OI Other Health Insurance Information

Opt

AtMax 1

To specify information associated with other health insurance coverage

Elements

Position	Element	Name		Type	Min/Max	Repeat

1	1032	Claim Filing Indicator Code	Opt	ID	1/2	Exact 1
2	1383	Claim Submission Reason Code	Opt	ID	2/2	Exact 1
3	1073	Yes/No Condition or Response Code	Opt	ID	1/1	Exact 1
4	1351	Patient Signature Source Code	Opt	ID	1/1	Exact 1
5	1360	Provider Agreement Code	Opt	ID	1/1	Exact 1
6	1363	Release of Information Code	Opt	ID	1/1	Exact 1

Element Details

ID1032

NameClaim Filing Indicator Code

LengthMin 1 / Max 2

Position1

RequirementOpt

Codes

<>15Indemnity Insurance
<>WCWorkers' Compensation Health Claim
<>07Property Preforeclosure Sale
<>VAVeteran Administration Plan
<>DSDisability
<>MBMedicare Part B
<>WEWorkers' Compensation Combined First and Subsequent Report
<>SASelf-administered Group
<>13Point of Service (POS)
<>14Exclusive Provider Organization (EPO)
<>MHManaged Care Non-HMO
<>WBWorkers' Compensation First Report of Injury
<>22Liability Insurance
<>19Deed-in-Lieu Property Not Sold
<>ZZMutually Defined
<>12Preferred Provider Organization (PPO)
<>WDWorkers' Compensation Subsequent Report of Injury
<>BLBlue Cross/Blue Shield
<>17Dental Maintenance Organization
<>01Property Conveyance
<>LMLiability Medical
<>OFOther Federal Program
<>18Deed-in-Lieu Property Sold
<>MAMedicare Part A
<>04Mortgage Coinsurance
<>AMAutomobile Medical
<>16Health Maintenance Organization (HMO) Medicare Risk
<>FIFederal Employees Program
<>TVTitle V
<>CICommercial Insurance Co.
<>20Foreclosure Complete Property Sold
<>02Mortgage Assignment
<>CNContractual
<>LILiability
<>05Supplemental Claim
<>HMHealth Maintenance Organization
<>08Initial Claim
<>11Other Non-Federal Programs
<>03Automatic Mortgage Assignment
<>CHChampus
<>21Foreclosure Complete Property Not Sold
<>MCMedicaid
<>06Property Nonconveyance (Claim without Conveyance of Title)
<>10Central Certification
<>09Self-pay