OTI Other insurance

To provide payer, insured, and payment information when benefits are being coordinated between third party benefit carriers.

Position
Element
Name
Type
Requirement
Min
Max
Repeat
010
Object identification
Composite (composite)
Mandatory
5
010
Object identifier
String (AN)
Mandatory
1
35
-
Code specifying the unique identity of an object.
020
Object identification code qualifier
String (AN)
Conditional
1
3
-
Code qualifying the identification of an object.
030
Status description code
String (AN)
Conditional
1
3
-
Code specifying a status.
1 For transport status, use UN/ECE Recommendation 24.
020
Payer responsibility level code
String (AN)
Mandatory
1
3
1
Code specifying the level of responsibility of a payer.
030
Date/time/period
Composite (composite)
Conditional
2
010
Date or time or period function code qualifier
String (AN)
Mandatory
1
3
-
Code qualifying the function of a date, time or period.
020
Date or time or period text
String (AN)
Conditional
1
35
-
The value of a date, a date and time, a time or of a period in a specified representation.
030
Date or time or period format code
String (AN)
Conditional
1
3
-
Code specifying the representation of a date, time or period.
040
Service type code
String (AN)
Conditional
1
3
10
Code specifying the type of service.
050
Monetary amount
Numeric (N)
Conditional
1
35
4
To specify a monetary amount.
060
Adjustment information
Composite (composite)
Conditional
15
010
Adjustment category code
String (AN)
Mandatory
1
3
-
Code specifying the general category of adjustment.
020
Adjustment reason description code
String (AN)
Mandatory
1
3
-
Code specifying the adjustment reason.
030
Monetary amount
Numeric (N)
Conditional
1
35
-
To specify a monetary amount.
070
Insurance cover type code
String (AN)
Conditional
1
3
1
Code specifying the meaning of the insurance cover.
080
Relationship description code
String (AN)
Conditional
1
3
1
Code specifying a relationship.
090
Yes or no indicator code
String (AN)
Conditional
1
3
1
Code specifying either a yes or no.

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