreatmentsarray
functionalLimitsOrReasonHomeboundarray
reasonsPatientLeavesHomearray
timesAndReasonsPatientNotAtHomearray
unusualHomeOrSocialEnvarray
safetyMeasuresarray
supplementalPlanOfTreatmentarray
updatedInformationarray
additionalInformationarray
claimDateInformationobject
admissionDateAndHourstring

Loop: 2300, Segment: DTP, Element: DTP03, Notes: Code D8 or DT in DTP03. Can express range of dates or single date.

statementBeginDate*string

Loop: 2300, Segment: DTP, Element: DTP03, Notes: DTP03=434, Can express range of dates or single date.

statementEndDate*string

Loop: 2300, Segment: DTP, Element: DTP03, Notes: DTP03=434, Can express range of dates or single date.

dischargeHourstring

Loop: 2300, Segment: DTP, Element: DTP03, Notes: Date, time, or range of dates

repricerReceivedDatestring

Loop: 2300, Segment: DTP, Element: DTP03, Notes: DTP01=505 DTP02=D8

claimContractInformationobject
contractTypeCode*string

Loop 2300; Segment: CN1; Element: CN101, Notes:Allowable values '01' Diagnosis Related Group (DRG), '02' Per Diem, '03' Variable Per Diem, '04' Flat, '05' Capitated, '06' Percent, and '09' Other

Enum: 01020304050609

contractAmountstring

Loop 2300; Segment: CN1; Element: CN102-Monetary Amount

contractPercentagestring

Loop 2300; Segment: CN1; Element: CN103-Contract Percentage

contractCode*string

Loop 2300; Segment: CN1; Element: CN104-Contract Code

termsDiscountPercentage*string

Loop 2300; Segment: CN1; Element: CN105-Terms Discount Percentage

contractVersionIdentifier*string

Loop 2300; Segment: CN1; Element: CN106-Contract Version Identifier

claimSupplementalInformationobject

Loop: 2400, Segment: PWK

reportInformationobject

Loop: 2300, 2400; Segment: PWK

attachmentReportTypeCode*string

Loop 2300, 2400; Segment: PWK, Element: PWK01, Notes: Allowed Values are '03' Report Justifying Treatment Beyond Utilization Guidelines, '04' Drugs Administered, '05' Treatment Diagnosis, '06' Initial Assessment, '07' Functional Goals, '08' Plan of Treatment, '09' Progress Report, '10' Continued Treatment, '11' Chemical Analysis, '13' Certified Test Report, '15' Justification for Admission, '21' Recovery Plan, 'A3' Allergies/Sensitivities Document, 'A4' Autopsy Report, 'AM' Ambulance Certification, 'AS' Admission Summary, 'B2' Prescription, 'B3' Physician Order, 'B4' Referral Form, 'BR' Benchmark Testing Results, 'BS' Baseline, 'BT' Blanket Test Results, 'CB' Chiropractic Justification, 'CK' Consent Form(s), 'CT' Certification, 'D2' Drug Profile Document, 'DA' Dental Models, 'DB' Durable Medical Equipment Prescription, 'DG' Diagnostic Report, 'DJ' Discharge Monitoring Report, 'DS' Discharge Summary, 'EB' Explanation of Benefits (Coordination of Benefits or Medicare Secondary Payor), 'HC' Health Certificate, 'HR' Health Clinic Records, 'I5' Immunization Record, 'IR' State School Immunization Records, 'LA' Laboratory Results, 'M1' Medical Record Attachment, 'MT' Models, 'NN' Nursing Notes, 'OB' Operative Note, 'OC' Oxygen Content Averaging Report, 'OD' Orders and Treatments Document, 'OE' Objective Physical Examination (including vital signs) Document, 'OX' Oxygen Therapy Certification, 'OZ' Support Data for Claim, 'P4' Pathology Report, 'P5' Patient Medical History Document, 'PE' Parenteral or Enteral Certification, 'PN' Physical Therapy Notes, 'PO' Prosthetics or Orthotic Certification, 'PQ' Paramedical Results, 'PY' Physician's Report, 'PZ' Physical Therapy Certification, 'RB' Radiology Films, 'RR' Radiology Reports, 'RT' Report of Tests and Analysis Report, 'RX' Renewable Oxygen Content Averaging Report, 'SG' Symptoms Document, 'V5' Death Notification, 'XP' Photographs

Enum: 030405060708091011131521A3A4AMASB2B3B4BRBSBTCBCKCTD2DADBDGDJDSEBHCHRI5IRLAM1MTNNOBOCODOEOXOZP4P5PEPNPOPQPYPZRBRRRTRXSGV5XP

attachmentTransmissionCode*string

Loop: 2300, 2400; Segment: PWK, Element: PWK02, Notes: Allowed Values are 'AA' Available on Request at Provider Site, 'BM' By Mail, 'EL' Electronically Only, 'EM' E-Mail, 'FT' File Transfer, 'FX' By Fax

