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K301"}},"claimDateInformation":{"$ref":"#/components/schemas/ClaimDateInformation"},"claimContractInformation":{"$ref":"#/components/schemas/ClaimContractInformation"},"claimSupplementalInformation":{"$ref":"#/components/schemas/ClaimSupplementalInformation"},"claimNote":{"$ref":"#/components/schemas/ClaimNote"},"ambulanceTransportInformation":{"$ref":"#/components/schemas/AmbulanceTransportInformation"},"spinalManipulationServiceInformation":{"$ref":"#/components/schemas/SpinalManipulationServiceInformation"},"ambulanceCertification":{"maxItems":3,"minItems":0,"type":"array","description":"Loop 2300, Segment: CRC","items":{"$ref":"#/components/schemas/AmbulanceCertification"}},"patientConditionInformationVision":{"maxItems":3,"minItems":0,"type":"array","description":"Loop 2300, Segment: CRC","items":{"$ref":"#/components/schemas/PatientConditionInformationVision"}},"homeboundIndicator":{"type":"boolean","description":"Loop 2300, Segment: 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2320","items":{"$ref":"#/components/schemas/OtherSubscriberInformation"}},"serviceLines":{"maxItems":50,"minItems":1,"type":"array","description":"Loop 2400","items":{"$ref":"#/components/schemas/ServiceLine"}}},"description":"Loop2300"},"ClaimNote":{"type":"object","properties":{"additionalInformation":{"type":"string","description":"Loop 2300, Segment: NTE, Element: NTE02, Note: NTE01=ADD"},"certificationNarrative":{"type":"string","description":"Loop 2300, Segment: NTE, Element: NTE02, Note: NTE01=CER"},"goalRehabOrDischargePlans":{"type":"string","description":"Loop 2300, Segment: NTE, Element: NTE02, Note: NTE01=DCP"},"diagnosisDescription":{"type":"string","description":"Loop 2300, Segment: NTE, Element: NTE02, Note: NTE01=DGN"},"thirdPartOrgNotes":{"type":"string","description":"Loop 2300, Segment: NTE, Element: NTE02, Note: NTE01=TPO"}},"description":"NTE"},"ClaimPricingRepricingInformation":{"required":["pricingMethodologyCode","repricedAllowedAmount"],"type":"object","properties":{"pricingMethodologyCode":{"type":"string","description":"Loop: 2300, Segment: HCP, Element: HCP01, Note: Allowed Values are: '00' Zero Pricing (Not Covered Under Contract), '01' Priced as Billed at 100%, '02' Priced at the Standard Fee Schedule, '03' Priced at a Contractual Percentage, '04' Bundled Pricing, '05' Peer Review Pricing, '06' Bundled Pricing, '07' Flat Rate Pricing, '08' Combination Pricing, '09' Maternity Pricing, '10' Other Pricing, '11' Lower of Cost, '12' Ratio of Cost, '13' Cost Reimbursed, '14' Adjustment Pricing","example":"01","enum":["00","01","02","03","04","05","06","07","08","09","10","11","12","13","14"]},"repricedAllowedAmount":{"type":"string","description":"Loop: 2300, Segment: HCP, Element: HCP02","example":"1"},"repricedSavingAmount":{"type":"string","description":"Loop: 2300, Segment: HCP, Element: HCP03"},"repricingOrganizationIdentifier":{"type":"string","description":"Loop: 2300, Segment: HCP, Element: HCP04"},"repricingPerDiemOrFlatRateAmount":{"type":"string","description":"Loop: 2300, Segment: HCP, Element: HCP05"},"repricedApprovedAmbulatoryPatientGroupCode":{"type":"string","description":"Loop: 2300, Segment: HCP, Element: HCP06"},"repricedApprovedAmbulatoryPatientGroupAmount":{"type":"string","description":"Loop: 2300, Segment: HCP, Element: HCP07"},"rejectReasonCode":{"type":"string","description":"Loop: 2300, Segment: HCP, Element: HCP13, Note: Allowed Values are: 'T1' Cannot Identify Provider as TPO (Third Party Organization) Participant, 'T2' Cannot Identify Payer as TPO (Third Party Organization) Participant, 'T3' Cannot Identify Insured as TPO (Third Party Organization) Participant, 'T4' Payer Name or Identifier Missing, 'T5' Certification Information Missing, '16' Claim does not contain enough information for repricing","enum":["T1","T2","T3","T4","T5","T6"]},"policyComplianceCode":{"type":"string","description":"Loop: 2300, Segment: HCP, Element: HCP14, Note: Allowed Values are: '1' Procedure Followed (Compliance), '2' Not Followed - Call Not Made (Non-Compliance Call Not Made), '3' Not Medically Necessary (Non-Compliance Non-Medically Necessary), '4' Not Followed Other (Non-Compliance Other), '5' Emergency Admit to Non-Network Hospital","enum":["1","2","3","4","5"]},"exceptionCode":{"type":"string","description":"Loop: 2300, Segment: HCP, Element: HCP15, Note: Allowed Values are: '1' Non-Network Professional Provider in Network Hospital, '2' Emergency Care, '3' Services or Specialist not in Network, '4' Out-of-Service Area, '5' State Mandates, '6' Other","enum":["1","2","3","4","5","6"]}},"description":"HCP"},"ClaimSubmissionRequest":{"required":["billing","claimInformation","controlNumber","receiver","submitter","subscriber"],"type":"object","properties":{"controlNumber":{"type":"string","description":"Header, Segment: ST02 (no loop), Notes: Transaction Set Control Number","example":"000000001"},"tradingPartnerServiceId":{"type":"string","description":"Loop: 2010BB Segment: NM1, Element: NM109, Notes: we send this as MN108 as PI = Payer Identification","example":"9496"},"submitter":{"$ref":"#/components/schemas/Submitter"},"receiver":{"$ref":"#/components/schemas/Receiver"},"subscriber":{"$ref":"#/components/schemas/Subscriber"},"dependent":{"$ref":"#/components/schemas/Dependent"},"providers":{"maxItems":2147483647,"minItems":1,"type":"array","description":"setting providers deprecated, please set all providers individually by it's type.","deprecated":true,"items":{"$ref":"#/components/schemas/supervising"}},"claimInformation":{"$ref":"#/components/schemas/ClaimInformation"},"payToAddress":{"$ref":"#/components/schemas/Address"},"payToPlan":{"$ref":"#/components/schemas/PayToPlan"},"payerAddress":{"$ref":"#/components/schemas/Address"},"usageIndicator":{"type":"string","description":"Interchange Usage Indicator ISA15; T-Test Data, P-Production Data","example":"T"},"billing":{"$ref":"#/components/schemas/billing"},"referring":{"$ref":"#/components/schemas/referring"},"rendering":{"$ref":"#/components/schemas/rendering"},"ordering":{"$ref":"#/components/schemas/ordering"},"supervising":{"$ref":"#/components/schemas/supervising"},"tradingPartnerName":{"type":"string","description":"Loop 