STANDARD DATA DICTIONARY #365 -- IIV RESPONSE FILE 6/27/25 PAGE 1
STORED IN ^IBCN(365, *** NO DATA STORED YET *** SITE: WWW.BMIRWIN.COM UCI: VISTA,VISTA (VERSION 2.0)
DATA NAME GLOBAL DATA
ELEMENT TITLE LOCATION TYPE
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This file holds all responses to HL7 messages generated from the IIV Transmission Queue File for Insurance Identification and
Verification. Per VHA Directive 10-93-142, this file definition should not be modified.
DD ACCESS: @
POINTED TO BY: EB DISPLAY ENTRY field (#8.03) of the INSURANCE TYPE sub-field (#2.312) of the PATIENT File (#2)
RESPONSE field (#.03) of the HL7 MESSAGES sub-field (#365.16) of the IIV TRANSMISSION QUEUE File (#365.1)
EICD RESPONSE field (#.06) of the EIV EICD TRACKING File (#365.18)
EICD VER RESPONSE field (#1.03) of the INSURANCE DISCOVERED sub-field (#365.185) of the EIV EICD TRACKING File
(#365.18)
RESPONSE ID field (#.01) of the IIV RESPONSE REVIEW File (#365.2)
CROSS
REFERENCED BY: TRANSMISSION STATUS(AC), DATE/TIME CREATED(AE), BUFFER ENTRY(AF), MESSAGE CONTROL ID(B), TRACE NUMBER(C)
INDEXED BY: DATE/TIME RECEIVED & PAYER & PATIENT (AD), DATE/TIME RECEIVED & PAYER & PATIENT & INSUR RECORD IEN & EIV AUTO-UPDATE
(AUTO)
LAST MODIFIED: MAY 26,2022@13:02:45
365,.01 MESSAGE CONTROL ID 0;1 FREE TEXT (Required)
INPUT TRANSFORM: K:$L(X)>20!($L(X)<1)!'(X'?1P.E) X
LAST EDITED: MAY 17, 2002
HELP-PROMPT: HL7 message control ID assigned. Answer must be 1-20 characters in length.
DESCRIPTION: This is the HL7 message control number that is generated at the time the HL7 message is generated
and placed in the outgoing HL7 message queue.
CROSS-REFERENCE: 365^B
1)= S ^IBCN(365,"B",$E(X,1,30),DA)=""
2)= K ^IBCN(365,"B",$E(X,1,30),DA)
This is the standard "B" cross-reference of the HL7 Message Control ID.
365,.02 PATIENT 0;2 POINTER TO PATIENT FILE (#2)
LAST EDITED: AUG 21, 2017
HELP-PROMPT: Selected patient
DESCRIPTION:
This the patient who was identified on the outgoing HL7 message.
RECORD INDEXES: AD (#275), AUTO (#481)
365,.03 PAYER 0;3 POINTER TO PAYER FILE (#365.12)
LAST EDITED: AUG 21, 2017
HELP-PROMPT: Selected payer
DESCRIPTION:
This is the payer that was selected for either identification or verification.
RECORD INDEXES: AD (#275), AUTO (#481)
365,.04 BUFFER ENTRY 0;4 POINTER TO INSURANCE VERIFICATION PROCESSOR FILE (#355.33)
LAST EDITED: JUN 13, 2002
DESCRIPTION: This field is a pointer to the Insurance Buffer File if a buffer record exists for this insurance
inquiry.
CROSS-REFERENCE: 365^AF
1)= S ^IBCN(365,"AF",$E(X,1,30),DA)=""
2)= K ^IBCN(365,"AF",$E(X,1,30),DA)
This cross-reference is by the Insurance Buffer Entry IEN. Used for error reporting.
365,.05 TRANSMISSION QUEUE 0;5 POINTER TO IIV TRANSMISSION QUEUE FILE (#365.1)
LAST EDITED: JUN 05, 2002
DESCRIPTION: This is the reference back to the Transmission Queue File. It provides a link between the inquiry
and the response.
365,.06 TRANSMISSION STATUS 0;6 POINTER TO IIV TRANSMISSION STATUS FILE (#365.14)
LAST EDITED: JUN 07, 2002
DESCRIPTION:
This is the status of the response record.
CROSS-REFERENCE: 365^AC
1)= S ^IBCN(365,"AC",$E(X,1,30),DA)=""
2)= K ^IBCN(365,"AC",$E(X,1,30),DA)
This is a standard cross-reference by the Transmission Status. It will be used to determined
records being processed.
365,.07 DATE/TIME RECEIVED 0;7 DATE
Response Date
INPUT TRANSFORM: S %DT="ESTXR" D ^%DT S X=Y K:Y<1 X
LAST EDITED: AUG 21, 2017
DESCRIPTION: This is the date and time that the HL7 response was received from the payer via the Eligibility
Communicator.
RECORD INDEXES: AD (#275), AUTO (#481)
365,.08 DATE/TIME CREATED 0;8 DATE
INPUT TRANSFORM: S %DT="ESTXR" D ^%DT S X=Y K:Y<1 X
LAST EDITED: JUN 11, 2002
DESCRIPTION: This is the date and time that the baseline response record was created when the outgoing HL7
message was generated.
CROSS-REFERENCE: 365^AE
1)= S ^IBCN(365,"AE",$E(X,1,30),DA)=""
2)= K ^IBCN(365,"AE",$E(X,1,30),DA)
Index used for IIV reporting - statistics
365,.09 TRACE NUMBER 0;9 FREE TEXT
Trace #
INPUT TRANSFORM: K:$L(X)>15!($L(X)<3) X
LAST EDITED: FEB 04, 2003
HELP-PROMPT: Answer must be 3-15 characters in length.
DESCRIPTION: This field will contain the Trace Number assigned by EC that is used for tracking a message between
EC and the vendor.
CROSS-REFERENCE: 365^C
1)= S ^IBCN(365,"C",$E(X,1,30),DA)=""
2)= K ^IBCN(365,"C",$E(X,1,30),DA)
This is the Trace Number assigned to the message from the incoming source.
365,.1 RESPONSE TYPE 0;10 SET
'O' FOR Original;
'U' FOR Unsolicited;
LAST EDITED: SEP 06, 2002
DESCRIPTION: This field identifies whether a response originated from the Transmission Queue file (Original) or
was received Unsolicited from the EC.
365,.11 DO NOT PURGE 0;11 SET
'1' FOR YES;
'0' FOR NO;
LAST EDITED: JAN 19, 2016
HELP-PROMPT: Enter 'YES' to prevent the entry from being purged. Otherwise, enter 'NO'.
DESCRIPTION: This is not to be edited by a user. If the value is 1, then this record may not be purged as it is
being referenced by a patient's insurance record.
TECHNICAL DESCR: Those records that are being pointed to by the patient's insurance subfile (#2.312) will be marked
as DO NOT PURGE (value of 1). The eIV purge routine(s) will honor this flag and not purge these
records. (^IBCNEKIT)
How this value is set: When a user accepts an insurance buffer entry #355.33 and decides to accept
the patient's eligibility benefit information, this field for the corresponding record will be
marked as DO NOT PURGE... (ICB or VistA). The field "EB DISPLAY ENTRY" (#2.312, 8.03) will be set
to point to this corresponding record in file #365 so that the data can be displayed in view only
mode; thus showing what the payer returned.
365,.12 INSUR RECORD IEN 0;12 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>999)!(X<1)!(X?.E1"."1N.N) X
LAST EDITED: AUG 21, 2017
HELP-PROMPT: Type a number between 1 and 999, 0 decimal digits.
DESCRIPTION: This field is the IEN of the insurance type record (2.312) which the code has determined is
associated with this payer response. The field is used to facilitate various auto-update reporting
TECHNICAL DESCR:
This field is set by incoming RPI messages and accept/reject buffer processing for eIV
RECORD INDEXES: AUTO (#481)
365,.13 EIV AUTO-UPDATE 0;13 SET
'0' FOR NO;
'1' FOR YES;
LAST EDITED: AUG 21, 2017
HELP-PROMPT: Set to "YES" to indicate that this response resulted in an auto-update of the patient policy
DESCRIPTION: Flag that determines whether this response successfully resulted in an auto-update of the patient
policy. A value of 1, "YES" means this response did auto-update the policy. A value of 0, "NO"
indicates that the policy was not auto-updated by this response.
TECHNICAL DESCR:
This flag is set by the incoming RPI message processing code
RECORD INDEXES: AUTO (#481)
365,.14 REQUESTED SERVICE DATE 0;14 DATE
INPUT TRANSFORM: S %DT="ESTX" D ^%DT S X=Y K:Y<1 X
LAST EDITED: DEC 20, 2021
HELP-PROMPT: Enter the service date that was sent on the X12 270, insurance inquiry.
DESCRIPTION: This is the date that was determined by the system to submit to the Payer as the date that service
was performed.
365,.15 REQUESTED SERVICE TYPE CODE 0;15 POINTER TO X12 271 SERVICE TYPE FILE (#365.013)
LAST EDITED: DEC 20, 2021
HELP-PROMPT: Enter the service type code that was sent on the X12 270, insurance inquiry.
DESCRIPTION:
Service Type code to be sent with eIV insurance inquiry.
365,1.01 *NAME OF INSURED 1;1 FREE TEXT
Subscriber
INPUT TRANSFORM: K:$L(X)>30!($L(X)<1) X
LAST EDITED: NOV 20, 2013
HELP-PROMPT: Answer must be 1-30 characters in length.
DESCRIPTION: This is the name of the insured person in LastName,FirstName MI format. If the patient is the
subscriber, this field is the same. If the patient is a dependent, the subscriber's name is stored
here.
This field is scheduled for deletion in May 2015.
NOTES: TRIGGERED by the NAME OF INSURED field of the IIV RESPONSE File
CROSS-REFERENCE: ^^TRIGGER^365^13.01
1)= X ^DD(365,1.01,1,1,1.3) I X S X=DIV S Y(1)=$S($D(^IBCN(365,D0,13)):^(13),1:"") S X=$P(Y(1),U,1)
,X=X S DIU=X K Y S X=DIV S X=$P(^IBCN(365,DA,1),U) X ^DD(365,1.01,1,1,1.4)
1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=($P(^IBCN(365,DA,1),U)'=$E($P($G(^IBCN(365,DA,13))
,U),1,30))
1.4)= S DIH=$G(^IBCN(365,DIV(0),13)),DIV=X S $P(^(13),U,1)=DIV,DIH=365,DIG=13.01 D ^DICR
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=($P(^IBCN(365,DA,1),U)="") I X S X=DIV S Y(1)=$S($D(
^IBCN(365,D0,13)):^(13),1:"") S X=$P(Y(1),U,1),X=X S DIU=X K Y S X="" X ^DD(365,1.01,1,1,2.4)
2.4)= S DIH=$G(^IBCN(365,DIV(0),13)),DIV=X S $P(^(13),U,1)=DIV,DIH=365,DIG=13.01 D ^DICR
CREATE CONDITION)= S X=($P(^IBCN(365,DA,1),U)'=$E($P($G(^IBCN(365,DA,13)),U),1,30))
CREATE VALUE)= S X=$P(^IBCN(365,DA,1),U)
DELETE CONDITION)= S X=($P(^IBCN(365,DA,1),U)="")
DELETE VALUE)= @
FIELD)= NAME OF INSURED
Triggers field 13.01 if first 30 chars of its value differ from the value in this field. Deletes
field 13.01 if field 1.01 is deleted.
365,1.02 INSURED DOB 1;2 FREE TEXT
Subscriber DOB
INPUT TRANSFORM: K:$L(X)>12!($L(X)<1) X
LAST EDITED: OCT 11, 2002
HELP-PROMPT: Answer must be 1-12 characters in length
DESCRIPTION:
The date of birth of the insured person.
365,1.03 INSURED SSN 1;3 FREE TEXT
Subscriber SSN
INPUT TRANSFORM: K:$L(X)>11!($L(X)<1) X
LAST EDITED: JUL 12, 2002
HELP-PROMPT: Answer must be 1-11 characters in length
DESCRIPTION:
The social security number of the insured person.
365,1.04 INSURED SEX 1;4 FREE TEXT
Subscriber Sex
INPUT TRANSFORM: K:$L(X)>6!($L(X)<1) X
LAST EDITED: OCT 11, 2002
HELP-PROMPT: Answer must be 1-6 characters in length
DESCRIPTION:
The sex of the insured person.
365,1.05 *SUBSCRIBER ID 1;5 FREE TEXT
Subscriber ID
INPUT TRANSFORM: K:$L(X)>20!($L(X)<1) X
LAST EDITED: NOV 20, 2013
HELP-PROMPT: Answer must be 1-20 characters in length.
DESCRIPTION: The subscriber identification of the insured person.
This field is scheduled for deletion in May 2015.
NOTES: TRIGGERED by the SUBSCRIBER ID field of the IIV RESPONSE File
CROSS-REFERENCE: ^^TRIGGER^365^13.02
1)= X ^DD(365,1.05,1,1,1.3) I X S X=DIV S Y(1)=$S($D(^IBCN(365,D0,13)):^(13),1:"") S X=$P(Y(1),U,2)
,X=X S DIU=X K Y S X=DIV S X=$P(^IBCN(365,DA,1),U,5) X ^DD(365,1.05,1,1,1.4)
1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=($P(^IBCN(365,DA,1),U,5)'=$E($P($G(^IBCN(365,DA,13
)),U,2),1,20))
1.4)= S DIH=$G(^IBCN(365,DIV(0),13)),DIV=X S $P(^(13),U,2)=DIV,DIH=365,DIG=13.02 D ^DICR
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=($P(^IBCN(365,DA,1),U,5)="") I X S X=DIV S Y(1)=$S($
D(^IBCN(365,D0,13)):^(13),1:"") S X=$P(Y(1),U,2),X=X S DIU=X K Y S X="" X ^DD(365,1.05,1,1,2.4)
2.4)= S DIH=$G(^IBCN(365,DIV(0),13)),DIV=X S $P(^(13),U,2)=DIV,DIH=365,DIG=13.02 D ^DICR
CREATE CONDITION)= S X=($P(^IBCN(365,DA,1),U,5)'=$E($P($G(^IBCN(365,DA,13)),U,2),1,20))
CREATE VALUE)= S X=$P(^IBCN(365,DA,1),U,5)
DELETE CONDITION)= S X=($P(^IBCN(365,DA,1),U,5)="")
DELETE VALUE)= @
FIELD)= SUBSCRIBER ID
Triggers field 13.02 if first 20 chars of its value differ from the value in this field. Deletes
field 13.02 if field 1.05 is deleted.
