EDI 5010 Documentation 837 Professional - Loop 2000C Patient Hierarchical Level

LOOP 2000C Patient Hierarchical Level and  and LOOP 2010CA – Patient Name

        

Important Note:

This loop required only when the patient is a different person than the subscriber.

In this loop, all the information will be taken from Patient demographics. Take a look of our sample screen here how Patient demographics information are stored in the system.

Now let’s start the detail implementation.

Loop	Seg ID	Segment Name	Format	Length	Ref#	Req	Value
2000C	HL	Patient Hierarchical Level	ID	2		R	HL
		Element Separator	AN	1			*
	HL01	Hierarchical ID Number	AN	1/12	828	R	Unique alphanumeric number for each occurrence of the HL segment in the transaction set. HL01 could be used to indicate the number of occurrences of the HL segment, in which case the value of HL01 would be “1" for the initial HL segment and would be incremented by one in each subsequent HL segment within the transaction
		Element Separator	AN	1			*
	HL02	Hierarchical Parent ID Number	AN	1/12	734	R	HL02 identifies the hierarchical ID number of the HL segment to which the current HL segment is subordinate
		Element Separator	AN	1			*
	HL03	Hierarchical Level Code	ID	1/2	735	R	23
		Element Separator	AN	1			*
	HL04	Hierarchical Child Code	ID	1/1	736	R	0
		Segment Terminator					~

 

LOOP 2000C  Patient Information

Loop	Seg ID	Segment Name	Format	Length	Ref#	Req	Value
2000C	PAT	Patient Information	ID	3		R	PAT
		Element Separator	AN	1			*
	PAT01	Individual Relationship Code	ID	2/2	1069	R	See below for more information
		Element Separator	AN	1			*
	PAT02	Patient Location Code	ID	1/1	1384	Not Used
		Element Separator	AN	1			*
	PAT03	Employment Status Code	ID	2/2	584	Not used
		Element Separator	AN	1			*
	PAT04	Student Status Code	AN	1/1	1220	Not used
		Element Separator	AN	1			*
	PAT05	Date Time Period Format Qualifier	ID	2/3	1250	S	D8 if patient is known to be deceased.
		Element Separator	AN	1			*
	PAT06	Date time Period	AN	1/35	1251	S	Print patient death date if patient is known to be deceased. Format CCYYMMDD
		Element Separator	AN	1			*
	PAT07	Unit or Basis for Measurement Code	ID	2/2	355	S	GR – Required when the patient’ age is less than 29 days old.
		Element Separator	AN	1			*
	PAT08	Weight	X	1/10	81	S	Print patient weight. Required when the patient’s age is less than 29 days old.
		Element Separator	AN	1			*
	PAT09	Yes/No Condition	ID	1/1	1073	O	Print “Y” if the patient is pregnant. Leave blank if the patient is not pregnant.
		Segment Terminator					~

 

PAT01 – Individual Relationship Code

Code	Definition
01	Spouse
19	Child
20	Employee
21	Unknown
39	Organ Donor
40	Cadaver Donor
53	Life Partner
G8	Other Relationship

 

 

LOOP 2010CA Patient Name

 

Loop	Seg ID	Segment Name	Format	Length	Ref#	Req	Value
2000CA	NM1	Patient Name	ID	3		R	NM1
		Element Separator	AN	1			*
	NM101	Entity Identifier Code	ID	2/3	98	R	QC
		Element Separator	AN	1			*
	NM102	Entity Type qualifier	ID	1/1	1065	R	1
		Element Separator	AN	1			*
	NM103	Name Last or Organization Name	AN	1/60	1035	R	Patient Last Name
		Element Separator	AN	1			*
	NM104	Name First	AN	1/35	1036	S	Patient First Name
		Element Separator	AN	1			*
	NM105	Name Middle	AN	1/25	1037	S	Patient Middle Name
		Element Separator	AN	1			*
	NM106	Name Prefix	AN	1/10	1038	Not used
		Element Separator	AN	1			*
	NM107	Name Suffix	AN	1/10	1039	S	Patient Suffix
		Element Separator	AN	1			*
	NM108	Identification code Qualifier	ID	1/2	66	R	MI (Required if the patient identifier is different than the subscriber identifier.
		Element Separator	AN	1			*
	NM109	Identification code	AN	2/80	67	R	Print Patient Primary Identification Number or Insured ID or Subscriber ID or Health Insurance claim Number
		Segment Terminator					~

 

NM102 - Entity Type Qualifier

Code qualifying the type of entity

Code	Definition
1	Person
2	Non-Person Entity

 

2010CA Patient Address

Loop	Seg ID	Segment Name	Format	Length	Ref#	Req	Value
2010CA	N3	Patient Address	AN	2		R	N3
		Element Separator	AN	1			*
	N301	Address Line 1	AN	1/55	166	R	Patient Address Line 1
		Element Separator	AN	1			*
	N302	Address Line 2	AN	1/55	1065	S	Patient Address Line 2 if exists
		Segment Terminator					~

2010CA  Patient City/State/Zip code

Loop	Seg ID	Segment Name	Format	Length	Ref#	Req	Value
2010CA	N4	Patient City / State / Zip Code	AN	2		R	N4
		Element Separator	AN	1			*
	N401	City Name	AN	2/30	19	R	Patient City Name
		Element Separator	AN	1			*
	N402	State or Province Code	ID	2/2	156	R	Patient State Code
		Element Separator	AN	1			*
	N403	Postal Code	ID	3/15	116	R	Patient Zip Code
		Segment Terminator					~

2010CA Patient Demographic Information.

Loop	Seg ID	Segment Name	Format	Length	Ref#	Req	Value
2010CA	DMG	Patient Demographic information	ID	3		R	DMG
		Element Separator	AN	1			*
	DMG01	Date time Period Format Qualifier	ID	2/3	1250	R	D8
		Element Separator	AN	1			*
	DMG02	Date time Period	AN	1/35	1251	R	Patient Date of birth in the Format CCYYMMDD
		Element Separator	AN	1			*
	DMG03	Gender Code	ID	1	1068	R	Print M for Male Print F for Female Print U for unknown
		Segment Terminator					~

 

Loop 2000C and 2010CA  Sample

Patient Demographic Information

Field	Value
Patient Last Name	Marvin
Patient First Name	White
Insured ID	86J353
Patient Address Line 1	2832 Linden Blvd
Patient Address Line 2	NA
Patient City	Southern View
Patient State	NY
Patient Zip Code	11234
Patient DOB (mm/dd/yyyy)	10/05/2002
Patient Gender	Female

 

PAT*19~
NM1*QC*1*MARVIN*WHITE****MI*86J353~
N3*2832 LINDEN BLVD~
N4*Southern View*NY*11234~
DMG*D8*20021005*F

 

 

        

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