Enum: AABMELEMFTFX

attachmentControlNumber*string

Loop: 2300, 2400; Segment: PWK, Element: PWK06, Notes: Required when PWK02 = 'BM', 'EL', 'EM', 'FX', or 'FT'. If not required by this implementation guide, do not send

priorAuthorizationNumberstring

Loop 2300; Segment: REF; Element: REF02 when REF01 = G1

referralNumberstring

Loop 2300; Segment: REF; Element: REF02 when REF01 = 9F

claimControlNumberstring

Loop 2300; Segment: REF; Element: REF02 when REF01 = F8

repricedClaimNumberstring

Loop 2300; Segment: REF; Element: REF02 when REF01 = 9A

investigationalDeviceExemptionNumberstring

Loop 2300; Segment: REF; Element: REF02 when REF01 = LX

claimNumberstring

Loop 2300; Segment: REF; Element: REF02 when REF01 = D9

medicalRecordNumberstring

Loop 2300; Segment: REF; Element: REF02 when REF01 = EA

demoProjectIdentifierstring

Loop 2300; Segment: REF; Element: REF02 when REF01 = P4

serviceAuthorizationExceptionCodestring

Loop 2300; Segment: REF; Element: REF02 when REF01 = 4N, Allowed Values are: '1' Immediate/Urgent Care , '2' Services Rendered in a Retroactive Period , '3' Emergency Care, '4' Client has Temporary Medicaid, '5' Request from County for Second Opinion to Determine if Recipient Can Work , '6' Request for Override Pending , '7' Special Handling

Enum: 1234567

autoAccidentStatestring

Loop 2300; Segment: REF; Element: REF02 when REF01 = LU

peerReviewAuthorizationNumberstring

Loop 2300; Segment: REF; Element: REF02 when REF01 = G4

adjustedRepricedClaimRefNumberstring

Loop 2300; Segment: REF; Element: REF02 when REF01 = 9C

conditionCodesarray

Loop 2300, Segment: CRC, Element: CRC03, CRC04, CRC05, Notes: Allowed Values are: 'AV' Available-Not Used, 'NU' Not Used, 'S2' Under Treatment, 'ST' New Services Requested.

principalDiagnosis*object

HI

qualifierCode*string

Loop: 2300, Segment: HI, Element: HI01-01, Notes: Allowed Values are: 'ABK' International Classification of Diseases Clinical Modification Principal Diagnosis,'BK' International Classification of Diseases Clinical Modification (ICD-9-CM) Principal Diagnosis

Enum: ABKBK

principalDiagnosisCode*string

Loop: 2300, Segment: HI, Element: HI01-02

presentOnAdmissionIndicatorstring

Loop: 2300, Segment: HI, Element: HI01-09, Notes: Allowed Values are: 'N' NO, 'Y' Yes, 'U' Unknown, 'W' Not Applicable

Enum: NYUW

admittingDiagnosisobject
qualifierCode*string

LOOP 2300, HI01-01, Notes: 'ABJ' International Classification of Diseases Clinical Modification (ICD-10-CM) Admitting Diagnosis and'BJ' International Classification of Diseases Clinical Modification (ICD-9-CM) Admitting Diagnosis

Enum: ABJBJ

admittingDiagnosisCode*string

LOOP 2300, HI01-02

patientReasonForVisitsarray
externalCauseOfInjuriesarray
diagnosisRelatedGroupInformationobject
drugRelatedGroupCode*string

LOOP: 2300, Segment: HI, Element:HI01-02

otherDiagnosisInformationListarray
principalProcedureInformationobject

HI

qualifierCode*string

Loop: 2300, Segment: HI, Element: HI01-01, Notes: Allowed Values are: 'BBR' International Classification of Diseases Clinical Modification Principal Procedure Codes, 'BR' International Classification of Diseases Clinical Modification Principal Procedure Codes 'CAH' Advanced Billing Concepts (ABC) Codes

Enum: BBRBRCAH

principalProcedureCode*string

Loop: 2300, Segment: HI, Element: HI01-02

principalProcedureDatestring

Loop: 2300, Segment: HI, Element: HI01-04 where HI01-03=D8, Notes: Date expressed in format CCYYMMDD

otherProcedureInformationListarray
occurrenceSpanInformationsarray
valueInformationListarray
occurrenceInformationListarray
treatmentCodeInformationListarray
conditionCodesListarray
claimPricingInformationobject

Loop 2400, Segment: HCP

pricingMethodologyCode*string

Loop: 2300 and 2400, Segment: HCP, Element: HCP01, Notes: Allowed Values are: '00' Zero Pricing (Not Covered Under Contract), '01' Priced as Billed at 100%, '02' Priced at the Standard Fee Schedule, '03' Not Priced at a Contractual Percentage, '04' Bundled Pricing, '05' Peer Review Pricing, '06' Per Diem Pricing, '07' Flat Rate Pricing, '08' Combination Pricing, '09' Maternity Pricing, '10' Other Pricing, '11' Lower of Cost, '12' Ratio of Cost, '13' Cost Reimbursed, '14' Adjustment Pricing.

