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 |