| | | | | | | | | | | |
| | _Ref_ | Id | _________Element Name__________ | Req | Type | Min/Max | | |
| | STC01 | C043 | Health Care Claim Status | M | Comp | | | |
| | | | Description: Used to convey status of the entire claim or a specific service line |
| | | 1271 | Industry Code | M | AN | 1/30 | | |
| | | | Description: Code indicating a code from a specific industry code list |
| | | 1271 | Industry Code | M | AN | 1/30 | | |
| | | | Description: Code indicating a code from a specific industry code list |
| | | 98 | Entity Identifier Code | O | ID | 2/3 | | |
| | | | Description: Code identifying an organizational entity, a physical location, property or an individual |
| | | | | Code | Name_______________________________ |
| | | | | 13 | Contracted Service Provider |
| | | | | 17 | Consultant's Office |
| | | | | 1E | Health Maintenance Organization (HMO) |
| | | | | 1G | Oncology Center |
| | | | | 1H | Kidney Dialysis Unit |
| | | | | 1I | Preferred Provider Organization (PPO) |
| | | | | 1O | Acute Care Hospital |
| | | | | 1P | Provider |
| | | | | 1Q | Military Facility |
| | | | | 1R | University, College or School |
| | | | | 1S | Outpatient Surgicenter |
| | | | | 1T | Physician, Clinic or Group Practice |
| | | | | 1U | Long Term Care Facility |
| | | | | 1V | Extended Care Facility |
| | | | | 1W | Psychiatric Health Facility |
| | | | | 1X | Laboratory |
| | | | | 1Y | Retail Pharmacy |
| | | | | 1Z | Home Health Care |
| | | | | 28 | Subcontractor |
| | | | | 2A | Federal, State, County or City Facility |
| | | | | 2B | Third-Party Administrator |
| | | | | 2E | Non-Health Care Miscellaneous Facility |
| | | | | 2I | Church Operated Facility |
| | | | | 2K | Partnership |
| | | | | 2P | Public Health Service Facility |
| | | | | 2Q | Veterans Administration Facility |
| | | | | 2S | Public Health Service Indian Service Facility |
| | | | | 2Z | Hospital Unit of an Institution (prison hospital, college infirmary, etc.) |
| | | | | 30 | Service Supplier |
| | | | | 36 | Employer |
| | | | | 3A | Hospital Unit Within an Institution for the Mentally Retarded |
| | | | | 3C | Tuberculosis and Other Respiratory Diseases Facility |
| | | | | 3D | Obstetrics and Gynecology Facility |
| | | | | 3E | Eye, Ear, Nose and Throat Facility |
| | | | | 3F | Rehabilitation Facility |
| | | | | 3G | Orthopedic Facility |
| | | | | 3H | Chronic Disease Facility |
| | | | | 3I | Other Specialty Facility |
| | | | | 3J | Children's General Facility |
| | | | | 3K | Children's Hospital Unit of an Institution |
| | | | | 3L | Children's Psychiatric Facility |
| | | | | 3M | Children's Tuberculosis and Other Respiratory Diseases Facility |
| | | | | 3N | Children's Eye, Ear, Nose and Throat Facility |
| | | | | 3O | Children's Rehabilitation Facility |
| | | | | 3P | Children's Orthopedic Facility |
| | | | | 3Q | Children's Chronic Disease Facility |
| | | | | 3R | Children's Other Specialty Facility |
| | | | | 3S | Institution for Mental Retardation |
| | | | | 3T | Alcoholism and Other Chemical Dependency Facility |
| | | | | 3U | General Inpatient Care for AIDS/ARC Facility |
| | | | | 3V | AIDS/ARC Unit |
| | | | | 3W | Specialized Outpatient Program for AIDS/ARC |
| | | | | 3X | Alcohol/Drug Abuse or Dependency Inpatient Unit |
| | | | | 3Y | Alcohol/Drug Abuse or Dependency Outpatient Services |
| | | | | 3Z | Arthritis Treatment Center |
| | | | | 40 | Receiver |
| | | | | | Description: Entity to accept transmission |
| | | | | 43 | Claimant Authorized Representative |
| | | | | 44 | Data Processing Service Bureau |
| | | | | 4A | Birthing Room/LDRP Room |
| | | | | 4B | Burn Care Unit |
| | | | | 4C | Cardiac Catherization Laboratory |
| | | | | 4D | Open-Heart Surgery Facility |
| | | | | 4E | Cardiac Intensive Care Unit |
| | | | | 4F | Angioplasty Facility |
| | | | | 4G | Chronic Obstructive Pulmonary Disease Service Facility |
| | | | | 4H | Emergency Department |
| | | | | 4I | Trauma Center (Certified) |
| | | | | 4J | Extracorporeal Shock-Wave Lithotripter (ESWL) Unit |
| | | | | 4L | Genetic Counseling/Screening Services |
| | | | | 4M | Adult Day Care Program Facility |
| | | | | 4N | Alzheimer's Diagnostic/Assessment Services |
| | | | | 4O | Comprehensive Geriatric Assessment Facility |
| | | | | 4P | Emergency Response (Geriatric) Unit |
| | | | | 4Q | Geriatric Acute Care Unit |
| | | | | 4R | Geriatric Clinics |
| | | | | 4S | Respite Care Facility |
| | | | | 4U | Patient Education Unit |
| | | | | 4V | Community Health Promotion Facility |
