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Attachments Retrieval JSON-to-EDI API Contents

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See JSON-to-EDI API Mapping.

The Consolidated 270/271 Implementation Guide discusses this in further detail.

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NOTE

The OpenAPI Spec file for this API lists out the complete contents of the Attachment Submission request body. In the file, look for the Request object. Whenever you submit a request with an unsolicited or solicited attachment, it will contain instances of all the other JSON objects that are described in this document and in the OpenAPI Spec.

Table of mapping tables

Header

FieldDescriptionC/R
controlNumberTransaction Set Control Number.
Maps to ST02 (no loop).		4/9
R
tradingPartnerServiceIdSend that value in:
Loop 2100A, NM109
Required if tradingPartnerServiceId is not present.		2/80
R
faxNumberFax number of the payers if they do not have connectivity.10/20

Submitter

NameElementLoopDescriptionC/R
submitterPG73ā€”Full name if an individual or organization
organizationNameNM1031000BOrganization name for the submitter. Can use organization or last name.1/60
R
lastNameNM1031000BThe subscriberā€™s last name as specified on their policy.1/60
R
firstNameNM1041000BThe subscriberā€™s first name as specified on their policy.1/35
R
etinNM1091000BElectronic Transmitter Identification Number (ETIN) 46.1/2
R

Provider

NameElementLoopDescriptionC/R
providerā€”ā€”ā€”ā€”
organizationNameNM1031000C
  • 85 = Billing Provider (2010BB)
  • 82 = Rendering Provider (2310B)
  • DN = Referring Provider (2310A)
    		• 2/3
    npiNM1091000CNational Provider Identification value.
    NM108 = XX    		2/80
    taxonomyCodePRV031000CHealth care provider taxonomy code.1/50
    R
    providerCommercialNumberREF021000CProvider commercial number.
    REF01 = G2    		1/50
    R
    locationNumberREF021000CProvider location number.
    REF01 = LU    		1/50
    R
    stateLicenseNumberREF021000CProvider state license number.
    REF01 = 0B    		1/50
    R
    providerUpinNumberREF021000CProvider UPIN number.
    REF01 = 1G    		1/50
    R
    address
    address1N3011000CProviderā€™s address line 1.1/35
    R
    address2N3021000CProviderā€™s address line 2.1/35
    R
    cityN4011000CProviderā€™s city.1/60
    R
    stateN4021000CProviderā€™s state.1/35
    postalCodeN4031000CProviderā€™s postal code.3/15
    faxNumberPER042010AAProvider tax number.
    PER03=FX    		1/256
    R
    phoneNumberPER042010AAProvider contact phone number.
    PER03=TE    		1/256
    R

    Subscriber

    NameElementLoopDescriptionC/R
    Subscriber Name InfoPG 112ā€”ā€”ā€”
    subscriberā€”ā€”ā€”ā€”
    memberIdNM1091000DThe subscriberā€™s insurance member ID.
    NM108 = MI = (Standard Unique Health Identifier for everyone in the United States)    		2/80
    lastNameNM1031000DThe subscriberā€™s last name as specified on their policy.1/60
    firstNameNM1041000DThe subscriberā€™s first name as specified on their policy.1/35

    Claim Information

    NameElementLoopDescriptionC/R
    claimInformationā€”ā€”ā€”ā€”
    patientControlNumberREF021000DPatient Control Number.
    Identifier used to track a claim from creation by the health care provider through payment.
    REF=EJ    		1/50
    R
    billingTypeIdentifierREF021000DInstitutional Type of Bill.
    REF=BLT    		1/50
    R
    medicalRecordIdentifierREF021000DMedical Record Identification Number.
    Required when the Medical Record Identification Number is submitted on the original claim.
    REF=EA    		1/50
    R
    claimNumberREF021000DClaim identification number for clearinghouses and other Transmission intermediaries.
    REF=D9    		1/50
    R
    ā€”ā€”ā€”ā€”ā€”
    payerControlNumberTRN022000APayer claim control Number/provider attachment Control number.1/50
    R
    ā€”ā€”ā€”ā€”ā€”
    beginClaimServiceDateDT031000DClaim start date.
    DTP01=472 (Service) and
    DTP02=RD8 (Range CCYYMMDD-CCYYMMDD)    		1/35
    R
    endClaimServiceDateDT031000DClaim end date.
    DTP01=472 (Service) and
    DTP02=RD8 (Range CCYYMMDD-CCYYMMDD)    		1/35
    R
    claimServiceDateDT031000DClaim service date.
    DTP01=472 (Service) and
    DTP02=D8 (Format CCYYMMDD)    		1/35
    R

