Segment
X12 EDI Release 00403
To supply provider-level control information
Elements
  • TS301127Reference Identification
    AN
    M必须(Mandatory)
    Min 1 / Max 50

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

  • TS3021331Facility Code Value
    AN
    M必须(Mandatory)
    Min 1 / Max 2

    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

  • TS303373Date
    DT
    M必须(Mandatory)
    Min 8 / Max 8

    Date expressed as CCYYMMDD where CC represents the first two digits of the calendar year

  • TS304380Quantity
    R
    M必须(Mandatory)
    Min 1 / Max 15

    Numeric value of quantity

  • TS305782Monetary Amount
    R
    M必须(Mandatory)
    Min 1 / Max 18

    Monetary amount

  • TS306782Monetary Amount
    R
    O可选(Optional)
    Min 1 / Max 18

    Monetary amount

  • TS307782Monetary Amount
    R
    O可选(Optional)
    Min 1 / Max 18

    Monetary amount

  • TS308782Monetary Amount
    R
    O可选(Optional)
    Min 1 / Max 18

    Monetary amount

  • TS309782Monetary Amount
    R
    O可选(Optional)
    Min 1 / Max 18

    Monetary amount

  • TS310782Monetary Amount
    R
    O可选(Optional)
    Min 1 / Max 18

    Monetary amount

  • TS311782Monetary Amount
    R
    O可选(Optional)
    Min 1 / Max 18

    Monetary amount

  • TS312782Monetary Amount
    R
    O可选(Optional)
    Min 1 / Max 18

    Monetary amount

  • TS313782Monetary Amount
    R
    O可选(Optional)
    Min 1 / Max 18

    Monetary amount

  • TS314782Monetary Amount
    R
    O可选(Optional)
    Min 1 / Max 18

    Monetary amount

  • TS315782Monetary Amount
    R
    O可选(Optional)
    Min 1 / Max 18

    Monetary amount

  • TS316782Monetary Amount
    R
    O可选(Optional)
    Min 1 / Max 18

    Monetary amount

  • TS317782Monetary Amount
    R
    O可选(Optional)
    Min 1 / Max 18

    Monetary amount

  • TS318782Monetary Amount
    R
    O可选(Optional)
    Min 1 / Max 18

    Monetary amount

  • TS319782Monetary Amount
    R
    O可选(Optional)
    Min 1 / Max 18

    Monetary amount

  • TS320782Monetary Amount
    R
    O可选(Optional)
    Min 1 / Max 18

    Monetary amount

  • TS321782Monetary Amount
    R
    O可选(Optional)
    Min 1 / Max 18

    Monetary amount

  • TS322782Monetary Amount
    R
    O可选(Optional)
    Min 1 / Max 18

    Monetary amount

  • TS323380Quantity
    R
    O可选(Optional)
    Min 1 / Max 15

    Numeric value of quantity

  • TS324782Monetary Amount
    R
    O可选(Optional)
    Min 1 / Max 18

    Monetary amount