| | | | | 4W | Worksite Health Promotion Facility |
| | | | | 4X | Hemodialysis Facility |
| | | | | 4Y | Home Health Services |
| | | | | 4Z | Hospice |
| | | | | 5A | Medical Surgical or Other Intensive Care Unit |
| | | | | 5B | Hisopathology Laboratory |
| | | | | 5C | Blood Bank |
| | | | | 5D | Neonatal Intensive Care Unit |
| | | | | 5E | Obstetrics Unit |
| | | | | 5F | Occupational Health Services |
| | | | | 5G | Organized Outpatient Services |
| | | | | 5H | Pediatric Acute Inpatient Unit |
| | | | | 5I | Psychiatric Child/Adolescent Services |
| | | | | 5J | Psychiatric Consultation-Liaison Services |
| | | | | 5K | Psychiatric Education Services |
| | | | | 5L | Psychiatric Emergency Services |
| | | | | 5M | Psychiatric Geriatric Services |
| | | | | 5N | Psychiatric Inpatient Unit |
| | | | | 5O | Psychiatric Outpatient Services |
| | | | | 5P | Psychiatric Partial Hospitalization Program |
| | | | | 5Q | Megavoltage Radiation Therapy Unit |
| | | | | 5R | Radioactive Implants Unit |
| | | | | 5S | Therapeutic Radioisotope Facility |
| | | | | 5T | X-Ray Radiation Therapy Unit |
| | | | | 5U | CT Scanner Unit |
| | | | | 5V | Diagnostic Radioisotope Facility |
| | | | | 5W | Magnetic Resonance Imaging (MRI) Facility |
| | | | | 5X | Ultrasound Unit |
| | | | | 5Y | Rehabilitation Inpatient Unit |
| | | | | 5Z | Rehabilitation Outpatient Services |
| | | | | 61 | Performed At |
| | | | | | Description: The facility where work was performed |
| | | | | 6A | Reproductive Health Services |
| | | | | 6B | Skilled Nursing or Other Long-Term Care Unit |
| | | | | 6C | Single Photon Emission Computerized Tomography (SPECT) Unit |
| | | | | 6D | Organized Social Work Service Facility |
| | | | | 6E | Outpatient Social Work Services |
| | | | | 6F | Emergency Department Social Work Services |
| | | | | 6G | Sports Medicine Clinic/Services |
| | | | | 6H | Hospital Auxiliary Unit |
| | | | | 6I | Patient Representative Services |
| | | | | 6J | Volunteer Services Department |
| | | | | 6K | Outpatient Surgery Services |
| | | | | 6L | Organ/Tissue Transplant Unit |
| | | | | 6M | Orthopedic Surgery Facility |
| | | | | 6N | Occupational Therapy Services |
| | | | | 6O | Physical Therapy Services |
| | | | | 6P | Recreational Therapy Services |
| | | | | 6Q | Respiratory Therapy Services |
| | | | | 6R | Speech Therapy Services |
| | | | | 6S | Women's Health Center/Services |
| | | | | 6U | Cardiac Rehabilitation Program Facility |
| | | | | 6V | Non-Invasive Cardiac Assessment Services |
| | | | | 6W | Emergency Medical Technician |
| | | | | 6X | Disciplinary Contact |
| | | | | 6Y | Case Manager |
| | | | | 71 | Attending Physician |
| | | | | | Description: Physician present when medical services are performed |
| | | | | 72 | Operating Physician |
| | | | | | Description: Doctor who performs a surgical procedure |
| | | | | 73 | Other Physician |
| | | | | | Description: Physician not one of the other specified choices |
| | | | | 74 | Corrected Insured |
| | | | | 77 | Service Location |
| | | | | 7C | Place of Occurrence |
| | | | | 80 | Hospital |
| | | | | | Description: An institution where the ill or injured may receive medical treatment |
| | | | | 82 | Rendering Provider |
| | | | | 84 | Subscriber's Employer |
| | | | | 85 | Billing Provider |
| | | | | 87 | Pay-to Provider |
| | | | | 95 | Research Institute |
| | | | | CK | Pharmacist |
| | | | | CZ | Admitting Surgeon |
| | | | | D2 | Commercial Insurer |
| | | | | DD | Assistant Surgeon |
| | | | | DJ | Consulting Physician |
| | | | | DK | Ordering Physician |
| | | | | DN | Referring Provider |
| | | | | DO | Dependent Name |
| | | | | DQ | Supervising Physician |
| | | | | E1 | Person or Other Entity Legally Responsible for a Child |
| | | | | E2 | Person or Other Entity With Whom a Child Resides |
| | | | | E7 | Previous Employer |
| | | | | E9 | Participating Laboratory |
| | | | | FA | Facility |
| | | | | FD | Physical Address |
| | | | | FE | Mail Address |
| | | | | G0 | Dependent Insured |
| | | | | G3 | Clinic |
| | | | | GB | Other Insured |
| | | | | GD | Guardian |
| | | | | GI | Paramedic |
| | | | | GK | Previous Insured |
| | | | | GM | Spouse Insured |
| | | | | GY | Treatment Facility |
| | | | | HF | Healthcare Professional Shortage Area (HPSA) Facility |
| | | | | | Description: Facility recognized by the Health Care Financing Administration as existing in an area of the country lacking in health care establishments and services |
| | | | | HH | Home Health Agency |
| | | | | I3 | Independent Physicians Association (IPA) |
