HL7 V2.4 Contents

HL7 V2.4 Chapter 6

• 6.
  Financial Management
  • 6.1 CHAPTER 6 CONTENTS
  • 6.2 PURPOSE
  • 6.3 PATIENT ACCOUNTING MESSAGE SET
  • 6.4 TRIGGER EVENTS AND MESSAGE DEFINITIONS
    • 6.4.1 BAR/ACK - add patient account (event P01)
    • 6.4.2 BAR/ACK - purge patient accounts (event P02)
    • 6.4.3 DFT/ACK - post detail financial transactions (event P03)
    • 6.4.4 QRY/DSR - generate bills and accounts receivable statements (event P04)
    • 6.4.5 BAR/ACK - update account (event P05)
    • 6.4.6 BAR/ACK - end account (event P06)
    • 6.4.7 BAR/ACK - transmit ambulatory payment classification (APC) groups (event P10)
  • 6.5 MESSAGE SEGMENTS
    • 6.5.1 FT1 - financial transaction segment
      • 6.5.1.0 FT1 field definitions
      • 6.5.1.1 FT1-1 Set ID - FT1- (SI) 00355
      • 6.5.1.2 FT1-2 Transaction ID (ST) 00356
      • 6.5.1.3 FT1-3 Transaction batch ID (ST) 00357
      • 6.5.1.4 FT1-4 Transaction date (TS) 00358
      • 6.5.1.5 FT1-5 Transaction posting date (TS) 00359
      • 6.5.1.6 FT1-6 Transaction type (IS) 00360
      • 6.5.1.7 FT1-7 Transaction code (CE) 00361
      • 6.5.1.8 FT1-8 Transaction description (ST) 00362
      • 6.5.1.9 FT1-9 Transaction description - Alt- (ST) 00363
      • 6.5.1.10 FT1-10 Transaction quantity (NM) 00364
      • 6.5.1.11 FT1-11 Transaction amount - extended- (CP) 00365
      • 6.5.1.12 FT1-12 Transaction amount - unit- (CP) 00366
      • 6.5.1.13 FT1-13 Department code (CE) 00367
      • 6.5.1.14 FT1-14 Insurance plan ID (CE) 00368
      • 6.5.1.15 FT1-15 Insurance amount (CP) 00369
      • 6.5.1.16 FT1-16 Assigned patient location (PL) 00133
      • 6.5.1.17 FT1-17 Fee schedule (IS) 00370
      • 6.5.1.18 FT1-18 Patient type (IS) 00148
      • 6.5.1.19 FT1-19 Diagnosis code - FT1 (CE) 00371
      • 6.5.1.20 FT1-20 Performed by code (XCN) 00372
      • 6.5.1.21 FT1-21 Ordered by code (XCN) 00373
      • 6.5.1.22 FT1-22 Unit cost (CP) 00374
      • 6.5.1.23 FT1-23 Filler order number (EI) 00217
      • 6.5.1.24 FT1-24 Entered by code (XCN) 00765
      • 6.5.1.25 FT1-25 Procedure code (CE) 00393
      • 6.5.1.26 FT1-26 Procedure code modifier (CE) 01316
    • 6.5.2 DG1 - diagnosis segment
      • 6.5.2.0 DG1 field definitions
      • 6.5.2.1 DG1-1 Set ID - DG1 (SI) 00375
      • 6.5.2.2 DG1-2 Diagnosis coding method (ID) 00376
      • 6.5.2.3 DG1-3 Diagnosis code - DG1 (CE) 00377
      • 6.5.2.4 DG1-4 Diagnosis description (ST) 00378
      • 6.5.2.5 DG1-5 Diagnosis date/time (TS) 00379
      • 6.5.2.6 DG1-6 Diagnosis type (IS) 00380
      • 6.5.2.7 DG1-7 Major diagnostic category (CE) 00381
      • 6.5.2.8 DG1-8 Diagnostic related group (CE) 00382
      • 6.5.2.9 DG1-9 DRG approval indicator (ID) 00383
      • 6.5.2.10 DG1-10 DRG grouper review code (IS) 00384
      • 6.5.2.11 DG1-11 Outlier type (CE) 00385
      • 6.5.2.12 DG1-12 Outlier days (NM) 00386
      • 6.5.2.13 DG1-13 Outlier cost (CP) 00387
      • 6.5.2.14 DG1-14 Grouper version and type (ST) 00388
      • 6.5.2.15 DG1-15 Diagnosis priority (ID) 00389
      • 6.5.2.16 DG1-16 Diagnosing clinician (XCN) 00390
      • 6.5.2.17 DG1-17 Diagnosis classification (IS) 00766
      • 6.5.2.18 DG1-18 Confidential indicator (ID) 00767
      • 6.5.2.19 DG1-19 Attestation date/time (TS) 00768
    • 6.5.3 DRG - diagnosis related group segment
      • 6.5.3.0 DRG field definitions
      • 6.5.3.1 DRG-1 Diagnostic related group (CE) 00382
      • 6.5.3.2 DRG-2 DRG assigned date/time (TS) 00769
      • 6.5.3.3 DRG-3 DRG approval indicator (ID) 00383
      • 6.5.3.4 DRG-4 DRG grouper review code (IS) 00384
      • 6.5.3.5 DRG-5 Outlier type (CE) 00385
      • 6.5.3.6 DRG-6 Outlier days (NM) 00386
      • 6.5.3.7 DRG-7 Outlier cost (CP) 00387
      • 6.5.3.8 DRG-8 DRG payor (IS) 00770
      • 6.5.3.9 DRG-9 Outlier reimbursement (CP) 00771
      • 6.5.3.10 DRG-10 Confidential indicator (ID) 00767
      • 6.5.3.11 DRG-11 DRG transfer type (IS) 01500
    • 6.5.4 PR1 - procedures segment
      • 6.5.4.0 PR1 field definitions
      • 6.5.4.1 PR1-1 Set ID - PR1- (SI) 00391
      • 6.5.4.2 PR1-2 Procedure coding method (IS) 00392
      • 6.5.4.3 PR1-3 Procedure code (CE) 00393
      • 6.5.4.4 PR1-4 Procedure description (ST) 00394
      • 6.5.4.5 PR1-5 Procedure date/time (TS) 00395
      • 6.5.4.6 PR1-6 Procedure functional type (IS) 00396
      • 6.5.4.7 PR1-7 Procedure minutes (NM) 00397
      • 6.5.4.8 PR1-8 Anesthesiologist (XCN) 00398
      • 6.5.4.9 PR1-9 Anesthesia code (IS) 00399
      • 6.5.4.10 PR1-10 Anesthesia minutes (NM) 00400
      • 6.5.4.11 PR1-11 Surgeon (XCN) 00401
      • 6.5.4.12 PR1-12 Procedure practitioner (XCN) 00402
      • 6.5.4.13 PR1-13 Consent code (CE) 00403
      • 6.5.4.14 PR1-14 Procedure priority (ID) 00404
      • 6.5.4.15 PR1-15 Associated diagnosis code (CE) 00772
      • 6.5.4.16 PR1-16 Procedure code modifier (CE) 01316
      • 6.5.4.17 PR1-17 Procedure DRG type (IS) 01501
      • 6.5.4.18 PR1-18 Tissue type code (CE) 01502
    • 6.5.5 GT1 - guarantor segment
      • 6.5.5.0 GT1 field definitions
      • 6.5.5.1 GT1-1 Set ID - GT1- (SI) 00405
      • 6.5.5.2 GT1-2 Guarantor number (CX) 00406
      • 6.5.5.3 GT1-3 Guarantor name (XPN) 00407
      • 6.5.5.4 GT1-4 Guarantor spouse name (XPN) 00408
      • 6.5.5.5 GT1-5 Guarantor address (XAD) 00409
      • 6.5.5.6 GT1-6 Guarantor ph num - home (XTN) 00410
      • 6.5.5.7 GT1-7 Guarantor ph num - business- (XTN) 00411
      • 6.5.5.8 GT1-8 Guarantor date/time of birth (TS) 00412
      • 6.5.5.9 GT1-9 Guarantor administrative sex (IS) 00413
      • 6.5.5.10 GT1-10 Guarantor type (IS) 00414
      • 6.5.5.11 GT1-11 Guarantor relationship (CE) 00415
      • 6.5.5.12 GT1-12 Guarantor SSN (ST) 00416
      • 6.5.5.13 GT1-13 Guarantor date - begin- (DT) 00417
      • 6.5.5.14 GT1-14 Guarantor date - end- (DT) 00418
      • 6.5.5.15 GT1-15 Guarantor priority (NM) 00419
      • 6.5.5.16 GT1-16 Guarantor employer name (XPN) 00420
      • 6.5.5.17 GT1-17 Guarantor employer address (XAD) 00421
      • 6.5.5.18 GT1-18 Guarantor employer phone number (XTN) 00422
      • 6.5.5.19 GT1-19 Guarantor employee ID number (CX) 00423
      • 6.5.5.20 GT1-20 Guarantor employment status (IS) 00424
      • 6.5.5.21 GT1-21 Guarantor organization name (XON) 00425
      • 6.5.5.22 GT1-22 Guarantor billing hold flag (ID) 00773
      • 6.5.5.23 GT1-23 Guarantor credit rating code (CE) 00774
      • 6.5.5.24 GT1-24 Guarantor death date and time (TS) 00775
      • 6.5.5.25 GT1-25 Guarantor death flag (ID) 00776
      • 6.5.5.26 GT1-26 Guarantor charge adjustment code (CE) 00777
      • 6.5.5.27 GT1-27 Guarantor household annual income (CP) 00778
      • 6.5.5.28 GT1-28 Guarantor household size (NM) 00779
      • 6.5.5.29 GT1-29 Guarantor employer ID number (CX) 00780
      • 6.5.5.30 GT1-30 Guarantor marital status code (CE) 00781
      • 6.5.5.31 GT1-31 Guarantor hire effective date (DT) 00782
      • 6.5.5.32 GT1-32 Employment stop date (DT) 00783
      • 6.5.5.33 GT1-33 Living dependency (IS) 00755
      • 6.5.5.34 GT1-34 Ambulatory status (IS) 00145
      • 6.5.5.35 GT1-35 Citizenship (CE) 00129
      • 6.5.5.36 GT1-36 Primary language (CE) 00118
      • 6.5.5.37 GT1-37 Living arrangement (IS) 00742
      • 6.5.5.38 GT1-38 Publicity code (CE) 00743
      • 6.5.5.39 GT1-39 Protection indicator (ID) 00744
      • 6.5.5.40 GT1-40 Student indicator (IS) 00745
      • 6.5.5.41 GT1-41 Religion (CE) 00120
      • 6.5.5.42 GT1-42 Mother's maiden name' (XPN) 00109
      • 6.5.5.43 GT1-43 Nationality (CE) 00739
      • 6.5.5.44 GT1-44 Ethnic group (CE) 00125
      • 6.5.5.45 GT1-45 Contact person's name' (XPN) 00748
      • 6.5.5.46 GT1-46 Contact person's telephone number' (XTN) 00749
      • 6.5.5.47 GT1-47 Contact reason (CE) 00747
      • 6.5.5.48 GT1-48 Contact relationship (IS) 00784
      • 6.5.5.49 GT1-49 Job title (ST) 00785
      • 6.5.5.50 GT1-50 Job code/class (JCC) 00786
      • 6.5.5.51 GT1-51 Guarantor employer's organization name' (XON) 01299
      • 6.5.5.52 GT1-52 Handicap (IS) 00753
      • 6.5.5.53 GT1-53 Job status (IS) 00752
      • 6.5.5.54 GT1-54 Guarantor financial class (FC) 01231
      • 6.5.5.55 GT1-55 Guarantor race (CE) 01291
    • 6.5.6 IN1 - insurance segment
      • 6.5.6.0 IN1 field definitions
      • 6.5.6.1 IN1-1 Set ID - IN1- (SI) 00426
      • 6.5.6.2 IN1-2 Insurance plan ID (CE) 00368
      • 6.5.6.3 IN1-3 Insurance company ID (CX) 00428
      • 6.5.6.4 IN1-4 Insurance company name (XON) 00429
      • 6.5.6.5 IN1-5 Insurance company address (XAD) 00430
      • 6.5.6.6 IN1-6 Insurance co contact person (XPN) 00431
      • 6.5.6.7 IN1-7 Insurance co phone number (XTN) 00432
      • 6.5.6.8 IN1-8 Group number (ST) 00433
      • 6.5.6.9 IN1-9 Group name (XON) 00434
      • 6.5.6.10 IN1-10 Insured's group emp. ID' (CX) 00435
      • 6.5.6.11 IN1-11 Insured's group emp name (XON) 00436
      • 6.5.6.12 IN1-12 Plan effective date (DT) 00437
      • 6.5.6.13 IN1-13 Plan expiration date (DT) 00438
      • 6.5.6.14 IN1-14 Authorization information (CM) 00439
      • 6.5.6.15 IN1-15 Plan type (IS) 00440
      • 6.5.6.16 IN1-16 Name of insured (XPN) 00441
      • 6.5.6.17 IN1-17 Insured's relationship to patient' (CE) 00442
      • 6.5.6.18 IN1-18 Insured's date of birth (TS) 00443
      • 6.5.6.19 IN1-19 Insured's address (XAD) 00444
      • 6.5.6.20 IN1-20 Assignment of benefits (IS) 00445
      • 6.5.6.21 IN1-21 Coordination of benefits (IS) 00446
      • 6.5.6.22 IN1-22 Coord of ben. priority (ST) 00447
      • 6.5.6.23 IN1-23 Notice of admission flag (ID) 00448
      • 6.5.6.24 IN1-24 Notice of admission date (DT) 00449
      • 6.5.6.25 IN1-25 Report of eligibility flag (ID) 00450
      • 6.5.6.26 IN1-26 Report of eligibility date (DT) 00451
      • 6.5.6.27 IN1-27 Release information code (IS) 00452
      • 6.5.6.28 IN1-28 Pre-admit cert (PAC)- (ST) 00453
      • 6.5.6.29 IN1-29 Verification date/time (TS) 00454
      • 6.5.6.30 IN1-30 Verification by (XCN) 00455
      • 6.5.6.31 IN1-31 Type of agreement code (IS) 00456
      • 6.5.6.32 IN1-32 Billing status (IS) 00457
      • 6.5.6.33 IN1-33 Lifetime reserve days (NM) 00458
      • 6.5.6.34 IN1-34 Delay before L.R. day (NM) 00459
      • 6.5.6.35 IN1-35 Company plan code (IS) 00460
      • 6.5.6.36 IN1-36 Policy number (ST) 00461
      • 6.5.6.37 IN1-37 Policy deductible (CP) 00462
      • 6.5.6.38 IN1-38 Policy limit - amount- (CP) 00463
      • 6.5.6.39 IN1-39 Policy limit - days- (NM) 00464
      • 6.5.6.40 IN1-40 Room rate - semi-private-- (CP) 00465
      • 6.5.6.41 IN1-41 Room rate - private- (CP) 00466
      • 6.5.6.42 IN1-42 Insured's employment status' (CE) 00467
      • 6.5.6.43 IN1-43 Insured's administrative sex' (IS) 00468
      • 6.5.6.44 IN1-44 Insured's employer's address' (XAD) 00469
      • 6.5.6.45 IN1-45 Verification status (ST) 00470
      • 6.5.6.46 IN1-46 Prior insurance plan ID (IS) 00471
      • 6.5.6.47 IN1-47 Coverage type (IS) 01227
      • 6.5.6.48 IN1-48 Handicap (IS) 00753
      • 6.5.6.49 IN1-49 Insured's ID number' (CX) 01230
    • 6.5.7 IN2 - insurance additional information segment
      • 6.5.7.0 IN2 field definitions
      • 6.5.7.1 IN2-1 Insured's employee ID (CX) 00472
      • 6.5.7.2 IN2-2 Insured's social security number' (ST) 00473
      • 6.5.7.3 IN2-3 Insured's employer's name and ID' (XCN) 00474
      • 6.5.7.4 IN2-4 Employer information data (IS) 00475
      • 6.5.7.5 IN2-5 Mail claim party (IS) 00476
