837P Edit Lookup Tool

The Edit Lookup Tools allow submitters to access rejection information they receive on their TA1, 999 or 277CA reports. The tool provides the user with detailed information as to what the rejection is related to.

To use the Edit Lookup Tool, enter in either part of the rejection code or a keyword.

Example of a rejection from a 277CA report:
STC*A7:500:GB*20240120*U*10384.72~

Using this example, enter either the A7, the 500 or the GB. The 500 would be the best option for narrowing down the specific error.

Enter rejection code or keyword

837P Edit Reference	Description	ID	Min. Max.	Usage Req.	Loop Repeat	5010A1 Values	TA1/ 999/ 277CA	Disposition/ Error Code	Proposed 5010A1 Edits Part B
X222 C3 ISA 010	INTERCHANGE CONTROL HEADER	N/A	1	R	1	N/A	TA1	TA105 = 024: "Invalid Interchange Content".	ISA must be present.
X222C3 ISA 015	N/A	N/A	N/A	N/A	N/A	N/A	TA1	TA105 = 022: "Invalid Control Structure" -OR- TA105 = 023: "Improper (Premature) End-of-File (Transmission)" -OR- TA105: 024 "Invalid Interchange Content".	Only one iteration of ISA is allowed.
X222 C3 ISA01 010	Authorization Information Qualifier	ID	2-2	R	N/A	00, 03	TA1	TA105 = 010: "Invalid Authorization Information Qualifier Value".	ISA01 must be present.
X222 C3 ISA01 020	N/A	N/A	N/A	N/A	N/A	N/A	TA1	TA105 = 010: "Invalid Authorization Information Qualifier Value".	ISA01 must be valid values.
X222 C3 ISA02 010	Authorization Information	AN	10-10	R	N/A	N/A	TA1	TA105 = 011: "Invalid Authorization Information Value".	ISA02 must be present.
X222 C3 ISA02 020	N/A	N/A	N/A	N/A	N/A	N/A	TA1	TA105 = 011: "Invalid Authorization Information Value".	ISA02 must be 10 characters.
X222 C3 ISA02 030	N/A	N/A	N/A	N/A	N/A	N/A	TA1	TA105 = 011: "Invalid Authorization Information Value".	ISA02 must be populated with accepted AN characters OR ISA02 must be populated with all spaces.
X222 C3 ISA03 010	Security Information Qualifier	ID	2-2	R	N/A	00, 01	TA1	TA105 = 012: "Security Information Qualifier Value".	ISA03 must be present.
X222 C3 ISA03 020	N/A	N/A	N/A	N/A	N/A	N/A	TA1	TA105 = 012: "Security Information Qualifier Value".	ISA03 must be valid values.
X222 C3 ISA04 010	Security Information	AN	10-10	R	N/A	N/A	TA1	TA105 = 013: "Security Information Value".	ISA04 must be present.
X222 C3 ISA04 020	N/A	N/A	N/A	N/A	N/A	N/A	TA1	TA105 = 013: "Security Information Value".	ISA04 must be 10 characters.
X222 C3 ISA04 030	N/A	N/A	N/A	N/A	N/A	N/A	TA1	TA105 = 013: "Security Information Value".	ISA04 must be populated with accepted AN characters OR ISA04 must be populated with all spaces.
X222 C3 ISA05 010	Interchange ID Qualifier	ID	2-2	R	N/A	01, 14, 20, 27, 28, 29, 30, 33, ZZ	TA1	TA105 = 005: "Invalid Interchange ID Qualifier for Sender".	ISA05 must be present.
X222 C3 ISA05 020	N/A	N/A	N/A	N/A	N/A	N/A	TA1	TA105 = 005: "Invalid Interchange ID Qualifier for Sender".	ISA05 must be "27", "28" or "ZZ".
X222 C3 ISA06 010	Interchange Sender ID	AN	15-15	R	N/A	N/A	TA1	TA105 = 006: "Invalid Interchange Sender ID".	ISA06 must be present.
X222 C3 ISA06 020	N/A	N/A	N/A	N/A	N/A	N/A	TA1	TA105 = 006: "Invalid Interchange Sender ID".	ISA06 must be 15 characters.
X222 C3 ISA06 030	N/A	N/A	N/A	N/A	N/A	N/A	TA1	TA105 = 006: "Invalid Interchange Sender ID".	ISA06 must contain at least one non-space character.
X222 C3 ISA06 040	N/A	N/A	N/A	N/A	N/A	N/A	TA1	TA105 = 006: "Invalid Interchange Sender ID".	ISA06 must be populated with accepted AN characters.
X222 C3 ISA07 010	Interchange ID Qualifier	ID	2-2	R	N/A	01, 14, 20, 27, 28, 29, 30, 33, ZZ	TA1	TA105 = 007: "Invalid Interchange ID Qualifier for Receiver".	ISA07 must be present.
X222 C3 ISA07 020	N/A	N/A	N/A	N/A	N/A	N/A	TA1	TA105 = 007: "Invalid Interchange ID Qualifier for Receiver".	ISA07 must be "27", "28" or "ZZ".
X222 C3 ISA08 010	Interchange Receiver ID	AN	15-15	R	N/A	N/A	TA1	TA105 = 008: "Invalid Interchange Receiver ID".	ISA08 must be present.
X222 C3 ISA08 020	N/A	N/A	N/A	N/A	N/A	N/A	TA1	TA105 = 008: "Invalid Interchange Receiver ID".	ISA08 must be 15 characters.
X222 C3 ISA08 030	N/A	N/A	N/A	N/A	N/A	N/A	TA1	TA105 = 008: "Invalid Interchange Receiver ID".	ISA08 must contain at least one non-space character.
X222 C3 ISA08 040	N/A	N/A	N/A	N/A	N/A	N/A	TA1	TA105 = 008: "Invalid Interchange Receiver ID".	ISA08 must be populated with accepted AN characters.
X222 C3 ISA09 010	Interchange Date	DT	6-6	R	N/A	YYMMDD	TA1	TA105 = 014: "Invalid Interchange Date Value".	ISA09 must be present.
X222 C3 ISA09 020	N/A	N/A	N/A	N/A	N/A	N/A	TA1	TA105 = 014: "Invalid Interchange Date Value".	ISA09 must be a valid date in YYMMDD format.
X222 C3 ISA09 030	N/A	N/A	N/A	N/A	N/A	N/A	TA1	TA105 = 014: "Invalid Interchange Date Value".	ISA09 must be a the date of the interchange; must not be a future date.
X222 C3 ISA10 010	Interchange Time	TM	4-4	R	N/A	HHMM	TA1	TA105 = 015: "Invalid Interchange Time Value".	ISA10 must be present.
X222 C3 ISA10 020	N/A	N/A	N/A	N/A	N/A	N/A	TA1	TA105 = 015: "Invalid Interchange Time Value".	ISA10 must be a valid time in HHMM format.
X222 C3 ISA11 010	Repetition Separator	N/A	1-1	R	N/A	N/A	TA1	TA105 = 024: "Invalid Interchange Content".	ISA11 must be present.
X222 C3 ISA11 020	N/A	N/A	N/A	N/A	N/A	N/A	TA1	TA105 = 024: "Invalid Interchange Content".	ISA11 must be 1 character.
X222 C3 ISA11 030	N/A	N/A	N/A	N/A	N/A	N/A	TA1	TA105 = 024: "Invalid Interchange Content".	ISA11 must contain at least one non-space character.
X222 C3 ISA12 010	Interchange Control Version Number	ID	5-5	R	N/A	00501	TA1	TA105 = 017: "Invalid Interchange Version ID Value".	ISA12 must be present.
X222 C3 ISA12 020	N/A	N/A	N/A	N/A	N/A	N/A	TA1	TA105 = 017: "Invalid Interchange Version ID Value".	ISA12 must be "00501".
X222 C3 ISA13 010	Interchange Control Number	N0	9-9	R	N/A	N/A	TA1	TA105 = 018: "Invalid Interchange Control Number Value".	ISA13 must be present.
X222 C3 ISA13 020	N/A	N/A	N/A	N/A	N/A	N/A	TA1	TA105 = 018: "Invalid Interchange Control Number Value".	ISA13 must be numeric.
X222 C3 ISA13 030	N/A	N/A	N/A	N/A	N/A	N/A	TA1	TA105 = 018: "Invalid Interchange Control Number Value".	ISA13 must be 9 characters.
X222 C3 ISA13 040	N/A	N/A	N/A	N/A	N/A	N/A	TA1	TA105 = 018: "Invalid Interchange Control Number Value".	ISA13 must be > 0.
X222 C3 ISA13 050	N/A	N/A	N/A	N/A	N/A	N/A	TA1	TA105 = 018: "Invalid Interchange Control Number Value".	ISA13 must be unsigned.
X222 C3 ISA14 010	Acknowledgement Requested	ID	1-1	R	N/A	0, 1	TA1	TA105 = 019: "Invalid Acknowledgment Requested Value".	ISA14 must be present.
X222 C3 ISA14 020	N/A	N/A	N/A	N/A	N/A	N/A	TA1	TA105 = 019: "Invalid Acknowledgment Requested Value".	ISA14 must be valid values.
X222 C3 ISA15 010	Usage Indicator	ID	1-1	R	N/A	P, T	TA1	TA105 = 020: "Invalid Test Indicator Value".	ISA15 must be present.
X222 C3 ISA15 020	N/A	N/A	N/A	N/A	N/A	N/A	TA1	TA105 = 020: "Invalid Test Indicator Value".	ISA15 must be valid values.
X222 C3 ISA16 010	Component Element Separator	N/A	1-1	R	N/A	N/A	TA1	TA105 = 027: "Invalid Component Element Separator"	ISA16 must be present.
X222 C3 ISA16 020	N/A	N/A	N/A	N/A	N/A	N/A	TA1	TA105 = 027: "Invalid Component Element Separator"	ISA16 must be 1 character.
X222 C3 ISA16 030	N/A	N/A	N/A	N/A	N/A	N/A	TA1	TA105 = 027: "Invalid Component Element Separator"	ISA16 must contain at least one non-space character.
X222 C7 GS 010	FUNCTIONAL GROUP HEADER	N/A	1	R	1	N/A	TA1	TA105 = 024: "Invalid Interchange Content".	GS must be present.
X222 C7 GS 020	N/A	N/A	N/A	N/A	N/A	N/A	999	AK905 = 1: "Functional Group Not Supported".	Only one iteration of GS is allowed.
X222 C7 GS01 010	Functional Identifier Code	ID	2-2	R	N/A	HC	999	AK905 = 1: "Functional Group Not Supported".	GS01 must be present.
X222 C7 GS01 020	N/A	N/A	N/A	N/A	N/A	HC	999	AK905 = 1: "Functional Group Not Supported".	GS01 must be "HC".
X222 C7 GS02 010	Application Sender Code	AN	2-15	R	N/A	N/A	999	AK905 = 14: "Unknown Security Originator".	GS02 must be present.
X222 C7 GS02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	AK905 = 14: "Unknown Security Originator".	GS02 must be 2 - 15 characters.
X222 C7 GS02 030	N/A	N/A	N/A	N/A	N/A	N/A	999	AK905 = 14: "Unknown Security Originator".	GS02 must contain at least two non-space characters.
X222 C7 GS02 040	N/A	N/A	N/A	N/A	N/A	N/A	999	AK905 = 14: "Unknown Security Originator".	GS02 must be populated with accepted AN characters.
X222 C7 GS03 010	Application Receiver Code	AN	2-15	R	N/A	N/A	999	AK905 = 13: "Unknown Security Recipient".	GS03 must be present.
X222 C7 GS03 020	N/A	N/A	N/A	N/A	N/A	N/A	999	AK905 = 13: "Unknown Security Recipient".	GS03 must be 2 - 15 characters.
X222 C7 GS03 030	N/A	N/A	N/A	N/A	N/A	N/A	999	AK905 = 13: "Unknown Security Recipient".	GS03 must contain at least two non-space characters.
X222 C7 GS03 040	N/A	N/A	N/A	N/A	N/A	N/A	999	AK905 = 13: "Unknown Security Recipient".	GS03 must be populated with accepted AN characters.
X222 C7 GS04 010	Date	DT	8-8	R	N/A	CCYYMMDD	TA1	TA105 = 024: "Invalid Interchange Content".	GS04 must be present.
X222 C7 GS04 020	N/A	N/A	N/A	N/A	N/A	N/A	TA1	TA105 = 024: "Invalid Interchange Content".	GS04 must be a valid date in CCYYMMDD format.
X222 C7 GS04 030	N/A	N/A	N/A	N/A	N/A	N/A	TA1	TA105 = 024: "Invalid Interchange Content".	GS04 must be the date the functional group is created; must not be a future date.
X222 C7 GS05 010	Time	TM	4-8	R	N/A	HHMM	TA1	TA105 = 024: "Invalid Interchange Content".	GS05 must be present.
X222 C7 GS05 020	N/A	N/A	N/A	N/A	N/A	N/A	TA1	TA105 = 024: "Invalid Interchange Content".	GS05 must be a valid time in a valid format.
X222 C7 GS06 010	Group Control Number	N0	1-9	R	N/A	N/A	999	AK905 = 6: "Group Control Number Violates Syntax".	GS06 must be present.
X222 C7 GS06 020	N/A	N/A	N/A	N/A	N/A	N/A	999	AK905 = 6: "Group Control Number Violates Syntax".	GS06 must be numeric.
X222 C7 GS06 030	N/A	N/A	N/A	N/A	N/A	N/A	999	AK905 = 6: "Group Control Number Violates Syntax".	GS06 must be > 0.
X222 C7 GS06 040	N/A	N/A	N/A	N/A	N/A	N/A	999	AK905 = 6: "Group Control Number Violates Syntax".	GS06 must be <= 999,999,999.
X222 C7 GS06 050	N/A	N/A	N/A	N/A	N/A	N/A	999	AK905 = 19: "Functional Group Control Number not Unique within Interchange.	GS06 must be unique within the interchange.
X222 C7 GS07 010	Responsible Agency Code	ID	1-2	R	N/A	X	TA1	TA105 = 024: "Invalid Interchange Content".	GS07 must be present.
X222 C7 GS07 020	N/A	N/A	N/A	N/A	N/A	N/A	TA1	TA105 = 024: "Invalid Interchange Content".	GS07 must be "X".
X222A1 60 GS08 010	Version Identifier Code	AN	1-12	R	N/A	005010X222A1	999	AK905 = 2: "Functional Group Version Not Supported"	GS08 must be present.
X222A1 60 GS08 020	N/A	N/A	N/A	N/A	N/A	N/A	999	AK905 = 2: "Functional Group Version Not Supported"	GS08 must be "005010X222A1"
X222 070 ST 010	TRANSACTION SET HEADER	N/A	1	R	>1	N/A	999	IK502 = 6: "Missing or Invalid Transaction Set Identifier".	ST must be present.
X222 070 ST 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK502 = 1: "Transaction Set Not Supported" OR AK905 = 5: "Number Included Transaction Sets Does Not Match Actual Count" OR IK502 = 6: "Missing or Invalid Transaction Set Identifier" OR IK502 = I5: "Implementation One or More Segments in Error"	Only one iteration of ST is allowed.
X222 070 ST01 010	Transaction Set Identifier Code	ID	3-3	R	N/A	837	999	IK502 = 6: "Missing or Invalid Transaction Set Identifier".	ST01 must be present.
X222 070 ST01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK502 = 6: "Missing or Invalid Transaction Set Identifier".	ST01 must be "837".
X222 070 ST02 010	Transaction Set Control Number	AN	4-9	R	N/A	N/A	999	IK502 = 7: "Missing or Invalid Transaction Set Control Number".	ST02 must be present.
X222 070 ST02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK502 = 7: "Missing or Invalid Transaction Set Control Number".	ST02 must be 4-9 characters.
X222 070 ST02 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK502 = 7: "Missing or Invalid Transaction Set Control Number".	ST02 must contain at least four non-space characters.
X222 070 ST02 040	N/A	N/A	N/A	N/A	N/A	N/A	999	IK502 = 7: "Missing or Invalid Transaction Set Control Number".	ST02 must be populated with accepted AN characters.
X222 070 ST02 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK502 = 23: "Transaction Set Control Number Not Unique within the Functional Group".	ST02 must be a unique number within the ISA-IEA envelope.
X222 070 ST03 010	Implementation Guide Version Name	AN	1-35	R	N/A	N/A	999	IK502 = I6: "Implementation Convention Not Supported".	ST03 must be present.
X222A1 014 ST03 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK502 = 19: "Invalid Transaction Set Implementation Convention Reference"	ST03 must be "005010X222A1".
X222 071 BHT 010	BEGINNING OF HIERARCHICAL TRANSACTION	N/A	1	R	1	N/A	999	IK304 = 3: "Required Segment Missing"	BHT must be present.
X222 071 BHT 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of BHT is allowed.
X222 071 BHT01 010	Hierarchical Structure Code	ID	4-4	R	N/A	0019	999	IK403 = 1: "Required Data Element Missing"	BHT01 must be present.
X222 071 BHT01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	BHT01 must be "0019".
X222 071 BHT02 010	Transaction Set Purpose Code	ID	2-2	R	N/A	00, 18	999	IK403 = 1: "Required Data Element Missing"	BHT02 must be present.
X222 071 BHT02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	BHT02 must be valid values.
X222 071 BHT03 010	Originator Application Transaction ID	AN	1-50	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	BHT03 must be present.
X222 071 BHT03 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	BHT03 must be 1 - 30 characters.
X222 071 BHT03 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	BHT03 must be populated with accepted AN characters.
X222 071 BHT04 010	Transaction Set Creation Date	DT	8-8	R	N/A	CCYYMMDD	999	IK403 = 1: "Required Data Element Missing"	BHT04 must be present.
X222 071 BHT04 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 8: "Invalid Date"	BHT04 must be a valid date in CCYYMMDD format.
X222 071 BHT05 010	Transaction Set Creation Time	TM	4-8	R	N/A	HHMM, HHMMSS, HHMMSSD, HHMMSSDD	999	IK403 = 1: "Required Data Element Missing"	BHT05 must be present.
X222 071 BHT05 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 9: "Invalid Time"	BHT05 must a valid time in a valid time format.
X222 071 BHT06 010	Claim or Encounter ID	ID	2-2	R	N/A	31, CH, RP	999	IK403 = 1: "Required Data Element Missing"	BHT06 must be present.
X222 071 BHT06 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	BHT06 must be"CH".
X222 074 1000A 010	SUBMITTER NAME loop	N/A	1	R	1	N/A	999	IK304 = 4: "Loop Occurs Over Maximum Times"	Only one iteration of 1000A is allowed.
X222 074 1000A NM1 010	SUBMITTER NAME	N/A	N/A	N/A	N/A	N/A	999	IK304 = 3: "Required Segment Missing"	1000A.NM1 must be present.
X222 074 1000A NM101 010	Entity Identifier Code	ID	2-3	R	N/A	41	999	IK403 = 1: "Required Data Element Missing"	1000A.NM101 must be present.
X222 074 1000A NM101 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	1000A.NM101 must be "41".
X222 074 1000A NM102 010	Entity Type Qualifier	ID	1-1	R	N/A	1, 2	999	IK403 = 1: "Required Data Element Missing"	1000A.NM102 must be present.
X222 074 1000A NM102 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	1000A.NM102 must be valid values.
X222 074 1000A NM103 010	Submitter Last or Organization Name	AN	1-60	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	1000A.NM103 must be present.
X222 074 1000A NM103 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	1000A.NM103 must be 1 - 60 characters.
X222 074 1000A NM103 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	1000A.NM103 must contain at least one non-space character.
X222 074 1000A NM103 040	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	1000A.NM103 must be populated with accepted AN characters.
X222 074 1000A NM104 010	Submitter First Name	AN	1-35	S	N/A	N/A	999	IK403 = I13: "Implementation Dependent "Not Used" Data Element Present"	If 1000A.NM102 is "2", 1000A.NM104 must not be present.
X222 074 1000A NM104 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	1000A.NM104 must be 1 - 35 characters.
X222 074 1000A NM104 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	1000A.NM104 must contain at least one non-space character.
X222 074 1000A NM104 060	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	1000A.NM104 must be populated with accepted AN characters.
X222 074 1000A NM105 010	Submitter Middle Name	AN	1-25	S	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	1000A.NM105 must contain at least one non-space character.
X222 074 1000A NM105 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = I13: "Implementation Dependent "Not Used" Data Element Present"	If 1000A.NM102 is "2", 1000A.NM105 must not be present.
X222 074 1000A NM105 040	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	1000A.NM105 must be 1 - 25 characters.
X222 074 1000A NM105 060	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	1000A.NM105 must be populated with accepted AN characters.
X222 074 1000A NM105 065	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement /Rejected for Invalid Information..." CSC 514: "Entity's Middle Name" EIC: 41 "Submitter"	The first position of 1000A.NM105 must be alphabetic (A...Z).
X222 074 1000A NM106 010	Name Prefix	AN	1-10	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 074 1000A NM107 010	Name Suffix	AN	1-10	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 074 1000A NM108 010	Identification Code Qualifier	ID	1-2	R	N/A	46	999	IK403 = 1: "Required Data Element Missing"	1000A.NM108 must be present.
X222 074 1000A NM108 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	1000A.NM108 must be "46".
X222 074 1000A NM109 010	Submitter Identifier	AN	2-80	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	1000A.NM109 must be present.
X222 074 1000A NM109 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	1000A.NM109 must contain at least two non-space characters.
X222 074 1000A NM109 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 4: "Data Element Too Short" IK403 = 5: "Data Element Too Long"	1000A.NM109 must be 2-80 characters.
X222 074 1000A NM109 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	1000A.NM109 must be populated with accepted AN characters.
X222 074 1000A NM109 070	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = I12: "Implementation Pattern Match Failure"	1000A.NM109 must be an approved electronic submitter.
X222 074 1000A NM110 010	Entity Relationship Code	ID	2-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 074 1000A NM111 010	Entity Identifier Code	ID	2-3	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 074 1000A NM112 010	Name Last or Organization Name	AN	1-60	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 076 1000A PER 010	SUBMITTER EDI CONTACT INFORMATION	N/A	2	R	N/A	N/A	999	IK304 = 3: "Required Segment Missing"	1000A.PER must be present.
X222 076 1000A PER 020	SUBMITTER EDI CONTACT INFORMATION	N/A	N/A	N/A	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only two iterations of 1000A.PER are allowed.
X222 076 1000A PER01 010	Contact Function Code	ID	2-2	R	N/A	IC	999	IK403 = 1: "Required Data Element Missing"	1000A.PER01 must be present.
X222 076 1000A PER01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	1000A.PER01 must be "IC".
X222 076 1000A PER02 010	Submitter Contact Name	AN	1-60	S	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	1000A.PER02 must contain at least one non-space character.
X222 076 1000A PER02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = I12: "Implementation Pattern Match Failure"	For the 1st 1000A.PER transmitted, 1000A.PER02 must not = 1000A.NM103.
X222 076 1000A PER02 040	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = I13: "Implementation Dependent "Not Used" Data Element Present"	For the 2nd 1000A.PER transmitted, 1000A.PER02 must not be present.
X222 076 1000A PER02 060	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	1000A.PER02 must be 1 - 60 characters.
X222 076 1000A PER02 080	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	1000A.PER02 must be populated with accepted AN characters.
X222 076 1000A PER03 010	Communication Number Qualifier	ID	2-2	R	N/A	EM, FX. TE	999	IK403 = 1: "Required Data Element Missing"	1000A.PER03 must be present.
X222 076 1000A PER03 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	1000A.PER03 must be valid values.
X222 076 1000A PER04 010	Communication Number	AN	1-256	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	1000A.PER04 must be present.
X222 076 1000A PER04 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	1000A.PER04 must contain at least one non-space character.
X222 076 1000A PER04 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	1000A.PER04 must be 1 - 256 characters.
X222 076 1000A PER04 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	1000A.PER04 must be populated with accepted AN characters.
X222 076 1000A PER04 070	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 127: "Entity's Communication Number" EIC: 41 "Submitter"	1000A.PER04 must be populated with exactly ten numeric characters when 1000A.PER03 equals TE or FX.
X222 076 1000A PER05 010	Communication Number Qualifier	ID	2-2	S	N/A	EM, EX, FX, TE	999	IK403 = 7: "Invalid Code Value"	1000A.PER05 must be valid values.
X222 076 1000A PER05 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	If 1000A.PER05 is "EX", 1000A.PER03 must be "TE".
X222 076 1000A PER06 010	Communication Number	AN	1-256	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	If 1000A.PER06 is present, 1000A.PER05 must be present.
X222 076 1000A PER06 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	1000A.PER06 must contain at least one non-space character.
X222 076 1000A PER06 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	1000A.PER06 must be 1 - 256 characters.
X222 076 1000A PER06 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	1000A.PER06 must be populated with accepted AN characters.
X222 076 1000A PER06 070	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 127: "Entity's Communication Number" EIC: 41 "Submitter"	1000A.PER06 must be populated with exactly ten numeric characters when 1000A.PER05 equals TE or FX.
X222 076 1000A PER07 010	Communication Number Qualifier	ID	2-2	S	N/A	EM, EX, FX, TE	999	IK403 = 2: "Conditional Required Data Element Missing"	If 1000A.PER07 is present, 1000A.PER05 must be present.
X222 076 1000A PER07 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	1000A.PER07 must be valid values.
X222 076 1000A PER07 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	If 1000A.PER07 is "EX", 1000A.PER05 must be "TE".
X222 076 1000A PER08 010	Communication Number	AN	1-256	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	If 1000A.PER08 is present, 1000A.PER07 must be present.
X222 076 1000A PER08 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	1000A.PER08 must contain at least one non-space character.
X222 076 1000A PER08 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	1000A.PER08 must be 1 - 256 characters.
X222 076 1000A PER08 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	1000A.PER08 must be populated with accepted AN characters.
X222 076 1000A PER08 070	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 127: "Entity's Communication Number" EIC: 41 "Submitter"	1000A.PER08 must be populated with exactly ten numeric characters when 1000A.PER07 equals TE or FX.
X222 076 1000A PER09 010	Contact Inquiry Reference	AN	1-20	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 079 1000B 010	RECEIVER NAME Loop	N/A	1	R	1	N/A	999	IK304 = 4: "Loop Occurs Over Maximum Times"	Only one iteration of 1000B is allowed.
X222 079 1000B NM1 010	RECEIVER NAME	N/A	N/A	N/A	N/A	N/A	999	IK304 = 3: "Required Segment Missing"	1000B.NM1 must be present.
X222 079 1000B NM101 010	Entity Identifier Code	ID	2-3	R	N/A	40	999	IK403 = 1: "Required Data Element Missing"	1000B.NM101 must be present.
X222 079 1000B NM101 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	1000B.NM101 must be "40".
X222 079 1000B NM102 010	Entity Type Qualifier	ID	1-1	R	N/A	2	999	IK403 = 1: "Required Data Element Missing"	1000B.NM102 must be present.
X222 079 1000B NM102 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	1000B.NM102 must be "2".
X222 079 1000B NM103 010	Receiver Name	AN	1-60	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	1000B.NM103 must be present.
X222 079 1000B NM103 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	1000B.NM103 must be 1 - 60 characters.
X222 079 1000B NM103 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	1000B.NM103 must be populated with accepted AN characters.
X222 079 1000B NM103 040	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	1000B.NM103 must contain at least one non-space character.
X222 079 1000B NM104 010	Name First	AN	1-35	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 079 1000B NM105 010	Name Middle	AN	1-25	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 079 1000B NM106 010	Name Prefix	AN	1-10	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 079 1000B NM107 010	Name Suffix	AN	1-10	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 079 1000B NM108 010	Identification Code Qualifier	ID	1-2	R	N/A	46	999	IK403 = 1: "Required Data Element Missing"	1000B.NM108 must be present.
X222 079 1000B NM108 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	1000B.NM108 must be "46".
X222 079 1000B NM109 010	Receiver Primary Identifier	AN	2-80	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	1000B.NM109 must be present.
X222 079 1000B NM109 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = I12: "Implementation Pattern Match Failure"	1000B.NM109 must be [contractor put receiver code here]
X222 079 1000B NM109 060	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = I12: "Implementation Pattern Match Failure"	1000B NM109 must equal GS03
X222 079 1000B NM110 010	Entity Relationship Code	ID	2-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 079 1000B NM111 010	Entity Identifier Code	ID	2-3	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 079 1000B NM112 010	Name Last or Organization Name	AN	1-60	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 081 2000A HL 010	BILLING PROVIDER HIERARCHICAL LEVEL	N/A	1	R	1	N/A	999	IK304 = 3: "Required Segment Missing"	2000A.HL must be present.
X222 081 2000A HL 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2000A.HL is allowed.
X222 081 2000A HL01 010	Hierarchical ID Number	AN	1-12	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2000A.HL01 must be present.
X222 081 2000A HL01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2000A.HL01 must be 1 - 12 characters.
X222 081 2000A HL01 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2000A.HL01 must be numeric.
X222 081 2000A HL01 040	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	The first HL01 must be "1".
