misc/837p.xml in pd_x12-1.4.3 vs misc/837p.xml in pd_x12-1.4.4

- old
+ new

@@ -59,193 +59,191 @@ <Segment name="N3" max="1" required="y" comment="Pay-to plan address"/> <Segment name="N4" max="1" required="y" comment="Pay-to plan city/state/zip code"/> <Segment name="REF" max="1" required="n" comment="Pay-to plan secondary id"/> <Segment name="REF" max="1" required="y" comment="Pay-to plan tax id"/> </Loop> - - <Loop name="L2000B" required="y"> - <Segment name="HL" max="1" required="y" comment="Subscriber heiarchical level"/> - <Segment name="SBR" max="1" required="y" comment="subscriber information"/> - <Segment name="PAT" max="1" required="n" comment="Patient information"/> + </Loop> + <Loop name="L2000B" required="y"> + <Segment name="HL" max="1" required="y" comment="Subscriber heiarchical level"/> + <Segment name="SBR" max="1" required="y" comment="subscriber information"/> + <Segment name="PAT" max="1" required="n" comment="Patient information"/> - <Loop name="L2010BA" max="1" required="y"> - <Segment name="NM1" max="1" required="y" comment="Subscriber name"/> - <Segment name="N3" max="1" required="n" comment="Subscriber address"/> - <Segment name="N4" max="1" required="n" comment="Subscriber city/state/zip"/> - <Segment name="DMG" max="1" required="n" comment="Subscriber demographic information"/> - <Segment name="REF" max="2" required="n"/> - <Segment name="PER" max="1" required="n" comment="Property and casualty subscriber contact information"/> - </Loop> - <Loop name="L2010BB" max="1" required="y"> - <Segment name="NM1" max="1" required="y" comment="Payer name"/> - <Segment name="N3" max="1" required="n" comment="Payer address"/> - <Segment name="N4" max="1" required="n" comment="Payer city/state/zip code"/> - <Segment name="REF" max="5" required="n" /> - </Loop> - - <Loop name="L2000C" required="n"> - <Segment name="HL" required="y" comment="Patient heirarchical level"/> - <Segment name="PAT" required="y" comment="Patient information"/> - <Loop name="L2010CA" max="1" required="n"> - <Segment name="NM1" max="1" required="y" comment="Patient name"/> - <Segment name="N3" max="1" required="y" comment="Patient address"/> - <Segment name="N4" max="1" required="y" comment="Patient city/state/zip"/> - <Segment name="DMG" max="1" required="y" comment="Patient demographic information"/> - <Segment name="REF" max="1" required="n" comment="Property and casualty claim number"/> - <Segment name="PER" max="1" required="n" comment="Property and casualty subscriber contact information"/> - </Loop> - </Loop> - <Loop name="L2300" max="100" required="y"> - <Segment name="CLM" max="1" required="y" comment="Claim information"/> - <Segment name="DTP" max="16" required="n" comment="Claim Dates. Up to 16 different dates can be set for a 837p" /> - <Segment name="PWK" max="10" required="n" comment="Claim supplemental information" /> - <Segment name="CN1" max="1" required="n" comment="Contract information" /> - <Segment name="AMT" max="1" required="n" comment="Patient amount paid" /> - <Segment name="REF" max="14" required="n" comment="Claim References. Up to 14 different claim references can be set for a 837p" /> - <Segment name="K3" max="10" required="n" comment="File information" /> - <Segment name="NTE" max="1" required="n" comment="Claim note" /> - <Segment name="CR1" max="1" required="n" comment="Ambulance transport information" /> - <Segment name="CR2" max="1" required="n" comment="Spinal manipulation service information" /> - <Segment name="CRC" max="8" required="n" comment="Code Category. Up to 8 different CRC categories can be set for an 837p" /> - <Segment name="HI" max="1" required="y" comment="Healthcare diagnostic code" /> - <Segment name="HI" max="1" required="n" comment="Anesthesia related procedure code" /> - <Segment name="HI" max="2" required="n" comment="Condition information" /> - <Segment name="HCP" max="1" required="n" comment="Claim pricing / repricing information" /> - - <Loop name="L2310A" max="1" required="n"> - <Segment name="NM1" max="1" required="y" comment="Referring provider name"/> - <Segment