365,1.06 *GROUP NAME 1;6 FREE TEXT
Group Name
INPUT TRANSFORM: K:$L(X)>20!($L(X)<1) X
LAST EDITED: NOV 20, 2013
HELP-PROMPT: Answer must be 1-20 characters in length.
DESCRIPTION: The name of the group or plan if not an individual policy.
This field is scheduled for deletion in May 2015.
NOTES: TRIGGERED by the GROUP NAME field of the IIV RESPONSE File
CROSS-REFERENCE: ^^TRIGGER^365^14.01
1)= X ^DD(365,1.06,1,1,1.3) I X S X=DIV S Y(1)=$S($D(^IBCN(365,D0,14)):^(14),1:"") S X=$P(Y(1),U,1)
,X=X S DIU=X K Y S X=DIV S X=$P(^IBCN(365,DA,1),U,6) X ^DD(365,1.06,1,1,1.4)
1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=($P(^IBCN(365,DA,1),U,6)'=$E($P($G(^IBCN(365,DA,14
)),U),1,20))
1.4)= S DIH=$G(^IBCN(365,DIV(0),14)),DIV=X S $P(^(14),U,1)=DIV,DIH=365,DIG=14.01 D ^DICR
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=($P(^IBCN(365,DA,1),U,6)="") I X S X=DIV S Y(1)=$S($
D(^IBCN(365,D0,14)):^(14),1:"") S X=$P(Y(1),U,1),X=X S DIU=X K Y S X="" X ^DD(365,1.06,1,1,2.4)
2.4)= S DIH=$G(^IBCN(365,DIV(0),14)),DIV=X S $P(^(14),U,1)=DIV,DIH=365,DIG=14.01 D ^DICR
CREATE CONDITION)= S X=($P(^IBCN(365,DA,1),U,6)'=$E($P($G(^IBCN(365,DA,14)),U),1,20))
CREATE VALUE)= S X=$P(^IBCN(365,DA,1),U,6)
DELETE CONDITION)= S X=($P(^IBCN(365,DA,1),U,6)="")
DELETE VALUE)= @
FIELD)= GROUP NAME
Triggers field 14.01 if first 20 chars of its value differ from the value in this field. Deletes
field 14.01 if field 1.06 is deleted.
365,1.07 *GROUP NUMBER 1;7 FREE TEXT
Group ID
INPUT TRANSFORM: K:$L(X)>17!($L(X)<1) X
LAST EDITED: NOV 20, 2013
HELP-PROMPT: Answer must be 1-17 characters in length.
DESCRIPTION: The number that identifies the group or plan.
This field is scheduled for deletion in May 2015.
NOTES: TRIGGERED by the GROUP NUMBER field of the IIV RESPONSE File
CROSS-REFERENCE: ^^TRIGGER^365^14.02
1)= X ^DD(365,1.07,1,1,1.3) I X S X=DIV S Y(1)=$S($D(^IBCN(365,D0,14)):^(14),1:"") S X=$P(Y(1),U,2)
,X=X S DIU=X K Y S X=DIV S X=$P(^IBCN(365,DA,1),U,7) X ^DD(365,1.07,1,1,1.4)
1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=($P(^IBCN(365,DA,1),U,7)'=$E($P($G(^IBCN(365,DA,14
)),U,2),1,17))
1.4)= S DIH=$G(^IBCN(365,DIV(0),14)),DIV=X S $P(^(14),U,2)=DIV,DIH=365,DIG=14.02 D ^DICR
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=($P(^IBCN(365,DA,1),U,7)="") I X S X=DIV S Y(1)=$S($
D(^IBCN(365,D0,14)):^(14),1:"") S X=$P(Y(1),U,2),X=X S DIU=X K Y S X="" X ^DD(365,1.07,1,1,2.4)
2.4)= S DIH=$G(^IBCN(365,DIV(0),14)),DIV=X S $P(^(14),U,2)=DIV,DIH=365,DIG=14.02 D ^DICR
CREATE CONDITION)= S X=($P(^IBCN(365,DA,1),U,7)'=$E($P($G(^IBCN(365,DA,14)),U,2),1,17))
CREATE VALUE)= S X=$P(^IBCN(365,DA,1),U,7)
DELETE CONDITION)= S X=($P(^IBCN(365,DA,1),U,7)="")
DELETE VALUE)= @
FIELD)= GROUP NUMBER
Triggers field 14.02 if first 17 chars of its value differ from the value in this field. Deletes
field 14.02 if field 1.07 is deleted.
365,1.08 WHOSE INSURANCE 1;8 SET
Whose Insurance
'v' FOR VETERAN;
's' FOR SPOUSE;
'o' FOR OTHER;
LAST EDITED: JUL 12, 2002
DESCRIPTION: This is a definition of who is the subscriber of the insurance; the veteran, a spouse or someone
else.
365,1.09 PT RELATIONSHIP TO INSURED 1;9 SET
Pt Rel to Insured
'01' FOR PATIENT;
'02' FOR SPOUSE;
'03' FOR NATURAL CHILD;
'08' FOR EMPLOYEE;
'09' FOR UNKNOWN;
'11' FOR ORGAN DONOR;
'15' FOR INJURED PLAINTIFF;
'18' FOR PARENT;
'34' FOR OTHER ADULT;
LAST EDITED: APR 29, 2010
HELP-PROMPT: What is patient's relationship to insured?
DESCRIPTION:
This is a definition of the patient's relationship to the insured person.
365,1.1 SERVICE DATE 1;10 DATE
Service Date
INPUT TRANSFORM: S %DT="E" D ^%DT S X=Y K:X<1 X
LAST EDITED: JUL 12, 2002
HELP-PROMPT: (No range limit on date)
DESCRIPTION: This is the date of service returned by the Eligibility Communicator. It may be different from the
one sent in the original inquiry.
365,1.11 EFFECTIVE DATE 1;11 DATE
Effective Date
INPUT TRANSFORM: S %DT="E" D ^%DT S X=Y K:X<1 X
LAST EDITED: JUL 12, 2002
HELP-PROMPT: (No range limit on date)
DESCRIPTION:
This is the date that the insurance coverage began.
365,1.12 EXPIRATION DATE 1;12 DATE
Expiration Date
INPUT TRANSFORM: S %DT="E" D ^%DT S X=Y K:X<1 X
LAST EDITED: JUL 12, 2002
HELP-PROMPT: (No range limit on date)
DESCRIPTION:
This is the date that the insurance coverage ends.
365,1.13 COORDINATION OF BENEFITS 1;13 SET
COB
'1' FOR PRIMARY;
'2' FOR SECONDARY;
'3' FOR TERTIARY;
LAST EDITED: JUL 12, 2002
DESCRIPTION:
If an insurance payer is identified as a primary, secondary or tertiary in the response.
365,1.14 ERROR CONDITION 1;14 POINTER TO X12 271 ERROR CONDITION FILE (#365.017)
Error Condition
LAST EDITED: JUL 12, 2002
DESCRIPTION:
This is an error value returned from either the payer or the Eligibility Communicator.
365,1.15 ERROR ACTION 1;15 POINTER TO X12 271 ERROR ACTION FILE (#365.018)
Error Action
LAST EDITED: JUL 12, 2002
DESCRIPTION: When an error condition is returned in the response, there may be an action that directs what
happens to the response.
365,1.16 DATE OF DEATH 1;16 DATE
Date of Death
INPUT TRANSFORM: S %DT="EX" D ^%DT S X=Y K:Y<1 X
LAST EDITED: JUL 12, 2002
DESCRIPTION: This is the date that the payer indicates that the person that verification was requested for has
died.
365,1.17 CERTIFICATION DATE 1;17 DATE
Certification Date
INPUT TRANSFORM: S %DT="EX" D ^%DT S X=Y K:Y<1 X
LAST EDITED: JUL 12, 2002
DESCRIPTION:
This field may be returned by the payer and is the date that the insurance coverage was certified.
365,1.18 MEMBER ID 1;18 FREE TEXT
Member ID
INPUT TRANSFORM: K:$L(X)>20!($L(X)<1) X
LAST EDITED: OCT 10, 2002
HELP-PROMPT: Answer must be 1-20 characters in length.
DESCRIPTION:
The member identification of the insured person.
365,1.19 PAYER UPDATED POLICY 1;19 DATE
Payer Updated Policy
INPUT TRANSFORM: S %DT="EST" D ^%DT S X=Y K:Y<1 X
LAST EDITED: JUL 20, 2005
HELP-PROMPT: Enter the date the payer updated their record of this policy.
DESCRIPTION: The date/time that the payer indicated they had updated their record of this policy. This
date/time was received by IIV from the Eligibility Communicator.
365,1.2 POLICY NUMBER 1;20 FREE TEXT
Policy Number
INPUT TRANSFORM: K:$L(X)>30!($L(X)<1) X
LAST EDITED: OCT 07, 2005
HELP-PROMPT: Answer must be 1-30 characters in length.
DESCRIPTION:
This field may be returned by the payer. It is the policy number of the insured person.
365,2 ELIGIBILITY/BENEFIT 2;0 Multiple #365.02
DESCRIPTION: This multiple contains all of the eligibility and benefit data for a specific insured person
returned from the Payer.
365.02,.01 EB NUMBER 0;1 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>999)!(X<1)!(X?.E1"."1.N) X
LAST EDITED: SEP 11, 2009
HELP-PROMPT: Type a number between 1 and 999, 0 Decimal Digits.
DESCRIPTION: This is a sequential number corresponding to the Set-ID for all of the eligibility/benefit (X.12
EB segments) segments coming into VISTA.
CROSS-REFERENCE: 365.02^B
1)= S ^IBCN(365,DA(1),2,"B",$E(X,1,30),DA)=""
2)= K ^IBCN(365,DA(1),2,"B",$E(X,1,30),DA)
365.02,.02 ELIGIBILITY/BENEFIT INFO 0;2 POINTER TO X12 271 ELIGIBILITY/BENEFIT FILE (#365.011)
Elig/Ben Info
LAST EDITED: MAR 07, 2013
HELP-PROMPT: Enter an eligibility/benefit code from the list.
DESCRIPTION: This field contains a code identifying the eligibility status of the individual or the benefit
returned by the Payer.
TECHNICAL DESCR:
It corresponds to X.12 271 EB01 data element.
365.02,.03 COVERAGE LEVEL 0;3 POINTER TO X12 271 COVERAGE LEVEL FILE (#365.012)
Coverage Level
LAST EDITED: MAR 07, 2013
HELP-PROMPT: Enter a coverage level code from the list.
DESCRIPTION:
This field identifies the level of coverage of benefits.
TECHNICAL DESCR:
It corresponds to X.12 271 EB02 data element.
365.02,.04 *SERVICE TYPE 0;4 POINTER TO X12 271 SERVICE TYPE FILE (#365.013)
Service Type
LAST EDITED: NOV 22, 2010
HELP-PROMPT: Enter the service type code from the list.
DESCRIPTION:
This field is a code identifying the classification of service.
TECHNICAL DESCR: It corresponds to X.12 271 EB03 data element. This field is deprecated via IB*2.0*438. Replaced
with 365.02/14 which is a multiple with #365.292/.01.
365.02,.05 INSURANCE TYPE 0;5 POINTER TO X12 271 INSURANCE TYPE FILE (#365.014)
Insurance Type
LAST EDITED: MAR 07, 2013
HELP-PROMPT: Enter the insurance type code from the list.
DESCRIPTION:
This is a code identifying the type of insurance policy within a specific insurance program.
TECHNICAL DESCR:
It corresponds to X.12 271 EB04 data element.
365.02,.06 PLAN COVERAGE DESCRIPTION 0;6 FREE TEXT
Plan Coverage Description
INPUT TRANSFORM: K:$L(X)>50!($L(X)<1) X
LAST EDITED: OCT 13, 2009
HELP-PROMPT: Answer must be 1-50 characters in length.
DESCRIPTION:
This code is a description or number that identifies the plan or coverage.
TECHNICAL DESCR:
It corresponds to X.12 271 EB05 data element.
365.02,.07 TIME PERIOD QUALIFIER 0;7 POINTER TO X12 271 TIME PERIOD QUALIFIER FILE (#365.015)
Time Period
LAST EDITED: MAR 07, 2013
HELP-PROMPT: Enter the type of time period code from the list.
DESCRIPTION: This is a code for the time period category that determines for how long the benefits are
available.
TECHNICAL DESCR:
It corresponds to X.12 271 EB06 data element.
365.02,.08 MONETARY AMOUNT 0;8 FREE TEXT
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(+X>999999999999999)!(+X<0)!(X?.E1"."3.N) X
LAST EDITED: JUN 12, 2013
HELP-PROMPT: Type a dollar amount between 0 and 999999999999999, 2 decimal digits.
DESCRIPTION:
This field is populated if eligibility or benefit must be qualified by a monetary amount.
TECHNICAL DESCR:
It corresponds to X.12 271 EB07 data element.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
365.02,.09 PERCENT 0;9 NUMBER
Percentage
INPUT TRANSFORM: K:+X'=X!(X>100)!(X<0)!(X?.E1"."6.N) X
LAST EDITED: OCT 13, 2009
HELP-PROMPT: Type a number between 0 and 100, 5 Decimal Digits.
DESCRIPTION:
This field is used if eligibility or benefit must be qualified by a percentage.
TECHNICAL DESCR:
It corresponds to X.12 271 EB08 data element.
365.02,.1 QUANTITY QUALIFIER 0;10 POINTER TO X12 271 QUANTITY QUALIFIER FILE (#365.016)
Quantity
LAST EDITED: MAR 07, 2013
HELP-PROMPT: Enter the type of quantity code from the list.
DESCRIPTION: This field is used to identify the type of units that are being conveyed in the QUANTITY field
(#.11).
TECHNICAL DESCR:
It corresponds to X.12 271 EB09 data element.
365.02,.11 QUANTITY 0;11 FREE TEXT
INPUT TRANSFORM: K:$L(X)>15!($L(X)<1) X
LAST EDITED: OCT 13, 2009
HELP-PROMPT: Answer must be 1-15 characters in length.
DESCRIPTION:
This field number is used for the quantity value as qualified by the QUANTITY QUALIFIER field.
TECHNICAL DESCR:
It corresponds to X.12 271 EB10 data element.