X222 081 2000A HL02 010	Hierarchical Parent ID Number	AN	1-12	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 081 2000A HL03 010	Hierarchical Level Code	ID	1-2	R	N/A	20	999	IK403 = 1: "Required Data Element Missing"	2000A.HL03 must be present.
X222 081 2000A HL03 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2000A.HL03 must be "20".
X222 081 2000A HL04 010	Hierarchical Child Code	ID	1-1	R	N/A	1	999	IK403 = 1: "Required Data Element Missing"	2000A.HL04 must be present.
X222 081 2000A HL04 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2000A.HL04 must be "1'.
X222 083 2000A PRV 010	BILLING PROVIDER SPECIALTY INFORMATION	N/A	1	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2000A.PRV is allowed.
X222 083 2000A PRV01 010	Provider Code	ID	1-3	R	N/A	BI	999	IK403 = 1: "Required Data Element Missing"	2000A PRV01 must be present.
X222 083 2000A PRV01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2000A.PRV01 must be "BI".
X222 083 2000A PRV02 010	Reference Identification Qualifier	ID	2-3	R	N/A	PXC	999	IK403 = 1: "Required Data Element Missing"	2000A.PRV02 must be present.
X222 083 2000A PRV02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2000A.PRV02 must be "PXC".
X222 083 2000A PRV03 010	Provider Taxonomy Code	AN	1-50	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2000A.PRV03 must be present.
X222 083 2000A PRV03 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 145: "Entity's specialty/taxonomy code" EIC: 85 "Billing Provider"	2000A.PRV03 must be a valid Provider Taxonomy Code
X222 083 2000A PRV04 010	State or Province Code	ID	2-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 083 2000A PRV05 010	PROVIDER SPECIALTY INFORMATION	N/A	N/A	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 083 2000A PRV06 010	Provider Organization Code	ID	3-3	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 084 2000A CUR 010	FOREIGN CURRENCY INFORMATION	N/A	1	S	N/A	N/A	999	IK304 = I4: "Implementation "Not Used" Segment Present"	2000A.CUR must not be present.
X222 084 2000A CUR 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 681: "Claim Currency Not Supported"	N/A
X222 087 2010AA 010	Billing Provider Name Loop	N/A	1	R	1	N/A	999	IK304 = 4: "Loop Occurs Over Maximum Times"	Only one iteration of 2010AA is allowed.
X222 087 2010AA NM1 010	Billing Provider Name	N/A	N/A	N/A	N/A	N/A	999	IK304 = 3: "Required Segment Missing"	2010AA.NM1 must be present.
X222 087 2010AA NM101 010	Entity Identifier Code	ID	2-3	R	N/A	85	999	IK403 = 1: "Required Data Element Missing"	2010AA.NM101 must be present.
X222 087 2010AA NM101 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2010AA.NM101 must be "85".
X222 087 2010AA NM102 010	Entity Type Qualifier	ID	1-1	R	N/A	1, 2	999	IK403 = 1: "Required Data Element Missing"	2010AA.NM102 must be present.
X222 087 2010AA NM102 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2010AA.NM102 must be valid values.
X222 087 2010AA NM103 010	Billing Provider Last or Organizational Name	AN	1-60	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2010AA.NM103 must be present.
X222 087 2010AA NM103 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2010AA.NM103 must contain at least one non-space character.
X222 087 2010AA NM103 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2010AA.NM103 must be 1 - 60 characters.
X222 087 2010AA NM103 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 504: "Entity's Last Name" EIC: 85 "Billing Provider"	N/A
X222 087 2010AA NM103 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2010AA.NM103 must be populated with accepted AN characters.
X222 087 2010AA NM104 010	Billing Provider First Name	AN	1-35	S	N/A	N/A	999	IK403 = I13: "Implementation Dependent "Not Used" Data Element Present"	If 2010AA.NM102 is "2", 2010AA.NM104 must not be present.
X222 087 2010AA NM104 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A8: "Acknowledgement/Rejected for relational field in error." CSC 505: "Entity's First Name" EIC: 85 "Billing Provider"	N/A
X222 087 2010AA NM104 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2010AA.NM104 must contain at least one non-space character.
X222 087 2010AA NM104 040	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2010AA.NM104 must be 1 - 35 characters.
X222 087 2010AA NM104 050	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 505: "Entity's First Name" EIC: 85 "Billing Provider"	N/A
X222 087 2010AA NM104 060	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2010AA.NM104 must be populated with accepted AN characters.
X222 087 2010AA NM105 010	Billing Provider Middle Name	AN	1-25	S	N/A	N/A	999	IK403 = I13: "Implementation Dependent "Not Used" Data Element Present"	If 2010AA.NM102 is "2", 2010AA.NM105 must not be present.
X222 087 2010AA NM105 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A8: "Acknowledgement/Rejected for relational field in error." CSC 514: "Entity's Middle Name" EIC: 85 "Billing Provider"	N/A
X222 087 2010AA NM105 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2010AA.NM105 must contain at least one non-space character.
X222 087 2010AA NM105 040	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2010AA.NM105 must be 1 - 25 characters.
X222 087 2010AA NM105 050	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 514: "Entity's Middle Name" EIC: 85 "Billing Provider"	N/A
X222 087 2010AA NM105 060	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2010AA.NM105 must be populated with accepted AN characters.
X222 087 2010AA NM105 065	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement /Rejected for Invalid Information..." CSC 514: "Entity's Middle Name" EIC: 85 "Billing Provider"	The first position of 2010AA.NM105 must be alphabetic (A...Z).
X222 087 2010AA NM106 010	Name Prefix	AN	1-10	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 087 2010AA NM107 010	Billing Provider Name Suffix	AN	1-10	S	N/A	N/A	999	IK403 = I13: "Implementation Dependent "Not Used" Data Element Present"	If 2010AA.NM102 is "2", 2010AA.NM107 must not be present.
X222 087 2010AA NM107 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A8: "Acknowledgement/Rejected for relational field in error." CSC 125: "Entity's Name" EIC: 85 "Billing Provider"	N/A
X222 087 2010AA NM107 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2010AA.NM107 must contain at least one non-space character.
X222 087 2010AA NM107 040	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2010AA.NM107 must be 1 - 10 characters.
X222 087 2010AA NM107 050	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 125: "Entity's Name" EIC: 85 "Billing Provider"	N/A
X222 087 2010AA NM107 060	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2010AA.NM107 must be populated with accepted AN characters.
X222 087 2010AA NM108 010	Identification Code Qualifier	ID	1-2	S	N/A	XX	277	CSCC A8: "Acknowledgement/Rejected for relational field in error." CSC 745: "Identifier Qualifier" CSC 562: "Entity's National Provider Identifier (NPI)" EIC: 85 "Billing Provider"	2010AA.NM108 must not be present when 2300.REF with REF01 = "P4" and REF02 is a valid VA identifier".
X222 087 2010AA NM108 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A6: "Acknowledgement/Rejected for Missing Information..." CSC 745: "Identifier Qualifier" CSC 562: "Entity's National Provider Identifier (NPI)" EIC: 85 "Billing Provider"	2010AA.NM108 must be present.
X222 087 2010AA NM108 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2010AA.NM108 must be "XX".
X222 087 2010AA NM109 010	Billing Provider Identifier	AN	2-80	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	2010AA.NM109 must be present if 2010AA.NM108 is present.
X222 087 2010AA NM109 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 562: "Entity's National Provider Identifier (NPI)" EIC: 85 "Billing Provider"	2010AA.NM109 must be valid according to the NPI algorithm.
X222 087 2010AA NM109 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 562: "Entity's National Provider Identifier (NPI)" EIC: 85 "Billing Provider"	2010AA.NM109 must be a valid NPI on the Crosswalk when evaluated with 1000B.NM109.
X222 087 2010AA NM109 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 562: "Entity's National Provider Identifier (NPI)" EIC: 85 "Billing Provider"	The first position of 2010AA.NM109 must be a "1".
X222 087 2010AA NM109 050	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A8: "Acknowledgement/Rejected for relational field in error" CSC 496 "Submitter not approved for electronic claim submissions on behalf of this entity." EIC: 85 "Billing Provider"	2010AA.NM109 billing provider must be "associated" to the submitter (from a trading partner management perspective) in 1000A.NM109. -OR-
X222 087 2010AA NM109 050	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A8: "Acknowledgement/Rejected for relational field in error" CSC 496 "Submitter not approved for electronic claim submissions on behalf of this entity." EIC: 85 "Billing Provider"	2010AA.NM109 billing provider must be "associated" to the submitter (from a trading partner management perspective) in 1000A.NM109.
X222 087 2010AA NM110 010	Entity Relationship Code	ID	2-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 087 2010AA NM111 010	Entity Identifier Code	ID	2-3	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 087 2010AA NM112 010	Name Last or Organization Name	AN	1-60	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 091 2010AA N3 010	BILLING PROVIDER ADDRESS	N/A	1	R	N/A	N/A	999	IK304 = 3: "Required Segment Missing"	2010AA.N3 must be present.
X222 091 2010AA N3 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2010AA.N3 is allowed.
X222 091 2010AA N301 010	Billing Provider Address Line	AN	1-55	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2010AA.N301 must be present.
X222 091 2010AA N301 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2010AA.N301 must contain at least one non-space character.
X222 091 2010AA N301 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2010AA.N301 must be 1 - 55 characters.
X222 091 2010AA N301 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 126: "Entity's Address" EIC: 85 "Billing Provider"	N/A
X222 091 2010AA N301 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2010AA.N301 must be populated with accepted AN characters.
X222 091 2010AA N301 070	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 503: "Entity's Street Address" EIC: 85 "Billing Provider"	2010AA.N301 must not contain the following exact phrases (not case sensitive): "Post Office Box", "P.O. Box", "PO Box", "P O Box", "Lock Box", "Lock Bin".
X222 091 2010AA N302 005	Billing Provider Address Line	AN	1-55	S	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2010AA.N302 must contain at least one non-space character.
X222 091 2010AA N302 010	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2010AA.N302 must be 1 - 55 characters.
X222 091 2010AA N302 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 126: "Entity's Address" EIC: 85 "Billing Provider"	N/A
X222 091 2010AA N302 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2010AA.N302 must be populated with accepted AN characters.
X222 091 2010AA N302 060	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 503: "Entity's Street Address" EIC: 85 "Billing Provider"	2010AA.N302 must not contain the following exact phrases (not case sensitive): "Post Office Box", "P.O. Box", "PO Box", "P O Box", "Lock Box", "Lock Bin".
X222 092 2010AA N4 010	BILLING PROVIDER CITY/STATE/ZIP CODE	N/A	1	R	N/A	N/A	999	IK304 = 3: "Required Segment Missing"	2010AA.N4 must be present.
X222 092 2010AA N4 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2010AA.N4 is allowed.
X222 092 2010AA N401 010	Billing Provider City Name	AN	2-30	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2010AA.N401 must be present.
X222 092 2010AA N401 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2010AA.N401 must contain at least two non-space characters.
X222 092 2010AA N401 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 4: "Data Element Too Short" IK403 = 5: "Data Element Too Long"	2010AA.N401 must be 2-30 characters.
X222 092 2010AA N401 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 502: "Entity's City" EIC: 85 "Billing Provider"	N/A
X222 092 2010AA N401 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2010AA.N401 must be populated with accepted AN characters.
X222 092 2010AA N402 010	Billing Provider State or Province Code	ID	2-2	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2010AA.N404 is not present, 2010AA.N402 must be present.
X222 092 2010AA N402 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 501: "Entity's State/Province" EIC: 85 "Billing Provider"	2010AA.N402 must be a valid State Code.
X222 092 2010AA N403 010	Billing Provider Postal Zone or ZIP Code	ID	3-15	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2010AA.N404 is not present, 2010AA.N403 must be present.
X222 092 2010AA N403 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 500: "Entity's Postal/Zip Code" EIC: 85 "Billing Provider"	2010AA.N403 must be a valid 9 digit Zip Code.
X222 092 2010AA N404 010	Country Code	ID	2-3	S	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 092 2010AA N405 010	Location Qualifier	ID	1-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 092 2010AA N406 010	Location Identifier	AN	1-30	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 092 2010AA N407 005	Country Subdivision Code	ID	1-3	S	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 094 2010AA REF 010	BILLING PROVIDER TAX IDENTIFICATION	N/A	1	R	N/A	N/A	999	IK304 = 3: "Required Segment Missing"	2010AA.REF must be present.
X222 094 2010AA REF 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2010AA.REF with REF01 = "EI" or "SY" is allowed.
X222 094 2010AA REF01 010	Reference Identification Qualifier	ID	2-3	R	N/A	EI, SY	999	IK403 = 1: "Required Data Element Missing"	2010AA.REF01 must be present.
X222 094 2010AA REF01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2010AA.REF01 must be valid values.
X222 094 2010AA REF02 010	Billing Provider Tax Identification Number	AN	1-50	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2010AA.REF02 must be present.
X222 094 2010AA REF02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2010AA.REF02 must be populated with accepted AN characters.
X222 094 2010AA REF02 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 128: "Entity's tax id" EIC: 85 "Billing Provider"	2010AA.REF02 must be nine digits with no punctuation.
X222 094 2010AA REF02 050	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A8: "Acknowledgement/Rejected for relational field in error" CSC 562: "Entity's National Provider Identifier (NPI)" CSC 128: "Entity's tax id" EIC: 85 "Billing Provider"	2010AA.REF must be associated with the provider identified in 2010AA.NM109
X222 094 2010AA REF03 010	Description	AN	1-80	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 094 2010AA REF04 010	REFERENCE IDENTIFIER	N/A	N/A	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 096 2010AA REF 010	BILLING PROVIDER UPIN/LICENSE INFORMATION	N/A	2	S	N/A	N/A	999	IK304 = I9: "Implementation Dependent "Not Used" Segment Present"	2010AA.REF with REF01 = "1G" may be present when 2010AA.NM1 is present and 2010AA.NM109 is not present.
X222 096 2010AA REF 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 732: "Information submitted inconsistent with billing guidelines." CSC 560: "Entity's Additional/Secondary Identifier." EIC: 85 "Billing Provider"	Only one iteration of 2010AA.REF with REF01 = "1G" is allowed.
X222 096 2010AA REF 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK304 = I9: "Implementation Dependent "Not Used" Segment Present"	2010AA.REF must not be present.
X222 096 2010AA REF01 010	Reference Identification Qualifier	ID	2-3	R	N/A	0B, 1G	999	IK403 = 1: "Required Data Element Missing"	2010AA.REF01 must be present.
X222 096 2010AA REF01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2010AA.REF01 must be "1G".
X222 096 2010AA REF02 010	Billing Provider Additional Identifier	AN	1-50	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2010AA.REF02 must be present.
X222 096 2010AA REF02 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 164: "Entity's contract/member number" EIC: 85 "Billing Provider"	When 2010AA.REF01 = "1G", 2010AA.REF02 must be in format ANNNNN or AAANNN (where A is an alpha character and N is a numeric digit).
X222 096 2010AA REF03 010	Description	AN	1-80	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 096 2010AA REF04 010	REFERENCE IDENTIFIER	N/A	N/A	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 098 2010AA PER 020	BILLING PROVIDER CONTACT INFORMATION	N/A	2	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only two iterations of 2010AA.PER are allowed.
X222 098 2010AA PER01 010	Contact Function Code	ID	2-2	R	N/A	IC	999	IK403 = 1: "Required Data Element Missing"	2010AA.PER01 must be present.
X222 098 2010AA PER01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2010AA.PER01 must be "IC".
X222 098 2010AA PER02 010	Billing Provider Contact Name	AN	1-60	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	For the 1st 2010AA.PER transmitted, 2010AA.PER02 must be present.
X222 098 2010AA PER02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = I13: "Implementation Dependent "Not Used" Data Element Present"	For the 2nd 2010AA.PER transmitted, 2010AA.PER02 must not be present.
X222 098 2010AA PER02 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 10: "Exclusion Condition Violated"	2010AA.PER02 must not = 1000A.PER02.
X222 098 2010AA PER02 040	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2010AA.PER02 must contain at least one non-space character.
X222 098 2010AA PER02 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2010AA.PER02 must be 1 - 60 characters.
X222 098 2010AA PER02 060	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 561: "Entity's Contact Name" EIC: 85 "Billing Provider"	N/A
X222 098 2010AA PER02 070	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2010AA.PER02 must be populated with accepted AN characters.
X222 098 2010AA PER03 010	Communication Number Qualifier	ID	2-2	R	N/A	EM, FX, TE	999	IK403 = 1: "Required Data Element Missing"	2010AA.PER03 must be present.
X222 098 2010AA PER03 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2010AA.PER03 must be valid values.
X222 098 2010AA PER04 010	Communication Number	AN	1-256	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2010AA.PER04 must be present.
X222 098 2010AA PER04 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2010AA.PER04 must contain at least one non-space character.
X222 098 2010AA PER04 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2010AA.PER04 must be 1 - 256 characters.
X222 098 2010AA PER04 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 127: "Entity's Communication Number" EIC: 85 "Billing Provider"	N/A
X222 098 2010AA PER04 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2010AA.PER04 must be populated with accepted AN characters.
X222 098 2010AA PER04 070	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 127: "Entity's Communication Number" EIC: 85 "Billing Provider"	2010AA.PER04 must be populated with exactly ten numeric characters when 2010AA.PER03 equals TE or FX.
X222 098 2010AA PER05 010	Communication Number Qualifier	ID	2-2	S	N/A	EM, EX, FX, TE	999	IK403 = 7: "Invalid Code Value"	2010AA.PER05 must be valid values.
X222 098 2010AA PER05 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	If 2010AA.PER05 is "EX" 2010AA.PER03 must be "TE"
X222 098 2010AA PER06 010	Communication Number	AN	1-256	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2010AA.PER06 is present 2010AA.PER05 must be present.
X222 098 2010AA PER06 015	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2010AA.PER06 must contain at least one non-space character.
X222 098 2010AA PER06 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2010AA.PER06 must be 1 - 256 characters.
X222 098 2010AA PER06 025	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 127: "Entity's Communication Number" EIC: 85 "Billing Provider"	N/A
X222 098 2010AA PER06 040	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2010AA.PER06 must be populated with accepted AN characters.
X222 098 2010AA PER06 060	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 127: "Entity's Communication Number" EIC: 85 "Billing Provider"	2010AA.PER06 must be populated with exactly ten numeric characters when 2010AA.PER05 equals TE or FX.
X222 098 2010AA PER07 010	Communication Number Qualifier	ID	2-2	S	N/A	EM, EX, FX, TE	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2010AA.PER07 is present, 2010AA.PER05 must be present.
X222 098 2010AA PER07 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2010AA.PER07 must be valid values.
X222 098 2010AA PER07 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	If 2010AA.PER07 is "EX", 2010AA.PER05 must be "TE".
X222 098 2010AA PER08 010	Communication Number	AN	1-256	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2010AA.PER07 is present, 2010AA.PER08 must be present.
X222 098 2010AA PER08 015	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2010AA.PER08 must contain at least one non-space character.
X222 098 2010AA PER08 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2010AA.PER08 must be 1 - 256 characters.
X222 098 2010AA PER08 040	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2010AA.PER08 must be populated with accepted AN characters.
X222 098 2010AA PER08 060	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 127: "Entity's Communication Number" EIC: 85 "Billing Provider"	2010AA.PER08 must be populated with exactly ten numeric characters when 2010AA.PER07 equals TE or FX.
X222 098 2010AA PER09 010	Contact Inquiry Reference	AN	1-20	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 101 2010AB NM1 010	PAY-TO ADDRESS NAME	N/A	1	S	1	N/A	999	IK304 = 4: "Loop Occurs Over Maximum Times"	Only one iteration of 2010AB.NM1 is allowed.
X222 101 2010AB NM101 010	Entity Identifier Code	ID	2-3	R	N/A	87	999	IK403 = 1: "Required Data Element Missing"	2010AB.NM101 must be present.
X222 101 2010AB NM101 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2010AB.NM101 must be "87".
X222 101 2010AB NM102 010	Entity Type Qualifier	ID	1-1	R	N/A	1, 2	999	IK403 = 1: "Required Data Element Missing"	2010AB.NM102 must be present.
X222 101 2010AB NM102 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2010AB.NM102 must be valid values.
X222 101 2010AB NM103 010	Pay-to Provider Last or Organization Name	AN	1-60	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 101 2010AB NM104 010	Pay-to Provider First Name	AN	1-35	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 101 2010AB NM105 010	Pay-to Provider Middle Name	AN	1-25	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 101 2010AB NM106 010	Name Prefix	AN	1-10	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 101 2010AB NM107 010	Pay-to Provider Name Suffix	AN	1-10	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 101 2010AB NM108 010	Identification Code Qualifier	ID	1-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 101 2010AB NM109 010	Pay-to Provider Identifier	AN	2-80	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 101 2010AB NM110 010	Entity Relationship Code	ID	2-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 101 2010AB NM111 010	Entity Identifier Code	ID	2-3	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 101 2010AB NM112 010	Name Last or Organization Name	AN	1-60	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 103 2010AB N3 010	PAY-TO ADDRESS	N/A	1	R	N/A	N/A	999	IK304 = I6: "Implementation Dependent Segment Missing"	If 2010AB.NM1 is present, 2010AB.N3 must be present.
X222 103 2010AB N3 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2010AB.N3 is allowed.
X222 103 2010AB N301 010	Pay-to Provider Address Line	AN	1-55	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2010AB.N301 must be present.
X222 103 2010AB N301 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2010AB.N301 must contain at least one non-space character.
X222 103 2010AB N301 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2010AB.N301 must be 1 - 55 characters.
X222 103 2010AB N301 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 126: "Entity's Address" EIC: 87 "Pay-to Provider"	N/A
X222 103 2010AB N301 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2010AB.N301 must be populated with accepted AN character.
X222 103 2010AB N302 010	Pay-to Provider Address Line	AN	1-55	S	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2010AB.N302 must contain at least one non-space character.
X222 103 2010AB N302 040	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2010AB.N302 must be 1 - 55 characters.
X222 103 2010AB N302 045	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 126: "Entity's Address" EIC: 87 "Pay-to Provider"	N/A
X222 103 2010AB N302 060	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2010AB.N302 must be populated with accepted AN character.
X222 104 2010AB N4 010	PAY-TO ADDRESS CITY/STATE/ZIP CODE	N/A	1	R	N/A	N/A	999	IK304 = I6: "Implementation Dependent Segment Missing"	If 2010AB.NM1 is present, 2010AB.N4 must be present.
X222 104 2010AB N4 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2010AB.N4 is allowed.
X222 104 2010AB N401 010	Pay-to Address City Name	AN	2-30	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2010AB.N401 must be present.
X222 104 2010AB N401 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2010AB.N401 must contain at least two non-space characters.
X222 104 2010AB N401 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 4: "Data Element Too Short" IK403 = 5: "Data Element Too Long"	2010AB.N401 must be 2-30 characters.
X222 104 2010AB N401 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 502: "Entity's City" EIC: 87 "Pay-to Provider"	N/A
X222 104 2010AB N401 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2010AB.N401 must be populated with accepted AN characters.
X222 104 2010AB N402 010	Pay-to Address State Code	ID	2-2	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2010AB.N404 is not present, 2010AB.N402 must be present.
X222 104 2010AB N402 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 501: "Entity's State/Province Code" EIC: 87 "Pay-to Provider"	2010AB.N402 must be a valid State Code.
X222 104 2010AB N403 010	Pay-to Address Postal Zone or ZIP Code	ID	3-15	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2010AB.N404 is not present, 2010AB.N403 must be present.
X222 104 2010AB N403 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 500: "Entity's Postal/Zip Code" EIC: 87 "Pay-to Provider"	2010AB.N403 must be a valid Zip Code.
X222 104 2010AB N404 010	Country Code	ID	2-3	S	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 104 2010AB N405 010	Location Qualifier	ID	1-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 104 2010AB N406 010	Location Identifier	AN	1-30	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 104 2010AB N407 005	Country Subdivision Code	ID	1-3	S	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 106 2010AC NM1 010	PAY-TO PLAN NAME	N/A	1	S	N/A	N/A	277	CSCC A3: "Acknowledgement/Returned as unprocessable claim" CSC 732: "Information submitted inconsistent with billing guidelines." CSC 125: "Entity's name." EIC: 87 "Pay-to Provider"	2010AC.NM1 must not be present
X222 108 2010AC N3 010	PAY-TO PLAN ADDRESS	N/A	1	R	N/A	N/A	277	CSCC A3: "Acknowledgement/Rejected as unprocessable claim" CSC 732: "Information submitted inconsistent with billing guidelines." CSC 503: "Entity's Street Address." EIC: 87 "Pay-to Provider"	2010AC.N3 must not be present.
X222 109 2010AC N4 010	PAY-TO PLAN CITY/STATE/ZIP CODE	N/A	1	R	N/A	N/A	277	CSCC A3: "Acknowledgement/Rejected as unprocessable claim" CSC 732: "Information submitted inconsistent with billing guidelines." CSC 126: "Entity's Address." EIC: 87 "Pay-to Provider"	2010AC.N4 must not be present.
X222 111 2010AC REF 010	PAY-TO PLAN SECONDARY IDENTIFICATION NUMBER	N/A	1	R	N/A	N/A	277	CSCC A3: "Acknowledgement/Rejected as unprocessable claim" CSC 732: "Information submitted inconsistent with billing guidelines." CSC 560: "Entity's Additional/Secondary Identifier. " EIC: 87 "Pay-to Provider"	2010AC.REF must not be present.
X222 113 2010AC REF 020	PAY-TO PLAN TAX IDENTIFICATION NUMBER	N/A	1	R	N/A	N/A	277	CSCC A3: "Acknowledgement/Rejected as unprocessable claim" CSC 732: "Information submitted inconsistent with billing guidelines." CSC 128: "Entity's tax id." EIC: 87 "Pay-to Provider"	2010AC.REF must not be present.
X222 114 2000B 010	SUBSCRIBER Loop	N/A	N/A	N/A	>1	N/A	999	IK304 = I7: "Implementation Loop Occurs Under Minimum Times"	2000B must be present.
X222 114 2000B HL 010	SUBSCRIBER HIERARCHICAL LEVEL	N/A	1	R	1	N/A	999	IK304 = 3: "Required Segment Missing"	2000B.HL must be present.
X222 114 2000B HL 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2000B.HL is allowed.
X222 114 2000B HL01 010	Hierarchical ID Number	AN	1-12	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2000B.HL01 must be present.
X222 114 2000B HL01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2000B.HL01 must be 1 - 12 characters.
X222 114 2000B HL01 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2000B.HL01 must be numeric.
X222 114 2000B HL01 040	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = I12: "Implementation Pattern Match Failure"	2000B.HL01 must be equal the value of the previous HL01 (2000A.HL01) plus one.
X222 114 2000B HL02 010	Hierarchical Parent ID Number	AN	1-12	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2000B.HL02 must be present.
X222 114 2000B HL02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = I12: "Implementation Pattern Match Failure"	2000B.HL02 must be equal to the value of the HL01 (2000A.HL01) of the parent HL.
X222 114 2000B HL03 010	Hierarchical Level Code	ID	1-2	R	N/A	22	999	IK403 = 1: "Required Data Element Missing"	2000B.HL03 must be present.
X222 114 2000B HL03 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2000B.HL03 must be "22".
X222 114 2000B HL04 010	Hierarchical Child Code	ID	1-1	R	N/A	0, 1	999	IK403 = 1: "Required Data Element Missing"	2000B.HL04 must be present.
X222 114 2000B HL04 015	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2000B.HL04 must be "0".
X222 116 2000B SBR 010	SUBSCRIBER INFORMATION	N/A	1	R	1	N/A	999	IK304 = 3: "Required Segment Missing"	2000B.SBR must be present.
X222 116 2000B SBR 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2000B.SBR is allowed.
X222 116 2000B SBR01 010	Payer Responsibility Sequence Number Code	ID	1-1	R	N/A	A, B, C, D, E, F, G, H, P, S, T, U	999	IK403 = 1: "Required Data Element Missing"	2000B.SBR01 must be present.
X222 116 2000B SBR01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2000B.SBR01 must be "S" or "P".
X222 116 2000B SBR01 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 732 "Information submitted inconsistent with billing guidelines." CSC 742 "Payer Responsibility Sequence Number Code."	N/A
X222 116 2000B SBR02 010	Individual Relationship Code	ID	2-2	S	N/A	18	999	IK403 = 1: "Required Data Element Missing"	2000B.SBR02 must be present.
X222 116 2000B SBR02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2000B.SBR02 must be "18".