| | | | | IJ | Injection Point |
| | | | | IL | Insured or Subscriber |
| | | | | IN | Insurer |
| | | | | LI | Independent Lab |
| | | | | | Description: Outside laboratory which provides test results for entity providing medical services |
| | | | | LR | Legal Representative |
| | | | | MR | Medical Insurance Carrier |
| | | | | OB | Ordered By |
| | | | | OD | Doctor of Optometry |
| | | | | OX | Oxygen Therapy Facility |
| | | | | | Description: Building in which oxygen treatment is provided for medical disorder |
| | | | | P0 | Patient Facility |
| | | | | | Description: Facility where patient resides |
| | | | | P2 | Primary Insured or Subscriber |
| | | | | | Description: A primary insured or subscriber is a person who elects the benefits and is affiliated with the employer or the insurer |
| | | | | P3 | Primary Care Provider |
| | | | | | Description: Physician that is selected by the insured to provide medical care |
| | | | | P4 | Prior Insurance Carrier |
| | | | | P6 | Third Party Reviewing Preferred Provider Organization (PPO) |
| | | | | P7 | Third Party Repricing Preferred Provider Organization (PPO) |
| | | | | PT | Party to Receive Test Report |
| | | | | PV | Party performing certification |
| | | | | PW | Pick Up Address |
| | | | | QA | Pharmacy |
| | | | | | Description: Establishment responsible for preparing and dispensing drugs and medicines |
| | | | | QB | Purchase Service Provider |
| | | | | | Description: Entity from which medical supplies may be bought |
| | | | | QC | Patient |
| | | | | | Description: Individual receiving medical care |
| | | | | QD | Responsible Party |
| | | | | | Description: Person responsible for the affairs of the person having services rendered |
| | | | | QE | Policyholder |
| | | | | QH | Physician |
| | | | | QK | Managed Care |
| | | | | QL | Chiropractor |
| | | | | QN | Dentist |
| | | | | QO | Doctor of Osteopathy |
| | | | | QS | Podiatrist |
| | | | | QV | Group Practice |
| | | | | QY | Medical Doctor |
| | | | | | Description: An individual trained and licensed to practice as a Medical Doctor (M.D.) |
| | | | | RC | Receiving Location |
| | | | | RW | Rural Health Clinic |
| | | | | S4 | Skilled Nursing Facility |
| | | | | SJ | Service Provider |
| | | | | | Description: Identifies name and address information as pertaining to a service provider for which billing is being rendered |
| | | | | SU | Supplier/Manufacturer |
| | | | | T4 | Transfer Point |
| | | | | | Description: A geographic location where a shipment is transferred or diverted to a new destination |
| | | | | TQ | Third Party Reviewing Organization (TPO) |
| | | | | TT | Transfer To |
| | | | | TU | Third Party Repricing Organization (TPO) |
| | | | | UH | Nursing Home |
| | | | | X3 | Utilization Management Organization |
| | | | | X4 | Spouse |
| | | | | X5 | Durable Medical Equipment Supplier |
| | | | | ZZ | Mutually Defined |
| | STC02 | 373 | Date | O | DT | 8/8 | | |
| | | | Description: Date expressed as CCYYMMDD |
| | STC04 | 782 | Monetary Amount | O | R | 1/18 | | |
| | | | Description: Monetary amount |
| | STC05 | 782 | Monetary Amount | O | R | 1/18 | | |
| | | | Description: Monetary amount |
| | STC10 | C043 | Health Care Claim Status | O | Comp | | | |
| | | | Description: Used to convey status of the entire claim or a specific service line |
| | | 1271 | Industry Code | M | AN | 1/30 | | |
| | | | Description: Code indicating a code from a specific industry code list |
| | | 1271 | Industry Code | M | AN | 1/30 | | |
| | | | Description: Code indicating a code from a specific industry code list |
| | | 98 | Entity Identifier Code | O | ID | 2/3 | | |
| | | | Description: Code identifying an organizational entity, a physical location, property or an individual |
| | | | | Code | Name_______________________________ |
| | | | | 13 | Contracted Service Provider |
| | | | | 17 | Consultant's Office |
| | | | | 1E | Health Maintenance Organization (HMO) |
| | | | | 1G | Oncology Center |
| | | | | 1H | Kidney Dialysis Unit |
| | | | | 1I | Preferred Provider Organization (PPO) |
| | | | | 1O | Acute Care Hospital |
| | | | | 1P | Provider |
| | | | | 1Q | Military Facility |
| | | | | 1R | University, College or School |
| | | | | 1S | Outpatient Surgicenter |
| | | | | 1T | Physician, Clinic or Group Practice |
| | | | | 1U | Long Term Care Facility |
| | | | | 1V | Extended Care Facility |
| | | | | 1W | Psychiatric Health Facility |
| | | | | 1X | Laboratory |
| | | | | 1Y | Retail Pharmacy |
| | | | | 1Z | Home Health Care |
