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

Code identifying the status of an entire claim as assigned by the payor, claim review organization or repricing organization

Monetary amount

Monetary amount

Monetary amount

Code identifying type of claim

Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier

Code identifying the type of facility where services were performed; the first and second positions of the Uniform Bill Type code or the Place of Service code from the Electronic Media Claims National Standard Format

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

Code indicating patient status as of the "statement covers through date"

Code indicating a patient's diagnosis group based on a patient's illness, diseases, and medical problems

Numeric value of quantity

Percentage expressed as a decimal