知行 EDI 规范查询平台™
Segment
X12 EDI Release 00304
SV1Professional Service
To specify the claim service detail for a Health Care professional
Elements
  • SV101C003Composite Medical Procedure IdentifierM必须(Mandatory)
    2352341339133913391339352
    • SV10101235Product/Service ID Qualifier
      ID
      M必须(Mandatory)

      Code identifying the type/source of the descriptive number used in Product/Service ID (234).

      Codes (307)
    • SV10102234Product/Service ID
      AN
      M必须(Mandatory)
      Min 0 / Max 30

      Identifying number for a product or service.

    • SV101031339Procedure Modifier
      AN
      O可选(Optional)
      Min 2 / Max 2

      This identifies special circumstances related to the performance of the service, as defined by trading partners

    • SV101041339Procedure Modifier
      AN
      O可选(Optional)
      Min 2 / Max 2

      This identifies special circumstances related to the performance of the service, as defined by trading partners

    • SV101051339Procedure Modifier
      AN
      O可选(Optional)
      Min 2 / Max 2

      This identifies special circumstances related to the performance of the service, as defined by trading partners

    • SV101061339Procedure Modifier
      AN
      O可选(Optional)
      Min 2 / Max 2

      This identifies special circumstances related to the performance of the service, as defined by trading partners

    • SV10107352Description
      AN
      O可选(Optional)
      Min 1 / Max 80

      A free-form description to clarify the related data elements and their content.

  • SV102782Monetary Amount
    R
    O可选(Optional)
    Min 1 / Max 15

    Monetary amount.

  • SV103355Unit or Basis for Measurement Code
    ID
    O可选(Optional)

    Code specifying the units in which a value is being expressed, or manner in which a measurement has been taken

    Codes (719)
  • SV104380Quantity
    R
    O可选(Optional)
    Min 1 / Max 15

    Numeric value of quantity.

  • SV1051331Facility Code Value
    AN
    O可选(Optional)
    Min 1 / Max 2

    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

  • SV1061365Service Type Code
    ID
    O可选(Optional)

    Code identifying the classification of service

    Codes (117)
  • SV107C004Composite Diagnosis Code PointerO可选(Optional)
    1328132813281328
    • SV107011328Diagnosis Code Pointer
      N
      M必须(Mandatory)
      Min 0 / Max 2

      A pointer to the claim diagnosis code in the order of importance to this service

    • SV107021328Diagnosis Code Pointer
      N
      O可选(Optional)
      Min 1 / Max 2

      A pointer to the claim diagnosis code in the order of importance to this service

    • SV107031328Diagnosis Code Pointer
      N
      O可选(Optional)
      Min 1 / Max 2

      A pointer to the claim diagnosis code in the order of importance to this service

    • SV107041328Diagnosis Code Pointer
      N
      O可选(Optional)
      Min 1 / Max 2

      A pointer to the claim diagnosis code in the order of importance to this service

  • SV108782Monetary Amount
    R
    O可选(Optional)
    Min 1 / Max 15

    Monetary amount.

  • SV1091073Yes/No Condition or Response Code
    ID
    O可选(Optional)

    Code indicating a Yes or No condition or response.

    Codes (3)
  • SV1101340Multiple Procedure Code
    ID
    O可选(Optional)

    Code indicating proper adjudication and payment determination in cases involving multiple surgical procedures during the same surgical session

    Codes (3)
  • SV1111073Yes/No Condition or Response Code
    ID
    O可选(Optional)

    Code indicating a Yes or No condition or response.

    Codes (3)
  • SV1121073Yes/No Condition or Response Code
    ID
    O可选(Optional)

    Code indicating a Yes or No condition or response.

    Codes (3)
  • SV1131364Review Code
    ID
    O可选(Optional)

    Code identifying extenuating circumstances or justifications which might assist any review of the medical necessity for this service

    Codes (6)
  • SV1141341National or Local Assigned Review Value
    AN
    O可选(Optional)
    Min 1 / Max 2

    Value assigned by national or local organizations for various healthcare data elements

  • SV1151327Copay Status Code
    ID
    O可选(Optional)

    Code indicating whether or not co-payment requirements were met on a line by line basis

    Codes (4)
  • SV1161334Healthcare Manpower Shortage Area Code
    ID
    O可选(Optional)
    Min 1 / Max 1

    Code identifying a Healthcare Manpower Shortage Area (HMSA)

  • SV117127Reference Number
    AN
    O可选(Optional)
    Min 1 / Max 30

    Reference number or identification number as defined for a particular Transaction Set, or as specified by the Reference Number Qualifier.

  • SV118116Postal Code
    ID
    O可选(Optional)
    Min 3 / Max 9

    Code defining international postal zone code excluding punctuation and blanks (zip code for United States).

  • SV119782Monetary Amount
    R
    O可选(Optional)
    Min 1 / Max 15

    Monetary amount.

  • SV1201337Level of Care Code
    ID
    O可选(Optional)

    Code specifying the level of care provided by a nursing home facility

    Codes (8)
  • SV1211360Provider Agreement Code
    ID
    O可选(Optional)

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

    Codes (7)
知行 EDI 规范查询平台™ 2023 - 3.1.18
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