Segment
X12 EDI Release 00504
To specify information associated with other health insurance coverage
Elements
  • OI011032Claim Filing Indicator Code
    ID
    O可选(Optional)

    Code identifying type of claim

    Codes (50)
  • OI021383Claim Submission Reason Code
    ID
    O可选(Optional)

    Code identifying reason for claim submission

    Codes (21)
  • OI031073Yes/No Condition or Response Code
    ID
    O可选(Optional)

    Code indicating a Yes or No condition or response

    Codes (4)
  • OI041351Patient Signature Source Code
    ID
    O可选(Optional)

    Code indicating how the patient or subscriber authorization signatures were obtained and how they are being retained by the provider

    Codes (5)
  • OI051360Provider Agreement Code
    ID
    O可选(Optional)

    Code indicating the type of agreement under which the provider is submitting this claim

    Codes (7)
  • OI061363Release of Information Code
    ID
    O可选(Optional)

    Code indicating whether the provider has on file a signed statement by the patient authorizing the release of medical data to other organizations

    Codes (6)