2010BB NM103"}}},"ClaimSupplementalInformation":{"type":"object","properties":{"reportInformation":{"$ref":"#/components/schemas/ReportInformation"},"priorAuthorizationNumber":{"type":"string","description":"Loop: 2300, Segment: REF, Element: REF02 and REF01=G1"},"referralNumber":{"type":"string","description":"Loop: 2300, Segment: REF, Element: REF02 and REF01=9F"},"claimControlNumber":{"type":"string","description":"Loop: 2300, Segment: REF, Element: REF02 and REF01=F8"},"cliaNumber":{"type":"string","description":"Loop: 2300, Segment: REF, Element: REF02 and REF01=X4"},"repricedClaimNumber":{"type":"string","description":"Loop: 2300, Segment: REF, Element: REF02 and REF01=9A","example":"00001"},"adjustedRepricedClaimNumber":{"type":"string","description":"Loop: 2300, Segment: REF, Element: REF02 and REF01=9C"},"investigationalDeviceExemptionNumber":{"type":"string","description":"Loop: 2300, Segment: REF, Element: REF02 and REF01=LX"},"claimNumber":{"type":"string","description":"Loop: 2300, Segment: REF, Element: REF02 and REF01=D9","example":"12345"},"mammographyCertificationNumber":{"type":"string","description":"Loop: 2300, Segment: REF, Element: REF02 and REF01=EW"},"medicalRecordNumber":{"type":"string","description":"Loop: 2300, Segment: REF, Element: REF02 and REF01=EA"},"demoProjectIdentifier":{"type":"string","description":"Loop: 2300, Segment: REF, Element: REF02 and REF01=P4"},"carePlanOversightNumber":{"type":"string","description":"Loop: 2300, Segment: REF, Element: REF02 and REF01=1J"},"medicareCrossoverReferenceId":{"type":"string","description":"Loop: 2300, Segment: REF, Element: REF02 and REF01=F5"},"serviceAuthorizationExceptionCode":{"type":"string","description":"Loop: 2300, Segment: REF, Element: REF02 and REF01=4N, Note: '1' Immediate/Urgent Care, '2' Services Rendered in a Retroactive Period, '3' Emergency Care, '4' Client has Temporary Medicaid, '5' Request from County for Second Opinion to Determine if Recipient Can Work, '6' Request for Override Pending, '7' Special Handling, Null","enum":["1","2","3","4","5","6","7"]}},"description":"PWK and REF"},"CompositeDiagnosisCodePointers":{"required":["diagnosisCodePointers"],"type":"object","properties":{"diagnosisCodePointers":{"maxItems":2147483647,"minItems":1,"type":"array","description":"Loop: 2400, Segment: SV1, Element: SV107-01, SV107-02, SV107-03, SV107-04","example":1,"items":{"type":"string"}}},"description":"SVC107"},"ConditionIndicatorDurableMedicalEquipment":{"required":["certificationConditionIndicator","conditionIndicator"],"type":"object","properties":{"certificationConditionIndicator":{"type":"string","description":"Loop 2400, Segment: CRC, Element: CRC02 and CRC01=09, Note: Allowed Values are: 'N' No, 'Y' Yes","example":"Y","enum":["Y","N"]},"conditionIndicator":{"type":"string","description":"Loop 2400, Segment: CRC, Element: CRC03, Note: Allowed Values are: '38' Certification signed by the physician is on file at the supplier's office, 'ZV' Replacement Item","example":"38","enum":["38","ZV"]},"conditionIndicatorCode":{"type":"string","description":"Loop 2400, Segment: CRC, Element: CRC04, Note: Allowed Values are: '38' Certification signed by the physician is on file at the supplier's office, 'ZV' Replacement Item","example":"38","enum":["38","ZV"]}},"description":"CRC"},"ConditionInformation":{"required":["conditionCodes"],"type":"object","properties":{"conditionCodes":{"maxItems":12,"minItems":1,"type":"array","items":{"type":"string","description":"Loop: 2300, Segment: HI, Element: HI01-02, HI02-02, HI03-02, HI04-02, HI05-02, HI06-02, HI07-02, HI08-02, HI09-02, HI10-02, HI11-02, HI11-02, HI12-02"}}},"description":"HI"},"ContactInformation":{"required":["name"],"type":"object","properties":{"name":{"type":"string","description":"Segment: PER, Element: PER02 and PER01=IC","example":"SUBMITTER CONTACT INFO"},"phoneNumber":{"type":"string","description":"Segment: PER, Element: PER04 (Provider, Submitter, Subscriber, Dependent) or PER06 (Provider, Submitter) or PER08 (Provider, Submitter), Note: Used when PER03=TE (Provider, Submitter, Subscriber, Dependent) or PER05=TE (Provider, Submitter) or PER07=TE (Provider, Submitter)","example":"5554567890"},"faxNumber":{"type":"string","description":"Segment: PER, Element: PER04 or PER06 or PER08, Note: This is used in (Provider, Submitter) when PER03=FX or PER05=FX or PER07=FX","example":"5551234567"},"email":{"type":"string","description":"Segment: PER, Element: PER04 or PER06 or PER08, Note: This used in (Provider, Submitter) when PER03=EM or PER05=EM or PER07=EM","example":"email@email.com"},"phoneExtension":{"type":"string","description":"Segment: PER, Element: PER06 (Provider, Submitter, Subscriber, Dependent) or PER08 (Provider, Submitter),Note: Used when PER05=EX (Provider, Submitter, Subscriber, Dependent) or PER07=EX (Provider, Submitter)","example":"1234"}},"description":"PER"},"ContactInformationOrderingProvider":{"required":["name"],"type":"object","properties":{"name":{"type":"string","description":"Segment: PER, Element: PER02 and PER01=IC","example":"SUBMITTER CONTACT INFO"},"phoneNumber":{"type":"string","description":"Segment: PER, Element: PER04 (Provider, Submitter, Subscriber, Dependent) or PER06 (Provider, Submitter) or PER08 (Provider, Submitter), Note: Used when PER03=TE (Provider, Submitter, Subscriber, Dependent) or PER05=TE (Provider, Submitter) or PER07=TE (Provider, Submitter)","example":"5554567890"},"faxNumber":{"type":"string","description":"Segment: PER, Element: PER04 or PER06 or PER08, Note: This is used in (Provider, Submitter) when PER03=FX or PER05=FX or PER07=FX","example":"5551234567"},"email":{"type":"string","description":"Segment: PER, Element: PER04 or PER06 or PER08, Note: This used in (Provider, Submitter) when PER03=EM or PER05=EM or PER07=EM","example":"email@email.com"},"phoneExtension":{"type":"string","description":"Segment: PER, Element: PER06 or PER08, Note: PER05=EX or PER07=EX","example":"1234"}},"description":"PER"},"ContractInformation":{"required":["contractTypeCode"],"type":"object","properties":{"contractTypeCode":{"type":"string","description":"Segment: CN1, Element: CN101, Allowed Values are: '01' Diagnosis Related Group (DRG), '02' Per