X12 824 Application Advice (X186A1)
ancial institution.
- ~ Segment
- * Element
- > Component
- ^ Repetition
Interchange Control Header
To start and identify an interchange of zero or more functional groups and interchange-related control segments
Code identifying the type of information in the Authorization Information
- 00
- No Authorization Information Present (No Meaningful Information in I02)
Information used for additional identification or authorization of the interchange sender or the data in the interchange; the type of information is set by the Authorization Information Qualifier (I01)
Code identifying the type of information in the Security Information
- 00
- No Security Information Present (No Meaningful Information in I04)
This is used for identifying the security information about the interchange sender or the data in the interchange; the type of information is set by the Security Information Qualifier (I03)
Code indicating the system/method of code structure used to designate the sender or receiver ID element being qualified
Identification code published by the sender for other parties to use as the receiver ID to route data to them; the sender always codes this value in the sender ID element
Code indicating the system/method of code structure used to designate the sender or receiver ID element being qualified
Identification code published by the receiver of the data; When sending, it is used by the sender as their sending ID, thus other parties sending to them will use this as a receiving ID to route data to them
Type is not applicable; the repetition separator is a delimiter and not a data element; this field provides the delimiter used to separate repeated occurrences of a simple data element or a composite data structure; this value must be different than the data element separator, component element separator, and the segment terminator
- ^
- Repetition Separator
Code specifying the version number of the interchange control segments
- 00501
- Standards Approved for Publication by ASC X12 Procedures Review Board through October 2003
A control number assigned by the interchange sender
Code indicating sender's request for an interchange acknowledgment
- 0
- No Interchange Acknowledgment Requested
- 1
- Interchange Acknowledgment Requested (TA1)
Code indicating whether data enclosed by this interchange envelope is test, production or information
- I
- Information
- P
- Production Data
- T
- Test Data
Type is not applicable; the component element separator is a delimiter and not a data element; this field provides the delimiter used to separate component data elements within a composite data structure; this value must be different than the data element separator and the segment terminator
- >
- Component Element Separator
Functional Group Header
To indicate the beginning of a functional group and to provide control information
Code identifying a group of application related transaction sets
- AG
- Application Advice (824)
Code identifying party sending transmission; codes agreed to by trading partners
Code identifying party receiving transmission; codes agreed to by trading partners
Date expressed as CCYYMMDD where CC represents the first two digits of the calendar year
Time expressed in 24-hour clock time as follows: HHMM, or HHMMSS, or HHMMSSD, or HHMMSSDD, where H = hours (00-23), M = minutes (00-59), S = integer seconds (00-59) and DD = decimal seconds; decimal seconds are expressed as follows: D = tenths (0-9) and DD = hundredths (00-99)
Assigned number originated and maintained by the sender
Code identifying the issuer of the standard; this code is used in conjunction with Data Element 480
- T
- Transportation Data Coordinating Committee (TDCC)
- X
- Accredited Standards Committee X12
Code indicating the version, release, subrelease, and industry identifier of the EDI standard being used, including the GS and GE segments; if code in DE455 in GS segment is X, then in DE 480 positions 1-3 are the version number; positions 4-6 are the release and subrelease, level of the version; and positions 7-12 are the industry or trade association identifiers (optionally assigned by user); if code in DE455 in GS segment is T, then other formats are allowed
- 005010X186A1
Heading
Transaction Set Header
To indicate the start of a transaction set and to assign a control number
Code uniquely identifying a Transaction Set
- The transaction set identifier (ST01) is used by the translation routines of the interchange partners to select the appropriate transaction set definition (e.g., 810 selects the Invoice Transaction Set).
- 824
- Application Advice
Identifying control number that must be unique within the transaction set functional group assigned by the originator for a transaction set
- The Transaction Set Control Numbers in ST02 and SE02 must be identical. The number is assigned by the originator and must be unique within a functional group (GS-GE). The number also aids in error resolution research. For example, start with the number 0001 and increment from there.
Reference assigned to identify Implementation Convention
- The implementation convention reference (ST03) is used by the translation routines of the interchange partners to select the appropriate implementation convention to match the transaction set definition. When used, this implementation convention reference takes precedence over the implementation reference specified in the GS08.
- This field contains the same value as data element GS08. This value is always 005010X186. Some translator products strip off the ISA and GS segments prior to application (ST - SE) processing. Providing the information from GS08 at this level will help ensure the appropriate application mapping is utilized at translation time.
- 005010X186A1
Beginning Segment
To indicate the beginning of a transaction set
Code identifying purpose of transaction set
- 11
- Response
Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier
- BGN02 is the transaction set reference number.
- Use a value assigned by the submitter of the 824 transaction set to uniquely identify this 824 transaction set, such as an internal tracking number, file name, etc.
Date expressed as CCYYMMDD where CC represents the first two digits of the calendar year
- BGN03 is the transaction set date.
Time expressed in 24-hour clock time as follows: HHMM, or HHMMSS, or HHMMSSD, or HHMMSSDD, where H = hours (00-23), M = minutes (00-59), S = integer seconds (00-59) and DD = decimal seconds; decimal seconds are expressed as follows: D = tenths (0-9) and DD = hundredths (00-99)
- BGN04 is the transaction set time.
Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier
- BGN06 is the transaction set reference number of a previously sent transaction affected by the current transaction.
- When used, this is the value in BGN02, BHT03, BIG02, or ST02 (depending on the value used in OTI10, as indicated in the situational note above) from the interchange containing the transaction set to which this 824 transaction set is responding.
Code indicating type of action
- RU
- Return
Required when a portion of the transaction set is being accepted.
- U
- Reject
Required when an entire transaction set is being rejected.
- WQ
- Accept
Required when an entire transaction set is being accepted.