365.02,.12 AUTHORIZATION/CERTIFICATION 0;12 POINTER TO X12 271 YES/NO RESPONSE CODE FILE (#365.033)
Authorization/Certification
LAST EDITED: MAR 26, 2013
HELP-PROMPT: Enter YES if authorization or certification is required.
DESCRIPTION:
This field indicates that an authorization or certification is required per plan provisions.
TECHNICAL DESCR:
It corresponds to X.12 271 EB11 data element.
365.02,.13 IN PLAN 0;13 POINTER TO X12 271 YES/NO RESPONSE CODE FILE (#365.033)
In-Plan-Network
LAST EDITED: MAR 26, 2013
HELP-PROMPT: Enter YES if the benefits identified are In-Plan-Network.
DESCRIPTION: This field indicates the plan network indicator. A YES value indicates the benefits identified
are considered In-Plan-Network. A NO value indicates that the benefits identified are considered
Out-Of-Plan-Network. A "U" value indicates it is unknown whether the benefits identified are
part of the Plan Network.
TECHNICAL DESCR:
It corresponds to X.12 271 EB12 data element.
365.02,1.01 PROCEDURE CODING METHOD 1;1 POINTER TO X12 271 PROCEDURE CODING METHOD FILE (#365.035)
LAST EDITED: MAR 07, 2013
HELP-PROMPT: Enter the code describing procedure coding method.
DESCRIPTION:
Two character code describing procedure coding method.
TECHNICAL DESCR:
Source: 271 HL7 message, ZEB.14.1
365.02,1.02 PROCEDURE CODE 1;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>48!($L(X)<1) X
LAST EDITED: JUL 10, 2009
HELP-PROMPT: Answer must be 1-48 characters in length.
DESCRIPTION:
Identification code for the procedure.
TECHNICAL DESCR:
Source: 271 HL7 message, ZEB.15
365.02,1.03 PROCEDURE MODIFIER 1 1;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>2!($L(X)<1) X
LAST EDITED: JUL 10, 2009
HELP-PROMPT: Answer must be 1-2 characters in length.
DESCRIPTION:
Identifies special circumstances related to the procedure; first modifier.
TECHNICAL DESCR:
Source: 271 HL7 message, ZEB.16 (repetition 1)
365.02,1.04 PROCEDURE MODIFIER 2 1;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>2!($L(X)<1) X
LAST EDITED: JUL 10, 2009
HELP-PROMPT: Answer must be 1-2 characters in length.
DESCRIPTION:
Identifies special circumstances related to the procedure; second modifier.
TECHNICAL DESCR:
Source: 271 HL7 message, ZEB.16 (repetition 2)
365.02,1.05 PROCEDURE MODIFIER 3 1;5 FREE TEXT
INPUT TRANSFORM: K:$L(X)>2!($L(X)<1) X
LAST EDITED: JUL 10, 2009
HELP-PROMPT: Answer must be 1-2 characters in length.
DESCRIPTION:
Identifies special circumstances related to the procedure; third modifier.
TECHNICAL DESCR:
Source: 271 HL7 message, ZEB.16 (repetition 3)
365.02,1.06 PROCEDURE MODIFIER 4 1;6 FREE TEXT
INPUT TRANSFORM: K:$L(X)>2!($L(X)<1) X
LAST EDITED: JUL 10, 2009
HELP-PROMPT: Answer must be 1-2 characters in length.
DESCRIPTION:
Identifies special circumstances related to the procedure; fourth modifier.
TECHNICAL DESCR:
Source: 271 HL7 message, ZEB.16 (repetition 4)
365.02,2 NOTES 2;0 WORD-PROCESSING #365.22
DESCRIPTION: This field contains any additional text about the eligibility benefit information. It is
transcribed from X.12 271 MSG segments.
LAST EDITED: SEP 10, 2009
DESCRIPTION: This field contains any additional text about the eligibility benefit information. It is
transcribed from X.12 271 MSG segments.
365.02,3.01 ENTITY ID CODE 3;1 POINTER TO X12 271 ENTITY IDENTIFIER CODE FILE (#365.022)
LAST EDITED: MAR 05, 2013
HELP-PROMPT: Select X12 code for entity identifier.
DESCRIPTION:
X12 Entity Identifier Code.
TECHNICAL DESCR:
Source: 271 HL7 message, ZTY.2.1
365.02,3.02 ENTITY TYPE 3;2 POINTER TO X12 271 ENTITY TYPE QUALIFIER FILE (#365.043)
LAST EDITED: MAR 05, 2013
HELP-PROMPT: Select type of the entity.
DESCRIPTION:
Describes the type of Entity.
TECHNICAL DESCR:
Source: 271 HL7 message, ZTY.3.1
365.02,3.03 NAME 3;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>98!($L(X)<1) X
LAST EDITED: JUL 10, 2009
HELP-PROMPT: Answer must be 1-98 characters in length.
DESCRIPTION:
Name of person or organization.
TECHNICAL DESCR: Source: 271 HL7 message, combined elements ZTY.4.1.1 (last name or organization name), ZTY.4.2
(first name) , ZTY.4.3 (middle name), and ZTY.4.4 (suffix).
365.02,3.04 ENTITY ID 3;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>80!($L(X)<1) X
LAST EDITED: JUL 10, 2009
HELP-PROMPT: Answer must be 1-80 characters in length.
DESCRIPTION:
Entity identifier.
TECHNICAL DESCR:
Source: 271 HL7 message, ZTY.6
365.02,3.05 ENTITY ID QUALIFIER 3;5 POINTER TO X12 271 IDENTIFICATION QUALIFIER FILE (#365.023)
LAST EDITED: MAR 06, 2013
HELP-PROMPT: Select X12 code for ID qualifier.
DESCRIPTION:
Code designating the system/method used for Identification.
TECHNICAL DESCR:
Source: 271 HL7 message, ZTY.5.1
365.02,3.06 ENTITY RELATIONSHIP CODE 3;6 POINTER TO X12 271 ENTITY RELATIONSHIP CODE FILE (#365.031)
LAST EDITED: MAR 18, 2013
HELP-PROMPT: Enter the code that represents the relationship to the patient.
DESCRIPTION:
Benefit Related Entity's relationship to the patient.
TECHNICAL DESCR:
Source: 271 HL7 message ZTY.13
365.02,4.01 ADDRESS LINE 1 4;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>55!($L(X)<1) X
LAST EDITED: JUL 10, 2009
HELP-PROMPT: Answer must be 1-55 characters in length.
DESCRIPTION:
Entity address, line 1.
TECHNICAL DESCR:
Source: 271 HL message, ZTY.7.1.1
365.02,4.02 ADDRESS LINE 2 4;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>55!($L(X)<1) X
LAST EDITED: JUL 10, 2009
HELP-PROMPT: Answer must be 1-55 characters in length.
DESCRIPTION:
Entity address, line 2.
TECHNICAL DESCR:
Source: 271 HL7 message, ZTY.7.2
365.02,4.03 CITY 4;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<1) X
LAST EDITED: JUL 10, 2009
HELP-PROMPT: Answer must be 1-30 characters in length.
DESCRIPTION:
Entity address, city.
TECHNICAL DESCR:
Source: 271 HL7 message, ZTY.7.3
365.02,4.04 STATE 4;4 POINTER TO STATE FILE (#5)
LAST EDITED: JUL 10, 2009
HELP-PROMPT: Select state/province code.
DESCRIPTION:
Entity address, state or province code.
TECHNICAL DESCR:
Source: 271 HL7 message, ZTY.7.4
365.02,4.05 ZIP 4;5 FREE TEXT
INPUT TRANSFORM: K:$L(X)>15!($L(X)<1) X
LAST EDITED: JUL 10, 2009
HELP-PROMPT: Answer must be 1-15 characters in length.
DESCRIPTION:
Entity address, zip or postal code.
TECHNICAL DESCR:
Source: 271 HL7 message, ZTY.7.5
365.02,4.06 COUNTRY CODE 4;6 FREE TEXT
INPUT TRANSFORM: K:$L(X)>3!($L(X)<2) X
LAST EDITED: JUL 10, 2009
HELP-PROMPT: Answer must be 2-3 characters in length.
DESCRIPTION:
Entity address, country code.
TECHNICAL DESCR:
Source: 271 HL7 message, ZTY.7.6
365.02,4.07 LOCATION 4;7 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<1) X
LAST EDITED: JUL 10, 2009
HELP-PROMPT: Answer must be 1-30 characters in length.
DESCRIPTION:
Entity address, location identifier.
TECHNICAL DESCR:
Source: 271 HL7 message, ZTY.9
365.02,4.08 LOCATION QUALIFIER 4;8 POINTER TO X12 271 LOCATION QUALIFER FILE (#365.034)
LAST EDITED: MAR 06, 2013
HELP-PROMPT: Select location qualifier.
DESCRIPTION:
Entity address, location qualifier.
TECHNICAL DESCR:
Source: 271 HL7 message, ZTY.8
365.02,4.09 SUBDIVISION CODE 4;9 FREE TEXT
INPUT TRANSFORM: K:$L(X)>3!($L(X)<1) X
LAST EDITED: AUG 10, 2010
HELP-PROMPT: Answer must be 1-3 characters in length.
DESCRIPTION:
Entity address, country subdivision code.
TECHNICAL DESCR:
Source: 271 HL7 message, ZTY.7.8.
365.02,5.01 PROVIDER CODE 5;1 POINTER TO X12 271 PROVIDER CODE FILE (#365.024)
LAST EDITED: MAR 06, 2013
HELP-PROMPT: Select provider code.
DESCRIPTION:
Code identifying the type of provider.
TECHNICAL DESCR:
Source: 271 HL7 message, ZTY.10.1
365.02,5.02 REFERENCE ID 5;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<1) X
LAST EDITED: JUL 13, 2009
HELP-PROMPT: Answer must be 1-30 characters in length.
DESCRIPTION:
Reference identifier.
TECHNICAL DESCR:
Source: 271 HL7 message, ZTY.12
365.02,5.03 REFERENCE ID QUALIFIER 5;3 POINTER TO X12 271 REFERENCE IDENTIFICATION FILE (#365.028)
LAST EDITED: MAR 06, 2013
HELP-PROMPT: Select reference id qualifier.
DESCRIPTION:
Reference identifier type.
TECHNICAL DESCR:
Source: 271 HL7 message, ZTY.11.1
365.02,6 CONTACT INFORMATION 6;0 Multiple #365.26 (Add New Entry without Asking)
DESCRIPTION:
This multiple contains contact information for an eligibility/benefit entity.
TECHNICAL DESCR:
Source: 271 HL7 message, CTD segment within G2O group.
365.26,.01 SEQUENCE 0;1 NUMBER (Required)
INPUT TRANSFORM: K:+X'=X!(X>99999)!(X<1)!(X?.E1"."1.N) X
LAST EDITED: SEP 10, 2009
HELP-PROMPT: Type a number between 1 and 99999, 0 Decimal Digits.
DESCRIPTION:
Sequential entry number.
TECHNICAL DESCR:
Sequential number of G2O.CTD segment.
CROSS-REFERENCE: 365.26^B
1)= S ^IBCN(365,DA(2),2,DA(1),6,"B",$E(X,1,30),DA)=""
2)= K ^IBCN(365,DA(2),2,DA(1),6,"B",$E(X,1,30),DA)
365.26,.02 NAME 0;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>98!($L(X)<1) X
LAST EDITED: JUL 13, 2009
HELP-PROMPT: Answer must be 1-98 characters in length.
DESCRIPTION:
Name of the contact.
TECHNICAL DESCR: Source: 271 HL7 message, G2O.CTD.2 - combined data from CTD.2.5 (prefix), CTD.2.1.1 (last
name), CTD.2.2 (first name), CTD.2.3 (middle name), CTD.2.4 (suffix), and CTD.2.6 (degree).
365.26,.03 *COMMUNICATION NUMBER 0;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<1) X
LAST EDITED: DEC 04, 2013
HELP-PROMPT: Answer must be 1-30 characters in length.
DESCRIPTION: Phone, fax, email, etc.
This field is scheduled for deletion in May 2015.
TECHNICAL DESCR:
Source: 271 HL7 message, G2O.CTD.5.1
NOTES: TRIGGERED by the COMMUNICATION NUMBER field of the CONTACT INFORMATION sub-field of the
ELIGIBILITY/BENEFIT sub-field of the IIV RESPONSE File
CROSS-REFERENCE: ^^TRIGGER^365.26^1
1)= X ^DD(365.26,.03,1,1,1.3) I X S X=DIV S Y(1)=$S($D(^IBCN(365,D0,2,D1,6,D2,1)):^(1),1:"") S X=$P
(Y(1),U,1),X=X S DIU=X K Y S X=DIV S X=$P(^IBCN(365,DA(2),2,DA(1),6,DA,0),U,3) X ^DD(365.26,.03,1,1
,1.4)
1.3)= K DIV S DIV=X,D0=DA(2),DIV(0)=D0,D1=DA(1),DIV(1)=D1,D2=DA,DIV(2)=D2 S Y(0)=X S X=($P(^IBCN(36
5,DA(2),2,DA(1),6,DA,0),U,3)'=$E($P($G(^IBCN(365,DA(2),2,DA(1),6,DA,1)),U),1,30))
1.4)= S DIH=$G(^IBCN(365,DIV(0),2,DIV(1),6,DIV(2),1)),DIV=X S $P(^(1),U,1)=DIV,DIH=365.26,DIG=1 D ^
DICR
2)= X ^DD(365.26,.03,1,1,2.3) I X S X=DIV S Y(1)=$S($D(^IBCN(365,D0,2,D1,6,D2,1)):^(1),1:"") S X=$P
(Y(1),U,1),X=X S DIU=X K Y S X="" S DIH=$G(^IBCN(365,DIV(0),2,DIV(1),6,DIV(2),1)),DIV=X S $P(^(1),U
,1)=DIV,DIH=365.26,DIG=1 D ^DICR
2.3)= K DIV S DIV=X,D0=DA(2),DIV(0)=D0,D1=DA(1),DIV(1)=D1,D2=DA,DIV(2)=D2 S Y(0)=X S X=($P(^IBCN(36
5,DA(2),2,DA(1),6,DA,0),U,3)="")
CREATE CONDITION)= S X=($P(^IBCN(365,DA(2),2,DA(1),6,DA,0),U,3)'=$E($P($G(^IBCN(365,DA(2),2,DA(1),6
,DA,1)),U),1,30))
CREATE VALUE)= S X=$P(^IBCN(365,DA(2),2,DA(1),6,DA,0),U,3)
DELETE CONDITION)= S X=($P(^IBCN(365,DA(2),2,DA(1),6,DA,0),U,3)="")
DELETE VALUE)= @
FIELD)= COMMUNICATION NUMBER
Triggers field 365.26/1 if first 30 chars of its value differ from the value in this field.