Diem, '03' Variable Per Diem, '04' Flat, '05' Capitated, '06' Percent, '09' Other","example":"01","enum":["01","02","03","04","05","06","09"]},"contractAmount":{"type":"string","description":"Segment: CN1, Element: CN102"},"contractPercentage":{"type":"string","description":"Segment: CN1, Element: CN103"},"contractCode":{"type":"string","description":"Segment: CN1, Element: CN104"},"termsDiscountPercentage":{"type":"string","description":"Segment: CN1, Element: CN105"},"contractVersionIdentifier":{"type":"string","description":"Segment: CN1, Element: CN106"}},"description":"CN1"},"Dependent":{"required":["dateOfBirth","firstName","gender","lastName","relationshipToSubscriberCode"],"type":"object","properties":{"firstName":{"type":"string","description":"Loop: 2010CA, Segment: NM1, Element: NM104","example":"janeone"},"lastName":{"type":"string","description":"Loop: 2010CA, Segment: NM1, Element: NM103","example":"doeOne"},"middleName":{"type":"string","description":"Loop: 2010CA, Segment: NM1, Element: NM105"},"suffix":{"type":"string","description":"Loop: 2010CA,  Segment: NM, Element: NM107","example":"Jr"},"gender":{"type":"string","description":"Loop: 2010CA, Segment: DMG, Element: DMG03, Note: Allowed Values are: 'M' Male, 'F' Female, 'U' Unknown","example":"F","enum":["M","F","U"]},"dateOfBirth":{"type":"string","description":"Loop: 2010CA, Segment: DMG, Element: DMG02 when DMG01=D8","example":"19800102"},"ssn":{"type":"string","description":"Loop: 2010CA, Segment: REF, Element: REF02 when REF01=SY","example":"19800102"},"memberId":{"type":"string","description":"Loop: 2010CA, Segment: REF, Element: REF02 when REF01=1W","example":"19800102"},"relationshipToSubscriberCode":{"type":"string","description":"Loop: 2000C, Segment: PAT, Element: PAT01, Note: Allowed Values are: '01' Spouse, '19' Child, '20' Employee, '21'  Unknown, '39'  Organ Donor, '40'  Cadaver Donor, '53'  Life Partner, 'G8' Other Relationship","example":"01","enum":["01","19","20","39","40","53","G8"]},"contactInformation":{"$ref":"#/components/schemas/ContactInformation"},"address":{"$ref":"#/components/schemas/Address"}},"description":"LOOP 2000C"},"DrugIdentification":{"required":["measurementUnitCode","nationalDrugCode","nationalDrugUnitCount","serviceIdQualifier"],"type":"object","properties":{"serviceIdQualifier":{"type":"string","description":"Loop: 2410, Segment: LIN, Element: LIN02, Note: Allowed Values are: 'EN' EAN/UCC - 13, 'EO' EAN/UCC - 8, 'HI' HIBC (Health Care Industry Bar Code) Supplier Labeling Standard Primary Data Message, 'N4' National Drug Code in 5-4-2 Format, 'ON' Customer Order Number, 'UK' GTIN 14-digit Data Structure, 'UP' UCC - 12","enum":["EN","EO","HI","N4","ON","UK","UP"]},"nationalDrugCode":{"type":"string","description":"Loop: 2410, Segment: LIN, Element: LIN03"},"nationalDrugUnitCount":{"type":"string","description":"Loop: 2410, Segment: CTP, Element: CTP04"},"measurementUnitCode":{"type":"string","description":"Loop: 2410, Segment: CTP05, Element: CTP05-01, Allowed Values are: 'F2' International Unit, 'GR' Gram, 'ME' Milligram, 'ML' Milliliter, 'UN' Unit","enum":["F2","GR","ME","ML","UN"]},"linkSequenceNumber":{"type":"string","description":"Loop: 2410, Segment: REF, Element: REF02 when REF01=VY"},"pharmacyPrescriptionNumber":{"type":"string","description":"Loop: 2410, Segment: REF, Element: REF02 when REF01=XZ"}},"description":"LOOP 2410"},"DurableMedicalEquipmentCertificateOfMedicalNecessity":{"required":["attachmentTransmissionCode"],"type":"object","properties":{"attachmentTransmissionCode":{"type":"string","description":"Loop: 2400, Segment: PWK, Element: PWK02 when PWK01=CT, Note: Allowed Values are: 'AB' Previously Submitted to Payer, 'AD' Certification Included in this Claim, 'AF' Narrative Segment Included in this Claim, 'AG' No Documentation is Required, 'NS' Not Specified","enum":["AB","AD","AF","AG","NS"]}},"description":"PWK"},"DurableMedicalEquipmentCertification":{"required":["certificationTypeCode","durableMedicalEquipmentDurationInMonths"],"type":"object","properties":{"certificationTypeCode":{"type":"string","description":"Loop: 2400, Segment: CR3, Element: CR301, Note: Allowed Values are: 'I' Initial, 'R' Renewal, 'S' Revised","enum":["I","R","S"]},"durableMedicalEquipmentDurationInMonths":{"type":"string","description":"Loop: 2400, Segment: CR3, Element: CR303 when CR302=MO"}},"description":"CR3"},"DurableMedicalEquipmentService":{"required":["days","frequencyCode","purchasePrice","rentalPrice"],"type":"object","properties":{"days":{"type":"string","description":"Loop: 2410, Segment: SV5, Element: SV503"},"rentalPrice":{"type":"string","description":"Loop: 2410, Segment: SV5, Element: SV504"},"purchasePrice":{"type":"string","description":"Loop: 2410, Segment: SV5, Element: SV505"},"frequencyCode":{"type":"string","description":"Loop: 2410, Segment: SV5, Element: SV506, Note: Allowed Values are: '1' weekly, '4' monthly, '6' daily","enum":["1","4","6"]}},"description":"SV5"},"EpsdtReferral":{"required":["certificationConditionCodeAppliesIndicator","conditionCodes"],"type":"object","properties":{"certificationConditionCodeAppliesIndicator":{"type":"string","description":"Loop: 2300, Segment: CRC, Element: CRC02 When CRC01=ZZ, Note: 'N' No, 'Y' Yes","enum":["N","Y"]},"conditionCodes":{"maxItems":3,"minItems":1,"type":"array","description":"Loop: 2300, Segment: CRC, Elements: CRC03, CRC04, CRC05 Note: Allowed Values are: 'AV' Available- Not Used, 'NU' Not Used, 'S2' Under Treatment, 'ST' New Services Requested","items":{"type":"string","enum":["AV","NU","S2","ST"]}}},"description":"CRC"},"FormIdentification":{"required":["formIdentifier","formTypeCode"],"type":"object","properties":{"formTypeCode":{"type":"string","description":"Loop: 2440, Segment: LQ, Element: LQ01, Note: Allowed Values are:'AS' Form Type Code, 'UT' Centers for Medicare and Medicaid Services (CMS) Durable Medical Equipment Regional Carrier (DMERC) Certificate of Medical Necessity (CMN) Forms","enum":["AS","UT"]},"formIdentifier":{"type":"string","description":"Loop: 2440, Segment: LQ, Element: LQ02"},"supportingDocumentation":{"maxItems":99,"minItems":0,"type":"array","description":"Loop: 2440, Segment: FRM","items":{"$ref":"#/components/schemas/SupportingDocumentation"}}},"description":"LQ and FRM"},"HealthCareInformation":{"required":["diagnosisCode","diagnosisTypeCode"],"type":"object","properties":{"diagnosisTypeCode":{"type":"string","description":"Loop: 2440, Segment: HI, Element: HI01-01 or HI02-01 or HI03-01 or HI04-01 or HI05-01 or HI06-01 or HI07-01 or HI08-01 or HI09-01 or HI10-01 or HI11-01 or HI12-01, Note: Allowed Values are: 'BK' International Classification of Diseases Clinical Modification (ICD-9-CM) Principal Diagnosis, 'ABK' International Classification of Diseases Clinical Modification (ICD-10-CM) Principal Diagnosis, 'BF' International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis, 'ABF' International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis","enum":["BK","ABK","BF","ABF"]},"diagnosisCode":{"type":"string","description":"Loop: 2440, Segment: HI, Element: HI01-02 or HI02-02 or HI03-02 or HI04-02 or HI05-02 or HI06-02 or HI07-02 or HI08-02 or HI09-02 or HI10-02 or HI11-02 or HI12-02"}},"description":"HI"},"LineAdjudicationInformation":{"required":["adjudicationOrPaymentDate","otherPayerPrimaryIdentifier","paidServiceUnitCount","procedureCode","serviceIdQualifier","serviceLinePaidAmount"],"type":"object","properties":{"otherPayerPrimaryIdentifier":{"type":"string","description":"Loop: 2430, Segment: SVD, Element: SVD01"},"serviceLinePaidAmount":{"type":"string","description":"Loop: 2430, Segment: SVD, Element: SVD02"},"serviceIdQualifier":{"type":"string","description":"Loop: 2430, Segment: SVD, Element: SVD03-01, Note: Allowed Values are: 'ER' Jurisdiction Specific Procedure and Supply Codes, 'HC' Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes, 'HP' Health Insurance Prospective Payment System (HIPPS) Skilled Nursing Facility Rate Code, 'IV' Home Infusion EDI Coalition (HIEC) Product/Service Code, 'WK' Advanced Billing Concepts (ABC) Codes","enum":["ER","HC","HP","IV","WK"]},"procedureCode":{"type":"string","description":"Loop: 2430, Segment: SVD, Element: SVD03-02"},"procedureModifier":{"maxItems":4,"minItems":0,"type":"array","items":{"type":"string","description":"Loop: 2430, Segment: SVD, Element: SVD03-03, SVD03-04, SVD03-05, SVD03-06"}},"procedureCodeDescription":{"type":"string","description":"Loop: 2430, Segment: SVD, Element: SVD03-07"},"paidServiceUnitCount":{"type":"string","description":"Loop: 2430, Segment: SVD, Element: SVD05"},"bundledOrUnbundledLineNumber":{"type":"string","description":"Loop: 2430, Segment: SVD, Element: SVD06"},"claimAdjustmentInformation":{"maxItems":5,"minItems":0,"type":"array","description":"Loop: 2430, Segment: CAS","items":{"$ref":"#/components/schemas/ClaimAdjustment"}},"adjudicationOrPaymentDate":{"type":"string","description":"Loop: 2430, Segment: DTP, Element=DTP03 when DTP02=D8 and DTP01=573"},"remainingPatientLiability":{"type":"string","description":"Loop: 2430, Segment: AMT, Element=AMT02 when AMT01=EAF"}},"description":"SVD, CAS, DTP and AMT"},"Measurements":{"required":["measurementQualifier","measurementReferenceIdentificationCode","testResults"],"type":"object","properties":{"measurementReferenceIdentificationCode":{"type":"string","description":"Loop 2400, Segment: MEA; Element: MEA01, Notes: Allowable values are 'OG' Original and 'TR' Test Results","enum":["OG","TR"]},"measurementQualifier":{"type":"string","description":"Loop 2400, Segment: MEA; Element: MEA02, Notes: Allowable values are 'HT' Height, 'R1' Hemoglobin, 'R2' Hematocrit, 'R3' Epoetin Starting Dosage, 'R4' Creatinine","enum":["HT","R1","R2","R3","R4"]},"testResults":{"type":"string","description":"Loop 2400, Segment: MEA; Element: MEA03"}}},"MedicareOutpatientAdjudication":{"type":"object","properties":{"reimbursementRate":{"type":"string","description":"Loop 2320, Segment: MOA; Element: MOA01"},"hcpcsPayableAmount":{"type":"string","description":"Loop 2320, Segment: MOA; Element: MOA02"},"claimPaymentRemarkCode":{"maxItems":5,"minItems":0,"type":"array","description":"Loop: 2320: Segment: MOA, Element: MOA03 to MOA07","items":{"type":"string"}},"endStageRenalDiseasePaymentAmount":{"type":"string","description":"Loop 2320, Segment: MOA; Element: MOA08"},"nonPayableProfessionalComponentBilledAmount":{"type":"string","description":"Loop 2320, Segment: MOA; Element: MOA09"}},"description":"Loop: 2320, Segment: MOA"},"OtherPayerBillingProvider":{"required":["entityTypeQualifier","otherPayerBillingProviderIdentifier"],"type":"object","properties":{"entityTypeQualifier":{"type":"string","description":"Loop 2330G, Segment: NM1; Element: NM101, Notes: Code identifying an organizational entity, a physical location, property or an individual. Allowablevalues: '1' Person, '2' Non-Person Entity ","enum":["1","2"]},"otherPayerBillingProviderIdentifier":{"maxItems":2,"minItems":1,"type":"array","description":"Loop 2330G, Segment: NM1 and REF","items":{"$ref":"#/components/schemas/ReferenceIdentification"}}},"description":"Loop 2330G"},"OtherPayerName":{"required":["otherPayerIdentifier","otherPayerIdentifierTypeCode","otherPayerOrganizationName"],"type":"object","properties":{"otherInsuredAdditionalIdentifier":{"type":"string","description":"Loop: 2330B; Segment: NM1, Element: NM111"},"otherPayerOrganizationName":{"type":"string","description":"Loop: 2330B; Segment: NM1, Element: NM103"},"otherPayerIdentifierTypeCode":{"type":"string","description":"Loop: 2330B; Segment: NM1, Element: NM108, Notes: Allowable values: 'PI' Payor Identification and 'XV' Centers for Medicare/Medicaid Services PlanID","enum":["PI","XV"]},"otherPayerIdentifier":{"type":"string","description":"Loop: 2330B; Segment: NM1, Element: NM109"},"otherPayerAddress":{"$ref":"#/components/schemas/Address"},"otherPayerAdjudicationOrPaymentDate":{"type":"string","description":"Loop: 2330B, Segment: DTP, Element: DTP03"},"otherPayerSecondaryIdentifier":{"maxItems":2,"minItems":0,"type":"array","description":"Loop: 2330B, Segment: REF","items":{"$ref":"#/components/schemas/ReferenceIdentification"}},"otherPayerPriorAuthorizationNumber":{"type":"string","description":"Loop: 2330B, Segment: REF, Element: REF02 when REF01=G1"},"otherPayerPriorAuthorizationOrReferralNumber":{"type":"string","description":"Loop: 2330B; Segment: REF, Element: REF02 when