Submitter Name
To identify a party by type of organization, name, and code
- This segment identifies the information about the Submitter of the 824 transaction set.
Code identifying an organizational entity, a physical location, property or an individual
- 41
- Submitter
Code designating the system/method of code structure used for Identification Code (67)
- 1
- D-U-N-S Number, Dun & Bradstreet
- 9
- D-U-N-S+4, D-U-N-S Number with Four Character Suffix
- 24
- Employer's Identification Number
- 46
- Electronic Transmitter Identification Number (ETIN)
- 75
- State or Province Assigned Number
- EQ
- Insurance Company Assigned Identification Number
- FI
- Federal Taxpayer's Identification Number
- PI
- Payor Identification
- XV
- Centers for Medicare and Medicaid Services PlanID
- XX
- Centers for Medicare and Medicaid Services National Provider Identifier
Code identifying a party or other code
- This segment, used alone, provides the most efficient method of providing organizational identification. To obtain this efficiency the "ID Code" (N104) must provide a key to the table maintained by the transaction processing party.
Submitter Secondary Indentifier
To specify identifying information
- Required when the entity identified in Loop 1000A (Submitter Name) is submitting this 824 on behalf of a sub-component, such as a branch or department within the submitter organization. If not required by this implementation guide, do not send.
- This REF segment identifies the sub-component within the submitter organization, as appropriate.
Code qualifying the Reference Identification
- 3L
- Branch Identifier
Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier
Submitter EDI Contact Information
To identify a person or office to whom administrative communications should be directed
- When the communication number represents a telephone number in the United States and other countries using the North American Dialing Plan (for voice, data, fax, etc.), the communication number must always include the area code and phone number using the format AAABBBCCCC where AAA is the area code, BBB is the telephone number prefix, and CCCC is the telephone number (e.g., (534) 224-2525 would be represented as 5342242525). The extension, if known, must be included in the communication number data element immediately after the telephone number.
- The PER segment must be filled from left to right. PER04 must be present before PER06. The PER06 must be present before using PER08.
- Only one of each type of communication number may be sent. In order to send all four types, repeat the PER segment for the fourth communication number. The PER02 must not be used in the second PER.
- The second repetition of the PER must not occur unless the first is full, if the information applies to the same contact.
- Required when contact information is other than indicated in the Trading Partner Agreement/profile. If not required by this implementation guide, do not send.
Code identifying the major duty or responsibility of the person or group named
- IC
- Information Contact
Code identifying the type of communication number
- EM
- Electronic Mail
- FX
- Facsimile
- TE
- Telephone
Complete communications number including country or area code when applicable
Code identifying the type of communication number
- EM
- Electronic Mail
- EX
- Telephone Extension
Extension cannot be reported unless TE and telephone number exist in PER03/PER04. (See PER example)
- FX
- Facsimile
- TE
- Telephone
Complete communications number including country or area code when applicable
Code identifying the type of communication number
- EM
- Electronic Mail
- EX
- Telephone Extension
Extension cannot be reported unless TE and telephone number exist in PER05/PER06. (See PER example)
- FX
- Facsimile
- TE
- Telephone
Complete communications number including country or area code when applicable
Receiver Name
To identify a party by type of organization, name, and code
- This segment identifies the information about the Receiver of the 824 transaction set.
Code identifying an organizational entity, a physical location, property or an individual
- 40
- Receiver
Code designating the system/method of code structure used for Identification Code (67)
- 1
- D-U-N-S Number, Dun & Bradstreet
- 9
- D-U-N-S+4, D-U-N-S Number with Four Character Suffix
- 24
- Employer's Identification Number
- 46
- Electronic Transmitter Identification Number (ETIN)
- 75
- State or Province Assigned Number
- EQ
- Insurance Company Assigned Identification Number
- FI
- Federal Taxpayer's Identification Number
- PI
- Payor Identification
- XV
- Centers for Medicare and Medicaid Services PlanID
- XX
- Centers for Medicare and Medicaid Services National Provider Identifier
Code identifying a party or other code
- This segment, used alone, provides the most efficient method of providing organizational identification. To obtain this efficiency the "ID Code" (N104) must provide a key to the table maintained by the transaction processing party.
Detail
Original Transaction Identification
To identify the edited transaction set and the level at which the results of the edit are reported, and to indicate the accepted, rejected, or accepted-with-change edit result
- An 824 transaction set may be used to report acceptance or rejection of an entire transaction set, an item within a transaction set, or a subordinate portion of a transaction set that contains one or more items. The OTI segment is used as the primary means to identify the portion (or all) of the received transaction set which is being reported upon.
For example, if an entire transaction set (i.e. ST/SE) is being rejected, then the OTI segment would likely indicate the ST control number to identify which ST/SE transaction set of the received file is being rejected. If part of the transaction set is being rejected (e.g. a single claim status request in a 276 transaction set), then the OTI segment could indicate the Submitter Trace number in the TRN segment of the rejected portion.
- When reporting with this 824 transaction set, the terms
acceptance' andrejection' refer to edits at the application level.
Code indicating the application system edit results of the business data
- The codes for the "Application Acknowledgement Code" contain two characters. The first character indicates the edit level, and the second character indicates the results of the edit. Any combination of the first and second characters is valid. The following values are valid for each set of characters:
- First character
T=Transaction Set.
B=Batch - A subordinate portion of a transaction set that contains one or more items. For example, an entire Subscriber Level (2000C) Loop in a 270 transaction set.
I=Item - A self-contained body of data that will trigger or support a business process. For example, a single claim in an 837 transaction set.
- Note: see section 1.5 for additional information.
- Second character
A=Accept: Use this code when no errors or informational messages are present and all data is accepted for further processing.
C=Accept with Data Content Change: Use this code when errors or informational messages are present and the data is changed to accept for further processing.
