C001 Composite Unit of Measure To identify a composite unit of measure

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1 COMPOSITE UIT OF MEASURE C001 C001 Composite Unit of Measure To identify a composite unit of measure (See Figures Appendix for examples of use) SEGMETS USED I ATR ATV BCS CBS CFT CRT CSF CSS CST CSU CTP EA FAA GDP III IC J K3 OC TR MEA MII MIR 12 CA OPS PAM PAY PD PDE PEX P POC PRC PSC PSD PTF QTY RAT RCD REA REC RT RPA SII SI S SPS STA TBA TIA TRF UCS UIT USD TRASACTIO SETS USED I COMMETS 1 If C is not used, its value is to be interpreted as 1. 2 If C is not used, its value is to be interpreted as 1. 3 If C is not used, its value is to be interpreted as 1. 4 If C is not used, its value is to be interpreted as 1. 5 If C is not used, its value is to be interpreted as 1. 6 If C is not used, its value is to be interpreted as 1. 7 If C is not used, its value is to be interpreted as 1. 8 If C is not used, its value is to be interpreted as 1. 9 If C is not used, its value is to be interpreted as If C is not used, its value is to be interpreted as 1. C C C C C C C001 UnitBasis Meas Exponent Multiplier UnitBasis Meas Exponent Multiplier M 22 O R 115 O R 110 O 22 O R 115 O R 110 C C C C C C UnitBasis Meas Exponent Multiplier UnitBasis Meas Exponent Multiplier O 22 O R 115 O R 110 O 22 O R 115 O R 110 C C C UnitBasis Meas Exponent Multiplier O 22 O R 115 O R 110 C002 Actions Indicated Actions to be performed on the piece of paperwork identified SEGMETS USED I PWK TRASACTIO SETS USED I C002 C C C C C Paperwork Action Paperwork Action Paperwork Action Paperwork Action Paperwork Action M 12 O 12 O 12 O 12 O 12 DECEMBER 1996 COMPOSITE DATA EEMET DIRECTORY 1

2 COMPOSITE MEDICA PROCEDURE ETIFIER C003 C003 Composite Medical Procedure Identifier To identify a medical procedure by its standardized codes and applicable modifiers SEGMETS USED I EB EQ SV1 SV2 SV3 SV4 SV5 SV6 SVC SVD TRASACTIO SETS USED I SEMATIC OTES 1 C modifies the value in C C modifies the value in C C modifies the value in C C modifies the value in C C is the description of the procedure identified in C C003 C C C C C C ProdServ Qual Product Service Procedure Modifier Procedure Modifier Procedure Modifier Procedure Modifier M 22 M A 148 O A 22 O A 22 O A 22 O A 22 C Description O A 180 C004 Composite Diagnosis Pointer To identify one or more diagnosis code pointers SEGMETS USED I SV1 SV3 SV6 TRASACTIO SETS USED I 837 SEMATIC OTES 1 C identifies the primary diagnosis code for this service line. 2 C identifies the second diagnosis code for this service line. 3 C identifies the third diagnosis code for this service line. 4 C identifies the fourth diagnosis code for this service line. C004 C C C C Diagnosis Pointr Diagnosis Pointr Diagnosis Pointr Diagnosis Pointr M 0 12 O 0 12 O 0 12 O 0 12 C005 Tooth Surface To identify one or more tooth surface codes SEGMETS USED I TOO TRASACTIO SETS USED I 837 C005 C C C C C Tooth Surf Tooth Surf Tooth Surf Tooth Surf Tooth Surf M 12 O 12 O 12 O 12 O 12 C006 Oral Cavity Designation To identify one or more areas of the oral cavity DECEMBER 1996 COMPOSITE DATA EEMET DIRECTORY 2