| | | | | 28 | Subcontractor |
| | | | | 2A | Federal, State, County or City Facility |
| | | | | 2B | Third-Party Administrator |
| | | | | 2E | Non-Health Care Miscellaneous Facility |
| | | | | 2I | Church Operated Facility |
| | | | | 2K | Partnership |
| | | | | 2P | Public Health Service Facility |
| | | | | 2Q | Veterans Administration Facility |
| | | | | 2S | Public Health Service Indian Service Facility |
| | | | | 2Z | Hospital Unit of an Institution (prison hospital, college infirmary, etc.) |
| | | | | 30 | Service Supplier |
| | | | | 36 | Employer |
| | | | | 3A | Hospital Unit Within an Institution for the Mentally Retarded |
| | | | | 3C | Tuberculosis and Other Respiratory Diseases Facility |
| | | | | 3D | Obstetrics and Gynecology Facility |
| | | | | 3E | Eye, Ear, Nose and Throat Facility |
| | | | | 3F | Rehabilitation Facility |
| | | | | 3G | Orthopedic Facility |
| | | | | 3H | Chronic Disease Facility |
| | | | | 3I | Other Specialty Facility |
| | | | | 3J | Children's General Facility |
| | | | | 3K | Children's Hospital Unit of an Institution |
| | | | | 3L | Children's Psychiatric Facility |
| | | | | 3M | Children's Tuberculosis and Other Respiratory Diseases Facility |
| | | | | 3N | Children's Eye, Ear, Nose and Throat Facility |
| | | | | 3O | Children's Rehabilitation Facility |
| | | | | 3P | Children's Orthopedic Facility |
| | | | | 3Q | Children's Chronic Disease Facility |
| | | | | 3R | Children's Other Specialty Facility |
| | | | | 3S | Institution for Mental Retardation |
| | | | | 3T | Alcoholism and Other Chemical Dependency Facility |
| | | | | 3U | General Inpatient Care for AIDS/ARC Facility |
| | | | | 3V | AIDS/ARC Unit |
| | | | | 3W | Specialized Outpatient Program for AIDS/ARC |
| | | | | 3X | Alcohol/Drug Abuse or Dependency Inpatient Unit |
| | | | | 3Y | Alcohol/Drug Abuse or Dependency Outpatient Services |
| | | | | 3Z | Arthritis Treatment Center |
| | | | | 40 | Receiver |
| | | | | | Description: Entity to accept transmission |
| | | | | 43 | Claimant Authorized Representative |
| | | | | 44 | Data Processing Service Bureau |
| | | | | 4A | Birthing Room/LDRP Room |
| | | | | 4B | Burn Care Unit |
| | | | | 4C | Cardiac Catherization Laboratory |
| | | | | 4D | Open-Heart Surgery Facility |
| | | | | 4E | Cardiac Intensive Care Unit |
| | | | | 4F | Angioplasty Facility |
| | | | | 4G | Chronic Obstructive Pulmonary Disease Service Facility |
| | | | | 4H | Emergency Department |
| | | | | 4I | Trauma Center (Certified) |
| | | | | 4J | Extracorporeal Shock-Wave Lithotripter (ESWL) Unit |
| | | | | 4L | Genetic Counseling/Screening Services |
| | | | | 4M | Adult Day Care Program Facility |
| | | | | 4N | Alzheimer's Diagnostic/Assessment Services |
| | | | | 4O | Comprehensive Geriatric Assessment Facility |
| | | | | 4P | Emergency Response (Geriatric) Unit |
| | | | | 4Q | Geriatric Acute Care Unit |
| | | | | 4R | Geriatric Clinics |
| | | | | 4S | Respite Care Facility |
| | | | | 4U | Patient Education Unit |
| | | | | 4V | Community Health Promotion Facility |
| | | | | 4W | Worksite Health Promotion Facility |
| | | | | 4X | Hemodialysis Facility |
| | | | | 4Y | Home Health Services |
| | | | | 4Z | Hospice |
| | | | | 5A | Medical Surgical or Other Intensive Care Unit |
| | | | | 5B | Hisopathology Laboratory |
| | | | | 5C | Blood Bank |
| | | | | 5D | Neonatal Intensive Care Unit |
| | | | | 5E | Obstetrics Unit |
| | | | | 5F | Occupational Health Services |
| | | | | 5G | Organized Outpatient Services |
| | | | | 5H | Pediatric Acute Inpatient Unit |
| | | | | 5I | Psychiatric Child/Adolescent Services |
| | | | | 5J | Psychiatric Consultation-Liaison Services |
| | | | | 5K | Psychiatric Education Services |
| | | | | 5L | Psychiatric Emergency Services |
| | | | | 5M | Psychiatric Geriatric Services |
| | | | | 5N | Psychiatric Inpatient Unit |
| | | | | 5O | Psychiatric Outpatient Services |
| | | | | 5P | Psychiatric Partial Hospitalization Program |
| | | | | 5Q | Megavoltage Radiation Therapy Unit |
| | | | | 5R | Radioactive Implants Unit |
| | | | | 5S | Therapeutic Radioisotope Facility |
| | | | | 5T | X-Ray Radiation Therapy Unit |
| | | | | 5U | CT Scanner Unit |
| | | | | 5V | Diagnostic Radioisotope Facility |
| | | | | 5W | Magnetic Resonance Imaging (MRI) Facility |
| | | | | 5X | Ultrasound Unit |
| | | | | 5Y | Rehabilitation Inpatient Unit |
| | | | | 5Z | Rehabilitation Outpatient Services |
| | | | | 61 | Performed At |
| | | | | | Description: The facility where work was performed |
