The Technical Steward for the PM1 segment is Orders and Observations.
The PM1 segment contains per insurance company (payer) the policies specific to their organization. Trailing this segment in the message structure are either the Limited Coverage Policy or the Approved Coverage Policy. If an insurance company is listed they have limited coverage. Note, the first 10 fields come directly from the IN1 segment.
HL7 Attribute Table - PM1 - Payer Master File
Base Framework | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|
Seq# | Data Element | Description | Flags | Implement | Cardinality | Length | C.LEN | Vocabulary | Data Type | |
PM1 | ||||||||||
1 | 00368 | Health Plan ID | SHOULD | [1..1] | InsurancePlanId (CD) | CWE Coded with Exceptions | ||||
2 | 00428 | Insurance Company ID | SHOULD | [1..*] | CX Extended Composite ID with Check Digit | |||||
3 | 00429 | Insurance Company Name | MAY | [0..*] | XON Extended Composite Name and Identification Number for Organizations | |||||
4 | 00430 | Insurance Company Address | MAY | [0..*] | XAD Extended Address | |||||
5 | 00431 | Insurance Co Contact Person | MAY | [0..*] | XPN Extended Person Name | |||||
6 | 00432 | Insurance Co Phone Number | MAY | [0..*] | XTN Extended Telecommunication Number | |||||
7 | 00433 | Group Number | = Truncation not allowed! | MAY | [0..1] | 12 | ST String Data | |||
8 | 00434 | Group Name | MAY | [0..*] | XON Extended Composite Name and Identification Number for Organizations | |||||
9 | 00437 | Plan Effective Date | MAY | [0..1] | DT Date | |||||
10 | 00438 | Plan Expiration Date | MAY | [0..1] | DT Date | |||||
11 | 03454 | Patient DOB Required | MAY | [0..1] | univ: Yes/noIndicator (CD) hl7VS-yes-no-Indicator (VS) expandedYes-NoIndicator (CS) | ID Coded Value for HL7 Defined Tables | ||||
12 | 03455 | Patient Gender Required | MAY | [0..1] | univ: Yes/noIndicator (CD) hl7VS-yes-no-Indicator (VS) expandedYes-NoIndicator (CS) | ID Coded Value for HL7 Defined Tables | ||||
13 | 03456 | Patient Relationship Required | MAY | [0..1] | univ: Yes/noIndicator (CD) hl7VS-yes-no-Indicator (VS) expandedYes-NoIndicator (CS) | ID Coded Value for HL7 Defined Tables | ||||
14 | 03457 | Patient Signature Required | MAY | [0..1] | univ: Yes/noIndicator (CD) hl7VS-yes-no-Indicator (VS) expandedYes-NoIndicator (CS) | ID Coded Value for HL7 Defined Tables | ||||
15 | 03458 | Diagnosis Required | MAY | [0..1] | univ: Yes/noIndicator (CD) hl7VS-yes-no-Indicator (VS) expandedYes-NoIndicator (CS) | ID Coded Value for HL7 Defined Tables | ||||
16 | 03459 | Service Required | MAY | [0..1] | univ: Yes/noIndicator (CD) hl7VS-yes-no-Indicator (VS) expandedYes-NoIndicator (CS) | ID Coded Value for HL7 Defined Tables | ||||
17 | 03460 | Patient Name Required | MAY | [0..1] | univ: Yes/noIndicator (CD) hl7VS-yes-no-Indicator (VS) expandedYes-NoIndicator (CS) | ID Coded Value for HL7 Defined Tables | ||||
18 | 03461 | Patient Address Required | MAY | [0..1] | univ: Yes/noIndicator (CD) hl7VS-yes-no-Indicator (VS) expandedYes-NoIndicator (CS) | ID Coded Value for HL7 Defined Tables | ||||
19 | 03462 | Subscribers Name Required | MAY | [0..1] | univ: Yes/noIndicator (CD) hl7VS-yes-no-Indicator (VS) expandedYes-NoIndicator (CS) | ID Coded Value for HL7 Defined Tables | ||||
20 | 03463 | Workman's Comp Indicator | MAY | [0..1] | univ: Yes/noIndicator (CD) hl7VS-yes-no-Indicator (VS) expandedYes-NoIndicator (CS) | ID Coded Value for HL7 Defined Tables | ||||