      • 6.5.7.6 IN2-6 Medicare health ins card number (ST) 00477
      • 6.5.7.7 IN2-7 Medicaid case name (XPN) 00478
      • 6.5.7.8 IN2-8 Medicaid case number (ST) 00479
      • 6.5.7.9 IN2-9 Military sponsor name (XPN) 00480
      • 6.5.7.10 IN2-10 Military ID number (ST) 00481
      • 6.5.7.11 IN2-11 Dependent of military recipient (CE) 00482
      • 6.5.7.12 IN2-12 Military organization (ST) 00483
      • 6.5.7.13 IN2-13 Military station (ST) 00484
      • 6.5.7.14 IN2-14 Military service (IS) 00485
      • 6.5.7.15 IN2-15 Military rank/grade (IS) 00486
      • 6.5.7.16 IN2-16 Military status (IS) 00487
      • 6.5.7.17 IN2-17 Military retire date (DT) 00488
      • 6.5.7.18 IN2-18 Military non-avail cert on file (ID) 00489
      • 6.5.7.19 IN2-19 Baby coverage (ID) 00490
      • 6.5.7.20 IN2-20 Combine baby bill (ID) 00491
      • 6.5.7.21 IN2-21 Blood deductible (ST) 00492
      • 6.5.7.22 IN2-22 Special coverage approval name (XPN) 00493
      • 6.5.7.23 IN2-23 Special coverage approval title (ST) 00494
      • 6.5.7.24 IN2-24 Non-covered insurance code (IS) 00495
      • 6.5.7.25 IN2-25 Payor ID (CX) 00496
      • 6.5.7.26 IN2-26 Payor subscriber ID (CX) 00497
      • 6.5.7.27 IN2-27 Eligibility source (IS) 00498
      • 6.5.7.28 IN2-28 Room coverage type/amount (CM) 00499
      • 6.5.7.29 IN2-29 Policy type/amount (CM) 00500
      • 6.5.7.30 IN2-30 Daily deductible (CM) 00501
      • 6.5.7.31 IN2-31 Living dependency (IS) 00755
      • 6.5.7.32 IN2-32 Ambulatory status (IS) 00145
      • 6.5.7.33 IN2-33 Citizenship (CE) 00129
      • 6.5.7.34 IN2-34 Primary language (CE) 00118
      • 6.5.7.35 IN2-35 Living arrangement (IS) 00742
      • 6.5.7.36 IN2-36 Publicity code (CE) 00743
      • 6.5.7.37 IN2-37 Protection indicator (ID) 00744
      • 6.5.7.38 IN2-38 Student indicator (IS) 00745
      • 6.5.7.39 IN2-39 Religion (CE) 00120
      • 6.5.7.40 IN2-40 Mother's maiden name' (XPN) 00109
      • 6.5.7.41 IN2-41 Nationality (CE) 00739
      • 6.5.7.42 IN2-42 Ethnic group (CE) 00125
      • 6.5.7.43 IN2-43 Marital status (CE) 00119
      • 6.5.7.44 IN2-44 Insured's employment start date' (DT) 00787
      • 6.5.7.45 IN2-45 Employment stop date (DT) 00783
      • 6.5.7.46 IN2-46 Job title (ST) 00785
      • 6.5.7.47 IN2-47 Job code/class (JCC) 00786
      • 6.5.7.48 IN2-48 Job status (IS) 00752
      • 6.5.7.49 IN2-49 Employer contact person name (XPN) 00789
      • 6.5.7.50 IN2-50 Employer contact person phone number (XTN) 00790
      • 6.5.7.51 IN2-51 Employer contact reason (IS) 00791
      • 6.5.7.52 IN2-52 Insured's contact person's name'' (XPN) 00792
      • 6.5.7.53 IN2-53 Insured's contact person phone number' (XTN) 00793
      • 6.5.7.54 IN2-54 Insured's contact person reason' (IS) 00794
      • 6.5.7.55 IN2-55 Relationship to the patient start date (DT) 00795
      • 6.5.7.56 IN2-56 Relationship to the patient stop date (DT) 00796
      • 6.5.7.57 IN2-57 Insurance co contact reason (IS) 00797
      • 6.5.7.58 IN2-58 Insurance co contact phone number (XTN) 00798
      • 6.5.7.59 IN2-59 Policy scope (IS) 00799
      • 6.5.7.60 IN2-60 Policy source (IS) 00800
      • 6.5.7.61 IN2-61 Patient member number (CX) 00801
      • 6.5.7.62 IN2-62 Guarantor's relationship to insured' (CE) 00802
      • 6.5.7.63 IN2-63 Insured's phone number - Home' (XTN) 00803
      • 6.5.7.64 IN2-64 Insured's employer phone number' (XTN) 00804
      • 6.5.7.65 IN2-65 Military handicapped program (CE) 00805
      • 6.5.7.66 IN2-66 Suspend flag (ID) 00806
      • 6.5.7.67 IN2-67 Copay limit flag (ID) 00807
      • 6.5.7.68 IN2-68 Stoploss limit flag (ID) 00808
      • 6.5.7.69 IN2-69 Insured organization name and ID (XON) 00809
      • 6.5.7.70 IN2-70 Insured employer organization name and ID (XON) 00810
      • 6.5.7.71 IN2-71 Race (CE) 00113
      • 6.5.7.72 IN2-72 HCFA patient's relationship to insured' (CE) 00811
    • 6.5.8 IN3 - insurance additional information, certification segment
      • 6.5.8.0 IN3 field definitions
      • 6.5.8.1 IN3-1 Set ID - IN3 (SI) 00502
      • 6.5.8.2 IN3-2 Certification number (CX) 00503
      • 6.5.8.3 IN3-3 Certified by (XCN) 00504
      • 6.5.8.4 IN3-4 Certification required (ID) 00505
      • 6.5.8.5 IN3-5 Penalty (CM) 00506
      • 6.5.8.6 IN3-6 Certification date/time (TS) 00507
      • 6.5.8.7 IN3-7 Certification modify date/time (TS) 00508
      • 6.5.8.8 IN3-8 Operator (XCN) 00509
      • 6.5.8.9 IN3-9 Certification begin date (DT) 00510
      • 6.5.8.10 IN3-10 Certification end date (DT) 00511
      • 6.5.8.11 IN3-11 Days (CM) 00512
      • 6.5.8.12 IN3-12 Non-concur code/description (CE) 00513
      • 6.5.8.13 IN3-13 Non-concur effective date/time (TS) 00514
      • 6.5.8.14 IN3-14 Physician reviewer (XCN) 00515
      • 6.5.8.15 IN3-15 Certification contact (ST) 00516
      • 6.5.8.16 IN3-16 Certification contact phone number (XTN) 00517
      • 6.5.8.17 IN3-17 Appeal reason (CE) 00518
      • 6.5.8.18 IN3-18 Certification agency (CE) 00519
      • 6.5.8.19 IN3-19 Certification agency phone number (XTN) 00520
      • 6.5.8.20 IN3-20 Pre-certification req/window (CM) 00521
      • 6.5.8.21 IN3-21 Case manager (ST) 00522
      • 6.5.8.22 IN3-22 Second opinion date (DT) 00523
      • 6.5.8.23 IN3-23 Second opinion status (IS) 00524
      • 6.5.8.24 IN3-24 Second opinion documentation received (IS) 00525
      • 6.5.8.25 IN3-25 Second opinion physician (XCN) 00526
    • 6.5.9 ACC - accident segment
      • 6.5.9.0 ACC field definitions
      • 6.5.9.1 ACC-1 Accident date/time (TS) 00527
      • 6.5.9.2 ACC-2 Accident code (CE) 00528
      • 6.5.9.3 ACC-3 Accident location (ST) 00529
      • 6.5.9.4 ACC-4 Auto accident state (CE) 00812
      • 6.5.9.5 ACC-5 Accident job related indicator (ID) 00813
      • 6.5.9.6 ACC-6 Accident death indicator (ID) 00814
      • 6.5.9.7 ACC-7 Entered by (XCN) 00224
      • 6.5.9.8 ACC-8 Accident description (ST) 01503
      • 6.5.9.9 ACC-9 Brought in by (ST) 01504
      • 6.5.9.10 ACC-10 Police notified indicator (ID) 01505
    • 6.5.10 UB1 - UB82 data segment
      • 6.5.10.0 UB1 field definitions
      • 6.5.10.1 UB1-1 Set ID - UB1- (SI) 00530
      • 6.5.10.2 UB1-2 Blood deductible (43) (NM) 00531
      • 6.5.10.3 UB1-3 Blood furnished-pints of (40) (NM) 00532
      • 6.5.10.4 UB1-4 Blood replaced-pints (41)- (NM) 00533
      • 6.5.10.5 UB1-5 Blood not replaced- pints (42)- (NM) 00534
      • 6.5.10.6 UB1-6 Co-insurance days (25)- (NM) 00535
      • 6.5.10.7 UB1-7 Condition code (35-39) (IS) 00536
      • 6.5.10.8 UB1-8 Covered days - (23)- (NM) 00537
      • 6.5.10.9 UB1-9 Non-covered days - (24)- (NM) 00538
      • 6.5.10.10 UB1-10 Value amount & code (46-49) (CM) 00539
      • 6.5.10.11 UB1-11 Number of grace days (90) (NM) 00540
      • 6.5.10.12 UB1-12 Special program indicator (44) (CE) 00541
      • 6.5.10.13 UB1-13 PSRO/UR approval indicator (87) (CE) 00542
      • 6.5.10.14 UB1-14 PSRO/UR approved stay-fm (88)- (DT) 00543
      • 6.5.10.15 UB1-15 PSRO/UR approved stay-to (89)- (DT) 00544
      • 6.5.10.16 UB1-16 Occurrence (28-32)- (CM) 00545
      • 6.5.10.17 UB1-17 Occurrence span (33) (CE) 00546
      • 6.5.10.18 UB1-18 Occur span start date (33) (DT) 00547
      • 6.5.10.19 UB1-19 Occur span end date (33) (DT) 00548
      • 6.5.10.20 UB1-20 UB-82 locator 2 (ST)- 00549
      • 6.5.10.21 UB1-21 UB-82 locator 9- (ST) 00550
      • 6.5.10.22 UB1-22 UB-82 locator 27- (ST) 00551
      • 6.5.10.23 UB1-23 UB-82 locator 45- (ST) 00552
    • 6.5.11 UB2 - UB92 data segment
      • 6.5.11.0 UB2 field definitions
      • 6.5.11.1 UB2-1 Set ID - UB2- (SI) 00553
      • 6.5.11.2 UB2-2 Co-insurance days (9) (ST) 00554
      • 6.5.11.3 UB2-3 Condition code (24-30) (IS) 00555
      • 6.5.11.4 UB2-4 Covered days (7) (ST) 00556
      • 6.5.11.5 UB2-5 Non-covered days (8) (ST) 00557
      • 6.5.11.6 UB2-6 Value amount & code (39-41) (CM) 00558
      • 6.5.11.7 UB2-7 Occurrence code & date (32-35) (CM) 00559
      • 6.5.11.8 UB2-8 Occurrence span code/dates (36) (CM) 00560
      • 6.5.11.9 UB2-9 UB92 locator 2 (state) (ST) 00561
      • 6.5.11.10 UB2-10 UB92 locator 11 (state) (ST) 00562
      • 6.5.11.11 UB2-11 UB92 locator 31 (national) (ST) 00563
      • 6.5.11.12 UB2-12 Document control number (ST) 00564
      • 6.5.11.13 UB2-13 UB92 locator 49 (national) (ST) 00565
      • 6.5.11.14 UB2-14 UB92 locator 56 (state) (ST) 00566
      • 6.5.11.15 UB2-15 UB92 locator 57 (national) (ST) 00567
      • 6.5.11.16 UB2-16 UB92 locator 78 (state) (ST) 00568
      • 6.5.11.17 UB2-17 Special visit count (NM) 00815
    • 6.5.12 ABS - abstract segment
      • 6.5.12.0 ABS field definitions
      • 6.5.12.1 ABS-1 Discharge care provider (XCN) 01514
      • 6.5.12.2 ABS-2 Transfer medical service code (CE) 01515
      • 6.5.12.3 ABS-3 Severity of illness code (CE) 01516
      • 6.5.12.4 ABS-4 Date/time of attestation (TS) 01517
      • 6.5.12.5 ABS-5 Attested by (XCN) 01518
      • 6.5.12.6 ABS-6 Triage code (CE) 01519
      • 6.5.12.7 ABS-7 Abstract completion date/time (TS) 01520
      • 6.5.12.8 ABS-8 Abstracted by (XCN) 01521
      • 6.5.12.9 ABS-9 Case category code (CE) 01522
      • 6.5.12.10 ABS-10 Caesarian section indicator (ID) 01523
      • 6.5.12.11 ABS-11 Gestation category code (CE) 01524
      • 6.5.12.12 ABS-12 Gestation period - weeks (NM) 01525
      • 6.5.12.13 ABS-13 Newborn code (CE) 01526
      • 6.5.12.14 ABS-14 Stillborn indicator (ID) 01527
    • 6.5.13 BLC - blood code segment
      • 6.5.13.0 BLC field definitions
      • 6.5.13.1 BLC-1 Blood product code (CE) 01528
      • 6.5.13.2 BLC-2 Blood amount (CQ) 01529
    • 6.5.14 RMI - risk management incident segment
      • 6.5.14.0 RMI field definitions
      • 6.5.14.1 RMI-1 Risk management incident code (CE) 01530
      • 6.5.14.2 RMI-2 Date/time incident (TS) 01531
      • 6.5.14.3 RMI-3 Incident type code (CE) 01533
    • 6.5.15 GP1 - grouping/reimbursement - visit segment
      • 6.5.15.0 GP1 field definitions
      • 6.5.15.1 GP1-1 Type of bill code (IS) 01599
      • 6.5.15.2 GP1-2 Revenue code (IS) 01600
      • 6.5.15.3 GP1-3 Overall claim disposition code (IS) 01601
      • 6.5.15.4 GP1-4 OCE edits per visit code (IS) 01602
      • 6.5.15.5 GP1-5 Outlier cost (CP) 00387
    • 6.5.16 GP2 - grouping/reimbursement - procedure line item segment
      • 6.5.16.0 GP2 field definitions
      • 6.5.16.1 GP2-1 Revenue code (IS) 01600
      • 6.5.16.2 GP2-2 Number of service units (NM) 01604
      • 6.5.16.3 GP2-3 Charge (CP) 01605
      • 6.5.16.4 GP2-4 Reimbursement action code (IS) 01606
      • 6.5.16.5 GP2-5 Denial or rejection code (IS) 01607
      • 6.5.16.6 GP2-6 OCE edit code (IS) 01608
      • 6.5.16.7 GP2-7 Ambulatory payment classification code (CE) 01609
      • 6.5.16.8 GP2-8 Modifier edit code (IS) 01610
      • 6.5.16.9 GP2-9 Payment adjustment code (IS) 01611
      • 6.5.16.10 GP2-10 Packaging status code (IS) 01617
      • 6.5.16.11 GP2-11 Expected HCFA payment amount (CP) 01618
      • 6.5.16.12 GP2-12 Reimbursement type code (IS) 01619
      • 6.5.16.13 GP2-13 Co-pay amount (CP) 01620
      • 6.5.16.14 GP2-14 Pay rate per service unit (NM) 01621
  • 6.6 EXAMPLE TRANSACTIONS
    • 6.6.1 Create a patient billing/accounts receivable record
    • 6.6.2 Post a charge to a patient's account
    • 6.6.3 Update patient accounts - update UB82 information
    • 6.6.4 Update patient accounts - update diagnosis and DRG information
  • 6.7 IMPLEMENTATION CONSIDERATIONS
  • 6.8 OUTSTANDING ISSUES