| | | | | 6A | Reproductive Health Services |
| | | | | 6B | Skilled Nursing or Other Long-Term Care Unit |
| | | | | 6C | Single Photon Emission Computerized Tomography (SPECT) Unit |
| | | | | 6D | Organized Social Work Service Facility |
| | | | | 6E | Outpatient Social Work Services |
| | | | | 6F | Emergency Department Social Work Services |
| | | | | 6G | Sports Medicine Clinic/Services |
| | | | | 6H | Hospital Auxiliary Unit |
| | | | | 6I | Patient Representative Services |
| | | | | 6J | Volunteer Services Department |
| | | | | 6K | Outpatient Surgery Services |
| | | | | 6L | Organ/Tissue Transplant Unit |
| | | | | 6M | Orthopedic Surgery Facility |
| | | | | 6N | Occupational Therapy Services |
| | | | | 6O | Physical Therapy Services |
| | | | | 6P | Recreational Therapy Services |
| | | | | 6Q | Respiratory Therapy Services |
| | | | | 6R | Speech Therapy Services |
| | | | | 6S | Women's Health Center/Services |
| | | | | 6U | Cardiac Rehabilitation Program Facility |
| | | | | 6V | Non-Invasive Cardiac Assessment Services |
| | | | | 6W | Emergency Medical Technician |
| | | | | 6X | Disciplinary Contact |
| | | | | 6Y | Case Manager |
| | | | | 71 | Attending Physician |
| | | | | | Description: Physician present when medical services are performed |
| | | | | 72 | Operating Physician |
| | | | | | Description: Doctor who performs a surgical procedure |
| | | | | 73 | Other Physician |
| | | | | | Description: Physician not one of the other specified choices |
| | | | | 74 | Corrected Insured |
| | | | | 77 | Service Location |
| | | | | 7C | Place of Occurrence |
| | | | | 80 | Hospital |
| | | | | | Description: An institution where the ill or injured may receive medical treatment |
| | | | | 82 | Rendering Provider |
| | | | | 84 | Subscriber's Employer |
| | | | | 85 | Billing Provider |
| | | | | 87 | Pay-to Provider |
| | | | | 95 | Research Institute |
| | | | | CK | Pharmacist |
| | | | | CZ | Admitting Surgeon |
| | | | | D2 | Commercial Insurer |
| | | | | DD | Assistant Surgeon |
| | | | | DJ | Consulting Physician |
| | | | | DK | Ordering Physician |
| | | | | DN | Referring Provider |
| | | | | DO | Dependent Name |
| | | | | DQ | Supervising Physician |
| | | | | E1 | Person or Other Entity Legally Responsible for a Child |
| | | | | E2 | Person or Other Entity With Whom a Child Resides |
| | | | | E7 | Previous Employer |
| | | | | E9 | Participating Laboratory |
| | | | | FA | Facility |
| | | | | FD | Physical Address |
| | | | | FE | Mail Address |
| | | | | G0 | Dependent Insured |
| | | | | G3 | Clinic |
| | | | | GB | Other Insured |
| | | | | GD | Guardian |
| | | | | GI | Paramedic |
| | | | | GJ | Paramedical Company |
| | | | | | Description: A company which performs physical examination services |
| | | | | GK | Previous Insured |
| | | | | GM | Spouse Insured |
| | | | | GY | Treatment Facility |
| | | | | HF | Healthcare Professional Shortage Area (HPSA) Facility |
| | | | | | Description: Facility recognized by the Health Care Financing Administration as existing in an area of the country lacking in health care establishments and services |
| | | | | HH | Home Health Agency |
| | | | | I3 | Independent Physicians Association (IPA) |
| | | | | IJ | Injection Point |
| | | | | IL | Insured or Subscriber |
| | | | | IN | Insurer |
| | | | | LI | Independent Lab |
| | | | | | Description: Outside laboratory which provides test results for entity providing medical services |
| | | | | LR | Legal Representative |
| | | | | MR | Medical Insurance Carrier |
| | | | | OB | Ordered By |
| | | | | OD | Doctor of Optometry |
| | | | | OX | Oxygen Therapy Facility |
| | | | | | Description: Building in which oxygen treatment is provided for medical disorder |
| | | | | P0 | Patient Facility |
| | | | | | Description: Facility where patient resides |
| | | | | P2 | Primary Insured or Subscriber |
| | | | | | Description: A primary insured or subscriber is a person who elects the benefits and is affiliated with the employer or the insurer |
| | | | | P3 | Primary Care Provider |
| | | | | | Description: Physician that is selected by the insured to provide medical care |
| | | | | P4 | Prior Insurance Carrier |
| | | | | P6 | Third Party Reviewing Preferred Provider Organization (PPO) |
| | | | | P7 | Third Party Repricing Preferred Provider Organization (PPO) |
| | | | | PT | Party to Receive Test Report |
| | | | | PV | Party performing certification |
| | | | | PW | Pick Up Address |
| | | | | QA | Pharmacy |
