EDI Dictionary

Transaction Sets Segments

EDI-Dictionary

7030

837 Health Care Claim

OI-3100

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	AtMax 1
2	1383	Claim Submission Reason Code	Opt	ID	2/2	AtMax 1
3	1073	Yes/No Condition or Response Code	Opt	ID	1/1	AtMax 1
4	1351	Patient Signature Source Code	Opt	ID	1/1	AtMax 1
5	1360	Provider Agreement Code	Opt	ID	1/1	AtMax 1
6	1363	Release of Information Code	Opt	ID	1/1	AtMax 1
7	1359	Provider Accept Assignment Code	Opt	ID	1/1	AtMax 1
8	1073	Yes/No Condition or Response Code	Opt	ID	1/1	AtMax 1
9	1073	Yes/No Condition or Response Code	Opt	ID	1/1	AtMax 1
10	1073	Yes/No Condition or Response Code	Opt	ID	1/1	AtMax 1
11	1073	Yes/No Condition or Response Code	Opt	ID	1/1	AtMax 1

Element Details

ID1032

NameClaim Filing Indicator Code

LengthMin 1 / Max 2

Position1

RequirementOpt

Codes

<>15
Indemnity Insurance
<>WC
Workers' Compensation Health Claim
<>07
Property Preforeclosure Sale
<>VA
Veterans Affairs Plan
<>DS
Disability
<>MB
Medicare Part B
<>WE
Workers' Compensation Combined First and Subsequent Report
<>SA
Self-administered Group
<>13
Point of Service (POS)
<>31
Special Forbearance
<>14
Exclusive Provider Organization (EPO)
<>MH
Managed Care Non-HMO
<>WB
Workers' Compensation First Report of Injury
<>22
Liability Insurance
<>19
Deed-in-Lieu Property Not Sold
<>ME
Medicare Advantage Plan
<>ZZ
Mutually Defined
<>12
Preferred Provider Organization (PPO)
<>WD
Workers' Compensation Subsequent Report of Injury
<>BL
Blue Cross/Blue Shield
<>17
Dental Maintenance Organization
<>01
Property Conveyance
<>LM
Liability Medical
<>OF
Other Federal Program
<>18
Deed-in-Lieu Property Sold
<>MD
Medicare Part D
<>MA
Medicare Part A
<>04
Mortgage Coinsurance
<>AM
Automobile Medical
<>16
Health Maintenance Organization (HMO) Medicare Risk
<>34
Managed Dental
<>FI
Federal Employees Program
<>TV
Title V
<>CI
Commercial Insurance Co.
<>20
Foreclosure Complete Property Sold
<>02
Mortgage Assignment
<>CN
Contractual
<>LI
Liability
<>05
Supplemental Claim
<>HM
Health Maintenance Organization
<>08
Initial Claim
<>11
Other Non-Federal Programs
<>33
Partial Claim
<>03
Automatic Mortgage Assignment
<>CH
Champus
<>21
Foreclosure Complete Property Not Sold
<>MC
Medicaid
<>UK
Unknown
<>06
Property Nonconveyance (Claim without Conveyance of Title)
<>10
Central Certification
<>32
Loan Modifications
<>09
Self-pay