Module: Stupidedi::TransactionSets::FiftyTen::Implementations::X222A1
- Defined in:
- lib/stupidedi/transaction_sets/005010/implementations.rb,
lib/stupidedi/transaction_sets/005010/implementations/X222A1-HC837.rb,
lib/stupidedi/transaction_sets/005010/implementations/X222A1-HC837P.rb
Constant Summary collapse
- HC837 =
b.build("HC", "837", "", d::TableDef.header("1 - Header", b::Segment(50, s::ST, "Transaction Set Header", r::Required, d::RepeatCount.bounded(1), b::Element(e::Required, "Transaction Set Identifier Code", b::Values("837")), b::Element(e::Required, "Transaction Set Control Number"), b::Element(e::Required, "Implementation Guide Version Name", b::Values("005010X222A1"))), b::Segment(100, s::BHT, "Beginning of Hierarchical Transaction", r::Required, d::RepeatCount.bounded(1), b::Element(e::Required, "Hierarchical Structure Code", b::Values("0019")), b::Element(e::Required, "Transaction Set Purpose Code", b::Values("00", "18")), b::Element(e::Required, "Originator Application Transaction Identifier", b::MaxLength(30)), b::Element(e::Required, "Transaction Set Creation Date"), b::Element(e::Required, "Transaction Set Creation Time"), b::Element(e::Required, "Claim or Encounter Identifier", b::Values("31", "CH", "RP"))), d::LoopDef.build("1000A SUBMITTER NAME", d::RepeatCount.bounded(1), b::Segment(200, s::NM1, "Submitter Name", r::Required, d::RepeatCount.bounded(1), b::Element(e::Required, "Entity Identifier Code", b::Values("41")), b::Element(e::Required, "Entity Type Qualifier", b::Values("1", "2")), b::Element(e::Required, "Submitter Last or Organization Name"), b::Element(e::Situational, "Submitter First Name"), b::Element(e::Situational, "Submitter Middle Name or Initial"), b::Element(e::NotUsed, "Name Prefix"), b::Element(e::NotUsed, "Name Suffix"), b::Element(e::Required, "Identification Qualifier Code", b::Values("46")), b::Element(e::Required, "Submitter Identifier"), b::Element(e::NotUsed, "Entity Relationship Code"), b::Element(e::NotUsed, "Entity Identifier Code"), b::Element(e::NotUsed, "Name Last or Organization Name")), b::Segment(450, s::PER, "Submitter EDI Contact Information", r::Required, d::RepeatCount.bounded(2), b::Element(e::Required, "Contact Function Code", b::Values("IC")), b::Element(e::Situational, "Submitter Contact Name"), b::Element(e::Required, "Communication Number Qualifier", b::Values("EM", "FX", "TE")), b::Element(e::Required, "Communication Number"), b::Element(e::Situational, "Communication Number Qualifier", b::Values("EM", "EX", "FX", "TE")), b::Element(e::Situational, "Communication Number"), b::Element(e::Situational, "Communication Number Qualifier", b::Values("EM", "EX", "FX", "TE")), b::Element(e::Situational, "Communication Number"), b::Element(e::NotUsed, "Contact Inquiry Reference"))), d::LoopDef.build("1000B RECEIVER NAME", d::RepeatCount.bounded(1), b::Segment(200, s::NM1, "Receiver Name", r::Required, d::RepeatCount.bounded(1), b::Element(e::Required, "Entity Identifier Code", b::Values("40")), b::Element(e::Required, "Entity Type Qualifier", b::Values("2")), b::Element(e::Required, "Receiver Name"), b::Element(e::NotUsed, "Name First"), b::Element(e::NotUsed, "Name Last"), b::Element(e::NotUsed, "Name Prefix"), b::Element(e::NotUsed, "Name Suffix"), b::Element(e::Required, "Identification Code Qualifier", b::Values("46")), b::Element(e::Required, "Receiver Primary Identifier"), b::Element(e::NotUsed, "Entity Relationship Code"), b::Element(e::NotUsed, "Entity Identifier Code"), b::Element(e::NotUsed, "Name