Data Element Number Data Type Minimum Length Maximum Length Data Element Name
100 ID 3 3 Currency Code
1004 ID 1 2 Percent Qualifier
1005 ID 4 4 Hierarchical Structure Code
1018 R 1 15 Exponent
102 ID 1 1 Ownership Code
1028 AN 1 38 Claim Submitters Identifier
1029 ID 1 2 Claim Status Code
103 AN 3 5 Packaging Code
1032 ID 1 2 Claim Filing Indicator Code
1033 ID 1 2 Claim Adjustment Group Code
1034 ID 1 5 Claim Adjustment Reason Code
1035 AN 1 35 Name Last or Organization Name
1036 AN 1 25 Name First
1037 AN 1 25 Name Middle
1038 AN 1 10 Name Prefix
1039 AN 1 10 Name Suffix
1048 ID 1 3 Business Function Code
1065 ID 1 1 Entity Type Qualifier
1066 ID 1 2 Citizenship Status Code
1067 ID 1 1 Marital Status Code
1068 ID 1 1 Gender Code
1069 ID 2 2 Individual Relationship Code
107 ID 1 2 Payment Method Code
1073 ID 1 1 Yes/No Condition or Response Code
1074 ID 2 2 Type of Real Estate Asset Code
1095 N0 4 4 Year
1109 ID 1 1 Race or Ethnicity Code
1129 ID 1 2 Adjustment Reason Code Characteristic
1130 ID 1 1 Primary or Contingent Code
1136 ID 2 2 Code Category
1137 AN 1 15 Medical Code Value
1138 ID 1 1 Payer Responsibility Sequence Number Code
1143 ID 1 1 Coordination of Benefits Code
1146 ID 1 1 Disability Type Code
1149 ID 4 6 Occupation Code
1154 ID 1 1 Work Intensity Code
116 ID 3 15 Postal Code
1161 ID 1 2 Product Option Code
1165 ID 1 1 Confidentiality Code
1166 ID 2 2 Contract Type Code
1167 R 1 6 Sample Selection Modulus
1176 ID 2 3 Employment Class Code
118 R 1 9 Rate
1186 ID 2 2 Type of Income Code
1187 ID 2 2 Type of Account Code
1188 ID 2 2 Type of Personal or Business Asset Code
1201 ID 1 1 Information Status Code
1202 ID 1 1 Flexible Spending Account Selection Code
1203 ID 2 3 Maintenance Reason Code
1204 AN 1 50 Plan Coverage Description
1205 ID 2 3 Insurance Line Code
1207 ID 3 3 Coverage Level Code
1209 ID 1 1 Underwriting Decision Code
1211 ID 2 3 Drug House Code
1212 ID 1 1 Health-Related Code
1213 ID 1 1 Current Health Condition Code
1214 AN 1 5 Salary Grade
1215 ID 1 1 Identification Card Type Code
1216 ID 1 1 Benefit Status Code
1218 ID 1 1 Medicare Plan Code
1219 ID 1 2 Consolidated Omnibus Budget Reconciliation Act (COBRA) Qualifying
1220 ID 1 1 Student Status Code
1221 ID 1 3 Provider Code
1222 AN 1 3 Provider Specialty Code
1223 ID 3 3 Provider Organization Code
1224 ID 2 2 Contribution Code
123 N0 1 6 Number of Received Transaction Sets
124 AN 2 15 124
1250 ID 2 3 Date Time Period Format Qualifier
1251 AN 1 35 Date Time Period
1253 ID 3 6 Immunization Type Code
1254 ID 1 2 Immunization Status Code
127 AN 1 30 Reference Identification
1270 ID 1 3 Code List Qualifier Code
1271 AN 1 30 Industry Code
128 ID 2 3 Reference Identification Qualifier
1295 ID 1 2 Participant Status Code
1296 AN 1 6 Special Processing Type
1303 ID 1 2 Use of Language Indicator
1314 ID 1 1 Admission Source Code
1315 ID 1 1 Admission Type Code
1316 ID 1 1 Ambulance Transport Code
1317 ID 1 1 Ambulance Transport Reason Code
1318 ID 1 1 Approval Code
1319 ID 1 2 Basis of Cost Determination Code
1320 ID 1 1 Basis of Days Supply Determination Code
1321 ID 2 2 Condition Indicator
1322 ID 1 1 Certification Type Code
1325 ID 1 1 Claim Frequency Type Code
1327 ID 1 1 Copay Status Code
1328 N0 1 2 Diagnosis Code Pointer
1329 ID 1 1 Dispense as Written Code
1330 ID 2 2 Dosage Form Code
1331 AN 1 2 Facility Code Value
1332 ID 1 2 Facility Code Qualifier
1333 ID 1 2 Record Format Code
1334 ID 1 1 Health Care Professional Shortage Area Code
1335 ID 1 1 Insulin Dependent Code
1336 ID 1 3 Insurance Type Code
