Identifier used to track a claim from creation by the health care provider through payment.

Monetary amount.

Code identifying type of claim

Code identifying the type of provider or claim

Code identifying the type of facility referenced

Code identifying the type of facility where services were performed; the first and second position of the uniform bill type or place of service from health care financing administration claim form, or place of treatment from the dental claim form

Code specifying the frequency of the claim; this is the third position of the Uniform Billing Claim Form Bill Type

Code indicating a Yes or No condition or response.

Code indicating whether the provider accepts assignment

Code indicating a Yes or No condition or response.

Code indicating whether the provider has on file a signed statement by the patient authorizing the release of medical data to other organizations in order to adjudicate the claim

Code indicating how the patient or subscriber authorization signatures were obtained and how they are being retained by the provider

Code identifying an accompanying cause of an illness or an accident

Code identifying an accompanying cause of an illness or an accident

Code identifying an accompanying cause of an illness or an accident

Code (Standard State/Province) as defined by appropriate government agency.

Code identifying the country.

Code indicating the Special Program under which the services rendered to the patient were performed

Code indicating a Yes or No condition or response.

Code specifying the level of service rendered

Code indicating a Yes or No condition or response.

Code indicating the type of agreement under which the provider is submitting this claim

Code identifying the status of an entire claim as assigned by the payor.

Code indicating a Yes or No condition or response.

Code identifying reason for claim submission