HIPAA Transactions Convergence Project

Disclaimer

Ingenix' Convergence Project reflects only the good faith interpretation of requirements for HIPAA transactions made by the publisher of each list. These interpretations are not reviewed or approved by Ingenix or any governmental or private entity. Publisher's or other person's interpretations may differ. Ingenix disclaims all warranties and accepts no liability for user's reliance or use of Ingenix' Convergence system.

Transaction Summary -- Billing - 5.1/1.1

133 Requirement Lists

Alphabetical Order       IG Order

Element   Required   Not Used
AccumulatedDeductibleAmount2 (2%)
AdditionalMessageInformation4 (3%)
AlternateID2 (2%) 4 (3%)
AmountAppliedToPeriodicDeductible1 (1%) 2 (2%)
AmountAttributedToProductSelection2 (2%)
AmountAttributedToSalesTax2 (2%)
AmountExceedingPeriodicBenefitMaximum2 (2%)
AmountOfCopay_Coinsurance1 (1%)
ApprovedMessageCode1 (1%) 2 (2%)
ApprovedMessageCodeCount1 (1%) 2 (2%)
AssociatedPrescription_ServiceDate4 (3%)
AssociatedPrescription_ServiceReferenceNumber4 (3%)
AuthorizationNumber10 (8%)
BasisOfCalculation_Copay2 (2%)
BasisOfCalculation_DispensingFee2 (2%)
BasisOfCalculation_FlatSalesTax2 (2%)
BasisOfCalculation_PercentageSalesTax2 (2%)
BasisOfCostDetermination5 (4%) 3 (2%)
BasisOfReimbursementDetermination2 (2%) 2 (2%)
BasisOfRequest3 (2%)
BINNumber57 (43%)
CardholderFirstName13 (10%) 1 (1%)
CardholderID53 (40%)
CardholderLastName12 (9%) 1 (1%)
ClinicalInformationCounter1 (1%) 3 (2%)
CompoundCode48 (36%)
CompoundDispensingUnitFormIndicator17 (13%) 2 (2%)
CompoundDosageFormDescriptionCode17 (13%) 2 (2%)
CompoundIngredientBasisofCostDetermination1 (1%) 8 (6%)
CompoundIngredientComponentCount18 (14%) 1 (1%)
CompoundIngredientDrugCost9 (7%) 3 (2%)
CompoundIngredientQuantity18 (14%) 1 (1%)
CompoundProductID18 (14%) 1 (1%)
CompoundProductIDQualifier17 (13%) 2 (2%)
CompoundRouteofAdministration17 (13%) 2 (2%)
CoordinationofBenefits_OtherPaymentsCount22 (17%)
DateOfBirth38 (29%) 3 (2%)
DateOfService55 (41%)
DateOfService25 (19%)
DatePrescriptionWritten44 (33%) 1 (1%)
DaysSupply51 (38%)
DaysSupplyIntendedToBeDispensed1 (1%) 4 (3%)
DiagnosisCode1 (1%)
DiagnosisCodeCount1 (1%)
DiagnosisCodeQualifier1 (1%)
DispenseAsWritten_DAW__ProductSelectionCode36 (27%) 1 (1%)
DispensingFeePaid6 (5%)
DispensingFeeSubmitted24 (18%) 5 (4%)
DispensingStatus1 (1%) 4 (3%)
DURCo_AgentID6 (5%)
DURCo_AgentIDQualifier6 (5%)
DUR_PPSCodeCounter15 (11%) 1 (1%)
DUR_PPSLevelOfEffort3 (2%) 6 (5%)
EligibilityClarificationCode6 (5%)
EmployerID6 (5%)
FacilityID4 (3%)
FillNumber46 (35%) 2 (2%)
FlatSalesTaxAmountPaid2 (2%)
FlatSalesTaxAmountSubmitted5 (4%)
GrossAmountDue31 (23%) 3 (2%)
GroupID26 (20%) 1 (1%)
GroupID2 (2%)
HeaderResponseStatus23 (17%)
HelpDeskPhoneNumber2 (2%)
HelpDeskPhoneNumberQualifier2 (2%)
HomePlan4 (3%)
IncentiveAmountPaid2 (2%)
IncentiveAmountSubmitted5 (4%)
IngredientCostPaid6 (5%)
IngredientCostSubmitted25 (19%) 3 (2%)
IntermediaryAuthorizationID5 (4%)
IntermediaryAuthorizationTypeID5 (4%)
LevelOfService3 (2%)
MeasurementDate3 (2%)
MeasurementDimension3 (2%)
MeasurementTime3 (2%)
MeasurementUnit3 (2%)
MeasurementValue3 (2%)
NetworkReimbursementID2 (2%)
NumberofRefillsAuthorized18 (14%) 6 (5%)
OriginallyPrescribedProduct_ServiceCode4 (3%)
OriginallyPrescribedProduct_ServiceIDQualifier4 (3%)
OriginallyPrescribedQuantity4 (3%)
OtherAmountClaimedSubmitted2 (2%) 3 (2%)
OtherAmountClaimedSubmittedCount1 (1%) 5 (4%)
OtherAmountClaimedSubmittedQualifier1 (1%) 3 (2%)
OtherCoverageCode13 (10%) 2 (2%)
OtherPayerAmountPaid7 (5%)
OtherPayerAmountPaidCount9 (7%)
OtherPayerAmountPaidQualifier6 (5%) 1 (1%)
OtherPayerAmountRecognized1 (1%)
OtherPayerCoverageType21 (16%) 1 (1%)
OtherPayerDate7 (5%) 4 (3%)