E=Accept with Errors: Use this code when all data is accepted for further processing even though errors or informational messages are present.
P=Partial Accept/Reject: Use this code when a portion of the data is accepted and a portion of the data is rejected due to errors. Informational messages may also be present. Some data has been accepted for further processing. Rejected data must be corrected by the submitter and resubmitted.
R=Reject: Use this code when all data is rejected due to errors. Informational messages may also be present. No data is accepted for further processing. Submitter must correct and resubmit the (batch, transaction set, or item) that was in error.
Note: Errors and informational messages are reported in the TED loop.
- BA
- Batch Accept
- BC
- Batch Accept with Data Content Change
- BE
- Batch Accept with Error
- BP
- Batch Partial Accept/Reject
- BR
- Batch Reject
- IA
- Item Accept
- IC
- Item Accept with Data Content Change
- IE
- Item Accept with Error
- IP
- Item Partial Accept/Reject
- IR
- Item Reject
- TA
- Transaction Set Accept
- TC
- Transaction Set Accept with Data Content Change
- TE
- Transaction Set Accept with Error
- TP
- Transaction Set Partial Accept/Reject
- TR
- Transaction Set Reject
Code qualifying the Reference Identification
- OTI02 contains the qualifier identifying the business transaction from the original business application, and OTI03 will contain the original business application identification.
- BT
- Batch Number
Required when OTI01 contains BA, BC, BE, BP, or BR.
- IX
- Item Number
Required when OTI01 contains IA, IC, IE, IP, or IR.
- TN
- Transaction Reference Number
Required when OTI01 contains TA, TC, TE, TP, or TR.
Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier
- OTI03 is the primary reference identification or number used to uniquely identify the original transaction set.
- This element is designed to contain a value to uniquely identify the transaction, batch, or item, as noted in the OTI02. However, it is not always possible to use a single value for this purpose, depending on the edit level (i.e. the value in OTI02), the transaction set to which this 824 is responding, and whether the creator of the 824 has access to the X12 format of the original data. When OTI02 = TN, and the creator of the 824 knows the ST02 value within the original transaction set to which this 824 is responding, the OTI09 value will contain the transaction set control number, which uniquely identifies the transaction set. In all other cases, the subsequent REF, DTM, AMT, QTY, and/or NM1 segments are used to uniquely identify the transaction, batch, or item described in this OTI loop. In each of these cases, the OTI03 value serves no useful purpose. However, since this element is required by the X12 standard, the value `NA' will always be used.
Date expressed as CCYYMMDD where CC represents the first two digits of the calendar year
- OTI06 is the group date.
- When used, this is the value in GS04 from the functional group containing the transaction set to which this 824 transaction set is responding.
Time expressed in 24-hour clock time as follows: HHMM, or HHMMSS, or HHMMSSD, or HHMMSSDD, where H = hours (00-23), M = minutes (00-59), S = integer seconds (00-59) and DD = decimal seconds; decimal seconds are expressed as follows: D = tenths (0-9) and DD = hundredths (00-99)
- OTI07 is the group time.
- When used, this is the value in GS05 from the functional group containing the transaction set to which this 824 transaction set is responding.
Assigned number originated and maintained by the sender
- When used, this is the value in GS06 from the functional group containing the transaction set to which this 824 transaction set is responding.
Identifying control number that must be unique within the transaction set functional group assigned by the originator for a transaction set
- If used, OTI09 through OTI10 will contain values from the original electronic transaction set generated by the sender.
- When used, this is the value in ST02 from the transaction set to which this 824 transaction set is responding.
Code uniquely identifying a Transaction Set
- 112
- Property Damage Report
- 124
- Vehicle Damage
- 148
- Report of Injury, Illness or Incident
- 187
- Premium Audit Request and Return
- 266
- Mortgage or Property Record Change Notification
- 269
- Health Care Benefit Coordination Verification
- 270
- Eligibility, Coverage or Benefit Inquiry
- 271
- Eligibility, Coverage or Benefit Information
- 272
- Property and Casualty Loss Notification
- 274
- Healthcare Provider Information
- 275
- Patient Information
- 276
- Health Care Claim Status Request
- 277
- Health Care Information Status Notification
- 278
- Health Care Services Review Information
- 811
- Consolidated Service Invoice/Statement
- 820
- Payment Order/Remittance Advice
- 834
- Benefit Enrollment and Maintenance
- 835
- Health Care Claim Payment/Advice
- 837
- Health Care Claim
Includes Property and Casualty Medical Bill Report to Regulatory Agencies.
- 841
- Specifications/Technical Information
Code indicating the version, release, subrelease, and industry identifier of the EDI standard being used, including the GS and GE segments; if code in DE455 in GS segment is X, then in DE 480 positions 1-3 are the version number; positions 4-6 are the release and subrelease, level of the version; and positions 7-12 are the industry or trade association identifiers (optionally assigned by user); if code in DE455 in GS segment is T, then other formats are allowed
- If OTI11 is present, it will contain the version/release under which the original electronic transaction was translated by the receiver.
- When used, this is the value in GS08 from the functional group containing the transaction set to which this 824 transaction set is responding.
Reference Information
To specify identifying information
- Required when additional information is necessary to identify the portion (or all) of the transaction set that is being reported in this Loop 2000 (OTI). If not required by this implementation guide, may be provided at the sender's discretion but cannot be required by the receiver.
- For example, if the Loop 2000 (OTI) is being used to define a provider loop, the REF segment could be used to identify the actual provider number, indicating the specific provider loop within the transaction set.
- The sender should consider `minimum necessary' privacy requirements in deciding to use this discretionary segment.