Deletes field 365.26/1 if field 365.26/.03 is deleted.
365.26,.04 COMMUNICATION QUALIFIER 0;4 POINTER TO X12 271 CONTACT QUALIFIER FILE (#365.021)
LAST EDITED: MAR 06, 2013
HELP-PROMPT:Select type of communication number.
DESCRIPTION:
Code describing type of communication number.
TECHNICAL DESCR:
Source: 271 HL7 message, G2O.CTD.5.9
365.26,1 COMMUNICATION NUMBER 1;1 FREE TEXT
INPUT TRANSFORM:K:$L(X)>245!($L(X)<1) X
LAST EDITED: DEC 04, 2013
HELP-PROMPT:Answer must be 1-245 characters in length.
DESCRIPTION:
Phone, fax, email, etc.
TECHNICAL DESCR:
Replaces field .03. Source: 271 HL7 message,G2O.CTD.5.1
NOTES: TRIGGERED by the *COMMUNICATION NUMBER field of the CONTACT INFORMATION sub-field of the
ELIGIBILITY/BENEFIT sub-field of the IIV RESPONSE File
CROSS-REFERENCE:^^TRIGGER^365.26^.03
1)= X ^DD(365.26,1,1,1,1.3) I X S X=DIV S Y(1)=$S($D(^IBCN(365,D0,2,D1,6,D2,0)):^(0),1:"") S X=$P(Y
(1),U,3),X=X S DIU=X K Y S X=DIV S X=$E($P(^IBCN(365,DA(2),2,DA(1),6,DA,1),U),1,30) X ^DD(365.26,1,
1,1,1.4)
1.3)= K DIV S DIV=X,D0=DA(2),DIV(0)=D0,D1=DA(1),DIV(1)=D1,D2=DA,DIV(2)=D2 S Y(0)=X S X=($P(^IBCN(36
5,DA(2),2,DA(1),6,DA,0),U,3)'=$E($P($G(^IBCN(365,DA(2),2,DA(1),6,DA,1)),U),1,30))
1.4)= S DIH=$G(^IBCN(365,DIV(0),2,DIV(1),6,DIV(2),0)),DIV=X S $P(^(0),U,3)=DIV,DIH=365.26,DIG=.03 D
^DICR
2)= X ^DD(365.26,1,1,1,2.3) I X S X=DIV S Y(1)=$S($D(^IBCN(365,D0,2,D1,6,D2,0)):^(0),1:"") S X=$P(Y
(1),U,3),X=X S DIU=X K Y S X="" S DIH=$G(^IBCN(365,DIV(0),2,DIV(1),6,DIV(2),0)),DIV=X S $P(^(0),U,3
)=DIV,DIH=365.26,DIG=.03 D ^DICR
2.3)= K DIV S DIV=X,D0=DA(2),DIV(0)=D0,D1=DA(1),DIV(1)=D1,D2=DA,DIV(2)=D2 S Y(0)=X S X=($P(^IBCN(36
5,DA(2),2,DA(1),6,DA,1),U)="")
CREATE CONDITION)= S X=($P(^IBCN(365,DA(2),2,DA(1),6,DA,0),U,3)'=$E($P($G(^IBCN(365,DA(2),2,DA(1),6
,DA,1)),U),1,30))
CREATE VALUE)= S X=$E($P(^IBCN(365,DA(2),2,DA(1),6,DA,1),U),1,30)
DELETE CONDITION)= S X=($P(^IBCN(365,DA(2),2,DA(1),6,DA,1),U)="")
DELETE VALUE)= @
FIELD)= COMMUNICATION NUMBER
Triggers field 365.26/.03 if its value differs from first 30 chars of the value in this field.
Deletes field 365.26/.03 if field 365.26/1 is deleted.
365.02,7 HEALTHCARE SERVICES DELIVERY 7;0 Multiple #365.27 (Add New Entry without Asking)
DESCRIPTION:
Healthcare services delivery multiple.
TECHNICAL DESCR:
Source: 271 HL7 ZHS segment.
365.27,.01 SEQUENCE 0;1 NUMBER
INPUT TRANSFORM:K:+X'=X!(X>99999)!(X<1)!(X?.E1"."1.N) X
LAST EDITED: SEP 11, 2009
HELP-PROMPT:Type a number between 1 and 99999, 0 Decimal Digits.
DESCRIPTION:
Sequential entry number.
TECHNICAL DESCR:
Sequential number of ZHS segment.
CROSS-REFERENCE:365.27^B
1)= S ^IBCN(365,DA(2),2,DA(1),7,"B",$E(X,1,30),DA)=""
2)= K ^IBCN(365,DA(2),2,DA(1),7,"B",$E(X,1,30),DA)
365.27,.02 BENEFIT QUANTITY 0;2 NUMBER
INPUT TRANSFORM:K:+X'=X!(X>99999)!(X<0)!(X?.E1"."4.N) X
LAST EDITED: APR 28, 2010
HELP-PROMPT:Type a number between 0 and 99999, 3 Decimal Digits.
DESCRIPTION:
Numeric value of benefit quantity as qualified by QUANTITY QUALIFIER field.
TECHNICAL DESCR:
Source: 271 HL7 message, ZHS.3
365.27,.03 QUANTITY QUALIFIER 0;3 POINTER TO X12 271 QUANTITY QUALIFIER FILE (#365.016)
LAST EDITED: MAY 02, 2013
HELP-PROMPT:Select benefit quantity qualifier.
DESCRIPTION:
Benefit quantity qualifier.
TECHNICAL DESCR:
Source: 271 HL7 message, ZHS.2.1
365.27,.04 SAMPLE SELECTION MODULUS 0;4 FREE TEXT
INPUT TRANSFORM:K:$L(X)>6!($L(X)<1) X
LAST EDITED: APR 28, 2010
HELP-PROMPT:Answer must be 1-6 characters in length.
DESCRIPTION:Sampling frequency in terms of a modulus of the Unit of Measure. Qualified by UNITS OF
MEASUREMENT field.
TECHNICAL DESCR:
Source: 271 HL7 message, ZHS.5
365.27,.05 UNITS OF MEASUREMENT 0;5 POINTER TO X12 271 UNITS OF MEASUREMENT FILE (#365.029)
LAST EDITED: MAR 07, 2013
HELP-PROMPT:Select units of measurement.
DESCRIPTION:
Units of measurement for frequency of the benefits.
TECHNICAL DESCR:
Source: 271 HL7 message, ZHS.4.1
365.27,.06 TIME PERIODS 0;6 NUMBER
INPUT TRANSFORM:K:+X'=X!(X>99999)!(X<0)!(X?.E1"."3.N) X
LAST EDITED: APR 28, 2010
HELP-PROMPT:Type a number between 0 and 99999, 2 Decimal Digits.
DESCRIPTION:
Number of time periods as qualified by TIME PERIOD QUALIFIER field.
TECHNICAL DESCR:
Source: 271 HL7 message, ZHS.7
365.27,.07 TIME PERIOD QUALIFIER 0;7 POINTER TO X12 271 TIME PERIOD QUALIFIER FILE (#365.015)
LAST EDITED: MAY 02, 2013
HELP-PROMPT:Select qualifier for the time period.
DESCRIPTION:
Code that defines a time period.
TECHNICAL DESCR:
Source: 271 HL7 message, ZHS.6.1
365.27,.08 DELIVERY FREQUENCY 0;8 POINTER TO X12 271 DELIVERY FREQUENCY CODE FILE (#365.025)
LAST EDITED: MAR 07, 2013
HELP-PROMPT:Select code for delivery frequency.
DESCRIPTION:
Code that defines frequency of deliveries.
TECHNICAL DESCR:
Source: 271 HL7 message, ZHS.8.1
365.27,.09 DELIVERY PATTERN 0;9 POINTER TO X12 271 DELIVERY PATTERN FILE (#365.036)
LAST EDITED: MAR 07, 2013
HELP-PROMPT:Select delivery pattern.
DESCRIPTION:
Code that defines pattern of deliveries.
TECHNICAL DESCR:
Source: 271 HL7 message, ZHS.9.1
365.02,8 SUBSCRIBER DATES 8;0 Multiple #365.28
DESCRIPTION:
Subscriber dates multiple.
TECHNICAL DESCR:
Source: 271 HL7 message, ZSD segment.
365.28,.01 SEQUENCE 0;1 NUMBER
INPUT TRANSFORM:K:+X'=X!(X>99999)!(X<1)!(X?.E1"."1.N) X
LAST EDITED: SEP 11, 2009
HELP-PROMPT:Type a number between 1 and 99999, 0 Decimal Digits.
DESCRIPTION:
Sequential number of ZSD segment.
TECHNICAL DESCR:
Sequential number 1..N, assigned automatically.
CROSS-REFERENCE:365.28^B
1)= S ^IBCN(365,DA(2),2,DA(1),8,"B",$E(X,1,30),DA)=""
2)= K ^IBCN(365,DA(2),2,DA(1),8,"B",$E(X,1,30),DA)
365.28,.02 DATE 0;2 FREE TEXT
INPUT TRANSFORM:K:$L(X)>50!($L(X)<8) X
LAST EDITED: JUL 14, 2009
HELP-PROMPT:Answer must be 8-50 characters in length.
DESCRIPTION:
Date or range of dates.
TECHNICAL DESCR:
Source: 271 HL7 message, ZSD.4.1
365.28,.03 DATE QUALIFIER 0;3 POINTER TO X12 271 DATE QUALIFIER FILE (#365.026)
LAST EDITED: MAR 06, 2013
HELP-PROMPT:Select date qualifier.
DESCRIPTION:
Code describing the type of date.
TECHNICAL DESCR:
Source: 271 HL7 message, ZSD.2.1
365.28,.04 DATE FORMAT 0;4 POINTER TO X12 271 DATE FORMAT QUALIFIER FILE (#365.032)
LAST EDITED: MAR 07, 2013
HELP-PROMPT:Select date format.
DESCRIPTION:
Format of the date representation.
TECHNICAL DESCR:
Source: 271 HL7 message, ZSD.3.1
365.02,9 SUBSCRIBER ADDITIONAL INFO 9;0 Multiple #365.29 (Add New Entry without Asking)
DESCRIPTION:
Additional subscriber information multiple.
TECHNICAL DESCR:
Source: 271 HL7 message, ZII segment.
365.29,.01 SEQUENCE 0;1 NUMBER
INPUT TRANSFORM:K:+X'=X!(X>99999)!(X<1)!(X?.E1"."1.N) X
LAST EDITED: SEP 11, 2009
HELP-PROMPT:Type a number between 1 and 99999, 0 Decimal Digits.
DESCRIPTION:
Sequential number of ZII segment.
TECHNICAL DESCR:
Sequential number 1..N, assigned automatically.
CROSS-REFERENCE:365.29^B
1)= S ^IBCN(365,DA(2),2,DA(1),9,"B",$E(X,1,30),DA)=""
2)= K ^IBCN(365,DA(2),2,DA(1),9,"B",$E(X,1,30),DA)
365.29,.02 PLACE OF SERVICE 0;2 POINTER TO PLACE OF SERVICE FILE (#353.1)
LAST EDITED: MAR 06, 2013
HELP-PROMPT:Select code for place of service.
DESCRIPTION:
Place of service code.
TECHNICAL DESCR:
Source: 271 HL7 message, ZII.3.1 when ZII.2.1 has value of "ZZ"
365.29,.03 DIAGNOSIS 0;3 POINTER TO ICD DIAGNOSIS FILE (#80)
LAST EDITED: JUL 30, 2009
HELP-PROMPT:Select diagnosis code.
DESCRIPTION:
Diagnosis code.
TECHNICAL DESCR:
Source: 271 HL7 message, ZII.3.1 when ZII.2.1 has value of "BF" or "BK"
365.29,.04 QUALIFIER 0;4 POINTER TO X12 271 CODE LIST QUALIFIER FILE (#365.044)
LAST EDITED: MAR 06, 2013
HELP-PROMPT:Select additional information qualifier.
DESCRIPTION:
Additional information qualifier.
TECHNICAL DESCR:
Source: 271 HL7 message, ZII.2.1
365.29,.05 NATURE OF INJURY CODE 0;5 POINTER TO X12 271 NATURE OF INJURY CODES FILE (#365.045)
LAST EDITED: MAR 06, 2013
HELP-PROMPT:Enter the Nature of Injury code.
DESCRIPTION:
Code that represents the nature of the patient injury.
TECHNICAL DESCR:
Source: 271 HL7 message, ZII.4 when ZII.2.1 has value of "GR" or "NI".
365.29,.06 NATURE OF INJURY CATEGORY 0;6 POINTER TO X12 271 INJURY CATEGORY FILE (#365.038)
LAST EDITED: MAY 06, 2013
HELP-PROMPT:Select the injury category.
DESCRIPTION:Specifies the situation or category to which the code applies. Used to categorize the data
in the NATURE OF INJURY TEXT (#.07) field.
TECHNICAL DESCR:
Source: 271 HL7 message, ZII.5
365.29,.07 NATURE OF INJURY TEXT 0;7 FREE TEXT
INPUT TRANSFORM:K:$L(X)>80!($L(X)<1) X
LAST EDITED: MAR 06, 2013
HELP-PROMPT:Answer must be 1-80 characters in length.
DESCRIPTION:
Describes the injured body part or parts.
TECHNICAL DESCR:
Source: 271 HL7 message, ZII.6
365.02,10 SUBSCRIBER REFERENCE ID 10;0 Multiple #365.291 (Add New Entry without Asking)
DESCRIPTION:
Subscriber reference id multiple.
TECHNICAL DESCR:
Source: 271 HL7 message, ZRF segment.
365.291,.01 SEQUENCE 0;1 NUMBER
INPUT TRANSFORM:K:+X'=X!(X>99999)!(X<1)!(X?.E1"."1.N) X
LAST EDITED: SEP 11, 2009
HELP-PROMPT:Type a number between 1 and 99999, 0 Decimal Digits.