3 AMOUT QUAIFYIG DESCRIPTIO C007 SEGMETS USED I SV3 TRASACTIO SETS USED I 837 C006 C C C C C Oral Cavity Desig. Oral Cavity Desig. Oral Cavity Desig. Oral Cavity Desig. Oral Cavity Desig. M 13 O 13 O 13 O 13 O 13 C007 Amount Qualifying Description To qualify an amount SEGMETS USED I ASO AWD TRASACTIO SETS USED I 155 SEMATIC OTES 1 C is the primary Amount. 2 C is used when a compound Amount is required. 3 C qualifies the Amount referenced in C and C C qualifies the Amount referenced in C and C C defines the time period of the Amount referenced in C and C C specifies whether the Amount referenced in C and C is net or gross. 7 C qualifies the amount when an exact amount is not available. 8 C is used for free-form description of an amount. COMMETS 1 This composite data element can be used to break apart the Amount into its individual components. See Appendix (Composite Data Structure Figures) for usage examples of C C is only used when C is "FK" (other). C C C C C C C007 Amount Qual Amount Qual Value Detail Cd Measurement Sig Unit Time Interval etgross M 12 O 12 O 11 O 22 O 22 O 11 C C Measurement Sig Description O 22 O A 180 C022 Health Care Information To send health care codes and their associated dates, amounts and quantities SEGMETS USED I HI TRASACTIO SETS USED I SYTAX OTES 1 P If either C02203 or C02204 is present, the - If either C02203, C02204, C022 -, C022 I, C022f, C022ei, C022th, C022er, C022 C, C02202, C02220, C0223, C022or, C022 C, C02202, C02220, C0224, C022is, C022 p, C022re, C022se, C022nt, C022, or C022th are present, then the others are required. SEMATIC OTES 1 C qualifies C022-02, C022-04, C and C C is the date format that will appear in C DECEMBER 1996 COMPOSITE DATA EEMET DIRECTORY 3

4 HEATH CARE SERVICE OCATIO IFORMATIO C023 3 C qualifies C C022 C C C C C C ist Qual Industry Date Time Format Qual Date Time Period Monetary Amount Quantity M 13 M A 130 C 23 C A 135 O R 115 O R 115 C O A 130 C023 Health Care Service ocation Information To provide information that identifies the place of service or the type of bill related to the location at which a health care service was rendered SEGMETS USED I CM UM TRASACTIO SETS USED I SEMATIC OTES 1 C qualifies C and C C023 C C C Facility Facility Qual Claim Freq Type M A 12 O 12 O 11 C024 Related Causes Information To identify one or more related causes and associated state or country information SEGMETS USED I CM UM TRASACTIO SETS USED I COMMETS 1 C and C apply only to auto accidents when C024-01, C024-02, or C is equal to "AA". C024 C C C C C Related Causes Related Causes Related Causes State or Prov Country M 23 O 23 O 23 O 22 O 23 C028 Assurance Token Parameters Parameters needed to calculate the Assurance Token SEGMETS USED I S1A S2A SYTAX OTES 1 C If C02804 is present, then C02803 is requi - If C02804 is present, then C02803, C028 -, C028 I, C028f, C028C0, C02828, C02804, C028 i, C028s, C028pr, C028es, C028en, C028t,, C028 t, C028he, C028n, C028C0, C02828, C02803, C028 i, C028s, C028re and C028qu are required. 2 C If C02806 is present, then C02805 is requi - If C02806 is present, then C02805, C028 -, C028 I, C028f, C028C0, C02828, C02806, C028 i, C028s, C028pr, C028es, C028en, C028t,, C028 t, C028he, C028n, C028C0, C02828, C02805, C028 i, C028s, C028re and C028qu are required. 3 C If C02808 is present, then C02807 is requi - If C02808 is present, then C02807, C028 -, C028 I, C028f, C028C0, C02828, C02808, C028 i, C028s, C028pr, C028es, C028en, C028t,, C028 t, C028he, C028n, C028C0, C02828, C02807, C028 i, C028s, C028re and C028qu are required. DECEMBER 1996 COMPOSITE DATA EEMET DIRECTORY 4