6.
Financial Management

6.1 CHAPTER 6 CONTENTS

6.2 PURPOSE

The Finance chapter describes patient accounting transactions. Other financial transactions may be added in the future. Financial transactions can be sent between applications either in batches or online. As defined in Chapter 2 on batch segments, multiple transactions may be grouped and sent through all file transfer media or programs when using the HL7 Encoding Rules.
This chapter defines the transactions that take place at the seventh level, that is, the abstract messages. The examples included in this chapter were constructed using the HL7 Encoding Rules.

6.3 PATIENT ACCOUNTING MESSAGE SET

The patient accounting message set provides for the entry and manipulation of information on billing accounts, charges, payments, adjustments, insurance, and other related patient billing and accounts receivable information.
This Standard includes all of the data defined in the National Uniform Billing Field Specifications. We have excluded state-specific coding and suggest that, where required, it be implemented in site-specific "Z" segments. State-specific fields may be included in the Standard at a later time. In addition, no attempt has been made to define data that have traditionally been required for the financial responsibility ("proration") of charges. This requirement is unique to a billing system and not a part of an interface.
We recognize that a wide variety of billing and accounts receivable systems exist today. Therefore, in an effort to accommodate the needs of the most comprehensive systems, we have defined an extensive set of transaction segments.

6.4 TRIGGER EVENTS AND MESSAGE DEFINITIONS

The triggering events that follow are served by Detail Financial Transaction (DFT), Add/Change Billing Account (BAR), and General Acknowledgment (ACK) messages.
Each trigger event is documented below, along with the applicable form of the message exchange. The notation used to describe the sequence, optionality, and repetition of segments is described in Chapter 2, "Format for Defining Abstract Messages."

6.4.1 BAR/ACK - add patient account (event P01)

Data are sent from some application (usually a Registration or an ADT system) for example, to the patient accounting or financial system to establish an account for a patient's billing/accounts receivable record. Many of the segments associated with this event are optional. This optionality allows those systems needing these fields to set up transactions that fulfill their requirements and yet satisfy the HL7 requirements.
When an account's start and end dates span a period greater than any particular visit, the P01 (add account) event should be used to transmit the opening of an account. The A01 (admit/visit notification) event can notify systems of the creation of an account as well as notify them of a patient's arrival in the healthcare facility. In order to create a new account without notifying systems of a patient's arrival, use the P01 trigger event.
From Standard Version 2.3 onward, the P01 event should only be used to add a new account that did not exist before, not to update an existing account. The new P05 (update account) event should be used to update an existing account. The new P06 (end account) event should be used to close an account. With the P01 event, EVN-2 - recorded date/time should contain the account start date.

The error segment will indicate the fields that caused a transaction to be rejected.

6.4.2 BAR/ACK - purge patient accounts (event P02)

Generally, the elimination of all billing/accounts receivable records will be an internal function controlled, for example, by the patient accounting or financial system. However, on occasion, there will be a need to correct an account, or a series of accounts, that may require that a notice of account deletion be sent from another sub-system and processed, for example, by the patient accounting or financial system. Although a series of accounts may be purged within this one event, we recommend that only one PID segment be sent per event.

The error segment indicates the fields that caused a transaction to be rejected.

6.4.3 DFT/ACK - post detail financial transactions (event P03)

The Detail Financial Transaction (DFT) message is used to describe a financial transaction transmitted between systems, that is, to the billing system for ancillary charges, ADT to billing system for patient deposits, etc. In HL7 2.4, the message construct for the P03 is expanded to support the use cases described below.
Use case for adding the INx and GT1 segments inside the FT1 repetition:
If the insurance and/or the guarantor information is specific to a certain financial transaction of a patient and differs from the patient's regular insurance and/or guarantor, you may use the INx and GT1 segments related to the FT1 segment. If being used, the information supersedes the information on the patient level.
Example: Before being employed by a company, a pre-employment physical is required. The cost of the examinations is paid by the company, and not by the person's private health insurance. One of the physicians examining the person is an eye doctor. For efficiency reasons, the person made an appointment for these examinations on the same day as he already had an appointment with his eye doctor in the same hospital. The costs for this eye doctor appointment are being paid by the patient's private health insurance. Both financial transactions for the same patient/person could be sent in the same message. To bill the examination for the future-employer to that organization, you need to use the GT1 segment that is related to the FT1.
Use case for Post Detail Financial Transaction with related Order:
This information can originate in many ways. For instance, a detailed financial transaction for an ancillary charge is sent to a billing system that also tracks the transaction(s) in relation to their order via placer order number or wishes to post these transactions with the additional order information. Therefore a service reaches a state where a detailed financial transaction is created and interfaced to other systems along with optional associated order information. If the message contains multiple transactions for the same order such as a test service and venipuncture charge on the same order the ordering information is entered in the Order segment construct that precedes the FT1 segments. If a message contains multiple transactions for disparate orders for the same account each FT1 segment construct may contain the order related information specific to that transaction within the message.
* If the common order information is sent, the Order Control Code should reflect the current state of the common order and is not intended to initiate any order related triggers on the receiving application. For example if observations are included along with common order information the order control code would indicate `RE' as observations to follow.
* If common order information is sent related to the entire message or a specific financial transaction, the required Order Control Code should reflect the current state of the common order and is not intended to initiate any order related triggers on the receiving application. For example if observations are included along with common order information the order control code would indicate `RE' as observations to follow.
* If order detail information is sent related to the entire message or a specific financial transaction, the required fields for that detail segment must accompany that information.
Use case for adding the DG1 segments inside the FT1 repetition:
If diagnosis information is specific to a certain financial transaction of a patient and differs from the patient's regular insurance and/or guarantor diagnosis, you may use the DG1 segment related to the FT1 segment. If used, the information supersedes the information on the patient level.
Example: A delivery person suffers severe bruising following a fall on an icy loading dock at a delivery location of a commercial account. The costs of the accident examination provided by a general practitioner chosen and are paid by the company owning the loading dock, and not by the person/patient's private health insurance. On that same day, another physician located within the same clinic sees the person/patient to provide a flu immunization. For efficiency reasons, the person/patient made an appointment for these examinations related to the accident with the general practitioner on the same day as he already had an appointment with his primary care physician for the immunization. The immunization cost is paid by the patient's private health insurance.
Both financial transactions for the same patient/person could be sent in the same message. To bill the examination for the accident to the company owning the loading dock, you need to use the DG1 segment that is related to the FT1.

Note: The ROL segment is optionally included after the PD1 to transmit information for patient level primary care providers, after the PV2 for additional information on the physicians whose information is sent there (i.e. Attending Doctor, Referring Doctor, Consulting Doctor), and within the insurance construct to transmit information for insurance level primary care providers.
Note: There is an information overlap between the FT1, DG1 and PR1 segments. If diagnosis information is sent in an FT1 segment, it should be consistent with the information contained in any DG1 segments present within its hierarchy. Since the procedure code field within the FT1 does not repeat, if procedure information is sent on an FT1 it is recommended that the single occurrence of the code in FT1 equates to the primary procedure (PR1-14 - Procedure Priority code value 1).
Special codes in the Event Type record are used for updating.

The error segment indicates the fields that caused a transaction to be rejected.

6.4.4 QRY/DSR - generate bills and accounts receivable statements (event P04)

For patient accounting systems that support demand billing, the QRY/DSR transaction, as defined in Chapter 5, will provide the mechanism with which to request a copy of the bill for printing or viewing by the requesting system.

Note: This is a display-oriented response. That is why the associated messages are defined in Chapter 5.

6.4.5 BAR/ACK - update account (event P05)

The P05 event is sent when an existing account is being updated. From Standard Version 2.3 onward, the P01 (add account) event should no longer be used for updating an existing account, but only for creating a new account. With the addition of P10 (transmit ambulatory payment classification [APC] groups) in Version 2.4, it is expected that the P05 (update account) will be used to send inpatient coding information and the P10 (transmit ambulatory payment classification [APC] groups) will be used to send outpatient coding information.

The error segment indicates the fields that caused a transaction to be rejected.

6.4.6 BAR/ACK - end account (event P06)

The P06 event is a notification that the account is no longer open, that is, no new charges can accrue to this account. This notification is not related to whether or not the account is paid in full. EVN-2 - recorded date/time must contain the account end date.

The error segment indicates the fields that caused a transaction to be rejected.
Note: P07-P09 have been defined by the Orders/Observations Technical Committee as product experience messages.

6.4.7 BAR/ACK - transmit ambulatory payment classification (APC) groups (event P10)

The P10 event is used to communicate Ambulatory Payment Classification (APC) grouping. The grouping can be estimated or actual, based on the APC status indictor in GP1-1. This information is mandated in the USA by the Health Care Financing Administration (HCFA) for reimbursement of outpatient services. The PID and PV1 segments are included for identification purposes only. When other important fields change, it is recommended that the A08 (update patient information) event be used in addition.

The error segment indicates the fields that caused a transaction to be rejected.

6.5 MESSAGE SEGMENTS

6.5.1 FT1 - financial transaction segment

The FT1 segment contains the detail data necessary to post charges, payments, adjustments, etc. to patient accounting records.

6.5.1.0 FT1 field definitions

6.5.1.1 FT1-1 Set ID - FT1- (SI) 00355

Definition: This field contains the number that identifies this transaction. For the first occurrence of the segment the sequence number shall be 1, for the second occurrence it shall be 2, etc.

6.5.1.2 FT1-2 Transaction ID (ST) 00356

Definition: This field contains a number assigned by the sending system for control purposes. The number can be returned by the receiving system to identify errors.