Last or Organization Name")))), d::TableDef.detail("2 - Billing Provider Detail", d::LoopDef.build("2000A BILLING PROVIDER HIERARCHICAL LEVEL", d::RepeatCount.unbounded, b::Segment(10, s::HL, "Billing Provider Hierarchical Level", r::Required, d::RepeatCount.bounded(1), b::Element(e::Required, "Hierarchical ID Number"), b::Element(e::NotUsed, "Hierarchical Parent ID Number"), b::Element(e::Required, "Hierarchical Level Code", b::Values("20")), b::Element(e::Required, "Hierachical Child Code")), b::Segment(30, s::PRV, "Billing Provider Specialty Information", r::Situational, d::RepeatCount.bounded(1), b::Element(e::Required, "Provider Code", b::Values("BI")), b::Element(e::Required, "Reference Identification Number", b::Values("PXC")), b::Element(e::Required, "Provider Taxonomy Code"), b::Element(e::NotUsed, "State or Province Code"), b::Element(e::NotUsed, "PROVIDER SPECIALTY INFORMATION"), b::Element(e::NotUsed, "Provider Organization Code")), b::Segment(100, s::CUR, "Foreign Currency Information", r::Situational, d::RepeatCount.bounded(1), b::Element(e::Required, "Entity Identifier Code", b::Values("85")), b::Element(e::Required, "Currency Code"), b::Element(e::NotUsed, "Exchange Rate"), b::Element(e::NotUsed, "Entity Identifier Code"), b::Element(e::NotUsed, "Currency Code"), b::Element(e::NotUsed, "Currency Market/Exchange Code"), b::Element(e::NotUsed, "Date/Time Qualifier"), b::Element(e::NotUsed, "Date"), b::Element(e::NotUsed, "Time"), b::Element(e::NotUsed, "Date/Time Qualifier"), b::Element(e::NotUsed, "Date"), b::Element(e::NotUsed, "Time"), b::Element(e::NotUsed, "Date/Time Qualifier"), b::Element(e::NotUsed, "Date"), b::Element(e::NotUsed, "Time"), b::Element(e::NotUsed, "Date/Time Qualifier"), b::Element(e::NotUsed, "Date"), b::Element(e::NotUsed, "Time"), b::Element(e::NotUsed, "Date/Time Qualifier"), b::Element(e::NotUsed, "Date"), b::Element(e::NotUsed, "Time")), d::LoopDef.build("2010AA BILLING PROVIDER NAME", d::RepeatCount.bounded(1), b::Segment(150, s::NM1, "Billing Provider Name", r::Required, d::RepeatCount.bounded(1), b::Element(e::Required, "Entity Identifier Code", b::Values("85")), b::Element(e::Required, "Entity Type Qualifier", b::Values("1", "2")), b::Element(e::Required, "Billing Provider Last or Organizational Name"), b::Element(e::Situational, "Billing Provider First Name"), b::Element(e::Situational, "Billing Provider Middle Name or Initial"), b::Element(e::NotUsed, "Name Prefix"), b::Element(e::Situational, "Billing Provider Name Suffix"), b::Element(e::Situational, "Identification Code Qualifier", b::Values("XX")), b::Element(e::Situational, "Billing Provider Identifier"), b::Element(e::NotUsed, "Entity Relationship Code"), b::Element(e::NotUsed, "Entity Identifier Code"), b::Element(e::NotUsed, "Name Last or Organization Name")), b::Segment(250, s::N3, "Billing Provider Address", r::Required, d::RepeatCount.bounded(1), b::Element(e::Required, "Billing Provider Address Line"), b::Element(e::Situational, "Billing Provider Address Line")), b::Segment(300, s::N4, "Billing Provider City, State, ZIP Code", r::Required, d::RepeatCount.bounded(1), b::Element(e::Required, "Billing Provider City Name"), b::Element(e::Situational, "Billing Provider State or Province Code"), b::Element(e::Situational, "Billing Provider Postal Zone or ZIP Code"), b::Element(e::Situational, "Country Code"), b::Element(e::NotUsed, "Location Qualifier"), b::Element(e::NotUsed, "Location Identifier"), b::Element(e::Situational, "Country Subdivision