5 POSITIO I SEGMET C030 4 C If C02810 is present, then C02809 is requi - If C02810 is present, then C02809, C028 -, C028 I, C028f, C028C0, C02828, C02810, C028 i, C028s, C028pr, C028es, C028en, C028t,, C028 t, C028he, C028n, C028C0, C02828, C02809, C028 i, C028s, C028re and C028qu are required. 5 C If C02812 is present, then C02811 is requi - If C02812 is present, then C02811, C028 -, C028 I, C028f, C028C0, C02828, C02812, C028 i, C028s, C028pr, C028es, C028en, C028t,, C028 t, C028he, C028n, C028C0, C02828, C02811, C028 i, C028s, C028re and C028qu are required. 6 C If C02814 is present, then C02813 is requi - If C02814 is present, then C02813, C028 -, C028 I, C028f, C028C0, C02828, C02814, C028 i, C028s, C028pr, C028es, C028en, C028t,, C028 t, C028he, C028n, C028C0, C02828, C02813, C028 i, C028s, C028re and C028qu are required. 7 C If C02816 is present, then C02815 is requi - If C02816 is present, then C02815, C028 -, C028 I, C028f, C028C0, C02828, C02816, C028 i, C028s, C028pr, C028es, C028en, C028t,, C028 t, C028he, C028n, C028C0, C02828, C02815, C028 i, C028s, C028re and C028qu are required. 8 C If C02818 is present, then C02817 is requi - If C02818 is present, then C02817, C028 -, C028 I, C028f, C028C0, C02828, C02818, C028 i, C028s, C028pr, C028es, C028en, C028t,, C028 t, C028he, C028n, C028C0, C02828, C02817, C028 i, C028s, C028re and C028qu are required. 9 C If C02820 is present, then C02819 is requi - If C02820 is present, then C02819, C028 -, C028 I, C028f, C028C0, C02828, C02820, C028 i, C028s, C028pr, C028es, C028en, C028t,, C028 t, C028he, C028n, C028C0, C02828, C02819, C028 i, C028s, C028re and C028qu are required. C C C C C C C028 M 22 M A 164 C 22 O A 164 C 22 O A 164 C C C C C C C 22 O A 164 C 22 O A 164 C 22 O A 164 C C C C C C C 22 O A 164 C 22 O A 164 C 22 O A 164 C C C 22 O A 164 C030 Position in Segment indicating the relative position of a simple data element, or the relative position of a composite data structure combined with the relative position of the component data element within the composite data structure, in error; the count starts with 1 for the simple data element or composite data structure immediately following the segment SEGMETS USED I AK4 TRASACTIO SETS USED I 997 C030 C C Element Pos in Segment DE Pos in Composite M 0 12 O 0 12 C031 Encryption Key Information Information needed to identify or obtain the encryption key DECEMBER 1996 COMPOSITE DATA EEMET DIRECTORY 5

6 ECRYPTIO SERVICE IFORMATIO C032 SEGMETS USED I S1S S2S C031 C C C C C Encryption Key ame Protocol ook-up Value Keying Material One-time Encrypt Key M A 164 O 33 O A O A 1512 O A 1512 C032 Encryption Service Information Information required by the encryption operation SEGMETS USED I S1S S2S SYTAX OTES 1 P If either C03204 or C03205 is present, the - If either C03204, C03205, C032 -, C032 I, C032f, C032ei, C032th, C032er, C032 C, C03203, C03220, C0324, C032or, C032 C, C03203, C03220, C0325, C032is, C032 p, C032re, C032se, C032nt, C032, or C032th are present, then the others are required. 2 P If either C03206 or C03207 is present, the - If either C03206, C03207, C032 -, C032 I, C032f, C032ei, C032th, C032er, C032 C, C03203, C03220, C0326, C032or, C032 C, C03203, C03220, C0327, C032is, C032 p, C032re, C032se, C032nt, C032, or C032th are present, then the others are required. C C C C C C C032 Encryption Serv Algorithm Algorithm Mode of Op Filter Compression M 13 O 33 O 33 C 33 C A 130 C 33 C C A 130 C033 Security Value Value of the Security Token SEGMETS USED I CSC SVA TRASACTIO SETS USED I 815 C033 C C Security Val Qual M 33 Encoded Secur Val M A 1 1E+16 C034 Computation Methods Algorithms used to calculate an assurance SEGMETS USED I S1A S2A C034 C C Assurance Algorithm Hashing Algorithm M 33 M 33 C035 Provider Specialty Information To provide provider specialty information DECEMBER 1996 COMPOSITE DATA EEMET DIRECTORY 6

