Attachments Retrieval JSON-to-EDI API Contents
The Consolidated 270/271 Implementation Guide discusses this in further detail.
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
Requestobject. 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
| Field | Description | C/R |
|---|---|---|
controlNumber | Transaction Set Control Number. Maps to ST02 (no loop). | 4/9 R |
tradingPartnerServiceId | Send that value in: Loop 2100A, NM109 Required if tradingPartnerServiceId is not present. | 2/80 R |
faxNumber | Fax number of the payers if they do not have connectivity. | 10/20 |
Submitter
| Name | Element | Loop | Description | C/R |
|---|---|---|---|---|
submitter | PG73 | — | Full name if an individual or organization | |
organizationName | NM103 | 1000B | Organization name for the submitter; can use organization or last name | 1/60 R |
lastName | NM103 | 1000B | The subscriber’s last name as specified on their policy | 1/60 R |
firstName | NM104 | 1000B | The subscriber’s first name as specified on their policy | 1/35 R |
etin | NM109 | 1000B | Electronic Transmitter Identification Number (ETIN) 46 | 1/2 R |
Provider
| Name | Element | Loop | Description | C/R |
|---|---|---|---|---|
provider | — | — | — | — |
organizationName | NM103 | 1000C | 2/3 | |
npi | NM109 | 1000C | National Provider Identification value. NM108 = XX | 2/80 |
taxonomyCode | PRV03 | 1000C | Health care provider taxonomy code. | 1/50 R |
providerCommercialNumber | REF02 | 1000C | Provider commercial number. REF01 = G2 | 1/50 R |
locationNumber | REF02 | 1000C | Provider location number. REF01 = LU | 1/50 R |
stateLicenseNumber | REF02 | 1000C | Provider state license number. REF01 = 0B | 1/50 R |
providerUpinNumber | REF02 | 1000C | Provider UPIN number. REF01 = 1G | 1/50 R |
address | ||||
address1 | N301 | 1000C | Provider’s address line 1. | 1/35 R |
address2 | N302 | 1000C | Provider’s address line 2. | 1/35 R |
city | N401 | 1000C | Provider’s city. | 1/60 R |
state | N402 | 1000C | Provider’s state. | 1/35 |
postalCode | N403 | 1000C | Provider’s postal code. | 3/15 |
faxNumber | PER04 | 2010AA | Provider tax number. PER03=FX | 1/256 R |
phoneNumber | PER04 | 2010AA | Provider contact phone number. PER03=TE | 1/256 R |
Subscriber
| Name | Element | Loop | Description | C/R |
|---|---|---|---|---|
| Subscriber Name Info | PG 112 | — | — | — |
subscriber | — | — | — | — |
memberId | NM109 | 1000D | The subscriber’s insurance member ID. NM108 = MI = (Standard Unique Health Identifier for everyone in the United States) | 2/80 |
lastName | NM103 | 1000D | The subscriber’s last name as specified on their policy | 1/60 |
firstName | NM104 | 1000D | The subscriber’s first name as specified on their policy | 1/35 |
Claim Information
| Name | Element | Loop | Description | C/R |
|---|---|---|---|---|
claimInformation | — | — | — | — |
patientControlNumber | REF02 | 1000D | Patient Control Number. Identifier used to track a claim from creation by the health care provider through payment REF=EJ | 1/50 R |
billingTypeIdentifier | REF02 | 1000D | Institutional Type of Bill. REF=BLT | 1/50 R |
medicalRecordIdentifier | REF02 | 1000D | Medical Record Identification Number Required when the Medical Record Identification Number is submitted on the original claim REF=EA | 1/50 R |
claimNumber | REF02 | 1000D | Claim identification number for clearinghouses and other Transmission intermediaries REF=D9 | 1/50 R |
| — | — | — | — | — |
payerControlNumber | TRN02 | 2000A | Payer claim control Number/provider attachment Control number | 1/50 R |
| — | — | — | — | — |
beginClaimServiceDate | DT03 | 1000D | Claim start date DTP01=472 (Service) and DTP02=RD8 (Range CCYYMMDD-CCYYMMDD) | 1/35 R |
endClaimServiceDate | DT03 | 1000D | Claim end date DTP01=472 (Service) and DTP02=RD8 (Range CCYYMMDD-CCYYMMDD) | 1/35 R |
claimServiceDate | DT03 | 1000D | Claim service date DTP01=472 (Service) and DTP02=D8 (Format CCYYMMDD) | 1/35 R |
Service Lines
| Name | Element | Loop | Description | C/R |
|---|---|---|---|---|
serviceLines | — | — | For each service Line, we will add LX segment and keep incrementing LX01 | — |
payerClaimControlNumber | TRN02 | 2000A | Payer 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 |
providerAttachmentControlNumber | TRN02 | 2000A | Provider 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 |
| — | — | — | — | — |
claimStatus | — | — | To report the status, required action, and paid information of a claim or service line | — |
claimStatusCategoryCode | STC01-1 | 2000A | Health Care Claim Status Category Code | 1/30 R |
additionalInformationRequestCode | STC01-2 | 2000A | LOINC® Code that defines the additional information that was requested Identifies the status of an entire claim or a service line | 1/30 R |
| — | — | — | — | — |
providerControlNumber | REF02 | 2000A | Provider Control Number REF01=6R | 1/50 R |
| — | — | — | — | — |
lineItemControlNumber | REF02 | 2000A | Line 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 |
| — | — | — | — | — |
procedureOrRevenueDetails | — | — | — | — |
procedureOrRevenueCode | REF01 | 2000A | Procedure or Revenue Code Valid values: CPT, F8, FO, PRT, RB, VP, YJ, ZZ | 2/3 R |
procedureOrRevenueValue | REF02 | 2000A | Value of the procedure or revenue code REF01 | 1/50 R |
revenueCode | REF04-2 | 2000A | Revenue code | 1/50 R |
| — | — | — | — | — |
procedureCodeModifier | — | — | — | — |
serviceChangeNumber | REF02 | 2000A | Service Change Number REF01=SK | 1/50 R |
objectCode | REF04-2 | 2000A | Object Code REF04-1=XX4 | 1/50 R |
systemNumber | REF04-4 | 2000A | System Number REF04-3=06 | 1/50 R |
specialPaymentReferenceNumber | REF04-6 | 2000A | Special Payment Reference Number REF04-5=4N | 1/50 R |
| — | — | — | — | |
serviceLineDateInformation | PG 87 | — | Service Line Date of Service | — |
serviceDate | DTP03 | 2100A | Service Date DTP01=472 (Service) and DTP02=D8 (Format CCYYMMDD) | 1/35 R |
beginServiceDate | DTP03 | 2100A | Service start date DTP01=472 (Service) and DTP02=RD8 (Range CCYYMMDD-CCYYMMDD) | 1/35 |
endServiceDate | DTP03 | 2100A | Service end date DTP01=472 (Service) and DTP02=RD8 (Range CCYYMMDD-CCYYMMDD) | 1/35 R |
submissionDate | DTP03 | 2100B | Submission date DTP01=472 (Service) and DTP02=D8 (Format CCYYMMDD) | 1/35 R |
| — | — | — | — | — |
attachmentDetails | PG 89 | — | Category of Patient Information Service | — |
name | — | 2100B | Should match a file name sent with Form-Data files Used to complete LOOP 2110B; BIN02 and LOOP 2110B; BIN01 | — |
Related Topic
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