Code qualifying the Reference Identification
- 0B
- State License Number
- 0F
- Subscriber Number
- 0M
- Mortgage Identification Number
- 1A
- Blue Cross Provider Number
- 1B
- Blue Shield Provider Number
- 1C
- Medicare Provider Number
- 1D
- Medicaid Provider Number
- 1E
- Dentist License Number
- 1F
- Anesthesia License Number
- 1G
- Provider UPIN Number
- 1H
- CHAMPUS Identification Number
- 1J
- Facility ID Number
- 1K
- Payor's Claim Number
- 1L
- Group or Policy Number
- 1S
- Ambulatory Patient Group (APG) Number
- 1W
- Member Identification Number
- 2F
- Consolidated Invoice Number
- 2I
- Tracking Number
- 2U
- Payer Identification Number
- 3H
- Case Number
- 3J
- Office Number
- 4A
- Personal Identification Number (PIN)
- 4N
- Special Payment Reference Number
- 5G
- Complaint
- 5H
- Incident
- 06
- System Number
- 6N
- Claimant Number
- 6P
- Group Number
- 6R
- Provider Control Number
- 7I
- Subscriber Authorization Number
- 7K
- List of Materials
- 8U
- Bank Assigned Security Identifier
- 8X
- Transaction Category or Type
- 9A
- Repriced Claim Reference Number
- 9B
- Repriced Line Item Reference Number
- 9C
- Adjusted Repriced Claim Reference Number
- 9D
- Adjusted Repriced Line Item Reference Number
- 9K
- Servicer
- 9N
- Investor
- 9R
- Job Order Number
- 11
- Account Number
- 14
- Master Account Number
- 17
- Client Reporting Category
- 18
- Plan Number
- 23
- Client Number
- 28
- Employee Identification Number
- 33
- Lender Case Number
- 38
- Master Policy Number
- 49
- Family Unit Number
- 60
- Account Suffix Code
- 72
- Schedule Reference Number
- 87
- Functional Category
- 89
- Assembly Number
- 94
- File Identification Number
- A9
- Health Insurance Account Number
- AAL
- Agent Number
- AB
- Acceptable Source Purchaser ID
- ADB
- Master Property Number
- AZ
- Health Insurance Policy Number
- B3
- Preferred Provider Organization Number
- B7
- Life Insurance Policy Number
- BA
- Retirement Plan Policy Number
- BB
- Authorization Number
- BLT
- Billing Type
- BQ
- Health Maintenance Organization Code Number
- BR
- Broker or Sales Office Number
- BT
- Batch Number
- CE
- Class of Contract Code
- CK
- Check Number
- CRN
- Casualty Report Number
- CT
- Contract Number
- D3
- National Council for Prescription Drug Programs Pharmacy Number
- D8
- Loss Report Number
- D9
- Claim Number
- DD
- Document Identification Code
- DX
- Department/Agency Number
- E5
- Claimant's Claim Number
- E9
- Attachment Code
- EA
- Medical Record Identification Number
- EI
- Employer's Identification Number
- EJ
- Patient Account Number
- EL
- Electronic device pin number
- EM
- Electronic Payment Reference Number
- EO
- Submitter Identification Number
- EV
- Receiver Identification Number
- EW
- Mammography Certification Number
- F2
- Version Code - Local
- F4
- Facility Certification Number
- F5
- Medicare Version Code
- F6
- Health Insurance Claim (HIC) Number
- F8
- Original Reference Number
- FH
- Clinic Number
- FI
- File Identifier
- FJ
- Line Item Control Number
- FY
- Claim Office Number
- G1
- Prior Authorization Number
- G2
- Provider Commercial Number
- G3
- Predetermination of Benefits Identification Number
- G4
- Peer Review Organization (PRO) Approval Number
- G5
- Provider Site Number
- HI
- Health Industry Number (HIN)
- HJ
- Identity Card Number
- HPI
- Centers for Medicare and Medicaid Services National Provider Identifier
- IF
- Issue Number
- IG
- Insurance Policy Number
- IJ
- Standard Industry Classification (SIC) Code
- IP
- Inspection Report Number
- IX
- Item Number
- JD
- User Identification
- KW
- Certification
- LC
- Lease Number
- LD
- Loan Number
- LU
- Location Number
- LX
- Qualified Products List
- LZ
- Lender Account Number
- ME
- Message Address or ID
- N5
- Provider Plan Network Identification Number
- N6
- Plan Network Identification Number
- N7
- Facility Network Identification Number
- NF
- National Association of Insurance Commissioners (NAIC) Code
- NQ
- Medicaid Recipient Identification Number
- OZ
- Product Number
- P4
- Project Code
- PG
- Product Group
- PM
- Part Number
- POL
- Policy Number
- PQ
- Payee Identification
- Q4
- Prior Identifier Number
- Q5
- Property Control Number
- Unit Number
- RB
- Rate code number
- S3
- Specification Number
- ST
- Store Number
- SY
- Social Security Number
- T4
- Signal Code
- T7
- Affected Subsystem Code
- TJ
- Federal Taxpayer's Identification Number
- TN
- Transaction Reference Number
- TT
- Terminal Code
- TX
- Tax Exempt Number
- U3
- Unique Supplier Identification Number (USIN)
- UA
- Mortgage Number
- VD
- Volume Number
- VE
- Vendor Abbreviation Code
- VP
- Vendor Product Number
- VR
- Vendor ID Number
- VT
- Motor Vehicle ID Number
- WU
- Vessel
- X1
- Provider Claim Number
- X4
- Clinical Laboratory Improvement Amendment Number
- X5
- State Industrial Accident Provider Number
- Y4
- Agency Claim Number
- Z8
- Federal Housing Administration Case Number
- Z9
- Veterans Affairs Case Number
- ZH
- Carrier Assigned Reference Number
- ZS
- Software Application Number
- ZZ
- Mutually Defined
Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier
Date/Time Reference
To specify pertinent dates and times
- Required when date information is necessary to identify the portion (or all) of the transaction set that is being reported in this Loop 2000 (OTI). If not required by this implementation guide, may be provided at the sender's discretion but cannot be required by the receiver.