name="REF" max="3" required="n" comment="Referring provider secondary id"/> - </Loop> - <Loop name="L2310B" max="1" required="n"> - <Segment name="NM1" max="1" required="n" comment="Rendering provider name"/> - <Segment name="PRV" max="1" required="n" comment="Rendering provider specialty information"/> - <Segment name="REF" max="4" required="n" comment="Rendering provider secondary id"/> - </Loop> - <Loop name="L2310C" required="n"> - <Segment name="NM1" max="1" required="y" comment="Service facility location"/> - <Segment name="N3" max="1" required="y" comment="Service facility address"/> - <Segment name="N4" max="1" required="y" comment="Service facility city/state/zip"/> - <Segment name="REF" max="3" required="n" comment="Service facility location secondary id"/> - <Segment name="PER" max="1" required="n" comment="Service facility contact information"/> - </Loop> - <Loop name="L2310D" max="1" required="n"> - <Segment name="NM1" max="1" required="n" comment="Supervising provider name"/> - <Segment name="REF" max="4" required="n" comment="Supervising provider secondary id"/> - </Loop> - <Loop name="L2310E" max="1" required="n"> - <Segment name="NM1" max="1" required="y" comment="Ambulance pick up location"/> - <Segment name="N3" max="1" required="y" comment="Ambulance pick up address"/> - <Segment name="N4" max="1" required="y" comment="Ambulance pick up city/state/zip"/> - </Loop> - <Loop name="L2310F" max="1" required="n"> - <Segment name="NM1" max="1" required="y" comment="Ambulance dropoff location"/> - <Segment name="N3" max="1" required="y" comment="Ambulance dropoff address"/> - <Segment name="N4" max="1" required="y" comment="Ambulance dropoff city/state/zip"/> - </Loop> - <Loop name="L2320" max="10" required="n"> - <Segment name="SBR" max="1" required="n" comment="Other subscriber information" /> - <Segment name="CAS" max="5" required="n" comment="Claim level adjustment" /> - <Segment name="AMT" max="3" required="n" comment="Claim level adjustment amounts" /> - <Segment name="OI" max="1" required="y" comment="Other insurance coverage information" /> - <Segment name="MOA" max="1" required="n" comment="Medicare outpatient adjudication information" /> - </Loop> - <Loop name="L2330A" max="1" required="n"> - <Segment name="NM1" max="1" required="y" comment="Other subscriber name"/> - <Segment name="N3" max="1" required="n" comment="Other subscriber address"/> - <Segment name="N4" max="1" required="y" comment="Other subscriber city/state/zip"/> - <Segment name="REF" max="1" required="n" comment="Other subscriber location secondary id"/> - </Loop> - <Loop name="L2330B" max="1" required="n"> - <Segment name="NM1" max="1" required="y" comment="Other payer name" /> - <Segment name="N3" max="1" required="n" comment="Other payer address"/> - <Segment name="N4" max="1" required="y" comment="Other payer city/state/zip"/> - <Segment name="DTP" max="1" required="n" comment="Date - claim check or remittance date" /> - <Segment name="REF" max="6" required="n" comment="Other reference information. Up to 6 different references can be associated to an 837p" /> - </Loop> - <Loop name="L2330CDEFG" max="6" required="n" comment="Loops 2330C through 2330G combined for inbound transactions, application needs to determine the correct loop being provided."> - <Segment name="NM1" max="1" required="y" comment="Name" /> - <Segment name="REF" max="3" required="y" comment="Secondary id"/> - </Loop> - <Loop name="L2400" max="50" required="y"> - <Segment name="LX" max="1" required="y" comment="Service line" /> - <Segment name="SV1" max="1" required="y" comment="Professional service" /> - <Segment name="SV5" max="1" required="n" comment="Durable medical equipment service" /> - <Segment name="PWK" max="10" required="n" comment="Line supplemental informtion" /> - <Segment name="PWK" max="1" required="n" comment="Durable medical equipment certificate of medical necessity indicator" /> - <Segment name="CR1" max="1" required="n" comment="Ambulance transport information" /> - <Segment name="CR3" max="1" required="n" comment="Durable medical equipment certification" /> - <Segment