Code")), b::Segment(350, s::REF, "Billing Provider Tax Identification", r::Required, d::RepeatCount.bounded(1), b::Element(e::Required, "Reference Identification Qualifier", b::Values("EI", "SY")), b::Element(e::Required, "Billing Provider Tax Identification Number"), b::Element(e::NotUsed, "Description"), b::Element(e::NotUsed, "REFERENCE IDENTIFIER")), b::Segment(350, s::REF, "Billing Provider UPIN/License Information", r::Situational, d::RepeatCount.bounded(2), b::Element(e::Required, "Reference Identification Qualifier", b::Values("0B", "1G")), b::Element(e::Required, "Billing Provider License and/or UPIN Information"), b::Element(e::NotUsed, "Description"), b::Element(e::NotUsed, "REFERENCE IDENTIFIER")), b::Segment(400, s::PER, "Billing Provider Contact Information", r::Situational, d::RepeatCount.bounded(2), b::Element(e::Required, "Contact Function Code", b::Values("IC")), b::Element(e::Situational, "Billing Provider Contact Name"), b::Element(e::Required, "Communication Number Qualifier", b::Values("EM", "FX", "TE")), b::Element(e::Required, "Communication Number"), b::Element(e::Situational, "Communication Number Qualifier", b::Values("EM", "EX", "FX", "TE")), b::Element(e::Situational, "Communication Number"), b::Element(e::Situational, "Communication Number Qualifier", b::Values("EM", "EX", "FX", "TE")), b::Element(e::Situational, "Communication Number"), b::Element(e::NotUsed, "Contact Inquiry Reference"))), d::LoopDef.build("2010AB PAY-TO ADDRESS NAME", d::RepeatCount.bounded(1), b::Segment(150, s::NM1, "Pay-to Address Name", r::Situational, d::RepeatCount.bounded(1), b::Element(e::Required, "Entity Identifier Code", b::Values("87")), b::Element(e::Required, "Entity Type Qualifier", b::Values("1", "2")), b::Element(e::NotUsed, "Name Last or Organizational Name"), b::Element(e::NotUsed, "Name First"), b::Element(e::NotUsed, "Name Middle"), b::Element(e::NotUsed, "Name Prefix"), b::Element(e::NotUsed, "Name Suffix"), b::Element(e::NotUsed, "Identification Code Qualifier"), b::Element(e::NotUsed, "Identifier Code"), b::Element(e::NotUsed, "Entity Relationship Code"), b::Element(e::NotUsed, "Entity Identifier Code"), b::Element(e::NotUsed, "Name Last or Organization Name")), b::Segment(250, s::N3, "Pay-to Address - ADDRESS", r::Required, d::RepeatCount.bounded(1), b::Element(e::Required, "Pay-To Address Line"), b::Element(e::Situational, "Pay-To Address Line")), b::Segment(300, s::N4, "Pay-To Address City, State, ZIP Code", r::Required, d::RepeatCount.bounded(1), b::Element(e::Required, "Pay-to City Name"), b::Element(e::Situational, "Pay-to State or Province Code"), b::Element(e::Situational, "Pay-to Postal Zone or ZIP Code"), b::Element(e::Situational, "Country Code"), b::Element(e::NotUsed, "Location Qualifier"), b::Element(e::NotUsed, "Location Identifier"), b::Element(e::Situational, "Country Subdivision Code"))), d::LoopDef.build("2010AC PAY-TO PLAN NAME", d::RepeatCount.bounded(1), b::Segment(150, s::NM1, "Pay-To Plan Name", r::Situational, d::RepeatCount.bounded(1), b::Element(e::Required, "Entity Identifier Code", b::Values("PE")), b::Element(e::Required, "Entity Type Qualifier", b::Values("2")), b::Element(e::Required, "Pay-To Plan Organizational Name"), b::Element(e::NotUsed, "Name First"), b::Element(e::NotUsed, "Name Middle"), b::Element(e::NotUsed, "Name Prefix"), b::Element(e::NotUsed, "Name Suffix"), b::Element(e::Required, "Identification Code Qualifier", b::Values("PI", "XV")), b::Element(e::Required, "Pay-To Plan Primary Identifier"), b::Element(e::NotUsed, "Entity