ITC Institutional claim

To provide specific claim information for services performed while admitted to an institution.

Position
Element
Name
Type
Requirement
Min
Max
Repeat
010
Invoice type
Composite (composite)
Mandatory
1
010
Invoice type code
String (AN)
Mandatory
1
3
-
Code specifying the type of invoice.
020
Frequency code
String (AN)
Conditional
1
3
-
Code specifying the rate of recurrence.
020
Quantity
String (AN)
Mandatory
1
35
4
Alphanumeric representation of a quantity.
030
Admission
Composite (composite)
Mandatory
1
010
Admission type description code
String (AN)
Conditional
1
3
-
Code specifying the type of admission.
020
Admission source code
String (AN)
Conditional
1
3
-
Code specifying the source of admission.
040
Discharge type description code
String (AN)
Mandatory
1
3
1
Code specifying the type of discharge.
050
Basis of service information
Composite (composite)
Conditional
9
010
Basis of service code qualifier
String (AN)
Mandatory
1
3
-
Code specifying the basis on which a service is performed.
020
Product identifier
String (AN)
Mandatory
1
35
-
To identify a product.
030
Code list identification code
String (AN)
Conditional
1
3
-
Identification of a code list.
040
Date/time/period value
String (AN)
Conditional
1
35
-
The value of a date, a date and time, a time or of a period in a specified representation.
050
Date/time/period format code
String (AN)
Conditional
1
3
-
Code specifying the representation of a date, time or period.
060
Monetary amount value
Numeric (N)
Conditional
1
35
-
To specify the value of a monetary amount.

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