Segment
X12 EDI Release 00503
To convey service line adjudication information for coordination of benefits between the initial payers of a health care claim and all subsequent payers
Elements
  • SVD0167Identification Code
    AN
    M必须(Mandatory)
    Min 2 / Max 80

    Code identifying a party or other code

  • SVD02782Monetary Amount
    R
    M必须(Mandatory)
    Min 1 / Max 18

    Monetary amount

  • SVD03C003Composite Medical Procedure IdentifierO可选(Optional)
    23523413391339133913393522341339133913391339
    • SVD0301235Product/Service ID Qualifier
      ID
      M必须(Mandatory)

      Code identifying the type/source of the descriptive number used in Product/Service ID (234)

      Codes (511)
    • SVD0302234Product/Service ID
      AN
      M必须(Mandatory)
      Min 0 / Max 48

      Identifying number for a product or service

    • SVD03031339Procedure Modifier
      AN
      O可选(Optional)
      Min 2 / Max 2

      This identifies special circumstances related to the performance of the service, as defined by trading partners

    • SVD03041339Procedure Modifier
      AN
      O可选(Optional)
      Min 2 / Max 2

      This identifies special circumstances related to the performance of the service, as defined by trading partners

    • SVD03051339Procedure Modifier
      AN
      O可选(Optional)
      Min 2 / Max 2

      This identifies special circumstances related to the performance of the service, as defined by trading partners

    • SVD03061339Procedure Modifier
      AN
      O可选(Optional)
      Min 2 / Max 2

      This identifies special circumstances related to the performance of the service, as defined by trading partners

    • SVD0307352Description
      AN
      O可选(Optional)
      Min 1 / Max 80

      A free-form description to clarify the related data elements and their content

    • SVD0308234Product/Service ID
      AN
      O可选(Optional)
      Min 1 / Max 48

      Identifying number for a product or service

    • SVD03091339Procedure Modifier
      AN
      O可选(Optional)
      Min 2 / Max 2

      This identifies special circumstances related to the performance of the service, as defined by trading partners

    • SVD03101339Procedure Modifier
      AN
      O可选(Optional)
      Min 2 / Max 2

      This identifies special circumstances related to the performance of the service, as defined by trading partners

    • SVD03111339Procedure Modifier
      AN
      O可选(Optional)
      Min 2 / Max 2

      This identifies special circumstances related to the performance of the service, as defined by trading partners

    • SVD03121339Procedure Modifier
      AN
      O可选(Optional)
      Min 2 / Max 2

      This identifies special circumstances related to the performance of the service, as defined by trading partners

  • SVD04234Product/Service ID
    AN
    O可选(Optional)
    Min 1 / Max 48

    Identifying number for a product or service

  • SVD05380Quantity
    R
    O可选(Optional)
    Min 1 / Max 15

    Numeric value of quantity

  • SVD06554Assigned Number
    N
    O可选(Optional)
    Min 1 / Max 6

    Number assigned for differentiation within a transaction set