OtherPayerID6 (5%) 4 (3%)
OtherPayerIDQualifier8 (6%) 4 (3%)
OtherPayerRejectCode3 (2%)
OtherPayerRejectCount2 (2%)
PatientCityAddress3 (2%) 4 (3%)
PatientFirstName21 (16%) 4 (3%)
PatientGenderCode34 (26%) 3 (2%)
PatientID1 (1%) 4 (3%)
PatientIDQualifier4 (3%)
PatientLastName19 (14%) 4 (3%)
PatientLocation8 (6%) 3 (2%)
PatientPaidAmountSubmitted12 (9%) 5 (4%)
PatientPayAmount9 (7%)
PatientPhoneNumber4 (3%)
PatientRelationshipCode26 (20%) 4 (3%)
PatientState_ProvinceAddress3 (2%) 4 (3%)
PatientStreetAddress3 (2%) 4 (3%)
PatientZip_PostalZone3 (2%) 4 (3%)
PayerID2 (2%)
PayerIDQualifier2 (2%)
PercentageSalesTaxAmountPaid2 (2%)
PercentageSalesTaxAmountSubmitted1 (1%) 5 (4%)
PercentageSalesTaxBasisPaid2 (2%)
PercentageSalesTaxBasisSubmitted1 (1%) 5 (4%)
PercentageSalesTaxRatePaid2 (2%)
PercentageSalesTaxRateSubmitted1 (1%) 5 (4%)
PersonCode9 (7%) 4 (3%)
PlanID5 (4%)
PlanID1 (1%) 3 (2%)
PreferredProductCopayIncentive2 (2%)
PreferredProductCount2 (2%)
PreferredProductDescription2 (2%)
PreferredProductID2 (2%)
PreferredProductIDQualifier2 (2%)
PreferredProductIncentive2 (2%)
PregnancyIndicator3 (2%)
PrescriberID41 (31%)
PrescriberIDQualifier37 (28%)
PrescriberLastName6 (5%) 4 (3%)
PrescriberLocationCode4 (3%)
PrescriberPhoneNumber4 (3%)
PrescriptionOriginCode4 (3%) 4 (3%)
Prescription_ServiceReferenceNumber55 (41%)
Prescription_ServiceReferenceNumber15 (11%)
Prescription_ServiceReferenceNumberQualifier54 (41%)
Prescription_ServiceReferenceNumberQualifier15 (11%)
PrimaryCareProviderID4 (3%)
PrimaryCareProviderIDQualifier4 (3%)
PrimaryCareProviderLastName4 (3%)
PrimaryCareProviderLocationCode4 (3%)
PriorAuthorizationNumberSubmitted1 (1%)
PriorAuthorizationTypeCode1 (1%) 5 (4%)
ProcedureModifierCode6 (5%)
ProcedureModifierCodeCount1 (1%) 6 (5%)
ProcessorControlNumber53 (40%) 2 (2%)
Product_ServiceID55 (41%)
Product_ServiceIDQualifier53 (40%)
ProfessionalServiceCode8 (6%) 1 (1%)
ProfessionalServiceFeePaid2 (2%)
ProfessionalServiceFeeSubmitted2 (2%) 3 (2%)
ProviderID1 (1%)
ProviderIDQualifier1 (1%)
QuantityDispensed53 (40%)
QuantityIntendedToBeDispensed1 (1%) 4 (3%)
QuantityPrescribed2 (2%) 4 (3%)
ReasonForServiceCode9 (7%) 2 (2%)
RejectCode10 (8%)
RejectCount11 (8%)
RejectedFieldOccurrenceIndicator2 (2%) 1 (1%)
RemainingBenefitAmount2 (2%)
RemainingDeductibleAmount1 (1%) 2 (2%)
RequestPeriodDate_Begin3 (2%)
RequestPeriodDate_End3 (2%)
RequestType3 (2%)
ResultofServiceCode9 (7%) 1 (1%)
ScheduledPrescriptionIDNumber4 (3%)
SegmentIdentification47 (35%)
SegmentIdentification53 (40%)
SegmentIdentification5 (4%)
SegmentIdentification4 (3%)
SegmentIdentification3 (2%)
SegmentIdentification6 (5%)
SegmentIdentification43 (32%)
SegmentIdentification23 (17%)
SegmentIdentification5 (4%)
SegmentIdentification55 (41%)
SegmentIdentification25 (19%)
SegmentIdentification5 (4%)
SegmentIdentification18 (14%)
SegmentIdentification55 (41%)
SegmentIdentification4 (3%) 5 (4%)
SegmentIdentification1 (1%)
SegmentIdentification21 (16%)
SegmentIdentification15 (11%)
SegmentIdentification10 (8%)
SegmentIdentification1 (1%)
ServiceProviderID55 (41%)
ServiceProviderID25 (19%)
ServiceProviderIDQualifier53 (40%) 2 (2%)
ServiceProviderIDQualifier25 (19%)
Smoker_Non_SmokerCode6 (5%)
SoftwareVendor_CertificationID52 (39%) 2 (2%)
SubmissionClarificationCode7 (5%) 3 (2%)
TaxExemptIndicator1 (1%) 2 (2%)
TotalAmountPaid10 (8%)
TransactionCode55 (41%)
TransactionCode25 (19%)
TransactionCount55 (41%)
TransactionCount23 (17%)
TransactionResponseStatus21 (16%)
UnitDoseIndicator2 (2%) 4 (3%)
UnitOfMeasure6 (5%) 4 (3%)
UsualandCustomaryCharge51 (38%)
Version_ReleaseNumber55 (41%)
Version_ReleaseNumber25 (19%)


  

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  wjcp3clcweb06 -- 17 April 2014 -- 07:15:25 AM MDT