name="CRC" max="3" required="n" comment="Ambulance certification" /> - <Segment name="CRC" max="1" required="n" comment="Hospice employee indicator" /> - <Segment name="CRC" max="1" required="n" comment="Condition indicator durable medical equipment" /> - <Segment name="DTP" max="1" required="y" comment="Date - service date; qualifier=472" /> - <Segment name="DTP" max="9" required="n" /> - <Segment name="QTY" max="1" required="n" comment="Ambulance patient count; qualifier=PT" /> - <Segment name="QTY" max="1" required="n" comment="Obstetric Anesthesia additional units; qualifier=FL" /> - <Segment name="MEA" max="5" required="n" comment="Test Results" /> - <Segment name="CN1" max="1" required="n" comment="Contract information" /> - <Segment name="REF" max="17" required="n" /> - <Segment name="AMT" max="2" required="n" /> - <Segment name="K3" max="10" required="n" comment="File information" /> - <Segment name="NTE" max="2" required="n" /> - <Segment name="PS1" max="1" required="n" comment="Purchasd service information" /> - <Segment name="HCP" max="1" required="n" comment="Line pricing/repricing information" /> - </Loop> - <Loop name="L2410" max="1" required="n" > - <Segment name="LIN" max="1" required="n" comment="Drug identification" /> - <Segment name="CTP" max="1" required="y" comment="Drug pricing" /> - <Segment name="REF" max="1" required="n" comment="Prescription or compound drug association number" /> - </Loop> - <Loop name="L2420A" max="1" required="n" > - <Segment name="NM1" max="1" required="n" comment="Rendering provider name" /> - <Segment name="PRV" max="1" required="n" comment="Rendering provider specialty information" /> - <Segment name="REF" max="20" required="n" comment="Rendering provider secondary id" /> - </Loop> - <Loop name="L2420B" max="1" required="n" > - <Segment name="NM1" max="1" required="n" comment="Purchased service provider name" /> - <Segment name="REF" max="20" required="n" comment="Purchased service provider secondary id" /> - </Loop> - <Loop name="L2420C" max="1" required="n" > - <Segment name="NM1" max="1" required="n" comment="Service facility location name" /> - <Segment name="N3" max="1" required="y" comment="Service facility location address" /> - <Segment name="N4" max="1" required="y" comment="Service facility location city/state/zip" /> - <Segment name="REF" max="3" required="n" comment="Service facility location secondary id" /> - </Loop> - <Loop name="L2420D" max="1" required="n"> - <Segment name="NM1" max="1" required="n" comment="Supervising provider name" /> - <Segment name="REF" max="20" required="n" comment="Supervising provider secondary id" /> - </Loop> - <Loop name="L2420E" required="n"> - <Segment name="NM1" max="1" required="n" comment="Ordering provider name" /> - <Segment name="N3" max="1" required="n" comment="Ordering provider address" /> - <Segment name="N4" max="1" required="y" comment="Ordering provider city/state/zip" /> - <Segment name="REF" max="20" required="n" comment="Ordering provider secondary id" /> - <Segment name="PER" max="1" required="n" comment="Ordering provider contact information" /> - </Loop> - <Loop name="L2420F" max="2" required="n"> - <Segment name="NM1" max="1" required="n" comment="Refering provider name" /> - <Segment name="REF" max="20" required="n" comment="Refering provider secondary id" /> - </Loop> - <Loop name="L2420G" max="1" required="n"> - <Segment name="NM1" max="1" required="n" comment="Ambulance pickup information" /> - <Segment name="N3" max="1" required="y" comment="Ambulance pickup address" /> - <Segment name="N4" max="1" required="y" comment="Ambulance pickup city/state/zip" /> - </Loop> - <Loop name="L2420H" max="1" required="n"> - <Segment name="NM1" max="1" required="n" comment="Ambulance dropoff information" /> - <Segment name="N3" max="1" required="y" comment="Ambulance dropoff address" /> - <Segment name="N4" max="1" required="y" comment="Ambulance dropoff city/state/zip" /> - </Loop> - <Loop name="L2430" max="15" required="n"> - <Segment name="SVD" max="1" required="n" comment="Line adjudication information" /> - <Segment