Roviyas: 270

Showing posts with label 270–5010. Show all posts

Friday, March 3, 2017

EDI 270–5010 Documentation–2000B Information Receiver Level

The information receiver is the entity who is asking the questions in a 270 Eligibility or Benefit transaction. The information receiver is typically the medical service provider (e.g., physician, hospital, laboratory, etc.).

Loop	Seg ID	Segment Name	Format	Length	Ref#	Req	Value
2000B	HL	Billing Hierarchical Level		2		R	HL
		Element Separator	AN	1			*
	HL01	Hierarchical ID Number	AN	1/12	628	R	2
		Element Separator	AN	1			*
	HL02	Hierarchical Parent ID Number	0	1/12	734		1
		Element Separator		1			*
	HL03	Hierarchical Level Code	ID	1/2	735	R	21
		Element Separator		1			*
	HL04	Hierarchical Child Code	ID	1/1	736	R	1
		Segment Terminator					~

Sample:
HL*2*1*21*1~

Segment Structure

Questions or feedback are always welcome. You can email me at vbsenthilinnet@gmail.com

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EDI 270–5010 Documentation GS – Functional Group Header

GS – Functional Group Header

Loop	Seg ID	Segment Name	Format	Length	Ref#	Req	Value
Header	GS	Functional Group Header		2		R	GS
		Element Separator	AN	1			*
	GS01	Functional Identifier Code	ID	2/2	479	R	HC
		Element Separator	AN	1			*
	GS02	Application Sender’s Code	AN	2/15	142	R	Same as IS06
		Element Separator	AN	1			*
	GS03	Application Receiver’s ode	AN	2/15	124	R	Same as ISA08
		Element Separator	AN	1			*
	GS04	Date	DT	8/8	373	R	Current date in YYYYMMDDD format
		Element Separator	AN	1			*
	GS05	Time	TM	4/8	337	R	Print time in HHMM Format
		Element Separator	AN	1			*
	GS06	Group Control Number	NO	1/9	28	R	See below for more information
		Element Separator	AN	1			*
	GS07	Responsible Agency Code	ID	1/2	455	R	x
		Element Separator	AN	1			*
	GS08	Version/Release/ No	AN	1/12	480	R	005010X279A1
		Segment Terminator					~

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Sample:

GS*HS*XX09211223*030240928*20130829*1102*1*X*005010X279A1~

------------------------------------------------------------------------------------------------------------------

GS06 – Group Control Number

Just for tracking purpose, Software should generate unique EDI File Batch Number.

Questions or feedback are always welcome. You can email me at vbsenthilinnet@gmail.com

Available link for download

EDI 270–5010 Documentation–2000A Hierarchical Level

HL – Hierarchical Level

Use the Billing Provider HL to identify the original entity who submitted the electronic claim/encounter to the destination payer

Hierarchical ID Number
A unique number assigned by the sender to identify a particular data segment in a hierarchical structure.
HL01 shall contain a unique alphanumeric number for each occurrence of the HL segment in the transaction set. For example, HL01 could be used to indicate the number of occurrences of the HL segment, in which case the value of HL01 would be “1" for the initial HL segment and would be incremented by one in each subsequent HL segment within the transaction.

HL01 must begin with “1" and be incremented by one each time an HL is used in the transaction. Only numeric values are allowed in HL01.

Loop	Seg ID	Segment Name	Format	Length	Ref#	Req	Value
2000A	HL	Billing Hierarchical Level		2		R	HL
		Element Separator	AN	1			*
	HL01	Hierarchical ID Number	AN	1/12	628	R	See above for information
		Element Separator	AN	1			*
	HL02	Hierarchical Parent ID Number	0	1/12	734	Not Used
		Element Separator		1			*
	HL03	Hierarchical Level Code	ID	1/2	735	R	20
		Element Separator		1			*
	HL04	Hierarchical Child Code	ID	1/1	736	R	1
		Segment Terminator					~

Sample:
HL*1**20*1~

Segment Structure

Questions or feedback are always welcome. You can email me at vbsenthilinnet@gmail.com

Available link for download

EDI 270–5010 Documentation–2100A Information Source Name

2100A Information Source Name

The information source is the entity who has the answer to the questions being asked in a 270 Eligibility or Benefit transaction. The information source is typically the insurer, or payer.