Enum: 000102030405060708091011121314

repricedAllowedAmount*string

Loop: 2300 and 2400, Segment: HCP, Element: HCP02

repricedSavingAmountstring

Loop: 2300 and 2400, Segment: HCP, Element: HCP03

repricedOrgIdentifierstring

Loop: 2300 and 2400, Segment: HCP, Element: HCP04

repricedPerDiemstring

Loop: 2300 and 2400, Segment: HCP, Element: HCP05

repricedApprovedDRGCodestring

Loop: 2300 and 2400, Segment: HCP, Element: HCP06

repricedApprovedAmountstring

Loop: 2300 and 2400, Segment: HCP, Element: HCP07

repricedApprovedRevenueCodestring

Loop: 2300 and 2400, Segment: HCP, Element: HCP08

repricedApprovedServiceUnitCodestring

Loop: 2300 and 2400, Segment: HCP, Element: HCP11, Notes: Allowed Values are: 'DA' Days, 'UN' Unit.

Enum: DAUN

repricedApprovedServiceUnitCountstring

Loop: 2300 and 2400, Segment: HCP, Element: HCP12

rejectReasonCodestring

Loop: 2300 and 2400, Segment: HCP, Element: HCP13, Notes: Allowed Values are: 'T1' Cannot Identify Provider as TPO (Third Party Organization) Participant, 'T2' Cannot Identify Payer as TPO (Third Party Organization) Participant, 'T3' Cannot Identify Insured as TPO (Third Party Organization) Participant, 'T4' Payer Name or Identifier Missing, 'T5' Certification Information Missing, 'T6' Claim does not contain enough information for re-pricing.

Enum: T1T2T3T4T5T6

policyComplianceCodestring

Loop: 2300 and 2400, Segment: HCP, Element: HCP14, Notes: Allowed Values are: '1' Procedure Followed (Compliance), '2' Not Followed - Call Not Made (Non-Compliance Call Not Made), '3' Not Medically Necessary (Non-Compliance Non-Medically Necessary), '4' Not Followed Other (Non-Compliance Other), '5' Emergency Admit to Non-Network Hospital.

Enum: 12345

exceptionCodestring

Loop: 2300 and 2400, Segment: HCP, Element: HCP15, Notes: Allowed Values are: '1' Non-Network Professional Provider in Network Hospital, '2' Emergency Care, '3' Services or Specialist not in Network, '4' Out-of-Service Area, '5' State Mandates, '6' Other.

Enum: 123456

productOrServiceIDQualifierstring

Loop: 2400, Segment: HCP, Element: HCP09, Notes: Allowed Values are: 'ER' Jurisdiction Specific Procedure and Supply Codes, 'HC' Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes, 'HP' Health Insurance Prospective Payment System (HIPPS) Skilled Nursing Facility Rate Code, 'IV' Home Infusion EDI Coalition (HIEC) Product/Service Code, 'WK' Advanced Billing Concepts (ABC) Codes

Enum: ERHCHPIVWK

repricedApprovedHCPCSCodestring

Loop: 2400, Segment: HCP, Element: HCP10

serviceFacilityLocationobject

Loop: 2310E

organizationName*string

Loop: 2310E, Segment: NM1, Element: NM103

address*object

N3 and N4

address1*string

N301

address2string

N302

city*string

N401

statestring

N402

postalCodestring

N403

countryCodestring

N404

countrySubDivisionCodestring

N407

secondaryIdentificationQualifierCodestring

Loop: 2310E, Segment: REF, Element: REF01, Notes: Allowed Values are: '0B' State License Number, 'G2' Provider Commercial Number, 'LU' Location Number

Enum: 0BG2LU

secondaryIdentifierstring

Loop: 2310E, Segment: REF, Element: REF02

identificationCodestring

Loop: 2310E, Segment: NM1, Element: NM109, Notes: Required when the service location to be identified has an NPI and is not a component or subpart of the Billing Provider entity. If not required by this implementation guide, do not send.

otherSubscriberInformationobject

Loop: 2320

paymentResponsibilityLevelCode*string

Loop: 2320, Segment: SBR, Element: SBR01, Notes: Code identifying the insurance carrier's level of responsibility for a payment of a claim, Allowed Values: 'A' Payer Responsibility Four, 'B' Payer Responsibility Five, 'C' Payer Responsibility Six, 'D' Payer Responsibility Seven, 'E' Payer Responsibility Eight, 'F' Payer Responsibility Nine, 'G' Payer Responsibility Ten, 'H' Payer Responsibility Eleven, 'P' Primary, 'S' Secondary, 'T' Tertiary, 'U' Unknown

Enum: ABCDEFGHPSTU

individualRelationshipCode*string

Loop: 2320, Segment: SBR, Element: SBR02, Notes: Code indicating the relationship between two individuals or entities, Allowed Values: '01' Spouse, '18' Self, '19' Child, '20' Employee, '21' Unknown, '39' Organ Donor, '40' Cadaver Donor, '53' Life Partner, 'G8' Other Relationship

Enum: 0118192021394053G8

policyNumberstring

Loop: 2320, Segment: SBR, Element: SBR03, Notes: Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier

groupNumberstring

Loop: 2320, Segment: SBR, Element: SBR03, Notes: Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier

otherInsuredGroupNamestring

Loop: 2320, Segment: SBR, Element: SBR04, Notes: Free form name.