- For example, if the Loop 2000 (OTI) is being used to define a particular insurance policy, the DTM segment could be used to identify the policy effective date, helping indicate the specific policy within the transaction set.
Code specifying type of date or time, or both date and time
- 003
- Invoice
- 007
- Effective
- 009
- Process
- 011
- Shipped
- 017
- Estimated Delivery
- 035
- Delivered
- 036
- Expiration
- 050
- Received
- 089
- Inquiry
- 090
- Report Start
- 091
- Report End
- 096
- Discharge
- 097
- Transaction Creation
- 102
- Issue
- 119
- Test Performed
- 142
- Loss
- 150
- Service Period Start
- 151
- Service Period End
- 186
- Invoice Period Start
- 187
- Invoice Period End
- 193
- Period Start
- 194
- Period End
- 198
- Completion
- 227
- Lease Term Start
- 228
- Lease Term End
- 232
- Claim Statement Period Start
- 233
- Claim Statement Period End
- 242
- Actual Start
- 245
- Estimated Completion
- 285
- Employment or Hire
- 286
- Retirement
- 296
- Initial Disability Period Return To Work
- 297
- Initial Disability Period Last Day Worked
- 300
- Enrollment Signature Date
- 301
- Consolidated Omnibus Budget Reconciliation Act (COBRA) Qualifying Event
- 303
- Maintenance Effective
- 304
- Latest Visit or Consultation
- 307
- Eligibility
- 310
- Date of Closing
- 313
- Cycle
- 330
- Referral Date
- 336
- Employment Begin
- 337
- Employment End
- 338
- Medicare Begin
- 339
- Medicare End
- 340
- Consolidated Omnibus Budget Reconciliation Act (COBRA) Begin
- 341
- Consolidated Omnibus Budget Reconciliation Act (COBRA) End
- 344
- Coordination of Benefits Begin
- 345
- Coordination of Benefits End
- 348
- Benefit Begin
- 349
- Benefit End
- 350
- Education Begin
- 351
- Education End
- 356
- Eligibility Begin
- 357
- Eligibility End
- 360
- Initial Disability Period Start
- 361
- Initial Disability Period End
- 370
- Actual Departure Date
- 372
- Actual Arrival Date
- 383
- Adjusted Hire
- 388
- Payment Commencement
- 393
- Plan Participation Suspension
- 394
- Rehire
- 405
- Production
- 431
- Onset of Current Symptoms or Illness
- 434
- Statement
- 435
- Admission
- 438
- Onset of Similar Symptoms or Illness
- 439
- Accident
- 441
- Prior Placement
- 446
- Replacement
- 452
- Appliance Placement
- 453
- Acute Manifestation of a Chronic Condition
- 454
- Initial Treatment
- 455
- Last X-Ray
- 456
- Surgery
- 461
- Last Certification
- 463
- Begin Therapy
- 471
- Prescription
- 472
- Service
- 473
- Medicaid Begin
- 474
- Medicaid End
- 480
- Arterial Blood Gas Test
- 481
- Oxygen Saturation Test
- 484
- Last Menstrual Period
- 485
- Injury Begin
- 486
- Injury End
- 517
- Inspected
- 523
- Date of Claim
- 539
- Policy Effective
- 540
- Policy Expiration
- 543
- Last Premium Paid Date
- 547
- Date of Loan
- 573
- Date Claim Paid
- 582
- Report Period
- 607
- Certification Revision
- 666
- Date Paid
- 738
- Most Recent Hemoglobin or Hematocrit or Both
- 739
- Most Recent Serum Creatine
- 809
- Posted
- 866
- Examination
- 881
- Request
- 938
- Order
- 999
- Document Date
- ABC
- Estimated Date of Birth
- INC
- Incident
- ZZZ
- Mutually Defined
Date expressed as CCYYMMDD where CC represents the first two digits of the calendar year
Monetary Amount Information
To indicate the total monetary amount
- Required when monetary information is necessary to identify the portion (or all) of the transaction set that is being reported in this Loop 2000 (OTI). If not required by this implementation guide, may be provided at the sender's discretion but cannot be required by the receiver.
- For example, if the Loop 2000 (OTI) is being used to define a premium payment, the AMT segment could be used to identify the premium amount, helping to indicate the specific premium payment within the transaction set.
Code to qualify amount
- 1
- Line Item Total
- 2
- Batch Total
- 3V
- Mortgage
- 3Y
- Non-operational Fixed Assets
- 4Y
- Damages
- 5
- Total Invoice Amount
- 8V
- Services
- 8Y
- Share Premium Capital
- A8
- Noncovered Charges - Actual
- AA
- Allocated
- AAE
- Approved Amount
- AU
- Coverage Amount
- B1
- Benefit Amount
- B6
- Allowed - Actual
- B7
- Deductible - Estimated
- B9
- Co-insurance - Actual
- BM
- Adjustments
- BR
- Adjusted Insured Loss Amount
- C1
- Co-Payment Amount
- C5
- Claim Amount Due - Estimated
- CE
- Summary Amount
- CI
- Funds Held for Insured
- D
- Payor Amount Paid
- D2
- Deductible Amount
- D8
- Discount Amount
- DX
- Deductible Waived
- DY
- Per Day Limit
- F2
- Patient Responsibility - Actual
- F3
- Patient Responsibility - Estimated
- F4
- Postage Claimed
- F5
- Patient Amount Paid
- F7
- Sales Tax
- GT
- Goods and Services Tax
- GW
- Total Charge
- I
- Interest
- KF
- Net Paid Amount
- KH
- Deduction Amount
- M8
- Markup Amount
- MA
- Maximum Amount
- N1
- Net Worth
- N8
- Miscellaneous Taxes
- NE
- Net Billed
- NL
- Negative Ledger Balance
- P3
- Premium Amount
- PG
- Payoff
- PN
- Prior Gross Invoice Total
- R
- Spend Down
- RP
- Repair
- SM
- Supplemental
- T
- Tax
- T2
- Total Claim Before Taxes
- T3
- Total Submitted Charges
- TP
- Total payment amount
- TT
- Total Transaction Amount
- YT
- Denied
- YU
- In Process
Use this code for "Amount (of batches or items as defined in OTI) Accepted".