21 | 03464 | Bill Type Required | MAY | [0..1] | univ: Yes/noIndicator (CD) hl7VS-yes-no-Indicator (VS) expandedYes-NoIndicator (CS) | ID Coded Value for HL7 Defined Tables | ||||
22 | 03465 | Commercial Carrier Name and Address Required | MAY | [0..1] | univ: Yes/noIndicator (CD) hl7VS-yes-no-Indicator (VS) expandedYes-NoIndicator (CS) | ID Coded Value for HL7 Defined Tables | ||||
23 | 03466 | Policy Number Pattern | MAY | [0..1] | ST String Data | |||||
24 | 03467 | Group Number Pattern | MAY | [0..1] | ST String Data |
Seq# | Data Element | Description | Flags | Implement | Cardinality | Length | C.LEN | Vocabulary | Data Type | |
---|---|---|---|---|---|---|---|---|---|---|
PM1 | ||||||||||
1 | 00368 | Health Plan ID | SHALL | [1..1] | InsurancePlanId (CD) | CWE Coded with Exceptions | ||||
2 | 00428 | Insurance Company ID | SHALL | [1..*] | CX Extended Composite ID with Check Digit | |||||
3 | 00429 | Insurance Company Name | MAY | [0..*] | XON Extended Composite Name and Identification Number for Organizations | |||||
4 | 00430 | Insurance Company Address | MAY | [0..*] | XAD Extended Address | |||||
5 | 00431 | Insurance Co Contact Person | MAY | [0..*] | XPN Extended Person Name | |||||
6 | 00432 | Insurance Co Phone Number | MAY | [0..*] | XTN Extended Telecommunication Number | |||||
7 | 00433 | Group Number | = Truncation not allowed! | MAY | [0..1] | 12 | ST String Data | |||
8 | 00434 | Group Name | MAY | [0..*] | XON Extended Composite Name and Identification Number for Organizations | |||||
9 | 00437 | Plan Effective Date | MAY | [0..1] | DT Date | |||||
10 | 00438 | Plan Expiration Date | MAY | [0..1] | DT Date | |||||
11 | 03454 | Patient DOB Required | MAY | [0..1] | univ: Yes/noIndicator (CD) hl7VS-yes-no-Indicator (VS) expandedYes-NoIndicator (CS) | ID Coded Value for HL7 Defined Tables | ||||
12 | 03455 | Patient Gender Required | MAY | [0..1] | univ: Yes/noIndicator (CD) hl7VS-yes-no-Indicator (VS) expandedYes-NoIndicator (CS) | ID Coded Value for HL7 Defined Tables | ||||
13 | 03456 | Patient Relationship Required | MAY | [0..1] | univ: Yes/noIndicator (CD) hl7VS-yes-no-Indicator (VS) expandedYes-NoIndicator (CS) | ID Coded Value for HL7 Defined Tables | ||||
14 | 03457 | Patient Signature Required | MAY | [0..1] | univ: Yes/noIndicator (CD) hl7VS-yes-no-Indicator (VS) expandedYes-NoIndicator (CS) | ID Coded Value for HL7 Defined Tables | ||||
15 | 03458 | Diagnosis Required | MAY | [0..1] | univ: Yes/noIndicator (CD) hl7VS-yes-no-Indicator (VS) expandedYes-NoIndicator (CS) | ID Coded Value for HL7 Defined Tables | ||||
16 | 03459 | Service Required | MAY | [0..1] | univ: Yes/noIndicator (CD) hl7VS-yes-no-Indicator (VS) expandedYes-NoIndicator (CS) | ID Coded Value for HL7 Defined Tables | ||||
17 | 03460 | Patient Name Required | MAY | [0..1] | univ: Yes/noIndicator (CD) hl7VS-yes-no-Indicator (VS) expandedYes-NoIndicator (CS) | ID Coded Value for HL7 Defined Tables | ||||
18 | 03461 | Patient Address Required | MAY | [0..1] | univ: Yes/noIndicator (CD) hl7VS-yes-no-Indicator (VS) expandedYes-NoIndicator (CS) | ID Coded Value for HL7 Defined Tables | ||||
19 | 03462 | Subscribers Name Required | MAY | [0..1] | univ: Yes/noIndicator (CD) hl7VS-yes-no-Indicator (VS) expandedYes-NoIndicator (CS) | ID Coded Value for HL7 Defined Tables | ||||
20 | 03463 | Workman's Comp Indicator | MAY | [0..1] | univ: Yes/noIndicator (CD) hl7VS-yes-no-Indicator (VS) expandedYes-NoIndicator (CS) | ID Coded Value for HL7 Defined Tables | ||||