claimFilingIndicatorCode*string

Loop: 2320, Segment: SBR, Element: SBR09, Notes: Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier, Allowed Values: '11' Other Non-Federal Programs, '12' Preferred Provider Organization (PPO), '13' Point of Service (POS), '14' Exclusive Provider Organization (EPO), '15' Indemnity Insurance, '16' Health Maintenance Organization (HMO) Medicare Risk,'17' Dental Maintenance Organization,'AM' Automobile Medical, 'BL' Blue Cross/Blue Shield, 'CH' Champus, 'CI' Commercial Insurance Co., 'DS' Disability, 'FI' Federal Employees Program, 'HM' Health Maintenance Organization, 'LM' Liability Medical, 'MA' Medicare Part A, 'MB' Medicare Part B, 'MC' Medicaid, 'OF' Other Federal Program, 'TV' Title V, 'VA' Veterans Affairs Plan, 'WC' Worker's Compensation Health Claim, 'ZZ' Mutually Defined

Enum: 11121314151617AMBLCHDSFIHMLMMAMBMCOFTVVAWCZZ

payerPaidAmountstring

Loop: 2320, Segment: AMT, Element: AMT02, Notes: Monetary amount

remainingPatientLiabilitystring

Loop: 2320, Segment: AMT, Element: AMT02, Notes: Monetary amount

nonCoveredChargeAmountstring

Loop: 2320, Segment: AMT, Element: AMT02, Notes: Monetary amount

benefitsAssignmentCertificationIndicator*string

Loop: 2320, Segment: AMT, Element: AMT02, Notes: Monetary amount, Allowed Values: 'N' No, 'Y' Yes, 'W' Not Applicable

Enum: NYW

releaseOfInformationCode*string

Loop:2320, Segment: OI, Element: OI06, Notes: Code indicating whether the provider has on file a signed statement by the patient authorising the release of medical data to other organizations, Allowed Values are: 'I' Informed Consent to Release Medical Information for Conditions or Diagnoses Regulated by Federal Statutes, 'Y' Yes, Provider has a Signed Statement Permitting Release of Medical Billing Data Related to a Claim

Enum: IY

medicareInpatientAdjudicationobject

Loop: 2320, Segment: MIA, Notes: Medical inpatient claim information

coveredDaysOrVisitsCount*string

Loop: 2320, Segment: MIA, Element: MIA01, Notes: Number of days covered

lifetimePsychiatricDaysCountstring

Loop: 2320, Segment: MIA, Element: MIA03, Notes: Lifetime of psychiatric days

claimDRGAmountstring

Loop: 2320, Segment: MIA, Element: MIA04, Notes: Diagnosis Related Group (DRG) amount

claimPaymentRemarkCodearray

Loop: 2320, Segment: MIA, Element: MIA05, Notes: Claim payment remark code

claimDisproportionateShareAmountstring

Loop: 2320, Segment: MIA, Element: MIA06, Notes: Disproportionate share amount

claimMspPassThroughAmountstring

Loop: 2320, Segment: MIA, Element: MIA07, Notes: Medicare Secondary Payer (MSP) pass-through amount

claimPpsCapitalAmountstring

Loop: 2320, Segment: MIA, Element: MIA08, Notes: Prospective Payment System (PPS) capital amount.

ppsCapitalHspDrgAmountstring

Loop: 2320, Segment: MIA, Element: MIA09, Notes: Prospective Payment System (PPS) capital, federal specific portion, Diagnosis Related Group (DRG) amount.

capitalHSPDRGAmountstring

Loop: 2320, Segment: MIA, Element: MIA10, Notes: Prospective Payment System (PPS) capital, hospital specific portion, Diagnosis Related Group (DRG) amount.

ppsCapitalDshDrgAmountstring

Loop: 2320, Segment: MIA, Element: MIA11, Notes: Prospective Payment System (PPS) capital, disproportionate share, hospital Diagnosis Related Group (DRG) amount.

oldCapitalAmountstring

Loop: 2320, Segment: MIA, Element: MIA12, Notes: The old capital amount

ppsCapitalImeAmountstring

Loop: 2320, Segment: MIA, Element: MIA13, Notes: Prospective Payment System (PPS) capital Indirect Medical Education (IME) claim amount

ppsOperatingHospitalSpecificDrgAmountstring

Loop: 2320, Segment: MIA, Element: MIA14, Notes: Hospital specific Diagnosis Related Group (DRG) amount

costReportDayCountstring

Loop: 2320, Segment: MIA, Element: MIA15, Notes: Cost report days

ppsOperatingFederalSpecificDrgAmountstring

Loop: 2320, Segment: MIA, Element: MIA16, Notes: Federal specific Diagnosis Related Group (DRG) amount

claimPpsCapitalOutlierAmmountstring

Loop: 2320, Segment: MIA, Element: MIA17, Notes: Prospective Payment System (PPS) capital outlier amount

claimIndirectTeachingAmountstring

Loop: 2320, Segment: MIA, Element: MIA18, Notes: Indirect teaching amount

nonPayableProfessionalComponentBilledAmountstring

Loop: 2320, Segment: MIA, Element: MIA19, Notes: The professional component amount billed but not payable

capitalExceptionAmountstring

Loop: 2320, Segment: MIA, Element: MIA24, Notes: The capital exception amount

medicareOutpatientAdjudicationobject

Loop: 2320, Segment: MOA, Notes: Medical outpatient claim information

reimbursementRatestring

Loop: 2320, Segment: MOA, Element: MOA01, Notes: The reimbursement rate

hcpcsPayableAmountstring

Loop: 2320, Segment: MOA, Element: MOA02, Notes: The claim Health Care Financing Administration Common Procedural Coding System (HCPCS) payable amount.