- YY
- Returned
Use this code for "Amount (of batches or items as defined in OTI) Rejected".
- ZK
- Federal Medicare or Medicaid Payment Mandate - Category 1
- ZL
- Federal Medicare or Medicaid Payment Mandate - Category 2
- ZM
- Federal Medicare or Medicaid Payment Mandate - Category 3
- ZN
- Federal Medicare or Medicaid Payment Mandate - Category 4
- ZO
- Federal Medicare or Medicaid Payment Mandate - Category 5
- ZZ
- Mutually Defined
Quantity Information
To specify quantity information
- Required when quantity information is necessary to identify the portion (or all) of the transaction set that is being reported in this Loop 2000 (OTI). If not required by this implementation guide, may be provided at the sender's discretion but cannot be required by the receiver.
- For example, if the LOOP 2000 (OTI) is being used to define a particular 2000 Loop in an 835 remittance advice, the QTY segment could be used to identify the total number of segments in that particular loop. This, along with corresponding REF and NM1 segments (to identify the particular provider in that loop) would help to indicate the specific 2000 Loop in that transaction set.
Code specifying the type of quantity
- 01
- Discrete Quantity
- 1N
- Scrap allowed
- 02
- Cumulative Quantity
- 2W
- Segments
- 2Y
- Functional Groups
- 2Z
- Transaction Sets
- 3S
- Total Debits
- 3T
- Total Credits
- 41
- Number of Batches
- 42
- Number of Checks
- 46
- Total transactions
- 90
- Acknowledged Quantity
Use this code for "Quantity (of batches or items as defined in OTI) Accepted".
- AA
- Unacknowledged Quantity
Use this code for "Quantity (of batches or items as defined in OTI) Rejected".
- BF
- Age Modifying Units
- CA
- Covered - Actual
- CD
- Co-insured - Actual
- EC
- Use of Extracorporeal Circulation
- EM
- Emergency Modifying Units
- HF
- Invoices
- HM
- Use of Hypothermia
- HO
- Use of Hypotension
- HP
- Use of Hyperbaric Pressurization
- HS
- Hours
- LA
- Life-time Reserve - Actual
- LE
- Life-time Reserve - Estimated
- NA
- Number of Non-covered Days
- NE
- Non-Covered - Estimated
- NP
- Number of Members
- NR
- Not Replaced Blood Units
- OU
- Outlier Days
- P3
- Physical Status III
- P4
- Physical Status IV
- P5
- Physical Status V
- P6
- Number of Services or Procedures
- PS
- Prescription
- SG
- Swan-Ganz
- TO
- Total
- VS
- Visits
- ZK
- Federal Medicare or Medicaid Payment Mandate - Category 1
- ZL
- Federal Medicare or Medicaid Payment Mandate - Category 2
- ZM
- Federal Medicare or Medicaid Payment Mandate - Category 3
- ZN
- Federal Medicare or Medicaid Payment Mandate - Category 4
- ZO
- Federal Medicare or Medicaid Payment Mandate - Category 5
Numeric value of quantity
Individual or Organizational Name
To supply the full name of an individual or organizational entity
- Required when names are necessary to identify the portion (or all) of the transaction set that is being reported in this Loop 2000 (OTI). If not required by this implementation guide, may be provided at the sender's discretion but cannot be required by the receiver.
- For example, if the Loop 2000 (OTI) is being used to define a specific dependent within an enrollment transaction set, the NM1 segment could be used to identify the specific dependent within the transaction set.
- The sender should consider `minimum necessary' privacy requirements in deciding to use this discretionary segment.