DESCRIPTION:
Sequential number of ZRF segment.
TECHNICAL DESCR:
Sequential number 1..N, assigned automatically.
CROSS-REFERENCE:365.291^B
1)= S ^IBCN(365,DA(2),2,DA(1),10,"B",$E(X,1,30),DA)=""
2)= K ^IBCN(365,DA(2),2,DA(1),10,"B",$E(X,1,30),DA)
365.291,.02 REFERENCE ID 0;2 FREE TEXT
INPUT TRANSFORM:K:$L(X)>30!($L(X)<1) X
LAST EDITED: SEP 09, 2009
HELP-PROMPT:Answer must be 1-30 characters in length.
DESCRIPTION:
Reference id value.
TECHNICAL DESCR:
Source: 271 HL7 message, ZRF.3.
365.291,.03 REFERENCE ID QUALIFIER 0;3 POINTER TO X12 271 REFERENCE IDENTIFICATION FILE (#365.028)
LAST EDITED: MAR 06, 2013
HELP-PROMPT:Select reference id qualifier.
DESCRIPTION:
Code describing the type of reference id.
TECHNICAL DESCR:
Source: 271 HL7 message, ZRF.2.1.
365.291,.04 DESCRIPTION 0;4 FREE TEXT
INPUT TRANSFORM:K:$L(X)>80!($L(X)<1) X
LAST EDITED: SEP 09, 2009
HELP-PROMPT:Answer must be 1-80 characters in length.
DESCRIPTION:
Short description of reference id.
TECHNICAL DESCR:
Source: 271 HL7 message, ZRF.4.
365.02,14 SERVICE TYPES 14;0 POINTER Multiple #365.292 (Add New Entry without Asking)
DESCRIPTION:
Contains the Service type codes returned from eligibility inquiry.
365.292,.01 SERVICE TYPES 0;1 POINTER TO X12 271 SERVICE TYPE FILE (#365.013)
LAST EDITED: MAY 06, 2013
HELP-PROMPT:Select/enter the code that identifies the type of service.
DESCRIPTION:
Contains the service type code returned from eligibility inquiry.
CROSS-REFERENCE:365.292^B
1)= S ^IBCN(365,DA(2),2,DA(1),14,"B",$E(X,1,30),DA)=""
2)= K ^IBCN(365,DA(2),2,DA(1),14,"B",$E(X,1,30),DA)
365,3 CONTACT PERSON 3;0 Multiple #365.03
DESCRIPTION: This field contains any persons identified by the Payer as a contact name and/or communications
number. There could be up to 3 different methods of communication.
365.03,.01 CONTACT PERSON 0;1 FREE TEXT (Multiply asked)
INPUT TRANSFORM: K:$L(X)>32!($L(X)<1) X
LAST EDITED: JUN 13, 2003
HELP-PROMPT: Answer must be 1-32 characters in length.
DESCRIPTION:
This is the name of the contact person.
CROSS-REFERENCE: 365.03^B
1)= S ^IBCN(365,DA(1),3,"B",$E(X,1,30),DA)=""
2)= K ^IBCN(365,DA(1),3,"B",$E(X,1,30),DA)
Standard "B" cross-reference
365.03,.02 COMMUNICATION QUALIFIER #1 0;2 POINTER TO X12 271 CONTACT QUALIFIER FILE (#365.021)
LAST EDITED: JUN 03, 2002
DESCRIPTION:
This field identifies a method of communication, whether by phone or email, etc.
365.03,.03 *COMMUNICATION NUMBER #1 0;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>20!($L(X)<1) X
LAST EDITED: NOV 20, 2013
HELP-PROMPT: Answer must be 1-20 characters in length.
DESCRIPTION: This is the value of the information defined in the COMMUNICATION QUALIFIER #1 field (field .02).
It could be a phone number or email address, etc.
This field is scheduled for deletion in May 2015.
NOTES: TRIGGERED by the COMMUNICATION NUMBER #1 field of the CONTACT PERSON sub-field of the IIV
RESPONSE File
CROSS-REFERENCE: ^^TRIGGER^365.03^1
1)= X ^DD(365.03,.03,1,1,1.3) I X S X=DIV S Y(1)=$S($D(^IBCN(365,D0,3,D1,1)):^(1),1:"") S X=$P(Y(1)
,U,1),X=X S DIU=X K Y S X=DIV S X=$P(^IBCN(365,DA(1),3,DA,0),U,3) X ^DD(365.03,.03,1,1,1.4)
1.3)= K DIV S DIV=X,D0=DA(1),DIV(0)=D0,D1=DA,DIV(1)=D1 S Y(0)=X S X=($P(^IBCN(365,DA(1),3,DA,0),U,3
)'=$E($P($G(^IBCN(365,DA(1),3,DA,1)),U),1,20))
1.4)= S DIH=$G(^IBCN(365,DIV(0),3,DIV(1),1)),DIV=X S $P(^(1),U,1)=DIV,DIH=365.03,DIG=1 D ^DICR
2)= K DIV S DIV=X,D0=DA(1),DIV(0)=D0,D1=DA,DIV(1)=D1 S Y(0)=X S X=($P(^IBCN(365,DA(1),3,DA,0),U,3)=
"") I X S X=DIV S Y(1)=$S($D(^IBCN(365,D0,3,D1,1)):^(1),1:"") S X=$P(Y(1),U,1),X=X S DIU=X K Y S X=
"" X ^DD(365.03,.03,1,1,2.4)
2.4)= S DIH=$G(^IBCN(365,DIV(0),3,DIV(1),1)),DIV=X S $P(^(1),U,1)=DIV,DIH=365.03,DIG=1 D ^DICR
CREATE CONDITION)= S X=($P(^IBCN(365,DA(1),3,DA,0),U,3)'=$E($P($G(^IBCN(365,DA(1),3,DA,1)),U),1,20)
)
CREATE VALUE)= S X=$P(^IBCN(365,DA(1),3,DA,0),U,3)
DELETE CONDITION)= S X=($P(^IBCN(365,DA(1),3,DA,0),U,3)="")
DELETE VALUE)= @
FIELD)= COMMUNICATION NUMBER #1 (LONG)
Triggers field 365.03/1 if first 20 chars of its value differ from the value in this field. Deletes
field 365.03/1 if field 365.03/.03 is deleted.
365.03,.04 COMMUNICATION QUALIFIER #2 0;4 POINTER TO X12 271 CONTACT QUALIFIER FILE (#365.021)
LAST EDITED: JUN 03, 2002
DESCRIPTION:
This field identifies a method of communication, whether by phone or email, etc.
365.03,.05 *COMMUNICATION NUMBER #2 0;5 FREE TEXT
INPUT TRANSFORM:K:$L(X)>20!($L(X)<1) X
LAST EDITED: NOV 20, 2013
HELP-PROMPT: Answer must be 1-20 characters in length.
DESCRIPTION: This is the value of the information defined in the COMMUNICATION QUALIFIER #2 field (field .04).
It could be a phone number or email address, etc.
This field is scheduled for deletion in May 2015.
NOTES: TRIGGERED by the COMMUNICATION NUMBER #2 field of the CONTACT PERSON sub-field of the IIV RESPONSE
File
CROSS-REFERENCE:^^TRIGGER^365.03^2
1)= X ^DD(365.03,.05,1,1,1.3) I X S X=DIV S Y(1)=$S($D(^IBCN(365,D0,3,D1,2)):^(2),1:"") S X=$P(Y(1)
,U,1),X=X S DIU=X K Y S X=DIV S X=$P(^IBCN(365,DA(1),3,DA,0),U,5) X ^DD(365.03,.05,1,1,1.4)
1.3)= K DIV S DIV=X,D0=DA(1),DIV(0)=D0,D1=DA,DIV(1)=D1 S Y(0)=X S X=($P(^IBCN(365,DA(1),3,DA,0),U,5
)'=$E($P($G(^IBCN(365,DA(1),3,DA,2)),U),1,20))
1.4)= S DIH=$G(^IBCN(365,DIV(0),3,DIV(1),2)),DIV=X S $P(^(2),U,1)=DIV,DIH=365.03,DIG=2 D ^DICR
2)= K DIV S DIV=X,D0=DA(1),DIV(0)=D0,D1=DA,DIV(1)=D1 S Y(0)=X S X=($P(^IBCN(365,DA(1),3,DA,0),U,5)=
"") I X S X=DIV S Y(1)=$S($D(^IBCN(365,D0,3,D1,2)):^(2),1:"") S X=$P(Y(1),U,1),X=X S DIU=X K Y S X=
"" X ^DD(365.03,.05,1,1,2.4)
2.4)= S DIH=$G(^IBCN(365,DIV(0),3,DIV(1),2)),DIV=X S $P(^(2),U,1)=DIV,DIH=365.03,DIG=2 D ^DICR
CREATE CONDITION)= S X=($P(^IBCN(365,DA(1),3,DA,0),U,5)'=$E($P($G(^IBCN(365,DA(1),3,DA,2)),U),1,20)
)
CREATE VALUE)= S X=$P(^IBCN(365,DA(1),3,DA,0),U,5)
DELETE CONDITION)= S X=($P(^IBCN(365,DA(1),3,DA,0),U,5)="")
DELETE VALUE)= @
FIELD)= COMMUNICATION NUMBER #2 (LONG)
Triggers field 365.03/2 if first 20 chars of its value differ from the value in this field. Deletes
field 365.03/2 if field 365.03/.05 is deleted.
365.03,.06 COMMUNICATION QUALIFIER #3 0;6 POINTER TO X12 271 CONTACT QUALIFIER FILE (#365.021)
LAST EDITED: JUN 03, 2002
DESCRIPTION:
This field identifies a method of communication, whether by phone or email, etc.
365.03,.07 *COMMUNICATION NUMBER #3 0;7 FREE TEXT
INPUT TRANSFORM:K:$L(X)>20!($L(X)<1) X
LAST EDITED: NOV 20, 2013
HELP-PROMPT: Answer must be 1-20 characters in length.
DESCRIPTION: This is the value of the information defined in the COMMUNICATION QUALIFIER #3 field (field .06).
It could be a phone number or email address, etc.
This field is scheduled for deletion in May 2015.
NOTES: TRIGGERED by the COMMUNICATION NUMBER #3 field of the CONTACT PERSON sub-field of the IIV RESPONSE
File
CROSS-REFERENCE:^^TRIGGER^365.03^3
1)= X ^DD(365.03,.07,1,1,1.3) I X S X=DIV S Y(1)=$S($D(^IBCN(365,D0,3,D1,3)):^(3),1:"") S X=$P(Y(1)
,U,1),X=X S DIU=X K Y S X=DIV S X=$P(^IBCN(365,DA(1),3,DA,0),U,7) X ^DD(365.03,.07,1,1,1.4)
1.3)= K DIV S DIV=X,D0=DA(1),DIV(0)=D0,D1=DA,DIV(1)=D1 S Y(0)=X S X=($P(^IBCN(365,DA(1),3,DA,0),U,7
)'=$E($P($G(^IBCN(365,DA(1),3,DA,3)),U),1,20))
1.4)= S DIH=$G(^IBCN(365,DIV(0),3,DIV(1),3)),DIV=X S $P(^(3),U,1)=DIV,DIH=365.03,DIG=3 D ^DICR
2)= K DIV S DIV=X,D0=DA(1),DIV(0)=D0,D1=DA,DIV(1)=D1 S Y(0)=X S X=($P(^IBCN(365,DA(1),3,DA,0),U,7)=
"") I X S X=DIV S Y(1)=$S($D(^IBCN(365,D0,3,D1,3)):^(3),1:"") S X=$P(Y(1),U,1),X=X S DIU=X K Y S X=
"" X ^DD(365.03,.07,1,1,2.4)
2.4)= S DIH=$G(^IBCN(365,DIV(0),3,DIV(1),3)),DIV=X S $P(^(3),U,1)=DIV,DIH=365.03,DIG=3 D ^DICR
CREATE CONDITION)= S X=($P(^IBCN(365,DA(1),3,DA,0),U,7)'=$E($P($G(^IBCN(365,DA(1),3,DA,3)),U),1,20)
)
CREATE VALUE)= S X=$P(^IBCN(365,DA(1),3,DA,0),U,7)
DELETE CONDITION)= S X=($P(^IBCN(365,DA(1),3,DA,0),U,7)="")
DELETE VALUE)= @
FIELD)= COMMUNICATION NUMBER #3 (LONG)
Triggers field 365.03/3 if first 20 chars of its value differ from the value in this field. Deletes
field 365.03/3 if field 365.03/.07 is deleted.
365.03,1 COMMUNICATION NUMBER #1 1;1 FREE TEXT
INPUT TRANSFORM:K:$L(X)>245!($L(X)<1) X
LAST EDITED: NOV 20, 2013
HELP-PROMPT: Answer must be 1-245 characters in length.
DESCRIPTION: This is the value of the information defined in the COMMUNICATION QUALIFIER #1 field (field .02).
It could be a phone number or email address, etc.
TECHNICAL DESCR:
Replaces field .03.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
TRIGGERED by the *COMMUNICATION NUMBER #1 field of the CONTACT PERSON sub-field of the IIV RESPONSE
File
CROSS-REFERENCE:^^TRIGGER^365.03^.03
1)= X ^DD(365.03,1,1,1,1.3) I X S X=DIV S Y(1)=$S($D(^IBCN(365,D0,3,D1,0)):^(0),1:"") S X=$P(Y(1),U
,3),X=X S DIU=X K Y S X=DIV S X=$E($P(^IBCN(365,DA(1),3,DA,1),U),1,20) X ^DD(365.03,1,1,1,1.4)
1.3)= K DIV S DIV=X,D0=DA(1),DIV(0)=D0,D1=DA,DIV(1)=D1 S Y(0)=X S X=($P(^IBCN(365,DA(1),3,DA,0),U,3
)'=$E($P(^IBCN(365,DA(1),3,DA,1),U),1,20))
1.4)= S DIH=$G(^IBCN(365,DIV(0),3,DIV(1),0)),DIV=X S $P(^(0),U,3)=DIV,DIH=365.03,DIG=.03 D ^DICR
2)= K DIV S DIV=X,D0=DA(1),DIV(0)=D0,D1=DA,DIV(1)=D1 S Y(0)=X S X=($P(^IBCN(365,DA(1),3,DA,1),U)=""
) I X S X=DIV S Y(1)=$S($D(^IBCN(365,D0,3,D1,0)):^(0),1:"") S X=$P(Y(1),U,3),X=X S DIU=X K Y S X=""
X ^DD(365.03,1,1,1,2.4)
2.4)= S DIH=$G(^IBCN(365,DIV(0),3,DIV(1),0)),DIV=X S $P(^(0),U,3)=DIV,DIH=365.03,DIG=.03 D ^DICR
CREATE CONDITION)= S X=($P(^IBCN(365,DA(1),3,DA,0),U,3)'=$E($P(^IBCN(365,DA(1),3,DA,1),U),1,20))
CREATE VALUE)= S X=$E($P(^IBCN(365,DA(1),3,DA,1),U),1,20)
DELETE CONDITION)= S X=($P(^IBCN(365,DA(1),3,DA,1),U)="")
DELETE VALUE)= @
FIELD)= COMMUNICATION NUMBER #1
Triggers field 365.03/.03 if its value differs from first 20 chars of the value in this field.
