Item | DT | Card | Conf | Description | Label |
---|
hl7v2:IN2.1
| CX | 0 … * | | Insured's Employee ID Contains 2.16.840.1.113883.3.1937.99.60.4.15.12 (DYNAMIC) | IN2_ment |
@Item
| | 0 … 1 | F | 472 |
@Type
| | 0 … 1 | F | CX |
@LongName
| | 0 … 1 | F | Insured's Employee ID |
hl7v2:IN2.2
| ST | 0 … 1 | | Insured's Social Security Number | IN2_ment |
@Item
| | 0 … 1 | F | 473 |
@Type
| | 0 … 1 | F | ST |
@LongName
| | 0 … 1 | F | Insured's Social Security Number |
hl7v2:IN2.3
| XCN | 0 … * | | Insured's Employer's Name and ID Contains 2.16.840.1.113883.3.1937.99.60.4.15.74 (DYNAMIC) | IN2_ment |
@Item
| | 0 … 1 | F | 474 |
@Type
| | 0 … 1 | F | XCN |
@LongName
| | 0 … 1 | F | Insured's Employer's Name and ID |
hl7v2:IN2.4
| IS | 0 … 1 | | Employer Information Data | IN2_ment |
@Item
| | 0 … 1 | F | 475 |
@Type
| | 0 … 1 | F | IS |
@Table
| | 0 … 1 | F | HL70139 |
@LongName
| | 0 … 1 | F | Employer Information Data |
hl7v2:IN2.5
| IS | 0 … * | | Mail Claim Party | IN2_ment |
@Item
| | 0 … 1 | F | 476 |
@Type
| | 0 … 1 | F | IS |
@Table
| | 0 … 1 | F | HL70137 |
@LongName
| | 0 … 1 | F | Mail Claim Party |
hl7v2:IN2.6
| ST | 0 … 1 | | Medicare Health Ins Card Number | IN2_ment |
@Item
| | 0 … 1 | F | 477 |
@Type
| | 0 … 1 | F | ST |
@LongName
| | 0 … 1 | F | Medicare Health Ins Card Number |
hl7v2:IN2.7
| XPN | 0 … * | | Medicaid Case Name Contains 2.16.840.1.113883.3.1937.99.60.4.15.76 (DYNAMIC) | IN2_ment |
@Item
| | 0 … 1 | F | 478 |
@Type
| | 0 … 1 | F | XPN |
@LongName
| | 0 … 1 | F | Medicaid Case Name |
hl7v2:IN2.8
| ST | 0 … 1 | | Medicaid Case Number | IN2_ment |
@Item
| | 0 … 1 | F | 479 |
@Type
| | 0 … 1 | F | ST |
@LongName
| | 0 … 1 | F | Medicaid Case Number |
hl7v2:IN2.9
| XPN | 0 … * | | Military Sponsor Name Contains 2.16.840.1.113883.3.1937.99.60.4.15.76 (DYNAMIC) | IN2_ment |
@Item
| | 0 … 1 | F | 480 |
@Type
| | 0 … 1 | F | XPN |
@LongName
| | 0 … 1 | F | Military Sponsor Name |
hl7v2:IN2.10
| ST | 0 … 1 | | Military ID Number | IN2_ment |
@Item
| | 0 … 1 | F | 481 |
@Type
| | 0 … 1 | F | ST |
@LongName
| | 0 … 1 | F | Military ID Number |
hl7v2:IN2.11
| CE | 0 … 1 | | Dependent Of Military Recipient Contains 2.16.840.1.113883.3.1937.99.60.4.15.5 (DYNAMIC) | IN2_ment |
@Item
| | 0 … 1 | F | 482 |
@Type
| | 0 … 1 | F | CE |
@Table
| | 0 … 1 | F | HL70342 |
@LongName
| | 0 … 1 | F | Dependent Of Military Recipient |
hl7v2:IN2.12
| ST | 0 … 1 | | Military Organization | IN2_ment |
@Item
| | 0 … 1 | F | 483 |
@Type
| | 0 … 1 | F | ST |
@LongName
| | 0 … 1 | F | Military Organization |
hl7v2:IN2.13
| ST | 0 … 1 | | Military Station | IN2_ment |
