OI Other Health Insurance Information

To specify information associated with other health insurance coverage

Position
Element
Name
Type
Requirement
Min
Max
Repeat
OI-01
Claim Filing Indicator Code
Identifier (ID)
Optional
1
2
1
Code identifying type of claim
OI-02
Claim Submission Reason Code
Identifier (ID)
Optional
2
2
1
Code identifying reason for claim submission
OI-03
Yes/No Condition or Response Code
Identifier (ID)
Optional
1
1
1
Code indicating a Yes or No condition or response
OI03 is the 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.
OI-04
Patient Signature Source Code
Identifier (ID)
Optional
1
1
1
Code indicating how the patient or subscriber authorization signatures were obtained and how they are being retained by the provider
OI-05
Provider Agreement Code
Identifier (ID)
Optional
1
1
1
Code indicating the type of agreement under which the provider is submitting this claim
OI-06
Release of Information Code
Identifier (ID)
Optional
1
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

Stedi is a registered trademark of Stedi, Inc. Stedi's EDI Reference is provided for marketing purposes and is free of charge. All names, logos, and brands of third parties listed on our site are trademarks of their respective owners (including “X12”, which is a trademark of X12 Incorporated). Stedi, Inc. and its products and services are not endorsed by, sponsored by, or affiliated with these third parties. Our use of these names, logos, and brands is for identification purposes only, and does not imply any such endorsement, sponsorship, or affiliation.