| | | | | | Description: Establishment responsible for preparing and dispensing drugs and medicines |
| | | | | QB | Purchase Service Provider |
| | | | | | Description: Entity from which medical supplies may be bought |
| | | | | QC | Patient |
| | | | | | Description: Individual receiving medical care |
| | | | | QD | Responsible Party |
| | | | | | Description: Person responsible for the affairs of the person having services rendered |
| | | | | QE | Policyholder |
| | | | | QH | Physician |
| | | | | QK | Managed Care |
| | | | | QL | Chiropractor |
| | | | | QN | Dentist |
| | | | | QO | Doctor of Osteopathy |
| | | | | QS | Podiatrist |
| | | | | QV | Group Practice |
| | | | | QY | Medical Doctor |
| | | | | | Description: An individual trained and licensed to practice as a Medical Doctor (M.D.) |
| | | | | RC | Receiving Location |
| | | | | RW | Rural Health Clinic |
| | | | | S4 | Skilled Nursing Facility |
| | | | | SJ | Service Provider |
| | | | | | Description: Identifies name and address information as pertaining to a service provider for which billing is being rendered |
| | | | | SU | Supplier/Manufacturer |
| | | | | T4 | Transfer Point |
| | | | | | Description: A geographic location where a shipment is transferred or diverted to a new destination |
| | | | | TQ | Third Party Reviewing Organization (TPO) |
| | | | | TT | Transfer To |
| | | | | TU | Third Party Repricing Organization (TPO) |
| | | | | UH | Nursing Home |
| | | | | X3 | Utilization Management Organization |
| | | | | X4 | Spouse |
| | | | | X5 | Durable Medical Equipment Supplier |
| | | | | ZZ | Mutually Defined |
| | STC11 | C043 | Health Care Claim Status | O | Comp | | | |
| | | | Description: Used to convey status of the entire claim or a specific service line |
| | | 1271 | Industry Code | M | AN | 1/30 | | |
| | | | Description: Code indicating a code from a specific industry code list |
| | | 1271 | Industry Code | M | AN | 1/30 | | |
| | | | Description: Code indicating a code from a specific industry code list |
| | | 98 | Entity Identifier Code | O | ID | 2/3 | | |
| | | | Description: Code identifying an organizational entity, a physical location, property or an individual |
| | | | | Code | Name_______________________________ |
| | | | | 13 | Contracted Service Provider |
| | | | | 17 | Consultant's Office |
| | | | | 1E | Health Maintenance Organization (HMO) |
| | | | | 1G | Oncology Center |
| | | | | 1H | Kidney Dialysis Unit |
| | | | | 1I | Preferred Provider Organization (PPO) |
| | | | | 1O | Acute Care Hospital |
| | | | | 1P | Provider |
| | | | | 1Q | Military Facility |
| | | | | 1R | University, College or School |
| | | | | 1S | Outpatient Surgicenter |
| | | | | 1T | Physician, Clinic or Group Practice |
| | | | | 1U | Long Term Care Facility |
| | | | | 1V | Extended Care Facility |
| | | | | 1W | Psychiatric Health Facility |
| | | | | 1X | Laboratory |
| | | | | 1Y | Retail Pharmacy |
| | | | | 1Z | Home Health Care |
| | | | | 28 | Subcontractor |
| | | | | 2A | Federal, State, County or City Facility |
| | | | | 2B | Third-Party Administrator |
| | | | | 2E | Non-Health Care Miscellaneous Facility |
| | | | | 2I | Church Operated Facility |
| | | | | 2K | Partnership |
| | | | | 2P | Public Health Service Facility |
| | | | | 2Q | Veterans Administration Facility |
| | | | | 2S | Public Health Service Indian Service Facility |
| | | | | 2Z | Hospital Unit of an Institution (prison hospital, college infirmary, etc.) |
| | | | | 30 | Service Supplier |
| | | | | 36 | Employer |
| | | | | 3A | Hospital Unit Within an Institution for the Mentally Retarded |
| | | | | 3C | Tuberculosis and Other Respiratory Diseases Facility |
| | | | | 3D | Obstetrics and Gynecology Facility |
| | | | | 3E | Eye, Ear, Nose and Throat Facility |
| | | | | 3F | Rehabilitation Facility |
| | | | | 3G | Orthopedic Facility |
| | | | | 3H | Chronic Disease Facility |
| | | | | 3I | Other Specialty Facility |
| | | | | 3J | Children's General Facility |
| | | | | 3K | Children's Hospital Unit of an Institution |
| | | | | 3L | Children's Psychiatric Facility |
| | | | | 3M | Children's Tuberculosis and Other Respiratory Diseases Facility |
| | | | | 3N | Children's Eye, Ear, Nose and Throat Facility |
| | | | | 3O | Children's Rehabilitation Facility |
| | | | | 3P | Children's Orthopedic Facility |
| | | | | 3Q | Children's Chronic Disease Facility |
| | | | | 3R | Children's Other Specialty Facility |
| | | | | 3S | Institution for Mental Retardation |
| | | | | 3T | Alcoholism and Other Chemical Dependency Facility |