1337 ID 1 1 Level of Care Code
1338 ID 1 3 Level of Service Code
1339 AN 2 2 Procedure Modifier
1340 ID 1 2 Multiple Procedure Code
1341 AN 1 2 National or Local Assigned Review Value
1342 ID 1 1 Nature of Condition Code
1343 ID 1 2 Non-Institutional Claim Type Code
1344 ID 1 1 Non-Visit Code
1345 ID 1 1 Nursing Home Residential Status Code
1346 ID 1 1 Nutrient Administration Method Code
1347 ID 1 1 Nutrient Administration Technique Code
1348 ID 1 1 Oxygen Equipment Type Code
1349 ID 1 1 Oxygen Test Condition Code
1350 ID 1 1 Oxygen Test Findings Code
1351 ID 1 1 Patient Signature Source Code
1352 ID 1 2 Patient Status Code
1354 ID 1 4 Diagnosis Related Group (DRG) Code
1355 ID 2 2 Prescription Denial Override Code
1356 ID 1 1 Prescription Origin Code
1357 ID 1 1 Prior Authorization Type Code
1358 ID 1 1 Prosthesis
1359 ID 1 1 Provider Accept Assignment Code
1360 ID 1 1 Provider Agreement Code
1361 ID 1 3 Oral Cavity Designation Code
1362 ID 2 3 Related-Causes Code
1363 ID 1 1 Release of Information Code
1364 ID 1 2 Review Code
1365 ID 1 2 Service Type Code
1366 ID 2 3 Special Program Code
1367 ID 2 3 Subluxation Level Code
1368 ID 1 2 Tooth Status Code
1369 ID 1 2 Tooth Surface Code
1370 ID 1 1 Unit Dose Code
1371 R 1 10 Unit Rate
1373 ID 2 4 Measurement Method or Device
1382 ID 1 1 Oxygen Delivery System Code
1383 ID 2 2 Claim Submission Reason Code
1384 ID 1 1 Patient Location Code
1390 ID 1 2 Eligibility or Benefit Information
1403 ID 1 1 Implant Type Code
1404 ID 1 1 Implant Status Code
142 AN 2 15 Application Senders Code
1429 ID 1 2 Construction Type
143 ID 3 3 Transaction Set Identifier Code
1470 N0 1 9 Number
1473 ID 2 2 Pricing Methodology
1476 ID 1 1 Language Proficiency Indicator
151 AN 1 20 Authority
1514 ID 1 2 Delay Reason Code
1525 ID 1 2 Request Category Code
1526 ID 1 2 Policy Compliance Code
1527 ID 1 2 Exception Code
1528 N0 1 2 Composite Data Element Position in Composite
156 ID 2 2 State or Province Code
166 AN 1 55 Address Information
1685 ID 1 2 Tax Treatment Code
1687 R 1 15 Earnings Rate of Pay
1705 AN 1 35 Implementation Convention Reference
183 R 1 8 Volume
184 ID 1 1 Volume Unit Qualifier
188 ID 1 1 Weight Unit Code
19 AN 2 30 City Name
2 N0 1 6 Number of Accepted Transaction Sets
212 R 1 17 Unit Price
22 AN 1 30 Commodity Code
23 ID 1 1 Commodity Code Qualifier
234 AN 1 48 Product/Service ID
235 ID 2 2 Product/Service ID Qualifier
236 ID 3 3 Price Identifier Code
26 ID 2 3 Country Code
28 N0 1 9 Group Control Number
29 DT 6 8 Date
30 TM 4 4 Time
280 R 4 10 Exchange Rate
289 N0 1 2 Multiple Price Quantity
305 ID 1 2 Transaction Handling Code
306 ID 1 2 Action Code
309 ID 1 2 Location Qualifier
310 AN 1 30 Location Identifier
324 AN 1 22 Purchase Order Number
328 AN 1 30 Release Number
329 AN 4 9 Transaction Set Control Number
332 R 1 6 Percent
337 TM 4 8 Time
338 R 1 6 Terms Discount Percent
349 ID 1 1 Item Description Type
350 AN 1 20 Assigned Identification
352 AN 1 80 Description
353 ID 2 2 Transaction Set Purpose Code
354 N0 1 6 Number of Line Items
355 ID 2 2 Unit or Basis for Measurement Code
358 R 1 10 Quantity Invoiced
363 ID 3 3 Note Reference Code
364 AN 1 80 Communication Number
365 ID 2 2 Communication Number Qualifier
366 ID 2 2 Contact Function Code
373 DT 8 8 Date
374 ID 3 3 Date/Time Qualifier
380 R 1 15 Quantity
426 ID 2 2 Adjustment Reason Code
429 AN 1 16 Check Number
443 AN 1 20 Contact Inquiry Reference
447 AN 1 6 Loop Identifier Code
449 AN 1 80 Fixed Format Information
455 ID 1 2 Responsible Agency Code
478 ID 1 1 Credit/Debit Flag Code