7 EX ETIFICATIO C036 SEGMETS USED I PRV TRASACTIO SETS USED I SEMATIC OTES 1 C qualifies C C is the provider specialty certification indicator. A "Y" value indicates the provider is certified in the specialty indicated. An "" value indicates the provider is not certified in the specialty indicated. A "U" value indicates that it is unknown whether the provider is certified in the specialty indicated. C035 C C C Provider Specy Agency Qual Yeso Cond Resp M A 13 O 22 O 11 C036 Index Identification To identify an index SEGMETS USED I IX TRASACTIO SETS USED I 194 SYTAX OTES 1 P If either C03602 or C03603 is present, the - If either C03602, C03603, C036 -, C036 I, C036f, C036ei, C036th, C036er, C036 C, C03603, C03660, C0362, C036or, C036 C, C03603, C03660, C0363, C036is, C036 p, C036re, C036se, C036nt, C036, or C036th are present, then the others are required. 2 R At least one of C03602 or C03604 is requir - At least one of C03602, C03604, C036 -, C036 A, C036t, C036le, C036as, C036t, C036on, C036e, C036of, C036 C, C03603, C03660, C0362, C036or, C036 C, C03603, C03660, C0364, C036is, C036 r, C036eq or C036ui is required. 3 P If either C03604 or C03605 is present, the - If either C03604, C03605, C036 -, C036 I, C036f, C036ei, C036th, C036er, C036 C, C03603, C03660, C0364, C036or, C036 C, C03603, C03660, C0365, C036is, C036 p, C036re, C036se, C036nt, C036, or C036th are present, then the others are required. SEMATIC OTES 1 C is the beginning range sequence number. It is the first cell included in either an absolute or relative load pattern. 2 C is the ending range sequence number. It is the last cell in an array identified by an absolute load pattern. In a relative load pattern, it is the count of the number of cells included in the array range inclusive of the beginning range sequence number. COMMETS 1 Use C to identify the array loading sequence or pattern. 2 Use C and C to express a range of array cell identifiers for which data is to be loaded to the array in an absolute reference or the beginning and total number of cells, inclusive, in a relative load pattern. 3 Use C and C to express the cell coordinates for an individual array cell value to be loaded to the array. C036 C C C C C Config Type X-Peg Y-Peg O 11 C A 130 C A 130 C R 16 C R 16 C037 Tax Field Identification To identify a data field and to indicate the field status SEGMETS USED I TIA DECEMBER 1996 COMPOSITE DATA EEMET DIRECTORY 7