| | | | | 3U | General Inpatient Care for AIDS/ARC Facility |
| | | | | 3V | AIDS/ARC Unit |
| | | | | 3W | Specialized Outpatient Program for AIDS/ARC |
| | | | | 3X | Alcohol/Drug Abuse or Dependency Inpatient Unit |
| | | | | 3Y | Alcohol/Drug Abuse or Dependency Outpatient Services |
| | | | | 3Z | Arthritis Treatment Center |
| | | | | 40 | Receiver |
| | | | | | Description: Entity to accept transmission |
| | | | | 43 | Claimant Authorized Representative |
| | | | | 44 | Data Processing Service Bureau |
| | | | | 4A | Birthing Room/LDRP Room |
| | | | | 4B | Burn Care Unit |
| | | | | 4C | Cardiac Catherization Laboratory |
| | | | | 4D | Open-Heart Surgery Facility |
| | | | | 4E | Cardiac Intensive Care Unit |
| | | | | 4F | Angioplasty Facility |
| | | | | 4G | Chronic Obstructive Pulmonary Disease Service Facility |
| | | | | 4H | Emergency Department |
| | | | | 4I | Trauma Center (Certified) |
| | | | | 4J | Extracorporeal Shock-Wave Lithotripter (ESWL) Unit |
| | | | | 4L | Genetic Counseling/Screening Services |
| | | | | 4M | Adult Day Care Program Facility |
| | | | | 4N | Alzheimer's Diagnostic/Assessment Services |
| | | | | 4O | Comprehensive Geriatric Assessment Facility |
| | | | | 4P | Emergency Response (Geriatric) Unit |
| | | | | 4Q | Geriatric Acute Care Unit |
| | | | | 4R | Geriatric Clinics |
| | | | | 4S | Respite Care Facility |
| | | | | 4U | Patient Education Unit |
| | | | | 4V | Community Health Promotion Facility |
| | | | | 4W | Worksite Health Promotion Facility |
| | | | | 4X | Hemodialysis Facility |
| | | | | 4Y | Home Health Services |
| | | | | 4Z | Hospice |
| | | | | 5A | Medical Surgical or Other Intensive Care Unit |
| | | | | 5B | Hisopathology Laboratory |
| | | | | 5C | Blood Bank |
| | | | | 5D | Neonatal Intensive Care Unit |
| | | | | 5E | Obstetrics Unit |
| | | | | 5F | Occupational Health Services |
| | | | | 5G | Organized Outpatient Services |
| | | | | 5H | Pediatric Acute Inpatient Unit |
| | | | | 5I | Psychiatric Child/Adolescent Services |
| | | | | 5J | Psychiatric Consultation-Liaison Services |
| | | | | 5K | Psychiatric Education Services |
| | | | | 5L | Psychiatric Emergency Services |
| | | | | 5M | Psychiatric Geriatric Services |
| | | | | 5N | Psychiatric Inpatient Unit |
| | | | | 5O | Psychiatric Outpatient Services |
| | | | | 5P | Psychiatric Partial Hospitalization Program |
| | | | | 5Q | Megavoltage Radiation Therapy Unit |
| | | | | 5R | Radioactive Implants Unit |
| | | | | 5S | Therapeutic Radioisotope Facility |
| | | | | 5T | X-Ray Radiation Therapy Unit |
| | | | | 5U | CT Scanner Unit |
| | | | | 5V | Diagnostic Radioisotope Facility |
| | | | | 5W | Magnetic Resonance Imaging (MRI) Facility |
| | | | | 5X | Ultrasound Unit |
| | | | | 5Y | Rehabilitation Inpatient Unit |
| | | | | 5Z | Rehabilitation Outpatient Services |
| | | | | 61 | Performed At |
| | | | | | Description: The facility where work was performed |
| | | | | 6A | Reproductive Health Services |
| | | | | 6B | Skilled Nursing or Other Long-Term Care Unit |
| | | | | 6C | Single Photon Emission Computerized Tomography (SPECT) Unit |
| | | | | 6D | Organized Social Work Service Facility |
| | | | | 6E | Outpatient Social Work Services |
| | | | | 6F | Emergency Department Social Work Services |
| | | | | 6G | Sports Medicine Clinic/Services |
| | | | | 6H | Hospital Auxiliary Unit |
| | | | | 6I | Patient Representative Services |
| | | | | 6J | Volunteer Services Department |
| | | | | 6K | Outpatient Surgery Services |
| | | | | 6L | Organ/Tissue Transplant Unit |
| | | | | 6M | Orthopedic Surgery Facility |
| | | | | 6N | Occupational Therapy Services |
| | | | | 6O | Physical Therapy Services |
| | | | | 6P | Recreational Therapy Services |
| | | | | 6Q | Respiratory Therapy Services |
| | | | | 6R | Speech Therapy Services |
| | | | | 6S | Women's Health Center/Services |
| | | | | 6U | Cardiac Rehabilitation Program Facility |
| | | | | 6V | Non-Invasive Cardiac Assessment Services |
| | | | | 6W | Emergency Medical Technician |
| | | | | 6X | Disciplinary Contact |
| | | | | 6Y | Case Manager |
| | | | | 71 | Attending Physician |
| | | | | | Description: Physician present when medical services are performed |
| | | | | 72 | Operating Physician |
| | | | | | Description: Doctor who performs a surgical procedure |
| | | | | 73 | Other Physician |
| | | | | | Description: Physician not one of the other specified choices |
| | | | | 74 | Corrected Insured |
| | | | | 77 | Service Location |
| | | | | 7C | Place of Occurrence |