name="CAS" max="5" required="n" comment="Line adjustment" /> - <Segment name="DTP" max="1" required="y" comment="Line check or remittance date" /> - <Segment name="AMT" max="1" required="n" comment="Remaining patient liability" /> - <Segment name="LQ" max="1" required="n" comment="Form identification code" /> - <Segment name="FRM" max="99" required="n" comment="Supporting documentation" /> - </Loop> - </Loop> + <Loop name="L2010BA" max="1" required="y"> + <Segment name="NM1" max="1" required="y" comment="Subscriber name"/> + <Segment name="N3" max="1" required="n" comment="Subscriber address"/> + <Segment name="N4" max="1" required="n" comment="Subscriber city/state/zip"/> + <Segment name="DMG" max="1" required="n" comment="Subscriber demographic information"/> + <Segment name="REF" max="2" required="n"/> + <Segment name="PER" max="1" required="n" comment="Property and casualty subscriber contact information"/> </Loop> + <Loop name="L2010BB" max="1" required="y"> + <Segment name="NM1" max="1" required="y" comment="Payer name"/> + <Segment name="N3" max="1" required="n" comment="Payer address"/> + <Segment name="N4" max="1" required="n" comment="Payer city/state/zip code"/> + <Segment name="REF" max="5" required="n" /> + </Loop> </Loop> + <Loop name="L2000C" required="n"> + <Segment name="HL" required="y" comment="Patient heirarchical level"/> + <Segment name="PAT" required="y" comment="Patient information"/> + <Loop name="L2010CA" max="1" required="n"> + <Segment name="NM1" max="1" required="y" comment="Patient name"/> + <Segment name="N3" max="1" required="y" comment="Patient address"/> + <Segment name="N4" max="1" required="y" comment="Patient city/state/zip"/> + <Segment name="DMG" max="1" required="y" comment="Patient demographic information"/> + <Segment name="REF" max="1" required="n" comment="Property and casualty claim number"/> + <Segment name="PER" max="1" required="n" comment="Property and casualty subscriber contact information"/> + </Loop> + </Loop> + <Loop name="L2300" max="100" required="y"> + <Segment name="CLM" max="1" required="y" comment="Claim information"/> + <Segment name="DTP" max="16" required="n" comment="Claim Dates. Up to 16 different dates can be set for a 837p" /> + <Segment name="PWK" max="10" required="n" comment="Claim supplemental information" /> + <Segment name="CN1" max="1" required="n" comment="Contract information" /> + <Segment name="AMT" max="1" required="n" comment="Patient amount paid" /> + <Segment name="REF" max="14" required="n" comment="Claim References. Up to 14 different claim references can be set for a 837p" /> + <Segment name="K3" max="10" required="n" comment="File information" /> + <Segment name="NTE" max="1" required="n" comment="Claim note" /> + <Segment name="CR1" max="1" required="n" comment="Ambulance transport information" /> + <Segment name="CR2" max="1" required="n" comment="Spinal manipulation service information" /> + <Segment name="CRC" max="8" required="n" comment="Code Category. Up to 8 different CRC categories can be set for an 837p" /> + <Segment name="HI" max="1" required="y" comment="Healthcare diagnostic code" /> + <Segment name="HI" max="1" required="n" comment="Anesthesia related procedure code" /> + <Segment name="HI" max="2" required="n" comment="Condition information" /> + <Segment name="HCP" max="1" required="n" comment="Claim pricing / repricing information" /> + + <Loop name="L2310A" max="1" required="n"> + <Segment name="NM1" max="1" required="y" comment="Referring provider name"/> + <Segment name="REF" max="3" required="n" comment="Referring provider secondary id"/> + </Loop> + <Loop name="L2310B" max="1" required="n"> + <Segment name="NM1" max="1" required="n" comment="Rendering provider name"/> + <Segment name="PRV" max="1" required="n" comment="Rendering provider specialty information"/> + <Segment name="REF" max="4" required="n" comment="Rendering provider secondary id"/> + </Loop> + <Loop name="L2310C" required="n"> + <Segment name="NM1" max="1" required="y" comment="Service facility location"/> + <Segment name="N3" max="1" required="y" comment="Service