6.5.1.3 FT1-3 Transaction batch ID (ST) 00357

Definition: This field uniquely identifies the batch in which this transaction belongs.

6.5.1.4 FT1-4 Transaction date (TS) 00358

Definition: This field contains the date of the transaction. For example, this field would be used to identify the date a procedure, item, or test was conducted or used. It may be defaulted to today's date.

6.5.1.5 FT1-5 Transaction posting date (TS) 00359

Definition: This field contains the date of the transaction that was sent to the financial system for posting.

6.5.1.6 FT1-6 Transaction type (IS) 00360

Definition: This field contains the code that identifies the type of transaction. Refer to User-defined Table 0017 - Transaction type for suggested values.

6.5.1.7 FT1-7 Transaction code (CE) 00361

Components: <identifier (ST)> ^ <text (ST)> ^ <name of coding system (IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^ <name of alternate coding system (IS)>
Definition: This field contains the code assigned by the institution for the purpose of uniquely identifying the transaction. For example, this field would be used to uniquely identify a procedure, supply item, or test for charging purposes. Refer to User-defined Table 0132 - Transaction code for suggested values. See Chapter 7 for a discussion of the universal service ID.

6.5.1.8 FT1-8 Transaction description (ST) 00362

Definition: This field has been retained for backward compatibility only. As of Version 2.3, FT1-7 - transaction code contains a component for the transaction description. When used for backward compatibility, FT1-8 - transaction description contains a description of the transaction associated with the code entered in FT1-7 - transaction code

6.5.1.9 FT1-9 Transaction description - Alt- (ST) 00363

Definition: This field has been retained for backward compatibility only. As of Version 2.3, FT1-7 - transaction code contains a component for the alternate transaction description. When used for backward compatibility, FT1-9 - transaction description-alt contains an alternate description of the transaction associated with the code entered in FT1-7 - transaction code.

6.5.1.10 FT1-10 Transaction quantity (NM) 00364

Definition: This field contains the quantity of items associated with this transaction.

6.5.1.11 FT1-11 Transaction amount - extended- (CP) 00365

Components: <price (MO)> ^ <price type (ID)> ^ <from value (NM)> ^ <to value (NM)> ^ <range units (CE)> ^ <range type (ID)>
Subcomponents of price: <quantity (NM)> & <denomination (ID)>
Subcomponents of range units: <identifier (ST)> & <text (ST)> & <name of coding system (IS)> & <alternate identifier (ID)> & <alternate text (ST)> & <name of alternate coding system (ST)>
Definition: This field contains the amount of a transaction. It may be left blank if the transaction is automatically priced. Total price for multiple items.

6.5.1.12 FT1-12 Transaction amount - unit- (CP) 00366

Components: <price (MO)> ^ <price type (ID)> ^ <from value (NM)> ^ <to value (NM)> ^ <range units (CE)> ^ <range type (ID)>
Subcomponents of price: <quantity (NM)> & <denomination (ID)>
Subcomponents of range units: <identifier (ST)> & <text (ST)> & <name of coding system (IS)> & <alternate identifier (ID)> & <alternate text (ST)> & <name of alternate coding system (ST)>
Definition: This field contains the unit price of a transaction. Price of a single item.

6.5.1.13 FT1-13 Department code (CE) 00367

Components: <identifier (ST)> ^ <text (ST)> ^ <name of coding system (IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^ <name of alternate coding system (IS)>
Definition: This field contains the department code that controls the transaction code described above. Refer to User-defined Table 0049 - Department code for suggested values.

6.5.1.14 FT1-14 Insurance plan ID (CE) 00368

Components: <identifier (ST)> ^ <text (ST)> ^ <name of coding system (IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^ <name of alternate coding system (IS)>
Definition: This field contains the identifier of the primary insurance plan with which this transaction should be associated. Refer to User-defined Table 0072 - Insurance plan ID for suggested values.

6.5.1.15 FT1-15 Insurance amount (CP) 00369

Components: <price (MO)> ^ <price type (ID)> ^ <from value (NM)> ^ <to value (NM)> ^ <range units (CE)> ^ <range type (ID)>
Subcomponents of price: <quantity (NM)> & <denomination (ID)>
Subcomponents of range units: <identifier (ST)> & <text (ST)> & <name of coding system (IS)> & <alternate identifier (ID)> & <alternate text (ST)> & <name of alternate coding system (ST)>
Definition: This field contains the amount to be posted to the insurance plan referenced above.

6.5.1.16 FT1-16 Assigned patient location (PL) 00133

Components: <point of care (IS)> ^ <room (IS)> ^ <bed (IS)> ^ <facility (HD)> ^ <location status (IS)> ^ <person location type (IS)> ^ <building (IS)> ^ <floor (IS)> ^ <location description (ST)>
Subcomponents of facility: <namespace ID (IS)> & <universal ID (ST)> & <universal ID type (ID)>
Definition: This field contains the current patient location. This can be the location of the patient when the charge item was ordered or when the charged service was rendered. For the current assigned patient location, use PV1-3 - assigned patient location.

6.5.1.17 FT1-17 Fee schedule (IS) 00370

Definition: This field contains the code used to select the appropriate fee schedule to be used for this transaction posting. Refer to User-defined Table 0024 - Fee schedule for suggested values.

6.5.1.18 FT1-18 Patient type (IS) 00148

Definition: This field contains the type code assigned to the patient for this episode of care (visit or stay). Refer to User-defined Table 0018 - Patient type for suggested values. This is for use when the patient type for billing purposes is different than the visit patient type in PV1-18 - patient type.

6.5.1.19 FT1-19 Diagnosis code - FT1 (CE) 00371

Components: <identifier (ST)> ^ <text (ST)> ^ <name of coding system (IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^ <name of alternate coding system (IS)>
Definition: This field contains the primary diagnosis code for billing purposes. ICD9-CM is assumed for all diagnosis codes. This is the most current diagnosis code that has been assigned to the patient. ICD10 can also be used. The name of coding system (third component) indicates which coding system is used. Refer to User-defined Table 0051 - Diagnosis code for suggested values.

6.5.1.20 FT1-20 Performed by code (XCN) 00372

Components: <ID number (ST)> ^ <family name (ST)> ^ <given name (ST)> ^ <middle initial or name (ST)> ^ <suffix (e.g., JR or III) (ST)> ^ <prefix (e.g., DR) (ST)> ^ <degree (e.g., MD) (IS)> ^ <source table (IS)> ^ <assigning authority (HD)> ^ <name type code (ID)> ^ <identifier check digit (ST)> ^ <code identifying the check digit scheme employed (ID)> ^ <identifier type code (IS)> ^ <assigning facility (HD)>^ <name representation code (ID)> ^ <name context (CE)> ^ <name validity range (DR)>
Subcomponents of family name: <family name (ST)> & <own family name prefix (ST)> & <own family name (ST)> & <family name prefix from partner/spouse (ST)> & <family name from partner/spouse (ST)>
Subcomponents of assigning authority: <namespace ID (IS)> & <universal ID (ST)> & <universal ID type (ID)
Subcomponents of assigning facility: <namespace ID (IS)> & <universal ID (ST)> & <universal ID type (ID)
Definition: This field contains the composite number/name of the person/group that performed the test/procedure/transaction, etc. This is the service provider. Refer to User-defined Table 0084 - Performed by for suggested values. Multiple names and identifiers for the same practitioner may be sent in this field, not multiple practitioners. The legal name is assumed to be in the first repetition. When the legal name is not sent, a repeat delimiter must be sent first for the first repetition.

6.5.1.21 FT1-21 Ordered by code (XCN) 00373

Components: <ID number (ST)> ^ <family name (ST)> ^ <given name (ST)> ^ <middle initial or name (ST)> ^ <suffix (e.g., JR or III) (ST)> ^ <prefix (e.g., DR) (ST)> ^ <degree (e.g., MD) (IS)> ^ <source table (IS)> ^ <assigning authority (HD)> ^ <name type code (ID)> ^ <identifier check digit (ST)> ^ <code identifying the check digit scheme employed (ID)> ^ <identifier type code (IS)> ^ <assigning facility (HD)>^ <name representation code (ID)> ^ <name context (CE)> ^ <name validity range (DR)>
Subcomponents of family name: <family name (ST)> & <own family name prefix (ST)> & <own family name (ST)> & <family name prefix from partner/spouse (ST)> & <family name from partner/spouse (ST)>
Subcomponents of assigning facility: <namespace ID (IS)> & <universal ID (ST)> & <universal ID type (ID)
Definition: This field contains the composite number/name of the person/group that ordered the test/ procedure/transaction, etc. Multiple names and identifiers for the same practitioner may be sent in this field, not multiple practitioners. The legal name is assumed to be in the first repetition. When the legal name is not sent, a repeat delimiter must be sent first for the first repetition.

6.5.1.22 FT1-22 Unit cost (CP) 00374

Components: <price (MO)> ^ <price type (ID)> ^ <from value (NM)> ^ <to value (NM)> ^ <range units (CE)> ^ <range type (ID)>
Subcomponents of price: <quantity (NM)> & <denomination (ID)>
Subcomponents of range units: <identifier (ST)> & <text (ST)> & <name of coding system (IS)> & <alternate identifier (ID)> & <alternate text (ST)> & <name of alternate coding system (ST)>
Definition: This field contains the unit cost of transaction. The cost of a single item.

6.5.1.23 FT1-23 Filler order number (EI) 00217

Components: <entity identifier (ST)> ^ <namespace ID (IS)> ^ <universal ID (ST)> ^ <universal ID type (ID)>
Definition: This field is used when the billing system is requesting observational reporting justification for a charge. This is the number used by a filler to uniquely identify a result. See Chapter 4 for a complete description.

6.5.1.24 FT1-24 Entered by code (XCN) 00765

Components: <ID number (ST)> ^ <family name (ST)> ^ <given name (ST)> ^ <middle initial or name (ST)> ^ <suffix (e.g., JR or III) (ST)> ^ <prefix (e.g., DR) (ST)> ^ <degree (e.g., MD) (IS)> ^ <source table (IS)> ^ <assigning authority (HD)> ^ <name type code (ID)> ^ <identifier check digit (ST)> ^ <code identifying the check digit scheme employed (ID)> ^ <identifier type code (IS)> ^ <assigning facility (HD)>^ <name representation code (ID)> ^ <name context (CE)> ^ <name validity range (DR)>
Subcomponents of family name: <family name (ST)> & <own family name prefix (ST)> & <own family name (ST)> & <family name prefix from partner/spouse (ST)> & <family name from partner/spouse (ST)>
Subcomponents of assigning authority: <namespace ID (IS)> & <universal ID (ST)> & <universal ID type (ID)
Subcomponents of assigning facility: <namespace ID (IS)> & <universal ID (ST)> & <universal ID type (ID)
Definition: This field identifies the composite number/name of the person who entered the insurance information.

6.5.1.25 FT1-25 Procedure code (CE) 00393

Components: <identifier (ST)> ^ <text (ST)> ^ <name of coding system (IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^ <name of alternate coding system (IS)>
Definition: This field contains a unique identifier assigned to the procedure, if any, associated with the charge. Refer to User-defined Table 0088 - Procedure code for suggested values. This field is a CE data type for compatibility with clinical and ancillary systems.

6.5.1.26 FT1-26 Procedure code modifier (CE) 01316

Components: <identifier (ST)> ^ <text (ST)> ^ <name of coding system (IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^ <name of alternate coding system (IS)>
Definition: This field contains the procedure code modifier to the procedure code reported in FT1-25-procedure code, when applicable. Procedure code modifiers are defined by regulatory agencies such as HCFA and the AMA. Multiple modifiers may be reported. Refer to User-defined Table 0340 - Procedure code modifier for suggested values.

6.5.2 DG1 - diagnosis segment

The DG1 segment contains patient diagnosis information of various types, for example, admitting, primary, etc. The DG1 segment is used to send multiple diagnoses (for example, for medical records encoding). It is also used when the FT1-19 - diagnosis code - FT1 does not provide sufficient information for a billing system. This diagnosis coding should be distinguished from the clinical problem segment used by caregivers to manage the patient (see Chapter 12, Patient Care). Coding methodologies are also defined.

6.5.2.0 DG1 field definitions

6.5.2.1 DG1-1 Set ID - DG1 (SI) 00375

Definition: This field contains the number that identifies this transaction. For the first occurrence of the segment the sequence number shall be 1, for the second occurrence it shall be 2, etc.

6.5.2.2 DG1-2 Diagnosis coding method (ID) 00376

Definition: This field has been retained for backward compatibility only. Use the components of DG1-3 - diagnosis code-DG1 instead of this field. When used for backward compatibility, ICD9 is the recommended coding methodology. Refer to User-de fined Table 0053 - Diagnosis coding method for suggested values.

6.5.2.3 DG1-3 Diagnosis code - DG1 (CE) 00377

Components: <identifier (ST)> ^ <text (ST)> ^ <name of coding system (IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^ <name of alternate coding system (IS)>
Definition: Use this field instead of DG1-2 - diagnosis coding method and DG1-4 - diagnosis description. (Those two fields have been retained for backward compatibility only.) DG1-3 - diagnosis code DG1 contains the diagnosis code assigned to this diagnosis. Refer to User-defined Table 0051 - Diagnosis code for suggested values. This field is a CE data type for compatibility with clinical and ancillary systems.
See Chapter 7 for suggested diagnosis codes. For the name of the coding system, refer to Chapter 7, Section 7.2.5, "Coding schemes."

6.5.2.4 DG1-4 Diagnosis description (ST) 00378

Definition: This field has been retained for backward compatibility only. Use the components of DG1-3 - diagnosis code-DG1 field instead of this field. When used for backward compatibility, DG1-4 - diagnosis description contains a description that best describes the diagnosis.

6.5.2.5 DG1-5 Diagnosis date/time (TS) 00379

Definition: This field contains the date/time that the diagnosis was determined.

