Monday, 5 May 2014

271–5010 Health Care Eligibility Benefit Response- Loop 2000A and 2100A Information Source Name



        

Use the Information Source Level HL to identify the original entity who responded  i.e Insurance Company

Hierarchical ID Number
A unique number assigned by the sender to identify a particular data segment in a hierarchical structure.

HL01 shall contain a unique alphanumeric number for each occurrence  of the HL segment in the transaction set. For example, HL01 could be used to indicate the number of occurrences of the HL segment, in which case the value of HL01 would be “1" for the initial HL segment and would be incremented by one in each subsequent HL segment within the transaction. HL01 must begin with “1" and be incremented by one each time an HL is used in the transaction. Only numeric values are allowed in HL01.



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



 

Loop 2100A Information Source Name

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

 

NM101 - Entity Identifier Code
Code List
Code Definition
2B Third Party Administrator
36 Employer
GP Gateway Provider
P5 Plan Sponsor
PR Payer

 

NM102 - Entity Type Qualifier
Code qualifying the type of entity
Code Definition
1 Person
2 Non-Person Entity

 

NM108 – Identification Code Qualifier
Code List
Code Definition
24 Employer Identification Number
46 Electronic Transmitter Identification Number (ETIN)
FI Federal TaxPayers Identification Number
NI National Association of Insurance Commissioners Identification
PI Payor Identification
XV Plan ID
XX National Provider Identifier


Loop 2100A Information EDI Contact Information
Loop Seg ID Segment Name Format Length Ref# Req Value
Header PER Submitter EDI Contact Information ID 3 R PER
Element Separator AN 1 *
PER01 Contact Function Code ID 2/2 366 R IC
Element Separator AN 1 *
PER02 Name AN 1/60 93 R contact Person Name for EDI Transmission issues.
Element Separator AN 1 *
PER03 Communication Number qualifier ID 2/2 365 R See below for more information
Element Separator AN 1 *
PER04 Communication Number AN 1/256 364 R Print Complete number including country code or area code when applicable.
Element Separator AN 1 *
PER05 Communication Number qualifier ID 2/2 365 R See below for more information
Element Separator AN 1 *
PER06 Communication Number AN 1/256 364 R Print Complete number including country code or area code when applicable.
PER07 Communication Number qualifier ID 2/2 365 R See below for more information
Element Separator AN 1 *
PER08 Communication Number AN 1/256 364 R Print Complete number including country code or area code when applicable.
Segment Terminator ~

 

Communication Number qualifier
Code identifying the type of communication number.
Code Definition
ED Electronic data interchange Access Number.
EM Electronic Mail
EX Telephone Extension
FX Facsimile
TE Telephone.
 


Sample :
HL*1**20*1
NM1*PR*2*CGLIC*****FI*06-0303370
PER*IC**TE*8002446224*UR*cignaforhcp.cigna.com

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

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