EDI 500 Medical Event Reporting

Functional Group MM

X12N Insurance Subcommittee

This Draft Standard for Trial Use contains the format and establishes the data contents of the Medical Event Reporting Transaction Set (500) for use within the context of an Electronic Data Interchange (EDI) environment. This standard can be used to make voluntary, mandatory, baseline, annual and semi-annual reports on medication and medical device adverse effects and product problems.

Heading

1. 010 · ST · Transaction Set Header · Max 1 · Mandatory

   To indicate the start of a transaction set and to assign a control number

2. 020 · BGN · Beginning Segment · Max 1 · Mandatory

   To indicate the beginning of a transaction set

3. NM1 Loop Optional Repeat >1

   1. 030 · NM1 · Individual or Organizational Name · Max 1 · Mandatory

      To supply the full name of an individual or organizational entity

      The NM1 loop carries information about the party transmitting the report.

   2. 040 · N2 · Additional Name Information · Max 2 · Optional

      To specify additional names or those longer than 35 characters in length

   3. 050 · N3 · Address Information · Max 2 · Optional

      To specify the location of the named party

   4. 060 · N4 · Geographic Location · Max 1 · Optional

      To specify the geographic place of the named party

   5. 070 · REF · Reference Identification · Max >1 · Optional

      To specify identifying information

   6. 080 · PER · Administrative Communications Contact · Max >1 · Optional

      To identify a person or office to whom administrative communications should be directed

   7. 090 · DTM · Date/Time Reference · Max >1 · Optional

      To specify pertinent dates and times

   8. 100 · QTY · Quantity · Max >1 · Optional

      To specify quantity information

   9. 110 · TRN · Trace · Max >1 · Optional

      To uniquely identify a transaction to an application

   10. LM Loop Optional Repeat >1

       1. 120 · LM · Code Source Information · Max 1 · Mandatory

          To transmit standard code list identification information

       2. 130 · LQ · Industry Code · Max >1 · Mandatory

          Code to transmit standard industry codes

Detail

1. HL Loop Optional Repeat >1

   1. 010 · HL · Hierarchical Level · Max 1 · Mandatory

      To identify dependencies among and the content of hierarchically related groups of data segments

      The HL loop divides a report into sections such as event, patient, device, medication, reporter, user facility, distributor and manufacturer.

   2. LM Loop Optional Repeat >1

      1. 020 · LM · Code Source Information · Max 1 · Mandatory

         To transmit standard code list identification information

         The LM loop provides report data in coded form.

      2. LQ Loop Mandatory Repeat >1

         1. 030 · LQ · Industry Code · Max 1 · Mandatory

            Code to transmit standard industry codes

         2. 040 · DTM · Date/Time Reference · Max >1 · Optional

            To specify pertinent dates and times

         3. 050 · REF · Reference Identification · Max >1 · Optional

            To specify identifying information

         4. 060 · QTY · Quantity · Max >1 · Optional

            To specify quantity information

         5. 070 · MTX · Text · Max >1 · Optional

            To specify textual data

   3. LIN Loop Optional Repeat >1

      1. 080 · LIN · Item Identification · Max 1 · Mandatory

         To specify basic item identification data

         The LIN loop provides product device or medication specific information.

      2. 090 · PID · Product/Item Description · Max >1 · Optional

         To describe a product or process in coded or free-form format

      3. 100 · QTY · Quantity · Max >1 · Optional

         To specify quantity information

      4. 110 · DTM · Date/Time Reference · Max >1 · Optional

         To specify pertinent dates and times

      5. 120 · REF · Reference Identification · Max >1 · Optional

         To specify identifying information

      6. 130 · MEA · Measurements · Max >1 · Optional

         To specify physical measurements or counts, including dimensions, tolerances, variances, and weights (See Figures Appendix for example of use of C001)

      7. 140 · TRN · Trace · Max >1 · Optional

         To uniquely identify a transaction to an application

      8. 150 · MTX · Text · Max >1 · Optional

         To specify textual data

   4. NM1 Loop Optional Repeat >1

      1. 160 · NM1 · Individual or Organizational Name · Max 1 · Mandatory

         To supply the full name of an individual or organizational entity

         The NM1 loop carries party or organization reporting information.

      2. 170 · N2 · Additional Name Information · Max 2 · Optional

         To specify additional names or those longer than 35 characters in length

      3. 180 · N3 · Address Information · Max 2 · Optional

         To specify the location of the named party

      4. 190 · N4 · Geographic Location · Max 1 · Optional

         To specify the geographic place of the named party

      5. 200 · REF · Reference Identification · Max >1 · Optional

         To specify identifying information

      6. 210 · PER · Administrative Communications Contact · Max >1 · Optional

         To identify a person or office to whom administrative communications should be directed

      7. 220 · DTM · Date/Time Reference · Max >1 · Optional

         To specify pertinent dates and times

      8. 230 · DMG · Demographic Information · Max >1 · Optional

         To supply demographic information

      9. 240 · MEA · Measurements · Max >1 · Optional

         To specify physical measurements or counts, including dimensions, tolerances, variances, and weights (See Figures Appendix for example of use of C001)

      10. 250 · PWK · Paperwork · Max >1 · Optional

          To identify the type or transmission or both of paperwork or supporting information

      11. 260 · TRN · Trace · Max >1 · Optional

          To uniquely identify a transaction to an application

      12. QTY Loop Optional Repeat >1

          1. 270 · QTY · Quantity · Max 1 · Mandatory

             To specify quantity information

          2. LM Loop Optional Repeat >1

             1. 280 · LM · Code Source Information · Max 1 · Mandatory

                To transmit standard code list identification information

             2. 290 · LQ · Industry Code · Max >1 · Mandatory

                Code to transmit standard industry codes

      13. PID Loop Optional Repeat >1

          1. 300 · PID · Product/Item Description · Max 1 · Mandatory

             To describe a product or process in coded or free-form format

          2. 310 · DTM · Date/Time Reference · Max >1 · Optional

             To specify pertinent dates and times

          3. 320 · QTY · Quantity · Max >1 · Optional

             To specify quantity information

      14. MTX Loop Optional Repeat >1

          1. 330 · MTX · Text · Max 1 · Mandatory

             To specify textual data

          2. 340 · DTM · Date/Time Reference · Max >1 · Optional

             To specify pertinent dates and times

2. 350 · CTT · Transaction Totals · Max 1 · Optional

   To transmit a hash total for a specific element in the transaction set

   CTT01 is the number of occurrences of the HL segment.

3. 360 · SE · Transaction Set Trailer · Max 1 · Mandatory

   To indicate the end of the transaction set and provide the count of the transmitted segments (including the beginning (ST) and ending (SE) segments)