Relationship Code"), b::Element(e::NotUsed, "Entity Identifier Code"), b::Element(e::NotUsed, "Name Last or Organization Name")), b::Segment(250, s::N3, "Pay-to Plan Address", r::Required, d::RepeatCount.bounded(1), b::Element(e::Required, "Pay-To Plan Address Line"), b::Element(e::Situational, "Pay-To Plan Address Line")), b::Segment(300, s::N4, "Pay-To Plan City, State, ZIP Code", r::Required, d::RepeatCount.bounded(1), b::Element(e::Required, "Pay-to Plan City Name"), b::Element(e::Situational, "Pay-to Plan State or Province Code"), b::Element(e::Situational, "Pay-to Plan Postal Zone or ZIP Code"), b::Element(e::Situational, "Country Code"), b::Element(e::NotUsed, "Location Qualifier"), b::Element(e::NotUsed, "Location Identifier"), b::Element(e::Situational, "Country Subdivision Code")), b::Segment(350, s::REF, "Pay-to Plan Secondary Identification", r::Situational, d::RepeatCount.bounded(1), b::Element(e::Required, "Reference Identification Qualifier", b::Values("2U", "FY", "NF")), b::Element(e::Required, "Pay-to Plan Secondary Identifier"), b::Element(e::NotUsed, "Description"), b::Element(e::NotUsed, "REFERENCE IDENTIFIER")), b::Segment(350, s::REF, "Pay-to Plan Tax Identification Number", r::Required, d::RepeatCount.bounded(1), b::Element(e::Required, "Reference Identification Qualifier", b::Values("EI")), b::Element(e::Required, "Pay-to Plan Tax Identification Number"), b::Element(e::NotUsed, "Description"), b::Element(e::NotUsed, "REFERENCE IDENTIFIER"))))), d::TableDef.detail("2 - Subscriber Detail", d::LoopDef.build("2000B SUBSCRIBER HIERARCHICAL LEVEL", d::RepeatCount.unbounded, b::Segment(10, s::HL, "Subscriber Hierarchical Level", r::Required, d::RepeatCount.bounded(1), b::Element(e::Required, "Hierarchical ID Number"), b::Element(e::Required, "Hierarchical Parent ID Number"), b::Element(e::Required, "Hierarchical Level Code", b::Values("22")), b::Element(e::Required, "Hierachical Child values", b::Values("0", "1"))), b::Segment(50, s::SBR, "Subscriber Information", r::Situational, d::RepeatCount.bounded(1), b::Element(e::Required, "Payer Responsibility Sequence Number", b::Values("A", "B", "C", "D", "E", "F", "G", "H", "P", "S", "T", "U")), b::Element(e::Situational, "Individual Relationship Code", b::Values("18")), b::Element(e::Situational, "Subscriber Group or Policy Number"), b::Element(e::Situational, "Subscriber Group Name"), b::Element(e::Situational, "Insurance Type Code", b::Values("12", "13", "14", "15", "16", "41", "42", "43", "47")), b::Element(e::NotUsed, "Coordination of Benefits Code"), b::Element(e::NotUsed, "Yes/No Condition or Response Code"), b::Element(e::NotUsed, "Employment Status Code"), b::Element(e::Situational, "Claim Filing Indicator Code", b::Values("11", "12", "13", "14", "15", "16", "17", "AM", "BL", "CH", "CI", "DS", "FI", "HM", "LM", "MA", "MB", "MC", "OF", "TV", "VA", "WC", "ZZ"))), b::Segment(70, s::PAT, "Patient Information", r::Situational, d::RepeatCount.bounded(1), b::Element(e::NotUsed, "Individual Relationship Code"), b::Element(e::NotUsed, "Patient Location Code"), b::Element(e::NotUsed, "Employment Status Code"), b::Element(e::NotUsed, "Student Status Code"), b::Element(e::Situational, "Date Time Period Format Qualifier", b::Values("D8")), b::Element(e::Situational, "Patient Death Date"), b::Element(e::Situational, "Unit or Basis for Measurement Code", b::Values("01")), b::Element(e::Situational, "Patient Weight"), b::Element(e::Situational, "Pregnancy Indicator", b::Values("Y"))), d::LoopDef.build("2010BA