21 | 03464 | Bill Type Required | MAY | [0..1] | univ: Yes/noIndicator (CD) hl7VS-yes-no-Indicator (VS) expandedYes-NoIndicator (CS) | ID Coded Value for HL7 Defined Tables | ||||
22 | 03465 | Commercial Carrier Name and Address Required | MAY | [0..1] | univ: Yes/noIndicator (CD) hl7VS-yes-no-Indicator (VS) expandedYes-NoIndicator (CS) | ID Coded Value for HL7 Defined Tables | ||||
23 | 03466 | Policy Number Pattern | MAY | [0..1] | ST String Data | |||||
24 | 03467 | Group Number Pattern | MAY | [0..1] | ST String Data |
Base Framework | Base Standard Profile | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Seq# | Data Element | Description | Flags | Implement | Cardinality | Length | C.LEN | Vocabulary | Data Type | Implement | Vocabulary | |
PM1 | ||||||||||||
1 | 00368 | Health Plan ID | SHOULD | [1..1] | InsurancePlanId (CD) | CWE Coded with Exceptions | SHALL | |||||
2 | 00428 | Insurance Company ID | SHOULD | [1..*] | CX Extended Composite ID with Check Digit | SHALL | ||||||
3 | 00429 | Insurance Company Name | MAY | [0..*] | XON Extended Composite Name and Identification Number for Organizations | MAY | ||||||
4 | 00430 | Insurance Company Address | MAY | [0..*] | XAD Extended Address | MAY | ||||||
5 | 00431 | Insurance Co Contact Person | MAY | [0..*] | XPN Extended Person Name | MAY | ||||||
6 | 00432 | Insurance Co Phone Number | MAY | [0..*] | XTN Extended Telecommunication Number | MAY | ||||||
7 | 00433 | Group Number | = Truncation not allowed! | MAY | [0..1] | 12 | ST String Data | MAY | ||||
8 | 00434 | Group Name | MAY | [0..*] | XON Extended Composite Name and Identification Number for Organizations | MAY | ||||||
9 | 00437 | Plan Effective Date | MAY | [0..1] | DT Date | MAY | ||||||
10 | 00438 | Plan Expiration Date | MAY | [0..1] | DT Date | MAY | ||||||
11 | 03454 | Patient DOB Required | MAY | [0..1] | univ: Yes/noIndicator (CD) hl7VS-yes-no-Indicator (VS) expandedYes-NoIndicator (CS) | ID Coded Value for HL7 Defined Tables | MAY | |||||
12 | 03455 | Patient Gender Required | MAY | [0..1] | univ: Yes/noIndicator (CD) hl7VS-yes-no-Indicator (VS) expandedYes-NoIndicator (CS) | ID Coded Value for HL7 Defined Tables | MAY | |||||
13 | 03456 | Patient Relationship Required | MAY | [0..1] | univ: Yes/noIndicator (CD) hl7VS-yes-no-Indicator (VS) expandedYes-NoIndicator (CS) | ID Coded Value for HL7 Defined Tables | MAY | |||||
14 | 03457 | Patient Signature Required | MAY | [0..1] | univ: Yes/noIndicator (CD) hl7VS-yes-no-Indicator (VS) expandedYes-NoIndicator (CS) | ID Coded Value for HL7 Defined Tables | MAY | |||||
15 | 03458 | Diagnosis Required | MAY | [0..1] | univ: Yes/noIndicator (CD) hl7VS-yes-no-Indicator (VS) expandedYes-NoIndicator (CS) | ID Coded Value for HL7 Defined Tables | MAY | |||||
16 | 03459 | Service Required | MAY | [0..1] | univ: Yes/noIndicator (CD) hl7VS-yes-no-Indicator (VS) expandedYes-NoIndicator (CS) | ID Coded Value for HL7 Defined Tables | MAY | |||||
17 | 03460 | Patient Name Required | MAY | [0..1] | univ: Yes/noIndicator (CD) hl7VS-yes-no-Indicator (VS) expandedYes-NoIndicator (CS) | ID Coded Value for HL7 Defined Tables | MAY | |||||
18 | 03461 | Patient Address Required | MAY | [0..1] | univ: Yes/noIndicator (CD) hl7VS-yes-no-Indicator (VS) expandedYes-NoIndicator (CS) | ID Coded Value for HL7 Defined Tables | MAY | |||||