@Item
| | 0 … 1 | F | 484 |
@Type
| | 0 … 1 | F | ST |
@LongName
| | 0 … 1 | F | Military Station |
hl7v2:IN2.14
| IS | 0 … 1 | | Military Service | IN2_ment |
@Item
| | 0 … 1 | F | 485 |
@Type
| | 0 … 1 | F | IS |
@Table
| | 0 … 1 | F | HL70140 |
@LongName
| | 0 … 1 | F | Military Service |
hl7v2:IN2.15
| IS | 0 … 1 | | Military Rank/Grade | IN2_ment |
@Item
| | 0 … 1 | F | 486 |
@Type
| | 0 … 1 | F | IS |
@Table
| | 0 … 1 | F | HL70141 |
@LongName
| | 0 … 1 | F | Military Rank/Grade |
hl7v2:IN2.16
| IS | 0 … 1 | | Military Status | IN2_ment |
@Item
| | 0 … 1 | F | 487 |
@Type
| | 0 … 1 | F | IS |
@Table
| | 0 … 1 | F | HL70142 |
@LongName
| | 0 … 1 | F | Military Status |
hl7v2:IN2.17
| DT | 0 … 1 | | Military Retire Date | IN2_ment |
@Item
| | 0 … 1 | F | 488 |
@Type
| | 0 … 1 | F | DT |
@LongName
| | 0 … 1 | F | Military Retire Date |
hl7v2:IN2.18
| ID | 0 … 1 | | Military Non-Avail Cert On File | IN2_ment |
@Item
| | 0 … 1 | F | 489 |
@Type
| | 0 … 1 | F | ID |
@Table
| | 0 … 1 | F | HL70136 |
@LongName
| | 0 … 1 | F | Military Non-Avail Cert On File |
hl7v2:IN2.19
| ID | 0 … 1 | | Baby Coverage | IN2_ment |
@Item
| | 0 … 1 | F | 490 |
@Type
| | 0 … 1 | F | ID |
@Table
| | 0 … 1 | F | HL70136 |
@LongName
| | 0 … 1 | F | Baby Coverage |
hl7v2:IN2.20
| ID | 0 … 1 | | Combine Baby Bill | IN2_ment |
@Item
| | 0 … 1 | F | 491 |
@Type
| | 0 … 1 | F | ID |
@Table
| | 0 … 1 | F | HL70136 |
@LongName
| | 0 … 1 | F | Combine Baby Bill |
hl7v2:IN2.21
| ST | 0 … 1 | | Blood Deductible | IN2_ment |
@Item
| | 0 … 1 | F | 492 |
@Type
| | 0 … 1 | F | ST |
@LongName
| | 0 … 1 | F | Blood Deductible |
hl7v2:IN2.22
| XPN | 0 … * | | Special Coverage Approval Name Contains 2.16.840.1.113883.3.1937.99.60.4.15.76 (DYNAMIC) | IN2_ment |
@Item
| | 0 … 1 | F | 493 |
@Type
| | 0 … 1 | F | XPN |
@LongName
| | 0 … 1 | F | Special Coverage Approval Name |
hl7v2:IN2.23
| ST | 0 … 1 | | Special Coverage Approval Title | IN2_ment |
@Item
| | 0 … 1 | F | 494 |
@Type
| | 0 … 1 | F | ST |
@LongName
| | 0 … 1 | F | Special Coverage Approval Title |
hl7v2:IN2.24
| IS | 0 … * | | Non-Covered Insurance Code | IN2_ment |
@Item
| | 0 … 1 | F | 495 |
@Type
| | 0 … 1 | F | IS |
@Table
| | 0 … 1 | F | HL70143 |
@LongName
| | 0 … 1 | F | Non-Covered Insurance Code |
hl7v2:IN2.25
| CX | 0 … * | | Payor ID Contains 2.16.840.1.113883.3.1937.99.60.4.15.12 (DYNAMIC) | IN2_ment |
@Item
| | 0 … 1 | F | 496 |
@Type
| | 0 … 1 | F | CX |
@LongName
| | 0 … 1 | F | Payor ID |
hl7v2:IN2.26
| CX | 0 … * | | Payor Subscriber ID Contains 2.16.840.1.113883.3.1937.99.60.4.15.12 (DYNAMIC) | IN2_ment |