6.5.2.6 DG1-6 Diagnosis type (IS) 00380

Definition: This field contains a code that identifies the type of diagnosis being sent. Refer to User-defined Table 0052 - Diagnosis type for suggested values. This field should no longer be used to indicate "DRG" because the DRG fields have moved to the new DRG segment.

6.5.2.7 DG1-7 Major diagnostic category (CE) 00381

Components: <identifier (ST)> ^ <text (ST)> ^ <name of coding system (IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^ <name of alternate coding system (IS)>
Definition: This field has been retained for backward compatibility only. This field should only be used in a master file transaction. Refer to User-defined Table 0118 - Major diagnostic category for suggested values.

6.5.2.8 DG1-8 Diagnostic related group (CE) 00382

Components: <identifier (ST)> ^ <text (ST)> ^ <name of coding system (IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^ <name of alternate coding system (IS)>
Definition: This field has been retained for backward compatibility only. This field has moved to the new DRG segment. It contains the DRG for the transaction. Interim DRGs could be determined for an encounter. Refer to User-defined Table 0055 - Diagnosis Related Group for suggested values.

6.5.2.9 DG1-9 DRG approval indicator (ID) 00383

Definition: This field has been retained for backward compatibility only. This field has moved to the new DRG segment. This field indicates if the DRG has been approved by a reviewing entity. Refer to HL7 table 0136 - Yes/no indicator for valid values.

6.5.2.10 DG1-10 DRG grouper review code (IS) 00384

Definition: This field has been retained for backward compatibility only. This field has moved to the new DRG segment. Refer to User-defined Table 0056 - DRG grouper review code for suggested values. This code indicates that the grouper results have been reviewed and approved.

6.5.2.11 DG1-11 Outlier type (CE) 00385

Components: <identifier (ST)> ^ <text (ST)> ^ <name of coding system (IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^ <name of alternate coding system (IS)>
Definition: This field has been retained for backward compatibility only. This field has moved to the new DRG segment. When used for backward compatibility, this field contains the type of outlier (i.e. period of care beyond DRG-standard stay in facility) that has been paid. Refer to User-defined Table 0083 - Outlier type for suggested values.

6.5.2.12 DG1-12 Outlier days (NM) 00386

Definition: This field has been retained for backward compatibility only. This field has moved to the new DRG segment. When used for backward compatibility, this field contains the number of days that have been approved for an outlier payment.

6.5.2.13 DG1-13 Outlier cost (CP) 00387

Components: <price (MO)> ^ <price type (ID)> ^ <from value (NM)> ^ <to value (NM)> ^ <range units (CE)> ^ <range type (ID)>
Subcomponents of price: <quantity (NM)> & <denomination (ID)>
Subcomponents of range units: <identifier (ST)> & <text (ST)> & <name of coding system (IS)> & <alternate identifier (ID)> & <alternate text (ST)> & <name of alternate coding system (ST)>
Definition: This field has been retained for backward compatibility only. This field has moved to the new DRG segment. When used for backward compatibility, this field contains the amount of money that has been approved for an outlier payment.

6.5.2.14 DG1-14 Grouper version and type (ST) 00388

Definition: This field has been retained for backward compatibility only. This field has moved to the new DRG segment; refer to the field definition in Section 6.5.3.1. When used for backward compatibility, this field contains the grouper version and type.

6.5.2.15 DG1-15 Diagnosis priority (ID) 00389

Definition: This field contains the number that identifies the significance or priority of the diagnosis code. Refer to User-defined Table 0359 - Diagnosis priority for suggested values.

6.5.2.16 DG1-16 Diagnosing clinician (XCN) 00390

Components: <ID number (ST)> ^ <family name (ST)> ^ <given name (ST)> ^ <middle initial or name (ST)> ^ <suffix (e.g., JR or III) (ST)> ^ <prefix (e.g., DR) (ST)> ^ <degree (e.g., MD) (IS)> ^ <source table (IS)> ^ <assigning authority (HD)> ^ <name type code(ID)> ^ <identifier check digit (ST)> ^ <code identifying the check digit scheme employed (ID)> ^ <identifier type code (IS)> ^ <assigning facility (HD)>^ <name representation code (ID)> ^ <name context (CE)> ^ <name validity range (DR)>
Subcomponents of family name: <family name (ST)> & <own family name prefix (ST)> & <own family name (ST)> & <family name prefix from partner/spouse (ST)> & <family name from partner/spouse (ST)>
Subcomponents of assigning authority: <namespace ID (IS)> & <universal ID (ST)> & <universal ID type (ID)
Subcomponents of assigning facility: <namespace ID (IS)> & <universal ID (ST)> & <universal ID type (ID)
Definition: This field contains the individual responsible for generating the diagnosis information. Multiple names and identifiers for the same person may be sent in this field, not multiple diagnosing clinicians. The legal name is assumed to be in the first repetition. When the legal name is not sent, a repeat delimiter must be sent first for the first repetition.

6.5.2.17 DG1-17 Diagnosis classification (IS) 00766

Definition: This field indicates if the patient information is for a diagnosis or a non-diagnosis code. Refer to User-defined Table 0228 - Diagnosis classification for suggested values.

6.5.2.18 DG1-18 Confidential indicator (ID) 00767

Definition: This field indicates whether the diagnosis is confidential. Refer to HL7 table 0136 - Yes/no indicator for valid values.
Y the diagnosis is a confidential diagnosis
N the diagnosis does not contain a confidential diagnosis

6.5.2.19 DG1-19 Attestation date/time (TS) 00768

Definition: This field contains the time stamp that indicates the date and time that the attestation was signed.

6.5.3 DRG - diagnosis related group segment

The DRG segment contains diagnoses-related grouping information of various types. The DRG segment is used to send the DRG information, for example, for billing and medical records encoding.

6.5.3.0 DRG field definitions

6.5.3.1 DRG-1 Diagnostic related group (CE) 00382

Components: <identifier (ST)> ^ <text (ST)> ^ <name of coding system (IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^ <name of alternate coding system (IS)>
Definition: This field contains the DRG for the transaction. Interim DRG's could be determined for an encounter. Refer to User-defined Table 0055 - DRG for suggested values. For the name of coding system component, send the grouper version and type.

6.5.3.2 DRG-2 DRG assigned date/time (TS) 00769

Definition: This field contains the time stamp to indicate the date and time that the DRG was assigned.

6.5.3.3 DRG-3 DRG approval indicator (ID) 00383

Definition: This field indicates if the DRG has been approved by a reviewing entity. Refer to HL7 table 0136 - Yes/no indicator for valid values.

6.5.3.4 DRG-4 DRG grouper review code (IS) 00384

Definition: This code indicates that the grouper results have been reviewed and approved. Refer to User-defined Table 0056 - DRG grouper review code for suggested values.

6.5.3.5 DRG-5 Outlier type (CE) 00385

Components: <identifier (ST)> ^ <text (ST)> ^ <name of coding system (IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^ <name of alternate coding system (IS)>
Definition: Refers to the type of outlier (i.e. period of care beyond DRG-standard stay in facility) that has been paid. Refer to User-defined Table 0083 - Outlier type for suggested values.

6.5.3.6 DRG-6 Outlier days (NM) 00386

Definition: This field contains the number of days that have been approved as an outlier payment.

6.5.3.7 DRG-7 Outlier cost (CP) 00387

Components: <price (MO)> ^ <price type (ID)> ^ <from value (NM)> ^ <to value (NM)> ^ <range units (CE)> ^ <range type (ID)>
Subcomponents of price: <quantity (NM)> & <denomination (ID)>
Subcomponents of range units: <identifier (ST)> & <text (ST)> & <name of coding system (IS)> & <alternate identifier (ID)> & <alternate text (ST)> & <name of alternate coding system (ST)>
Definition: This field contains the amount of money that has been approved for an outlier payment.

6.5.3.8 DRG-8 DRG payor (IS) 00770

Definition: This field indicates the associated DRG Payor. Refer to User-defined Table 0229 - DRG payor for suggested values.

6.5.3.9 DRG-9 Outlier reimbursement (CP) 00771

Components: <price (MO)> ^ <price type (ID)> ^ <from value (NM)> ^ <to value (NM)> ^ <range units (CE)> ^ <range type (ID)>
Subcomponents of price: <quantity (NM)> & <denomination (ID)>
Subcomponents of range units: <identifier (ST)> & <text (ST)> & <name of coding system (IS)> & <alternate identifier (ID)> & <alternate text (ST)> & <name of alternate coding system (ST)>
Definition: Where applicable, the outlier reimbursement amount indicates the part of the total reimbursement designated for reimbursement of outlier conditions (day or cost).

6.5.3.10 DRG-10 Confidential indicator (ID) 00767

Definition: This field indicates if the DRG contains a confidential diagnosis. Refer to HL7 table 0136 - Yes/no indicator for valid values.
Y the DRG contains a confidential diagnosis
N the DRG does not contain a confidential diagnosis

6.5.3.11 DRG-11 DRG transfer type (IS) 01500

Definition: This field indicates the type of hospital receiving a transfer patient, which affects how a facility is reimbursed under diagnosis related group (DRGs), for example, exempt or non-exempt. Refer to User-defined Table 0415 - DRG transfer type for suggested values.

6.5.4 PR1 - procedures segment

The PR1 segment contains information relative to various types of procedures that can be performed on a patient. The PR1 segment can be used to send procedure information, for example: Surgical, Nuclear Medicine, X-ray with contrast, etc. The PR1 segment is used to send multiple procedures, for example, for medical records encoding or for billing systems.

6.5.4.0 PR1 field definitions

6.5.4.1 PR1-1 Set ID - PR1- (SI) 00391

Definition: This field contains the number that identifies this transaction. For the first occurrence of the segment the sequence number shall be 1, for the second occurrence it shall be 2, etc.

6.5.4.2 PR1-2 Procedure coding method (IS) 00392

Definition: This field has been retained for backward compatibility only. Use the components of PR1-3 - procedure code instead of this field.
When used for backward compatibility, PR1-2 - procedure coding method contains the methodology used to assign a code to the procedure (CPT4, for example). If more than one coding method is needed for a single procedure, this field and the associated values in PR1-3 - procedure code and PR1-4 - procedure description may repeat. In this instance, the three fields (PR1-2 through PR1-4) are directly associated with one another. Refer to User-defined Table 0089 - Procedure coding method for suggested values.

6.5.4.3 PR1-3 Procedure code (CE) 00393

Components: <identifier (ST)> ^ <text (ST)> ^ <name of coding system (IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^ <name of alternate coding system (IS)>
Definition: Use this field instead of PR1-2 - procedure coding method and PR1-4 - procedure description. Those two fields have been retained for backward compatibility only. This field contains a unique identifier assigned to the procedure. Refer to User-defined Table 0088 - Procedure code for suggested values. This field is a CE data type for compatibility with clinical and ancillary systems.

6.5.4.4 PR1-4 Procedure description (ST) 00394

Definition: This field has been retained for backward compatibility only. Use the components of PR1-3 - procedure code instead of this field. The field contains a text description that describes the procedure.

6.5.4.5 PR1-5 Procedure date/time (TS) 00395

Definition: This field contains the date/time that the procedure was performed.

6.5.4.6 PR1-6 Procedure functional type (IS) 00396

Definition: This field contains the optional code that further defines the type of procedure. Refer to User-defined Table 0230 - Procedure functional type for suggested values.

6.5.4.7 PR1-7 Procedure minutes (NM) 00397

Definition: This field indicates the length of time in whole minutes that the procedure took to complete.

6.5.4.8 PR1-8 Anesthesiologist (XCN) 00398

Components: <ID number (ST)> ^ <family name (ST)> ^ <given name (ST)> ^ <middle initial or name (ST)> ^ <suffix (e.g., JR or III) (ST)> ^ <prefix (e.g., DR) (ST)> ^ <degree (e.g., MD) (IS)> ^ <source table (IS)> ^ <assigning authority (HD)> ^ <name type code(ID)> ^ <identifier check digit (ST)> ^ <code identifying the check digit scheme employed (ID)> ^ <identifier type code (IS)> ^ <assigning facility (HD)>^ <name representation code (ID)> ^ <name context (CE)> ^ <name validity range (DR)>
Subcomponents of family name: <family name (ST)> & <own family name prefix (ST)> & <own family name (ST)> & <family name prefix from partner/spouse (ST)> & <family name from partner/spouse (ST)>
Subcomponents of assigning authority: <namespace ID (IS)> & <universal ID (ST)> & <universal ID type (ID)
Subcomponents of assigning facility: <namespace ID (IS)> & <universal ID (ST)> & <universal ID type (ID)
Definition: HL7 has introduced the ROL segment to report a wide range of practitioner roles related to a single procedure. This segment is described in Chapter 12. When using trigger events introduced in HL7 Version 2.3, it is recommended that the ROL segment be used to report all practitioner roles related to the procedure.
However, in order to maintain backward compatibility, the practitioner roles existing in HL7 Version 2.2 (PR1-8 - anesthesiologist, PR1-11 - surgeon, and PR1-12 - procedure practitioner) should also be populated in the PR1 segment as per the HL7 2.2 specifications. You may additionally report the practitioner information in the ROL segment (See Chapter 12, Section 12.4.3, "ROL - role segment").
When this field is used for backward compatibility, the XCN data type applies. It contains the anesthesiologist who administered the anesthesia. Use values in User-defined Table 0010 - Physician ID for first component. Multiple names and identifiers for the same person should be sent in this field, not multiple anesthesiologists. The legal name is assumed to be in the first repetition. When the legal name is not sent, a repeat delimiter must be sent first for the first repetition.

6.5.4.9 PR1-9 Anesthesia code (IS) 00399

Definition: This field contains a unique identifier of the anesthesia used during the procedure. Refer to User-defined Table 0019 - Anesthesia code for suggested values.

6.5.4.10 PR1-10 Anesthesia minutes (NM) 00400

Definition: This field contains the length of time in minutes that the anesthesia was administered.

