OI Other Health Insurance Information

To specify information associated with other health insurance coverage

Position
Element
Name
Type
Requirement
Min
Max
Repeat
OI01
Claim Filing Indicator Code
Identifier (ID)
Optional
1
2
-
Code identifying type of claim
OI02
Claim Submission Reason Code
Identifier (ID)
Optional
2
2
-
Code identifying reason for claim submission
OI03
Yes/No Condition or Response Code
Identifier (ID)
Optional
1
1
-
Code indicating a Yes or No condition or response.
OI03 is assignment of benefits indicator. A ``Y'' value indicates insured or authorized person authorizes benefits to be assigned to the provider. An ``N'' value indicates benefits have not been assigned to the provider.
OI04
Patient Signature Source Code
Identifier (ID)
Optional
1
1
-
Code indicating how the patient or subscriber authorization signatures were obtained and how they are being retained by the provider
OI05
Provider Agreement Code
Identifier (ID)
Optional
1
1
-
Code indicating the type of agreement under which the provider is submitting this claim
OI06
Release of Information Code
Identifier (ID)
Optional
1
1
-
Code indicating whether the provider has on file a signed statement by the patient authorizing the release of medical data to other organizations in order to adjudicate the claim

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