REF01=9F"},"otherPayerClaimAdjustmentIndicator":{"type":"boolean","description":"Loop: 2330B, Segment: REF, Element: REF02 when REF01=T4"},"otherPayerClaimControlNumber":{"type":"string","description":"Loop: 2330B, Segment: REF, Element: REF02 when REF01=F8"}},"description":"Loop: 2330B"},"OtherPayerReferringProvider":{"required":["otherPayerReferringProviderIdentifier"],"type":"object","properties":{"otherPayerReferringProviderIdentifier":{"maxItems":3,"minItems":1,"type":"array","description":"Loop 2330E, Segment: NM1 and REF","items":{"$ref":"#/components/schemas/ReferenceIdentification"}}},"description":"Loop 2330C"},"OtherPayerRenderingProvider":{"required":["entityTypeQualifier"],"type":"object","properties":{"entityTypeQualifier":{"type":"string","description":"Loop: 2330D, Segment NM1, Element: NM102, Notes: Allowable values are '1' Person and '2' Non-Person Entity","enum":["1","2"]},"otherPayerRenderingProviderSecondaryIdentifier":{"maxItems":3,"minItems":1,"type":"array","description":"Loop 2330D, Segment: NM1 and REF","items":{"$ref":"#/components/schemas/ReferenceIdentification"}}},"description":"Loop 2330D"},"OtherPayerServiceFacilityLocation":{"required":["otherPayerServiceFacilityLocationSecondaryIdentifier"],"type":"object","properties":{"otherPayerServiceFacilityLocationSecondaryIdentifier":{"maxItems":3,"minItems":1,"type":"array","description":"Loop 2330E, Segments: NM1 and REF","items":{"$ref":"#/components/schemas/ReferenceIdentification"}}},"description":"Loop 2330E"},"OtherPayerSupervisingProvider":{"required":["otherPayerSupervisingProviderIdentifier"],"type":"object","properties":{"otherPayerSupervisingProviderIdentifier":{"maxItems":3,"minItems":1,"type":"array","description":"Loop 2330F, Segments: NM1 and REF","items":{"$ref":"#/components/schemas/ReferenceIdentification"}}},"description":"Loop 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Defined","enum":["11","12","13","14","15","16","17","AM","BL","CH","CI","DS","FI","HM","LM","MA","MB","MC","OF","TV","VA","WC","ZZ"]},"claimLevelAdjustments":{"maxItems":5,"minItems":0,"type":"array","description":"Loop: 2320, Segment: CAS","items":{"$ref":"#/components/schemas/ClaimAdjustment"}},"payerPaidAmount":{"type":"string","description":"Loop: 2320, Segment: AMT, Element: AMT02 when AMT01=D, Notes: It is acceptable to show '0' (Zero)"},"nonCoveredChargeAmount":{"type":"string","description":"Loop: 2320, Segment: AMT, Element: AMT02 when AMT01=A8"},"remainingPatientLiability":{"type":"string","description":"Loop: 2320, Segment: AMT, Element: AMT02 when AMT01=EAF"},"benefitsAssignmentCertificationIndicator":{"type":"string","description":"Loop: 2320, Segment: OI, Element: OI03, Notes: Allowable values are: 'N' No, 'W' Not Applicable, 'Y' Yes","enum":["N","W","Y"]},"patientSignatureGeneratedForPatient":{"type":"boolean","description":"Loop: 2320, Segment: OI, Element: OI04, Notes: Allowable value is 'P' Signature generated by provider because the patient was not physically present for services"},"releaseOfInformationCode":{"type":"string","description":"Loop: 2320, Segment: OI, Element: OI04, Notes: Allowable values are 'I' Informed Consent to Release Medical Information, 'Y' 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2320"},"OtherSubscriberName":{"required":["otherInsuredIdentifier","otherInsuredIdentifierTypeCode","otherInsuredLastName","otherInsuredQualifier"],"type":"object","properties":{"otherInsuredQualifier":{"type":"string","description":"Loop: 2330A, Segment: NM1, Element: NM102, Notes: Allowed Values are: '1' Person, '2' Non-Person Entity","enum":["1","2"]},"otherInsuredLastName":{"type":"string","description":"Loop: 2330A, Segment: NM1, Element: NM103"},"otherInsuredFirstName":{"type":"string","description":"Loop: 2330A, Segment: NM1, Element: NM102, Notes: Required when NM102 = 1 (Person)"},"otherInsuredMiddleName":{"type":"string","description":"Loop: 2330A, Segment: NM1, Element: NM105, Notes: Required when NM102 = 1 (Person)"},"otherInsuredNameSuffix":{"type":"string","description":"Loop: 2330A, Segment: NM1, Element: NM107, Notes: Required when NM102 = 1 (Person)"},"otherInsuredIdentifierTypeCode":{"type":"string","description":"Loop: 2330A, Segment: NM1, Element: NM108, Notes: 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Allowed Values are: 'L1' General Standard of 20 Degree or .5 Diopter Sphere or Cylinder Change Met, 'L2' Replacement Due to Loss or Theft, 'L3' Replacement Due to Breakage or Damage, L4' Replacement Due to Patient Preference, 'L5' Replacement Due to Medical Reason","items":{"type":"string","enum":["L1","L2","L3","L4","L5"]}}},"description":"Loop 2300, Segment: CRC"},"PayToPlan":{"required":["address","organizationName","primaryIdentifier","primaryIdentifierTypeCode","taxIdentificationNumber"],"type":"object","properties":{"organizationName":{"type":"string","description":"Loop: 2010AC, Segment: NM1, Element: NM103","example":"Example Org"},"primaryIdentifierTypeCode":{"type":"string","description":"Loop: 2010AC, Segment: NM1, Element: NM108, Notes: 'PI' Payor Identification and 'XV' Centers for Medicare/Medicaid Services PlanID","example":"PI","enum":["PI","XV"]},"primaryIdentifier":{"type":"string","description":"Loop: 2010AC, Segment: NM1, Element: NM109"},"address":{"$ref":"#/components/schemas/Address"},"secondaryIdentifierTypeCode":{"type":"string","description":"Loop: 2010AC, Segment: REF, Element: REF01, Notes: '2U Payer Identification Number, 'FY' Claim Office Number, 'NF National Association of Insurance Commissioners'","example":"2U","enum":["2U","FY","NF"]},"secondaryIdentifier":{"type":"string","description":"Loop: 2010AC, Segment: REF, Element: REF02","example":"11"},"taxIdentificationNumber":{"type":"string","description":"Loop: 2010AC, Segment: REF, Element: REF02 when REF01=EI"}},"description":"2010AC"},"PriorAuthorization":{"required":["priorAuthorizationOrReferralNumber"],"type":"object","properties":{"priorAuthorizationOrReferralNumber":{"type":"string","description":"Loop: 2400, Segment: REF, Element: REF02 when REF01=G1"},"otherPayerPrimaryIdentifier":{"type":"string","description":"Loop: 2400, Segment: REF, Element: REF04-2 when REF04-1=2U"}},"description":"Loop 2400 REF"},"ProfessionalService":{"required":["compositeDiagnosisCodePointers","lineItemChargeAmount","measurementUnit","procedureCode","procedureIdentifier","serviceUnitCount"],"type":"object","properties":{"procedureIdentifier":{"type":"string","description":"Loop: 2400, Segment: SV1, Element: SV101-01, Notes: Allowed Values are: 'ER' Jurisdiction Specific Procedure and Supply Codes, 'HC' Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes, 'IV' Home Infusion EDI Coalition (HIEC) Product/Service Code,'WK' Advanced Billing Concepts (ABC) Codes","example":"HC","enum":["ER","HC","IV","WK"]},"procedureCode":{"type":"string","description":"Loop 2400, Segment: SV1, Element: SV101-02","example":"E0570"},"procedureModifiers":{"maxItems":4,"minItems":0,"type":"array","description":"Loop 2400, Segment: SV1, Elements: SV101-03 to SV101-06, Notes: Required when modifier clarifies or improves the reporting accuracy of the associated procedure code. 