Code identifying an organizational entity, a physical location, property or an individual
- 1B
- Applicant
- 1E
- Health Maintenance Organization (HMO)
- 1H
- Kidney Dialysis Unit
- 1I
- Preferred Provider Organization (PPO)
- 1K
- Franchisor
- 1P
- Provider
- 1R
- University, College or School
- 1T
- Physician, Clinic or Group Practice
- 1X
- Laboratory
- 2B
- Third-Party Administrator
- 2D
- Miscellaneous Health Care Facility
- 2K
- Partnership
- 03
- Dependent
- 3D
- Obstetrics and Gynecology Facility
- 8W
- Payment Address
- 13
- Contracted Service Provider
- 30
- Service Supplier
- 31
- Postal Mailing Address
- 36
- Employer
- 40
- Receiver
- 41
- Submitter
- 47
- Estimator
- 69
- Repairing Outlet
- 70
- Prior Incorrect Insured
- 71
- Attending Physician
- 72
- Operating Physician
- 73
- Other Physician
- 74
- Corrected Insured
- 77
- Service Location
- 80
- Hospital
- 82
- Rendering Provider
- 85
- Billing Provider
- 87
- Pay-to Provider
- AAP
- Employee
- ACV
- Information Source
- AG
- Agent/Agency
- AI
- Airline
- AO
- Account Of
- BB
- Business Partner
- BE
- Beneficiary
- BR
- Broker
- BV
- Billing Service
- CC
- Claimant
- CX
- Claim Administrator
- DK
- Ordering Physician
- DN
- Referring Provider
- DQ
- Supervising Physician
- E1
- Person or Other Entity Legally Responsible for a Child
- EF
- Electronic Filer
- EI
- Executor of Estate
- ENR
- Enroller
- EXS
- Ex-spouse
- EY
- Employee Name
- FA
- Facility
- FW
- Forwarder
- GD
- Guardian
- GP
- Gateway Provider
- GW
- Group
- GY
- Treatment Facility
- H5
- Paying Agent
- HA
- Owner
- HK
- Subscriber
- IAE
- Member
- IL
- Insured or Subscriber
- IN
- Insurer
- IP
- Independent Adjuster
- J6
- Power of Attorney
- KU
- Receiver Site
- L5
- Contact
- LE
- Lessor
- LI
- Independent Lab
- LN
- Lender
- LS
- Lessee
- M8
- Educational Institution
- MH
- Mortgage Insurer
- NZ
- Primary Physician
- OD
- Doctor of Optometry
- OW
- Owner of Property or Unit
- P2
- Primary Insured or Subscriber
- P3
- Primary Care Provider
- P4
- Prior Insurance Carrier
- P5
- Plan Sponsor
- PE
- Payee
- PR
- Payer
- PRP
- Primary Payer
- PV
- Party performing certification
- QA
- Pharmacy
- QB
- Purchase Service Provider
- QC
- Patient
- QD
- Responsible Party
- QE
- Policyholder
- QH
- Physician
- QN
- Dentist
- QV
- Group Practice
- R6
- Requester
- RI
- Remit To
- S3
- Custodial Parent
- SEP
- Secondary Payer
- SJ
- Service Provider
- SU
- Supplier/Manufacturer
- TL
- Testing Laboratory
- TM
- Transmitter
- TT
- Transfer To
- TTP
- Tertiary Payer
- TV
- Third Party Administrator (TPA)
- UY
- Vehicle
- VN
- Vendor
- X3
- Utilization Management Organization
- Y2
- Managed Care Organization
- ZZ
- Mutually Defined
Code qualifying the type of entity
- NM102 qualifies NM103.
- 1
- Person
- 2
- Non-Person Entity
Individual last name or organizational name
Individual middle name or initial
Code designating the system/method of code structure used for Identification Code (67)
- When used, this is the value from the original transaction set to which this 824 is responding.
Error or Informational Message Location
To identify the error and, if feasible, the erroneous segment, or data element, or both
- Required when OTI01 is equal to "BR", "IR", "TR", "BC", "IC", "TC", "BE", "IE", "TE", "BP", "IP", or "TP". If not required by this implementation guide, do not send.
- The TED Loop is used to report errors or warnings about the data referenced in this OTI Loop.
Errors indicate rejection of all or part of the data referenced in the OTI Loop.
Warnings do not indicate rejection of the data referenced in the OTI Loop, but may result in rejection in the future.
Code indicating application error condition
- The error or informational code is reported in RED06.
- 024
- Other Unlisted Reason
Value chosen to make segment compliant with X12 syntax.
Code defining the segment ID of the data segment in error (See Appendix A - Number 77)
The numerical count position of this data segment from the start of the transaction set: the transaction set header is count position 1
- If segment is missing, indicate the numerical count position of the next identifiable segment in this instance of the transaction set.
Required when TED03 is used and RED06 applies to a data element. If not required by this implementation guide, do not send.
This is used to indicate the relative position of a simple data element, or the relative position of a composite data structure with the relative position of the component within the composite data structure, in error; in the data segment the count starts with 1 for the simple data element or composite data structure immediately following the segment ID
To identify the component data element position within the composite that is in error
To identify the specific repetition of a data element that is in error
This is a copy of the data element in error
New data which has replaced erroneous data
Situational Context Location
Describes an event context in terms of the application or implementation contexts in force at the time the event occurred and the position in the EDI stream at which that context was activated
- Required when the error in RED06 was triggered by a situational requirement of the business application and the submitter of the 824 knows the segment ID and segment position within the original transaction set of the data that triggered the situation. If not required by this implementation guide, do not send.
- The CTX is used to identify the situational Requirement.
Holds the name or 'tag' of a context
- Holds the name or "TAG" of a context, such as the industry name.
Code defining the segment ID of the data segment in error (See Appendix A - Number 77)
The numerical count position of this data segment from the start of the transaction set: the transaction set header is count position 1
The loop ID number given on the transaction set diagram is the value for this data element in segments LS and LE
Required when situational requirement relates to an element. If not required by this implementation guide, do not send.
This is used to indicate the relative position of a simple data element, or the relative position of a composite data structure with the relative position of the component within the composite data structure, in error; in the data segment the count starts with 1 for the simple data element or composite data structure immediately following the segment ID
To identify the component data element position within the composite that is in error
To identify the specific repetition of a data element that is in error
Required when this supplemental information is necessary to identify the situational requirement that triggered the error. If not required by this implementation guide, do not send.
Reference number used to locate the data element in the Data Element Dictionary
- This element holds the reference number of the simple or composite element at segment level.
Reference number used to locate the data element in the Data Element Dictionary
- This element holds the reference number of the simple element within a composite.
Error or Informational Message
To provide business data related to an item within a transaction to which a business application editing process has been applied, and an error condition has resulted
A free-form description to clarify the related data elements and their content
- RED01 provides the related business data, whose nature is defined by the code in RED02 or RED06.
- As an example of the use of the RED01 element, an application edit is applied to the Unit Price element within an Invoice (810) transaction set.
The result of that edit indicates an invalid unit price. One piece of related business data would be the associated Product or Service Identification (data element #234). In this example, RED01 would be used to convey the associated Product or Service Identification.