facility address"/> + <Segment name="N4" max="1" required="y" comment="Service facility city/state/zip"/> + <Segment name="REF" max="3" required="n" comment="Service facility location secondary id"/> + <Segment name="PER" max="1" required="n" comment="Service facility contact information"/> + </Loop> + <Loop name="L2310D" max="1" required="n"> + <Segment name="NM1" max="1" required="n" comment="Supervising provider name"/> + <Segment name="REF" max="4" required="n" comment="Supervising provider secondary id"/> + </Loop> + <Loop name="L2310E" max="1" required="n"> + <Segment name="NM1" max="1" required="y" comment="Ambulance pick up location"/> + <Segment name="N3" max="1" required="y" comment="Ambulance pick up address"/> + <Segment name="N4" max="1" required="y" comment="Ambulance pick up city/state/zip"/> + </Loop> + <Loop name="L2310F" max="1" required="n"> + <Segment name="NM1" max="1" required="y" comment="Ambulance dropoff location"/> + <Segment name="N3" max="1" required="y" comment="Ambulance dropoff address"/> + <Segment name="N4" max="1" required="y" comment="Ambulance dropoff city/state/zip"/> + </Loop> + <Loop name="L2320" max="10" required="n"> + <Segment name="SBR" max="1" required="n" comment="Other subscriber information" /> + <Segment name="CAS" max="5" required="n" comment="Claim level adjustment" /> + <Segment name="AMT" max="3" required="n" comment="Claim level adjustment amounts" /> + <Segment name="OI" max="1" required="y" comment="Other insurance coverage information" /> + <Segment name="MOA" max="1" required="n" comment="Medicare outpatient adjudication information" /> + </Loop> + <Loop name="L2330A" max="1" required="n"> + <Segment name="NM1" max="1" required="y" comment="Other subscriber name"/> + <Segment name="N3" max="1" required="n" comment="Other subscriber address"/> + <Segment name="N4" max="1" required="y" comment="Other subscriber city/state/zip"/> + <Segment name="REF" max="1" required="n" comment="Other subscriber location secondary id"/> + </Loop> + <Loop name="L2330B" max="1" required="n"> + <Segment name="NM1" max="1" required="y" comment="Other payer name" /> + <Segment name="N3" max="1" required="n" comment="Other payer address"/> + <Segment name="N4" max="1" required="y" comment="Other payer city/state/zip"/> + <Segment name="DTP" max="1" required="n" comment="Date - claim check or remittance date" /> + <Segment name="REF" max="6" required="n" comment="Other reference information. Up to 6 different references can be associated to an 837p" /> + </Loop> + <Loop name="L2330CDEFG" max="6" required="n" comment="Loops 2330C through 2330G combined for inbound transactions, application needs to determine the correct loop being provided."> + <Segment name="NM1" max="1" required="y" comment="Name" /> + <Segment name="REF" max="3" required="y" comment="Secondary id"/> + </Loop> + <Loop name="L2400" max="50" required="y"> + <Segment name="LX" max="1" required="y" comment="Service line" /> + <Segment name="SV1" max="1" required="y" comment="Professional service" /> + <Segment name="SV5" max="1" required="n" comment="Durable medical equipment service" /> + <Segment name="PWK" max="10" required="n" comment="Line supplemental informtion" /> + <Segment name="PWK" max="1" required="n" comment="Durable medical equipment certificate of medical necessity indicator" /> + <Segment name="CR1" max="1" required="n" comment="Ambulance transport information" /> + <Segment name="CR3" max="1" required="n" comment="Durable medical equipment certification" /> + <Segment name="CRC" max="3" required="n" comment="Ambulance certification" /> + <Segment name="CRC" max="1" required="n" comment="Hospice employee indicator" /> + <Segment name="CRC" max="1" required="n" comment="Condition indicator durable medical equipment" /> + <Segment name="DTP" max="1" required="y" comment="Date - service date; qualifier=472" /> + <Segment name="DTP" max="9" required="n" /> + <Segment name="QTY" max="1" required="n" comment="Ambulance patient count; qualifier=PT" /> + <Segment name="QTY" max="1" required="n" comment="Obstetric