IHCLME Health care claim or encounter request and response
TBG10 Healthcare
This message is to support interactive submittal and response of health care claims or encounters for the point of sale environment. It will be used in health care information scenarios when immediate response is appropriate.
Header
- 0010Interactive message headerMandatoryMax 1
To head, identify and specify a message.
- 0020Message action detailsConditionalMax 1
To specify the message and business function and to provide a tracking mechanism.
- 0030Party informationConditionalMax 9
To provide specific identification number and demographic information regarding the identity of the participating parties.
- 0040Name and addressConditionalMax 9
To specify the name/address and their related function, either by E082 only and/or unstructured by E058 or structured by E080 through 3207.
- 0050Contact informationConditionalMax 9
To specify contact communication numbers and names.
- 0060Billable informationConditionalMax 1
To provide billable information for a claim or encounter.
- 0070Institutional claimConditionalMax 1
To provide specific claim information for services performed while admitted to an institution.
- 0080Health care claim adjudication informationConditionalMax 99
To provide adjudication information for all services in a health care claim.
- 0090Follow-up actionConditionalMax 99
To identify a follow-up action that should occur.
- Segment group 1Repeat 3
- 0110Other insuranceMandatoryMax 1
To provide payer, insured, and payment information when benefits are being coordinated between third party benefit carriers.
- 0120Name and addressConditionalMax 2
To specify the name/address and their related function, either by E082 only and/or unstructured by E058 or structured by E080 through 3207.
- 0110Other insuranceMandatoryMax 1
- Segment group 2Repeat 99
- 0140Service informationMandatoryMax 1
To provide detail information about the service.
- 0150Dental informationConditionalMax 35
To provide specific tooth and oral cavity information.
- 0140Service informationMandatoryMax 1
- 0160Interactive message trailerMandatoryMax 1
To end and check the completeness of a message.
1. 0340, the value shall be identical to the value in 0340 in thecorresponding UIH segment.