Segment
X12 EDI Release 00303
To supply payment and control information to a provider for a particular service
Elements
  • SVC01235Product/Service ID Qualifier
    ID
    M必须(Mandatory)

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

    Codes (275)
  • SVC02234Product/Service ID
    AN
    M必须(Mandatory)
    Min 1 / Max 30

    Identifying number for a product or service.

  • SVC03782Monetary Amount
    R
    M必须(Mandatory)
    Min 1 / Max 15

    Monetary amount.

  • SVC04782Monetary Amount
    R
    M必须(Mandatory)
    Min 1 / Max 15

    Monetary amount.

  • SVC05234Product/Service ID
    AN
    O可选(Optional)
    Min 1 / Max 30

    Identifying number for a product or service.

  • SVC061339Procedure 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

  • SVC071339Procedure 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

  • SVC081339Procedure 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