Anesthesia additional units; qualifier=FL" /> + <Segment name="MEA" max="5" required="n" comment="Test Results" /> + <Segment name="CN1" max="1" required="n" comment="Contract information" /> + <Segment name="REF" max="17" required="n" /> + <Segment name="AMT" max="2" required="n" /> + <Segment name="K3" max="10" required="n" comment="File information" /> + <Segment name="NTE" max="2" required="n" /> + <Segment name="PS1" max="1" required="n" comment="Purchasd service information" /> + <Segment name="HCP" max="1" required="n" comment="Line pricing/repricing information" /> + </Loop> + <Loop name="L2410" max="1" required="n" > + <Segment name="LIN" max="1" required="n" comment="Drug identification" /> + <Segment name="CTP" max="1" required="y" comment="Drug pricing" /> + <Segment name="REF" max="1" required="n" comment="Prescription or compound drug association number" /> + </Loop> + <Loop name="L2420A" max="1" required="n" > + <Segment name="NM1" max="1" required="n" comment="Rendering provider name" /> + <Segment name="PRV" max="1" required="n" comment="Rendering provider specialty information" /> + <Segment name="REF" max="20" required="n" comment="Rendering provider secondary id" /> + </Loop> + <Loop name="L2420B" max="1" required="n" > + <Segment name="NM1" max="1" required="n" comment="Purchased service provider name" /> + <Segment name="REF" max="20" required="n" comment="Purchased service provider secondary id" /> + </Loop> + <Loop name="L2420C" max="1" required="n" > + <Segment name="NM1" max="1" required="n" comment="Service facility location name" /> + <Segment name="N3" max="1" required="y" comment="Service facility location address" /> + <Segment name="N4" max="1" required="y" comment="Service facility location city/state/zip" /> + <Segment name="REF" max="3" required="n" comment="Service facility location secondary id" /> + </Loop> + <Loop name="L2420D" max="1" required="n"> + <Segment name="NM1" max="1" required="n" comment="Supervising provider name" /> + <Segment name="REF" max="20" required="n" comment="Supervising provider secondary id" /> + </Loop> + <Loop name="L2420E" required="n"> + <Segment name="NM1" max="1" required="n" comment="Ordering provider name" /> + <Segment name="N3" max="1" required="n" comment="Ordering provider address" /> + <Segment name="N4" max="1" required="y" comment="Ordering provider city/state/zip" /> + <Segment name="REF" max="20" required="n" comment="Ordering provider secondary id" /> + <Segment name="PER" max="1" required="n" comment="Ordering provider contact information" /> + </Loop> + <Loop name="L2420F" max="2" required="n"> + <Segment name="NM1" max="1" required="n" comment="Refering provider name" /> + <Segment name="REF" max="20" required="n" comment="Refering provider secondary id" /> + </Loop> + <Loop name="L2420G" max="1" required="n"> + <Segment name="NM1" max="1" required="n" comment="Ambulance pickup information" /> + <Segment name="N3" max="1" required="y" comment="Ambulance pickup address" /> + <Segment name="N4" max="1" required="y" comment="Ambulance pickup city/state/zip" /> + </Loop> + <Loop name="L2420H" max="1" required="n"> + <Segment name="NM1" max="1" required="n" comment="Ambulance dropoff information" /> + <Segment name="N3" max="1" required="y" comment="Ambulance dropoff address" /> + <Segment name="N4" max="1" required="y" comment="Ambulance dropoff city/state/zip" /> + </Loop> + <Loop name="L2430" max="15" required="n"> + <Segment name="SVD" max="1" required="n" comment="Line adjudication information" /> + <Segment name="CAS" max="5" required="n" comment="Line adjustment" /> + <Segment name="DTP" max="1" required="y" comment="Line check or remittance date" /> + <Segment name="AMT" max="1" required="n" comment="Remaining patient liability" /> + <Segment name="LQ" max="1" required="n" comment="Form identification code" /> + <Segment name="FRM" max="99" required="n" comment="Supporting documentation" /> + </Loop> + </Loop> <Segment name="SE" required="y" /> </Loop> <Segment name="GE" max="1" required="y"/> <Segment name="IEA" max="1" required="y"/> </Loop>