SUBSCRIBER NAME", d::RepeatCount.bounded(1), b::Segment(150, s::NM1, "Subscriber Name", r::Required, d::RepeatCount.bounded(1), b::Element(e::Required, "Entity Identifier Code", b::Values("IL")), b::Element(e::Required, "Entity Type Qualifier", b::Values("1", "2")), b::Element(e::Situational, "Subscriber Last Name"), b::Element(e::Situational, "Subscriber First Name"), b::Element(e::Situational, "Subscriber Middle Name or Initial"), b::Element(e::NotUsed, "Name Prefix"), b::Element(e::Situational, "Subscriber Name Suffix"), b::Element(e::Situational, "Identification Code Qualifier", b::Values("II", "MI")), b::Element(e::Situational, "Subscriber Primary Identifier"), b::Element(e::NotUsed, "Entity Relationship Code"), b::Element(e::NotUsed, "Entity Identifier Code"), b::Element(e::NotUsed, "Name Last or Organization Name")), b::Segment(250, s::N3, "Subscriber Address", r::Situational, d::RepeatCount.bounded(1), b::Element(e::Required, "Subscriber Address Line"), b::Element(e::Situational, "Subscriber Address Line")), b::Segment(300, s::N4, "Subscriber City, State, ZIP Code", r::Situational, d::RepeatCount.bounded(1), b::Element(e::Required, "Subscriber City Name"), b::Element(e::Situational, "Subscriber State Code"), b::Element(e::Situational, "Subscriber Postal Zone or ZIP Code"), b::Element(e::Situational, "Country Code"), b::Element(e::NotUsed, "Location Qualifier"), b::Element(e::NotUsed, "Location Identifier"), b::Element(e::Situational, "Country Subdivision Code")), b::Segment(320, s::DMG, "Subscriber Demographic Information", r::Situational, d::RepeatCount.bounded(1), b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")), b::Element(e::Required, "Subscriber Birth Date"), b::Element(e::Required, "Subscriber Gender Code", b::Values("F", "M", "U")), b::Element(e::NotUsed, "Marital Status Code"), b::Element(e::NotUsed, "COMPOSITE RACE OR ETHNICITY INFORMATION"), b::Element(e::NotUsed, "Citizenship Status Code"), b::Element(e::NotUsed, "Country Code"), b::Element(e::NotUsed, "Basis of Verification Code"), b::Element(e::NotUsed, "Quantity"), b::Element(e::NotUsed, "Code List Qualifier Code"), b::Element(e::NotUsed, "Industry Code")), b::Segment(350, s::REF, "Subscriber Secondary Identification", r::Situational, d::RepeatCount.bounded(1), b::Element(e::Required, "Reference Identification Qualifier", b::Values("SY")), b::Element(e::Required, "Subscriber Supplemental Identifier"), b::Element(e::NotUsed, "Description"), b::Element(e::NotUsed, "REFERENCE IDENTIFIER")), b::Segment(350, s::REF, "Property and Casualty Claim Number", r::Situational, d::RepeatCount.bounded(1), b::Element(e::Required, "Reference Identification Qualifier", b::Values("Y4")), b::Element(e::Required, "Property Casualty Claim Number"), b::Element(e::NotUsed, "Description"), b::Element(e::NotUsed, "REFERENCE IDENTIFIER")), b::Segment(400, s::PER, "Property and Casualty Subscriber Contact Information", r::Situational, d::RepeatCount.bounded(1), b::Element(e::Required, "Contact Fuction Code", b::Values("IC")), b::Element(e::Situational, "Name"), b::Element(e::Required, "Communication Qualifier Number", b::Values("TE")), b::Element(e::Required, "Communication Number"), b::Element(e::Situational, "Communication Qualifier Number", b::Values("TE", "EX")), b::Element(e::Situational, "Communication Number"), b::Element(e::NotUsed, "Communication Qualifier Number"), b::Element(e::NotUsed, "Communication Number"), b::Element(e::NotUsed, "Contact Inquiry Reference"))), d::LoopDef.build("2010BB