Deletes field 365.03/.03 if field 365.03/1 is deleted.
365.03,2 COMMUNICATION NUMBER #2 2;1 FREE TEXT
INPUT TRANSFORM:K:$L(X)>245!($L(X)<1) X
LAST EDITED: NOV 20, 2013
HELP-PROMPT: Answer must be 1-245 characters in length.
DESCRIPTION: This is the value of the information defined in the COMMUNICATION QUALIFIER #2 field (field .04).
It could be a phone number or email address, etc.
TECHNICAL DESCR:
Replaces field .05.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
TRIGGERED by the *COMMUNICATION NUMBER #2 field of the CONTACT PERSON sub-field of the IIV RESPONSE
File
CROSS-REFERENCE:^^TRIGGER^365.03^.05
1)= X ^DD(365.03,2,1,1,1.3) I X S X=DIV S Y(1)=$S($D(^IBCN(365,D0,3,D1,0)):^(0),1:"") S X=$P(Y(1),U
,5),X=X S DIU=X K Y S X=DIV S X=$E($P(^IBCN(365,DA(1),3,DA,2),U),1,20) X ^DD(365.03,2,1,1,1.4)
1.3)= K DIV S DIV=X,D0=DA(1),DIV(0)=D0,D1=DA,DIV(1)=D1 S Y(0)=X S X=($P(^IBCN(365,DA(1),3,DA,0),U,5
)'=$E($P(^IBCN(365,DA(1),3,DA,2),U),1,20))
1.4)= S DIH=$G(^IBCN(365,DIV(0),3,DIV(1),0)),DIV=X S $P(^(0),U,5)=DIV,DIH=365.03,DIG=.05 D ^DICR
2)= K DIV S DIV=X,D0=DA(1),DIV(0)=D0,D1=DA,DIV(1)=D1 S Y(0)=X S X=($P(^IBCN(365,DA(1),3,DA,2),U)=""
) I X S X=DIV S Y(1)=$S($D(^IBCN(365,D0,3,D1,0)):^(0),1:"") S X=$P(Y(1),U,5),X=X S DIU=X K Y S X=""
X ^DD(365.03,2,1,1,2.4)
2.4)= S DIH=$G(^IBCN(365,DIV(0),3,DIV(1),0)),DIV=X S $P(^(0),U,5)=DIV,DIH=365.03,DIG=.05 D ^DICR
CREATE CONDITION)= S X=($P(^IBCN(365,DA(1),3,DA,0),U,5)'=$E($P(^IBCN(365,DA(1),3,DA,2),U),1,20))
CREATE VALUE)= S X=$E($P(^IBCN(365,DA(1),3,DA,2),U),1,20)
DELETE CONDITION)= S X=($P(^IBCN(365,DA(1),3,DA,2),U)="")
DELETE VALUE)= @
FIELD)= COMMUNICATION NUMBER #2
Triggers field 365.03/.05 if its value differs from first 20 chars of the value in this field.
Deletes field 365.03/.05 if field 365.03/2 is deleted.
365.03,3 COMMUNICATION NUMBER #3 3;1 FREE TEXT
INPUT TRANSFORM:K:$L(X)>245!($L(X)<1) X
LAST EDITED: NOV 20, 2013
HELP-PROMPT: Answer must be 1-245 characters in length.
DESCRIPTION: This is the value of the information defined in the COMMUNICATION QUALIFIER #3 field (field .06).
It could be a phone number or email address, etc.
TECHNICAL DESCR:
Replaces field .07.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
TRIGGERED by the *COMMUNICATION NUMBER #3 field of the CONTACT PERSON sub-field of the IIV RESPONSE
File
CROSS-REFERENCE:^^TRIGGER^365.03^.07
1)= X ^DD(365.03,3,1,1,1.3) I X S X=DIV S Y(1)=$S($D(^IBCN(365,D0,3,D1,0)):^(0),1:"") S X=$P(Y(1),U
,7),X=X S DIU=X K Y S X=DIV S X=$E($P(^IBCN(365,DA(1),3,DA,3),U),1,20) X ^DD(365.03,3,1,1,1.4)
1.3)= K DIV S DIV=X,D0=DA(1),DIV(0)=D0,D1=DA,DIV(1)=D1 S Y(0)=X S X=($P(^IBCN(365,DA(1),3,DA,0),U,7
)'=$E($P(^IBCN(365,DA(1),3,DA,3),U),1,20))
1.4)= S DIH=$G(^IBCN(365,DIV(0),3,DIV(1),0)),DIV=X S $P(^(0),U,7)=DIV,DIH=365.03,DIG=.07 D ^DICR
2)= K DIV S DIV=X,D0=DA(1),DIV(0)=D0,D1=DA,DIV(1)=D1 S Y(0)=X S X=($P(^IBCN(365,DA(1),3,DA,3),U)=""
) I X S X=DIV S Y(1)=$S($D(^IBCN(365,D0,3,D1,0)):^(0),1:"") S X=$P(Y(1),U,7),X=X S DIU=X K Y S X=""
X ^DD(365.03,3,1,1,2.4)
2.4)= S DIH=$G(^IBCN(365,DIV(0),3,DIV(1),0)),DIV=X S $P(^(0),U,7)=DIV,DIH=365.03,DIG=.07 D ^DICR
CREATE CONDITION)= S X=($P(^IBCN(365,DA(1),3,DA,0),U,7)'=$E($P(^IBCN(365,DA(1),3,DA,3),U),1,20))
CREATE VALUE)= S X=$E($P(^IBCN(365,DA(1),3,DA,3),U),1,20)
DELETE CONDITION)= S X=($P(^IBCN(365,DA(1),3,DA,3),U)="")
DELETE VALUE)= @
FIELD)= COMMUNICATION NUMBER #3
Triggers field 365.03/.07 if its value differs from first 20 chars of the value in this field.
Deletes field 365.03/.07 if field 365.03/3 is deleted.
365,4.01 ERROR TEXT 4;1 FREE TEXT
Error Text
INPUT TRANSFORM: K:$L(X)>80!($L(X)<1) X
LAST EDITED: SEP 06, 2002
HELP-PROMPT: Answer must be 1-80 characters in length.
DESCRIPTION: This field contains error message text which is sent from the Eligibility Communicator if an error
does not fall within one of the standard X.12 error conditions.
365,5.01 SUBSCRIBER ADDRESS LINE 1 5;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>55!($L(X)<1) X
LAST EDITED: SEP 24, 2009
HELP-PROMPT: Answer must be 1-55 characters in length.
DESCRIPTION:
Subscriber address, line 1.
TECHNICAL DESCR:
Source: 271 HL7 message, PID.11.1.1.
365,5.02 SUBSCRIBER ADDRESS LINE 2 5;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>55!($L(X)<1) X
LAST EDITED: SEP 24, 2009
HELP-PROMPT: Answer must be 1-55 characters in length.
DESCRIPTION:
Subscriber address, line 2.
TECHNICAL DESCR:
Source: 271 HL7 message, PID.11.2.
365,5.03 SUBSCRIBER ADDRESS CITY 5;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<1) X
LAST EDITED: SEP 24, 2009
HELP-PROMPT: Answer must be 1-30 characters in length.
DESCRIPTION:
Subscriber address, city.
TECHNICAL DESCR:
Source: 271 HL7 message, PID.11.3.
365,5.04 SUBSCRIBER ADDRESS STATE 5;4 POINTER TO STATE FILE (#5)
LAST EDITED: SEP 24, 2009
HELP-PROMPT: Please select state.
DESCRIPTION:
Subscriber address, state.
TECHNICAL DESCR:
Source: 271 HL7 message, PID.11.4.
365,5.05 SUBSCRIBER ADDRESS ZIP 5;5 FREE TEXT
INPUT TRANSFORM: K:$L(X)>15!($L(X)<1) X
LAST EDITED: SEP 24, 2009
HELP-PROMPT: Answer must be 1-15 characters in length.
DESCRIPTION:
Subscriber address, zip code.
TECHNICAL DESCR:
Source: 271 HL7 message, PID.11.5.
365,5.06 SUBSCRIBER ADDRESS COUNTRY 5;6 FREE TEXT
INPUT TRANSFORM: K:$L(X)>3!($L(X)<2) X
LAST EDITED: AUG 10, 2010
HELP-PROMPT: Answer must be 2-3 characters in length.
DESCRIPTION:
Subscriber address, country code.
TECHNICAL DESCR:
Source: 271 HL7 message, PID.11.6.
365,5.07 SUBSCRIBER ADDRESS SUBDIVISION 5;7 FREE TEXT
INPUT TRANSFORM: K:$L(X)>3!($L(X)<1) X
LAST EDITED: AUG 10, 2010
HELP-PROMPT: Answer must be 1-3 characters in length.
DESCRIPTION:
Subscriber address, country subdivision code.
TECHNICAL DESCR:
Source: 271 HL7 message, PID.11.8.
365,6 REJECT REASONS 6;0 Multiple #365.06 (Add New Entry without Asking)
DESCRIPTION:
This multiple contains reject reason codes.
TECHNICAL DESCR:
Source: 271 HL7 message, ERR segment(s).
365.06,.01 SEQUENCE 0;1 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>99999)!(X<1)!(X?.E1"."1.N) X
LAST EDITED: SEP 12, 2010
HELP-PROMPT: Type a number between 1 and 99999, 0 decimal digits.
DESCRIPTION:
Sequential entry number.
TECHNICAL DESCR:
Sequential number of ERR segment.
CROSS-REFERENCE: 365.06^B
1)= S ^IBCN(365,DA(1),6,"B",$E(X,1,30),DA)=""
2)= K ^IBCN(365,DA(1),6,"B",$E(X,1,30),DA)
365.06,.02 ERROR LOCATION 0;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>50!($L(X)<1) X
LAST EDITED: SEP 12, 2010
HELP-PROMPT: Answer must be 1-50 characters in length.
DESCRIPTION:
Error location within HL7 message.
TECHNICAL DESCR:
Source: 271 HL7 message, ERR.2
365.06,.03 REJECT REASON 0;3 POINTER TO X12 271 ERROR CONDITION FILE (#365.017)
LAST EDITED: MAR 06, 2013
HELP-PROMPT: Enter code describing the reason for inquiry rejection.
DESCRIPTION:
Code describing the reason for inquiry rejection.
TECHNICAL DESCR:
Source: 271 HL7 message, ERR.5.1
365.06,.04 ACTION CODE 0;4 POINTER TO X12 271 ERROR ACTION FILE (#365.018)
LAST EDITED: MAR 06, 2013
HELP-PROMPT: Enter the code for action needed to correct the error.
DESCRIPTION:
Code describing an action needed to correct the error.
TECHNICAL DESCR:
Source: 271 HL7 message, ERR.8
365.06,.05 LOOP ID 0;5 POINTER TO X12 271 LOOP ID FILE (#365.027)
LAST EDITED: SEP 12, 2010
HELP-PROMPT: Enter the code for HIPAA loop in which the error occured.
DESCRIPTION:
Code describing HIPAA loop in which the error occured.
TECHNICAL DESCR:
Source: 271 HL7 message, ERR.7
365.06,.06 SOURCE 0;6 FREE TEXT
INPUT TRANSFORM: K:$L(X)>1!($L(X)<1) X
LAST EDITED: SEP 12, 2010
HELP-PROMPT: Answer must be 1 character in length.
DESCRIPTION:
Code describing the source of the error message (FSC, Payer, etc.)
TECHNICAL DESCR:
Source: 271 HL7 message, ERR.5.2
365.06,1 ADDITIONAL MSGS 1;0 Multiple #365.061 (Add New Entry without Asking)
DESCRIPTION:
This multiple contains additional error or informational messages associated with reject reasons.
TECHNICAL DESCR:
Source: 271 HL7 message, error group, NTE.3 (repeating field).
365.061,.01 ADDITIONAL MSG 0;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>250!($L(X)<1) X
LAST EDITED: FEB 20, 2013
HELP-PROMPT: Answer must be 1-250 characters in length.
DESCRIPTION:
Contains a single additional error / informational message.
TECHNICAL DESCR:
Source: 271 HL7 message, error group, NTE.3.
CROSS-REFERENCE: 365.061^B
1)= S ^IBCN(365,DA(2),6,DA(1),1,"B",$E(X,1,30),DA)=""
2)= K ^IBCN(365,DA(2),6,DA(1),1,"B",$E(X,1,30),DA)
365,7 SUBSCRIBER DATES 7;0 Multiple #365.07 (Add New Entry without Asking)
DESCRIPTION: Subscriber dates multiple. Contains subscriber level dates, as opposed to eligibility/benefit level
dates.
TECHNICAL DESCR:
Source: 271 HL7 message, ZTP segment.
365.07,.01 SEQUENCE 0;1 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>99999)!(X<1)!(X?.E1"."1N.N) X
LAST EDITED: SEP 12, 2010
HELP-PROMPT: Type a number between 1 and 99999, 0 decimal digits.
DESCRIPTION:
Sequential number of ZTP segment.
TECHNICAL DESCR:
Sequential number 1..N, assigned automatically.
CROSS-REFERENCE: 365.07^B
1)= S ^IBCN(365,DA(1),7,"B",$E(X,1,30),DA)=""
2)= K ^IBCN(365,DA(1),7,"B",$E(X,1,30),DA)
365.07,.02 DATE 0;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>50!($L(X)<8) X
LAST EDITED: SEP 12, 2010
HELP-PROMPT: Answer must be 8-50 characters in length.
DESCRIPTION:
Date or range of dates.