@Item
| | 0 … 1 | F | 497 |
@Type
| | 0 … 1 | F | CX |
@LongName
| | 0 … 1 | F | Payor Subscriber ID |
hl7v2:IN2.27
| IS | 0 … 1 | | Eligibility Source | IN2_ment |
@Item
| | 0 … 1 | F | 498 |
@Type
| | 0 … 1 | F | IS |
@Table
| | 0 … 1 | F | HL70144 |
@LongName
| | 0 … 1 | F | Eligibility Source |
hl7v2:IN2.28
| RMC | 0 … * | | Room Coverage Type/Amount Contains 2.16.840.1.113883.3.1937.99.60.4.15.55 (DYNAMIC) | IN2_ment |
@Item
| | 0 … 1 | F | 499 |
@Type
| | 0 … 1 | F | RMC |
@LongName
| | 0 … 1 | F | Room Coverage Type/Amount |
hl7v2:IN2.29
| PTA | 0 … * | | Policy Type/Amount Contains 2.16.840.1.113883.3.1937.99.60.4.15.49 (DYNAMIC) | IN2_ment |
@Item
| | 0 … 1 | F | 500 |
@Type
| | 0 … 1 | F | PTA |
@LongName
| | 0 … 1 | F | Policy Type/Amount |
hl7v2:IN2.30
| DDI | 0 … 1 | | Daily Deductible Contains 2.16.840.1.113883.3.1937.99.60.4.15.13 (DYNAMIC) | IN2_ment |
@Item
| | 0 … 1 | F | 501 |
@Type
| | 0 … 1 | F | DDI |
@LongName
| | 0 … 1 | F | Daily Deductible |
hl7v2:IN2.31
| IS | 0 … 1 | | Living Dependency | IN2_ment |
@Item
| | 0 … 1 | F | 755 |
@Type
| | 0 … 1 | F | IS |
@Table
| | 0 … 1 | F | HL70223 |
@LongName
| | 0 … 1 | F | Living Dependency |
hl7v2:IN2.32
| IS | 0 … * | | Ambulatory Status | IN2_ment |
@Item
| | 0 … 1 | F | 145 |
@Type
| | 0 … 1 | F | IS |
@Table
| | 0 … 1 | F | HL70009 |
@LongName
| | 0 … 1 | F | Ambulatory Status |
hl7v2:IN2.33
| CE | 0 … * | | Citizenship Contains 2.16.840.1.113883.3.1937.99.60.4.15.5 (DYNAMIC) | IN2_ment |
@Item
| | 0 … 1 | F | 129 |
@Type
| | 0 … 1 | F | CE |
@Table
| | 0 … 1 | F | HL70171 |
@LongName
| | 0 … 1 | F | Citizenship |
hl7v2:IN2.34
| CE | 0 … 1 | | Primary Language Contains 2.16.840.1.113883.3.1937.99.60.4.15.5 (DYNAMIC) | IN2_ment |
@Item
| | 0 … 1 | F | 118 |
@Type
| | 0 … 1 | F | CE |
@Table
| | 0 … 1 | F | HL70296 |
@LongName
| | 0 … 1 | F | Primary Language |
hl7v2:IN2.35
| IS | 0 … 1 | | Living Arrangement | IN2_ment |
@Item
| | 0 … 1 | F | 742 |
@Type
| | 0 … 1 | F | IS |
@Table
| | 0 … 1 | F | HL70220 |
@LongName
| | 0 … 1 | F | Living Arrangement |
hl7v2:IN2.36
| CE | 0 … 1 | | Publicity Code Contains 2.16.840.1.113883.3.1937.99.60.4.15.5 (DYNAMIC) | IN2_ment |
@Item
| | 0 … 1 | F | 743 |
@Type
| | 0 … 1 | F | CE |
@Table
| | 0 … 1 | F | HL70215 |
@LongName
| | 0 … 1 | F | Publicity Code |
hl7v2:IN2.37
| ID | 0 … 1 | | Protection Indicator | IN2_ment |
@Item
| | 0 … 1 | F | 744 |
@Type
| | 0 … 1 | F | ID |
@Table
| | 0 … 1 | F | HL70136 |
@LongName
| | 0 … 1 | F | Protection Indicator |
hl7v2:IN2.38
| IS | 0 … 1 | | Student Indicator | IN2_ment |
@Item
| | 0 … 1 | F | 745 |