6.5.4.11 PR1-11 Surgeon (XCN) 00401

Components: <ID number (ST)> ^ <family name (ST)> ^ <given name (ST)> ^ <middle initial or name (ST)> ^ <suffix (e.g., JR or III) (ST)> ^ <prefix (e.g., DR) (ST)> ^ <degree (e.g., MD) (IS)> ^ <source table (IS)> ^ <assigning authority (HD)> ^ <name type code(ID)> ^ <identifier check digit (ST)> ^ <code identifying the check digit scheme employed (ID)> ^ <identifier type code (IS)> ^ <assigning facility (HD)>^ <name representation code (ID)> ^ <name context (CE)> ^ <name validity range (DR)>
Subcomponents of family name: <family name (ST)> & <own family name prefix (ST)> & <own family name (ST)> & <family name prefix from partner/spouse (ST)> & <family name from partner/spouse (ST)>
Subcomponents of assigning authority: <namespace ID (IS)> & <universal ID (ST)> & <universal ID type (ID)
Subcomponents of assigning facility: <namespace ID (IS)> & <universal ID (ST)> & <universal ID type (ID)
Definition: HL7 has introduced the ROL segment to report a wide range of practitioner roles related to a single procedure. This segment is described in Chapter 12. When using trigger events introduced in HL7 Version 2.3, it is recommended that the ROL segment be used to report all practitioner roles related to the procedure.
However, in order to maintain backward compatibility, the practitioner roles existing in HL7 Version 2.2 (PR1-8 - anesthesiologist, PR1-11 - surgeon, and PR1-12 - procedure practitioner) should also be populated in the PR1 segment as per the HL7 2.2 specifications. You may additionally report the practitioner information in the ROL segment (See Chapter 12, Section 12.4.3, "ROL - role segment").
When this field is being used for backward compatibility, the XCN data type applies. It contains the surgeon who performed the procedure. Use the values in User-defined Table 0010 - Physician ID for the first component. Multiple names and identifiers for the same person should be sent in this field, not multiple surgeons. The legal name is assumed to be in the first repetition. When the legal name is not sent, a repeat delimiter must be sent first for the first repetition.

6.5.4.12 PR1-12 Procedure practitioner (XCN) 00402

Components: <ID number (ST)> ^ <family name (ST)> ^ <given name (ST)> ^ <middle initial or name (ST)> ^ <suffix (e.g., JR or III) (ST)> ^ <prefix (e.g., DR) (ST)> ^ <degree (e.g., MD) (IS)> ^ <source table (IS)> ^ <assigning authority (HD)> ^ <name type code(ID)> ^ <identifier check digit (ST)> ^ <code identifying the check digit scheme employed (ID)> ^ <identifier type code (IS)> ^ <assigning facility (HD)>^ <name representation code (ID)> ^ <name context (CE)> ^ <name validity range (DR)>
Subcomponents of family name: <family name (ST)> & <own family name prefix (ST)> & <own family name (ST)> & <family name prefix from partner/spouse (ST)> & <family name from partner/spouse (ST)>
Subcomponents of assigning authority: <namespace ID (IS)> & <universal ID (ST)> & <universal ID type (ID)
Subcomponents of assigning facility: <namespace ID (IS)> & <universal ID (ST)> & <universal ID type (ID)
Definition: HL7 has introduced the ROL segment to report a wide range of practitioner roles related to a single procedure. This segment is described in Chapter 12. When using trigger events introduced in HL7 Version 2.3, it is recommended that the ROL segment be used to report all practitioner roles related to the procedure.
However, in order to maintain backward compatibility, the practitioner roles existing in HL7 Version 2.2 (PR1-8 - anesthesiologist, PR1-11 - surgeon, and PR1-12 - procedure practitioner) should also be populated in the PR1 segment as per the HL7 2.2 specifications. You may additionally report the practitioner information in the ROL segment (See Chapter 12, Section 12.4.3, "ROL - role segment").
This field contains the different types of practitioners associated with this procedure. The ID and name components follow the standard rules defined for a composite name (XCN) field. The last component, identifier type code, indicates which type of procedure practitioner is shown. When the identifier type component is unvalued, it is assumed that the practitioner identified is a resident. Use values in User-defined Table 0010 - Physician ID for the first component. Refer to User-defined Table 0133 - Procedure practitioner identifier code type for suggested values for the identifier type code component.

6.5.4.13 PR1-13 Consent code (CE) 00403

Components: <identifier (ST)> ^ <text (ST)> ^ <name of coding system (IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^ <name of alternate coding system (IS)>
Definition: This field contains the type of consent that was obtained for permission to treat the patient. Refer to User-defined Table 0059 - Consent code for suggested values.

6.5.4.14 PR1-14 Procedure priority (ID) 00404

Definition: This field contains a number that identifies the significance or priority of the procedure code. Refer to HL7 table 0418 - Procedure priority for valid values.

6.5.4.15 PR1-15 Associated diagnosis code (CE) 00772

Components: <identifier (ST)> ^ <text (ST)> ^ <name of coding system (IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^ <name of alternate coding system (IS)>
Definition: This field contains the diagnosis that is the primary reason this procedure was performed, e.g. in the US, Medicare wants to know for which diagnosis this procedure is submitted for inclusion on HCFA 1500 form. Refer to User-defined Table 0051 - Diagnosis code for suggested values.

6.5.4.16 PR1-16 Procedure code modifier (CE) 01316

Components: <identifier (ST)> ^ <text (ST)> ^ <name of coding system (IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^ <name of alternate coding system (IS)>
Definition: This field contains the procedure code modifier to the procedure code reported in field 3, when applicable. Procedure code modifiers are defined by regulatory agencies such as HCFA and the AMA. Multiple modifiers may be reported. Refer to User-defined Table 0340 - Procedure code modifier for suggested values.

6.5.4.17 PR1-17 Procedure DRG type (IS) 01501

Definition: This field indicates a procedure's priority ranking relative to its DRG. Refer to User-defined Table 0416 - Procedure DRG type for suggested values.

6.5.4.18 PR1-18 Tissue type code (CE) 01502

Components: <identifier (ST)> ^ <text (ST)> ^ <name of coding system (IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^ <name of alternate coding system (IS)>
Definition: Code representing type of tissue removed from a patient during this procedure. Refer to User-defined Table 0417 - Tissue type code for suggested values.

6.5.5 GT1 - guarantor segment

The GT1 segment contains guarantor (e.g., the person or the organization with financial responsibility for payment of a patient account) data for patient and insurance billing applications.

6.5.5.0 GT1 field definitions

6.5.5.1 GT1-1 Set ID - GT1- (SI) 00405

Definition: GT1-1 - set ID contains a number that identifies this transaction. For the first occurrence of the segment the sequence shall be 1, for the second occurrence it shall be 2, etc.

6.5.5.2 GT1-2 Guarantor number (CX) 00406

Components: <ID (ST)> ^ <check digit (ST)> ^ <code identifying the check digit scheme employed (ID)> ^ < assigning authority (HD)> ^ <identifier type code (ID)> ^ < assigning facility (HD) ^ <effective date (DT)> ^ <expiration date (DT)>
Subcomponents of assigning authority: <namespace ID (IS)> & <universal ID (ST)> & <universal ID type (ID)
Subcomponents of assigning facility: <namespace ID (IS)> & <universal ID (ST)> & <universal ID type (ID)
Definition: This field contains the primary identifier, or other identifiers, assigned to the guarantor. The assigning authority and identifier type code are strongly recommended for all CX data types.

6.5.5.3 GT1-3 Guarantor name (XPN) 00407

Components: In Version 2.3, replaces the PN data type. <family name (FN)> ^ <given name (ST)> ^ <second and further given names or initials thereof (ST)> ^ <suffix (e.g., JR or III) (ST)> ^ <prefix (e.g., DR) (ST)> ^ <degree (e.g., MD) (IS)> ^ <name type code (ID) > ^ <name representation code (ID)> ^ <name context (CE)> ^ <name validity range (DR)> ^ <name assembly order (ID)>
Subcomponents of family name: <family name (ST)> & <own family name prefix (ST)> & <own family name (ST)> & <family name prefix from partner/spouse (ST)> & <family name from partner/spouse (ST)>
Definition: This field contains the name of the guarantor. Multiple names for the same guarantor may be sent in this field. The legal name is assumed to be in the first repetition. When the legal name is not sent, a repeat delimiter must be sent first for the first repetition.
Beginning with Version 2.3, if the guarantor is an organization, send a null value ("") in GT1-3 - guarantor name and put the organization name in GT1-21 - guarantor organization name. Either guarantor name or guarantor organization name is required.

6.5.5.4 GT1-4 Guarantor spouse name (XPN) 00408

Components: In Version 2.3, replaces the PN data type. <family name (FN)> ^ <given name (ST)> ^ <second and further given names or initials thereof (ST)> ^ <suffix (e.g., JR or III) (ST)> ^ <prefix (e.g., DR) (ST)> ^ <degree (e.g., MD) (IS)> ^ <name type code (ID) > ^ <name representation code (ID)> ^ <name context (CE)> ^ <name validity range (DR)> ^ <name assembly order (ID)>
Subcomponents of family name: <family name (ST)> & <own family name prefix (ST)> & <own family name (ST)> & <family name prefix from partner/spouse (ST)> & <family name from partner/spouse (ST)>
Definition: This field contains the name of the guarantor's spouse. Multiple names for the same guarantor spouse may be sent in this field. The legal name is assumed to be in the first repetition. When the legal name is not sent, a repeat delimiter must be sent first for the first repetition.

6.5.5.5 GT1-5 Guarantor address (XAD) 00409

Components: In Version 2.3 and later, replaces the AD data type. <street address (ST)> ^ <other designation (ST)> ^ <city (ST)> ^ <state or province (ST)> ^ <zip or postal code (ST)> ^ <country (ID)> ^ < address type (ID)> ^ <other geographic designation (ST)> ^ <county/parish code (IS)> ^ <census tract (IS)> ^ <address representation code (ID)> ^ <address validity range (DR)>
Subcomponents of street address: <street address (ST)> & <street name (ST)> & <dwelling number (ST)>
Definition: This field contains the guarantor's address. Multiple addresses for the same person may be sent in this field. The mailing address is assumed to be in the first repetition. When the mailing address is not sent, a repeat delimiter must be sent first for the first repetition.

6.5.5.6 GT1-6 Guarantor ph num - home (XTN) 00410

components: [NNN] [(999)]999-9999 [X99999] [B99999] [C any text] ^ <telecommunication use code (ID)> ^ <telecommunication equipment type (ID)> ^ <email address (ST)> ^ <country code (NM)> ^ <area/city code (NM)> ^ <phone number (NM)> ^ <extension (NM)> ^ <any text (ST)>
Definition: This field contains the guarantor's home phone number. All personal phone numbers for the guarantor may be sent in this field. The primary telephone number is assumed to be in the first repetition. When the primary telephone number is not sent, a repeat delimiter must be sent first for the first repetition.

6.5.5.7 GT1-7 Guarantor ph num - business- (XTN) 00411

Components: [NNN] [(999)]999-9999 [X99999] [B99999] [C any text] ^ <telecommunication use code (ID)> ^ <telecommunication equipment type (ID)> ^ <email address (ST)> ^ <country code (NM)> ^ <area/city code (NM)> ^ <phone number (NM)> ^ <extension (NM)> ^ <any text (ST)>
Definition: This field contains the guarantor's business phone number. All business phone numbers for the guarantor may be sent in this field. The primary telephone number is assumed to be in the first repetition. When the primary telephone number is not sent, a repeat delimiter must be sent first for the first repetition.

6.5.5.8 GT1-8 Guarantor date/time of birth (TS) 00412

Definition: This field contains the guarantor's date of birth.

6.5.5.9 GT1-9 Guarantor administrative sex (IS) 00413

Definition: This field contains the guarantor's gender. Refer to User-defined Table 0001 - Administrative sex for suggested values.

6.5.5.10 GT1-10 Guarantor type (IS) 00414

Definition: This field indicates the type of guarantor, e.g., individual, institution, etc. Refer to User-defined Table 0068 - Guarantor type for suggested values.

6.5.5.11 GT1-11 Guarantor relationship (CE) 00415

Components: <identifier (ST)> ^ <text (ST)> ^ <name of coding system (IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^ <name of alternate coding system (IS)>
Definition: This field indicates the relationship of the guarantor with the patient, e.g., parent, child, etc. Refer to User-defined Table 0063 - Relationship for suggested values.

6.5.5.12 GT1-12 Guarantor SSN (ST) 00416

Definition: This field contains the guarantor's social security number.

6.5.5.13 GT1-13 Guarantor date - begin- (DT) 00417

Definition: This field contains the date that the guarantor becomes responsible for the patient's account.

6.5.5.14 GT1-14 Guarantor date - end- (DT) 00418

Definition: This field contains the date that the guarantor stops being responsible for the patient's account.

6.5.5.15 GT1-15 Guarantor priority (NM) 00419

Definition: This field is used to determine the order in which the guarantors are responsible for the patient's account.
"1" = primary guarantor
"2" = secondary guarantor, etc.

6.5.5.16 GT1-16 Guarantor employer name (XPN) 00420

Components: In Version 2.3, replaces the PN data type. <family name (FN)> ^ <given name (ST)> ^ <second and further given names or initials thereof (ST)> ^ <suffix (e.g., JR or III) (ST)> ^ <prefix (e.g., DR) (ST)> ^ <degree (e.g., MD) (IS)> ^ <name type code (ID) > ^ <name representation code (ID)> ^ <name context (CE)> ^ <name validity range (DR)> ^ <name assembly order (ID)>
Subcomponents of family name: <family name (ST)> & <own family name prefix (ST)> & <own family name (ST)> & <family name prefix from partner/spouse (ST)> & <family name from partner/spouse (ST)>
Definition: This field contains the name of the guarantor's employer, if the employer is a person. When the guarantor's employer is an organization, use GT1-51 - guarantor employer's organization name. Multiple names for the same person may be sent in this field, not multiple employers. The legal name must be sent first in the repetition. When the legal name is not sent, a repeat delimiter must be sent first for the first repetition.