claimPaymentRemarkCodearray

Loop: 2320, Segment: MOA, Element: MOA03 through MOA07, Notes: The claim payment remark code

endStageRenalDiseasePaymentAmountstring

Loop: 2320, Segment: MOA, Element: MOA08, Notes: The End Stage Renal Disease (ESRD) payment amount

nonPayableProfessionalComponentBilledAmountstring

Loop: 2320, Segment: MOA, Element: MOA09, Notes: The professional component amount billed but not payable

otherSubscriberName*object

Loop: 2330A, Notes: Information regarding other subscriber

otherInsuredQualifier*string

Loop: 2330A, Segment: NM1, Element: NM102, Notes: Code qualifying the Reference Identification, Allowed Values: '1' Person '2' Non-Person Entity

Enum: 12

otherInsuredLastName*string

Loop: 2330A, Segment: NM1, Element: NM103, Notes: Individual last name or organizational name.

otherInsuredFirstNamestring
otherInsuredMiddleNamestring

Loop: 2330A, Segment: NM1, Element: NM105, Notes: Individual middle name.

otherInsuredSuffixstring

Loop: 2330A, Segment: NM1, Element: NM107, Notes: Individual suffix.

otherInsuredIdentifierTypeCode*string

Loop: 2330A, Segment: NM1, Element: NM108, Notes: Code identifying an organizational entity, a physical location, property or an individual, Allowed Values: 'II' Standard Unique Health Identifier for each Individual in the United States, 'MI' Member Identification Number

Enum: IIMI

otherInsuredIdentifier*string

Loop: 2330A, Segment: NM1, Element: NM109, Notes: Code identifying a party or other code.

otherInsuredAdditionalIdentifierarray
addressobject

N3 and N4

address1*string

N301

address2string

N302

city*string

N401

statestring

N402

postalCodestring

N403

countryCodestring

N404

countrySubDivisionCodestring

N407

firstNamestring
claimLevelAdjustmentsarray
otherPayerName*object

Loop: 2330B, Notes: Information regarding other payer

otherInsuredAdditionalIdentifierstring
otherPayerOrganizationName*string

Loop: 2330B, Segment: NM1, Element: NM103, Notes: Individual last name or organizational name.

otherPayerIdentifierTypeCode*string

Loop: 2330B, Segment: NM1, Element: NM108, Notes: Allowable values: 'PI' Payor Identification and 'XV' Centers for Medicare and Medicaid Services PlanID

Enum: PIXV

otherPayerIdentifier*string

Loop: 2330B, Segment: NM1, Element: NM109, Notes: Code identifying a party or other code.

otherPayerAddressobject

N3 and N4

address1*string

N301

address2string

N302

city*string

N401

statestring

N402

postalCodestring

N403

countryCodestring

N404

countrySubDivisionCodestring

N407

otherPayerAdjudicationOrPaymentDatestring

Loop: 2330B, Segment: DTP, Element: DTP03, Notes: Expression of a date, a time, or range of dates, times or dates and times

otherPayerSecondaryIdentifierarray

Loop: 2330B, Segment: REF

otherPayerPriorAuthorizationNumberstring

Loop: 2330B, Segment: REF, Element: REF02, Notes: Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier.

otherPayerPriorAuthorizationOrReferralNumberstring

Loop: 2330B, Segment: REF, Element: REF02, Notes: Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier.

otherPayerClaimAdjustmentIndicatorboolean

Loop: 2330B, Segment: REF, Element: REF02, Notes: Allowable value: 'Y'

Enum: false

otherPayerClaimControlNumberstring

Loop: 2330B, Segment: REF, Element: REF02, Notes: Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier.

otherPayerAttendingProviderobject

Loop: 2330C, Notes: Information regarding other attending provider

otherPayerAttendingProviderIdentifier*array

Loop: 2330C, Segment: REF

otherPayerOperatingPhysicianobject

REF

otherPayerOperatingPhysicianIdentifier*array

Loop: 2330D, Segment: REF, Notes: Code qualifying the Reference Identification.

otherPayerOtherOperatingPhysicianobject

REF

otherPayerOtherOperatingPhysicianIdentifier*array

Loop: 2330E, Segment: REF, Notes: Code qualifying the Reference Identification.

otherPayerServiceFacilityLocationobject

Loop: 2330F, Notes: Information regarding other payer service facility location

otherPayerServiceFacilityLocationIdentifier*array

Loop: 2330F, Segment: REF, Notes: Code qualifying the Reference Identification.

otherPayerRenderingProviderobject

REF

otherPayerRenderingProviderIdentifier*array

Loop: 2330G, Segment: REF, Notes: Code qualifying the Reference Identification.

otherPayerReferringProviderobject

REF

otherPayerReferringProviderIdentifier*array

Loop: 2330H, Segment: REF, Notes: Code qualifying the Reference Identification.