X222 116 2000B SBR03 004	Subscriber Group or Policy Number	AN	1-50	S	N/A	N/A	999	IK403 = I13: "Implementation Dependent "Not Used" Data Element Present"	2000B.SBR03 must not be present
X222 116 2000B SBR03 006	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A8: "Acknowledgement/Rejected for relational field in error" CSC 163: "Entity's Policy Number" CSC 732 "Information submitted inconsistent with billing guidelines." EIC: IL "Subscriber"	N/A
X222 116 2000B SBR04 005	Insured Group Name	AN	1-60	S	N/A	N/A	999	IK403 = I13: "Implementation Dependent "Not Used" Data Element Present"	2000B.SBR04 must not be present
X222 116 2000B SBR04 007	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A8: "Acknowledgement/Rejected for relational field in error" CSC 663: "Entity's Group Name" CSC 732 "Information submitted inconsistent with billing guidelines." EIC: IL "Subscriber"	N/A
X222 116 2000B SBR05 010	Insurance Type Code	ID	1-3	S	N/A	12, 13, 14, 15, 16, 41, 42, 43, 47	999	IK403 = 7: "Invalid Code Value"	2000B.SBR05 must be valid values.
X222 116 2000B SBR05 040	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	If 2000B.SBR01 is "P", 2000B.SBR05 must not be present.
X222 116 2000B SBR05 045	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A8: "Acknowledgement/Rejected for relational field in error" CSC 578: "Insurance Type Code" EIC: IL "Subscriber"	N/A
X222 116 2000B SBR05 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2000B.SBR01 is not "P", 2000B.SBR05 must be present.
X222 116 2000B SBR05 055	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A6: "Acknowledgement/Rejected for Missing Information " CSC 578: "Insurance Type Code" EIC: IL "Subscriber"	N/A
X222 116 2000B SBR06 010	Coordination of Benefits Code	ID	1-1	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 116 2000B SBR07 010	Yes/No Condition or Response Code	ID	1-1	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 116 2000B SBR08 010	Employment Status Code	ID	2-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 116 2000B SBR09 010	Claim Filing Indicator Code	ID	1-2	S	N/A	11, 12, 13, 14, 15, 16, 17, AM, BL, CH, CI, DS, FI, HM, LM, MA, MB, MC, OF, TV, VA, WC, ZZ	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 732 "Information submitted inconsistent with billing guidelines." CSC 480 "Entity's claim filing indicator." EIC: PR "Payer"	2000B.SBR09 must be "MB".
X222 119 2000B PAT 010	PATIENT INFORMATION	N/A	1	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2000B.PAT is allowed.
X222 119 2000B PAT01 010	Individual Relationship Code	ID	2-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 119 2000B PAT02 010	Patient Location Code	ID	1-1	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 119 2000B PAT03 010	Employment Status Code	ID	2-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 119 2000B PAT04 010	Student Status Code	ID	1-1	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 119 2000B PAT05 010	Date Time Period Format Qualifier	ID	2-3	S	N/A	D8	999	IK403 = 7: "Invalid Code Value"	2000B.PAT05 must be "D8"
X222 119 2000B PAT06 010	Patient Death Date	AN	1-35	S	N/A	CCYYMMDD	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2000B.PAT05 is present, 2000B.PAT06 must be present.
X222 119 2000B PAT06 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 8: "Invalid Date"	2000B.PAT06 must be a valid date in CCYYMMDD format.
X222 119 2000B PAT07 015	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 119 2000B PAT08 005	Patient Weight	R	1-10	S	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 119 2000B PAT09 010	Pregnancy Indicator	ID	1-1	S	N/A	Y	999	IK403 = 7: "Invalid Code Value"	2000B.PAT09 must be "Y".
X222 121 2010BA NM1 010	SUBSCRIBER NAME	N/A	1	R	1	N/A	999	IK304 = 3: "Required Segment Missing"	2010BA.NM1 must be present.
X222 121 2010BA NM1 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK304 = 4: "Loop Occurs Over Maximum Times"	Only one iteration of 2010BA.NM1 allowed.
X222 121 2010BA NM101 010	Entity Identifier Code	ID	2-3	R	N/A	IL	999	IK403 = 1: "Required Data Element Missing"	2010BA.NM101 must be present.
X222 121 2010BA NM101 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2010BA.NM101 must be "IL".
X222 121 2010BA NM102 010	Entity Type Qualifier	ID	1-1	R	N/A	1, 2	999	IK403 = 1: "Required Data Element Missing"	2010BA.NM102 must be present.
X222 121 2010BA NM102 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 732: "Information submitted inconsistent with billing guidelines." CSC741 "Entity must be a person." EIC: IL "Subscriber"	2010BA.NM102 must be "1".
X222 121 2010BA NM103 010	Subscriber Last Name	AN	1-60	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2010BA.NM103 must be present.
X222 121 2010BA NM103 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2010BA.NM103 must contain at least one non-space character.
X222 121 2010BA NM103 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2010BA.NM103 must be 1 - 60 characters.
X222 121 2010BA NM103 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 504: "Entity's Last Name" EIC: IL "Subscriber"	N/A
X222 121 2010BA NM103 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2010BA.NM103 must be populated with accepted AN characters.
X222 121 2010BA NM104 010	Subscriber First Name	AN	1-35	S	N/A	N/A	277	CSCC A6: "Acknowledgement/Rejected for Missing Information..." CSC 505: "Entity's First Name" EIC: IL "Subscriber"	2010BA.NM104 must be present.
X222 121 2010BA NM104 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2010BA.NM104 must contain at least one non-space character.
X222 121 2010BA NM104 030	N/A	AN	1-35	S	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2010BA.NM104 must be 1 - 35 characters.
X222 121 2010BA NM104 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 505: "Entity's First Name" EIC: IL "Subscriber"	N/A
X222 121 2010BA NM104 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2010BA.NM104 must be populated with accepted AN characters.
X222 121 2010BA NM104 070	Subscriber First Name	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement /Rejected for Invalid Information..." CSC 511: "Invalid character" CSC 505: "Entity's First Name" EIC: IL "Subscriber"	First position of 2010BA.NM104 must not be numeric.
X222 121 2010BA NM105 010	Subscriber Middle Name or Initial	AN	1-25	S	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2010BA.NM105 must contain at least one non-space character.
X222 121 2010BA NM105 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2010BA.NM105 must be 1 - 25 characters.
X222 121 2010BA NM105 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 514: "Entity's Middle Name" EIC: IL "Subscriber"	N/A
X222 121 2010BA NM105 040	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2010BA.NM105 must be populated with accepted AN characters.
X222 121 2010BA NM105 045	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement /Rejected for Invalid Information..." CSC 514: "Entity's Middle Name" EIC: IL "Subscriber"	The first position of 2010BA.NM105 must be alphabetic (A...Z).
X222 121 2010BA NM106 010	Name Prefix	AN	1-10	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 121 2010BA NM107 010	Subscriber Name Suffix	AN	1-10	S	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2010BA.NM107 must contain at least one non-space character.
X222 121 2010BA NM107 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2010BA.NM107 must be 1 - 10 characters.
X222 121 2010BA NM107 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 125: "Entity's Name" EIC: IL "Subscriber"	N/A
X222 121 2010BA NM107 040	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2010BA.NM107 must be populated with accepted AN characters.
X222A1 015 2010BA NM108 010	Identification Code Qualifier	ID	1-2	S	N/A	II, MI	999	IK403 = 1: "Required Data Element Missing"	2010BA.NM108 must be present.
X222 121 2010BA NM108 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2010BA.NM108 must be "MI".
X222A1 016 2010BA NM109 010	Subscriber Primary Identifier	AN	2-80	S	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2010BA.NM109 must be present.
X222 121 2010BA NM109 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 164: "Entity's contract/member number" EIC: IL "Subscriber"	If Medicare HICN: 2010BA.NM109 must be 10 - 11 positions in the format of NNNNNNNNNA or NNNNNNNNNAA or NNNNNNNNNAN where "A" represents an alpha character and "N" represents a numeric digit. -OR- If Railroad HICN: 2010BA.NM109 must be 7 - 12 positions in the format of ANNNNNN, AANNNNNN, ANNNNNNNNN, AANNNNNNNNN, AAANNNNNN, or AAANNNNNNNNN where "A" represents an alpha character and "N" represents a numeric digit. If MBI: 2010BA.NM109 must be 11 positions in the format of C A AN N A AN N A A N N where "C" represents a constrained numeric 1 thru 9, "A" represents alphabetic character A - Z but excluding S, L, O, I, B, Z, "N" represents numeric 0 thru 9 and "AN" represents either "A" or "N".
X222 121 2010BA NM109 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 164: "Entity's contract/member number" EIC: IL "Subscriber"	If the HIC/MBI format is valid, 2010BA.NM109 must be a valid HICN prior to the MBI transition start date, must be a valid HICN or valid MBI on or after the MBI transition start date, must be a valid MBI after the MBI transition end date based on the date in the +RC DTP segment.
X222 121 2010BA NM110 010	Entity Relationship Code	ID	2-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 121 2010BA NM111 010	Entity Identifier Code	ID	2-3	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 121 2010BA NM112 010	Name Last or Organization Name	AN	1-60	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 124 2010BA N3 005	SUBSCRIBER ADDRESS	N/A	1	S	N/A	N/A	999	IK304 = I6: "Implementation Dependent Segment Missing"	2010BA.N3 must be present when 2000B.SBR02 is "18".
X222 124 2010BA N3 010	N/A	N/A	N/A	N/A	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2010BA.N3 is allowed.
X222 124 2010BA N301 010	Subscriber Address Line	AN	1-55	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2010BA.N301 must be present.
X222 124 2010BA N301 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2010BA.N301 must contain at least one non-space character.
X222 124 2010BA N301 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2010BA.N301 must be 1 - 55 characters.
X222 124 2010BA N301 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 503: "Entity's Street Address" EIC: IL "Subscriber"	N/A
X222 124 2010BA N301 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2010BA.N301 must be populated with accepted AN characters.
X222 124 2010BA N302 020	Subscriber Address Line	AN	1-55	S	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2010BA.N302 must contain at least one non-space character.
X222 124 2010BA N302 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2010BA.N302 must be 1 - 55 characters.
X222 124 2010BA N302 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 503: "Entity's Street Address" EIC: IL "Subscriber"	N/A
X222 124 2010BA N302 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2010BA.N302 must be populated with accepted AN characters.
X222A1 017 2010BA N4 005	SUBSCRIBER CITY/STATE/ZIP CODE	N/A	1	S	N/A	N/A	999	IK304 = I6: "Implementation Dependent Segment Missing"	2010BA.N4 must be present when 2000B.SBR02 is "18".
X222A1 017 2010BA N4 010	N/A	N/A	N/A	N/A	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2010BA.N4 is allowed.
X222 125 2010BA N401 010	Subscriber City Name	AN	2-30	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2010BA.N401 must be present.
X222 125 2010BA N401 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2010BA.N401 must contain at least two non-space characters.
X222 125 2010BA N401 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 4: "Data Element Too Short" IK403 = 5: "Data Element Too Long"	2010BA.N401 must be 2-30 characters.
X222 125 2010BA N401 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 502: "Entity's City" EIC: IL "Subscriber"	N/A
X222 125 2010BA N401 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2010BA.N401 must be populated with accepted AN characters.
X222 125 2010BA N402 010	Subscriber State Code	ID	2-2	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2010BA.N404 is not present, 2010BA.N402 must be present.
X222 125 2010BA N402 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 501: "Entity's State/Province" EIC: IL "Subscriber"	2010BA.N402 must be a valid state or province code.
X222 125 2010BA N403 010	Subscriber Postal Zone or ZIP Code	ID	3-15	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2010BA.N404 is not present, 2010BA.N403 must be present.
X222 125 2010BA N403 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 500: "Entity's Postal/Zip Code" EIC: IL "Subscriber"	2010BA.N403 must be a valid postal/zip Code when N404 equals US or blank
X222 125 2010BA N404 010	Country Code	ID	2-3	S	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 680: "Entity's Country" EIC: IL "Subscriber"	2010BA.N404 must be a valid 2 character Country Code.
X222 125 2010BA N405 010	Location Qualifier	ID	1-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 125 2010BA N406 010	Location Identifier	AN	1-30	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 125 2010BA N407 010	Country Subdivision Code	ID	1-3	S	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 695: "Entity's Country Subdivision Code" EIC: IL "Subscriber"	2010BA.N407 must be a valid Country Subdivision Code.
X222 127 2010BA DMG 010	SUBSCRIBER DEMOGRAPHIC INFORMATION	N/A	1	S	N/A	N/A	999	IK304 = I6: "Implementation Dependent Segment Missing"	2010BA.DMG must be present.
X222 127 2010BA DMG 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2010BA.DMG is allowed.
X222 127 2010BA DMG01 010	Date Time Period Format Qualifier	ID	2-3	R	N/A	D8	999	IK403 = 1: "Required Data Element Missing"	2010BA.DMG01 must be present.
X222 127 2010BA DMG01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2010BA.DMG01 must be "D8".
X222 127 2010BA DMG02 010	Subscriber Birth Date	AN	1-35	R	N/A	CCYYMMDD	999	IK403 = 1: "Required Data Element Missing"	2010BA.DMG02 must be present.
X222 127 2010BA DMG02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 8: "Invalid Date"	2010BA.DMG02 must be a valid date in format CCYYMMDD
X222 127 2010BA DMG02 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 510: "Future date" CSC 158: "Entity's date of birth" EIC: IL "Subscriber"	2010BA.DMG02 must not be a future date.
X222 127 2010BA DMG03 010	Subscriber Gender Code	ID	1-1	R	N/A	F, M, U	999	IK403 = 1: "Required Data Element Missing"	2010BA.DMG03 must be present.
X222 127 2010BA DMG03 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2010BA.DMG03 must be valid values.
X222 127 2010BA DMG04 010	Marital Status Code	ID	1-1	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 127 2010BA DMG05 010	Race or Ethnicity Code	ID	1-1	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 127 2010BA DMG06 010	Citizenship Status Code	ID	1-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 127 2010BA DMG07 010	Country Code	ID	2-3	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 127 2010BA DMG08 010	Basis of Verification Code	ID	1-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 127 2010BA DMG09 010	Quantity	R	1-15	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 127 2010BA DMG10 010	Code List Qualifier Code	ID	1-3	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 127 2010BA DMG11 010	Industry Code	AN	1-30	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 129 2010BA REF 010	SUBSCRIBER SECONDARY IDENTIFICATION	N/A	1	S	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 732: "Information submitted inconsistent with billing guidelines." CSC 560: "Entity's Additional/Secondary Identifier." EIC: HK "Subscriber"	2010BA.REF with REF01 = "SY" must not be present.
X222 130 2010BA REF 010	PROPERTY AND CASUALTY CLAIM NUMBER	N/A	1	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2010BA.REF with REF01 = "Y4" is allowed.
X222 130 2010BA REF01 010	Reference Identification Qualifier	ID	2-3	R	N/A	Y4	999	IK403 = 1: "Required Data Element Missing"	2010BA.REF01 must be present.
X222 130 2010BA REF01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2010BA.REF01 must be 'Y4".
X222 130 2010BA REF02 010	Property Casualty Claim Number	AN	1-50	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2010BA.REF02 must be present.
X222 130 2010BA REF02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2010BA.REF02 must contain at least one non-space character.
X222 130 2010BA REF02 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2010BA.REF02 must be 1 - 50 characters.
X222 130 2010BA REF02 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 629: "Property Casualty Claim Number" EIC: IL "Subscriber"	N/A
X222 130 2010BA REF02 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2010BA.REF02 must be populated with accepted AN characters.
X222 130 2010BA REF03 010	Description	AN	1-80	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 130 2010BA REF04 010	REFERENCE IDENTIFIER	N/A	N/A	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 131 2010BA PER 010	PROPERTY AND CASUALTY SUBSCRIBER CONTACT INFORMATION	N/A	1	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2010BA.PER is allowed.
X222 131 2010BA PER01 010	Contact Function Code	ID	2-2	R	N/A	IC	999	IK403 = 7: "Invalid Code Value"	2010BA.PER01 must be "IC".
X222 131 2010BA PER02 010	Information Contact Name	AN	1-60	S	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2010BA.PER02 must be 1 - 60 characters.
X222 131 2010BA PER02 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 561: "Entity's Contact Name" EIC: IL "Subscriber"	N/A
X222 131 2010BA PER02 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2010BA.PER02 must be populated with accepted AN characters.
X222 131 2010BA PER03 010	Communication Number Qualifier	ID	2-2	R	N/A	TE	999	IK403 = 1: "Required Data Element Missing"	2010BA.PER03 must be present.
X222 131 2010BA PER03 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2010BA.PER03 must be "TE".
X222 131 2010BA PER04 010	Communication Number	AN	1-256	R	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2010BA.PER04 must contain at least one non-space character.
X222 131 2010BA PER04 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2010BA.PER04 must be present.
X222 131 2010BA PER04 060	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2010BA.PER04 must be populated with accepted AN characters.
X222 131 2010BA PER04 070	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 127: "Entity's Communication Number" EIC: IL "Subscriber"	2010BA.PER04 must be populated with exactly ten numeric characters.
X222 131 2010BA PER05 010	Communication Number Qualifier	ID	2-2	S	N/A	EX	999	IK403 = 7: "Invalid Code Value"	2010BA.PER05 must be "EX".
X222 131 2010BA PER06 010	Communication Number	AN	1-256	S	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2010BA.PER06 must contain at least one non-space character.
X222 131 2010BA PER06 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2010BA.PER06 is present 2010BA.PER05 must be present.
X222 131 2010BA PER06 040	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2010BA.PER06 must be 1 - 256 characters.
X222 131 2010BA PER06 050	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 127: "Entity's Communication Number" EIC: IL "Subscriber"	N/A
X222 131 2010BA PER06 060	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2010BA.PER06 must be populated with accepted AN characters.
X222 131 2010BA PER07 010	Communication Number Qualifier	ID	2-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 131 2010BA PER08 010	Communication Number	AN	1-256	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 131 2010BA PER09 010	Contact Inquiry Reference	AN	1-20	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 133 2010BB NM1 010	PAYER NAME	N/A	1	R	1	N/A	999	IK304 = 3: "Required Segment Missing"	2010BB.NM1 must be present.
X222 133 2010BB NM1 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK304 = 4: "Loop Occurs Over Maximum Times"	Only one iteration of 2010BB.NM1 is allowed.
X222 133 2010BB NM101 010	Entity Identifier Code	ID	2-3	R	N/A	PR	999	IK403 = 1: "Required Data Element Missing"	2010BB.NM101 must be present.
X222 133 2010BB NM101 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2010BB.NM101 must be "PR".
X222 133 2010BB NM102 010	Entity Type Qualifier	ID	1-1	R	N/A	2	999	IK403 = 1: "Required Data Element Missing"	2010BB.NM102 must be present.
X222 133 2010BB NM102 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2010BB.NM102 must be "2".
X222 133 2010BB NM103 010	Payer Name	AN	1-60	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2010BB.NM103 must be present.
X222 133 2010BB NM103 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2010BB.NM103 must contain at least one non-space character.
X222 133 2010BB NM103 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2010BB.NM103 must be 1 - 60 characters.
X222 133 2010BB NM103 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 504: "Entity's Last Name" EIC: PR "Payer"	N/A
X222 133 2010BB NM103 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2010BB.NM103 must be populated with accepted AN characters.
X222 133 2010BB NM104 010	Name First	AN	1-35	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 133 2010BB NM105 010	Name Middle	AN	1-25	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 133 2010BB NM106 010	Name Prefix	AN	1-10	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 133 2010BB NM107 010	Name Suffix	AN	1-10	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 133 2010BB NM108 010	Identification Code Qualifier	ID	1-2	R	N/A	PI, XV	999	IK403 = 1: "Required Data Element Missing"	2010BB.NM108 must be present.
X222 133 2010BB NM108 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2010BB.NM108 must be "PI".
X222 133 2010BB NM109 010	Payer Identifier	AN	2-80	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2010BB.NM109 must be present.
X222 133 2010BB NM109 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2010BB.NM109 must contain at least two non-space characters.
X222 133 2010BB NM109 025	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 21: "Missing or Invalid Information" CSC 153: "Entity ID Number" EIC: "PR" Payer CSC 153: "Entity ID Number" EIC: 40 "Receiver"	2010BB.NM109 must be the same value as 1000B.NM109.
X222 133 2010BB NM109 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 4: "Data Element Too Short" IK403 = 5: "Data Element Too Long"	2010BB.NM109 must be 2-80 characters.
X222 133 2010BB NM109 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 153: "Entity ID Number" EIC: PR "Payer"	N/A
X222 133 2010BB NM109 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2010BB.NM109 must be populated with accepted AN characters.
X222 133 2010BB NM110 010	Entity Relationship Code	ID	2-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 133 2010BB NM111 010	Entity Identifier Code	ID	2-3	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 133 2010BB NM112 010	Name Last or Organization Name	AN	1-60	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 135 2010BB N3 010	PAYER ADDRESS	N/A	1	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2010BB.N3 is allowed.
X222 135 2010BB N301 010	Payer Address Line	AN	1-55	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2010BB.N301 must be present.
X222 135 2010BB N301 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2010BB.N301 must contain at least one non-space character.
X222 135 2010BB N301 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2010BB.N301 must be 1 - 55 characters.
X222 135 2010BB N301 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 503: "Entity's Street Address" EIC: PR "Payer"	N/A
X222 135 2010BB N301 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2010BB.N301 must be populated with accepted AN characters.
X222 135 2010BB N302 020	Payer Address Line	AN	1-55	S	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2010BB.N302 must contain at least one non-space character.
X222 135 2010BB N302 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2010BB.N302 must be 1 - 55 characters.
X222 135 2010BB N302 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 503: "Entity's Street Address" EIC: PR "Payer"	N/A
X222 135 2010BB N302 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2010BB.N302 must be populated with accepted AN characters.
X222A1 018 2010BB N4 010	PAYER CITY/STATE/ZIP CODE	N/A	1	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2010BB.N4 is allowed.
X222 136 2010BB N401 010	Payer City Name	AN	2-30	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2010BB.N401 must be present.
X222 136 2010BB N401 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2010BB.N401 must contain at least two non-space characters.
X222 136 2010BB N401 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 4: "Data Element Too Short" IK403 = 5: "Data Element Too Long"	2010BB.N401 must be 2-30 characters.
X222 136 2010BB N401 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 502: "Entity's City" EIC: PR "Payer"	N/A
X222 136 2010BB N401 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2010BB.N401 must be populated with accepted AN characters.
X222 136 2010BB N402 010	Payer State Code	ID	2-2	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2010BB.N404 is not present, 2010BB.N402 must be present.
X222 136 2010BB N402 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 501: "Entity's State/Province" EIC: PR "Payer"	2010BB.N402 must be a valid State Code.
X222 136 2010BB N403 010	Payer Postal Zone or ZIP Code	ID	3-15	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2010BB.N404 is not present, 2010BB.N403 must be present.
X222 136 2010BB N403 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 500: "Entity's Postal/Zip Code" EIC: PR "Payer"	2010BB.N403 must be a valid Zip Code.
X222 136 2010BB N404 010	Payer Country Code	ID	2-3	S	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 136 2010BB N405 010	Location Qualifier	ID	1-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 136 2010BB N406 010	Location Identifier	AN	1-30	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 136 2010BB N407 005	Country Subdivision Code	ID	1-3	S	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 138 2010BB REF 010	PAYER SECONDARY IDENTIFICATION	N/A	3	S	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 732: "Information submitted inconsistent with billing guidelines." CSC 560: "Entity's Additional/Secondary Identifier." EIC: PR "Payer"	Non-VA claims: 2010BB.REF with REF01 = "2U", "EI", "FY" or "NF" must not be present. VA claims: 2010BB.REF with REF01 = "EI", "FY" or "NF" must not be present.
X222 140 2010BB REF 010	BILLING PROVIDER SECONDARY IDENTIFICATION	N/A	2	S	N/A	N/A	999	IK304 = 2: "Unexpected Segment"	2010BB.REF with REF01 = "G2" must be present when 2010AA.NM109 is not present.
X222 140 2010BB REF 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only two iterations of 2010BB.REF with REF01 = "G2" or "LU" are allowed.
X222 140 2010BB REF 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK304 = I9: "Implementation Dependent "Not Used" Segment Present"	2010BB.REF must not be present.
X222 140 2010BB REF01 010	Reference Identification Qualifier	ID	2-3	R	N/A	G2, LU	999	IK403 = 1: "Required Data Element Missing"	2010BB.REF01 must be present.
X222 140 2010BB REF01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2010BB.REF01 must be valid values.
X222 140 2010BB REF02 010	Payer Additional Identifier	AN	1-50	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2010BB.REF02 must be present.
X222 140 2010BB REF02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2010BB.REF02 must contain at least one-none space character.
X222 140 2010BB REF02 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2010BB.REF02 must be 1 - 50 characters.
X222 140 2010BB REF02 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 560: "Entity's Additional/Secondary Identifier" EIC: PR "Payer"	N/A
X222 140 2010BB REF02 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2010BB.REF02 must be populated with accepted AN characters.
X222 140 2010BB REF02 075	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A8: "Acknowledgement/Rejected for relational field in error" CSC 496 "Submitter not approved for electronic claim submissions on behalf of this entity." EIC: 85 "Billing Provider"	2010BB.REF02 billing provider must be "associated" to the submitter (from a trading partner management perspective) in 1000A.NM109. -OR-
X222 140 2010BB REF02 075	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A8: "Acknowledgement/Rejected for relational field in error" CSC 496 "Submitter not approved for electronic claim submissions on behalf of this entity." EIC: 85 "Billing Provider"	2010BB.REF02 billing provider must be "associated" to the submitter (from a trading partner management perspective) in 1000A.NM109.
X222 140 2010BB REF03 010	Description	AN	1-80	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 140 2010BB REF04 010	REFERENCE IDENTIFIER	N/A	N/A	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 142 2000C HL 010	PATIENT HIERARCHICAL LEVEL	N/A	1	S	>1	N/A	999	IK304 = I9: "Implementation Dependent "Not Used" Segment Present"	Loop must not be present.
X222 144 2000C PAT 010	PATIENT INFORMATION	N/A	1	R	N/A	N/A	999	IK304 = I9: "Implementation Dependent "Not Used" Segment Present"	Segment must not be present.
X222 147 2010CA NM1 010	PATIENT NAME	N/A	1	R	N/A	N/A	999	IK304 = I9: "Implementation Dependent "Not Used" Segment Present"	Loop must not be present.
X222 149 2010CA N3 010	PATIENT ADDRESS	N/A	1	R	N/A	N/A	999	IK304 = I9: "Implementation Dependent "Not Used" Segment Present"	Segment must not be present.
X222 150 2010CA N4 010	PATIENT CITY/STATE/ZIP CODE	N/A	1	R	N/A	N/A	999	IK304 = I9: "Implementation Dependent "Not Used" Segment Present"	Segment must not be present.
X222 152 2010CA DMG 010	PATIENT DEMOGRAPHIC INFORMATION	N/A	1	R	N/A	N/A	999	IK304 = I9: "Implementation Dependent "Not Used" Segment Present"	Segment must not be present.
X222 154 2010CA REF 010	PROPERTY AND CASUALTY CLAIM NUMBER	N/A	1	S	N/A	N/A	999	IK304 = I9: "Implementation Dependent "Not Used" Segment Present"	2010CA.REF must not be present.
X222A1 019 2010CA REF 010	PROPERTY AND CASUALTY PATIENT IDENTIFIER	N/A	1	S	N/A	N/A	999	IK304 = I9: "Implementation Dependent "Not Used" Segment Present"	2010CA.REF must not be present.
X222 155 2010CA PER 010	PROPERTY AND CASUALTY PATIENT CONTACT INFORMATION	N/A	1	S	N/A	N/A	999	IK304 = I9: "Implementation Dependent "Not Used" Segment Present"	Segment must not be present.
X222 157 2300 CLM Loop 010	CLAIM INFORMATION Loop	N/A	N/A	N/A	100	N/A	999	IK304 = 4: "Loop Occurs Over Maximum Times"	Only one00 iterations of the 2300 loop are allowed.
X222 157 2300 CLM 010	CLAIM INFORMATION	N/A	1	R	1	N/A	999	IK304 = 3: "Required Segment Missing" OR IK304 = I7: "Implementation Loop Occurs Under Minimum Times"	2300.CLM must be present.
X222 157 2300 CLM 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2300.CLM is allowed.
X222 157 2300 CLM01 010	Patient Control Number	AN	1-38	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2300.CLM01 must be present.
X222 157 2300 CLM01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2300.CLM01 must contain at least one non-space character.
X222 157 2300 CLM01 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2300.CLM01 must be 1 - 38 characters.
X222 157 2300 CLM01 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 478:: "Claim submitter's identifier"	N/A
X222 157 2300 CLM01 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2300.CLM01 must be populated with accepted AN characters.
X222 157 2300 CLM02 010	Total Claim Charge Amount	R	1-18	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2300.CLM02 must be present.
X222 157 2300 CLM02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2300.CLM02 must be numeric.
X222 157 2300 CLM02 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 178: "Submitted Charges"	2300.CLM02 must be >= 0 and <= 99,999.99.
X222 157 2300 CLM02 045	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2300.CLM02 must be >= 0 and <= 99,999,999.99 and limited to 0, 1, or 2 decimal positions.