6.5.5.17 GT1-17 Guarantor employer address (XAD) 00421

Components: In Version 2.3 and later, replaces the AD data type. <street address (ST)> ^ <other designation (ST)> ^ <city (ST)> ^ <state or province (ST)> ^ <zip or postal code (ST)> ^ <country (ID)> ^ < address type (ID)> ^ <other geographic designation (ST)> ^ <county/parish code (IS)> ^ <census tract (IS)> ^ <address representation code (ID)> ^ <address validity range (DR)>
Subcomponents of street address: <street address (ST)> & <street name (ST)> & <dwelling number (ST)>
Definition: This field contains the guarantor's employer's address. Multiple addresses for the same employer may be sent in this field. The mailing address must be sent first in the repetition. When the mailing address is not sent, a repeat delimiter must be sent first for the first repetition.

6.5.5.18 GT1-18 Guarantor employer phone number (XTN) 00422

Components: [NNN] [(999)]999-9999 [X99999] [B99999] [C any text] ^ <telecommunication use code (ID)> ^ <telecommunication equipment type (ID)> ^ <email address (ST)> ^ <country code (NM)> ^ <area/city code (NM)> ^ <phone number (NM)> ^ <extension (NM)> ^ <any text (ST)>
Definition: This field contains the guarantor's employer's phone number. Multiple phone numbers for the same employer may be sent in this field. The primary telephone number must be sent first in the sequence. When the primary telephone number is not sent, a repeat delimiter must be sent first for the first repetition.

6.5.5.19 GT1-19 Guarantor employee ID number (CX) 00423

Components: <ID (ST)> ^ <check digit (ST)> ^ <code identifying the check digit scheme employed (ID)> ^ < assigning authority (HD)> ^ <identifier type code (ID)> ^ < assigning facility (HD) ^ <effective date (DT)> ^ <expiration date (DT)>
Subcomponents of assigning authority: <namespace ID (IS)> & <universal ID (ST)> & <universal ID type (ID)
Subcomponents of assigning facility: <namespace ID (IS)> & <universal ID (ST)> & <universal ID type (ID)
Definition: This field contains the guarantor's employee number. The assigning authority and identifier type code are strongly recommended for all CX data types.

6.5.5.20 GT1-20 Guarantor employment status (IS) 00424

Definition: This field contains the code that indicates the guarantor's employment status. Refer to User-defined Table 0066 - Employment status for suggested values.

6.5.5.21 GT1-21 Guarantor organization name (XON) 00425

Components: <organization name (ST)> ^ <organization name type code (ID)> ^ <ID number (ID)> ^ <check digit (NM)> ^ < check digit scheme (ID)> ^ <assigning authority (HD)> ^ <identifier type code (ID)> ^ <assigning facility ID (HD)> ^ <name representation code (ID)>
Subcomponents of assigning authority: <namespace ID (IS)> & <universal ID (ST)> & <universal ID type (ID)
Subcomponents of assigning facility: <namespace ID (IS)> & <universal ID (ST)> & <universal ID type (ID)
Definition: This field contains the name of the guarantor when the guarantor is an organization. Multiple names for the same guarantor may be sent in this field, not multiple guarantors. The legal name is assumed to be in the first repetition. When the legal name is not sent, a repeat delimiter must be sent first for the first repetition.
Beginning with Version 2.3, if the guarantor is a person, send a null value ("") in GT1-21 - guarantor organization name and put the person name in GT1-3 - guarantor name. Either guarantor person name or guarantor organization name is required.

6.5.5.22 GT1-22 Guarantor billing hold flag (ID) 00773

Definition: Refer to HL7 table 0136 - Yes/no indicator for valid values. This field indicates whether or not a system should suppress printing of the guarantor's bills.
Y a system should suppress printing of guarantor's bills
N a system should not suppress printing of guarantor's bills

6.5.5.23 GT1-23 Guarantor credit rating code (CE) 00774

Components: <identifier (ST)> ^ <text (ST)> ^ <name of coding system (IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^ <name of alternate coding system (IS)>
Definition: This field contains the guarantor's credit rating. Refer to User-defined Table 0341 - Guarantor credit rating code for suggested values.

6.5.5.24 GT1-24 Guarantor death date and time (TS) 00775

Definition: This field is used to indicate the date and time at which the guarantor's death occurred.

6.5.5.25 GT1-25 Guarantor death flag (ID) 00776

Definition: This field indicates whether or not the guarantor is deceased. Refer to HL7 table 0136 - Yes/no indicator for valid values.
Y the guarantor is deceased
N the guarantor is living

6.5.5.26 GT1-26 Guarantor charge adjustment code (CE) 00777

Components: <identifier (ST)> ^ <text (ST)> ^ <name of coding system (IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^ <name of alternate coding system (IS)>
Definition: This field contains user-defined codes that indicate which adjustments should be made to this guarantor's charges. For example, when the hospital agrees to adjust this guarantor's charges to a sliding scale. Refer to User-defined Table 0218 - Patient charge adjustment for suggested values.
Example: This field would contain the value used for sliding-fee scale processing.

6.5.5.27 GT1-27 Guarantor household annual income (CP) 00778

Components: <price (MO)> ^ <price type (ID)> ^ <from value (NM)> ^ <to value (NM)> ^ <range units (CE)> ^ <range type (ID)>
Subcomponents of price: <quantity (NM)> & <denomination (ID)>
Subcomponents of range units: <identifier (ST)> & <text (ST)> & <name of coding system (IS)> & <alternate identifier (ID)> & <alternate text (ST)> & <name of alternate coding system (ST)>
Definition: This field contains the combined annual income of all members of the guarantor's household.

6.5.5.28 GT1-28 Guarantor household size (NM) 00779

Definition: This field specifies the number of people living at the guarantor's primary residence.

6.5.5.29 GT1-29 Guarantor employer ID number (CX) 00780

Components: <ID (ST)> ^ <check digit (ST)> ^ <code identifying the check digit scheme employed (ID)> ^ < assigning authority (HD)> ^ <identifier type code (ID)> ^ < assigning facility (HD) ^ <effective date (DT)> ^ <expiration date (DT)>
Subcomponents of assigning authority: <namespace ID (IS)> & <universal ID (ST)> & <universal ID type (ID)
Subcomponents of assigning facility: <namespace ID (IS)> & <universal ID (ST)> & <universal ID type (ID)
Definition: This is a code that uniquely identifies the guarantor's employer when the employer is a person. It may be a user-defined code or a code defined by a government agency (Federal Tax ID#).
When further breakdowns of employer information are needed, such as a division or plant, it is recommended that the coding scheme incorporate the relationships (e.g., define separate codes for each division). The assigning authority and identifier type code are strongly recommended for all CX data types.

6.5.5.30 GT1-30 Guarantor marital status code (CE) 00781

Components: <identifier (ST)> ^ <text (ST)> ^ <name of coding system (IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^ <name of alternate coding system (IS)>
Definition: This field contains the marital status of the guarantor. Refer to User-defined Table 0002 - Marital status for suggested values.

6.5.5.31 GT1-31 Guarantor hire effective date (DT) 00782

Definition: This field contains the date that the guarantor's employment began.

6.5.5.32 GT1-32 Employment stop date (DT) 00783

Definition: This field indicates the date on which the guarantor's employment with a particular employer ended.

6.5.5.33 GT1-33 Living dependency (IS) 00755

Definition: Identifies the specific living conditions of the guarantor. Refer to User-defined Table 0223 - Living dependency for suggested values.

6.5.5.34 GT1-34 Ambulatory status (IS) 00145

Definition: Identifies the transient state of mobility for the guarantor. Refer to User-defined Table 0009 - Ambulatory status for suggested values.

6.5.5.35 GT1-35 Citizenship (CE) 00129

Components: <identifier (ST)> ^ <text (ST)> ^ <name of coding system (IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^ <name of alternate coding system (IS)>
Definition: This field contains the code to identify the guarantor's citizenship. HL7 recommends using ISO table 3166 as the suggested values in User-defined Table 0171 - Citizenship.

6.5.5.36 GT1-36 Primary language (CE) 00118

Components: <identifier (ST)> ^ <text (ST)> ^ <name of coding system (IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^ <name of alternate coding system (IS)>
Definition: This field identifies the guarantor's primary speaking language. HL7 recommends using ISO table 639 as the suggested values in User-defined Table 0296 - Primary language.

6.5.5.37 GT1-37 Living arrangement (IS) 00742

Definition: This field identifies the situation in which the person lives at his residential address. Refer to User-defined Table 0220 - Living arrangement for suggested values.

6.5.5.38 GT1-38 Publicity code (CE) 00743

Components: <identifier (ST)> ^ <text (ST)> ^ <name of coding system (IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^ <name of alternate coding system (IS)>
Definition: This field contains a user-defined code indicating what level of publicity is allowed (e.g., No Publicity, Family Only) for a guarantor. Refer to User-defined Table 0215 - Publicity code for suggested values.

6.5.5.39 GT1-39 Protection indicator (ID) 00744

Definition: This field identifies the guarantor's protection, which determines whether or not access to information about this enrollee should be restricted from users who do not have adequate authority. Refer to HL7 table 0136 - Yes/no indicator for valid values.
Y restrict access
N do not restrict access

6.5.5.40 GT1-40 Student indicator (IS) 00745

Definition: This field indicates whether the guarantor is currently a student, and whether the guarantor is a full-time or part-time student. This field does not indicate the degree level (high school, college) of the student, or his/her field of study (accounting, engineering, etc.). Refer to User-defined Table 0231- Student status for suggested values.

6.5.5.41 GT1-41 Religion (CE) 00120

Components: <identifier (ST)> ^ <text (ST)> ^ <name of coding system (IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^ <name of alternate coding system (IS)>
Definition: This field indicates the type of religion practiced by the guarantor. Refer to User-defined Table 0006 - Religion for suggested values.

6.5.5.42 GT1-42 Mother's maiden name' (XPN) 00109

Components: In Version 2.3, replaces the PN data type. <family name (FN)> ^ <given name (ST)> ^ <second and further given names or initials thereof (ST)> ^ <suffix (e.g., JR or III) (ST)> ^ <prefix (e.g., DR) (ST)> ^ <degree (e.g., MD) (IS)> ^ <name type code (ID) > ^ <name representation code (ID)> ^ <name context (CE)> ^ <name validity range (DR)> ^ <name assembly order (ID)>
Subcomponents of family name: <family name (ST)> & <own family name prefix (ST)> & <own family name (ST)> & <family name prefix from partner/spouse (ST)> & <family name from partner/spouse (ST)>
Definition: This field indicates the guarantor's mother's maiden name.

6.5.5.43 GT1-43 Nationality (CE) 00739

Components: <identifier (ST)> ^ <text (ST)> ^ <name of coding system (IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^ <name of alternate coding system (IS)>
Definition: This field contains a code that identifies the nation or national grouping to which the person belongs. This may be different from a person's citizenship in countries in which multiple nationalities are recognized (for example, Spain: Basque, Catalan, etc.). HL7 recommends using ISO table 3166 as suggested values in User-defined Table 0212 - Nationality.

6.5.5.44 GT1-44 Ethnic group (CE) 00125

Components: <identifier (ST)> ^ <text (ST)> ^ <name of coding system (IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^ <name of alternate coding system (IS)>
Definition: This field contains the guarantor's ethnic group. Refer to User-defined Table 0189 - Ethnic group for suggested values. The second triplet of the CE data type for ethnic group (alternate identifier, alternate text, and name of alternate coding system) is reserved for governmentally assigned codes. In the US, a current use is to report ethnicity in line with US federal standards for Hispanic origin.

6.5.5.45 GT1-45 Contact person's name' (XPN) 00748

Components: In Version 2.3, replaces the PN data type. <family name (FN)> ^ <given name (ST)> ^ <second and further given names or initials thereof (ST)> ^ <suffix (e.g., JR or III) (ST)> ^ <prefix (e.g., DR) (ST)> ^ <degree (e.g., MD) (IS)> ^ <name type code (ID) > ^ <name representation code (ID)> ^ <name context (CE)> ^ <name validity range (DR)> ^ <name assembly order (ID)>
Subcomponents of family name: <family name (ST)> & <own family name prefix (ST)> & <own family name (ST)> & <family name prefix from partner/spouse (ST)> & <family name from partner/spouse (ST)>
Definition: This field contains the name of the person who should be contacted regarding the guarantor bills, etc. This may be someone other than the guarantor. (Contact guarantor's wife regarding all bills - guarantor lives out of country).
This is a repeating field that allows for multiple names for the same person. The legal name is assumed to be in the first repetition. When the legal name is not sent, a repeat delimiter must be sent first for the first repetition.

6.5.5.46 GT1-46 Contact person's telephone number' (XTN) 00749

Components: [NNN] [(999)]999-9999 [X99999] [B99999] [C any text] ^ <telecommunication use code (ID)> ^ <telecommunication equipment type (ID)> ^ <email address (ST)> ^ <country code (NM)> ^ <area/city code (NM)> ^ <phone number (NM)> ^ <extension (NM)> ^ <any text (ST)>
Definition: This field contains the telephone number of the guarantor (person) to contact regarding guarantor bills, etc. Multiple phone numbers for that person may be sent in this sequence. The primary telephone number is assumed to be in the first repetition. When the primary telephone number is not sent, a repeat delimiter must be sent first for the first repetition.