TECHNICAL DESCR:
Source: 271 HL7 message, ZTP.3.1.1 and ZTP.3.2.1.
365.07,.03 DATE QUALIFIER 0;3 POINTER TO X12 271 DATE QUALIFIER FILE (#365.026)
LAST EDITED: MAY 06, 2013
HELP-PROMPT: Select date qualifier.
DESCRIPTION:
Code describing the type of date.
TECHNICAL DESCR:
Source: 271 HL7 message, ZTP.2.1.
365.07,.04 LOOP ID 0;4 POINTER TO X12 271 LOOP ID FILE (#365.027)
LAST EDITED: SEP 12, 2010
HELP-PROMPT: Enter the code for HIPAA loop this date belongs to.
DESCRIPTION:
Code describing HIPAA loop this date belongs to.
TECHNICAL DESCR:
Source: 271 HL7 message, ZTP.4
365,8.01 PT. RELATIONSHIP - HIPAA 8;1 POINTER TO X12 271 PATIENT RELATIONSHIP FILE (#365.037)
LAST EDITED: MAR 18, 2013
HELP-PROMPT: Enter the HIPAA code which indicates the patient's relationship to the injured party.
DESCRIPTION: This is the HIPAA relationship code that describes the relationship this patient has to the holder
of this insurance policy. If the policy belongs to the patient enter '18' for SELF. If the policy
belongs to the spouse enter '01' for SPOUSE, etc.
TECHNICAL DESCR:
Data comes in the IN1 segment - IN1.17.1
365,9 GROUP REFERENCE INFORMATION 9;0 Multiple #365.09
LAST EDITED: MAY 22, 2013
DESCRIPTION:
Subscriber/Dependent additional identification data.
365.09,.01 SEQUENCE 0;1 NUMBER (Required) (Multiply asked)
INPUT TRANSFORM: K:+X'=X!(X>99999)!(X<1)!(X?.E1"."1.N) X
LAST EDITED: JUN 10, 2013
HELP-PROMPT: Type a number between 1 and 99999, 0 decimal digits.
DESCRIPTION:
This field contains a sequential number generated at the time a record is stored in the subfile.
TECHNICAL DESCR:
Sequential number 1..N, assigned automatically.
CROSS-REFERENCE: 365.09^B
1)= S ^IBCN(365,DA(1),9,"B",$E(X,1,30),DA)=""
2)= K ^IBCN(365,DA(1),9,"B",$E(X,1,30),DA)
365.09,.02 REFERENCE ID (GROUP) 0;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>50!($L(X)<1) X
LAST EDITED: MAY 22, 2013
HELP-PROMPT: Answer must be 1-50 characters in length.
DESCRIPTION:
Subscriber Supplemental Identifier.
TECHNICAL DESCR:
X12: 271, 2100C/2100D, REF02 Reference Identification. Source: 271 HL7 message, ZRF.3
365.09,.03 REF ID QUALIFIER (GROUP) 0;3 POINTER TO X12 271 REFERENCE IDENTIFICATION FILE (#365.028)
LAST EDITED: MAY 22, 2013
HELP-PROMPT: Select the reference ID qualifier.
DESCRIPTION:
Describes the type of reference ID at the REFERENCE ID (GROUP) (#.02) field.
TECHNICAL DESCR: X12: 271, 2100C/2100D, REF01 Reference Identification Qualifier. Source: 271 HL7 message,
ZRF.2.1
365.09,.04 DESCRIPTION 0;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>80!($L(X)<1) X
LAST EDITED: MAY 22, 2013
HELP-PROMPT: Answer must be 1-80 characters in length.
DESCRIPTION: A free-form description to clarify the Reference ID in the REFERENCE ID (GROUP) (#.02) field. It
will be populated with the Plan, Group or Plan Network Name.
TECHNICAL DESCR:
X12: 271, 2100C/2100D, REF03 DESCRIPTION. 271 HL7 message, ZRF.4
365,10 GROUP PROVIDER INFO 10;0 Multiple #365.04
DESCRIPTION:
Entries in this sub-file identify the characteristics of a provider.
365.04,.01 SEQUENCE 0;1 NUMBER (Multiply asked)
INPUT TRANSFORM: K:+X'=X!(X>99999)!(X<1)!(X?.E1"."1.N) X
LAST EDITED: JUN 10, 2013
HELP-PROMPT: Type a number between 1 and 99999, 0 decimal digits.
DESCRIPTION:
This field contains a sequential number generated at the time a record is stored in the subfile.
TECHNICAL DESCR:
Sequential number 1..N, assigned automatically.
CROSS-REFERENCE: 365.04^B
1)= S ^IBCN(365,DA(1),10,"B",$E(X,1,30),DA)=""
2)= K ^IBCN(365,DA(1),10,"B",$E(X,1,30),DA)
365.04,.02 PROVIDER CODE 0;2 POINTER TO X12 271 PROVIDER CODE FILE (#365.024)
LAST EDITED: MAY 22, 2013
HELP-PROMPT: Select the group provider code.
DESCRIPTION:
Code that identifies the type of provider (e.g., "AD" for Admitting).
TECHNICAL DESCR:
Source: X12 271 LOOPS 2100B, 2100C, 2100D. PRV01 PROVIDER CODE HL7 message, ROL.3.1
365.04,.03 PROV REFERENCE ID 0;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>50!($L(X)<1) X
LAST EDITED: MAY 22, 2013
HELP-PROMPT: Describe provider's specialty type (1-50 characters).
DESCRIPTION:
Provider specialty type identifier.
TECHNICAL DESCR:
Source: X12 271 LOOPS 2100B, 2100C, 2100D. PRV03 PROVIDER CODE HL7 message ROL.4.1
365,11 HEALTH CARE CODE INFORMATION 11;0 Multiple #365.01
DESCRIPTION:
To supply information related to the delivery of health care.
365.01,.01 SEQUENCE 0;1 NUMBER (Required)
INPUT TRANSFORM: K:+X'=X!(X>99999)!(X<1)!(X?.E1"."1.N) X
LAST EDITED: JUN 10, 2013
HELP-PROMPT: Type a number between 1 and 99999, 0 decimal digits.
DESCRIPTION:
This field contains a sequential number generated at the time a record is stored in the subfile.
TECHNICAL DESCR:
Sequential number 1..N, assigned automatically.
CROSS-REFERENCE: 365.01^B
1)= S ^IBCN(365,DA(1),11,"B",$E(X,1,30),DA)=""
2)= K ^IBCN(365,DA(1),11,"B",$E(X,1,30),DA)
365.01,.02 DIAGNOSIS CODE 0;2 POINTER TO ICD DIAGNOSIS FILE (#80)
LAST EDITED: MAY 22, 2013
HELP-PROMPT: Select the diagnosis code.
DESCRIPTION:
Diagnosis Code sent by the payer in response to the insurance eligibility inquiry.
TECHNICAL DESCR: Source: Health Care Diagnosis Code information in the X12 271 HI segment in these X12 loops:
2100C, 2100D. 271 HL7 message DG1.3.1
365.01,.03 DIAGNOSIS CODE QUALIFIER 0;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<1) X
LAST EDITED: MAY 22, 2013
HELP-PROMPT: Answer must be 1-10 characters in length.
DESCRIPTION:
Diagnosis Type Code identifying a specific industry code list ICD-9 or ICD-10.
TECHNICAL DESCR: Source: 271 HL7 message DG1.3.3
ABK or BK" - represent ICD-10-CM and ICD-9-CM principal diagnosis code qualifiers. These
qualifiers also represent the code as a primary code.
"ABF or BF" - also represent ICD-10-CM and ICD-9-CM diagnosis code qualifiers and these
qualifiers represent the code as a secondary code.
When the payer sends an ABK or an ABF, the Eligibility Communicator will map these to the HL7
code "I10C".
When the payer sends an ABK or an ABF, the Eligibility Communicator will map these to the HL7
code "I9C".
SOURCE OF DATA:
365.01,.04 PRIMARY OR SECONDARY? 0;4 SET
'P' FOR PRIMARY;
'S' FOR SECONDARY;
LAST EDITED: MAY 22, 2013
HELP-PROMPT: Does this code represent a primary or secondary diagnosis?
DESCRIPTION: This field indicates whether the code in the DIAGNOSIS CODE (#.02) field is a primary or
secondary diagnosis.
365,12.01 MILITARY INFO STATUS CODE 12;1 POINTER TO X12 271 MILITARY PERSONNEL INFO STATUS CODE FILE (#365.039)
LAST EDITED: MAY 14, 2013
HELP-PROMPT: Enter the military information status code.
DESCRIPTION:
Code to indicate the status of the military information sent by the payer.
TECHNICAL DESCR:
Source: 271 HL7 message ZMP.2
365,12.02 MILITARY EMPLOYMENT STATUS 12;2 POINTER TO X12 271 MILITARY EMPLOYMENT STATUS CODE FILE (#365.046)
LAST EDITED: MAY 14, 2013
HELP-PROMPT: Select the appropriate code for claimant's military employment status.
DESCRIPTION:
Code showing the general military employment status of an employee/claimant.
TECHNICAL DESCR:
Source: 271 HL7 message ZMP.3
365,12.03 MILITARY GOVT AFFILIATION CODE 12;3 POINTER TO X12 271 MILITARY GOVT SERVICE AFFILIATION FILE (#365.041)
LAST EDITED: JUN 12, 2013
HELP-PROMPT: Select the code that supports the claimant's military affiliation.
DESCRIPTION:
Code specifying the military service affiliation.
TECHNICAL DESCR:
Source: 271 HL7 message ZMP.4
365,12.04 MILITARY PERSONNEL DESCRIPTION 12;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>80!($L(X)<1) X
LAST EDITED: MAY 14, 2013
HELP-PROMPT: Answer must be 1-80 characters in length.
DESCRIPTION:
Free-form text description that further identifies the exact military unit.
TECHNICAL DESCR:
Source: 271 HL7 message ZMP.5
365,12.05 MILITARY SERVICE RANK CODE 12;5 POINTER TO X12 271 MILITARY SERVICE RANK FILE (#365.042)
LAST EDITED: MAY 21, 2013
HELP-PROMPT: Select the Military Service Rank code.
DESCRIPTION:
Code specifying the military service rank.
TECHNICAL DESCR:
Source: 271 HL7 message ZMP.6
365,12.06 DATE TIME PERIOD FORMAT QUAL 12;6 POINTER TO X12 271 DATE FORMAT QUALIFIER FILE (#365.032)
LAST EDITED: MAY 15, 2013
HELP-PROMPT: Select the qualifier for the date time period.
DESCRIPTION: Code qualifier indicating the date format, time format, or date and time format respective of the
DATE TIME PERIOD field (#12.07).
TECHNICAL DESCR:
Source: 271 HL7 message ZMP.7
365,12.07 DATE TIME PERIOD 12;7 FREE TEXT
INPUT TRANSFORM: K:$L(X)>17!($L(X)<8)!'(X?8N!(X?8N1"-"8N)) X
LAST EDITED: MAY 14, 2013
HELP-PROMPT: Answer must be 8-17 characters in length.
DESCRIPTION:
Expression of a date or range of dates that indicates the date span of military service.
TECHNICAL DESCR:
Source: 271 HL7 message ZMP.8
365,13.01 NAME OF INSURED 13;1 FREE TEXT
Subscriber
INPUT TRANSFORM: K:$L(X)>130!($L(X)<1)!'$$LENCHK^IBCNEUT1(X,30,0) X
LAST EDITED: NOV 20, 2013
HELP-PROMPT: Answer must be 1-30 characters in length.
DESCRIPTION: This is the name of the insured person in LastName,FirstName MI format. If the patient is the
subscriber, this field is the same. If the patient is a dependent, the subscriber's name is stored
here.
TECHNICAL DESCR:
Replaces field 1.01. Length of this field is temporarily limited to 30 characters.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
TRIGGERED by the *NAME OF INSURED field of the IIV RESPONSE File
CROSS-REFERENCE: ^^TRIGGER^365^1.01
1)= X ^DD(365,13.01,1,1,1.3) I X S X=DIV S Y(1)=$S($D(^IBCN(365,D0,1)):^(1),1:"") S X=$P(Y(1),U,1),
X=X S DIU=X K Y S X=DIV S X=$E($P(^IBCN(365,DA,13),U),1,30) X ^DD(365,13.01,1,1,1.4)
1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=($P(^IBCN(365,DA,1),U)'=$E($P(^IBCN(365,DA,13),U),
1,30))
1.4)= S DIH=$G(^IBCN(365,DIV(0),1)),DIV=X S $P(^(1),U,1)=DIV,DIH=365,DIG=1.01 D ^DICR
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=($P(^IBCN(365,DA,13),U)="") I X S X=DIV S Y(1)=$S($D
(^IBCN(365,D0,1)):^(1),1:"") S X=$P(Y(1),U,1),X=X S DIU=X K Y S X="" X ^DD(365,13.01,1,1,2.4)
2.4)= S DIH=$G(^IBCN(365,DIV(0),1)),DIV=X S $P(^(1),U,1)=DIV,DIH=365,DIG=1.01 D ^DICR
CREATE CONDITION)= S X=($P(^IBCN(365,DA,1),U)'=$E($P(^IBCN(365,DA,13),U),1,30))
CREATE VALUE)= S X=$E($P(^IBCN(365,DA,13),U),1,30)
DELETE CONDITION)= S X=($P(^IBCN(365,DA,13),U)="")
DELETE VALUE)= @
FIELD)= *NAME OF INSURED
Triggers field 1.01 if its value differs from first 30 chars of the value in this field. Deletes
field 1.01 if field 13.01 is deleted.
365,13.02 SUBSCRIBER ID 13;2 FREE TEXT
Subscriber ID
INPUT TRANSFORM: K:$L(X)>80!($L(X)<1)!'$$LENCHK^IBCNEUT1(X,20,0) X
LAST EDITED: NOV 20, 2013
HELP-PROMPT: Answer must be 1-20 characters in length.
DESCRIPTION:
The subscriber identification of the insured person.