X222 157 2300 CLM02 050	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 178: "Submitted Charges"	N/A
X222 157 2300 CLM02 070	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 178: "Submitted Charges"	2300.CLM02 must equal the sum of all 2400.SV102 amounts.
X222 157 2300 CLM02 090	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 400: "Claim is out of Balance" CSC 672: "Payer's payment information is out of balance"	2300.CLM02 must equal the sum of all 2320 & 2430 CAS amounts and the 2320 AMT02 (AMT01=D).
X222 157 2300 CLM03 010	Claim Filing Indicator Code	ID	1-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 157 2300 CLM04 010	Non-Institutional Claim Type Code	ID	1-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 157 2300 CLM05-1 010	Facility Type Code	AN	1-2	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2300.CLM05-1 must be present.
X222 157 2300 CLM05-1 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 249: "Place of service"	2300.CLM05-1 must be a valid POS code. Code must be valid for the transaction set creation date (BHT04).
X222 157 2300 CLM05-2 010	Facility Code Qualifier	ID	1-2	R	N/A	B	999	IK403 = 1: "Required Data Element Missing"	2300.CLM05-2 must be present.
X222 157 2300 CLM05-2 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2300.CLM05-2 must be "B".
X222 157 2300 CLM05-3 010	Claim Frequency Code	ID	1-1	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2300.CLM05-3 must be present.
X222 157 2300 CLM05-3 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 535: "Claim Frequency Code"	2300.CLM05-3 must be "1".
X222 157 2300 CLM06 010	Provider or Supplier Signature Indicator	ID	1-1	R	N/A	N, Y	999	IK403 = 1: "Required Data Element Missing"	2300.CLM06 must be present.
X222 157 2300 CLM06 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2300.CLM06 must be valid values.
X222 157 2300 CLM07 010	Medicare Assignment Code	ID	1-1	R	N/A	A, B, C	999	IK403 = 1: "Required Data Element Missing"	2300.CLM07 must be present.
X222 157 2300 CLM07 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2300.CLM07 must be valid values.
X222 157 2300 CLM08 010	Benefits Assignment Certification Indicator	ID	1-1	R	N/A	N, W, Y	999	IK403 = 1: "Required Data Element Missing"	2300.CLM08 must be present.
X222 157 2300 CLM08 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2300.CLM08 must be valid values.
X222 157 2300 CLM09 010	Release of Information Code	ID	1-1	R	N/A	I, Y	999	IK403 = 1: "Required Data Element Missing"	2300.CLM09 must be present.
X222 157 2300 CLM09 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2300.CLM09 must be valid values.
X222 157 2300 CLM10 010	Patient Signature Source Code	ID	1-1	S	N/A	P	999	IK403 = 7: "Invalid Code Value"	2300.CLM10 must be "P".
X222 157 2300 CLM11-1 010	Related Causes Code	ID	2-3	R	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2300.DTP with DTP01 = 439 is present, then 2300.CLM11 must be present.
X222 157 2300 CLM11-1 020	Related Causes Code	ID	2-3	R	N/A	AA, EM, OA	999	IK403 = 7: "Invalid Code Value"	2300.CLM11-1 must be valid values.
X222 157 2300 CLM11-2 010	Related Causes Code	ID	2-3	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	2300.CLM11-2 is present 2300.CLM11-1 must be present.
X222 157 2300 CLM11-2 020	N/A	N/A	N/A	N/A	N/A	AA, EM, OA	999	IK403 = 7: "Invalid Code Value"	2300.CLM11-2 must be valid values.
X222 157 2300 CLM11-3 010	Related Causes Code	ID	2-3	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 157 2300 CLM11-4 010	Auto Accident State or Province Code	ID	2-2	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2300.CLM11-1 or 2300.CLM11-2 is "AA", then 2300.CLM11-4 must be present.
X222 157 2300 CLM11-4 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 501: "Entity's State/Province" EIC: IL "Subscriber"	If 2300.CLM11-4 must be a valid State Code.
X222 157 2300 CLM11-5 010	Country Code	ID	2-3	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2300.CLM11-1 or 2300.CLM11-2 is "AA" and 2300.CLM11-4 is not present, then 2300.CLM11-5 must be present.
X222 157 2300 CLM11-5 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 680: "Entity's Country" EIC: IL "Subscriber"	2300.CLM11-5 must be a valid Country Code.
X222 157 2300 CLM12 010	Special Program Indicator	ID	2-3	S	N/A	02, 03, 05, 09	999	IK403 = 7: "Invalid Code Value"	2300.CLM12 must be valid values.
X222 157 2300 CLM13 010	Yes/No Condition or Response Code	ID	1-1	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 157 2300 CLM14 010	Level of Service Code	ID	1-3	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 157 2300 CLM15 010	Yes/No Condition or Response Code	ID	1-1	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 157 2300 CLM16 010	Participation Agreement	ID	1-1	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 157 2300 CLM17 010	Claim Status Code	ID	1-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 157 2300 CLM18 010	Yes/No Condition or Response Code	ID	1-1	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 157 2300 CLM19 010	Claim Submission Reason Code	ID	2-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 157 2300 CLM20 010	Delay Reason Code	ID	1-2	S	N/A	1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 15	999	IK403 = 7: "Invalid Code Value"	2300.CLM20 must be valid values.
X222 164 2300 DTP 010	DATE - ONSET OF CURRENT ILLNESS OR SYMPTOM	N/A	1	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2300.DTP with DTP01 = "431" is allowed.
X222 164 2300 DTP01 010	Date Time Qualifier	ID	3-3	R	N/A	431	999	IK403 = 1: "Required Data Element Missing"	2300.DTP01 must be present.
X222 164 2300 DTP01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2300.DTP01 must be "431".
X222 164 2300 DTP02 010	Date Time Period Format Qualifier	ID	2-3	R	N/A	D8	999	IK403 = 1: "Required Data Element Missing"	2300.DTP02 must be present.
X222 164 2300 DTP02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2300.DTP02 must be "D8".
X222 164 2300 DTP03 010	Onset of Current Illness or Injury Date	AN	1-35	R	N/A	CCYYMMDD	999	IK403 = 1: "Required Data Element Missing"	2300.DTP03 must be present.
X222 164 2300 DTP03 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 8: "Invalid Date"	2300.DTP03 must be a valid date in CCYYMMDD format.
X222 164 2300 DTP03 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 397: "Date of onset/exacerbation of illness/condition" CSC 510: "Future date"	2300.DTP03 must not be a future date.
X222 165 2300 DTP 010	DATE - INITIAL TREATMENT	N/A	1	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2300.DTP with DTP01 = "454" is allowed.
X222 165 2300 DTP01 010	Date Time Qualifier	ID	3-3	R	N/A	454	999	IK403 = 1: "Required Data Element Missing"	2300.DTP01 must be present.
X222 165 2300 DTP01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2300.DTP01 must be "454".
X222 165 2300 DTP02 010	Date Time Period Format Qualifier	ID	2-3	R	N/A	D8	999	IK403 = 1: "Required Data Element Missing"	2300.DTP02 must be present.
X222 165 2300 DTP02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2300.DTP02 must be "D8".
X222 165 2300 DTP03 010	Initial Treatment Date	AN	1-35	R	N/A	CCYYMMDD	999	IK403 = 1: "Required Data Element Missing"	2300.DTP03 must be present.
X222 165 2300 DTP03 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 8: "Invalid Date"	2300.DTP03 must be a valid date in CCYYMMDD format.
X222 165 2300 DTP03 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 510: "Future date" CSC 701: "Initial Treatment Date"	2300.DTP03 must not be a future date.
X222 166 2300 DTP 010	DATE - DATE LAST SEEN	N/A	1	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2300.DTP with DTP01 = "304" is allowed.
X222 166 2300 DTP01 010	Date Time Qualifier	ID	3-3	R	N/A	304	999	IK403 = 1: "Required Data Element Missing"	2300.DTP01 must be present.
X222 166 2300 DTP01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2300.DTP01 must be"304".
X222 166 2300 DTP02 010	Date Time Period Format Qualifier	ID	2-3	R	N/A	D8	999	IK403 = 1: "Required Data Element Missing"	2300.DTP02 must be present.
X222 166 2300 DTP02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2300.DTP02 must be "D8".
X222 166 2300 DTP03 010	Last Seen Date	AN	1-35	R	N/A	CCYYMMDD	999	IK403 = 1: "Required Data Element Missing"	2300.DTP03 must be present.
X222 166 2300 DTP03 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 8: "Invalid Date"	2300.DTP03 must be a valid date in CCYYMMDD format.
X222 166 2300 DTP03 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 510: "Future date" CSC 757: "Last Seen Date"	2300.DTP03 must not be a future date.
X222 167 2300 DTP 010	DATE - ACUTE MANIFESTATION	N/A	1	S	N/A	N/A	999	IK304 = I6: "Implementation Dependent Segment Missing"	If 2300.CR208 = "A" or "M" then 2300.DTP with DTP01 = "453" must be present.
X222 167 2300 DTP 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2300.DTP with DTP01 = "453" is allowed.
X222 167 2300 DTP01 010	Date Time Qualifier	ID	3-3	R	N/A	453	999	IK403 = 1: "Required Data Element Missing"	2300.DTP01 must be present.
X222 167 2300 DTP01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2300.DTP01 must be "453".
X222 167 2300 DTP02 010	Date Time Period Format Qualifier	ID	2-3	R	N/A	D8	999	IK403 = 1: "Required Data Element Missing"	2300.DTP02 must be present.
X222 167 2300 DTP02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2300.DTP02 must be "D8".
X222 167 2300 DTP03 010	Acute Manifestation Date	AN	1-35	R	N/A	CCYYMMDD	999	IK403 = 1: "Required Data Element Missing"	2300.DTP03 must be present.
X222 167 2300 DTP03 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 8: "Invalid Date"	2300.DTP03 must be a valid date in CCYYMMDD format.
X222 167 2300 DTP03 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 510: "Future date" CSC 715:: "Acute Manifestation Date"	2300.DTP03 must not be a future date.
X222 168 2300 DTP 010	DATE - ACCIDENT	N/A	1	S	N/A	N/A	999	IK304 = I6: "Implementation Dependent Segment Missing"	If 2300.CLM11-1 or CLM11-2 = "AA" or "OA" then 2300.DTP with DTP01 = "439" must be present.
X222 168 2300 DTP 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2300.DTP with DTP01 = "439" is allowed.
X222 168 2300 DTP01 010	Date Time Qualifier	ID	3-3	R	N/A	439	999	IK403 = 1: "Required Data Element Missing"	2300.DTP01 must be present.
X222 168 2300 DTP01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2300.DTP01 must be "439".
X222 168 2300 DTP02 010	Date Time Period Format Qualifier	ID	2-3	R	N/A	D8,	999	IK403 = 1: "Required Data Element Missing"	2300.DTP02 must be present.
X222 168 2300 DTP02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2300.DTP02 must be "D8".
X222 168 2300 DTP03 010	Accident Date	AN	1-35	R	N/A	CCYYMMDD	999	IK403 = 1: "Required Data Element Missing"	2300.DTP03 must be present.
X222 168 2300 DTP03 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 8: "Invalid Date"	2300.DTP03 must be a valid date in CCYYMMDD format.
X222 168 2300 DTP03 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 510: "Future date" CSC 727: "Accident date"	2300.DTP03 must not be a future date.
X222 169 2300 DTP 010	DATE - LAST MENSTRUAL PERIOD	N/A	1	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2300.DTP with DTP01 = "484" is allowed.
X222 169 2300 DTP01 010	Date Time Qualifier	ID	3-3	R	N/A	484	999	IK403 = 1: "Required Data Element Missing"	2300.DTP01 must be present.
X222 169 2300 DTP01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2300.DTP01 must be "484".
X222 169 2300 DTP02 010	Date Time Period Format Qualifier	ID	2-3	R	N/A	D8	999	IK403 = 1: "Required Data Element Missing"	2300.DTP02 must be present.
X222 169 2300 DTP02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2300.DTP02 must be "D8".
X222 169 2300 DTP03 010	Last Menstrual Period Date	AN	1-35	R	N/A	CCYYMMDD	999	IK403 = 1: "Required Data Element Missing"	2300.DTP03 must be present.
X222 169 2300 DTP03 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 8: "Invalid Date"	2300.DTP03 must be a valid date in CCYYMMDD format.
X222 169 2300 DTP03 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 510: "Future date" CSC 191: "Date of Last Menstrual Period (LMP)"	2300.DTP03 must not be a future date.
X222 170 2300 DTP 010	DATE - LAST X-RAY	N/A	1	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2300.DTP with DTP01 = "455" is allowed.
X222 170 2300 DTP01 010	Date Time Qualifier	ID	3-3	R	N/A	455	999	IK403 = 1: "Required Data Element Missing"	2300.DTP01 must be present.
X222 170 2300 DTP01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2300.DTP01 must be "455".
X222 170 2300 DTP02 010	Date Time Period Format Qualifier	ID	2-3	R	N/A	D8	999	IK403 = 1: "Required Data Element Missing"	2300.DTP02 must be present.
X222 170 2300 DTP02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2300.DTP02 must be "D8".
X222 170 2300 DTP03 010	Last X-Ray Date	AN	1-35	R	N/A	CCYYMMDD	999	IK403 = 1: "Required Data Element Missing"	2300.DTP03 must be present.
X222 170 2300 DTP03 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 8: "Invalid Date"	2300.DTP03 must be a valid date in CCYYMMDD format.
X222 170 2300 DTP03 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 510: "Future date" CSC 210: "Date of the last x-ray."	2300.DTP03 must not be a future date.
X222 171 2300 DTP 010	DATE - HEARING AND VISION PRESCRIPTION DATE	N/A	1	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2300.DTP with DTP01 = "471" is allowed.
X222 171 2300 DTP01 010	Date Time Qualifier	ID	3-3	R	N/A	471	999	IK403 = 1: "Required Data Element Missing"	2300.DTP01 must be present.
X222 171 2300 DTP01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2300.DTP01 must be "471".
X222 171 2300 DTP02 010	Date Time Period Format Qualifier	ID	2-3	R	N/A	D8	999	IK403 = 1: "Required Data Element Missing"	2300.DTP02 must be present.
X222 171 2300 DTP02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2300.DTP02 must be "D8".
X222 171 2300 DTP03 010	Prescription Date	AN	1-35	R	N/A	CCYYMMDD	999	IK403 = 1: "Required Data Element Missing"	2300.DTP03 must be present.
X222 171 2300 DTP03 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 8: "Invalid Date"	2300.DTP03 must be a valid date in CCYYMMDD format.
X222 171 2300 DTP03 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 510: "Future date" CSC 214: "Original date of prescription/orders/referral"	2300.DTP03 must not be a future date.
X222 172 2300 DTP 010	DATE - DISABILITY DATES	N/A	1	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2300.DTP with DTP01 = "314", "360" or "361" is allowed.
X222 172 2300 DTP01 010	Date Time Qualifier	ID	3-3	R	N/A	314, 360, 361	999	IK403 = 1: "Required Data Element Missing"	2300.DTP01 must be present.
X222 172 2300 DTP01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2300.DTP01 must be valid values.
X222 172 2300 DTP02 010	Date Time Period Format Qualifier	ID	2-3	R	N/A	D8, RD8	999	IK403 = 1: "Required Data Element Missing"	2300.DTP02 must be present.
X222 172 2300 DTP02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2300.DTP02 must be valid values.
X222 172 2300 DTP02 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 195: "Unable to work dates/Disability Date."	If 2300.DTP01 = "314" then 2300.DTP02 must = "RD8".
X222 172 2300 DTP03 010	Disability From Date	AN	1-35	R	N/A	CCYYMMDD or CCYYMMDD-CCYYMMDD	999	IK403 = 1: "Required Data Element Missing"	2300.DTP03 must be present.
X222 172 2300 DTP03 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 8: "Invalid Date"	If 2300.DTP02 = "D8" then 2300.DTP03 must be a valid date in CCYYMMDD format.
X222 172 2300 DTP03 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 8: "Invalid Date"	If 2300.DTP02 = "RD8" then 2300.DTP03 must be a valid date in CCYYMMDD-CCYYMMDD format.
X222 174 2300 DTP 010	DATE - LAST WORKED	N/A	1	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2300.DTP with DTP01 = "297" is allowed.
X222 174 2300 DTP01 010	Date Time Qualifier	ID	3-3	R	N/A	297	999	IK403 = 1: "Required Data Element Missing"	2300.DTP01 must be present.
X222 174 2300 DTP01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2300.DTP01 must be "297".
X222 174 2300 DTP02 010	Date Time Period Format Qualifier	ID	2-3	R	N/A	D8	999	IK403 = 1: "Required Data Element Missing"	2300.DTP02 must be present.
X222 174 2300 DTP02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2300.DTP02 must be "D8".
X222 174 2300 DTP03 010	Last Worked Date	AN	1-35	R	N/A	CCYYMMDD	999	IK403 = 1: "Required Data Element Missing"	2300.DTP03 must be present.
X222 174 2300 DTP03 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 8: "Invalid Date"	2300.DTP03 must be a valid date in CCYYMMDD format.
X222 174 2300 DTP03 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 510: "Future date" CSC 581: "Last Worked Date"	2300.DTP03 must not be a future date.
X222 175 2300 DTP 010	DATE - AUTHORIZED RETURN TO WORK	N/A	1	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2300.DTP with DTP01 = "296" is allowed.
X222 175 2300 DTP01 010	Date Time Qualifier	ID	3-3	R	N/A	296	999	IK403 = 1: "Required Data Element Missing"	2300.DTP01 must be present.
X222 175 2300 DTP01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2300.DTP01 must be "296".
X222 175 2300 DTP02 010	Date Time Period Format Qualifier	ID	2-3	R	N/A	D8	999	IK403 = 1: "Required Data Element Missing"	2300.DTP02 must be present.
X222 175 2300 DTP02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2300.DTP02 must be "D8".
X222 175 2300 DTP03 010	Work Return Date	AN	1-35	R	N/A	CCYYMMDD	999	IK403 = 1: "Required Data Element Missing"	2300.DTP03 must be present.
X222 175 2300 DTP03 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 8: "Invalid Date"	2300.DTP03 must be a valid date in CCYYMMDD format.
X222 176 2300 DTP 010	DATE - ADMISSION	N/A	1	S	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 189: "Facility admission date"	If 2300.CLM05-1 or 2400.SV105 = "21", "51" or "61" then 2300.DTP with DTP01 = "435" must be present.
X222 176 2300 DTP 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2300.DTP with DTP01 = "435" is allowed.
X222 176 2300 DTP01 010	Date Time Qualifier	ID	3-3	R	N/A	435	999	IK403 = 1: "Required Data Element Missing"	2300.DTP01 must be present.
X222 176 2300 DTP01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2300.DTP01 must be "435".
X222 176 2300 DTP02 010	Date Time Period Format Qualifier	ID	2-3	R	N/A	D8	999	IK403 = 1: "Required Data Element Missing"	2300.DTP02 must be present.
X222 176 2300 DTP02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2300.DTP02 must be "D8".
X222 176 2300 DTP03 010	Related Hospitalization Admission Date	AN	1-35	R	N/A	CCYYMMDD	999	IK403 = 1: "Required Data Element Missing"	2300.DTP03 must be present.
X222 176 2300 DTP03 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 8: "Invalid Date"	2300.DTP03 must be a valid date in CCYYMMDD format.
X222 176 2300 DTP03 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 510: "Future date" CSC 189: "Facility Admission Date"	2300.DTP03 must not be a future date.
X222 177 2300 DTP 010	DATE - DISCHARGE	N/A	1	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2300.DTP with DTP01 = "096" is allowed.
X222 177 2300 DTP01 010	Date Time Qualifier	ID	3-3	R	N/A	096	999	IK403 = 1: "Required Data Element Missing"	2300.DTP01 must be present.
X222 177 2300 DTP01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2300.DTP01 must be "096".
X222 177 2300 DTP02 010	Date Time Period Format Qualifier	ID	2-3	R	N/A	D8	999	IK403 = 1: "Required Data Element Missing"	2300.DTP02 must be present.
X222 177 2300 DTP02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2300.DTP02 must be "D8".
X222 177 2300 DTP03 010	Related Hospitalization Discharge Date	AN	1-35	R	N/A	CCYYMMDD	999	IK403 = 1: "Required Data Element Missing"	2300.DTP03 must be present.
X222 177 2300 DTP03 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 8: "Invalid Date"	2300.DTP03 must be a valid date in CCYYMMDD format.
X222 177 2300 DTP03 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 510: "Future date" CSC 190: "Facility Discharge Date"	2300.DTP03 must not be a future date.
X222 178 2300 DTP 010	DATE - ASSUMED AND RELINQUISHED CARE DATES	N/A	2	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only two iteration of 2300.DTP with DTP01 = "090" or "091" are allowed.
X222 178 2300 DTP01 010	Date Time Qualifier	ID	3-3	R	N/A	090, 091	999	IK403 = 1: "Required Data Element Missing"	2300.DTP01 must be present.
X222 178 2300 DTP01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2300.DTP01 must be valid values.
X222 178 2300 DTP02 010	Date Time Period Format Qualifier	ID	2-3	R	N/A	D8	999	IK403 = 1: "Required Data Element Missing"	2300.DTP02 must be present.
X222 178 2300 DTP02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2300.DTP02 must be "D8".
X222 178 2300 DTP03 010	Assumed or Relinquished Care Date	AN	1-35	R	N/A	CCYYMMDD	999	IK403 = 1: "Required Data Element Missing"	2300.DTP03 must be present.
X222 178 2300 DTP03 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 8: "Invalid Date"	2300.DTP03 must be a valid date in CCYYMMDD format.
X222 180 2300 DTP 010	DATE - PROPERTY AND CASUALTY DATE OF FIRST CONTACT	N/A	1	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2300.DTP with DTP01 = "444" is allowed.
X222 180 2300 DTP01 010	Date Time Qualifier	ID	3-3	R	N/A	444	999	IK403 = 1: "Required Data Element Missing"	2300.DTP01 must be present.
X222 180 2300 DTP01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2300.DTP01 must be "444".
X222 180 2300 DTP02 010	Date Time Period Format Qualifier	ID	2-3	R	N/A	D8	999	IK403 = 1: "Required Data Element Missing"	2300.DTP02 must be present.
X222 180 2300 DTP02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2300.DTP02 must be "D8".
X222 180 2300 DTP03 010	Order Date	AN	1-35	R	N/A	CCYYMMDD	999	IK403 = 1: "Required Data Element Missing"	2300.DTP03 must be present.
X222 180 2300 DTP03 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 8: "Invalid Date"	2300.DTP03 must be a valid date in CCYYMMDD format.
X222 181 2300 DTP 010	DATE - REPRICER RECEIVED DATE	N/A	1	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2300.DTP with DTP01 = "050" is allowed.
X222 181 2300 DTP01 010	Date Time Qualifier	ID	3-3	R	N/A	050	999	IK403 = 1: "Required Data Element Missing"	2300.DTP01 must be present.
X222 181 2300 DTP01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2300.DTP01 must be "050".
X222 181 2300 DTP02 010	Date Time Period Format Qualifier	ID	2-3	R	N/A	D8	999	IK403 = 1: "Required Data Element Missing"	2300.DTP02 must be present.
X222 181 2300 DTP02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2300.DTP02 must be "D8".
X222 181 2300 DTP03 010	Order Date	AN	1-35	R	N/A	CCYYMMDD	999	IK403 = 1: "Required Data Element Missing"	2300.DTP03 must be present.
X222 181 2300 DTP03 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 8: "Invalid Date"	2300.DTP03 must be a valid date in CCYYMMDD format.
X222 182 2300 PWK 010	CLAIM SUPPLEMENTAL INFORMATION	N/A	10	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only ten iterations of 2300.PWK are allowed.
X222 182 2300 PWK01 010	Attachment Report Type Code	ID	2-2	R	N/A	03, 04, 05, 06, 07, 08, 09, 10, 11, 13, 15, 21, A3, A4, AM, AS, B2, B3, B4, BR, BS, BT, CB, CK, CT, D2, DA, DB, DG, DJ, DS, EB, HC, HR, I5, IR, LA, M1, MT, NN, OB, OC, OD, OE, OX, OZ, P4, P5, PE, PN, PO, PQ, PY, PZ, RB, RR, RT, RX, SG, V5, XP	999	IK403 = 1: "Required Data Element Missing"	2300.PWK01 must be present.
X222 182 2300 PWK01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2300.PWK01 must be valid values.
X222 182 2300 PWK02 010	Attachment Transmission Code	ID	1-2	R	N/A	AA, BM, EL, EM, FT, FX	999	IK403 = 1: "Required Data Element Missing"	2300.PWK02 must be present.
X222 182 2300 PWK02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2300.PWK02 must be valid values.
X222 182 2300 PWK03 010	Report Copies Needed	N0	1-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 182 2300 PWK04 010	Entity Identifier Code	ID	2-3	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 182 2300 PWK05 010	Identification Code Qualifier	ID	1-2	S	N/A	AC	999	IK403 = 2: "Conditional Required Data Element Missing"	When 2300.PWK05 is present, 2300.PWK02 must be "BM", "EL", "EM", "FX" or "FT" .
X222 182 2300 PWK05 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2300.PWK05 must be "AC".
X222 182 2300 PWK06 010	Attachment Control Number	AN	2-80	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	When 2300.PWK06 is present, 2300.PWK02 must be "BM", "EL", "EM", "FX" or "FT" .
X222 182 2300 PWK06 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 4: "Data Element Too Short" IK403 = 5: "Data Element Too Long"	2300.PWK06 must be 2-50 characters.
X222 182 2300 PWK06 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 489: "Attachment Control Number"	N/A
X222 182 2300 PWK06 040	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2300.PWK06 must be populated with accepted AN characters.
X222 182 2300 PWK06 060	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2300.PWK06 must contain at least two non-space characters.
X222 182 2300 PWK07 010	Description	AN	1-80	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 182 2300 PWK08 010	ACTIONS INDICATED	N/A	N/A	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 182 2300 PWK09 010	Request Category Code	ID	1-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 186 2300 CN1 010	CONTRACT INFORMATION	N/A	1	S	N/A	N/A	999	IK304 = I9: "Implementation Dependent "Not Used" Segment Present"	2300.CN1 must not be present.
X222 188 2300 AMT 010	PATIENT AMOUNT PAID	N/A	1	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2300.AMT is allowed.
X222 188 2300 AMT01 010	Amount Qualifier Code	ID	1-3	R	N/A	F5	999	IK403 = 1: "Required Data Element Missing"	2300.AMT01 must be present.
X222 188 2300 AMT01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2300.AMT01 must be "F5".
X222 188 2300 AMT02 005	Patient Amount Paid	R	1-18	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2300.AMT02 must be present.
X222 188 2300 AMT02 010	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2300.AMT02 must be numeric.
X222 188 2300 AMT02 015	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2300.AMT02 must be >= 0 and <= 99,999.99.
X222 188 2300 AMT02 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 183: "Amount entity has paid" EIC: QC "Patient"	N/A
X222 188 2300 AMT02 050	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 697: "Invalid Decimal Precision" CSC 183: "Amount entity has paid" EIC: QC "Patient"	2300.AMT02 is limited to 0, 1 or 2 decimal positions.
X222 188 2300 AMT03 010	Credit/Debit Flag Code	ID	1-1	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 189 2300 REF 010	SERVICE AUTHORIZATION EXCEPTION CODE	N/A	1	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2300.REF with REF01 = "4N" is allowed.
X222 189 2300 REF01 010	Reference Identification Qualifier	ID	2-3	R	N/A	4N	999	IK403 = 1: "Required Data Element Missing"	2300.REF01 must be present.
X222 189 2300 REF01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2300.REF01 must be "4N".
X222 189 2300 REF02 010	Service Authorization Exception Code	AN	1-50	R	N/A	1, 2, 3, 4, 5, 6, 7	999	IK403 = 1: "Required Data Element Missing"	2300.REF02 must be present.
X222 189 2300 REF02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2300.REF02 must be valid values.
X222 189 2300 REF03 010	Description	AN	1-80	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 189 2300 REF04 010	REFERENCE IDENTIFIER	N/A	N/A	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 191 2300 REF 010	MANDATORY MEDICARE (SECTION 4081) CROSSOVER INDICATOR	N/A	1	S	N/A	N/A	999	IK304 = I9: "Implementation Dependent "Not Used" Segment Present"	2300.REF with REF01 = "F5" must not be present.
X222 192 2300 REF 010	MAMMOGRAPHY CERTIFICATION NUMBER	N/A	1	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2300.REF with REF01 = "EW" is allowed.
X222 192 2300 REF01 010	Reference Identification Qualifier	ID	2-3	R	N/A	EW	999	IK403 = 1: "Required Data Element Missing"	2300.REF01 must be present.
X222 192 2300 REF01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2300.REF01 must be"EW".
X222 192 2300 REF02 010	Mammography Certification Number	AN	1-50	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2300.REF02 must be present.
X222 192 2300 REF02 060	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 252: "Entity's authorization/certification number" EIC: MSC "Mammography Screening Center"	2300.REF02 must be a valid Mammography Certification Number.
