3650
LX
Transaction Set Line Number
To reference a line number in a transaction set
To specify the service line item detail for a health care professional
To specify the service line item detail for a health care institution
To specify the service line item detail for dental work
To identify a tooth by number and, if applicable, one or more tooth surfaces
To specify the claim service detail for prescription drugs
4000
SV5
Durable Medical Equipment Service
To specify the claim service detail for durable medical equipment
To specify the claim service detail for anesthesia
To specify the claim service detail for drug services that have been adjudicated
4150
HI
Health Care Information Codes
To supply information related to the delivery of health care
To identify the type or transmission or both of paperwork or supporting information
To supply information related to the ambulance service rendered to a patient
4300
CR2
Chiropractic Certification
To supply information related to the chiropractic service rendered to a patient
4350
CR3
Durable Medical Equipment Certification
To supply information regarding a physician's certification for durable medical equipment
4400
CR4
Enteral or Parenteral Therapy Certification
To supply information regarding certification of medical necessity for enteral or parenteral nutrition therapy
4450
CR5
Oxygen Therapy Certification
To supply information regarding certification of medical necessity for home oxygen therapy
To supply information on conditions
To specify any or all of a date, a time, or a time period
To specify quantity information
To specify physical measurements or counts, including dimensions, tolerances, variances, and weights(See Figures Appendix for example of use of C001)
To specify basic data about the contract or contract line item
To specify identifying information
4750
AMT
Monetary Amount Information
To indicate the total monetary amount
To transmit a fixed-format record or matrix contents
To transmit information in a free-form format, if necessary, for comment or special instruction
To specify the information about services that are purchased
To provide the receiving school district or postsecondary institution with a notice of the immunization status of the student
4910
HSD
Health Care Services Delivery
To specify the delivery pattern of health care services
To specify pricing or repricing information about a health care claim or line item
To specify basic item identification data
To specify pricing information
To specify identifying information
To specify the claim service detail for prescription drugs
To specify the claim service detail for drug services that have been adjudicated
5000
NM1
Individual or Organizational Name
To supply the full name of an individual or organizational entity
To specify the identifying characteristics of a provider
5100
N2
Additional Name Information
To specify additional names
To specify the location of the named party
To specify the geographic place of the named party
To specify identifying information
5300
PER
Administrative Communications Contact
To identify a person or office to whom administrative communications should be directed
5400
SVD
Service Line Adjudication
To convey service line adjudication information for coordination of benefits between the initial payers of a health care claim and all subsequent payers
To supply adjustment reason codes and amounts as needed for an entire claim or for a particular service within the claim being paid
To supply Claim Adjustment Reason Codes and amounts as needed for an entire claim or for a particular service within the claim being paid
To specify any or all of a date, a time, or a time period
5505
AMT
Monetary Amount Information
To indicate the total monetary amount
5510
LQ
Industry Code Identification
To identify standard industry codes
To specify information in response to a codified questionnaire document