| | | | | 80 | Hospital |
| | | | | | Description: An institution where the ill or injured may receive medical treatment |
| | | | | 82 | Rendering Provider |
| | | | | 84 | Subscriber's Employer |
| | | | | 85 | Billing Provider |
| | | | | 87 | Pay-to Provider |
| | | | | 95 | Research Institute |
| | | | | CK | Pharmacist |
| | | | | CZ | Admitting Surgeon |
| | | | | D2 | Commercial Insurer |
| | | | | DD | Assistant Surgeon |
| | | | | DJ | Consulting Physician |
| | | | | DK | Ordering Physician |
| | | | | DN | Referring Provider |
| | | | | DO | Dependent Name |
| | | | | DQ | Supervising Physician |
| | | | | E1 | Person or Other Entity Legally Responsible for a Child |
| | | | | E2 | Person or Other Entity With Whom a Child Resides |
| | | | | E7 | Previous Employer |
| | | | | E9 | Participating Laboratory |
| | | | | FA | Facility |
| | | | | FD | Physical Address |
| | | | | FE | Mail Address |
| | | | | G0 | Dependent Insured |
| | | | | G3 | Clinic |
| | | | | GB | Other Insured |
| | | | | GD | Guardian |
| | | | | GI | Paramedic |
| | | | | GJ | Paramedical Company |
| | | | | | Description: A company which performs physical examination services |
| | | | | GK | Previous Insured |
| | | | | GM | Spouse Insured |
| | | | | GY | Treatment Facility |
| | | | | HF | Healthcare Professional Shortage Area (HPSA) Facility |
| | | | | | Description: Facility recognized by the Health Care Financing Administration as existing in an area of the country lacking in health care establishments and services |
| | | | | HH | Home Health Agency |
| | | | | I3 | Independent Physicians Association (IPA) |
| | | | | IJ | Injection Point |
| | | | | IL | Insured or Subscriber |
| | | | | IN | Insurer |
| | | | | LI | Independent Lab |
| | | | | | Description: Outside laboratory which provides test results for entity providing medical services |
| | | | | LR | Legal Representative |
| | | | | MR | Medical Insurance Carrier |
| | | | | OB | Ordered By |
| | | | | OD | Doctor of Optometry |
| | | | | OX | Oxygen Therapy Facility |
| | | | | | Description: Building in which oxygen treatment is provided for medical disorder |
| | | | | P0 | Patient Facility |
| | | | | | Description: Facility where patient resides |
| | | | | P2 | Primary Insured or Subscriber |
| | | | | | Description: A primary insured or subscriber is a person who elects the benefits and is affiliated with the employer or the insurer |
| | | | | P3 | Primary Care Provider |
| | | | | | Description: Physician that is selected by the insured to provide medical care |
| | | | | P4 | Prior Insurance Carrier |
| | | | | P6 | Third Party Reviewing Preferred Provider Organization (PPO) |
| | | | | P7 | Third Party Repricing Preferred Provider Organization (PPO) |
| | | | | PT | Party to Receive Test Report |
| | | | | PV | Party performing certification |
| | | | | PW | Pick Up Address |
| | | | | QA | Pharmacy |
| | | | | | Description: Establishment responsible for preparing and dispensing drugs and medicines |
| | | | | QB | Purchase Service Provider |
| | | | | | Description: Entity from which medical supplies may be bought |
| | | | | QC | Patient |
| | | | | | Description: Individual receiving medical care |
| | | | | QD | Responsible Party |
| | | | | | Description: Person responsible for the affairs of the person having services rendered |
| | | | | QE | Policyholder |
| | | | | QH | Physician |
| | | | | QK | Managed Care |
| | | | | QL | Chiropractor |
| | | | | QN | Dentist |
| | | | | QO | Doctor of Osteopathy |
| | | | | QS | Podiatrist |
| | | | | QV | Group Practice |
| | | | | QY | Medical Doctor |
| | | | | | Description: An individual trained and licensed to practice as a Medical Doctor (M.D.) |
| | | | | RC | Receiving Location |
| | | | | RW | Rural Health Clinic |
| | | | | S4 | Skilled Nursing Facility |
| | | | | SJ | Service Provider |
| | | | | | Description: Identifies name and address information as pertaining to a service provider for which billing is being rendered |
| | | | | SU | Supplier/Manufacturer |
| | | | | T4 | Transfer Point |
| | | | | | Description: A geographic location where a shipment is transferred or diverted to a new destination |
| | | | | TQ | Third Party Reviewing Organization (TPO) |
| | | | | TT | Transfer To |
| | | | | TU | Third Party Repricing Organization (TPO) |
| | | | | UH | Nursing Home |
| | | | | X3 | Utilization Management Organization |
| | | | | X4 | Spouse |
| | | | | X5 | Durable Medical Equipment Supplier |
| | | | | ZZ | Mutually Defined |