otherPayerBillingProviderobject

Loop: 2330I, Notes: Information regarding other payer billing provider

otherPayerBillingProviderIdentifier*array

Loop: 2330I, Segment: REF

serviceLines*array
claimCodeInformation*object
admissionTypeCode*string

Loop 2300; Segment: CL1; Element: CL101; Notes: Code indicating the priority type of this admission.

admissionSourceCodestring

Loop 2300; Segment: CL1; Element: CL102; Notes: Point of origin for admission or visit.

patientStatusCode*string

Loop 2300; Segment: CL1; Element: CL103

epsdtReferralobject
certificationConditionCodeAppliesIndicator*string

Loop: 2300, Segment: CRC, Element: CRC02 when CRC01 = ZZ, Notes: Allowable values 'Y' Yes and 'N' No - if no then choose NU in CRC02 indicating no referral given

Enum: NY

conditionCodes*array

Loop: 2300, Segment: CRC, Element: CRC03, CRC04, CRC05, Notes: Allowed Values are: 'AV' Available- Not Used,'NU' Not Used, 'S2' Under Treatment, 'ST' New Services Requested

payerAddressobject

N3 and N4

address1*string

N301

address2string

N302

city*string

N401

statestring

N402

postalCodestring

N403

countryCodestring

N404

countrySubDivisionCodestring

N407

usageIndicatorstring

Interchange Usage Indicator ISA15; T-Test Data, P-Production Data

billing*object

Loop: 2000A

providerType*string

Type of Provider, sets properties to map to Loop 2000A for BillingProvider or 2310A for AttendingProvider or 2310D RenderingProvider or 2310F ReferringProvider

Enum: BillingProviderAttendingProviderReferringProviderRenderingProvider

npistring

Segment: NM1, Element:NM109 where NM108=XX

secondaryIdentificationQualifierCodestring

Segment: REF, Element: REF01, Notes: Allowed Values are: '0B' State License Number, '1G' Provider UPIN Number, 'G2' Provider Commercial Number,'LU' Location Number

Enum: 0B1GG2LU

secondaryIdentifierstring

Segment: REF, Element: REF02

employerIdstring

Segment: REF, Element: REF02 where REF01=EI

commercialNumberstring

Segment: REF, Element: REF02 where REF01=G2, Notes: Deprecated see otherPayerAttendingProvider, otherPayerRenderingProvider and otherPayerReferringProvider.

locationNumberstring

Segment: REF, Element: REF02 where REF01=LU, Notes: Deprecated see otherPayerAttendingProvider, otherPayerRenderingProvider and otherPayerReferringProvider.

stateLicenseNumberstring

Segment: REF, Element: REF02 where REF01=0B, Notes: Deprecated see otherPayerAttendingProvider, otherPayerRenderingProvider and otherPayerReferringProvider.

providerUpinNumberstring

Segment: REF, Element: REF02 where REF01=1G, Notes: Deprecated see otherPayerAttendingProvider, otherPayerRenderingProvider and otherPayerReferringProvider.

taxonomyCodestring

Segment: PRV03, Element: PRV03 where PRV02=PXC

firstNamestring

Segment: NM1, Element: NM104

lastNamestring

Segment: NM1, Element: NM103

middleNamestring

Segment: NM1, Element: NM105

suffixstring

Segment: NM1, Element: NM107

organizationNamestring

Segment: NM1, Element:NM103

addressobject

N3 and N4

address1*string

N301

address2string

N302

city*string

N401

statestring

N402

postalCodestring

N403

countryCodestring

N404

countrySubDivisionCodestring

N407

contactInformationobject

PER

name*string

Loop: 1000A, Segment: PER, Element: PER02

phoneNumberstring

Loop: 1000A, Segment: PER, Element: PER04, Notes: PER04-6-8 where PER03-5-7=TE

faxNumberstring

Loop: 1000A, Segment: PER, Element: PER04, Notes:PER04-6-8 where PER03-5-7=FX

emailstring

Loop: 1000A, Segment: PER, Element: PER04, Notes:PER04-6-8 where PER03-5-7=EM

validContactboolean
referringobject

Loop: 2310F

providerType*string

Type of Provider, sets properties to map to Loop 2000A for BillingProvider or 2310A for AttendingProvider or 2310D RenderingProvider or 2310F ReferringProvider

Enum: BillingProviderAttendingProviderReferringProviderRenderingProvider

npistring

Segment: NM1, Element:NM109 where NM108=XX

secondaryIdentificationQualifierCodestring

Segment: REF, Element: REF01, Notes: Allowed Values are: '0B' State License Number, '1G' Provider UPIN Number, 'G2' Provider Commercial Number,'LU' Location Number

Enum: 0B1GG2LU

secondaryIdentifierstring

Segment: REF, Element: REF02

employerIdstring

Segment: REF, Element: REF02 where REF01=EI

commercialNumberstring

Segment: REF, Element: REF02 where REF01=G2, Notes: Deprecated see otherPayerAttendingProvider, otherPayerRenderingProvider and otherPayerReferringProvider.

locationNumberstring

Segment: REF, Element: REF02 where REF01=LU, Notes: Deprecated see otherPayerAttendingProvider, otherPayerRenderingProvider and otherPayerReferringProvider.

stateLicenseNumberstring

Segment: REF, Element: REF02 where REF01=0B, Notes: Deprecated see otherPayerAttendingProvider, otherPayerRenderingProvider and otherPayerReferringProvider.