@Type
| | 0 … 1 | F | IS |
@Table
| | 0 … 1 | F | HL70231 |
@LongName
| | 0 … 1 | F | Student Indicator |
hl7v2:IN2.39
| CE | 0 … 1 | | Religion Contains 2.16.840.1.113883.3.1937.99.60.4.15.5 (DYNAMIC) | IN2_ment |
@Item
| | 0 … 1 | F | 120 |
@Type
| | 0 … 1 | F | CE |
@Table
| | 0 … 1 | F | HL70006 |
@LongName
| | 0 … 1 | F | Religion |
hl7v2:IN2.40
| XPN | 0 … * | | Mother's Maiden Name Contains 2.16.840.1.113883.3.1937.99.60.4.15.76 (DYNAMIC) | IN2_ment |
@Item
| | 0 … 1 | F | 109 |
@Type
| | 0 … 1 | F | XPN |
@LongName
| | 0 … 1 | F | Mother's Maiden Name |
hl7v2:IN2.41
| CE | 0 … 1 | | Nationality Contains 2.16.840.1.113883.3.1937.99.60.4.15.5 (DYNAMIC) | IN2_ment |
@Item
| | 0 … 1 | F | 739 |
@Type
| | 0 … 1 | F | CE |
@Table
| | 0 … 1 | F | HL70212 |
@LongName
| | 0 … 1 | F | Nationality |
hl7v2:IN2.42
| CE | 0 … * | | Ethnic Group Contains 2.16.840.1.113883.3.1937.99.60.4.15.5 (DYNAMIC) | IN2_ment |
@Item
| | 0 … 1 | F | 125 |
@Type
| | 0 … 1 | F | CE |
@Table
| | 0 … 1 | F | HL70189 |
@LongName
| | 0 … 1 | F | Ethnic Group |
hl7v2:IN2.43
| CE | 0 … * | | Marital Status Contains 2.16.840.1.113883.3.1937.99.60.4.15.5 (DYNAMIC) | IN2_ment |
@Item
| | 0 … 1 | F | 119 |
@Type
| | 0 … 1 | F | CE |
@Table
| | 0 … 1 | F | HL70002 |
@LongName
| | 0 … 1 | F | Marital Status |
hl7v2:IN2.44
| DT | 0 … 1 | | Insured's Employment Start Date | IN2_ment |
@Item
| | 0 … 1 | F | 787 |
@Type
| | 0 … 1 | F | DT |
@LongName
| | 0 … 1 | F | Insured's Employment Start Date |
hl7v2:IN2.45
| DT | 0 … 1 | | Employment Stop Date | IN2_ment |
@Item
| | 0 … 1 | F | 783 |
@Type
| | 0 … 1 | F | DT |
@LongName
| | 0 … 1 | F | Employment Stop Date |
hl7v2:IN2.46
| ST | 0 … 1 | | Job Title | IN2_ment |
@Item
| | 0 … 1 | F | 785 |
@Type
| | 0 … 1 | F | ST |
@LongName
| | 0 … 1 | F | Job Title |
hl7v2:IN2.47
| JCC | 0 … 1 | | Job Code/Class Contains 2.16.840.1.113883.3.1937.99.60.4.15.30 (DYNAMIC) | IN2_ment |
@Item
| | 0 … 1 | F | 786 |
@Type
| | 0 … 1 | F | JCC |
@LongName
| | 0 … 1 | F | Job Code/Class |
hl7v2:IN2.48
| IS | 0 … 1 | | Job Status | IN2_ment |
@Item
| | 0 … 1 | F | 752 |
@Type
| | 0 … 1 | F | IS |
@Table
| | 0 … 1 | F | HL70311 |
@LongName
| | 0 … 1 | F | Job Status |
hl7v2:IN2.49
| XPN | 0 … * | | Employer Contact Person Name Contains 2.16.840.1.113883.3.1937.99.60.4.15.76 (DYNAMIC) | IN2_ment |
@Item
| | 0 … 1 | F | 789 |
@Type
| | 0 … 1 | F | XPN |
@LongName
| | 0 … 1 | F | Employer Contact Person Name |
hl7v2:IN2.50
| XTN | 0 … * | | Employer Contact Person Phone Number Contains 2.16.840.1.113883.3.1937.99.60.4.15.77 (DYNAMIC) | IN2_ment |
@Item
| | 0 … 1 | F | 790 |