19 | 03462 | Subscribers Name Required | MAY | [0..1] | univ: Yes/noIndicator (CD) hl7VS-yes-no-Indicator (VS) expandedYes-NoIndicator (CS) | ID Coded Value for HL7 Defined Tables | MAY | |||||
20 | 03463 | Workman's Comp Indicator | MAY | [0..1] | univ: Yes/noIndicator (CD) hl7VS-yes-no-Indicator (VS) expandedYes-NoIndicator (CS) | ID Coded Value for HL7 Defined Tables | MAY | |||||
21 | 03464 | Bill Type Required | MAY | [0..1] | univ: Yes/noIndicator (CD) hl7VS-yes-no-Indicator (VS) expandedYes-NoIndicator (CS) | ID Coded Value for HL7 Defined Tables | MAY | |||||
22 | 03465 | Commercial Carrier Name and Address Required | MAY | [0..1] | univ: Yes/noIndicator (CD) hl7VS-yes-no-Indicator (VS) expandedYes-NoIndicator (CS) | ID Coded Value for HL7 Defined Tables | MAY | |||||
23 | 03466 | Policy Number Pattern | MAY | [0..1] | ST String Data | MAY | ||||||
24 | 03467 | Group Number Pattern | MAY | [0..1] | ST String Data | MAY |
Base Framework | Base Standard Profile | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Seq# | Data Element | Description | Flags | Optionality | Repetition | Length | C.LEN | Table | Data Type | Optionality | Table | |
PM1 | ||||||||||||
1 | 00368 | Health Plan ID | O | (0072) | CWE Coded with Exceptions |
R | ||||||
2 | 00428 | Insurance Company ID | O | Y | CX Extended Composite ID with Check Digit |
R | ||||||
3 | 00429 | Insurance Company Name | O | Y | XON Extended Composite Name and Identification Number for Organizations |
|||||||
4 | 00430 | Insurance Company Address | O | Y | XAD Extended Address |
|||||||
5 | 00431 | Insurance Co Contact Person | O | Y | XPN Extended Person Name |
|||||||
6 | 00432 | Insurance Co Phone Number | O | Y | XTN Extended Telecommunication Number |
|||||||
7 | 00433 | Group Number | O | 12= | ST String Data |
|||||||
8 | 00434 | Group Name | O | Y | XON Extended Composite Name and Identification Number for Organizations |
|||||||
9 | 00437 | Plan Effective Date | O | DT Date |
||||||||
10 | 00438 | Plan Expiration Date | O | DT Date |
||||||||
11 | 03454 | Patient DOB Required | O | ID Coded Value for HL7 Defined Tables |
(0136) | |||||||
12 | 03455 | Patient Gender Required | O | ID Coded Value for HL7 Defined Tables |
(0136) | |||||||
13 | 03456 | Patient Relationship Required | O | ID Coded Value for HL7 Defined Tables |
(0136) | |||||||
14 | 03457 | Patient Signature Required | O | ID Coded Value for HL7 Defined Tables |
(0136) | |||||||
15 | 03458 | Diagnosis Required | O | ID Coded Value for HL7 Defined Tables |
(0136) | |||||||
16 | 03459 | Service Required | O | ID Coded Value for HL7 Defined Tables |
(0136) | |||||||
17 | 03460 | Patient Name Required | O | ID Coded Value for HL7 Defined Tables |
(0136) | |||||||
18 | 03461 | Patient Address Required | O | ID Coded Value for HL7 Defined Tables |
(0136) | |||||||
19 | 03462 | Subscribers Name Required | O | ID Coded Value for HL7 Defined Tables |
(0136) | |||||||
20 | 03463 | Workman's Comp Indicator | O | ID Coded Value for HL7 Defined Tables |
(0136) | |||||||
21 | 03464 | Bill Type Required | O | ID Coded Value for HL7 Defined Tables |
(0136) | |||||||
22 | 03465 | Commercial Carrier Name and Address Required | O | ID Coded Value for HL7 Defined Tables |
(0136) | |||||||
23 | 03466 | Policy Number Pattern | O | ST String Data |
||||||||
24 | 03467 | Group Number Pattern | O | ST String Data |
Seq# | Data Element | Description | Optionality | Repetition | Length | C.LEN | Table | Data Type | |
---|---|---|---|---|---|---|---|---|---|
PM1 | |||||||||