X222 192 2300 REF03 010	Description	AN	1-80	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 192 2300 REF04 010	REFERENCE IDENTIFIER	N/A	N/A	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 193 2300 REF 010	REFERRAL NUMBER	N/A	1	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2300.REF with REF01 = "9F" is allowed.
X222 193 2300 REF01 010	Reference Identification Qualifier	ID	2-3	R	N/A	9F	999	IK403 = 1: "Required Data Element Missing"	2300.REF01 must be present.
X222 193 2300 REF01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2300.REF01 must be"9F".
X222 193 2300 REF02 010	Prior Authorization or Referral Number	AN	1-50	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2300.REF02 must be present.
X222 193 2300 REF02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2300.REF02 must contain at least one non-space character.
X222 193 2300 REF02 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2300.REF02 must be 1 - 50 characters.
X222 193 2300 REF02 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 761: "Entity's referral number" EIC: PR "Payer"	N/A
X222 193 2300 REF02 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2300.REF02 must be populated with accepted AN characters.
X222 193 2300 REF03 010	Description	AN	1-80	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 193 2300 REF04 010	REFERENCE IDENTIFIER	N/A	N/A	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 194 2300 REF 010	PRIOR AUTHORIZATION	N/A	1	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2300.REF with REF01 = "G1" is allowed.
X222 194 2300 REF01 010	Reference Identification Qualifier	ID	2-3	R	N/A	G1	999	IK403 = 1: "Required Data Element Missing"	2300.REF01 must be present.
X222 194 2300 REF01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2300.REF01 must be "G1".
X222 194 2300 REF02 010	Prior Authorization or Referral Number	AN	1-50	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2300.REF02 must be present.
X222 194 2300 REF02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2300.REF02 must contain at least one non-space character.
X222 194 2300 REF02 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2300.REF02 must be 1 - 50 characters.
X222 194 2300 REF02 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information... "CSC 512: "Length invalid for receiver's application system" CSC 252: "Entity's authorization/certification number" EIC: PR "Payer"	N/A
X222 194 2300 REF02 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2300.REF02 must be populated with accepted AN characters.
X222 194 2300 REF03 010	Description	AN	1-80	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 194 2300 REF04 010	REFERENCE IDENTIFIER	N/A	N/A	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 196 2300 REF 010	PAYER CLAIM CONTROL NUMBER	N/A	1	S	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 732: "Information submitted inconsistent with billing guidelines." CSC 464: "Payer Assigned Claim Control Number."	2300.REF with REF01 = "F8" must not be present.
X222 197 2300 REF 010	CLINICAL LABORATORY IMPROVEMENT AMENDMENT (CLIA) NUMBER	N/A	1	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2300.REF with REF01 = "X4" is allowed.
X222 197 2300 REF01 010	Reference Identification Qualifier	ID	2-3	R	N/A	X4	999	IK403 = 1: "Required Data Element Missing"	2300.REF01 must be present.
X222 197 2300 REF01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2300.REF01 must be "X4".
X222 197 2300 REF02 010	Clinical Laboratory Improvement Amendment Number	AN	1-50	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2300.REF02 must be present.
X222 197 2300 REF02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2300.REF02 must contain at least one non-space character.
X222 197 2300 REF02 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2300.REF02 must be 1 - 50 characters.
X222 197 2300 REF02 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 630: "Referring CLIA Number"	N/A
X222 197 2300 REF02 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2300.REF02 must be populated with accepted AN characters.
X222 197 2300 REF02 070	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 544: "Clinical Laboratory Improvement Amendment"	When 2300.REF01 = 'X4', 2300.REF02 must be a 10 character alphanumeric value and the third position = D
X222 197 2300 REF03 010	Description	AN	1-80	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 197 2300 REF04 010	REFERENCE IDENTIFIER	N/A	N/A	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 199 2300 REF 010	REPRICED CLAIM NUMBER	N/A	1	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2300.REF with REF01 = "9A" is allowed.
X222 199 2300 REF01 010	Reference Identification Qualifier	ID	2-3	R	N/A	9A	999	IK403 = 1: "Required Data Element Missing"	2300.REF01 must be present.
X222 199 2300 REF01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2300.REF01 must be "9A".
X222 199 2300 REF02 010	Repriced Claim Reference Number	AN	1-50	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2300.REF02 must be present.
X222 199 2300 REF02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2300.REF02 must contain at least one non-space character.
X222 199 2300 REF02 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2300.REF02 must be 1-50 characters.
X222 199 2300 REF02 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 702: "Repriced Claim Reference Number"	N/A
X222 199 2300 REF02 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2300.REF02 must be populated with accepted AN characters.
X222 199 2300 REF03 010	Description	AN	1-80	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 199 2300 REF04 010	REFERENCE IDENTIFIER	N/A	N/A	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 200 2300 REF 010	ADJUSTED REPRICED CLAIM NUMBER	N/A	1	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2300.REF with REF01 = "9C" is allowed.
X222 200 2300 REF01 010	Reference Identification Qualifier	ID	2-3	R	N/A	9C	999	IK403 = 1: "Required Data Element Missing"	2300.REF01 must be present.
X222 200 2300 REF01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2300.REF01 must be "9C".
X222 200 2300 REF02 010	Adjusted Repriced Line Item Reference Number	AN	1-50	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2300.REF02 must be present.
X222 200 2300 REF02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2300.REF02 must contain at least one non-space character.
X222 200 2300 REF02 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2300.REF02 must be 1-50 characters.
X222 200 2300 REF02 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 517: "Adjusted Repriced Claim Reference Number"	N/A
X222 200 2300 REF02 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2300.REF02 must be populated with accepted AN characters.
X222 200 2300 REF03 010	Description	AN	1-80	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 200 2300 REF04 010	REFERENCE IDENTIFIER	N/A	N/A	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 201 2300 REF 010	INVESTIGATIONAL DEVICE EXEMPTION NUMBER	N/A	1	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2300.REF with REF01 = "LX" is allowed.
X222 201 2300 REF01 010	Reference Identification Qualifier	ID	2-3	R	N/A	LX	999	IK403 = 1: "Required Data Element Missing"	2300.REF01 must be present.
X222 201 2300 REF01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2300.REF01 must be "LX".
X222 201 2300 REF02 010	Investigational Device Exemption Number	AN	1-50	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2300.REF02 must be present.
X222 201 2300 REF02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2300.REF02 must contain at least one non-space character.
X222 201 2300 REF02 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2300.REF02 must be 1 - 50 characters.
X222 201 2300 REF02 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 579: "Investigational Device Exemption Identifier"	N/A
X222 201 2300 REF02 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2300.REF02 must be populated with accepted AN characters.
X222 201 2300 REF03 010	Description	AN	1-80	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 201 2300 REF04 010	REFERENCE IDENTIFIER	N/A	N/A	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 202 2300 REF 010	CLAIM IDENTIFIER FOR TRANSMISSION INTERMEDIARIES	N/A	1	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2300.REF with REF01 = "D9" is allowed.
X222 202 2300 REF01 010	Reference Identification Qualifier	ID	2-3	R	N/A	D9	999	IK403 = 1: "Required Data Element Missing"	2300.REF01 must be present.
X222 202 2300 REF01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2300.REF01 must be "D9".
X222 202 2300 REF02 010	Clearinghouse Trace Number	AN	1-50	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2300.REF02 must be present.
X222 202 2300 REF02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2300.REF02 must contain at least one non-space character.
X222 202 2300 REF02 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2300.REF02 must be 1-20 characters.
X222 202 2300 REF02 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 543: "Clearinghouse or Value Added Network Trace"	N/A
X222 202 2300 REF02 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2300.REF02 must be populated with accepted AN characters.
X222 202 2300 REF03 010	Description	AN	1-80	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 202 2300 REF04 010	REFERENCE IDENTIFIER	N/A	N/A	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 204 2300 REF 010	MEDICAL RECORD NUMBER	N/A	1	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2300.REF with REF01 = "EA" is allowed.
X222 204 2300 REF01 010	Reference Identification Qualifier	ID	2-3	R	N/A	EA	999	IK403 = 1: "Required Data Element Missing"	2300.REF01 must be present.
X222 204 2300 REF01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2300.REF01 must be "EA".
X222 204 2300 REF02 010	Medical Record Number	AN	1-50	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2300.REF02 must be present.
X222 204 2300 REF02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2300.REF02 must contain at least one non-space character.
X222 204 2300 REF02 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2300.REF02 must be 1 - 50 characters.
X222 204 2300 REF02 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 588: "Medical Record Number"	N/A
X222 204 2300 REF02 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2300.REF02 must be populated with accepted AN characters.
X222 204 2300 REF03 010	Description	AN	1-80	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 204 2300 REF04 010	REFERENCE IDENTIFIER	N/A	N/A	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 205 2300 REF 010	DEMONSTRATION PROJECT IDENTIFIER	N/A	1	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2300.REF with REF01 = "P4" is allowed.
X222 205 2300 REF01 010	Reference Identification Qualifier	ID	2-3	R	N/A	P4	999	IK403 = 1: "Required Data Element Missing"	2300.REF01 must be present.
X222 205 2300 REF01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2300.REF01 must be "P4".
X222 205 2300 REF02 010	Demonstration Project Identifier	AN	1-50	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2300.REF02 must be present.
X222 205 2300 REF02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2300.REF02 must contain at least one non-space character.
X222 205 2300 REF02 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2300.REF02 must be 1-50 characters.
X222 205 2300 REF02 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 556: "Demonstration Project Identifier"	N/A
X222 205 2300 REF02 050	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 732: Information submitted inconsistent with billing guidelines CSC 556: Demonstration Project Identifier	If 2300.REF02 (REF01=P4) is a valid VA demonstration project identifier, 1000B.NM109 must be the number identifying the current contractor for processing VA MRA project claims.
X222 205 2300 REF02 060	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 732: Information submitted inconsistent with billing guidelines CSC 556: Demonstration Project Identifier	2300 REF02 (when REF01=P4) must not contain the value 74.
X222 205 2300 REF03 010	Description	AN	1-80	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 205 2300 REF04 010	REFERENCE IDENTIFIER	N/A	N/A	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 206 2300 REF 010	CARE PLAN OVERSIGHT	N/A	1	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2300.REF with REF01 = "1J" is allowed.
X222 206 2300 REF01 010	Reference Identification Qualifier	ID	2-3	R	N/A	1J	999	IK403 = 1: "Required Data Element Missing"	2300.REF01 must be present.
X222 206 2300 REF01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2300.REF01 must be "1J".
X222 206 2300 REF02 010	Care Plan Oversight Number	AN	1-50	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2300.REF02 must be present.
X222 206 2300 REF02 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 714:: "Care Plan Oversight Number"	2300.REF02 must be valid according to the NPI algorithm.
X222 206 2300 REF02 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 714:: "Care Plan Oversight Number"	The first position of 2300.REF02 must be a "1".
X222 206 2300 REF03 010	Description	AN	1-80	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 206 2300 REF04 010	REFERENCE IDENTIFIER	N/A	N/A	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 207 2300 K3 010	FILE INFORMATION	N/A	10	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only ten iterations of K3 are allowed.
X222 207 2300 K301 010	Fixed Format Information	AN	1-80	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2300.K301 must be present.
X222 207 2300 K301 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2300.K301 must contain at least one non-space character.
X222 207 2300 K301 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2300.K301 must be 1-80 characters.
X222 207 2300 K301 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 569: "Fixed Format Information"	N/A
X222 207 2300 K301 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2300.K301 must be populated with accepted AN characters.
X222 207 2300 K302 010	Record Format Code	ID	1-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 207 2300 K303 010	COMPOSITE UNIT OF MEASURE	N/A	N/A	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 209 2300 NTE 010	CLAIM NOTE	N/A	1	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2300.NTE is allowed.
X222 209 2300 NTE01 010	Note Reference Code	ID	3-3	R	N/A	ADD, CER, DCP, DGN, TPO	999	IK403 = 1: "Required Data Element Missing"	2300.NTE01 must be present.
X222 209 2300 NTE01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2300.NTE01 must be valid values.
X222 209 2300 NTE02 010	Claim Note Text	AN	1-80	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2300.NTE02 must be present.
X222 209 2300 NTE02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2300.NTE02 must contain at least one non-space character.
X222 209 2300 NTE02 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2300.NTE02 must be 1 - 80 characters.
X222 209 2300 NTE02 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 297: "Medical Notes/Report"	N/A
X222 209 2300 NTE02 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2300.NTE02 must be populated with accepted AN characters.
X222 211 2300 CR1 010	AMBULANCE TRANSPORT INFORMATION	N/A	1	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2300.CR1 is allowed.
X222 211 2300 CR1 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 337: "Ambulance certification/documentation"	If 2300.CR1 is present, 2300.CLM05-1 must be "41" or "42".
X222 211 2300 CR101 010	Unit or Basis for Measurement Code	ID	2-2	S	N/A	LB	999	IK403 = 7: "Invalid Code Value"	2300.CR101 must be "LB".
X222 211 2300 CR102 010	Patient Weight	R	1-10	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2300.CR101 is present, then 2300.CR102 must be present.
X222 211 2300 CR102 015	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2300.CR102 must be > 0 and <= 9,999.99
X222 211 2300 CR102 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 273: "Weight" CSC 337: "Ambulance certification/documentation"	N/A
X222 211 2300 CR103 010	Ambulance Transport Code	ID	1-1	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 211 2300 CR104 010	Ambulance Transport Reason Code	ID	1-1	R	N/A	A, B, C, D, E	999	IK403 = 1: "Required Data Element Missing"	2300.CR104 must be present.
X222 211 2300 CR104 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2300.CR104 must be valid values.
X222 211 2300 CR105 010	Unit or Basis for Measurement Code	ID	2-2	R	N/A	DH	999	IK403 = 1: "Required Data Element Missing"	2300.CR105 must be present.
X222 211 2300 CR105 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2300.CR105 must be "DH".
X222 211 2300 CR106 010	Transport Distance	R	1-15	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2300.CR106 must be present.
X222 211 2300 CR106 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2300.CR106 must be numeric.
X222 211 2300 CR106 025	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2300.CR106 must be => 0 and <= 9999.
X222 211 2300 CR106 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 267 "Number of miles patient was transported"	N/A
X222 211 2300 CR107 010	Address Information	AN	1-55	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 211 2300 CR108 010	Address Information	AN	1-55	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 211 2300 CR109 010	Round Trip Purpose Description	AN	1-80	S	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2300.CR109 must be 1 - 80 characters.
X222 211 2300 CR109 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 266: "Facility point of origin and destination - ambulance"	N/A
X222 211 2300 CR109 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2300.CR109 must be populated with accepted AN characters.
X222 211 2300 CR109 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 266: "Facility point of origin and destination - ambulance"	N/A
X222 211 2300 CR109 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2300.CR109 must contain at least one non-space character.
X222 211 2300 CR110 010	Stretcher Purpose Description	AN	1-80	S	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2300.CR110 must contain at least one non-space character.
X222 211 2300 CR110 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2300.CR110 must be 1 - 80 characters.
X222 211 2300 CR110 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 711:: "Stretcher Purpose:	N/A
X222 211 2300 CR110 040	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2300.CR110 must be populated with accepted AN characters.
X222 214 2300 CR2 010	SPINAL MANIPULATION SERVICE INFORMATION	N/A	1	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2300.CR2 is allowed.
X222 214 2300 CR201 010	Treatment Series Number	N0	1-9	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 214 2300 CR202 010	Treatment Count	R	1-15	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 214 2300 CR203 010	Subluxation Level Code	ID	2-3	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 214 2300 CR204 010	Subluxation Level Code	ID	2-3	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 214 2300 CR205 010	Unit or Basis for Measurement Code	ID	2-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 214 2300 CR206 010	Treatment Period Count	R	1-15	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 214 2300 CR207 010	Monthly Treatment Count	R	1-15	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 214 2300 CR208 010	Patient Condition Code	ID	1-1	R	N/A	A, C, D, E, F, G, M	999	IK403 = 1: "Required Data Element Missing"	2300.CR208 must be present.
X222 214 2300 CR208 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2300.CR208 must be valid values.
X222 214 2300 CR209 010	Complication Indicator	ID	1-1	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 214 2300 CR210 010	Patient Condition Description	AN	1-80	S	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2300.CR210 must contain at least one non-space character.
X222 214 2300 CR210 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2300.CR210 must be 1 - 80 characters.
X222 214 2300 CR210 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 713:: "Patient Condition Description"	N/A
X222 214 2300 CR210 040	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2300.CR210 must be populated with accepted AN characters.
X222 214 2300 CR211 010	Patient Condition Description	AN	1-80	S	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2300.CR211 must contain at least one non-space character.
X222 214 2300 CR211 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2300.CR211 must be 1 - 80 characters.
X222 214 2300 CR211 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 713:: "Patient Condition Description"	N/A
X222 214 2300 CR211 040	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2300.CR211 must be populated with accepted AN characters.
X222 214 2300 CR212 010	Yes/No Condition or Response Code	ID	1-1	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 216 2300 CRC 010	AMBULANCE CERTIFICATION	N/A	3	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only three iterations of 2300.CRC with CRC01 = "07" are allowed.
X222 216 2300 CRC 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 337: "Ambulance certification/documentation"	If 2300.CRC is present, 2300.CLM05-1 must be "41" or "42".
X222 216 2300 CRC01 010	Code Category	ID	2-2	R	N/A	07	999	IK403 = 1: "Required Data Element Missing"	2300.CRC01 must be present.
X222 216 2300 CRC01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2300.CRC01 must be "07".
X222 216 2300 CRC02 010	Certification Condition Indicator	ID	1-1	R	N/A	N, Y	999	IK403 = 1: "Required Data Element Missing"	2300.CRC02 must be present.
X222 216 2300 CRC02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2300.CRC02 must be valid values.
X222 216 2300 CRC03 010	Condition Code	ID	2-3	R	N/A	01, 04, 05, 06, 07, 08, 09, 12	999	IK403 = 1: "Required Data Element Missing"	2300.CRC03 must be present.
X222 216 2300 CRC03 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2300.CRC03 must be valid values.
X222 216 2300 CRC04 010	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2300.CRC04 must be valid values.
X222 216 2300 CRC05 010	Condition Code	ID	2-3	S	N/A	01, 04, 05, 06, 07, 08, 09, 12	999	IK403 = 2: "Conditional Required Data Element Missing"	2300.CRC05 can only be present if 2300.CRC04 is present.
X222 216 2300 CRC05 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2300.CRC05 must be valid values.
X222 216 2300 CRC06 010	Condition Code	ID	2-3	S	N/A	01, 04, 05, 06, 07, 08, 09, 12	999	IK403 = 2: "Conditional Required Data Element Missing"	2300.CRC06 can only be present if 2300.CRC05 is present.
X222 216 2300 CRC06 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2300.CRC06 must be valid values.
X222 216 2300 CRC07 010	Condition Code	ID	2-3	S	N/A	01, 04, 05, 06, 07, 08, 09, 12	999	IK403 = 2: "Conditional Required Data Element Missing"	2300.CRC07 can only be present if 2300.CRC06 is present.
X222 216 2300 CRC07 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2300.CRC07 must be valid values.
X222 219 2300 CRC 010	PATIENT CONDITION INFORMATION: VISION	N/A	3	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only three iterations of 2300.CRC with CRC01 = "E1", "E2" or "E3" are allowed.
X222 219 2300 CRC01 010	Code Category	ID	2-2	R	N/A	E1, E2, E3	999	IK403 = 1: "Required Data Element Missing"	2300.CRC01 must be present.
X222 219 2300 CRC01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2300.CRC01 must be valid values.
X222 219 2300 CRC02 010	Certification Condition Indicator	ID	1-1	R	N/A	N, Y	999	IK403 = 1: "Required Data Element Missing"	2300.CRC02 must be present.
X222 219 2300 CRC02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2300.CRC02 must be valid values.
X222 219 2300 CRC03 010	Condition Code	ID	2-3	R	N/A	L1, L2, L3, L4, L5	999	IK403 = 1: "Required Data Element Missing"	2300.CRC03 must be present.
X222 219 2300 CRC03 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2300.CRC03 must be valid values.
X222 219 2300 CRC04 010	Condition Code	ID	2-3	S	N/A	L1, L2, L3, L4, L5	999	IK403 = 2: "Conditional Required Data Element Missing"	2300.CRC04 can only be present if 2300.CRC03 is present.
X222 219 2300 CRC04 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2300.CRC04 must be valid values.
X222 219 2300 CRC05 010	Condition Code	ID	2-3	S	N/A	L1, L2, L3, L4, L5	999	IK403 = 2: "Conditional Required Data Element Missing"	2300.CRC05 can only be present if 2300.CRC04 is present.
X222 219 2300 CRC05 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2300.CRC05 must be valid values.
X222 219 2300 CRC06 010	Condition Code	ID	2-3	S	N/A	L1, L2, L3, L4, L5	999	IK403 = 2: "Conditional Required Data Element Missing"	2300.CRC06 can only be present if 2300.CRC05 is present.
X222 219 2300 CRC06 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2300.CRC06 must be valid values.
X222 219 2300 CRC07 010	Condition Code	ID	2-3	S	N/A	L1, L2, L3, L4, L5	999	IK403 = 2: "Conditional Required Data Element Missing"	2300.CRC07 can only be present if 2300.CRC06 is present.
X222 219 2300 CRC07 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2300.CRC07 must be valid values.
X222 221 2300 CRC 010	HOMEBOUND INDICATOR	N/A	1	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2300.CRC with CRC01 = "75" is allowed.
X222 221 2300 CRC01 010	Code Category	ID	2-2	R	N/A	75	999	IK403 = 1: "Required Data Element Missing"	2300.CRC01 must be present.
X222 221 2300 CRC01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2300.CRC01 must be "75".
X222 221 2300 CRC02 010	Certification Condition Indicator	ID	1-1	R	N/A	Y	999	IK403 = 1: "Required Data Element Missing"	2300.CRC02 must be present.
X222 221 2300 CRC02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2300.CRC02 must be "Y".
X222 221 2300 CRC03 010	Homebound Indicator	ID	2-3	R	N/A	IH	999	IK403 = 1: "Required Data Element Missing"	2300.CRC03 must be present.
X222 221 2300 CRC03 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2300.CRC03 must be "IH".
X222 221 2300 CRC04 010	Condition Indicator	ID	2-3	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 221 2300 CRC05 010	Condition Indicator	ID	2-3	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 221 2300 CRC06 010	Condition Indicator	ID	2-3	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 221 2300 CRC07 010	Condition Indicator	ID	2-3	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 223 2300 CRC 010	EPSDT REFERRAL	N/A	1	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2300.CRC with CRC01 = "ZZ" is allowed.
X222 223 2300 CRC01 010	Code Category	ID	2-2	R	N/A	ZZ	999	IK403 = 1: "Required Data Element Missing"	2300.CRC01 must be present.
X222 223 2300 CRC01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2300.CRC01 must be "ZZ".
X222 223 2300 CRC02 010	Certification Condition Indicator	ID	1-1	R	N/A	N, Y	999	IK403 = 1: "Required Data Element Missing"	2300.CRC02 must be present.
X222 223 2300 CRC02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2300.CRC02 must be valid values.
X222 223 2300 CRC03 010	Condition Code	ID	2-3	R	N/A	AV, NU, S2, ST	999	IK403 = 1: "Required Data Element Missing"	2300.CRC03 must be present.
X222 223 2300 CRC03 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	If 2300.CRC02 is "Y", 2300.CRC03 must be valid values.
X222 223 2300 CRC03 025	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement /Rejected for Invalid Information..." CSC: 527 "Certification Condition Indicator"	If 2300.CRC02 is "Y", 2300.CRC03 must not be "NU".
X222 223 2300 CRC03 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	If 2300.CRC02 is "N", 2300.CRC03 must be "NU".
X222 223 2300 CRC04 010	Condition Code	ID	2-3	S	N/A	AV, NU, S2, ST	999	IK403 = 7: "Invalid Code Value"	2300.CRC04 must be valid values.
X222 223 2300 CRC04 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement /Rejected for Invalid Information..." CSC: 527 "Certification Condition Indicator"	2300.CRC04 must not be "NU".
X222 223 2300 CRC05 010	Condition Code	ID	2-3	S	N/A	AV, NU, S2, ST	999	IK403 = 7: "Invalid Code Value"	2300.CRC05 must be valid values.
X222 223 2300 CRC05 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement /Rejected for Invalid Information..." CSC: 527 "Certification Condition Indicator"	2300.CRC05 must not be "NU".
X222 223 2300 CRC06 010	Condition Indicator	ID	2-3	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 223 2300 CRC07 010	Condition Indicator	ID	2-3	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 226 2300 HI 010	N/A	N/A	N/A	N/A	N/A	N/A	999	IK304 = 3: "Required Segment Missing"	2300.HI with HI01-1 = "BK" or "ABK" must be present.
X222 226 2300 HI 040	N/A	N/A	N/A	N/A	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2300.HI with HI01-1 = "BK" or "ABK" is allowed.
X222 226 2300 HI01 010	HEALTH CARE CODE INFORMATION	N/A	N/A	R	N/A	N/A	N/A	N/A	N/A
X222 226 2300 HI01-1 010	Code List Qualifier Code	ID	1-3	R	N/A	ABK, BK	999	IK403 = 1: "Required Data Element Missing"	2300.HI01-1 must be present.
X222 226 2300 HI01-1 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2300.HI01-1 must be "BK" or "ABK".
X222 226 2300 HI01-2 010	Diagnosis Code	AN	1-30	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2300.HI01-2 must be present.
X222 226 2300 HI01-2 030	Diagnosis Code	AN	1-30	R	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 254: "Principal diagnosis code"	If 2400.SV107-1, SV107-2, SV107-3, or SV107-4 is "1" and 2300.HI01-1 is "BK" then 2300.HI01-2 must be a valid ICD-9-CM Diagnosis code on the date in 2400.DTP03 when DTP01 = "472", based on the ICD-9-CM Diagnosis Code list table. If 2400.DTP02=RD8, use the "from" date to validate.
X222 226 2300 HI01-2 050	Diagnosis Code	AN	1-30	R	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 254: "Principal diagnosis code"	If 2400.SV107-1, SV107-2, SV107-3, or SV107-4 is "1" and 2300.HI01-1 is "ABK" then 2300.HI01-2 must be a valid ICD-10-CM Diagnosis code on the date in 2400.DTP03 when DTP01 = "472", based on the ICD-10-CM Diagnosis Code list table. If DTP02=RD8, use the "from" date to validate
X222 226 2300 HI01-2 070	Diagnosis Code	AN	1-30	R	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 254: "Principal diagnosis code"	If 2400.SV107-1, SV107-2, SV107-3 and SV107-4 are not "1" (all lines) and 2300.HI01-1 is "BK", 2300.HI01-2 must be a valid ICD-9-CM Principal Diagnosis code on the date in 2400.DTP03 (all lines) when DTP01 = "472", based on the ICD-9-CM Diagnosis Code list table. If 2400.DTP02=RD8, use the "from" date to validate.
X222 226 2300 HI01-2 090	Diagnosis Code	AN	1-30	R	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 254: "Principal Diagnosis code"	If 2400.SV107-1, SV107-2, SV107-3 and SV107-4 are not "1" (all lines) and 2300.HI01-1 is "ABK", 2300.HI01-2 must be a valid ICD-10-CM Principal Diagnosis code on the date in 2400.DTP03 (all lines) when DTP01 = "472", based on the ICD-10-CM Diagnosis Code list table. If 2400.DTP02=RD8, use the "from" date to validate.
X222 226 2300 HI01-2 100	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2300.HI01-2 must not contain a "."
X222 226 2300 HI01-2 110	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 511: "Invalid character" CSC 254: "Principal diagnosis code"	N/A
X222 226 2300 HI01-2 120	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 254: "Principal diagnosis code" CSC 509: External Cause of Injury	If 2300.HI01-1 equals BK, then 2300.HI01-2 must not begin with "E".
X222 226 2300 HI01-2 125	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 254: "Principal diagnosis code" CSC 509: External Cause of Injury	If 2300.HI01-1 equals ABK, then 2300.HI01-2 must not begin with a "V", "W", "X" or "Y".
X222 226 2300 HI01-2 130	N/A	AN	1-30	R	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 255: "Diagnosis Code"	If 2300.HI01-1 equals BK or ABK the Diagnosis codes within this HI segment must not be duplicated.
X222 226 2300 HI01-3 010	Date Time Period Format Qualifier	ID	2-3	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 226 2300 HI01-4 010	Date Time Period	AN	1-35	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 226 2300 HI01-5 010	Monetary Amount	R	1-18	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 226 2300 HI01-6 010	Quantity	R	1-15	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 226 2300 HI01-7 010	Version Identifier	AN	1-30	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 226 2300 HI01-8 010	Industry code	AN	1-30	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 226 2300 HI01-9 010	Yes/No Condition or response Code	ID	1-1	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 226 2300 HI02-1 020	Diagnosis Type Code	ID	1-3	S	N/A	ABF, BF	999	IK403 = 7: "Invalid Code Value"	2300.HI02-1 must be "BF" or "ABF".