6.5.5.47 GT1-47 Contact reason (CE) 00747

Components: <identifier (ST)> ^ <text (ST)> ^ <name of coding system (IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^ <name of alternate coding system (IS)>
Definition: This field contains a user-defined code that identifies the reason for contacting the guarantor, for example, to phone the guarantor if payments are late. Refer to User-defined Table 0222 - Contact reason for suggested values.

6.5.5.48 GT1-48 Contact relationship (IS) 00784

Definition: Identifies the guarantor relationship to the contact person specified above. Refer to User-defined Table 0063 - Relationship for suggested values. Examples include wife, attorney, power of attorney, self, and organization.

6.5.5.49 GT1-49 Job title (ST) 00785

Definition: This field contains a descriptive name of the guarantor's occupation (e.g., Sr. Systems Analyst, Sr. Accountant).

6.5.5.50 GT1-50 Job code/class (JCC) 00786

Components: <job code (IS)> ^ <job class (IS)>
Definition: This field contains the guarantor's job code and employee classification. Refer to User-defined Table 0327 - Job code/class and User-defined Table 0328 - Employee classification for suggested values.

6.5.5.51 GT1-51 Guarantor employer's organization name' (XON) 01299

Components: <organization name (ST)> ^ <organization name type code (ID)> ^ <ID number (ID)> ^ <check digit (NM)> ^ < check digit scheme (ID)> ^ <assigning authority (HD)> ^ <identifier type code (ID)> ^ <assigning facility ID (HD)> ^ <name representation code (ID)>
Subcomponents of assigning authority: <namespace ID (IS)> & <universal ID (ST)> & <universal ID type (ID)
Subcomponents of assigning facility: <namespace ID (IS)> & <universal ID (ST)> & <universal ID type (ID)
Definition: This field contains the name of the guarantor's employer when the guarantor's employer is an organization. When the guarantor's employer is a person, use GT1-16 - guarantor employer name. Multiple names for the same guarantor may be sent in this field. The legal name is assumed to be in the first repetition. When the legal name is not sent, a repeat delimiter must be sent first for the first repetition.

6.5.5.52 GT1-52 Handicap (IS) 00753

Definition: This field contains a code to describe the guarantor's disability. Refer to User-defined Table 0295 - Handicap for suggested values.

6.5.5.53 GT1-53 Job status (IS) 00752

Definition: This field contains a code that identifies the guarantor's current job status. Refer to User-defined Table 0311 - Job status for suggested values.

6.5.5.54 GT1-54 Guarantor financial class (FC) 01231

Components: <financial class (IS)> ^ <effective date (TS)>
Definition: This field contains the financial class (FC) assigned to the guarantor for the purpose of identifying sources of reimbursement. It can be different than that of the patient. When the FC of the guarantor is different than the FC of the patient, and the guarantor's coverage for that patient has been exhausted, the source of reimbursement falls back onto the FC of the patient. Refer to User-defined Table 0064 - Financial class for suggested values.

6.5.5.55 GT1-55 Guarantor race (CE) 01291

Components: <identifier (ST)> ^ <text (ST)> ^ <name of coding system (IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^ <name of alternate coding system (IS)>
Definition: This field refers to the guarantor's race. Refer to User-defined Table 0005 - Race for suggested values. The second triplet of the CE data type for race (alternate identifier, alternate text, and name of alternate coding system) is reserved for governmentally assigned codes.

6.5.6 IN1 - insurance segment

The IN1 segment contains insurance policy coverage information necessary to produce properly pro-rated patient and insurance bills.

6.5.6.0 IN1 field definitions

6.5.6.1 IN1-1 Set ID - IN1- (SI) 00426

Definition: IN1-1 - set ID contains the number that identifies this transaction. For the first occurrence the sequence number shall be 1, for the second occurrence it shall be 2, etc. The Set ID in the IN1 segment is used to aggregate the grouping of insurance segments. For example, a patient with two insurance plans would have two groupings of insurance segments. IN1, IN2, and IN3 segments for Insurance Plan A with set ID 1, followed by IN1, IN2, and IN3 segments for Insurance Plan B, with set ID 2. There is no set ID in the IN2 segment because it is contained in the IN1, IN2, IN3 grouping, and is therefore not needed. The set ID in the IN3 segment is provided because there can be multiple repetitions of the IN3 segment if there are multiple certifications for the same insurance plan, e.g., IN1 (Set ID 1), IN2, IN3 (Set ID 1), IN3 (Set ID 2), IN3 (Set ID 3)

6.5.6.2 IN1-2 Insurance plan ID (CE) 00368

Components: <identifier (ST)> ^ <text (ST)> ^ <name of coding system (IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^ <name of alternate coding system (IS)>
Definition: This field contains a unique identifier for the insurance plan. Refer to User-defined Table 0072 - Insurance plan ID 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.

6.5.6.3 IN1-3 Insurance company ID (CX) 00428

Components: <ID (ST)> ^ <check digit (ST)> ^ <code identifying the check digit scheme employed (ID)> ^ < assigning authority (HD)> ^ <identifier type code (ID)> ^ < assigning facility (HD) ^ <effective date (DT)> ^ <expiration date (DT)>
Subcomponents of assigning authority: <namespace ID (IS)> & <universal ID (ST)> & <universal ID type (ID)
Subcomponents of assigning facility: <namespace ID (IS)> & <universal ID (ST)> & <universal ID type (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.

6.5.6.4 IN1-4 Insurance company name (XON) 00429

Components: <organization name (ST)> ^ <organization name type code (ID)> ^ <ID number (ID)> ^ <check digit (NM)> ^ < check digit scheme (ID)> ^ <assigning authority (HD)> ^ <identifier type code (ID)> ^ <assigning facility ID (HD)> ^ <name representation code (ID)>
Subcomponents of assigning authority: <namespace ID (IS)> & <universal ID (ST)> & <universal ID type (ID)
Subcomponents of assigning facility: <namespace ID (IS)> & <universal ID (ST)> & <universal ID type (ID)
Definition: This field contains the name of the insurance company. Multiple names for the same insurance company may be sent in this field. The legal name is assumed to be in the first repetition. When the legal name is not sent, a repeat delimiter must be sent first for the first repetition.

6.5.6.5 IN1-5 Insurance company address (XAD) 00430

Components: In Version 2.3 and later, replaces the AD data type. <street address (ST)> ^ <other designation (ST)> ^ <city (ST)> ^ <state or province (ST)> ^ <zip or postal code (ST)> ^ <country (ID)> ^ < address type (ID)> ^ <other geographic designation (ST)> ^ <county/parish code (IS)> ^ <census tract (IS)> ^ <address representation code (ID)> ^ <address validity range (DR)>
Subcomponents of street address: <street address (ST)> & <street name (ST)> & <dwelling number (ST)>
Definition: This field contains the address of the insurance company. Multiple addresses for the same insurance company may be sent in this field. The mailing address is assumed to be in the first repetition. When the mailing address is not sent, a repeat delimiter must be sent first for the first repetition.

6.5.6.6 IN1-6 Insurance co contact person (XPN) 00431

Components: In Version 2.3, replaces the PN data type. <family name (FN)> ^ <given name (ST)> ^ <second and further given names or initials thereof (ST)> ^ <suffix (e.g., JR or III) (ST)> ^ <prefix (e.g., DR) (ST)> ^ <degree (e.g., MD) (IS)> ^ <name type code (ID) > ^ <name representation code (ID)> ^ <name context (CE)> ^ <name validity range (DR)> ^ <name assembly order (ID)>
Subcomponents of family name: <family name (ST)> & <own family name prefix (ST)> & <own family name (ST)> & <family name prefix from partner/spouse (ST)> & <family name from partner/spouse (ST)>
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. The legal name is assumed to be in the first repetition. When the legal name is not sent, a repeat delimiter must be sent first for the first repetition.

6.5.6.7 IN1-7 Insurance co phone number (XTN) 00432

Components: [NNN] [(999)]999-9999 [X99999] [B99999] [C any text] ^ <telecommunication use code (ID)> ^ <telecommunication equipment type (ID)> ^ <email address (ST)> ^ <country code (NM)> ^ <area/city code (NM)> ^ <phone number (NM)> ^ <extension (NM)> ^ <any text (ST)>
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. The primary phone number is assumed to be in the first repetition. When the primary phone number is not sent, a repeat delimiter must be sent first for the first repetition.

6.5.6.8 IN1-8 Group number (ST) 00433

Definition: This field contains the group number of the insured's insurance.

6.5.6.9 IN1-9 Group name (XON) 00434

Components: <organization name (ST)> ^ <organization name type code (ID)> ^ <ID number (ID)> ^ <check digit (NM)> ^ < check digit scheme (ID)> ^ <assigning authority (HD)> ^ <identifier type code (ID)> ^ <assigning facility ID (HD)> ^ <name representation code (ID)>
Subcomponents of assigning authority: <namespace ID (IS)> & <universal ID (ST)> & <universal ID type (ID)
Subcomponents of assigning facility: <namespace ID (IS)> & <universal ID (ST)> & <universal ID type (ID)
Definition: This field contains the group name of the insured's insurance.

6.5.6.10 IN1-10 Insured's group emp. ID' (CX) 00435

Components: <ID (ST)> ^ <check digit (ST)> ^ <code identifying the check digit scheme employed (ID)> ^ < assigning authority (HD)> ^ <identifier type code (ID)> ^ < assigning facility (HD) ^ <effective date (DT)> ^ <expiration date (DT)>
Subcomponents of assigning authority: <namespace ID (IS)> & <universal ID (ST)> & <universal ID type (ID)
Subcomponents of assigning facility: <namespace ID (IS)> & <universal ID (ST)> & <universal ID type (ID)
Definition: This field holds the group employer ID for the insured's insurance. The assigning authority and identifier type code are strongly recommended for all CX data types.

6.5.6.11 IN1-11 Insured's group emp name (XON) 00436

Components: <organization name (ST)> ^ <organization name type code (ID)> ^ <ID number (ID)> ^ <check digit (NM)> ^ < check digit scheme (ID)> ^ <assigning authority (HD)> ^ <identifier type code (ID)> ^ <assigning facility ID (HD)> ^ <name representation code (ID)>
Subcomponents of assigning authority: <namespace ID (IS)> & <universal ID (ST)> & <universal ID type (ID)
Subcomponents of assigning facility: <namespace ID (IS)> & <universal ID (ST)> & <universal ID type (ID)
Definition: This field contains the name of the employer that provides the employee's insurance. Multiple names for the same employer may be sent in this sequence. The legal name must be sent first. When the legal name is not sent, a repeat delimiter must be sent first for the first repetition.

6.5.6.12 IN1-12 Plan effective date (DT) 00437

Definition: This field contains the date that the insurance goes into effect.

6.5.6.13 IN1-13 Plan expiration date (DT) 00438

Definition: This field indicates the last date of service that the insurance will cover or be responsible for.

6.5.6.14 IN1-14 Authorization information (CM) 00439

Components: <authorization number (ST)> ^ <date (DT)> ^ <source (ST)>
Definition: Based on the type of insurance, some coverage plans require that an authorization number or code be obtained prior to all non-emergency admissions, and within 48 hours of an emergency admission. Insurance billing would not be permitted without this number. The date and source of authorization are the components of this field.

6.5.6.15 IN1-15 Plan type (IS) 00440

Definition: This field contains the coding structure that identifies the various plan types, for example, Medicare, Medicaid, Blue Cross, HMO, etc. Refer to User-defined Table 0086 - Plan ID for suggested values.

6.5.6.16 IN1-16 Name of insured (XPN) 00441

Components: In Version 2.3, replaces the PN data type. <family name (FN)> ^ <given name (ST)> ^ <second and further given names or initials thereof (ST)> ^ <suffix (e.g., JR or III) (ST)> ^ <prefix (e.g., DR) (ST)> ^ <degree (e.g., MD) (IS)> ^ <name type code (ID) > ^ <name representation code (ID)> ^ <name context (CE)> ^ <name validity range (DR)> ^ <name assembly order (ID)>
Subcomponents of family name: <family name (ST)> & <own family name prefix (ST)> & <own family name (ST)> & <family name prefix from partner/spouse (ST)> & <family name from partner/spouse (ST)>
Definition: This field contains the name of the insured person. The insured is the person who has an agreement with the insurance company to provide healthcare services to persons covered by the insurance policy. Multiple names for the same insured person may be sent in this field. The legal name is assumed to be in the first repetition. When the legal name is not sent, a repeat delimiter must be sent first for the first repetition.

6.5.6.17 IN1-17 Insured's relationship to patient' (CE) 00442

Components: <identifier (ST)> ^ <text (ST)> ^ <name of coding system (IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^ <name of alternate coding system (IS)>
Definition: This field indicates the insured's relationship to the patient. Refer to User-defined Table 0063 - Relationship for suggested values.

6.5.6.18 IN1-18 Insured's date of birth (TS) 00443

Definition: This field contains the date of birth of the insured.

6.5.6.19 IN1-19 Insured's address (XAD) 00444

Components: <street address (ST)> ^ <other designation (ST)> ^ <city (ST)> ^ <state or province (ST)> ^ <zip or postal code(ST)> ^ <country (ID)> ^ < address type (ID)> ^ <other geographic designation (ST)> ^ <county/parish code (IS)> ^ <census tract (IS)> ^ <address representation code (ID)> ^ <address validity range (DR)>
Subcomponents of street address: <street address (ST)> & <street name (ST)> & <dwelling number (ST)>
Definition: This field contains the address of the insured person. The insured is the person who has an agreement with the insurance company to provide healthcare services to persons covered by an insurance policy. Multiple addresses for the same insured person may be in this field. The mailing address must be sent in the first repetition. When the legal name is not sent, a repeat delimiter must be sent first for the first repetition.

6.5.6.20 IN1-20 Assignment of benefits (IS) 00445

Definition: This field indicates whether the insured agreed to assign the insurance benefits to the healthcare provider. If so, the insurance will pay the provider directly. Refer to User-defined Table 0135 - Assignment of benefits for suggested values.