@Type
| | 0 … 1 | F | XTN |
@LongName
| | 0 … 1 | F | Employer Contact Person Phone Number |
hl7v2:IN2.51
| IS | 0 … 1 | | Employer Contact Reason | IN2_ment |
@Item
| | 0 … 1 | F | 791 |
@Type
| | 0 … 1 | F | IS |
@Table
| | 0 … 1 | F | HL70222 |
@LongName
| | 0 … 1 | F | Employer Contact Reason |
hl7v2:IN2.52
| XPN | 0 … * | | Insured's Contact Person's Name Contains 2.16.840.1.113883.3.1937.99.60.4.15.76 (DYNAMIC) | IN2_ment |
@Item
| | 0 … 1 | F | 792 |
@Type
| | 0 … 1 | F | XPN |
@LongName
| | 0 … 1 | F | Insured's Contact Person's Name |
hl7v2:IN2.53
| XTN | 0 … * | | Insured's Contact Person Phone Number Contains 2.16.840.1.113883.3.1937.99.60.4.15.77 (DYNAMIC) | IN2_ment |
@Item
| | 0 … 1 | F | 793 |
@Type
| | 0 … 1 | F | XTN |
@LongName
| | 0 … 1 | F | Insured's Contact Person Phone Number |
hl7v2:IN2.54
| IS | 0 … * | | Insured's Contact Person Reason | IN2_ment |
@Item
| | 0 … 1 | F | 794 |
@Type
| | 0 … 1 | F | IS |
@Table
| | 0 … 1 | F | HL70222 |
@LongName
| | 0 … 1 | F | Insured's Contact Person Reason |
hl7v2:IN2.55
| DT | 0 … 1 | | Relationship to the Patient Start Date | IN2_ment |
@Item
| | 0 … 1 | F | 795 |
@Type
| | 0 … 1 | F | DT |
@LongName
| | 0 … 1 | F | Relationship to the Patient Start Date |
hl7v2:IN2.56
| DT | 0 … * | | Relationship to the Patient Stop Date | IN2_ment |
@Item
| | 0 … 1 | F | 796 |
@Type
| | 0 … 1 | F | DT |
@LongName
| | 0 … 1 | F | Relationship to the Patient Stop Date |
hl7v2:IN2.57
| IS | 0 … 1 | | Insurance Co. Contact Reason | IN2_ment |
@Item
| | 0 … 1 | F | 797 |
@Type
| | 0 … 1 | F | IS |
@Table
| | 0 … 1 | F | HL70232 |
@LongName
| | 0 … 1 | F | Insurance Co. Contact Reason |
hl7v2:IN2.58
| XTN | 0 … 1 | | Insurance Co Contact Phone Number Contains 2.16.840.1.113883.3.1937.99.60.4.15.77 (DYNAMIC) | IN2_ment |
@Item
| | 0 … 1 | F | 798 |
@Type
| | 0 … 1 | F | XTN |
@LongName
| | 0 … 1 | F | Insurance Co Contact Phone Number |
hl7v2:IN2.59
| IS | 0 … 1 | | Policy Scope | IN2_ment |
@Item
| | 0 … 1 | F | 799 |
@Type
| | 0 … 1 | F | IS |
@Table
| | 0 … 1 | F | HL70312 |
@LongName
| | 0 … 1 | F | Policy Scope |
hl7v2:IN2.60
| IS | 0 … 1 | | Policy Source | IN2_ment |
@Item
| | 0 … 1 | F | 800 |
@Type
| | 0 … 1 | F | IS |
@Table
| | 0 … 1 | F | HL70313 |
@LongName
| | 0 … 1 | F | Policy Source |
hl7v2:IN2.61
| CX | 0 … 1 | | Patient Member Number Contains 2.16.840.1.113883.3.1937.99.60.4.15.12 (DYNAMIC) | IN2_ment |
@Item
| | 0 … 1 | F | 801 |
@Type
| | 0 … 1 | F | CX |
@LongName
| | 0 … 1 | F | Patient Member Number |
hl7v2:IN2.62
| CE | 0 … 1 | | Guarantor's Relationship To Insured Contains 2.16.840.1.113883.3.1937.99.60.4.15.5 (DYNAMIC) | IN2_ment |