X222 226 2300 HI02-1 040	Diagnosis Type Code	ID	1-3	S	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 255: "Diagnosis code"	If 2300 HI01-1 = "BK", then 2300.HI02-1 must be "BF."
X222 226 2300 HI02-1 050	Diagnosis Type Code	ID	1-3	S	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 255: "Diagnosis code"	If 2300 HI01-1 = "ABK", then 2300.HI02-1 must be "ABF".
X222 226 2300 HI02-2 020	Diagnosis Code	AN	1-30	R	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 255: "Diagnosis code"	If 2400.SV107-1, SV107-2, SV107-3, or SV107-4 is "2" and 2300.HI02-1 is "BF" then 2300.HI02-2 must be a valid ICD-9-CM Diagnosis code on the date in 2400.DTP03 when DTP01 = "472", based on the ICD-9-CM Diagnosis Code list table. If 2400.DTP02=RD8, use the "from" date to validate.
X222 226 2300 HI02-2 040	Diagnosis Code	AN	1-30	R	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 255: "Diagnosis code"	If 2400.SV107-1, SV107-2, SV107-3, or SV107-4 is "2" and 2300.HI02-1 is "ABF" then 2300.HI02-2 must be a valid ICD-10-CM Diagnosis code on the date in 2400.DTP03 when DTP01 = "472", based on the ICD-10-CM Diagnosis Code list table. If 2400.DTP02=RD8, use the "from" date to validate.
X222 226 2300 HI02-2 060	Diagnosis Code	AN	1-30	R	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 255: "Diagnosis code"	If 2400.SV107-1, SV107-2, SV107-3 and SV107-4 are not "2" (all lines) and 2300.HI02-1 is "BF", 2300.HI02-2 must be a valid ICD-9-CM Diagnosis code on the date in 2400.DTP03 (all lines) when DTP01 = "472", based on the ICD-9-CM Diagnosis Code list table. If 2400.DTP02=RD8, use the "from" date to validate.
X222 226 2300 HI02-2 080	Diagnosis Code	AN	1-30	R	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 255: " Diagnosis code"	If 2400.SV107-1, SV107-2, SV107-3 and SV107-4 are not "2" and 2300.HI02-1 is "ABF", 2300.HI02-2 must be a valid ICD-10-CM Diagnosis code on the date in 2400.DTP03 (all lines) when DTP01 = "472", based on the ICD-10-CM Diagnosis Code list table. If 2400.DTP02=RD8, use the "from" date to validate.
X222 226 2300 HI02-2 090	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2300.HI02-2 must not contain a "."
X222 226 2300 HI02-2 100	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 511: "Invalid character" CSC 255: "Diagnosis code"	N/A
X222 226 2300 HI02-3 010	Date Time Period Format Qualifier	ID	2-3	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 226 2300 HI02-4 010	Date Time Period	AN	1-35	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 226 2300 HI02-5 010	Monetary Amount	R	1-18	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 226 2300 HI02-6 010	Quantity	R	1-15	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 226 2300 HI02-7 010	Version Identifier	AN	1-30	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 226 2300 HI02-8 010	Industry code	AN	1-30	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 226 2300 HI02-9 010	Yes/No Condition or response Code	ID	1-1	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 226 2300 HI03 010	HEALTH CARE CODE INFORMATION	N/A	N/A	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	2300.HI03 can only be present if 2300.HI02 is present.
X222 226 2300 HI03-1 020	Diagnosis Type Code	ID	1-3	R	N/A	ABF, BF	999	IK403 = 7: "Invalid Code Value"	2300.HI03-1 must be "BF" or "ABF".
X222 226 2300 HI03-1 040	Diagnosis Type Code	ID	1-3	S	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 255: "Diagnosis code"	If 2300 HI01-1 = "BK", then 2300.HI03-1 must be "BF."
X222 226 2300 HI03-1 050	Diagnosis Type Code	ID	1-3	S	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 255: "Diagnosis code""	If 2300 HI01-1 = "ABK", then 2300.HI03-1 must be "ABF".
X222 226 2300 HI03-2 020	Diagnosis Code	AN	1-30	R	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 255: "Diagnosis code"	If 2400.SV107-1, SV107-2, SV107-3, or SV107-4 is "3" and 2300.HI03-1 is "BF" then 2300.HI03-2 must be a valid ICD-9-CM Diagnosis code on the date in 2400.DTP03 when DTP01 = "472", based on the ICD-9-CM Diagnosis Code list table. If 2400.DTP02=RD8, use the "from" date to validate.
X222 226 2300 HI03-2 040	Diagnosis Code	AN	1-30	R	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 255: "Diagnosis code"	If 2400.SV107-1, SV107-2, SV107-3, or SV107-4 is "3" and 2300.HI03-1 is "ABF" then 2300.HI03-2 must be a valid ICD-10-CM Diagnosis code on the date in 2400.DTP03 when DTP01 = "472", based on the ICD-10-CM Diagnosis Code list table. If 2400.DTP02=RD8, use the "from" date to validate.
X222 226 2300 HI03-2 060	Diagnosis Code	AN	1-30	R	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 255: "Diagnosis code"	If 2400.SV107-1, SV107-2, SV107-3 and SV107-4 are not "3" (all lines) and 2300.HI03-1 is "BF", 2300.HI03-2 must be a valid ICD-9-CM Diagnosis code on the date in 2400.DTP03 (all lines) when DTP01 = "472", based on the ICD-9-CM Diagnosis Code list table. If 2400.DTP02=RD8, use the "from" date to validate.
X222 226 2300 HI03-2 080	Diagnosis Code	AN	1-30	R	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 255: "Diagnosis code"	If 2400.SV107-1, SV107-2, SV107-3 and SV107-4 are not "3" and 2300.HI03-1 is "ABF", 2300.HI03-2 must be a valid ICD-10-CM Diagnosis code on the date in 2400.DTP03 (all lines) when DTP01 = "472", based on the ICD-10-CM Diagnosis Code list table. If 2400.DTP02=RD8, use the "from" date to validate.
X222 226 2300 HI03-2 090	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2300.HI03-2 must not contain a "."
X222 226 2300 HI03-2 100	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 511: "Invalid character" CSC 255: "Diagnosis code"	N/A
X222 226 2300 HI03-3 010	Date Time Period Format Qualifier	ID	2-3	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 226 2300 HI03-4 010	Date Time Period	AN	1-35	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 226 2300 HI03-5 010	Monetary Amount	R	1-18	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 226 2300 HI03-6 010	Quantity	R	1-15	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 226 2300 HI03-7 010	Version Identifier	AN	1-30	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 226 2300 HI03-8 010	Industry code	AN	1-30	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 226 2300 HI03-9 010	Yes/No Condition or response Code	ID	1-1	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 226 2300 HI04 010	HEALTH CARE CODE INFORMATION	N/A	N/A	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	2300.HI04 can only be present if 2300.HI03 is present.
X222 226 2300 HI04-1 020	Diagnosis Type Code	ID	1-3	R	N/A	ABF, BF	999	IK403 = 7: "Invalid Code Value"	2300.HI04-1 must be "BF" or "ABF".
X222 226 2300 HI04-1 040	Diagnosis Type Code	ID	1-3	S	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 255: "Diagnosis code"	If 2300 HI01-1 = "BK", then 2300.HI04-1 must be "BF."
X222 226 2300 HI04-1 050	Diagnosis Type Code	ID	1-3	S	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 255: "Diagnosis code"	If 2300 HI01-1 = "ABK", then 2300.HI04-1 must be "ABF".
X222 226 2300 HI04-2 020	Diagnosis Code	AN	1-30	R	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 255: "Diagnosis code"	If 2400.SV107-1, SV107-2, SV107-3, or SV107-4 is "4" and 2300.HI04-1 is "BF" then 2300.HI04-2 must be a valid ICD-9-CM Diagnosis code on the date in 2400.DTP03 when DTP01 = "472", based on the ICD-9-CM Diagnosis Code list table. If 2400.DTP02=RD8, use the "from" date to validate.
X222 226 2300 HI04-2 040	Diagnosis Code	AN	1-30	R	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 255: "Diagnosis code"	If 2400.SV107-1, SV107-2, SV107-3, or SV107-4 is "4" and 2300.HI04-1 is "ABF" then 2300.HI04-2 must be a valid ICD-10-CM Diagnosis code on the date in 2400.DTP03 when DTP01 = "472", based on the ICD-10-CM Diagnosis Code list table. If 2400.DTP02=RD8, use the "from" date to validate. table.
X222 226 2300 HI04-2 060	Diagnosis Code	AN	1-30	R	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 255: "Diagnosis code"	If 2400.SV107-1, SV107-2, SV107-3 and SV107-4 are not "4" (all lines) and 2300.HI04-1 is "BF", 2300.HI04-2 must be a valid ICD-9-CM Diagnosis code on the date in 2400.DTP03 (all lines) when DTP01 = "472", based on the ICD-9-CM Diagnosis Code list table. If 2400.DTP02=RD8, use the "from" date to validate.
X222 226 2300 HI04-2 080	Diagnosis Code	AN	1-30	R	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 255: "Diagnosis code"	If 2400.SV107-1, SV107-2, SV107-3 and SV107-4 are not "4" and 2300.HI04-1 is "ABF", 2300.HI04-2 must be a valid ICD-10-CM Diagnosis code on the date in 2400.DTP03 (all lines) when DTP01 = "472", based on the ICD-10-CM Diagnosis Code list table. If 2400.DTP02=RD8, use the "from" date to validate.
X222 226 2300 HI04-2 090	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2300.HI04-2 must not contain a "."
X222 226 2300 HI04-2 100	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 511: "Invalid character" CSC 255: "Diagnosis code"	N/A
X222 226 2300 HI04-3 010	Date Time Period Format Qualifier	ID	2-3	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 226 2300 HI04-4 010	Date Time Period	AN	1-35	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 226 2300 HI04-5 010	Monetary Amount	R	1-18	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 226 2300 HI04-6 010	Quantity	R	1-15	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 226 2300 HI04-7 010	Version Identifier	AN	1-30	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 226 2300 HI04-8 010	Industry code	AN	1-30	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 226 2300 HI04-9 010	Yes/No Condition or response Code	ID	1-1	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 226 2300 HI05 010	HEALTH CARE CODE INFORMATION	N/A	N/A	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	2300.HI05 can only be present if 2300.HI04 is present.
X222 226 2300 HI05-1 020	Diagnosis Type Code	ID	1-3	R	N/A	ABF, BF	999	IK403 = 7: "Invalid Code Value"	2300.HI05-1 must be "BF" or "ABF".
X222 226 2300 HI05-1 040	Diagnosis Type Code	ID	1-3	S	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 255: "Diagnosis code"	If 2300 HI01-1 = "BK", then 2300.HI05-1 must be "BF."
X222 226 2300 HI05-1 050	Diagnosis Type Code	ID	1-3	S	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 255: "Diagnosis code"	If 2300 HI01-1 = "ABK", then 2300.HI05-1 must be "ABF".
X222 226 2300 HI05-2 020	Diagnosis Code	AN	1-30	R	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 255: "Diagnosis code"	If 2400.SV107-1, SV107-2, SV107-3, or SV107-4 is "5" and 2300.HI05-1 is "BF" then 2300.HI05-2 must be a valid ICD-9-CM Diagnosis code on the date in 2400.DTP03 when DTP01 = "472", based on the ICD-9-CM Diagnosis Code list table. If 2400.DTP02=RD8, use the "from" date to validate.
X222 226 2300 HI05-2 040	Diagnosis Code	AN	1-30	R	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 255: "Diagnosis code"	If 2400.SV107-1, SV107-2, SV107-3, or SV107-4 is "5" and 2300.HI05-1 is "ABF" then 2300.HI05-2 must be a valid ICD-10-CM Diagnosis code on the date in 2400.DTP03 when DTP01 = "472", based on the ICD-10-CM Diagnosis Code list table. If 2400.DTP02=RD8, use the "from" date to validate. table.
X222 226 2300 HI05-2 060	Diagnosis Code	AN	1-30	R	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 255: "Diagnosis code"	If 2400.SV107-1, SV107-2, SV107-3 and SV107-4 are not "5" (all lines) and 2300.HI05-1 is "BF", 2300.HI05-2 must be a valid ICD-9-CM Diagnosis code on the date in 2400.DTP03 (all lines) when DTP01 = "472", based on the ICD-9-CM Diagnosis Code list table. If 2400.DTP02=RD8, use the "from" date to validate.
X222 226 2300 HI05-2 080	Diagnosis Code	AN	1-30	R	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 255: "Diagnosis code"	If 2400.SV107-1, SV107-2, SV107-3 and SV107-4 are not "5" and 2300.HI05-1 is "ABF", 2300.HI05-2 must be a valid ICD-10-CM Diagnosis code on the date in 2400.DTP03 (all lines) when DTP01 = "472", based on the ICD-10-CM Diagnosis Code list table. If 2400.DTP02=RD8, use the "from" date to validate.
X222 226 2300 HI05-2 090	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2300.HI05-2 must not contain a "."
X222 226 2300 HI05-2 100	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 511: "Invalid character" CSC 255: "Diagnosis code"	N/A
X222 226 2300 HI05-3 010	Date Time Period Format Qualifier	ID	2-3	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 226 2300 HI05-4 010	Date Time Period	AN	1-35	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 226 2300 HI05-5 010	Monetary Amount	R	1-18	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 226 2300 HI05-6 010	Quantity	R	1-15	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 226 2300 HI05-7 010	Version Identifier	AN	1-30	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 226 2300 HI05-8 010	Industry code	AN	1-30	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 226 2300 HI05-9 010	Yes/No Condition or response Code	ID	1-1	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 226 2300 HI06 010	HEALTH CARE CODE INFORMATION	N/A	N/A	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	2300.HI06 can only be present if 2300.HI05 is present.
X222 226 2300 HI06-1 020	Diagnosis Type Code	ID	1-3	R	N/A	ABF, BF	999	IK403 = 7: "Invalid Code Value"	2300.HI06-1 must be "BF" or "ABF".
X222 226 2300 HI06-1 040	Diagnosis Type Code	ID	1-3	S	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 255: "Diagnosis code"	If 2300 HI01-1 = "BK", then 2300.HI06-1 must be "BF."
X222 226 2300 HI06-1 050	Diagnosis Type Code	ID	1-3	S	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 255: "Diagnosis code"	If 2300 HI01-1 = "ABK", then 2300.HI06-1 must be "ABF".
X222 226 2300 HI06-2 020	Diagnosis Code	AN	1-30	R	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 255: "Diagnosis code"	If 2400.SV107-1, SV107-2, SV107-3, or SV107-4 is "6" and 2300.HI06-1 is "BF" then 2300.HI06-2 must be a valid ICD-9-CM Diagnosis code on the date in 2400.DTP03 when DTP01 = "472", based on the ICD-9-CM Diagnosis Code list table. If 2400.DTP02=RD8, use the "from" date to validate.
X222 226 2300 HI06-2 040	Diagnosis Code	AN	1-30	R	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 255: "Diagnosis code"	If 2400.SV107-1, SV107-2, SV107-3, or SV107-4 is "6" and 2300.HI06-1 is "ABF" then 2300.HI06-2 must be a valid ICD-10-CM Diagnosis code on the date in 2400.DTP03 when DTP01 = "472", based on the ICD-10-CM Diagnosis Code list table. If 2400.DTP02=RD8, use the "from" date to validate. table.
X222 226 2300 HI06-2 060	Diagnosis Code	AN	1-30	R	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 255: "Diagnosis code"	If 2400.SV107-1, SV107-2, SV107-3 and SV107-4 are not "6" (all lines) and 2300.HI06-1 is "BF", 2300.HI06-2 must be a valid ICD-9-CM Diagnosis code on the date in 2400.DTP03 (all lines) when DTP01 = "472", based on the ICD-9-CM Diagnosis Code list table. If 2400.DTP02=RD8, use the "from" date to validate.
X222 226 2300 HI06-2 080	Diagnosis Code	AN	1-30	R	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 255: "Diagnosis code"	If 2400.SV107-1, SV107-2, SV107-3 and SV107-4 are not "6" and 2300.HI06-1 is "ABF", 2300.HI06-2 must be a valid ICD-10-CM Diagnosis code on the date in 2400.DTP03 (all lines) when DTP01 = "472", based on the ICD-10-CM Diagnosis Code list table. If 2400.DTP02=RD8, use the "from" date to validate.
X222 226 2300 HI06-2 090	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2300.HI06-2 must not contain a "."
X222 226 2300 HI06-2 100	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 511: "Invalid character" CSC 255: "Diagnosis code"	N/A
X222 226 2300 HI06-3 010	Date Time Period Format Qualifier	ID	2-3	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 226 2300 HI06-4 010	Date Time Period	AN	1-35	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 226 2300 HI06-5 010	Monetary Amount	R	1-18	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 226 2300 HI06-6 010	Quantity	R	1-15	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 226 2300 HI06-7 010	Version Identifier	AN	1-30	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 226 2300 HI06-8 010	Industry code	AN	1-30	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 226 2300 HI06-9 010	Yes/No Condition or response Code	ID	1-1	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 226 2300 HI07 010	HEALTH CARE CODE INFORMATION	N/A	N/A	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	2300.HI07 can only be present if 2300.HI06 is present.
X222 226 2300 HI07-1 020	Diagnosis Type Code	ID	1-3	R	N/A	ABF, BF	999	IK403 = 7: "Invalid Code Value"	2300.HI07-1 must be "BF" or "ABF".
X222 226 2300 HI07-1 040	Diagnosis Type Code	ID	1-3	S	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 255: "Diagnosis code"	If 2300 HI01-1 = "BK", then 2300.HI07-1 must be "BF."
X222 226 2300 HI07-1 050	Diagnosis Type Code	ID	1-3	S	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 255: "Diagnosis code"	If 2300 HI01-1 = "ABK", then 2300.HI07-1 must be "ABF".
X222 226 2300 HI07-2 020	Diagnosis Code	AN	1-30	R	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 255: "Diagnosis code"	If 2400.SV107-1, SV107-2, SV107-3, or SV107-4 is "7" and 2300.HI07-1 is "BF" then 2300.HI07-2 must be a valid ICD-9-CM Diagnosis code on the date in 2400.DTP03 when DTP01 = "472", based on the ICD-9-CM Diagnosis Code list table. If 2400.DTP02=RD8, use the "from" date to validate.
X222 226 2300 HI07-2 040	Diagnosis Code	AN	1-30	R	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 255: "Diagnosis code"	If 2400.SV107-1, SV107-2, SV107-3, or SV107-4 is "7" and 2300.HI07-1 is "ABF" then 2300.HI07-2 must be a valid ICD-10-CM Diagnosis code on the date in 2400.DTP03 when DTP01 = "472", based on the ICD-10-CM Diagnosis Code list table. If 2400.DTP02=RD8, use the "from" date to validate. table.
X222 226 2300 HI07-2 060	Diagnosis Code	AN	1-30	R	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 255: "Diagnosis code"	If 2400.SV107-1, SV107-2, SV107-3 and SV107-4 are not "7" (all lines) and 2300.HI07-1 is "BF", 2300.HI07-2 must be a valid ICD-9-CM Diagnosis code on the date in 2400.DTP03 (all lines) when DTP01 = "472", based on the ICD-9-CM Diagnosis Code list table. If 2400.DTP02=RD8, use the "from" date to validate.
X222 226 2300 HI07-2 080	Diagnosis Code	AN	1-30	R	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 255: "Diagnosis code"	If 2400.SV107-1, SV107-2, SV107-3 and SV107-4 are not "7" and 2300.HI07-1 is "ABF", 2300.HI07-2 must be a valid ICD-10-CM Diagnosis code on the date in 2400.DTP03 (all lines) when DTP01 = "472", based on the ICD-10-CM Diagnosis Code list table. If 2400.DTP02=RD8, use the "from" date to validate.
X222 226 2300 HI07-2 090	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2300.HI07-2 must not contain a "."
X222 226 2300 HI07-2 100	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 511: "Invalid character" CSC 255: "Diagnosis code"	N/A
X222 226 2300 HI07-3 010	Date Time Period Format Qualifier	ID	2-3	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 226 2300 HI07-4 010	Date Time Period	AN	1-35	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 226 2300 HI07-5 010	Monetary Amount	R	1-18	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 226 2300 HI07-6 010	Quantity	R	1-15	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 226 2300 HI07-7 010	Version Identifier	AN	1-30	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 226 2300 HI07-8 010	Industry code	AN	1-30	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 226 2300 HI07-9 010	Yes/No Condition or response Code	ID	1-1	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 226 2300 HI08 010	HEALTH CARE CODE INFORMATION	N/A	N/A	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	2300.HI08 can only be present if 2300.HI07 is present.
X222 226 2300 HI08-1 020	Diagnosis Type Code	ID	1-3	R	N/A	ABF, BF	999	IK403 = 7: "Invalid Code Value"	2300.HI08-1 must be "BF" or "ABF".
X222 226 2300 HI08-1 040	Diagnosis Type Code	ID	1-3	S	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 255: "Diagnosis code"	If 2300 HI01-1 = "BK", then 2300.HI08-1 must be "BF."
X222 226 2300 HI08-1 050	Diagnosis Type Code	ID	1-3	S	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 255: "Diagnosis code"	If 2300 HI01-1 = "ABK", then 2300.HI08-1 must be "ABF".
X222 226 2300 HI08-2 020	Diagnosis Code	AN	1-30	R	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 255: "Diagnosis code"	If 2400.SV107-1, SV107-2, SV107-3, or SV107-4 is "8" and 2300.HI08-1 is "BF" then 2300.HI08-2 must be a valid ICD-9-CM Diagnosis code on the date in 2400.DTP03 when DTP01 = "472", based on the ICD-9-CM Diagnosis Code list table. If 2400.DTP02=RD8, use the "from" date to validate.
X222 226 2300 HI08-2 040	Diagnosis Code	AN	1-30	R	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 255: "Diagnosis code"	If 2400.SV107-1, SV107-2, SV107-3, or SV107-4 is "8" and 2300.HI08-1 is "ABF" then 2300.HI08-2 must be a valid ICD-10-CM Diagnosis code on the date in 2400.DTP03 when DTP01 = "472", based on the ICD-10-CM Diagnosis Code list table. If 2400.DTP02=RD8, use the "from" date to validate.
X222 226 2300 HI08-2 060	Diagnosis Code	AN	1-30	R	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 255: "Diagnosis code"	If 2400.SV107-1, SV107-2, SV107-3 and SV107-4 are not "8" (all lines) and 2300.HI08-1 is "BF", 2300.HI08-2 must be a valid ICD-9-CM Diagnosis code on the date in 2400.DTP03 (all lines) when DTP01 = "472", based on the ICD-9-CM Diagnosis Code list table. If 2400.DTP02=RD8, use the "from" date to validate.
X222 226 2300 HI08-2 080	Diagnosis Code	AN	1-30	R	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 255: "Diagnosis code"	If 2400.SV107-1, SV107-2, SV107-3 and SV107-4 are not "8" and 2300.HI08-1 is "ABF", 2300.HI08-2 must be a valid ICD-10-CM Diagnosis code on the date in 2400.DTP03 (all lines) when DTP01 = "472", based on the ICD-10-CM Diagnosis Code list table. If 2400.DTP02=RD8, use the "from" date to validate.
X222 226 2300 HI08-2 090	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2300.HI08-2 must not contain a "."
X222 226 2300 HI08-2 100	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 511: "Invalid character" CSC 255: "Diagnosis code"	N/A
X222 226 2300 HI08-3 010	Date Time Period Format Qualifier	ID	2-3	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 226 2300 HI08-4 010	Date Time Period	AN	1-35	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 226 2300 HI08-5 010	Monetary Amount	R	1-18	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 226 2300 HI08-6 010	Quantity	R	1-15	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 226 2300 HI08-7 010	Version Identifier	AN	1-30	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 226 2300 HI08-8 010	Industry code	AN	1-30	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 226 2300 HI08-9 010	Yes/No Condition or response Code	ID	1-1	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 226 2300 HI09 010	HEALTH CARE CODE INFORMATION	N/A	N/A	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	2300.HI09 can only be present if 2300.HI08 is present.
X222 226 2300 HI09-1 020	Diagnosis Type Code	ID	1-3	R	N/A	ABF, BF	999	IK403 = 7: "Invalid Code Value"	2300.HI09-1 must be "BF" or "ABF".
X222 226 2300 HI09-1 040	Diagnosis Type Code	ID	1-3	S	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 255: "Diagnosis code"	If 2300 HI01-1 = "BK", then 2300.HI09-1 must be "BF."
X222 226 2300 HI09-1 050	Diagnosis Type Code	ID	1-3	S	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 255: "Diagnosis code"	If 2300 HI01-1 = "ABK", then 2300.HI09-1 must be "ABF".
X222 226 2300 HI09-2 030	Diagnosis Code	AN	1-30	R	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 255: "Diagnosis code"	If 2400.SV107-1, SV107-2, SV107-3, or SV107-4 is "9" and 2300.HI09-1 is "BF" then 2300.HI09-2 must be a valid ICD-9-CM Diagnosis code on the date in 2400.DTP03 when DTP01 = "472", based on the ICD-9-CM Diagnosis Code list table. If 2400.DTP02=RD8, use the "from" date to validate.
X222 226 2300 HI09-2 050	Diagnosis Code	AN	1-30	R	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 255: "Diagnosis code"	If 2400.SV107-1, SV107-2, SV107-3, or SV107-4 is "9" and 2300.HI09-1 is "ABF" then 2300.HI09-2 must be a valid ICD-10-CM Diagnosis code on the date in 2400.DTP03 when DTP01 = "472", based on the ICD-10-CM Diagnosis Code list table. If 2400.DTP02=RD8, use the "from" date to validate.
X222 226 2300 HI09-2 070	Diagnosis Code	AN	1-30	R	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 255: "Diagnosis code"	If 2400.SV107-1, SV107-2, SV107-3 and SV107-4 are not "9" (all lines) and 2300.HI09-1 is "BF", 2300.HI09-2 must be a valid ICD-9-CM Diagnosis code on the date in 2400.DTP03 (all lines) when DTP01 = "472", based on the ICD-9-CM Diagnosis Code list table. If 2400.DTP02=RD8, use the "from" date to validate.
X222 226 2300 HI09-2 090	Diagnosis Code	AN	1-30	R	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 255: "Diagnosis code"	If 2400.SV107-1, SV107-2, SV107-3 and SV107-4 are not "9" and 2300.HI09-1 is "ABF", 2300.HI09-2 must be a valid ICD-10-CM Diagnosis code on the date in 2400.DTP03 (all lines) when DTP01 = "472", based on the ICD-10-CM Diagnosis Code list table. If 2400.DTP02=RD8, use the "from" date to validate.
X222 226 2300 HI09-2 100	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2300.HI09-2 must not contain a "."
X222 226 2300 HI09-2 110	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 511: "Invalid character" CSC 255: "Diagnosis code"	N/A
X222 226 2300 HI09-3 010	Date Time Period Format Qualifier	ID	2-3	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 226 2300 HI09-4 010	Date Time Period	AN	1-35	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 226 2300 HI09-5 010	Monetary Amount	R	1-18	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 226 2300 HI09-6 010	Quantity	R	1-15	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 226 2300 HI09-7 010	Version Identifier	AN	1-30	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 226 2300 HI09-8 010	Industry code	AN	1-30	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 226 2300 HI09-9 010	Yes/No Condition or response Code	ID	1-1	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 226 2300 HI10 010	HEALTH CARE CODE INFORMATION	N/A	N/A	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	2300.HI10 can only be present if 2300.HI09 is present.
X222 226 2300 HI10-1 020	Diagnosis Type Code	ID	1-3	R	N/A	ABF, BF	999	IK403 = 7: "Invalid Code Value"	2300.HI10-1 must be "BF" or "ABF".
X222 226 2300 HI10-1 040	Diagnosis Type Code	ID	1-3	S	N/A	N/A	277	ICSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 255: "Diagnosis code"	If 2300 HI01-1 = "BK", then 2300.HI10-1 must be "BF."
X222 226 2300 HI10-1 050	Diagnosis Type Code	ID	1-3	S	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 255: "Diagnosis code"	If 2300 HI01-1 = "ABK", then 2300.HI10-1 must be "ABF".
X222 226 2300 HI10-2 030	Diagnosis Code	AN	1-30	R	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 255: "Diagnosis code"	If 2400.SV107-1, SV107-2, SV107-3, or SV107-4 is "10" and 2300.HI10-1 is "BF" then 2300.HI10-2 must be a valid ICD-9-CM Diagnosis code on the date in 2400.DTP03 when DTP01 = "472", based on the ICD-9-CM Diagnosis Code list table. If 2400.DTP02=RD8, use the "from" date to validate.