    Service Lines

    NameElementLoopDescriptionC/R
    serviceLinesā€”ā€”For each service Line, we will add LX segment and keep incrementing LX01.ā€”
    payerClaimControlNumberTRN022000APayer claim control number/provider attachment control number.
    TRN01=2 (Referenced Transaction Trace Numbers)
    Payer Claim Control Number is the value from the TRN segment loop 2200D of the 277 when in response to a solicited request.    		1/50
    R
    providerAttachmentControlNumberTRN022000AProvider Attachment Control Number.
    TRN01=1
    For the unsolicited 275, the Attachment Control Number is the value from PWK06 loop 2300 of the 837. This is the main matching criteria and must be unique on a per attachment basis.    		1/50
    R
    ā€”ā€”ā€”ā€”ā€”
    claimStatusā€”ā€”To report the status, required action, and paid information of a claim or service line.ā€”
    claimStatusCategoryCodeSTC01-12000AHealth Care Claim Status Category Code1/30
    R
    additionalInformationRequestCodeSTC01-22000ALOINCĀ® Code that defines the additional information that was requested.
    Identifies the status of an entire claim or a service line.    		1/30
    R
    ā€”ā€”ā€”ā€”ā€”
    providerControlNumberREF022000AProvider Control Number.
    REF01=6R    		1/50
    R
    ā€”ā€”ā€”ā€”ā€”
    lineItemControlNumberREF022000ALine Item Control Number.
    This is the provider control number or the line item control number that is associated with the additional information.
    REF01=FJ    		1/50
    R
    ā€”ā€”ā€”ā€”ā€”
    procedureOrRevenueDetailsā€”ā€”ā€”ā€”
    procedureOrRevenueCodeREF012000AProcedure or Revenue Code
    Valid values: CPT, F8, FO, PRT, RB, VP, YJ, ZZ    		2/3
    R
    procedureOrRevenueValueREF022000AValue of the procedure or revenue code.
    REF01    		1/50
    R
    revenueCodeREF04-22000ARevenue code.1/50
    R
    ā€”ā€”ā€”ā€”ā€”
    procedureCodeModifierā€”ā€”ā€”ā€”
    serviceChangeNumberREF022000AService Change Number.
    REF01=SK    		1/50
    R
    objectCodeREF04-22000AObject Code.
    REF04-1=XX4    		1/50
    R
    systemNumberREF04-42000ASystem Number.
    REF04-3=06    		1/50
    R
    specialPaymentReferenceNumberREF04-62000ASpecial Payment Reference Number.
    REF04-5=4N    		1/50
    R
    ā€”ā€”ā€”ā€”
    serviceLineDateInformationPG 87ā€”Service Line Date of Service.ā€”
    serviceDateDTP032100AService Date.
    DTP01=472 (Service) and
    DTP02=D8 (Format CCYYMMDD)    		1/35
    R
    beginServiceDateDTP032100AService start date.
    DTP01=472 (Service) and
    DTP02=RD8 (Range CCYYMMDD-CCYYMMDD)    		1/35
    endServiceDateDTP032100AService end date.
    DTP01=472 (Service) and
    DTP02=RD8 (Range CCYYMMDD-CCYYMMDD)    		1/35
    R
    submissionDateDTP032100BSubmission date.
    DTP01=472 (Service) and
    DTP02=D8 (Format CCYYMMDD)    		1/35
    R
    ā€”ā€”ā€”ā€”ā€”
    attachmentDetailsPG 89ā€”Category of Patient Information Service.ā€”
    nameā€”2100BShould match a file name sent with Form-Data files.
    Used to complete LOOP 2110B; BIN02 and LOOP 2110B; BIN01.    		ā€”

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