@Item
| | 0 … 1 | F | 802 |
@Type
| | 0 … 1 | F | CE |
@Table
| | 0 … 1 | F | HL70063 |
@LongName
| | 0 … 1 | F | Guarantor's Relationship To Insured |
hl7v2:IN2.63
| XTN | 0 … * | | Insured's Phone Number - Home Contains 2.16.840.1.113883.3.1937.99.60.4.15.77 (DYNAMIC) | IN2_ment |
@Item
| | 0 … 1 | F | 803 |
@Type
| | 0 … 1 | F | XTN |
@LongName
| | 0 … 1 | F | Insured's Phone Number - Home |
hl7v2:IN2.64
| XTN | 0 … * | | Insured's Employer Phone Number Contains 2.16.840.1.113883.3.1937.99.60.4.15.77 (DYNAMIC) | IN2_ment |
@Item
| | 0 … 1 | F | 804 |
@Type
| | 0 … 1 | F | XTN |
@LongName
| | 0 … 1 | F | Insured's Employer Phone Number |
hl7v2:IN2.65
| CE | 0 … 1 | | Military Handicapped Program Contains 2.16.840.1.113883.3.1937.99.60.4.15.5 (DYNAMIC) | IN2_ment |
@Item
| | 0 … 1 | F | 805 |
@Type
| | 0 … 1 | F | CE |
@Table
| | 0 … 1 | F | HL70343 |
@LongName
| | 0 … 1 | F | Military Handicapped Program |
hl7v2:IN2.66
| ID | 0 … 1 | | Suspend Flag | IN2_ment |
@Item
| | 0 … 1 | F | 806 |
@Type
| | 0 … 1 | F | ID |
@Table
| | 0 … 1 | F | HL70136 |
@LongName
| | 0 … 1 | F | Suspend Flag |
hl7v2:IN2.67
| ID | 0 … 1 | | Copay Limit Flag | IN2_ment |
@Item
| | 0 … 1 | F | 807 |
@Type
| | 0 … 1 | F | ID |
@Table
| | 0 … 1 | F | HL70136 |
@LongName
| | 0 … 1 | F | Copay Limit Flag |
hl7v2:IN2.68
| ID | 0 … 1 | | Stoploss Limit Flag | IN2_ment |
@Item
| | 0 … 1 | F | 808 |
@Type
| | 0 … 1 | F | ID |
@Table
| | 0 … 1 | F | HL70136 |
@LongName
| | 0 … 1 | F | Stoploss Limit Flag |
hl7v2:IN2.69
| XON | 0 … * | | Insured Organization Name and ID Contains 2.16.840.1.113883.3.1937.99.60.4.15.75 (DYNAMIC) | IN2_ment |
@Item
| | 0 … 1 | F | 809 |
@Type
| | 0 … 1 | F | XON |
@LongName
| | 0 … 1 | F | Insured Organization Name and ID |
hl7v2:IN2.70
| XON | 0 … * | | Insured Employer Organization Name and ID Contains 2.16.840.1.113883.3.1937.99.60.4.15.75 (DYNAMIC) | IN2_ment |
@Item
| | 0 … 1 | F | 810 |
@Type
| | 0 … 1 | F | XON |
@LongName
| | 0 … 1 | F | Insured Employer Organization Name and ID |
hl7v2:IN2.71
| CE | 0 … * | | Race Contains 2.16.840.1.113883.3.1937.99.60.4.15.5 (DYNAMIC) | IN2_ment |
@Item
| | 0 … 1 | F | 113 |
@Type
| | 0 … 1 | F | CE |
@Table
| | 0 … 1 | F | HL70005 |
@LongName
| | 0 … 1 | F | Race |
hl7v2:IN2.72
| CE | 0 … 1 | | CMS Patient_s Relationship to Insured Contains 2.16.840.1.113883.3.1937.99.60.4.15.5 (DYNAMIC) | IN2_ment |
@Item
| | 0 … 1 | F | 811 |
@Type
| | 0 … 1 | F | CE |
@Table
| | 0 … 1 | F | HL70344 |
@LongName
| | 0 … 1 | F | CMS Patient_s Relationship to Insured |