X222 226 2300 HI10-2 050	Diagnosis Code	AN	1-30	R	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 255: "Diagnosis code"	If 2400.SV107-1, SV107-2, SV107-3, or SV107-4 is "10" and 2300.HI10-1 is "ABF" then 2300.HI10-2 must be a valid ICD-10-CM Diagnosis code on the date in 2400.DTP03 when DTP01 = "472", based on the ICD-10-CM Diagnosis Code list table. If 2400.DTP02=RD8, use the "from" date to validate.
X222 226 2300 HI10-2 070	Diagnosis Code	AN	1-30	R	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 255: "Diagnosis code"	If 2400.SV107-1, SV107-2, SV107-3 and SV107-4 are not "10" (all lines) and 2300.HI10-1 is "BF", 2300.HI10-2 must be a valid ICD-9-CM Diagnosis code on the date in 2400.DTP03 (all lines) when DTP01 = "472", based on the ICD-9-CM Diagnosis Code list table. If 2400.DTP02=RD8, use the "from" date to validate.
X222 226 2300 HI10-2 090	Diagnosis Code	AN	1-30	R	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 255: "Diagnosis code"	If 2400.SV107-1, SV107-2, SV107-3 and SV107-4 are not "10" and 2300.HI10-1 is "ABF", 2300.HI10-2 must be a valid ICD-10-CM Diagnosis code on the date in 2400.DTP03 (all lines) when DTP01 = "472", based on the ICD-10-CM Diagnosis Code list table. If 2400.DTP02=RD8, use the "from" date to validate.
X222 226 2300 HI10-2 100	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2300.HI10-2 must not contain a "."
X222 226 2300 HI10-2 110	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 511: "Invalid character" CSC 255: "Diagnosis code"	N/A
X222 226 2300 HI10-3 010	Date Time Period Format Qualifier	ID	2-3	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 226 2300 HI10-4 010	Date Time Period	AN	1-35	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 226 2300 HI10-5 010	Monetary Amount	R	1-18	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 226 2300 HI10-6 010	Quantity	R	1-15	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 226 2300 HI10-7 010	Version Identifier	AN	1-30	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 226 2300 HI10-8 010	Industry code	AN	1-30	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 226 2300 HI10-9 010	Yes/No Condition or response Code	ID	1-1	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 226 2300 HI11 010	HEALTH CARE CODE INFORMATION	N/A	N/A	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	2300.HI11 can only be present if 2300.HI10 is present.
X222 226 2300 HI11-1 020	Diagnosis Type Code	ID	1-3	R	N/A	ABF, BF	999	IK403 = 7: "Invalid Code Value"	2300.HI11-1 must be "BF" or "ABF".
X222 226 2300 HI11-1 040	Diagnosis Type Code	ID	1-3	S	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 255: "Diagnosis code"	If 2300 HI01-1 = "BK", then 2300.HI11-1 must be "BF."
X222 226 2300 HI11-1 050	Diagnosis Type Code	ID	1-3	S	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 255: "Diagnosis code"	If 2300 HI01-1 = "ABK", then 2300.HI11-1 must be "ABF".
X222 226 2300 HI11-2 030	Diagnosis Code	AN	1-30	R	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 255: "Diagnosis code"	If 2400.SV107-1, SV107-2, SV107-3, or SV107-4 is "11" and 2300.HI11-1 is "BF" then 2300.HI11-2 must be a valid ICD-9-CM Diagnosis code on the date in 2400.DTP03 when DTP01 = "472", based on the ICD-9-CM Diagnosis Code list table. If 2400.DTP02=RD8, use the "from" date to validate.
X222 226 2300 HI11-2 050	Diagnosis Code	AN	1-30	R	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 255: "Diagnosis code"	If 2400.SV107-1, SV107-2, SV107-3, or SV107-4 is "11" and 2300.HI11-1 is "ABF" then 2300.HI11-2 must be a valid ICD-10-CM Diagnosis code on the date in 2400.DTP03 when DTP01 = "472", based on the ICD-10-CM Diagnosis Code list table. If 2400.DTP02=RD8, use the "from" date to validate.
X222 226 2300 HI11-2 070	Diagnosis Code	AN	1-30	R	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 255: "Diagnosis code"	If 2400.SV107-1, SV107-2, SV107-3 and SV107-4 are not "11" (all lines) and 2300.HI11-1 is "BF", 2300.HI11-2 must be a valid ICD-9-CM Diagnosis code on the date in 2400.DTP03 (all lines) when DTP01 = "472", based on the ICD-9-CM Diagnosis Code list table. If 2400.DTP02=RD8, use the "from" date to validate.
X222 226 2300 HI11-2 090	Diagnosis Code	AN	1-30	R	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 255: "Diagnosis code"	If 2400.SV107-1, SV107-2, SV107-3 and SV107-4 are not "11" and 2300.HI11-1 is "ABF", 2300.HI11-2 must be a valid ICD-10-CM Diagnosis code on the date in 2400.DTP03 (all lines) when DTP01 = "472", based on the ICD-10-CM Diagnosis Code list table. If 2400.DTP02=RD8, use the "from" date to validate.
X222 226 2300 HI11-2 100	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2300.HI11-2 must not contain a "."
X222 226 2300 HI11-2 110	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 511: "Invalid character" CSC 255: "Diagnosis code"	N/A
X222 226 2300 HI11-3 010	Date Time Period Format Qualifier	ID	2-3	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 226 2300 HI11-4 010	Date Time Period	AN	1-35	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 226 2300 HI11-5 010	Monetary Amount	R	1-18	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 226 2300 HI11-6 010	Quantity	R	1-15	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 226 2300 HI11-7 010	Version Identifier	AN	1-30	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 226 2300 HI11-8 010	Industry code	AN	1-30	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 226 2300 HI11-9 010	Yes/No Condition or response Code	ID	1-1	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 226 2300 HI12 010	HEALTH CARE CODE INFORMATION	N/A	N/A	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	2300.HI12 can only be present if 2300.HI11 is present.
X222 226 2300 HI12-1 020	Diagnosis Type Code	ID	1-3	R	N/A	ABF, BF	999	IK403 = 7: "Invalid Code Value"	2300.HI12-1 must be "BF" or "ABF".
X222 226 2300 HI12-1 040	Diagnosis Type Code	ID	1-3	S	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 255: "Diagnosis code"	If 2300 HI01-1 = "BK", then 2300.HI12-1 must be "BF."
X222 226 2300 HI12-1 050	Diagnosis Type Code	ID	1-3	S	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 255: "Diagnosis code"	If 2300 HI01-1 = "ABK", then 2300.H12-1 must be "ABF".
X222 226 2300 HI12-2 030	Diagnosis Code	AN	1-30	R	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 255: "Diagnosis code"	If 2400.SV107-1, SV107-2, SV107-3, or SV107-4 is "12" and 2300.HI12-1 is "BF" then 2300.HI12-2 must be a valid ICD-9-CM Diagnosis code on the date in 2400.DTP03 when DTP01 = "472", based on the ICD-9-CM Diagnosis Code list table. If 2400.DTP02=RD8, use the "from" date to validate.
X222 226 2300 HI12-2 050	Diagnosis Code	AN	1-30	R	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 255: "Diagnosis code"	If 2400.SV107-1, SV107-2, SV107-3, or SV107-4 is "12" and 2300.HI12-1 is "ABF" then 2300.HI12-2 must be a valid ICD-10-CM Diagnosis code on the date in 2400.DTP03 when DTP01 = "472", based on the ICD-10-CM Diagnosis Code list table. If 2400.DTP02=RD8, use the "from" date to validate. table.
X222 226 2300 HI12-2 070	Diagnosis Code	AN	1-30	R	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 255: "Diagnosis code"	If 2400.SV107-1, SV107-2, SV107-3 and SV107-4 are not "12" (all lines) and 2300.HI12-1 is "BF", 2300.HI12-2 must be a valid ICD-9-CM Diagnosis code on the date in 2400.DTP03 (all lines) when DTP01 = "472", based on the ICD-9-CM Diagnosis Code list table. If 2400.DTP02=RD8, use the "from" date to validate.
X222 226 2300 HI12-2 090	Diagnosis Code	AN	1-30	R	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 255: "Diagnosis code"	If 2400.SV107-1, SV107-2, SV107-3 and SV107-4 are not "12" and 2300.HI12-1 is "ABF", 2300.HI12-2 must be a valid ICD-10-CM Diagnosis code on the date in 2400.DTP03 (all lines) when DTP01 = "472", based on the ICD-10-CM Diagnosis Code list table. If 2400.DTP02=RD8, use the "from" date to validate.
X222 226 2300 HI12-2 100	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2300.HI12-2 must not contain a "."
X222 226 2300 HI12-2 110	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 511: "Invalid character" CSC 255: "Diagnosis code"	N/A
X222 226 2300 HI12-3 010	Date Time Period Format Qualifier	ID	2-3	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 226 2300 HI12-4 010	Date Time Period	AN	1-35	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 226 2300 HI12-5 010	Monetary Amount	R	1-18	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 226 2300 HI12-6 010	Quantity	R	1-15	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 226 2300 HI12-7 010	Version Identifier	AN	1-30	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 226 2300 HI12-8 010	Industry code	AN	1-30	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 226 2300 HI12-9 010	Yes/No Condition or response Code	ID	1-1	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 239 2300 HI 010	ANESTHESIA RELATED PROCEDURE	N/A	1	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2300.HI with HI01-1 = "BP" is allowed.
X222 239 2300 HI01 010	HEALTH CARE CODE INFORMATION	N/A	N/A	R	N/A	N/A	N/A	N/A	N/A
X222 239 2300 HI01-1 010	Code List Qualifier	ID	1-3	R	N/A	BP	999	IK403 = 1: "Required Data Element Missing"	2300.HI01-1 must be present.
X222 239 2300 HI01-1 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2300.HI01-1 must be "BP".
X222 239 2300 HI01-2 010	Anesthesia Related Surgical Procedure	AN	1-30	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2300.HI01-2 must be present.
X222 239 2300 HI01-2 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 465: "Principal Procedure Code for Service(s) Rendered"	2300.HI01-2 must be a valid HCPCS Principle Procedure code.
X222 239 2300 HI01-3 010	Date Time Period Format Qualifier	ID	2-3	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 239 2300 HI01-4 010	Date Time Period	AN	1-35	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 239 2300 HI01-5 010	Monetary Amount	R	1-18	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 239 2300 HI01-6 010	Quantity	R	1-15	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 239 2300 HI01-7 010	Version Identifier	AN	1-30	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 239 2300 HI01-8 010	Industry code	AN	1-30	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 239 2300 HI01-9 010	Yes/No Condition or response Code	ID	1-1	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 239 2300 HI02-1 010	Code List Qualifier	ID	1-3	R	N/A	BO	999	IK403 = 7: "Invalid Code Value"	2300.HI02-1 must be "BO".
X222 239 2300 HI02-2 010	Anesthesia Related Surgical Procedure	AN	1-30	R	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 454: "Procedure code for services rendered"	2300.HI02-2 must be a valid HCPCS Principle Procedure code.
X222 239 2300 HI02-3 010	Date Time Period Format Qualifier	ID	2-3	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 239 2300 HI02-4 010	Date Time Period	AN	1-35	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 239 2300 HI02-5 010	Monetary Amount	R	1-18	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 239 2300 HI02-6 010	Quantity	R	1-15	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 239 2300 HI02-7 010	Version Identifier	AN	1-30	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 239 2300 HI02-8 010	Industry code	AN	1-30	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 239 2300 HI02-9 010	Yes/No Condition or response Code	ID	1-1	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 239 2300 HI03 010	HEALTH CARE CODE INFORMATION	N/A	N/A	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 239 2300 HI04 010	HEALTH CARE CODE INFORMATION	N/A	N/A	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 239 2300 HI05 010	HEALTH CARE CODE INFORMATION	N/A	N/A	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 239 2300 HI06 010	HEALTH CARE CODE INFORMATION	N/A	N/A	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 239 2300 HI07 010	HEALTH CARE CODE INFORMATION	N/A	N/A	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 239 2300 HI08 010	HEALTH CARE CODE INFORMATION	N/A	N/A	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 239 2300 HI09 010	HEALTH CARE CODE INFORMATION	N/A	N/A	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 239 2300 HI10 010	HEALTH CARE CODE INFORMATION	N/A	N/A	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 239 2300 HI11 010	HEALTH CARE CODE INFORMATION	N/A	N/A	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 239 2300 HI12 010	HEALTH CARE CODE INFORMATION	N/A	N/A	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 242 2300 HI 010	CONDITION INFORMATION	N/A	2	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only two iteration of 2300.HI with HI01-1 = "BG" are allowed.
X222 242 2300 HI01 010	HEALTH CARE CODE INFORMATION	N/A	N/A	R	N/A	N/A	N/A	N/A	N/A
X222 242 2300 HI01-1 010	Code List Qualifier	ID	1-3	R	N/A	BG	999	IK403 = 1: "Required Data Element Missing"	2300.HI01-1 must be present.
X222 242 2300 HI01-1 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2300.HI01-1 must be "BG".
X222 242 2300 HI01-2 010	Condition Code	AN	1-30	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2300.HI01-2 must be present.
X222 242 2300 HI01-2 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 460: "NUBC Condition Code(s)"	2300.HI01-2 must be a valid Condition code.
X222 242 2300 HI01-2 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 460: "NUBC Condition Code(s)"	If 2300.HI01-1 equals BG the Condition codes within this HI segment must not be duplicated.
X222 242 2300 HI01-3 010	Date Time Period Format Qualifier	ID	2-3	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 242 2300 HI01-4 010	Date Time Period	AN	1-35	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 242 2300 HI01-5 010	Monetary Amount	R	1-18	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 242 2300 HI01-6 010	Quantity	R	1-15	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 242 2300 HI01-7 010	Version Identifier	AN	1-30	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 242 2300 HI01-8 010	Industry code	AN	1-30	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 242 2300 HI01-9 010	Yes/No Condition or response Code	ID	1-1	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 242 2300 HI02-1 010	Code List Qualifier	ID	1-3	R	N/A	BG	999	IK403 = 7: "Invalid Code Value"	2300.HI02-1 must be "BG".
X222 242 2300 HI02-2 010	Condition Code	AN	1-30	R	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 460: "NUBC Condition Code(s)"	2300.HI02-2 must be a valid Condition code.
X222 242 2300 HI02-3 010	Date Time Period Format Qualifier	ID	2-3	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 242 2300 HI02-4 010	Date Time Period	AN	1-35	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 242 2300 HI02-5 010	Monetary Amount	R	1-18	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 242 2300 HI02-6 010	Quantity	R	1-15	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 242 2300 HI02-7 010	Version Identifier	AN	1-30	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 242 2300 HI02-8 010	Industry code	AN	1-30	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 242 2300 HI02-9 010	Yes/No Condition or response Code	ID	1-1	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 242 2300 HI03 010	HEALTH CARE CODE INFORMATION	N/A	N/A	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	2300.HI03 can only be present if 2300.HI02 is present.
X222 242 2300 HI03-1 010	Code List Qualifier	ID	1-3	R	N/A	BG	999	IK403 = 7: "Invalid Code Value"	2300.HI03-1 must be "BG".
X222 242 2300 HI03-2 010	Condition Code	AN	1-30	R	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 460: "NUBC Condition Code(s)"	2300.HI03-2 must be a valid Condition code.
X222 242 2300 HI03-3 010	Date Time Period Format Qualifier	ID	2-3	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 242 2300 HI03-4 010	Date Time Period	AN	1-35	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 242 2300 HI03-5 010	Monetary Amount	R	1-18	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 242 2300 HI03-6 010	Quantity	R	1-15	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 242 2300 HI03-7 010	Version Identifier	AN	1-30	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 242 2300 HI03-8 010	Industry code	AN	1-30	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 242 2300 HI03-9 010	Yes/No Condition or response Code	ID	1-1	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 242 2300 HI04 010	HEALTH CARE CODE INFORMATION	N/A	N/A	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	2300.HI04 can only be present if 2300.HI03 is present.
X222 242 2300 HI04-1 010	Code List Qualifier	ID	1-3	R	N/A	BG	999	IK403 = 7: "Invalid Code Value"	2300.HI04-1 must be "BG".
X222 242 2300 HI04-2 010	Condition Code	AN	1-30	R	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 460: "NUBC Condition Code(s)"	2300.HI04-2 must be a valid Condition code.
X222 242 2300 HI04-3 010	Date Time Period Format Qualifier	ID	2-3	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 242 2300 HI04-4 010	Date Time Period	AN	1-35	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 242 2300 HI04-5 010	Monetary Amount	R	1-18	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 242 2300 HI04-6 010	Quantity	R	1-15	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 242 2300 HI04-7 010	Version Identifier	AN	1-30	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 242 2300 HI04-8 010	Industry code	AN	1-30	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 242 2300 HI04-9 010	Yes/No Condition or response Code	ID	1-1	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 242 2300 HI05 010	HEALTH CARE CODE INFORMATION	N/A	N/A	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	2300.HI05 can only be present if 2300.HI04 is present.
X222 242 2300 HI05-1 010	Code List Qualifier	ID	1-3	R	N/A	BG	999	IK403 = 7: "Invalid Code Value"	2300.HI05-1 must be "BG".
X222 242 2300 HI05-2 010	Condition Code	AN	1-30	R	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 460: "NUBC Condition Code(s)"	2300.HI05-2 must be a valid Condition code.
X222 242 2300 HI05-3 010	Date Time Period Format Qualifier	ID	2-3	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 242 2300 HI05-4 010	Date Time Period	AN	1-35	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 242 2300 HI05-5 010	Monetary Amount	R	1-18	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 242 2300 HI05-6 010	Quantity	R	1-15	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 242 2300 HI05-7 010	Version Identifier	AN	1-30	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 242 2300 HI05-8 010	Industry code	AN	1-30	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 242 2300 HI05-9 010	Yes/No Condition or response Code	ID	1-1	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 242 2300 HI06 010	HEALTH CARE CODE INFORMATION	N/A	N/A	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	2300.HI06 can only be present if 2300.HI05 is present.
X222 242 2300 HI06-1 010	Code List Qualifier	ID	1-3	R	N/A	BG	999	IK403 = 7: "Invalid Code Value"	2300.HI06-1 must be "BG".
X222 242 2300 HI06-2 010	Condition Code	AN	1-30	R	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 460: "NUBC Condition Code(s)"	2300.HI06-2 must be a valid Condition code.
X222 242 2300 HI06-3 010	Date Time Period Format Qualifier	ID	2-3	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 242 2300 HI06-4 010	Date Time Period	AN	1-35	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 242 2300 HI06-5 010	Monetary Amount	R	1-18	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 242 2300 HI06-6 010	Quantity	R	1-15	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 242 2300 HI06-7 010	Version Identifier	AN	1-30	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 242 2300 HI06-8 010	Industry code	AN	1-30	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 242 2300 HI06-9 010	Yes/No Condition or response Code	ID	1-1	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 242 2300 HI07 010	HEALTH CARE CODE INFORMATION	N/A	N/A	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	2300.HI07 can only be present if 2300.HI06 is present.
X222 242 2300 HI07-1 010	Code List Qualifier	ID	1-3	R	N/A	BG	999	IK403 = 7: "Invalid Code Value"	2300.HI07-1 must be "BG".
X222 242 2300 HI07-2 010	Condition Code	AN	1-30	R	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 460: "NUBC Condition Code(s)"	2300.HI07-2 must be a valid Condition code.
X222 242 2300 HI07-3 010	Date Time Period Format Qualifier	ID	2-3	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 242 2300 HI07-4 010	Date Time Period	AN	1-35	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 242 2300 HI07-5 010	Monetary Amount	R	1-18	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 242 2300 HI07-6 010	Quantity	R	1-15	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 242 2300 HI07-7 010	Version Identifier	AN	1-30	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 242 2300 HI07-8 010	Industry code	AN	1-30	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 242 2300 HI07-9 010	Yes/No Condition or response Code	ID	1-1	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 242 2300 HI08 010	HEALTH CARE CODE INFORMATION	N/A	N/A	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	2300.HI08 can only be present if 2300.HI07 is present.
X222 242 2300 HI08-1 010	Code List Qualifier	ID	1-3	R	N/A	BG	999	IK403 = 7: "Invalid Code Value"	2300.HI08-1 must be "BG".
X222 242 2300 HI08-2 010	Condition Code	AN	1-30	R	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 460: "NUBC Condition Code(s)"	2300.HI08-2 must be a valid Condition code.
X222 242 2300 HI08-3 010	Date Time Period Format Qualifier	ID	2-3	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 242 2300 HI08-4 010	Date Time Period	AN	1-35	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 242 2300 HI08-5 010	Monetary Amount	R	1-18	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 242 2300 HI08-6 010	Quantity	R	1-15	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 242 2300 HI08-7 010	Version Identifier	AN	1-30	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 242 2300 HI08-8 010	Industry code	AN	1-30	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 242 2300 HI08-9 010	Yes/No Condition or response Code	ID	1-1	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 242 2300 HI09 010	HEALTH CARE CODE INFORMATION	N/A	N/A	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	2300.HI09 can only be present if 2300.HI08 is present.
X222 242 2300 HI09-1 010	Code List Qualifier	ID	1-3	R	N/A	BG	999	IK403 = 7: "Invalid Code Value"	2300.HI09-1 must be "BG".
X222 242 2300 HI09-2 010	Condition Code	AN	1-30	R	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 460: "NUBC Condition Code(s)"	2300.HI09-2 must be a valid Condition code.
X222 242 2300 HI09-3 010	Date Time Period Format Qualifier	ID	2-3	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 242 2300 HI09-4 010	Date Time Period	AN	1-35	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 242 2300 HI09-5 010	Monetary Amount	R	1-18	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 242 2300 HI09-6 010	Quantity	R	1-15	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 242 2300 HI09-7 010	Version Identifier	AN	1-30	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 242 2300 HI09-8 010	Industry code	AN	1-30	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 242 2300 HI09-9 010	Yes/No Condition or response Code	ID	1-1	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 242 2300 HI10 010	HEALTH CARE CODE INFORMATION	N/A	N/A	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	2300.HI10 can only be present if 2300.HI09 is present.
X222 242 2300 HI10-1 010	Code List Qualifier	ID	1-3	R	N/A	BG	999	IK403 = 7: "Invalid Code Value"	2300.HI10-1 must be "BG".
X222 242 2300 HI10-2 010	Condition Code	AN	1-30	R	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 460: "NUBC Condition Code(s)"	2300.HI10-2 must be a valid Condition code.
X222 242 2300 HI10-3 010	Date Time Period Format Qualifier	ID	2-3	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 242 2300 HI10-6 010	Quantity	R	1-15	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 242 2300 HI10-7 010	Version Identifier	AN	1-30	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 242 2300 HI10-8 010	Industry code	AN	1-30	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 242 2300 HI10-9 010	Yes/No Condition or response Code	ID	1-1	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 242 2300 HI11 010	HEALTH CARE CODE INFORMATION	N/A	N/A	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	2300.HI11 can only be present if 2300.HI10 is present.
X222 242 2300 HI11-1 010	Code List Qualifier	ID	1-3	R	N/A	BG	999	IK403 = 7: "Invalid Code Value"	2300.HI11-1 must be "BG".
X222 242 2300 HI11-2 010	Condition Code	AN	1-30	R	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 460: "NUBC Condition Code(s)"	2300.HI11-2 must be a valid Condition code.
X222 242 2300 HI11-3 010	Date Time Period Format Qualifier	ID	2-3	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 242 2300 HI11-4 010	Date Time Period	AN	1-35	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 242 2300 HI11-5 010	Monetary Amount	R	1-18	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 242 2300 HI11-6 010	Quantity	R	1-15	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 242 2300 HI11-7 010	Version Identifier	AN	1-30	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 242 2300 HI11-8 010	Industry code	AN	1-30	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 242 2300 HI11-9 010	Yes/No Condition or response Code	ID	1-1	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 242 2300 HI12 010	HEALTH CARE CODE INFORMATION	N/A	N/A	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	2300.HI12 can only be present if 2300.HI11 is present.
X222 242 2300 HI12-1 010	Code List Qualifier	ID	1-3	R	N/A	BG	999	IK403 = 7: "Invalid Code Value"	2300.HI12-1 must be "BG".
X222 242 2300 HI12-2 010	Condition Code	AN	1-30	R	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 460: "NUBC Condition Code(s)"	2300.HI12-2 must be a valid Condition code.
X222 242 2300 HI12-3 010	Date Time Period Format Qualifier	ID	2-3	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 242 2300 HI12-4 010	Date Time Period	AN	1-35	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 242 2300 HI12-5 010	Monetary Amount	R	1-18	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 242 2300 HI12-6 010	Quantity	R	1-15	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 242 2300 HI12-7 010	Version Identifier	AN	1-30	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 242 2300 HI12-8 010	Industry code	AN	1-30	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 242 2300 HI12-9 010	Yes/No Condition or response Code	ID	1-1	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 252 2300 HCP 005	CLAIM PRICING/REPRICING INFORMATION	N/A	1	S	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 732: "Information submitted inconsistent with billing guidelines." CSC 64: "Re-pricing information."	Segment must not be present.
X222 257 2310A NM1 010	REFERRING PROVIDER NAME Loop	N/A	N/A	N/A	2	N/A	999	IK304 = 4: "Loop Occurs Over Maximum Times"	Only two iterations of 2310A are allowed.
X222 257 2310A NM1 020	REFERRING PROVIDER NAME	N/A	1	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2310A.NM1 is allowed.
X222 257 2310A NM101 010	Entity Identifier Code	ID	2-3	R	N/A	DN, P3	999	IK304 = 2: "Unexpected segment"	2310A.NM101 must be present and a valid value.
X222 257 2310A NM101 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	For the first iteration of the referring provider loop, 2310A.NM101 must be "DN".
X222 257 2310A NM101 040	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	For the second iteration of the referring provider loop, 2310A.NM101 must be "P3".
X222 257 2310A NM102 010	Entity Type Qualifier	ID	1-1	R	N/A	1	999	IK403 = 1: "Required Data Element Missing"	2310A.NM102 must be present.
X222 257 2310A NM102 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2310A.NM102 must be "1".
X222 257 2310A NM103 010	Referring Provider Last Name	AN	1-60	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2310A.NM103 must be present.
X222 257 2310A NM103 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2310A.NM103 must contain at least one non-space character.
X222 257 2310A NM103 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2310A.NM103 must be 1 - 60 characters.
X222 257 2310A NM103 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 504: "Entity's Last Name" EIC: DN "Referring Provider"	N/A
X222 257 2310A NM103 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2310A.NM103 must be populated with accepted AN characters.
X222 257 2310A NM104 010	Referring Provider First Name	AN	1-35	S	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2310A.NM104 must contain at least one non-space character.
X222 257 2310A NM104 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2310A.NM104 must be 1 - 35 characters.
X222 257 2310A NM104 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 505: "Entity's First Name" EIC: DN "Referring Provider"	N/A
X222 257 2310A NM104 040	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2310A.NM104 must be populated with accepted AN characters.
X222 257 2310A NM105 010	Referring Provider Middle Name	AN	1-25	S	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2310A.NM105 must contain at least one non-space character.
X222 257 2310A NM105 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2310A.NM105 must be 1 - 25 characters.
X222 257 2310A NM105 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 514: "Entity's Middle Name" EIC: DN "Referring Provider"	N/A
X222 257 2310A NM105 040	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2310A.NM105 must be populated with accepted AN characters.
X222 257 2310A NM105 045	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement /Rejected for Invalid Information..." CSC 514: "Entity's Middle Name" EIC: DN "Referring Provider"	The first position of 2310A.NM105 must be alphabetic (A...Z).
X222 257 2310A NM106 010	Name Prefix	AN	1-10	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 257 2310A NM107 010	Referring Provider Name Suffix	AN	1-10	S	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2310A.NM107 must contain at least one non-space character.
X222 257 2310A NM107 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2310A.NM107 must be 1 - 10 characters.
X222 257 2310A NM107 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 125: "Entity's Name" EIC: DN "Referring Provider"	N/A
X222 257 2310A NM107 040	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2310A.NM107 must be populated with accepted AN characters.
X222 257 2310A NM108 010	Identification Code Qualifier	ID	1-2	S	N/A	XX	277	CSCC A8: "Acknowledgement/Rejected for relational field in error." CSC 745: "Identifier Qualifier" CSC 562: "Entity's National Provider Identifier (NPI)" EIC: DN "Referring Provider"	2310A.NM108 must not be present when 2300.REF with REF01 = "P4" and REF02 is a valid VA identifier".
X222 257 2310A NM108 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A6: "Acknowledgement/Rejected for Missing Information..." CSC 745: "Identifier Qualifier" CSC 562: "Entity's National Provider Identifier (NPI)" EIC: DN "Referring Provider"	2310A.NM108 must be present.
X222 257 2310A NM108 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2310A.NM108 must be "XX".
X222 257 2310A NM109 010	Referring Provider Identifier	AN	2-80	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	2310A.NM109 must be present if 2310A.NM108 is present.
X222 257 2310A NM109 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 562: "Entity's National Provider Identifier (NPI)" EIC: DN "Referring Provider"	2310A.NM109 must be valid according to the NPI algorithm.