providerUpinNumberstring

Segment: REF, Element: REF02 where REF01=1G, Notes: Deprecated see otherPayerAttendingProvider, otherPayerRenderingProvider and otherPayerReferringProvider.

taxonomyCodestring

Segment: PRV03, Element: PRV03 where PRV02=PXC

firstNamestring

Segment: NM1, Element: NM104

lastNamestring

Segment: NM1, Element: NM103

middleNamestring

Segment: NM1, Element: NM105

suffixstring

Segment: NM1, Element: NM107

organizationNamestring

Segment: NM1, Element:NM103

addressobject

N3 and N4

address1*string

N301

address2string

N302

city*string

N401

statestring

N402

postalCodestring

N403

countryCodestring

N404

countrySubDivisionCodestring

N407

contactInformationobject

PER

name*string

Loop: 1000A, Segment: PER, Element: PER02

phoneNumberstring

Loop: 1000A, Segment: PER, Element: PER04, Notes: PER04-6-8 where PER03-5-7=TE

faxNumberstring

Loop: 1000A, Segment: PER, Element: PER04, Notes:PER04-6-8 where PER03-5-7=FX

emailstring

Loop: 1000A, Segment: PER, Element: PER04, Notes:PER04-6-8 where PER03-5-7=EM

validContactboolean
renderingobject

Loop: 2310D

providerType*string

Type of Provider, sets properties to map to Loop 2000A for BillingProvider or 2310A for AttendingProvider or 2310D RenderingProvider or 2310F ReferringProvider

Enum: BillingProviderAttendingProviderReferringProviderRenderingProvider

npistring

Segment: NM1, Element:NM109 where NM108=XX

secondaryIdentificationQualifierCodestring

Segment: REF, Element: REF01, Notes: Allowed Values are: '0B' State License Number, '1G' Provider UPIN Number, 'G2' Provider Commercial Number,'LU' Location Number

Enum: 0B1GG2LU

secondaryIdentifierstring

Segment: REF, Element: REF02

employerIdstring

Segment: REF, Element: REF02 where REF01=EI

commercialNumberstring

Segment: REF, Element: REF02 where REF01=G2, Notes: Deprecated see otherPayerAttendingProvider, otherPayerRenderingProvider and otherPayerReferringProvider.

locationNumberstring

Segment: REF, Element: REF02 where REF01=LU, Notes: Deprecated see otherPayerAttendingProvider, otherPayerRenderingProvider and otherPayerReferringProvider.

stateLicenseNumberstring

Segment: REF, Element: REF02 where REF01=0B, Notes: Deprecated see otherPayerAttendingProvider, otherPayerRenderingProvider and otherPayerReferringProvider.

providerUpinNumberstring

Segment: REF, Element: REF02 where REF01=1G, Notes: Deprecated see otherPayerAttendingProvider, otherPayerRenderingProvider and otherPayerReferringProvider.

taxonomyCodestring

Segment: PRV03, Element: PRV03 where PRV02=PXC

firstNamestring

Segment: NM1, Element: NM104

lastNamestring

Segment: NM1, Element: NM103

middleNamestring

Segment: NM1, Element: NM105

suffixstring

Segment: NM1, Element: NM107

organizationNamestring

Segment: NM1, Element:NM103

addressobject

N3 and N4

address1*string

N301

address2string

N302

city*string

N401

statestring

N402

postalCodestring

N403

countryCodestring

N404

countrySubDivisionCodestring

N407

contactInformationobject

PER

name*string

Loop: 1000A, Segment: PER, Element: PER02

phoneNumberstring

Loop: 1000A, Segment: PER, Element: PER04, Notes: PER04-6-8 where PER03-5-7=TE

faxNumberstring

Loop: 1000A, Segment: PER, Element: PER04, Notes:PER04-6-8 where PER03-5-7=FX

emailstring

Loop: 1000A, Segment: PER, Element: PER04, Notes:PER04-6-8 where PER03-5-7=EM

validContactboolean
attendingobject

Loop: 2310A

providerType*string

Type of Provider, sets properties to map to Loop 2000A for BillingProvider or 2310A for AttendingProvider or 2310D RenderingProvider or 2310F ReferringProvider

Enum: BillingProviderAttendingProviderReferringProviderRenderingProvider

npistring

Segment: NM1, Element:NM109 where NM108=XX

secondaryIdentificationQualifierCodestring

Segment: REF, Element: REF01, Notes: Allowed Values are: '0B' State License Number, '1G' Provider UPIN Number, 'G2' Provider Commercial Number,'LU' Location Number

Enum: 0B1GG2LU

secondaryIdentifierstring

Segment: REF, Element: REF02

employerIdstring

Segment: REF, Element: REF02 where REF01=EI

commercialNumberstring

Segment: REF, Element: REF02 where REF01=G2, Notes: Deprecated see otherPayerAttendingProvider, otherPayerRenderingProvider and otherPayerReferringProvider.

locationNumberstring

Segment: REF, Element: REF02 where REF01=LU, Notes: Deprecated see otherPayerAttendingProvider, otherPayerRenderingProvider and otherPayerReferringProvider.