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PS102","example":"10"}}},"Receiver":{"required":["organizationName"],"type":"object","properties":{"organizationName":{"type":"string","description":"Loop: 1000B, Segment: NM1, Element: NM103","example":"EXTRA HEALTHY INSURANCE"}},"description":"Loop: 1000B"},"ReferenceIdentification":{"required":["identifier","qualifier"],"type":"object","properties":{"qualifier":{"type":"string","description":"Segment: REF, Element: REF01"},"identifier":{"type":"string","description":"Segment: REF, Element: REF02"},"otherIdentifier":{"type":"string","description":"Segment: REF, Element: REF03"}}},"ReportInformation":{"required":["attachmentReportTypeCode","attachmentTransmissionCode"],"type":"object","properties":{"attachmentReportTypeCode":{"type":"string","description":"Loop: 2400, Segment: PWK, Element: PWK01, Notes: Allowed Values are: '03' Report Justifying Treatment Beyond Utilization Guidelines, '04' Drugs Administered, '05' Treatment Diagnosis, '06' Initial Assessment, '07' Functional Goals, '08' Plan of Treatment, '09' Progress Report, '10' Continued Treatment, '11' Chemical Analysis, '13' Certified Test Report, '15' Justification for Admission, '21' Recovery Plan, 'A3' Allergies/Sensitivities Document, 'A4' Autopsy Report, 'AM' Ambulance Certification, 'AS' Admission Summary, 'B2' Prescription, 'B3' Physician Order, 'B4' Referral Form, 'BR' Benchmark Testing Results, 'BS' Baseline, 'BT' Blanket Test Results, 'CB' Chiropractic Justification, 'CK' Consent Form(s), 'CT' Certification, 'D2' Drug Profile Document, 'DA' Dental Models, 'DB' Durable Medical Equipment Prescription, 'DG' Diagnostic Report, 'DJ' Discharge Monitoring Report, 'DS' Discharge Summary, 'EB' Explanation of Benefits (Coordination of Benefits or Medicare Secondary Payor), 'HC' Health Certificate, 'HR' Health Clinic Records, 'I5' Immunization Record,'IR' State School Immunization Records, 'LA' Laboratory Results, 'M1' Medical Record Attachment, 'MT' Models, 'NM Nursing Notes', 'OB' Operative Note, 'OC' Oxygen Content Averaging Report, 'OD' Orders and Treatments Document, 'OE' Objective Physical Examination (including vital signs) Document, 'OX' Oxygen Therapy Certification, 'OZ' Support Data for Claim, 'P4' Pathology Report, 'P5' Patient Medical History Document, 'PE' Parenteral or Enteral Certification, 'PN' Physical Therapy Notes, 'PO' Prosthetics or Orthotic Certification, 'PQ' Paramedical Results, 'PY' Physician's Report, 'PZ' Physical Therapy Certification, 'RB' Radiology Films, 'RR' Radiology Reports, 'RT' Report of Tests and Analysis Report, 'RX' Renewable Oxygen Content Averaging Report, 'SG' Symptoms Document, 'V5' Death Notification, 'XP' 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NTE01=TPO"},"purchasedServiceInformation":{"$ref":"#/components/schemas/PurchasedServiceInformation"},"linePricingRepricingInformation":{"$ref":"#/components/schemas/ClaimPricingRepricingInformation"},"drugIdentification":{"$ref":"#/components/schemas/DrugIdentification"},"renderingProvider":{"$ref":"#/components/schemas/ServiceLineProvider"},"purchasedServiceProvider":{"$ref":"#/components/schemas/ServiceLineProvider"},"serviceFacilityLocation":{"$ref":"#/components/schemas/ServiceFacilityLocation"},"supervisingProvider":{"$ref":"#/components/schemas/ServiceLineProvider"},"orderingProvider":{"$ref":"#/components/schemas/ServiceLineOrderingProvider"},"referringProvider":{"$ref":"#/components/schemas/ServiceLineProvider"},"ambulancePickUpLocation":{"$ref":"#/components/schemas/Address"},"ambulanceDropOffLocation":{"$ref":"#/components/schemas/Address"},"lineAdjudicationInformation":{"maxItems":15,"minItems":0,"type":"array","items":{"$ref":"#/components/schemas/LineAdjudicationInformation"}},"formIdentification":{"type":"array","items":{"$ref":"#/components/schemas/FormIdentification"}}},"description":"Loop 2400"},"ServiceLineDateInformation":{"type":"object","properties":{"prescriptionDate":{"type":"string","description":"Loop: 2400, Segment: DPT, Element: DTP03 when DPT01=471, Notes: Date Expressed in Format CCYYMMDD"},"certificationRevisionOrRecertificationDate":{"type":"string","description":"Loop: 2400, Segment: DPT, Element: DTP03 when DPT01=607, Notes: Date Expressed in Format CCYYMMDD"},"beginTherapyDate":{"type":"string","description":"Loop: 2400, Segment: DPT, Element: DTP03 when DPT01=463, Notes: Date Expressed in Format CCYYMMDD"},"lastCertificationDate":{"type":"string","description":"Loop: 2400, Segment: DPT, Element: DTP03 when DPT01=461, Notes: Date Expressed in Format CCYYMMDD"},"treatmentOrTherapyDate":{"type":"string","description":"Loop: 2400, Segment: DPT, Element: DTP03 when DPT01=304, Notes: Date Expressed in Format CCYYMMDD"},"hemoglobinTestDate":{"type":"string","description":"Loop: 2400, Segment: DPT, Element: DTP03 when DPT01=738, Notes: Date Expressed in Format CCYYMMDD"},"serumCreatineTestDate":{"type":"string","description":"Loop: 2400, Segment: DPT, Element: DTP03 when DPT01=739, Notes: Date Expressed in Format CCYYMMDD"},"shippedDate":{"type":"string","description":"Loop: 2400, Segment: DPT, Element: DTP03 when DPT01=011, Notes: Date Expressed in Format CCYYMMDD"},"lastXRayDate":{"type":"string","description":"Loop: 2400, Segment: DPT, Element: DTP03 when DPT01=455, Notes: Date Expressed in Format