Use this segment to identify an entity by name and/or identification number. This NM1 loop is used to identify the eligibility or benefit information source (e.g., insurance company, HMO, IPA, employer).

Now let’s start the detail implementation.

Loop	Seg ID	Segment Name	Format	Length	Ref#	Req	Value
Header	NM1	Payer Name	ID	3		R	NM1
		Element Separator	AN	1			*
	NM101	Entity Identifier Code	ID	2/3	98	R	PR
		Element Separator	AN	1			*
	NM102	Entity Type qualifier	ID	1/1	1065	R	2 (See below for more Information)
		Element Separator	AN	1			*
	NM103	Name Last or Organization Name	AN	1/60	1035	R	Insurance Name
		Element Separator	AN	1			*
	NM104	Name First	AN	1/35	1036	Not used
		Element Separator	AN	1			*
	NM105	Name Middle	AN	1/25	1037	Not Used
		Element Separator	AN	1			*
	NM106	Name Prefix	AN	1/10	1038	Not used
		Element Separator	AN	1			*
	NM107	Name Suffix	AN	1/10	1039	Not Used
		Element Separator	AN	1			*
	NM108	Identification code Qualifier	ID	1/2	66	R	PI
		Element Separator	AN	1			*
	NM109	Identification code	AN	2/80	67	R	Payer ID
		Segment Terminator					~

NM102 - Entity Type Qualifier

Code qualifying the type of entity

Code	Definition
1	Person
2	Non-Person Entity

Sample
NM1*PR*2*FLORIDA BLUE*****PI*BCBSF~

Segment Structure

Questions or feedback are always welcome. You can email me at Available link for download

EDI 270–5010 Documentation– Loop 2100C SUBSCRIBER Name

2100C Subscriber Name

Use this segment to identify an entity by name and/or identification number. Use this NM1 loop to identify the insured or subscriber

Loop	Seg ID	Segment Name	Format	Length	Ref#	Req	Value
2100C	NM1	Subscriber Name	ID	3		R	NM1
		Element Separator	AN	1			*
	NM101	Entity Identifier Code	ID	2/3	98	R	IL
		Element Separator	AN	1			*
	NM102	Entity Type qualifier	ID	1/1	1065	R	1
		Element Separator	AN	1			*
	NM103	Name Last or Organization Name	AN	1/60	1035	R	Insured Person Last Name
		Element Separator	AN	1			*
	NM104	Name First	AN	1/35	1036	S	Insured Person First Name
		Element Separator	AN	1			*
	NM105	Name Middle	AN	1/25	1037	S	Insured Person Middle Name
		Element Separator	AN	1			*
	NM106	Name Prefix	AN	1/10	1038	Not used
		Element Separator	AN	1			*
	NM107	Name Suffix	AN	1/10	1039	S	Insured Person Suffix
		Element Separator	AN	1			*
	NM108	Identification code Qualifier	ID	1/2	66	R	MI
		Element Separator	AN	1			*
	NM109	Identification code	AN	2/80	67	R	Insured Policy No
		Segment Terminator					~

NM102 - Entity Type Qualifier

Code qualifying the type of entity

Code	Definition
1	Person
2	Non-Person Entity

Sample
NM1*IL*1*MULLIN*DANIEL****MI*XJBH12345678~

Segment Structure

SUBSCRIBER DEMOGRAPHIC INFORMATION

Use this segment to convey the birth date or gender demographic information for the subscriber. Use this segment only if the subscriber is the patient and if this information is available from the Information Source’s database.

Available link for download

Roviyas

Friday, March 3, 2017

EDI 270–5010 Documentation–2000B Information Receiver Level

EDI 270–5010 Documentation–2000B Information Receiver Level

Tuesday, February 28, 2017

EDI 270–5010 Documentation GS – Functional Group Header

EDI 270–5010 Documentation GS – Functional Group Header

GS – Functional Group Header

Monday, February 27, 2017

EDI 270–5010 Documentation–2000A Hierarchical Level

EDI 270–5010 Documentation–2000A Hierarchical Level

Sunday, February 26, 2017

EDI 270–5010 Documentation–2100A Information Source Name

EDI 270–5010 Documentation–2100A Information Source Name

Saturday, February 25, 2017

EDI 270–5010 Documentation– Loop 2100C SUBSCRIBER Name

EDI 270–5010 Documentation– Loop 2100C SUBSCRIBER Name