stateLicenseNumberstring

Segment: REF, Element: REF02 where REF01=0B, Notes: Deprecated see otherPayerAttendingProvider, otherPayerRenderingProvider and otherPayerReferringProvider.

providerUpinNumberstring

Segment: REF, Element: REF02 where REF01=1G, Notes: Deprecated see otherPayerAttendingProvider, otherPayerRenderingProvider and otherPayerReferringProvider.

taxonomyCodestring

Segment: PRV03, Element: PRV03 where PRV02=PXC

firstNamestring

Segment: NM1, Element: NM104

lastNamestring

Segment: NM1, Element: NM103

middleNamestring

Segment: NM1, Element: NM105

suffixstring

Segment: NM1, Element: NM107

organizationNamestring

Segment: NM1, Element:NM103

addressobject

N3 and N4

address1*string

N301

address2string

N302

city*string

N401

statestring

N402

postalCodestring

N403

countryCodestring

N404

countrySubDivisionCodestring

N407

contactInformationobject

PER

name*string

Loop: 1000A, Segment: PER, Element: PER02

phoneNumberstring

Loop: 1000A, Segment: PER, Element: PER04, Notes: PER04-6-8 where PER03-5-7=TE

faxNumberstring

Loop: 1000A, Segment: PER, Element: PER04, Notes:PER04-6-8 where PER03-5-7=FX

emailstring

Loop: 1000A, Segment: PER, Element: PER04, Notes:PER04-6-8 where PER03-5-7=EM

validContactboolean
tradingPartnerNamestring

Loop: 2010BB NM103 where NM101=PR and NM102=2. Notes: Required

Responses

200OK
object
statusstring

Status of claim

controlNumberstring

Transaction Set Control Number

tradingPartnerServiceIdstring

Payer ID

claimReferenceobject

ClaimReference

correlationIdstring

Claim correlation ID

submitterIdstring

Submitter ID for transaction

customerClaimNumberstring

Claim number

patientControlNumberstring

Control number for claim

timeOfResponsestring

Time of response for claim

formatVersionstring

Claim format version

claimTypestring

Claim Type

rhClaimNumberstring

RH Claim Number

errorsarray

List of errors

httpStatusCodestring

Enum: 100 CONTINUE101 SWITCHING_PROTOCOLS102 PROCESSING103 CHECKPOINT200 OK201 CREATED202 ACCEPTED203 NON_AUTHORITATIVE_INFORMATION204 NO_CONTENT205 RESET_CONTENT206 PARTIAL_CONTENT207 MULTI_STATUS208 ALREADY_REPORTED226 IM_USED300 MULTIPLE_CHOICES301 MOVED_PERMANENTLY302 FOUND302 MOVED_TEMPORARILY303 SEE_OTHER304 NOT_MODIFIED305 USE_PROXY307 TEMPORARY_REDIRECT308 PERMANENT_REDIRECT400 BAD_REQUEST401 UNAUTHORIZED402 PAYMENT_REQUIRED403 FORBIDDEN404 NOT_FOUND405 METHOD_NOT_ALLOWED406 NOT_ACCEPTABLE407 PROXY_AUTHENTICATION_REQUIRED408 REQUEST_TIMEOUT409 CONFLICT410 GONE411 LENGTH_REQUIRED412 PRECONDITION_FAILED413 PAYLOAD_TOO_LARGE413 REQUEST_ENTITY_TOO_LARGE414 URI_TOO_LONG414 REQUEST_URI_TOO_LONG415 UNSUPPORTED_MEDIA_TYPE416 REQUESTED_RANGE_NOT_SATISFIABLE417 EXPECTATION_FAILED418 I_AM_A_TEAPOT419 INSUFFICIENT_SPACE_ON_RESOURCE420 METHOD_FAILURE421 DESTINATION_LOCKED422 UNPROCESSABLE_ENTITY423 LOCKED424 FAILED_DEPENDENCY425 TOO_EARLY426 UPGRADE_REQUIRED428 PRECONDITION_REQUIRED429 TOO_MANY_REQUESTS431 REQUEST_HEADER_FIELDS_TOO_LARGE451 UNAVAILABLE_FOR_LEGAL_REASONS500 INTERNAL_SERVER_ERROR501 NOT_IMPLEMENTED502 BAD_GATEWAY503 SERVICE_UNAVAILABLE504 GATEWAY_TIMEOUT505 HTTP_VERSION_NOT_SUPPORTED506 VARIANT_ALSO_NEGOTIATES507 INSUFFICIENT_STORAGE508 LOOP_DETECTED509 BANDWIDTH_LIMIT_EXCEEDED510 NOT_EXTENDED511 NETWORK_AUTHENTICATION_REQUIRED

metaobject

meta data about the request

submitterIdstring

submitterId assigned to this request

senderIdstring

senderId assigned to this request

billerIdstring

billerId assigned to this request

traceIdstring

Unique Id assigned to each request by Optum

applicationModestring

Used by Optum to identify where this request can be found for support

editStatusstring
editResponsesarray
payerobject
payerNamestring
payerIDstring
failureobject
descriptionstring
codestring

Example Request

cURL
curl -X POST \
  'https://sandbox-apigw.optum.com/medicalnetwork/institutionalclaims/v1/validation'