PAYER NAME", d::RepeatCount.bounded(10), b::Segment(150, s::NM1, "Payer Name", r::Required, d::RepeatCount.bounded(1), b::Element(e::Required, "Entity Identifier Code", b::Values("PR")), b::Element(e::Required, "Entity Type Qualifier", b::Values("2")), b::Element(e::Required, "Payer Name"), b::Element(e::NotUsed, "Name Last"), b::Element(e::NotUsed, "Name Middle"), b::Element(e::NotUsed, "Name Prefix"), b::Element(e::NotUsed, "Name Suffix"), b::Element(e::Required, "Identification Code Qualifier", b::Values("PI", "XV")), b::Element(e::Required, "Payer Identification"), b::Element(e::NotUsed, "Entity Relationship Code"), b::Element(e::NotUsed, "Entity Identifier Code"), b::Element(e::NotUsed, "Name Last or Organization Name")), b::Segment(250, s::N3, "Payer Address", r::Situational, d::RepeatCount.bounded(2), b::Element(e::Required, "Payer Address Line"), b::Element(e::Situational, "Payer Address Line")), b::Segment(300, s::N4, "Payer City, State, ZIP Code", r::Situational, d::RepeatCount.bounded(1), b::Element(e::Required, "Payer City Name"), b::Element(e::Situational, "Payer State or Province Code"), b::Element(e::Situational, "Payer Postal Zone or ZIP Code"), b::Element(e::Situational, "Country Code"), b::Element(e::NotUsed, "Location Qualifier"), b::Element(e::NotUsed, "Location Identifier"), b::Element(e::Situational, "Country Subdivision Code")), b::Segment(350, s::REF, "Payer Secondary Identification", r::Situational, d::RepeatCount.bounded(3), b::Element(e::Required, "Reference Identification Qualifier", b::Values("2U", "EI", "FY", "NF")), b::Element(e::Required, "Payer Secondary Identifier"), b::Element(e::NotUsed, "Description"), b::Element(e::NotUsed, "REFERENCE IDENTIFIER")), b::Segment(350, s::REF, "Billing Provider Secondary Identification", r::Situational, d::RepeatCount.bounded(2), b::Element(e::Required, "Reference Identification Qualifier", b::Values("G2", "LU")), b::Element(e::Required, "Billing Provider Secondary Identifier"), b::Element(e::NotUsed, "Description"), b::Element(e::NotUsed, "REFERENCE IDENTIFIER"))), loop2300)), d::TableDef.detail("2 - Patient Detail", d::LoopDef.build("2000C PATIENT HIERARCHICAL LEVEL", d::RepeatCount.unbounded, b::Segment(10, s::HL, "Patient Hierachical Level", r::Situational, d::RepeatCount.bounded(1), b::Element(e::Required, "Hierarchical ID Number"), b::Element(e::Required, "Hierarchical Parent ID Number"), b::Element(e::Required, "Hierarchical Level Code", b::Values("23")), b::Element(e::Required, "Hierarchical Child Code", b::Values("0"))), b::Segment(70, s::PAT, "Patient Information", r::Required, d::RepeatCount.bounded(1), b::Element(e::Required, "Individual Relationship Code", b::Values("01", "19", "20", "21", "39", "40", "53", "G8")), b::Element(e::NotUsed, "Patient Location Code"), b::Element(e::NotUsed, "Employment Status Code"), b::Element(e::NotUsed, "Student Status Code"), b::Element(e::Situational, "Date Time Period Format Qualifier"), b::Element(e::Situational, "Patient Death Date"), b::Element(e::Situational, "Unit Basis for Measurement Code", b::Values("01")), b::Element(e::Situational, "Patient Weight"), b::Element(e::Situational, "Pregnancy Indicator", b::Values("Y"))), d::LoopDef.build("2010CA PATIENT NAME", d::RepeatCount.bounded(1), b::Segment(150, s::NM1, "Patient Name", r::Required, d::RepeatCount.bounded(1), b::Element(e::Required, "Entity Qualifier Code", b::Values("QC")), b::Element(e::Required, "Entity Type Qualifier", b::Values("1")), b::Element(e::Required, "Patient Last