| | | | | | | | | | | |
| | _Ref_ | Id | _________Element Name__________ | Req | Type | Min/Max | | |
| | TS301 | 127 | Reference Identification | M | AN | 1/30 | | |
| | | | Description: Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier |
| | TS302 | 1331 | Facility Code Value | M | AN | 1/2 | | |
| | | | Description: Code identifying the type of facility where services were performed; the first and second positions of the Uniform Bill Type code or the Place of Service code from the Electronic Media Claims National Standard Format |
| | TS303 | 373 | Date | M | DT | 8/8 | | |
| | | | Description: Date expressed as CCYYMMDD |
| | TS304 | 380 | Quantity | M | R | 1/15 | | |
| | | | Description: Numeric value of quantity |
| | TS305 | 782 | Monetary Amount | M | R | 1/18 | | |
| | | | Description: Monetary amount |
| | TS306 | 782 | Monetary Amount | O | R | 1/18 | | |
| | | | Description: Monetary amount |
| | TS307 | 782 | Monetary Amount | O | R | 1/18 | | |
| | | | Description: Monetary amount |
| | TS308 | 782 | Monetary Amount | O | R | 1/18 | | |
| | | | Description: Monetary amount |
| | TS309 | 782 | Monetary Amount | O | R | 1/18 | | |
| | | | Description: Monetary amount |
| | TS310 | 782 | Monetary Amount | O | R | 1/18 | | |
| | | | Description: Monetary amount |
| | TS311 | 782 | Monetary Amount | O | R | 1/18 | | |
| | | | Description: Monetary amount |
| | TS312 | 782 | Monetary Amount | O | R | 1/18 | | |
| | | | Description: Monetary amount |
| | TS313 | 782 | Monetary Amount | O | R | 1/18 | | |
| | | | Description: Monetary amount |
| | TS314 | 782 | Monetary Amount | O | R | 1/18 | | |
| | | | Description: Monetary amount |
| | TS315 | 782 | Monetary Amount | O | R | 1/18 | | |
| | | | Description: Monetary amount |
| | TS316 | 782 | Monetary Amount | O | R | 1/18 | | |
| | | | Description: Monetary amount |
| | TS317 | 782 | Monetary Amount | O | R | 1/18 | | |
| | | | Description: Monetary amount |
| | TS318 | 782 | Monetary Amount | O | R | 1/18 | | |
| | | | Description: Monetary amount |
| | TS319 | 782 | Monetary Amount | O | R | 1/18 | | |
| | | | Description: Monetary amount |
| | TS320 | 782 | Monetary Amount | O | R | 1/18 | | |
| | | | Description: Monetary amount |
| | TS321 | 782 | Monetary Amount | O | R | 1/18 | | |
| | | | Description: Monetary amount |
| | TS322 | 782 | Monetary Amount | O | R | 1/18 | | |
| | | | Description: Monetary amount |
| | TS323 | 380 | Quantity | O | R | 1/15 | | |
| | | | Description: Numeric value of quantity |
| | TS324 | 782 | Monetary Amount | O | R | 1/18 | | |
| | | | Description: Monetary amount |