1 | 00368 | Health Plan ID | R | (0072) | CWE Coded with Exceptions |
||||
2 | 00428 | Insurance Company ID | R | Y | CX Extended Composite ID with Check Digit |
||||
3 | 00429 | Insurance Company Name | O | Y | XON Extended Composite Name and Identification Number for Organizations |
||||
4 | 00430 | Insurance Company Address | O | Y | XAD Extended Address |
||||
5 | 00431 | Insurance Co Contact Person | O | Y | XPN Extended Person Name |
||||
6 | 00432 | Insurance Co Phone Number | O | Y | XTN Extended Telecommunication Number |
||||
7 | 00433 | Group Number | O | 12= | ST String Data |
||||
8 | 00434 | Group Name | O | Y | XON Extended Composite Name and Identification Number for Organizations |
||||
9 | 00437 | Plan Effective Date | O | DT Date |
|||||
10 | 00438 | Plan Expiration Date | O | DT Date |
|||||
11 | 03454 | Patient DOB Required | O | (0136) | ID Coded Value for HL7 Defined Tables |
||||
12 | 03455 | Patient Gender Required | O | (0136) | ID Coded Value for HL7 Defined Tables |
||||
13 | 03456 | Patient Relationship Required | O | (0136) | ID Coded Value for HL7 Defined Tables |
||||
14 | 03457 | Patient Signature Required | O | (0136) | ID Coded Value for HL7 Defined Tables |
||||
15 | 03458 | Diagnosis Required | O | (0136) | ID Coded Value for HL7 Defined Tables |
||||
16 | 03459 | Service Required | O | (0136) | ID Coded Value for HL7 Defined Tables |
||||
17 | 03460 | Patient Name Required | O | (0136) | ID Coded Value for HL7 Defined Tables |
||||
18 | 03461 | Patient Address Required | O | (0136) | ID Coded Value for HL7 Defined Tables |
||||
19 | 03462 | Subscribers Name Required | O | (0136) | ID Coded Value for HL7 Defined Tables |
||||
20 | 03463 | Workman's Comp Indicator | O | (0136) | ID Coded Value for HL7 Defined Tables |
||||
21 | 03464 | Bill Type Required | O | (0136) | ID Coded Value for HL7 Defined Tables |
||||
22 | 03465 | Commercial Carrier Name and Address Required | O | (0136) | ID Coded Value for HL7 Defined Tables |
||||
23 | 03466 | Policy Number Pattern | O | ST String Data |
|||||
24 | 03467 | Group Number Pattern | O | ST String Data |
Definition: This field contains a unique identifier for the insurance plan. Refer to User-defined Table 0072 - Insurance Plan ID in Chapter 2C, Code Tables, for suggested values. To eliminate a plan, the plan could be sent with null values in each subsequent element. If the respective systems can support it, a null value can be sent in the plan field.
The assigning authority for PM1-1, Health Plan ID is assumed to be the Entity named in PM1-2, Insurance Company ID.
Definition: This field contains unique identifiers for the insurance company. The assigning authority and identifier type code are strongly recommended for all CX data types.
Definition: This field contains the name of the insurance company. Multiple names for the same insurance company may be sent in this field.
Definition: This field contains the address of the insurance company. Multiple addresses for the same insurance company may be sent in this field. As of v 2.7, no assumptions can be made based on position or sequence. Specification of meaning based on sequence is deprecated.
Definition: This field contains the name of the person who should be contacted at the insurance company. Multiple names for the same contact person may be sent in this field. As of v 2.7, no assumptions can be made based on position or sequence. Specification of meaning based on sequence is deprecated.