8 REFERECE ETIFIER C040 TRASACTIO SETS USED I C037 C C Tax Info umber Appl Error Cond M A 130 O 13 C040 Identifier To identify one or more reference numbers or identification numbers as specified by the SEGMETS USED I CSC 2 9 PDS RDM REF TRASACTIO SETS USED I SYTAX OTES 1 P If either C04003 or C04004 is present, the - If either C04003, C04004, C040 -, C040 I, C040f, C040ei, C040th, C040er, C040 C, C04004, C04000, C0403, C040or, C040 C, C04004, C04000, C0404, C040is, C040 p, C040re, C040se, C040nt, C040, or C040th are present, then the others are required. 2 P If either C04005 or C04006 is present, the - If either C04005, C04006, C040 -, C040 I, C040f, C040ei, C040th, C040er, C040 C, C04004, C04000, C0405, C040or, C040 C, C04004, C04000, C0406, C040is, C040 p, C040re, C040se, C040nt, C040, or C040th are present, then the others are required. C040 C C C C C C Qual Qual Qual M 23 M A 130 C 23 C A 130 C 23 C A 130 C041 Composite Date To identify the complete date, including century, year, month and day SEGMETS USED I BAK BCA BCH BEG TRASACTIO SETS USED I C C C041 Date Century M DT 66 O 0 22 C042 Adjustment Identifier To provide the category and identifying reference information for an adjustment SEGMETS USED I PB DECEMBER 1996 COMPOSITE DATA EEMET DIRECTORY 8

9 HEATH CARE CAIM STATUS C043 TRASACTIO SETS USED I 835 C042 C C Adjustment Reason M 22 O A 130 C043 Health Care Claim Status Used to convey status of the entire claim or a specific service line SEGMETS USED I STC TRASACTIO SETS USED I SEMATIC OTES 1 C is used to specify the logical groupings of Health Care Claim Status s (See Source 507). 2 C is used to identify the status of an entire claim or a serviceline (See Source 508). 3 C identifies the entity associated with the Health Care Claim Status. C043 C C C Industry Industry Entity M A 130 M A 130 O 23 C045 Conditions Indicated To identify one or more conditions qualifying an option or event SEGMETS USED I CDI TRASACTIO SETS USED I 205 C045 C C C C C Certificate Cond Certificate Cond Certificate Cond Certificate Cond Certificate Cond M 22 O 22 O 22 O 22 O 22 C046 Composite Identifier To identify one or more qualifiers describing a rate or value SEGMETS USED I VDI TRASACTIO SETS USED I 205 C046 C C C C C RateValue RateValue RateValue RateValue RateValue M 22 O 22 O 22 O 22 O 22 C050 Certificate ook-up Information Conveys the information related to or used for certificate identification SEGMETS USED I CSC DECEMBER 1996 COMPOSITE DATA EEMET DIRECTORY 9

10 CERTIFICATE OOK-UP IFORMATIO C050 TRASACTIO SETS USED I 815 SYTAX OTES 1 P If either C05005, C05006, C05007 or C0 - If either C05005, C05006, C05007, C05008, C050 -, C050 I, C050f, C050ei, C050th, C050er, C050 C, C05005, C05000, C0505,, C050 C, C05005, C05000, C0506,, C050 C, C05005, C05000, C0507, C050or or C050 C are present, then the others are required. 2 P If either C05009, C05010, C05011 or C0 - If either C05009, C05010, C05011, C05012, C050 -, C050 I, C050f, C050ei, C050th, C050er, C050 C, C05005, C05000, C0509,, C050 C, C05005, C05001, C0500,, C050 C, C05005, C05001, C0501, C050or or C050 C are present, then the others are required. C C C C C C C050 ookup Val Protocol Cd Filter ook-up Value ookup Val Protocol Cd Filter M 22 M 33 M A 130 M A C 22 C 33 C C C C C C ook-up Value ookup Val Protocol Cd Filter ook-up Value C A 130 C A C 22 C 33 C A 130 C A DECEMBER 1996 COMPOSITE DATA EEMET DIRECTORY 10

2.1 CURRENT DATA MAINTENANCE FOR X12 VOTE 2.2 CURRENT DATA MAINTENANCE FOR REBUTTAL VOTE 2.3 SUBCOMMITTEE INDEX 2.

DISA DATABASE OUTPUT 107199 DATA MAINTENANCE INDEX 2.1 CURRENT DATA MAINTENANCE FOR X12 VOTE Table 1 lists those DMs included in this report which are approved for ballot to the X12 Committee by the ASC