CCYYMMDD"},"initialTreatmentDate":{"type":"string","description":"Loop: 2400, Segment: DPT, Element: DTP03 when DPT01=454, Notes: Date Expressed in Format CCYYMMDD"}}},"ServiceLineOrderingProvider":{"required":["providerType"],"type":"object","properties":{"providerType":{"type":"string","example":"BillingProvider"},"npi":{"type":"string","description":"NM109, Notes: National Provider Identifier","example":"1760854442"},"ssn":{"type":"string","description":"REF02 when REF01=SY, Notes: The Social Security Number must be a string of nine numbers 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REF01=0B"},"providerUpinNumber":{"type":"string","description":"REF02 when REF01=1G, Notes: UPINs must be formatted as either X99999 or XXX999"},"taxonomyCode":{"type":"string","description":"PRV03"},"firstName":{"type":"string","description":"NM104","example":"johnone"},"lastName":{"type":"string","description":"NM103","example":"doeone"},"middleName":{"type":"string","description":"NM105","example":"middleone"},"suffix":{"type":"string","description":"NM107","example":"Jr"},"organizationName":{"type":"string","description":"NM103","example":"HAPPY DOCTORS 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REF01=G2"},"locationNumber":{"type":"string","description":"REF02 when REF01=LU"},"payerIdentificationNumber":{"type":"string","description":"LOOP: 2010AC, Segment: REF, Element: REF02 when REF01=2U"},"employerIdentificationNumber":{"type":"string","description":"LOOP: 2010AC, Segment: REF, Element: REF02 when REF01=EI"},"claimOfficeNumber":{"type":"string","description":"Loop: 2010AC, Segment: REF, Element: REF02 when REF01=FY"},"naic":{"type":"string","description":"Loop: 2010AC, Segment: REF, Element: REF02 when REF01=NF, Notes: National Association of Insurance Commissioners (NAIC) Code"},"stateLicenseNumber":{"type":"string","description":"REF02 when REF01=0B"},"providerUpinNumber":{"type":"string","description":"REF02 when REF01=1G, Notes: UPINs must be formatted as either X99999 or XXX999"},"taxonomyCode":{"type":"string","description":"PRV03"},"firstName":{"type":"string","description":"NM104","example":"johnone"},"lastName":{"type":"string","description":"NM103","example":"doeone"},"middleName":{"type":"string","description":"NM105","example":"middleone"},"suffix":{"type":"string","description":"NM107","example":"Jr"},"organizationName":{"type":"string","description":"NM103","example":"HAPPY DOCTORS GROUPPRACTICE"},"address":{"$ref":"#/components/schemas/Address"},"contactInformation":{"$ref":"#/components/schemas/ContactInformation"},"otherIdentifier":{"type":"string"},"secondaryIdentifier":{"maxItems":20,"minItems":0,"type":"array","items":{"$ref":"#/components/schemas/ReferenceIdentification"}}}},"ServiceLineReferenceInformation":{"type":"object","properties":{"repricedLineItemReferenceNumber":{"type":"string","description":"Loop: 2400, Segment: REF, Element: REF02 Notes: When REF01=9B"},"adjustedRepricedLineItemReferenceNumber":{"type":"string","description":"Loop: 2400, Segment: REF, Element: REF02 Note: When REF01=9D"},"priorAuthorization":{"maxItems":5,"minItems":0,"type":"array","description":"Loop 2400 REF","items":{"$ref":"#/components/schemas/PriorAuthorization"}},"mammographyCertificationNumber":{"type":"string","description":"Loop: 2400, Segment: REF, Element: REF02 Note: When REF01=EW"},"clinicalLaboratoryImprovementAmendmentNumber":{"type":"string","description":"Loop: 2400, Segment: REF, Element: REF02 Note: When REF01=X4"},"referringCliaNumber":{"type":"string","description":"Loop: 2400, Segment: REF, Element: REF02 Note: When REF01=F4"},"immunizationBatchNumber":{"type":"string","description":"Loop: 2400, Segment: REF, Element: REF02 Note: When REF01=BT"},"referralNumber":{"maxItems":5,"minItems":0,"type":"array","description":"Loop: 2400, Segment: REF, Element: REF Note: When REF01=9F","items":{"type":"string","description":"Loop: 2400, Segment: REF, Element: REF Note: When REF01=9F"}}}},"SpinalManipulationServiceInformation":{"required":["patientConditionCode"],"type":"object","properties":{"patientConditionCode":{"type":"string","description":"Loop: 2300, Segment: CR, Element: CR208"},"patientConditionDescription1":{"type":"string","description":"Loop: 2300, Segment: CR, Element: CR210 Note: Allowed Values are: 'A' Acute Condition, 'C' Chronic Condition, 'D' Chronic Condition, 'E' Non-Life Threatening, 'F' Routine, 'G' Symptomatic, 'M' Acute Manifestation of a Chronic Condition","enum":["A","C","D","E","F","G","M"]},"patientConditionDescription2":{"type":"string","description":"Loop: 2300, Segment: CR, Element: CR211"}},"description":"Loop 2300, Segment: CR2"},"Submitter":{"required":["contactInformation"],"type":"object","properties":{"organizationName":{"type":"string","description":"Loop: 1000A,  Segment: NM1, Element: NM103","example":"REGIONAL PPO NETWORK"},"lastName":{"type":"string","description":"Loop: 1000A,  Segment: NM1, Element: NM103","example":"doeOne"},"firstName":{"type":"string","description":"Loop: 1000A,  Segment: NM1, Element: NM104","example":"janeone"},"middleName":{"type":"string","description":"Loop: 1000A,  Segment: NM1, Element: NM105","example":"middleone"},"contactInformation":{"$ref":"#/components/schemas/ContactInformation"}},"description":"Loop: 1000A"},"Subscriber":{"required":["paymentResponsibilityLevelCode"],"type":"object","properties":{"memberId":{"type":"string","description":"Loop: 2010BA,  Segment: NM1, Element: NM109","example":"0000000001"},"ssn":{"type":"string","description":"Loop: 2010BA,  Segment: REF, Element: REF02 when REF01=SY"},"paymentResponsibilityLevelCode":{"type":"string","description":"Loop: 2000B, Segment: SBR, Element: SBR01, Allowed Values:'A' Payer Responsibility Four 'B' Payer Responsibility Five 'C' Payer Responsibility Six 'D' Payer Responsibility Seven 'E' Payer Responsibility Eight 'F' Payer Responsibility Nine 'G' Payer Responsibility Ten 'H' Payer Responsibility Eleven 'P' Primary 'S' Secondary 'T' Tertiary 'U' Unknown","example":"P","enum":["A","B","C","D","E","F","G","H","P","S","T","U"]},"organizationName":{"type":"string","description":"Loop: 2010BA, Segment: NM1, Element: NM103 when NM102=2, Notes: when subscriber is organization pass patient as