Definition: This field contains the phone number of the insurance company. Multiple phone numbers for the same insurance company may be sent in this field. As of v 2.7, no assumptions can be made based on position or sequence. Specification of meaning based on sequence is deprecated.
Definition: This field contains the group number of the insured's insurance.
Definition: This field contains the group name of the insured's insurance.
Definition: This field contains the date that the insurance goes into effect.
Definition: This field indicates the last date of service that the insurance will cover or be responsible for.
Definition: This field indicates whether this insurance carrier requires the patient DOB. Refer to HL7 Table 0136 - Yes/no Indicator in Chapter 2C, Code Tables, for valid values.
Definition: This field indicates whether this insurance carrier requires the patient Gender. Refer to HL7 Table 0136 - Yes/no Indicator in Chapter 2C, Code Tables, for valid values.
Definition: This field indicates whether this insurance carrier requires the patient’s Relationship to insured. Refer to HL7 Table 0136 - Yes/no Indicator in Chapter 2C, Code Tables, for valid values.
Definition: This field indicates whether this insurance carrier requires the patient Signature. Refer to HL7 Table 0136 - Yes/no Indicator in Chapter 2C, Code Tables, for valid values.
Definition: This field indicates whether this insurance carrier requires a diagnosis. Refer to HL7 Table 0136 - Yes/no Indicator in Chapter 2C, Code Tables, for valid values.
Definition: This field indicates whether this insurance carrier requires services to be listed. Refer to HL7 Table 0136 - Yes/no Indicator in Chapter 2C, Code Tables, for valid values.
Definition: This field indicates whether this insurance carrier requires a patient name on all requests. Refer to HL7 Table 0136 - Yes/no Indicator in Chapter 2C, Code Tables, for valid values.
Definition: This field indicates whether this insurance carrier requires a patient address on all requests. Refer to HL7 Table 0136 - Yes/no Indicator in Chapter 2C, Code Tables, for valid values.
Definition: This field indicates whether this insurance carrier requires subscribers name on all requests. Refer to HL7 Table 0136 - Yes/no Indicator in Chapter 2C, Code Tables, for valid values.
Definition: This field indicates whether this insurance carrier requires workman compensation to be identified. Refer to HL7 Table 0136 - Yes/no Indicator in Chapter 2C, Code Tables, for valid values.
Definition: This field indicates whether this insurance carrier requires subscribers bill type. Refer to HL7 Table 0136 - Yes/no Indicator in Chapter 2C, Code Tables, for valid values.
Definition: This field indicates whether this insurance carrier requires commerical carrier name and address. Refer to HL7 Table 0136 - Yes/no Indicator in Chapter 2C, Code Tables, for valid values.
Definition: This field contains the policy number pattern. This describes what the policy number should look like. There will likely be multiple patterns to identify the Policy number. It is recommended that Edit patterns are a sequence of the characters ‘A’ for alpha, ‘N’ for numeric, ‘X’ for alphanumeric, ‘B’ for blank, and ‘*’ for wildcard. Digits positionally refer to the two-character edit pattern list in the corresponding list field.
Edit pattern lists are a sequence characters to respresent the format and size of the Policy Number.
Example 1: The policy number has 3 numbers, 1 blank, 5 numbers and it would be defined in a Pattern as NNNBNNNNN
Example 2: The policy number has 2 numerics, 2 characters for state, 1 blank 5 Alphanumerics and would be represented as NNCCBXXXXX
Definition: This field contains the Group number pattern. This describes what the group number should look like. There will likely be multiple patterns to identify the group number. It is recommended that Edit patterns are a sequence of the characters ‘A’ for alpha, ‘N’ for numeric, ‘X’ for alphanumeric, ‘B’ for blank, and ‘*’ for wildcard. Digits positionally refer to the two-character edit pattern list in the corresponding list field.
Edit pattern lists are a sequence characters to respresent the format and size of the Group Number.
Example 1: The group number has 3 numbers, 1 blank, 5 numbers and it would be defined in a Pattern as NNNBNNNNN
Example 2: The group number has 2 numerics, 2 characters for state, 1 blank 5 Alphanumerics and would be represented as NNCCBXXXXX