TECHNICAL DESCR:
Replaces field 1.05. Length of this field is temporarily limited to 20 characters.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
TRIGGERED by the *SUBSCRIBER ID field of the IIV RESPONSE File
CROSS-REFERENCE: ^^TRIGGER^365^1.05
1)= X ^DD(365,13.02,1,1,1.3) I X S X=DIV S Y(1)=$S($D(^IBCN(365,D0,1)):^(1),1:"") S X=$P(Y(1),U,5),
X=X S DIU=X K Y S X=DIV S X=$E($P(^IBCN(365,DA,13),U,2),1,20) X ^DD(365,13.02,1,1,1.4)
1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=($P(^IBCN(365,DA,1),U,5)'=$E($P(^IBCN(365,DA,13),U
,2),1,20))
1.4)= S DIH=$G(^IBCN(365,DIV(0),1)),DIV=X S $P(^(1),U,5)=DIV,DIH=365,DIG=1.05 D ^DICR
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=($P(^IBCN(365,DA,13),U,2)="") I X S X=DIV S Y(1)=$S(
$D(^IBCN(365,D0,1)):^(1),1:"") S X=$P(Y(1),U,5),X=X S DIU=X K Y S X="" X ^DD(365,13.02,1,1,2.4)
2.4)= S DIH=$G(^IBCN(365,DIV(0),1)),DIV=X S $P(^(1),U,5)=DIV,DIH=365,DIG=1.05 D ^DICR
CREATE CONDITION)= S X=($P(^IBCN(365,DA,1),U,5)'=$E($P(^IBCN(365,DA,13),U,2),1,20))
CREATE VALUE)= S X=$E($P(^IBCN(365,DA,13),U,2),1,20)
DELETE CONDITION)= S X=($P(^IBCN(365,DA,13),U,2)="")
DELETE VALUE)= @
FIELD)= *SUBSCRIBER ID
Triggers field 1.05 if its value differs from first 20 chars of the value in this field. Deletes
field 1.05 if field 13.02 is deleted.
365,14.01 GROUP NAME 14;1 FREE TEXT
Group Name
INPUT TRANSFORM: K:$L(X)>80!($L(X)<1)!'$$LENCHK^IBCNEUT1(X,20,0) X
LAST EDITED: NOV 20, 2013
HELP-PROMPT: Answer must be 1-20 characters in length.
DESCRIPTION:
The name of the group or plan if not an individual policy.
TECHNICAL DESCR:
Replaces field 1.06. Length of this field is temporarily limited to 20 characters.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
TRIGGERED by the *GROUP NAME field of the IIV RESPONSE File
CROSS-REFERENCE: ^^TRIGGER^365^1.06
1)= X ^DD(365,14.01,1,1,1.3) I X S X=DIV S Y(1)=$S($D(^IBCN(365,D0,1)):^(1),1:"") S X=$P(Y(1),U,6),
X=X S DIU=X K Y S X=DIV S X=$E($P(^IBCN(365,DA,14),U),1,20) X ^DD(365,14.01,1,1,1.4)
1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=($P(^IBCN(365,DA,1),U,6)'=$E($P(^IBCN(365,DA,14),U
),1,20))
1.4)= S DIH=$G(^IBCN(365,DIV(0),1)),DIV=X S $P(^(1),U,6)=DIV,DIH=365,DIG=1.06 D ^DICR
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=($P(^IBCN(365,DA,14),U)="") I X S X=DIV S Y(1)=$S($D
(^IBCN(365,D0,1)):^(1),1:"") S X=$P(Y(1),U,6),X=X S DIU=X K Y S X="" X ^DD(365,14.01,1,1,2.4)
2.4)= S DIH=$G(^IBCN(365,DIV(0),1)),DIV=X S $P(^(1),U,6)=DIV,DIH=365,DIG=1.06 D ^DICR
CREATE CONDITION)= S X=($P(^IBCN(365,DA,1),U,6)'=$E($P(^IBCN(365,DA,14),U),1,20))
CREATE VALUE)= S X=$E($P(^IBCN(365,DA,14),U),1,20)
DELETE CONDITION)= S X=($P(^IBCN(365,DA,14),U)="")
DELETE VALUE)= @
FIELD)= *GROUP NAME
Triggers field 1.06 if its value differs from first 20 chars of the value in this field. Deletes
field 1.06 if field 14.01 is deleted.
365,14.02 GROUP NUMBER 14;2 FREE TEXT
Group ID
INPUT TRANSFORM: K:$L(X)>55!($L(X)<1)!'$$LENCHK^IBCNEUT1(X,17,0) X
LAST EDITED: NOV 20, 2013
HELP-PROMPT: Answer must be 1-17 characters in length.
DESCRIPTION:
The number that identifies the group or plan.
TECHNICAL DESCR:
Replaces field 1.07. Length of this field is temporarily limited to 17 characters.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
TRIGGERED by the *GROUP NUMBER field of the IIV RESPONSE File
CROSS-REFERENCE: ^^TRIGGER^365^1.07
1)= X ^DD(365,14.02,1,1,1.3) I X S X=DIV S Y(1)=$S($D(^IBCN(365,D0,1)):^(1),1:"") S X=$P(Y(1),U,7),
X=X S DIU=X K Y S X=DIV S X=$E($P(^IBCN(365,DA,14),U,2),1,17) X ^DD(365,14.02,1,1,1.4)
1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=($P(^IBCN(365,DA,1),U,7)'=$E($P(^IBCN(365,DA,14),U
,2),1,17))
1.4)= S DIH=$G(^IBCN(365,DIV(0),1)),DIV=X S $P(^(1),U,7)=DIV,DIH=365,DIG=1.07 D ^DICR
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=($P(^IBCN(365,DA,14),U,2)="") I X S X=DIV S Y(1)=$S(
$D(^IBCN(365,D0,1)):^(1),1:"") S X=$P(Y(1),U,7),X=X S DIU=X K Y S X="" X ^DD(365,14.02,1,1,2.4)
2.4)= S DIH=$G(^IBCN(365,DIV(0),1)),DIV=X S $P(^(1),U,7)=DIV,DIH=365,DIG=1.07 D ^DICR
CREATE CONDITION)= S X=($P(^IBCN(365,DA,1),U,7)'=$E($P(^IBCN(365,DA,14),U,2),1,17))
CREATE VALUE)= S X=$E($P(^IBCN(365,DA,14),U,2),1,17)
DELETE CONDITION)= S X=($P(^IBCN(365,DA,14),U,2)="")
DELETE VALUE)= @
FIELD)= *GROUP NUMBER
Triggers field 1.07 if its value differs from first 17 chars of the value in this field. Deletes
field 1.07 if field 14.02 is deleted.
FILES POINTED TO FIELDS
ICD DIAGNOSIS (#80) HEALTH CARE CODE INFORMATION:DIAGNOSIS CODE (#.02)
SUBSCRIBER ADDITIONAL INFO:DIAGNOSIS (#.03)
IIV TRANSMISSION QUEUE (#365.1) TRANSMISSION QUEUE (#.05)
IIV TRANSMISSION STATUS (#365.14) TRANSMISSION STATUS (#.06)
INSURANCE VERIFICATION PROCESS
(#355.33) BUFFER ENTRY (#.04)
PATIENT (#2) PATIENT (#.02)
PAYER (#365.12) PAYER (#.03)
PLACE OF SERVICE (#353.1) SUBSCRIBER ADDITIONAL INFO:PLACE OF SERVICE (#.02)
STATE (#5) SUBSCRIBER ADDRESS STATE (#5.04)
ELIGIBILITY/BENEFIT:STATE (#4.04)
X12 271 CODE LIST QUALIFIER
(#365.044) SUBSCRIBER ADDITIONAL INFO:QUALIFIER (#.04)
X12 271 CONTACT QUALIFIER
(#365.021) CONTACT PERSON:COMMUNICATION QUALIFIER #1 (#.02)
COMMUNICATION QUALIFIER #2 (#.04)
COMMUNICATION QUALIFIER #3 (#.06)
CONTACT INFORMATION:COMMUNICATION QUALIFIER (#.04)
X12 271 COVERAGE LEVEL (#365.012) ELIGIBILITY/BENEFIT:COVERAGE LEVEL (#.03)
X12 271 DATE FORMAT QUALIFIER
(#365.032) DATE TIME PERIOD FORMAT QUAL (#12.06)
SUBSCRIBER DATES:DATE FORMAT (#.04)
X12 271 DATE QUALIFIER (#365.026) SUBSCRIBER DATES:DATE QUALIFIER (#.03)
SUBSCRIBER DATES:DATE QUALIFIER (#.03)
X12 271 DELIVERY FREQUENCY COD
(#365.025) HEALTHCARE SERVICES DELIVERY:DELIVERY FREQUENCY (#.08)
X12 271 DELIVERY PATTERN
(#365.036) HEALTHCARE SERVICES DELIVERY:DELIVERY PATTERN (#.09)
X12 271 ELIGIBILITY/BENEFIT
(#365.011) ELIGIBILITY/BENEFIT:ELIGIBILITY/BENEFIT INFO (#.02)
X12 271 ENTITY IDENTIFIER CODE
(#365.022) ELIGIBILITY/BENEFIT:ENTITY ID CODE (#3.01)
X12 271 ENTITY RELATIONSHIP CO
(#365.031) ELIGIBILITY/BENEFIT:ENTITY RELATIONSHIP CODE (#3.06)
X12 271 ENTITY TYPE QUALIFIER
(#365.043) ELIGIBILITY/BENEFIT:ENTITY TYPE (#3.02)
X12 271 ERROR ACTION (#365.018) ERROR ACTION (#1.15)
REJECT REASONS:ACTION CODE (#.04)
X12 271 ERROR CONDITION (#365.017) ERROR CONDITION (#1.14)
REJECT REASONS:REJECT REASON (#.03)
X12 271 IDENTIFICATION QUALIFI
(#365.023) ELIGIBILITY/BENEFIT:ENTITY ID QUALIFIER (#3.05)
X12 271 INJURY CATEGORY (#365.038) SUBSCRIBER ADDITIONAL INFO:NATURE OF INJURY CATEGORY (#.06)
X12 271 INSURANCE TYPE (#365.014) ELIGIBILITY/BENEFIT:INSURANCE TYPE (#.05)
X12 271 LOCATION QUALIFER
(#365.034) ELIGIBILITY/BENEFIT:LOCATION QUALIFIER (#4.08)
X12 271 LOOP ID (#365.027) REJECT REASONS:LOOP ID (#.05)
SUBSCRIBER DATES:LOOP ID (#.04)
X12 271 MILITARY EMPLOYMENT ST
(#365.046) MILITARY EMPLOYMENT STATUS (#12.02)
X12 271 MILITARY GOVT SERVICE
(#365.041) MILITARY GOVT AFFILIATION CODE (#12.03)
X12 271 MILITARY PERSONNEL INF
(#365.039) MILITARY INFO STATUS CODE (#12.01)
X12 271 MILITARY SERVICE RANK
(#365.042) MILITARY SERVICE RANK CODE (#12.05)
X12 271 NATURE OF INJURY CODES
(#365.045) SUBSCRIBER ADDITIONAL INFO:NATURE OF INJURY CODE (#.05)
X12 271 PATIENT RELATIONSHIP
(#365.037) PT. RELATIONSHIP - HIPAA (#8.01)
X12 271 PROCEDURE CODING METHO
(#365.035) ELIGIBILITY/BENEFIT:PROCEDURE CODING METHOD (#1.01)
X12 271 PROVIDER CODE (#365.024) ELIGIBILITY/BENEFIT:PROVIDER CODE (#5.01)
GROUP PROVIDER INFO:PROVIDER CODE (#.02)
X12 271 QUANTITY QUALIFIER
(#365.016) ELIGIBILITY/BENEFIT:QUANTITY QUALIFIER (#.1)
HEALTHCARE SERVICES DELIVERY:QUANTITY QUALIFIER (#.03)
X12 271 REFERENCE IDENTIFICATI
(#365.028) ELIGIBILITY/BENEFIT:REFERENCE ID QUALIFIER (#5.03)
GROUP REFERENCE INFORMATION:REF ID QUALIFIER (GROUP) (#.03)
SUBSCRIBER REFERENCE ID:REFERENCE ID QUALIFIER (#.03)
X12 271 SERVICE TYPE (#365.013) REQUESTED SERVICE TYPE CODE (#.15)
ELIGIBILITY/BENEFIT:*SERVICE TYPE (#.04)
SERVICE TYPES:SERVICE TYPES (#.01)
X12 271 TIME PERIOD QUALIFIER
(#365.015) ELIGIBILITY/BENEFIT:TIME PERIOD QUALIFIER (#.07)
HEALTHCARE SERVICES DELIVERY:TIME PERIOD QUALIFIER (#.07)
X12 271 UNITS OF MEASUREMENT
(#365.029) HEALTHCARE SERVICES DELIVERY:UNITS OF MEASUREMENT (#.05)
X12 271 YES/NO RESPONSE CODE
(#365.033) ELIGIBILITY/BENEFIT:AUTHORIZATION/CERTIFICATION (#.12)
IN PLAN (#.13)
File #365
Record Indexes:
AD (#275) RECORD REGULAR IR SORTING ONLY
Short Descr: Cross-reference for reports
Description: This cross-reference is used to generate reports.
Set Logic: S ^IBCN(365,"AD",X(1),X(2),X(3),DA)=""
Kill Logic: K ^IBCN(365,"AD",X(1),X(2),X(3),DA)
Whole Kill: K ^IBCN(365,"AD")
X(1): DATE/TIME RECEIVED (365,.07) (Subscr 1) (forwards)
X(2): PAYER (365,.03) (Subscr 2) (forwards)
X(3): PATIENT (365,.02) (Subscr 3) (forwards)
AUTO (#481) RECORD REGULAR IR SORTING ONLY
Short Descr: Cross reference for auto-update
Description: This cross reference is used to facilitate various auto-update reporting.
Set Logic: S ^IBCN(365,"AUTO",X(1),X(2),X(3),X(4),X(5),DA)=""
Set Cond: S X=+$G(X(4))&(+$G(X(5)))
Kill Logic: K ^IBCN(365,"AUTO",X(1),X(2),X(3),X(4),X(5),DA)
Whole Kill: K ^IBCN(365,"AUTO")
X(1): DATE/TIME RECEIVED (365,.07) (Subscr 1) (forwards)
X(2): PAYER (365,.03) (Subscr 2) (forwards)
X(3): PATIENT (365,.02) (Subscr 3) (forwards)
X(4): INSUR RECORD IEN (365,.12) (Subscr 4) (forwards)
X(5): EIV AUTO-UPDATE (365,.13) (Subscr 5) (forwards)
INPUT TEMPLATE(S):
PRINT TEMPLATE(S):
SORT TEMPLATE(S):
FORM(S)/BLOCK(S):