dependent"},"insuranceTypeCode":{"type":"string","description":"Loop: 2000B,  Segment: SBR, Element:SBR05 Notes: Allowed values: '12' Medicare Secondary Working Aged Beneficiary or Spouse with Employer Group Health Plan, '13' Medicare Secondary End-Stage Renal Disease Beneficiary in the Mandated Coordination Period with an Employer's Group Health Plan, '14' Medicare Secondary, No-fault Insurance including Auto is Primary, '15' Medicare Secondary Worker's Compensation, '16' Medicare Secondary Public Health Service (PHS)or Other Federal Agency, '41' Medicare Secondary Black Lung, '42' Medicare Secondary Veteran's Administration, '43' Medicare Secondary Disabled Beneficiary Under Age 65 with Large Group Health Plan (LGHP), '47' Medicare Secondary, Other Liability Insurance is Primary","enum":["12","13","14","15","16","41","42","43","47"]},"subscriberGroupName":{"type":"string","description":"Loop: 2000B,  Segment: SBR, Element: SBR04 Notes: Freeform text","example":"Subscriber Group Name"},"firstName":{"type":"string","description":"Loop: 2010BA,  Segment: NM1, Element: NM104","example":"johnone"},"lastName":{"type":"string","description":"Loop: 2010BA,  Segment: NM1, Element: NM103","example":"doeOne"},"middleName":{"type":"string","description":"Loop: 2010BA,  Segment: NM, Element: NM105"},"suffix":{"type":"string","description":"Loop: 2010BA,  Segment: NM, Element: NM107","example":"Jr"},"gender":{"type":"string","description":"Loop: 2010BA,  Segment: DMG, Element: DMG03 Subscriber Gender, Notes: 'M' Male, 'F' Female'U' Unknown","example":"M","enum":["M","F","U"]},"dateOfBirth":{"type":"string","description":"Loop: 2010BA,  Segment: DMG, Element: DMG02","example":"19800102"},"policyNumber":{"type":"string","description":"Loop: 2000B,  Segment: SBR, Element: SBR03","example":"00001"},"groupNumber":{"type":"string","description":"Loop: 2010BA,  Segment: SBR, Element: SBR04"},"contactInformation":{"$ref":"#/components/schemas/ContactInformation"},"address":{"$ref":"#/components/schemas/Address"}},"description":"Loop: 2000B"},"SupportingDocumentation":{"required":["questionNumber"],"type":"object","properties":{"questionNumber":{"type":"string","description":"Loop: 2440,  Segment: FRM, Element: FRM01"},"questionResponseCode":{"type":"string","description":"Loop: 2440,  Segment: FRM, Element: FRM02, Notes: Allowed Values are: 'N' No, 'W' Not Applicable, 'Y' Yes","enum":["N","W","Y"]},"questionResponse":{"type":"string","description":"Loop: 2440,  Segment: FRM, Element: FRM03"},"questionResponseAsDate":{"type":"string","description":"Loop: 2440,  Segment: FRM, Element: FRM04"},"questionResponseAsPercent":{"type":"string","description":"Loop: 2440,  Segment: FRM, Element: FRM05"}},"description":"Loop: 2440, Segment: FRM"},"ClaimReference":{"type":"object","properties":{"correlationId":{"type":"string","description":"Claim correlation ID","example":"200715R999898"},"submitterId":{"type":"string","description":"Submitter ID for transaction","example":"999898"},"customerClaimNumber":{"type":"string","description":"Claim number","example":"000000001"},"patientControlNumber":{"type":"string","description":"Control number for claim","example":"12345"},"timeOfResponse":{"type":"string","description":"Time of response for claim","example":"2020-07-15T12:44:17.994-05:00"},"claimType":{"type":"string","description":"Claim Type","example":"PRO"},"payerID":{"type":"string","description":"Payer ID","example":"9496"},"formatVersion":{"type":"string","description":"Format version","example":"5010"},"rhclaimNumber":{"type":"string"}},"description":"Collection of info specific to a given claim"},"EditResponse":{"type":"object","properties":{"errorDescription":{"type":"string"},"badData":{"type":"string"},"fieldIndex":{"type":"string"},"editName":{"type":"string"},"editActivity":{"type":"string"},"phaseID":{"type":"string"},"referenceID":{"type":"string"},"claimCorePath":{"type":"string"},"allowOverride":{"type":"string"},"qualifierCode":{"type":"string"},"element":{"type":"string"},"loop":{"type":"string"},"segment":{"type":"string"}}},"Error":{"type":"object","properties":{"field":{"type":"string","description":"The field related to the error","example":"claimInformation.serviceLines[0].serviceDate"},"value":{"type":"string","description":"Value for bad data error","example":"123"},"code":{"type":"string","description":"Error code","example":"123"},"description":{"type":"string","description":"Description of error message.","example":"Must not be empty"},"followupAction":{"type":"string","description":"Follow up action to correct","example":"Add 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UPGRADE_REQUIRED","428 PRECONDITION_REQUIRED","429 TOO_MANY_REQUESTS","431 REQUEST_HEADER_FIELDS_TOO_LARGE","451 UNAVAILABLE_FOR_LEGAL_REASONS","500 INTERNAL_SERVER_ERROR","501 NOT_IMPLEMENTED","502 BAD_GATEWAY","503 SERVICE_UNAVAILABLE","504 GATEWAY_TIMEOUT","505 HTTP_VERSION_NOT_SUPPORTED","506 VARIANT_ALSO_NEGOTIATES","507 INSUFFICIENT_STORAGE","508 LOOP_DETECTED","509 BANDWIDTH_LIMIT_EXCEEDED","510 NOT_EXTENDED","511 NETWORK_AUTHENTICATION_REQUIRED"]},"meta":{"$ref":"#/components/schemas/ResponseMeta"},"editStatus":{"type":"string"},"payer":{"$ref":"#/components/schemas/Payer"},"editResponses":{"type":"array","items":{"$ref":"#/components/schemas/EditResponse"}},"failure":{"$ref":"#/components/schemas/Failure"}}},"ResponseMeta":{"type":"object","properties":{"submitterId":{"type":"string","description":"submitterId assigned to this request"},"senderId":{"type":"string","description":"senderId assigned to this request"},"billerId":{"type":"string","description":"billerId assigned to 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Data","example":"T"},"billing":{"$ref":"#/components/schemas/billing"},"referring":{"$ref":"#/components/schemas/referring"},"rendering":{"$ref":"#/components/schemas/rendering"},"ordering":{"$ref":"#/components/schemas/ordering"},"supervising":{"$ref":"#/components/schemas/supervising"},"tradingPartnerName":{"type":"string","description":"Loop 2010BB NM103"},"precisionThreshold":{"type":"number","format":"double"}}}},"securitySchemes":{"bearer-key":{"type":"http","scheme":"bearer","bearerFormat":"JWT"}}},"x-readme":{"explorer-enabled":true,"proxy-enabled":true}}