479 ID 2 2 Functional Identifier Code
480 AN 1 12 Version / Release / Industry Identifier Code
481 ID 1 2 Trace Type Code
482 ID 2 2 Payment Action Code
499 AN 1 10 Condition Value
506 ID 2 2 (DFI) ID Number Qualifier
507 AN 3 12 (DFI) Identification Number
508 AN 1 35 Account Number
509 AN 10 10 Originating Company Identifier
510 AN 9 9 Originating Company Supplemental Code
522 ID 1 3 Amount Qualifier Code
539 AN 1 25 Vehicle Identification Number
554 N0 1 6 Assigned Number
559 ID 2 2 Agency Qualifier Code
569 ID 1 3 Account Number Qualifier
584 ID 2 2 Employment Status Code
591 ID 3 3 Payment Method Code
594 ID 1 1 Frequency Code
609 N0 1 9 Count
61 AN 1 30 Free-Form Message
610 N2 1 15 Amount
615 ID 1 2 Time Period Qualifier
616 N0 1 3 Number of Periods
623 ID 2 2 Time Code
628 AN 1 12 Hierarchical ID Number
639 ID 2 2 Basis of Unit Price Code
640 ID 2 2 Transaction Type Code
648 ID 3 3 Price Multiplier Qualifier
649 R 1 10 Multiplier
65 R 1 8 Height
659 ID 1 2 Basis of Verification Code
66 ID 1 2 Identification Code Qualifier
662 ID 1 1 Relationship Code
669 ID 3 3 Currency Market/Exchange Code
67 AN 2 80 Identification Code
672 ID 2 2 Resource Authorization Code
673 ID 2 2 Quantity Qualifier
675 ID 2 2 Schedule Type Qualifier
676 ID 1 1 Schedule Quantity Qualifier
678 ID 1 2 Ship/Delivery or Calendar Pattern Code
679 ID 1 1 Ship/Delivery Pattern Time Code
680 ID 1 1 Forecast Qualifier
681 ID 1 1 Forecast Timing Qualifier
687 ID 2 2 Class of Trade Code
689 ID 2 2 Occupancy Code
704 ID 1 2 Paperwork/Report Action Code
706 ID 2 2 Entity Relationship Code
715 ID 1 1 Functional Group Acknowledgment Code
716 ID 1 3 Functional Group Syntax Error Code
717 ID 1 1 Transaction Set Acknowledgment Code
718 ID 1 3 Transaction Set Syntax Error Code
719 N0 1 6 Segment Position in Transaction Set
720 ID 1 3 Segment Syntax Error Code
721 ID 2 3 Segment ID Code
722 N0 1 2 Element Position in Segment
723 ID 1 3 Data Element Syntax Error Code
724 AN 1 99 Copy of Bad Data Element
725 N0 1 4 Data Element Reference Number
734 AN 1 12 Hierarchical Parent ID Number
735 ID 1 2 Hierarchical Level Code
736 ID 1 1 Hierarchical Child Code
737 ID 2 2 Measurement Reference ID Code
738 ID 1 3 Measurement Qualifier
739 R 1 20 Measurement Value
740 R 1 20 Range Minimum
741 R 1 20 Range Maximum
750 ID 2 3 Product/Process Characteristic Code
751 AN 1 12 Product Description Code
752 ID 2 2 Surface/Layer/Position Code
754 AN 1 7 Packaging Description Code
755 ID 2 2 Report Type Code
756 ID 1 2 Report Transmission Code
757 N0 1 2 Report Copies Needed
782 R 1 18 Monetary Amount
786 ID 2 2 Security Level Code
799 AN 1 30 Version Identifier
81 R 1 10 Weight
812 ID 1 10 Payment Format Code
819 ID 2 3 Language Code
82 R 1 8 Length
821 ID 3 3 Safety Characteristic/Hazard Code
822 AN 1 15 Source Subqualifier
875 ID 3 3 Maintenance Type Code
889 ID 1 1 Follow-up Action Code
9 ID 2 2 Late Reason Code
901 ID 2 2 Reject Reason Code
921 ID 2 2 Discipline Type Code
923 ID 1 1 Prognosis Code
93 AN 1 60 Name
933 AN 1 264 Free-Form Message Text
934 ID 2 2 Printer Carriage Control Code
935 ID 2 2 Measurement Significance Code
936 ID 2 2 Measurement Attribute Code
954 R 1 10 Percent
96 N0 1 10 Number of Included Segments
97 N0 1 6 97
98 ID 2 3 Entity Identifier Code
I01 ID 2 2 I01
I02 AN 10 10 I02
I03 ID 2 2 I03
I04 AN 10 10 I04
I05 ID 2 2 I05
I06 AN 15 15 I06
I07 AN 15 15 I07
I08 DT 6 6 I08
I09 TM 4 4 I09
I10 ID 1 1 I10
I11 ID 5 5 I11
I12 N0 9 9 I12
I13 ID 1 1 I13
I14 ID 1 1 I14
I15 AN 1 1 I15
I16 N0 1 5 I16
I17 ID 1 1 I17
I18 ID 3 3 I18