- No description is needed to clarify the error code in RED06. If additional error codes are needed, a request should be submitted to the Insurance Business Process Application Error Code List Maintenance Committee (see Appendix A for details). However, since this data element is required according to the X12 standard, use the default value of "NA".
Code identifying the agency assigning the code values
- RED03 identifies the agency maintaining the code list identified in RED05.
- This element is not useful in defining the error or informational message reported in this segment.
- 94
- Code Assigned by the Organization that is the Ultimate Destination of the Transaction Set
Code identifying a specific industry code list
- RED05 identifies the code list containing the code indicated in RED06.
- IBP
- Insurance Business Process Application Error Code
This code set is for use in reporting application errors for insurance business processes. See Appendix A for Code Source 895, Insurance Business Process Application Error Codes.
Code indicating a code from a specific industry code list
- RED06 is an industry-defined code identifying the specific type of related data in RED01.
Transaction Set Trailer
To indicate the end of the transaction set and provide the count of the transmitted segments (including the beginning (ST) and ending (SE) segments)
Total number of segments included in a transaction set including ST and SE segments
Identifying control number that must be unique within the transaction set functional group assigned by the originator for a transaction set
Functional Group Trailer
To indicate the end of a functional group and to provide control information
Total number of transaction sets included in the functional group or interchange (transmission) group terminated by the trailer containing this data element
Assigned number originated and maintained by the sender
Interchange Control Trailer
To define the end of an interchange of zero or more functional groups and interchange-related control segments
Example 1: Positive Acknowledgment
GS*AG*SENDERGS*RECEIVERGS*20240221*140702*000000001*X*005010X186A1~
ST*824*021390001*005010X186A1~
BGN*11*FFA.ABCDEF.123456*20020709*0932**123456789**WQ~
N1*41*ABC INSURANCE*46*111111111~
PER*IC*JOHN JOHNSON*TE*8005551212*EX*1439~
N1*40*SMITHCO*46*A1234~
OTI*TA*TN*NA***20020709*0902*2*0001*834*005010X220A1~
SE*7*021390001~
GE*1*000000001~
IEA*1*000000001~
Example 2: Complete Transaction Set Reject Reporting
GS*AG*SENDERGS*RECEIVERGS*20240221*140729*000000001*X*005010X186A1~
ST*824*021390002*005010X186A1~
BGN*11*FFA.ABCDEF.123456*20020709*0932**123456789**U~
N1*41*DEF INSURANCE*46*222222222~
PER*IC*TOM EVANS*TE*8005551212*EX*1439~
N1*40*JONESCO*46*B5678~
OTI*TR*TN*NA***20020709*0902*2*0001*124*005010~
TED*024**VEH*36*2~
RED*NA**94**IBP*E054~
SE*9*021390002~
GE*1*000000001~
IEA*1*000000001~
Example 3: Partial Transaction Set Reject Reporting
GS*AG*SENDERGS*RECEIVERGS*20240221*140914*000000001*X*005010X186A1~
ST*824*0001*005010X186A1~
BGN*11*12345*20040831*150057**0123**RU~
N1*41*CONSOLIDATED INSURANCE CO*46*00000~
PER*IC*CUSTOMER SERVICE*TE*8005551212~
N1*40*PHIL GOOD, M.D.*46*TXX23~
OTI*TA*TN*NA***20040812*1253*1000001*0021*837*005010X222A1~
REF*F8*0123~
DTM*050*20040814~
AMT*GW*16970.33~
QTY*TO*5~
NM1*41*2*PHIL GOOD, M.D.*****46*TXX23~
TED*024~
RED*NA**94**IBP*W050~
OTI*BP*BT*NA***20040812*1253*1000001*0021*837*005010X222A1~
REF*1C*99983000~
AMT*2*16970.33~
QTY*46*5~
NM1*85*2*GOOD AND ASSOCIATES*****24*555667777~
OTI*IA*IX*NA***20040812*1253*1000001*0021*837*005010X222A1~
REF*EJ*26462967~
AMT*GW*540~
NM1*QC*1*SMITH*TED****MI*000221111A~
OTI*IE*IX*NA***20040812*1253*1000001*0021*837*005010X222A1~
REF*EJ*78945639837~
AMT*GW*1100.67~
NM1*QC*1*BROWN*ROBERT*W***MI*888553737~
TED*024**N4*32*3**10407~
RED*NA**94**IBP*E038~
OTI*IR*IX*NA***20040812*1253*1000001*0021*837*005010X222A1~
REF*EJ*8437450584598~
AMT*GW*12642.16~
NM1*QC*1*JAMES*JIM*D***MI*011332211~
TED*024**N4*54*3**73076~
RED*NA**94**IBP*E038~
TED*024**REF*68~
CTX*2310A REFERRING PROVIDER*NM1*65*2310~
CTX*2010BB PAYER NAME*NM1*18*2010~
CTX*CLAIM FILING INDICATOR CODE - MB*SBR*13*2000*9~
RED*NA**94**IBP*E019~
OTI*IA*IX*NA***20040812*1253*1000001*0021*837*005010X222A1~
REF*EJ*984576898~
AMT*GW*1900.5~
NM1*QC*1*MAE*SALLIE*M***MI*987654321~
OTI*IE*IX*NA***20040812*1253*1000001*0021*837*005010X222A1~
REF*EJ*8767657645765~
AMT*GW*787~
NM1*QC*1*DOE*JANE****MI*777553333~
TED*024**N4*113*3**27387~
RED*NA**94**IBP*E038~
TED*024**N4*124*3**27378~
RED*NA**94**IBP*E038~
SE*52*0001~
GE*1*000000001~
IEA*1*000000001~
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