Name"), b::Element(e::Situational, "Patient First Name"), b::Element(e::Situational, "Patient Middle Name or Initial"), b::Element(e::NotUsed, "Name Prefix"), b::Element(e::Situational, "Patient Name Suffix"), b::Element(e::NotUsed, "Identification Code Qualifier"), b::Element(e::NotUsed, "Identification Code"), b::Element(e::NotUsed, "Entity Relationship Code"), b::Element(e::NotUsed, "Entity Identification Code"), b::Element(e::NotUsed, "Name Last or Organization Name")), b::Segment(250, s::N3, "Patient Address", r::Required, d::RepeatCount.bounded(1), b::Element(e::Required, "Patient Address Line"), b::Element(e::Situational, "Patient Address Line")), b::Segment(300, s::N4, "Patient City, State, ZIP Code", r::Required, d::RepeatCount.bounded(1), b::Element(e::Required, "Patient City Name"), b::Element(e::Situational, "Patient State Code"), b::Element(e::Situational, "Patient Postal Zone or ZIP Code"), b::Element(e::Situational, "Country Code"), b::Element(e::NotUsed, "Location Qualifier"), b::Element(e::NotUsed, "Location Identifier"), b::Element(e::Situational, "Country Subdivision Code")), b::Segment(320, s::DMG, "Patient Demographic Information", r::Required, d::RepeatCount.bounded(1), b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")), b::Element(e::Required, "Patient Birth Date"), b::Element(e::Required, "Patient Gender Code", b::Values("F", "M", "U")), b::Element(e::NotUsed, "Marital Status Code"), b::Element(e::NotUsed, "COMPOSITE RACE OR ETHNICITY INFORMATION"), b::Element(e::NotUsed, "Citizenship Status Code"), b::Element(e::NotUsed, "Country Code"), b::Element(e::NotUsed, "Basis of Verification Code"), b::Element(e::NotUsed, "Quantity"), b::Element(e::NotUsed, "Code List Qualifier Code"), b::Element(e::NotUsed, "Industry Code")), b::Segment(350, s::REF, "Property and Casualty Claim Number", r::Situational, d::RepeatCount.bounded(1), b::Element(e::Required, "Reference Identifier Qualifier", b::Values("Y4")), b::Element(e::Required, "Property Casualty Claim Number"), b::Element(e::NotUsed, "Description"), b::Element(e::NotUsed, "REFERENCE IDENTIFIER")), b::Segment(350, s::REF, "Property and Casualty Patient Identifier", r::Situational, d::RepeatCount.bounded(1), b::Element(e::Required, "Reference Identifier Qualifier", b::Values("1W", "SY")), b::Element(e::Required, "Property Casualty Patient Identifier"), b::Element(e::NotUsed, "Description"), b::Element(e::NotUsed, "REFERENCE IDENTIFIER")), b::Segment(400, s::PER, "Property and Casualty Patient Contact Information", r::Situational, d::RepeatCount.bounded(1), b::Element(e::Required, "Contact Function Code", b::Values("IC")), b::Element(e::Situational, "Name"), b::Element(e::Required, "Communication Number Qualifier", b::Values("TE")), b::Element(e::Required, "Communication Number"), b::Element(e::Situational, "Communication Number Qualifier", b::Values("EX")), b::Element(e::Situational, "Communication Number"), b::Element(e::NotUsed, "Communication Number Qualifier"), b::Element(e::NotUsed, "Communication Number"), b::Element(e::NotUsed, "Contact Inquiry Reference"))), loop2300)), # This structure doesn't match the specification, but it does ensure # that the first occurrence of SE terminates the transaction set. d::TableDef.summary("3 - Summary", b::Segment(5550, s::SE, "Transaction Set Trailer", r::Required, d::RepeatCount.bounded(1), b::Element(e::Required, "Number of Included Segments"), b::Element(e::Required, "Transaction Set Control Number"))))
- HC837P =
Deprecated.
Use HC837 instead
HC837