# | Name | Location | Type | Details | Index | Description |
---|---|---|---|---|---|---|
.01 | message control id(+) | 0;1 | FREE TEXT | B | 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. | |
.02 | patient | 0;2 | POINTER | 2 | This the patient who was identified on the outgoing HL7 message. | |
.03 | payer | 0;3 | POINTER | 365.12 | This is the payer that was selected for either identification or verification. | |
.04 | buffer entry | 0;4 | POINTER | 355.33 | AF | This field is a pointer to the Insurance Buffer File if a buffer record exists for this insurance inquiry. |
.05 | transmission queue | 0;5 | POINTER | 365.1 | This is the reference back to the Transmission Queue File. It provides a link between the inquiry and the response. | |
.06 | transmission status | 0;6 | POINTER | 365.14 | AC | This is the status of the response record. |
.07 | date/time received | 0;7 | DATE-TIME | This is the date and time that the HL7 response was received from the payer via the Eligibility Communicator. | ||
.08 | date/time created | 0;8 | DATE-TIME | AE | This is the date and time that the baseline response record was created when the outgoing HL7 message was generated. | |
.09 | trace number | 0;9 | FREE TEXT | C | This field will contain the Trace Number assigned by EC that is used for tracking a message between EC and the vendor. | |
.1 | response type | 0;10 | SET OF CODES | O:Original U:Unsolicited | This field identifies whether a response originated from the Transmission Queue file (Original) or was received Unsolicited from the EC. | |
1.01 | *name of insured | 1;1 | FREE TEXT | 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. | ||
1.02 | insured dob | 1;2 | FREE TEXT | The date of birth of the insured person. | ||
1.03 | insured ssn | 1;3 | FREE TEXT | The social security number of the insured person. | ||
1.04 | insured sex | 1;4 | FREE TEXT | The sex of the insured person. | ||
1.05 | *subscriber id | 1;5 | FREE TEXT | The subscriber identification of the insured person. This field is scheduled for deletion in May 2015. | ||
1.06 | *group name | 1;6 | FREE TEXT | The name of the group or plan if not an individual policy. This field is scheduled for deletion in May 2015. | ||
1.07 | *group number | 1;7 | FREE TEXT | The number that identifies the group or plan. This field is scheduled for deletion in May 2015. | ||
1.08 | whose insurance | 1;8 | SET OF CODES | v:VETERAN s:SPOUSE o:OTHER | This is a definition of who is the subscriber of the insurance; the veteran, a spouse or someone else. | |
1.09 | pt relationship to insured | 1;9 | SET OF CODES | 01:PATIENT 02:SPOUSE 03:NATURAL CHILD 08:EMPLOYEE 09:UNKNOWN 11:ORGAN DONOR 15:INJURED PLAINTIFF 18:PARENT 34:OTHER ADULT | This is a definition of the patient's relationship to the insured person. | |
1.1 | service date | 1;10 | DATE-TIME | This is the date of service returned by the Eligibility Communicator. It may be different from the one sent in the original inquiry. | ||
1.11 | effective date | 1;11 | DATE-TIME | This is the date that the insurance coverage began. | ||
1.12 | expiration date | 1;12 | DATE-TIME | This is the date that the insurance coverage ends. | ||
1.13 | coordination of benefits | 1;13 | SET OF CODES | 1:PRIMARY 2:SECONDARY 3:TERTIARY | If an insurance payer is identified as a primary, secondary or tertiary in the response. | |
1.14 | error condition | 1;14 | POINTER | 365.017 | This is an error value returned from either the payer or the Eligibility Communicator. | |
1.15 | error action | 1;15 | POINTER | 365.018 | When an error condition is returned in the response, there may be an action that directs what happens to the response. | |
1.16 | date of death | 1;16 | DATE-TIME | This is the date that the payer indicates that the person that verification was requested for has died. | ||
1.17 | certification date | 1;17 | DATE-TIME | This field may be returned by the payer and is the date that the insurance coverage was certified. | ||
1.18 | member id | 1;18 | FREE TEXT | The member identification of the insured person. | ||
1.19 | payer updated policy | 1;19 | DATE-TIME | 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. | ||
1.2 | policy number | 1;20 | FREE TEXT | This field may be returned by the payer. It is the policy number of the insured person. | ||
2 | eligibility/benefit | 2;0 | MULTIPLE | 365.02 | This multiple contains all of the eligibility and benefit data for a specific insured person returned from the Payer. | |
3 | contact person | 3;0 | MULTIPLE | 365.03 | 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. | |
4.01 | error text | 4;1 | FREE TEXT | 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. | ||
5.01 | subscriber address line 1 | 5;1 | FREE TEXT | Subscriber address, line 1. | ||
5.02 | subscriber address line 2 | 5;2 | FREE TEXT | Subscriber address, line 2. | ||
5.03 | subscriber address city | 5;3 | FREE TEXT | Subscriber address, city. | ||
5.04 | subscriber address state | 5;4 | POINTER | 5 | Subscriber address, state. | |
5.05 | subscriber address zip | 5;5 | FREE TEXT | Subscriber address, zip code. | ||
5.06 | subscriber address country | 5;6 | FREE TEXT | Subscriber address, country code. | ||
5.07 | subscriber address subdivision | 5;7 | FREE TEXT | Subscriber address, country subdivision code. | ||
6 | reject reasons | 6;0 | MULTIPLE | 365.06 | This multiple contains reject reason codes. | |
7 | subscriber dates | 7;0 | MULTIPLE | 365.07 | Subscriber dates multiple. Contains subscriber level dates, as opposed to eligibility/benefit level dates. | |
8.01 | pt. relationship - hipaa | 8;1 | POINTER | 365.037 | 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. | |
9 | group reference information | 9;0 | MULTIPLE | 365.09 | Subscriber/Dependent additional identification data. | |
10 | group provider info | 10;0 | MULTIPLE | 365.04 | Entries in this sub-file identify the characteristics of a provider. | |
11 | health care code information | 11;0 | MULTIPLE | 365.01 | To supply information related to the delivery of health care. | |
12.01 | military info status code | 12;1 | POINTER | 365.039 | Code to indicate the status of the military information sent by the payer. | |
12.02 | military employment status | 12;2 | POINTER | 365.046 | Code showing the general military employment status of an employee/claimant. | |
12.03 | military govt affiliation code | 12;3 | POINTER | 365.041 | Code specifying the military service affiliation. | |
12.04 | military personnel description | 12;4 | FREE TEXT | Free-form text description that further identifies the exact military unit. | ||
12.05 | military service rank code | 12;5 | POINTER | 365.042 | Code specifying the military service rank. | |
12.06 | date time period format qual | 12;6 | POINTER | 365.032 | Code qualifier indicating the date format, time format, or date and time format respective of the DATE TIME PERIOD field (#12.07). | |
12.07 | date time period | 12;7 | FREE TEXT | Expression of a date or range of dates that indicates the date span of military service. | ||
13.01 | name of insured | 13;1 | FREE TEXT | 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. | ||
13.02 | subscriber id | 13;2 | FREE TEXT | The subscriber identification of the insured person. | ||
14.01 | group name | 14;1 | FREE TEXT | The name of the group or plan if not an individual policy. | ||
14.02 | group number | 14;2 | FREE TEXT | The number that identifies the group or plan. |