X222 257 2310A NM109 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 562: "Entity's National Provider Identifier (NPI)" EIC: DN "Referring Provider"	The first position of 2310A.NM109 must be a "1".
X222 257 2310A NM110 010	Entity Relationship Code	ID	2-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 257 2310A NM111 010	Entity Identifier Code	ID	2-3	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 257 2310A NM112 010	Name Last or Organization Name	AN	1-60	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 260 2310A REF 010	REFERRING PROVIDER SECONDARY IDENTIFICATION	N/A	3	S	N/A	N/A	999	IK304 = I9: "Implementation Dependent "Not Used" Segment Present"	If 2310A.NM1 is present, 2310A.REF with REF01 = "1G" or "0B" may be present when 2310A.NM109 is not present.
X222 260 2310A REF 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 732: "Information submitted inconsistent with billing guidelines." CSC 560: "Entity's Additional/Secondary Identifier." EIC: DN "Referring Provider"	Only two iterations of 2310A.REF with REF01 = "0B"or "IG" are allowed.
X222 260 2310A REF 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK304 = I9: "Implementation Dependent "Not Used" Segment Present"	2310A.REF must not be present.
X222 260 2310A REF01 010	Reference Identification Qualifier	ID	2-3	R	N/A	0B, 1G, G2	999	IK403 = 1: "Required Data Element Missing"	2310A.REF01 must be present.
X222 260 2310A REF01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2310A.REF01 must be valid values.
X222 260 2310A REF02 010	Referring Provider Secondary Identifier	AN	1-50	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2310A.REF02 must be present.
X222 260 2310A REF02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	When 2310A.REF01 = "0B", 2310A.REF02 must contain at least one non-space character.
X222 260 2310A REF02 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A8: "Acknowledgement/Rejected for relational field in error." CSC 560: "Entity's Additional/Secondary Identifier" CSC 133: "Entity's UPIN" EIC: DN "Referring Provider"	When 2310A.REF01 = "1G", 2310A.REF02 must be in format ANNNNN or AAANNN (where A is an alpha character and N is a numeric digit).
X222 260 2310A REF02 040	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	When 2310A.REF01 = "0B", 2310A.REF02 must be 1 - 50 characters.
X222 260 2310A REF02 050	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 133: "Entity's UPIN" EIC: DN "Referring Provider"	N/A
X222 260 2310A REF02 060	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	When 2310A.REF01 = "0B", 2310A.REF02 must be populated with accepted AN characters.
X222 260 2310A REF03 010	Description	AN	1-80	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 260 2310A REF04 010	REFERENCE IDENTIFIER	N/A	N/A	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 262 2310B NM1 010	RENDERING PROVIDER NAME	N/A	1	S	1	N/A	999	IK304 = 4: "Loop Occurs Over Maximum Times"	Only one iteration of 2310B.NM1 is allowed.
X222 262 2310B NM101 010	Entity Identifier Code	ID	2-3	R	N/A	82	999	IK304 = 2: "Unexpected segment"	2310B.NM101 must be present and a valid value.
X222 262 2310B NM102 010	Entity Type Qualifier	ID	1-1	R	N/A	1, 2	999	IK403 = 1: "Required Data Element Missing"	2310B.NM102 must be present.
X222 262 2310B NM102 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2310B.NM102 must be valid values.
X222 262 2310B NM103 010	Rendering Provider Last or Organization Name	AN	1-60	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2310B.NM103 must be present.
X222 262 2310B NM103 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2310B.NM103 must contain at least one non-space character.
X222 262 2310B NM103 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2310B.NM103 must be 1 - 60 characters.
X222 262 2310B NM103 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 504: "Entity's Last Name" EIC: 82 "Rendering Provider"	N/A
X222 262 2310B NM103 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2310B.NM103 must be populated with accepted AN characters.
X222 262 2310B NM104 015	Rendering Provider First Name	AN	1-35	S	N/A	N/A	999	IK403 = I13: "Implementation Dependent "Not Used" Data Element Present"	If 2310B.NM102 is "2", 2310B.NM104 must not be present.
X222 262 2310B NM104 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2310B.NM104 must contain at least one non-space character.
X222 262 2310B NM104 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2310B.NM104 must be 1 - 35 characters.
X222 262 2310B NM104 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 505: "Entity's First Name" EIC: 82 "Rendering Provider"	N/A
X222 262 2310B NM104 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2310B.NM104 must be populated with accepted AN characters.
X222 262 2310B NM105 015	Rendering Provider Middle Name	AN	1-25	S	N/A	N/A	999	IK403 = I13: "Implementation Dependent "Not Used" Data Element Present"	If 2310B.NM102 is "2", 2310B.NM105 must not be present.
X222 262 2310B NM105 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2310B.NM105 must contain at least one non-space character.
X222 262 2310B NM105 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2310B.NM105 must be 1 - 25 characters.
X222 262 2310B NM105 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 514: "Entity's Middle Name" EIC: 82 "Rendering Provider"	N/A
X222 262 2310B NM105 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2310B.NM105 must be populated with accepted AN characters.
X222 262 2310B NM105 055	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement /Rejected for Invalid Information..." CSC 514: "Entity's Middle Name" EIC: 82 "Rendering Provider"	The first position of 2310B.NM105 must be alphabetic (A...Z).
X222 262 2310B NM106 010	Name Prefix	AN	1-10	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 262 2310B NM107 010	Rendering Provider Name Suffix	AN	1-10	S	N/A	N/A	999	IK403 = I13: "Implementation Dependent "Not Used" Data Element Present"	If 2310B.NM102 is "2", 2310B.NM107 must not be present.
X222 262 2310B NM107 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2310B.NM107 must contain at least one non-space character.
X222 262 2310B NM107 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	If 2310B.NM107 must be 1 - 10 characters.
X222 262 2310B NM107 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 125: "Entity's Name" EIC: 82 "Rendering Provider"	N/A
X222 262 2310B NM107 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2310B.NM107 must be populated with accepted AN characters.
X222 262 2310B NM108 010	Identification Code Qualifier	ID	1-2	S	N/A	XX	277	CSCC A8: "Acknowledgement/Rejected for relational field in error." CSC 745: "Identifier Qualifier" CSC 562: "Entity's National Provider Identifier (NPI)" EIC: 82 "Rendering Provider"	2310B.NM108 must not be present when 2300.REF with REF01 = "P4" and REF02 is a valid VA identifier".
X222 262 2310B NM108 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A6: "Acknowledgement/Rejected for Missing Information..." CSC 745: "Identifier Qualifier" CSC 562: "Entity's National Provider Identifier (NPI)" EIC: 82 "Rendering Provider"	2310B.NM108 must be present.
X222 262 2310B NM108 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2310B.NM108 must be "XX".
X222 262 2310B NM109 010	Rendering Provider Identifier	AN	2-80	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	2310B.NM109 must be present if 2310B.NM108 is present.
X222 262 2310B NM109 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 562: "Entity's National Provider Identifier (NPI)" EIC: 82 "Rendering Provider"	2310B.NM109 must be valid according to the NPI algorithm.
X222 262 2310B NM109 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 562: "Entity's National Provider Identifier (NPI)" EIC: 82 "Rendering Provider"	2310B.NM109 must be a valid NPI on the Crosswalk when evaluated with 1000B.NM109, except when 2300.REF with REF01 = "P4" and REF02 = "82".
X222 262 2310B NM109 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 562: "Entity's National Provider Identifier (NPI)" EIC: 82 "Rendering Provider"	The first position of 2310B.NM109 must be a "1".
X222 262 2310B NM110 010	Entity Relationship Code	ID	2-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 262 2310B NM111 010	Entity Identifier Code	ID	2-3	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 262 2310B NM112 010	Name Last or Organization Name	AN	1-60	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 265 2310B PRV 020	RENDERING PROVIDER SPECIALTY INFORMATION	N/A	1	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2310B.PRV with PRV01 = "PE" is allowed.
X222 265 2310B PRV01 010	Provider Code	ID	1-3	R	N/A	PE	999	IK403 = 1: "Required Data Element Missing"	2310B.PRV01 must be present.
X222 265 2310B PRV01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2310B.PRV01 must be "PE".
X222 265 2310B PRV02 010	Reference Identification Qualifier	ID	2-3	R	N/A	PXC	999	IK403 = 1: "Required Data Element Missing"	2310B.PRV02 must be present.
X222 265 2310B PRV02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2310B.PRV02 must be "PXC".
X222 265 2310B PRV03 010	Provider Taxonomy Code	AN	1-50	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2310B.PRV03 must be present.
X222 265 2310B PRV03 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 145: "Entity's specialty/taxonomy code" EIC: 82 "Rendering Provider"	2310B.PRV03 must be a valid Provider Taxonomy Code
X222 265 2310B PRV04 010	State or Province Code	ID	2-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 265 2310B PRV05 010	PROVIDER SPECIALTY INFORMATION	N/A	N/A	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 265 2310B PRV06 010	Provider Organization Code	ID	3-3	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 267 2310B REF 010	RENDERING PROVIDER SECONDARY IDENTIFICATION	N/A	4	S	N/A	N/A	999	IK304 = I9: "Implementation Dependent "Not Used" Segment Present"	If 2310B.NM1 is present, 2310B.REF with REF01 = "1G", "0B", "G2" or "LU" may be present when 2310B.NM109 is not present.
X222 267 2310B REF 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 732: "Information submitted inconsistent with billing guidelines." CSC 560: "Entity's Additional/Secondary Identifier." EIC: 82 "Rendering Provider"	Only four iterations of 2310B.REF with REF01 = "1G", "0B", "G2" or "LU" are allowed.
X222 267 2310B REF 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK304 = I9: "Implementation Dependent "Not Used" Segment Present"	2310B.REF must not be present.
X222 267 2310B REF01 010	Reference Identification Qualifier	ID	2-3	R	N/A	0B, 1G, G2, LU	999	IK403 = 1: "Required Data Element Missing"	2310B.REF01 must be present.
X222 267 2310B REF01 025	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2310B.REF01 must be valid values.
X222 267 2310B REF02 010	Rendering Provider Secondary Identifier	AN	1-50	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2310B.REF02 must be present.
X222 267 2310B REF02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	When 2310B.REF01 = = "0B", "G2" or "LU", 2310B.REF02 must contain at least one non-space character.
X222 267 2310B REF02 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 133: "Entity's UPIN" CSC 560: "EIC: EIC: 82 "Rendering Provider"	When 2310B.REF01 = "1G", 2310B.REF02 must be in format ANNNNN or AAANNN (where A is an alpha character and N is a numeric digit).
X222 267 2310B REF02 040	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	When 2310B.REF01 = "0B", "G2" or "LU", 2310B.REF02 must be 1 - 50 characters.
X222 267 2310B REF02 050	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 133: "Entity's UPIN" EIC: 82 "Rendering Provider"	N/A
X222 267 2310B REF02 060	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	When 2310B.REF01 = = "0B", "G2" or "LU", 2310B.REF02 must be populated with accepted AN characters.
X222 267 2310B REF03 010	Description	AN	1-80	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 267 2310B REF04 010	REFERENCE IDENTIFIER	N/A	N/A	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 269 2310C NM1 010	SERVICE FACILITY LOCATION NAME	N/A	1	S	1	N/A	999	IK304 = 4: "Loop Occurs Over Maximum Times"	Only one iteration of 2310C.NM1 is allowed.
X222 269 2310C NM101 010	Entity Identifier Code	ID	2-3	R	N/A	77	999	IK304 = 2: "Unexpected segment"	2310C.NM101 must be present and a valid value.
X222 269 2310C NM102 010	Entity Type Qualifier	ID	1-1	R	N/A	2	999	IK403 = 1: "Required Data Element Missing"	2310C.NM102 must be present.
X222 269 2310C NM102 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2310C.NM102 must be "2".
X222 269 2310C NM103 010	Laboratory or Facility Name	AN	1-60	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2310C.NM103 must be present.
X222 269 2310C NM103 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2310C.NM103 must contain at least one non-space character.
X222 269 2310C NM103 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2310C.NM103 must be 1 - 60 characters.
X222 269 2310C NM103 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 504: "Entity's Last Name" EIC: 77 "Service Location"	N/A
X222 269 2310C NM103 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2310C.NM103 must be populated with accepted AN characters.
X222 269 2310C NM104 010	Name First	AN	1-35	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 269 2310C NM105 010	Name Middle	AN	1-25	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 269 2310C NM106 010	Name Prefix	AN	1-10	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 269 2310C NM107 010	Name Suffix	AN	1-10	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 269 2310C NM108 010	Identification Code Qualifier	ID	1-2	S	N/A	XX	999	IK403 = 7: "Invalid Code Value"	2310C.NM108 must be "XX".
X222 269 2310C NM109 010	Laboratory or Facility Primary Identifier	AN	2-80	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2310C.NM108 is present, 2310C.NM109 must be present.
X222 269 2310C NM109 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 562: "Entity's National Provider Identifier (NPI)" EIC: 77 "Service Location"	2310C.NM109 must be valid according to the NPI algorithm.
X222 269 2310C NM109 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 562: "Entity's National Provider Identifier (NPI)" EIC: 77 "Service Location"	The first position of 2310C.NM109 must be a "1".
X222 269 2310C NM110 010	Entity Relationship Code	ID	2-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 269 2310C NM111 010	Entity Identifier Code	ID	2-3	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 269 2310C NM112 010	Name Last or Organization Name	AN	1-60	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 272 2310C N3 010	SERVICE FACILITY LOCATION ADDRESS	N/A	1	R	N/A	N/A	999	IK304 = I6: "Implementation Dependent Segment Missing"	If 2310C.NM1 is present, 2310.N3 must be present.
X222 272 2310C N3 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2310C.N3 is allowed.
X222 272 2310C N301 010	Laboratory or Facility Address Line	AN	1-55	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2310C.N301 must be present.
X222 272 2310C N301 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2310C.N301 must contain at least one non-space character.
X222 272 2310C N301 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2310C.N301 must be 1 - 55 characters.
X222 272 2310C N301 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 503: "Entity's Street address" EIC: 77 "Service Location"	N/A
X222 272 2310C N301 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2310C.N301 must be populated with accepted AN characters.
X222 272 2310C N302 020	Laboratory or Facility Address Line	AN	1-55	S	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2310C.N302 must contain at least one non-space character.
X222 272 2310C N302 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2310C.N302 must be 1 - 55 characters.
X222 272 2310C N302 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 503: "Entity's Street address" EIC: 77 "Service Location"	N/A
X222 272 2310C N302 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2310C.N302 must be populated with accepted AN characters.
X222 273 2310C N4 010	SERVICE FACILITY LOCATION CITY/STATE/ZIP	N/A	1	R	N/A	N/A	999	IK304 = I6: "Implementation Dependent Segment Missing"	If 2310C.NM1 is present, 2310.N4 must be present.
X222 273 2310C N4 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2310C.N4 is allowed.
X222 273 2310C N401 010	Laboratory or Facility City Name	AN	2-30	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2310C.N401 must be present.
X222 273 2310C N401 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2310C.N401 must contain at least two non-space characters.
X222 273 2310C N401 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 4: "Data Element Too Short" IK403 = 5: "Data Element Too Long"	2310C.N401 must be 2-30 characters.
X222 273 2310C N401 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 502: "Entity's City" EIC: 77 "Service Location"	N/A
X222 273 2310C N401 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2310C.N401 must be populated with accepted AN characters.
X222 273 2310C N402 010	Laboratory or Facility State or Province Code	ID	2-2	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2310C.N404 is not present, 2310C.N402 must be present.
X222 273 2310C N402 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 501: "Entity's State/Province" EIC: 77 "Service Location"	2310C.N402 must be a valid State Code.
X222 273 2310C N403 010	Laboratory or Facility Postal Zone ZIP Code	ID	3-15	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2310C.N404 is not present, 2310C.N403 must be present.
X222 273 2310C N403 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 500: "Entity's Postal/Zip Code" EIC: 77 "Service Location"	2310C.N403 must be a valid 9 digit Zip Code.
X222 273 2310C N404 010	Laboratory or Facility Country Code	ID	2-3	S	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 273 2310C N405 010	Location Qualifier	ID	1-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 273 2310C N406 010	Location Identifier	AN	1-30	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 273 2310C N407 005	Country Subdivision Code	ID	1-3	S	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 275 2310C REF 010	SERVICE FACILITY LOCATION SECONDARY IDENTIFICATION	N/A	3	S	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 732: "Information submitted inconsistent with billing guidelines." CSC 560: "Entity's Additional/Secondary Identifier." EIC: 77 "Service Location"	2310C.REF must not be present.
X222 277 2310C PER 020	SERVICE FACILITY CONTACT INFORMATION	N/A	1	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2310C.PER is allowed.
X222 277 2310C PER01 010	Contact Function Code	ID	2-2	R	N/A	IC	999	IK403 = 1: "Required Data Element Missing"	2310C.PER01 must be present.
X222 277 2310C PER01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2310C.PER01 must be "IC".
X222 277 2310C PER02 010	Submitter Contact Name	AN	1-60	S	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2310C.PER02 must be 1 - 60 characters.
X222 277 2310C PER02 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 561: "Entity's Contact Name" EIC: 77 "Service Location"	N/A
X222 277 2310C PER03 010	Communication Number Qualifier	ID	2-2	R	N/A	TE	999	IK403 = 1: "Required Data Element Missing"	2310C.PER03 must be present.
X222 277 2310C PER03 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2310C.PER03 must be "TE".
X222 277 2310C PER04 010	Communication Number	AN	1-256	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2310C.PER04 must be present.
X222 277 2310C PER04 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2310C.PER04 must contain at least one non-space character.
X222 277 2310C PER04 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2310C.PER04 must be populated with accepted AN characters.
X222 277 2310C PER04 060	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 127: "Entity's Communication Number" EIC: 77 "Service Location"	2310C.PER04 must be populated with exactly ten numeric characters.
X222 277 2310C PER05 010	Communication Number Qualifier	ID	2-2	S	N/A	EX	999	IK403 = 7: "Invalid Code Value"	2310C.PER05 must be "EX".
X222 277 2310C PER06 010	Communication Number	AN	1-256	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2310C.PER06 is present, 2310C.PER05 must be present.
X222 277 2310C PER06 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2310C.PER06 must contain at least one non-space character.
X222 277 2310C PER06 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2310C.PER06 must be 1 - 256 characters.
X222 277 2310C PER06 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 127: "Entity's Communication Number" EIC: 77 "Service Location"	N/A
X222 277 2310C PER06 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2310C.PER06 must be populated with accepted AN characters.
X222 277 2310C PER07 010	Communication Number Qualifier	ID	2-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 277 2310C PER08 010	Communication Number	AN	1-256	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 277 2310C PER09 010	Contact Inquiry Reference	AN	1-20	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 280 2310D NM1 010	SUPERVISING PROVIDER NAME	N/A	1	S	1	N/A	999	IK304 = 4: "Loop Occurs Over Maximum Times"	Only one iteration 2310D.NM1 is allowed.
X222 280 2310D NM101 010	Entity Identifier Code	ID	2-3	R	N/A	DQ	999	IK304 = 2: "Unexpected segment"	2310D.NM101 must be present and a valid value.
X222 280 2310D NM102 010	Entity Type Qualifier	ID	1-1	R	N/A	1	999	IK403 = 1: "Required Data Element Missing"	2310D.NM102 must be present.
X222 280 2310D NM102 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2310D.NM102 must be "1".
X222 280 2310D NM103 010	Supervising Provider Last Name	AN	1-60	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2310D.NM103 must be present.
X222 280 2310D NM103 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2310D.NM103 must contain at least one non-space character.
X222 280 2310D NM103 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2310D.NM103 must be 1 - 60 characters.
X222 280 2310D NM103 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 504: "Entity's Last Name" EIC: DQ "Supervising Physician"	N/A
X222 280 2310D NM103 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2310D.NM103 must be populated with accepted AN characters.
X222 280 2310D NM104 010	Supervising Provider First Name	AN	1-35	S	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2310D.NM104 must contain at least one non-space character.
X222 280 2310D NM104 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2310D.NM104 must be 1 - 35 characters.
X222 280 2310D NM104 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 505: "Entity's First Name" EIC: DQ "Supervising Physician"	N/A
X222 280 2310D NM104 040	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2310D.NM104 must be populated with accepted AN characters.
X222 280 2310D NM105 010	Supervising Provider Middle Name	AN	1-25	S	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2310D.NM105 must contain at least one non-space character.
X222 280 2310D NM105 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2310D.NM105 must be 1 - 25 characters.
X222 280 2310D NM105 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 514: "Entity's Middle Name" EIC: DQ "Supervising Physician"	N/A
X222 280 2310D NM105 040	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2310D.NM105 must be populated with accepted AN characters.
X222 280 2310D NM105 045	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement /Rejected for Invalid Information..." CSC 514: "Entity's Middle Name" EIC: DQ "Supervising Physician"	The first position of 2310D.NM105 must be alphabetic (A...Z).
X222 280 2310D NM106 010	Name Prefix	AN	1-10	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 280 2310D NM107 010	Supervising Provider Name Suffix	AN	1-10	S	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2310D.NM107 must contain at least one non-space character.
X222 280 2310D NM107 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2310D.NM107 must be 1 - 10 characters.
X222 280 2310D NM107 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 125: "Entity's Name" EIC: DQ "Supervising Physician"	N/A
X222 280 2310D NM107 040	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2310D.NM107 must be populated with accepted AN characters.
X222 280 2310D NM108 010	Identification Code Qualifier	ID	1-2	S	N/A	XX	277	CSCC A8: "Acknowledgement/Rejected for relational field in error." CSC 745: "Identifier Qualifier" CSC 562: "Entity's National Provider Identifier (NPI)" EIC: DQ "Supervising Physician"	2310D.NM108 must not be present when 2300.REF with REF01 = "P4" and REF02 is a valid VA identifier".
X222 280 2310D NM108 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A6: "Acknowledgement/Rejected for Missing Information..." CSC 745: "Identifier Qualifier" CSC 562: "Entity's National Provider Identifier (NPI)" EIC: DQ "Supervising Physician"	2310D.NM108 must be present.
X222 280 2310D NM108 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2310D.NM108 must be "XX".
X222 280 2310D NM109 010	Supervising Provider Identifier	AN	2-80	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2310D.NM108 is present, 2310D.NM109 must be present.
X222 280 2310D NM109 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 562: "Entity's National Provider Identifier (NPI)" EIC: DQ "Supervising Physician"	2310D.NM109 must be valid according to the NPI algorithm.
X222 280 2310D NM109 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 562: "Entity's National Provider Identifier (NPI)" EIC: DQ "Supervising Physician"	The first position of 2310D.NM109 must be a "1".
X222 280 2310D NM110 010	Entity Relationship Code	ID	2-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 280 2310D NM111 010	Entity Identifier Code	ID	2-3	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 280 2310D NM112 010	Name Last or Organization Name	AN	1-60	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 283 2310D REF 010	SUPERVISING PROVIDER SECONDARY IDENTIFIER	N/A	4	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only three iterations of 2310D.REF are allowed.
X222 283 2310D REF 015	N/A	N/A	N/A	N/A	N/A	N/A	999	IK304 = I9: "Implementation Dependent "Not Used" Segment Present"	2310D.REF must not be present.
X222 283 2310D REF01 010	Reference Identification Qualifier	ID	2-3	R	N/A	0B, 1G, G2, LU	999	IK403 = 1: "Required Data Element Missing"	2310D.REF01 must be present.
X222 283 2310D REF01 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 732: "Information submitted inconsistent with billing guidelines." CSC 560: "Entity's Additional/Secondary Identifier." EIC: DQ "Supervising Physician"	2310D.REF01 must be "0B", "1G"or "LU".
X222 283 2310D REF02 010	Supervising Provider Secondary Identifier	AN	1-50	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2310D.REF02 must be present.
X222 283 2310D REF02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	When 2310D.REF01 = "0B" or "LU", 2310D.REF02 must contain at least one non-space character.
X222 283 2310D REF02 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 133: "Entity's UPIN" EIC: DQ "Supervising Physician"	When 2310D.REF01 = "1G", 2310D.REF02 must be in format ANNNNN or AAANNN (where A is an alpha character and N is a numeric digit).
X222 283 2310D REF02 040	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	When 2310D.REF01 = "0B" or "LU", 2310D.REF02 must be 1 - 50 characters.
X222 283 2310D REF02 050	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 629: "Property Casualty Claim Number" EIC DQ "Supervising Physician"	N/A
X222 283 2310D REF02 060	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	When 2310D.REF01 = "0B" or "LU", 2310D.REF02 must be populated with accepted AN characters.
X222 283 2310D REF03 010	Description	AN	1-80	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 283 2310D REF04 010	REFERENCE IDENTIFIER	N/A	N/A	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 285 2310E NM1 010	AMBULANCE PICK UP LOCATION	N/A	1	S	1	N/A	999	IK304 = 4: "Loop Occurs Over Maximum Times"	Only one iteration 2310E.NM1 is allowed.
X222 285 2310E NM101 010	Entity Identifier Code	ID	2-3	R	N/A	PW	999	IK304 = 2: "Unexpected segment"	2310E.NM101 must be present and a valid value.
X222 285 2310E NM102 010	Entity Type Qualifier	ID	1-1	R	N/A	2	999	IK403 = 1: "Required Data Element Missing"	2310E.NM102 must be present.
X222 285 2310E NM102 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2310E.NM102 must be "2".
X222 285 2310E NM103 010	Name Last or Organization Name	AN	1-60	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 285 2310E NM104 010	Name First	AN	1-35	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 285 2310E NM105 010	Name Middle	AN	1-25	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 285 2310E NM106 010	Name Prefix	AN	1-10	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 285 2310E NM107 010	Name Suffix	AN	1-10	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 285 2310E NM108 010	Identification Code Qualifier	ID	1-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 285 2310E NM109 010	Identification Code	AN	2-80	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 285 2310E NM110 010	Entity Relationship Code	ID	2-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 285 2310E NM111 010	Entity Identifier Code	ID	2-3	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 285 2310E NM112 010	Name Last or Organization Name	AN	1-60	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 287 2310E N3 010	AMBULANCE PICK UP LOCATION ADDRESS	N/A	1	R	N/A	N/A	999	IK304 = I6: "Implementation Dependent Segment Missing"	If 2310E.NM1 is present, 2310E.N3 must be present.
X222 287 2310E N3 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2310E.N3 is allowed.
X222 287 2310E N301 010	Ambulance Pick Up Address Line	AN	1-55	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2310E.N301 must be present.
X222 287 2310E N301 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2310E.N301 must contain at least one non-space character.
X222 287 2310E N301 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2310E.N301 must be 1 - 55 characters.
X222 287 2310E N301 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 126: "Entity's Address" CSC 266 Facility point of origin and destination - ambulance EIC: 77 "Service Location"	N/A
X222 287 2310E N301 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2310E.N301 must be populated with accepted AN characters.
X222 287 2310E N302 020	Ambulance Pick Up Address Line	AN	1-55	S	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2310E.N302 must contain at least one non-space character.
X222 287 2310E N302 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2310E.N302 must be 1 - 55 characters.
X222 287 2310E N302 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 126: "Entity's Address" CSC 266 "Facility point of origin and destination - ambulance" EIC: 77 "Service Location"	N/A
X222 287 2310E N302 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2310E.N302 must be populated with accepted AN characters.
X222 288 2310E N4 010	AMBULANCE PICK UP LOCATION CITY/STATE/ZIP	N/A	1	R	N/A	N/A	999	IK304 = I6: "Implementation Dependent Segment Missing"	If 2310E.NM1 is present, 2310E.N4 must be present.
X222 288 2310E N4 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2310E.N4 is allowed.
X222 288 2310E N401 010	Ambulance Pick Up City Name	AN	2-30	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2310E.N401 must be present.
X222 288 2310E N401 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2310E.N401 must contain at least two non-space characters.
X222 288 2310E N401 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 4: "Data Element Too Short" IK403 = 5: "Data Element Too Long"	2310E.N401 must be 2-30 characters.
X222 288 2310E N401 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 502: "Entity's City" CSC 266 "Facility point of origin and destination - ambulance" EIC: 77 "Service Location"	N/A
X222 288 2310E N401 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2310E.N401 must be populated with accepted AN characters.
X222 288 2310E N402 010	Ambulance Pick Up State or Province Code	ID	2-2	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2310E.N404 is not present, 2310E.N402 must be present.
X222 288 2310E N402 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 501: "Entity's State/Province" CSC 266 "Facility point of origin and destination - ambulance" EIC: 77 "Service Location"	2310E.N402 must be a valid State Code.
X222 288 2310E N403 010	Ambulance Pick Up Postal Zone ZIP Code	ID	3-15	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2310E.N404 is not present, 2310E.N403 must be present.
X222 288 2310E N403 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 500: "Entity's Postal/Zip Code" CSC 266 "Facility point of origin and destination - ambulance" EIC: 77 "Service Location"	2310E.N403 must be a valid Zip Code.
X222 288 2310E N404 010	Ambulance Pick Up Country Code	ID	2-3	S	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 288 2310E N405 010	Location Qualifier	ID	1-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 288 2310E N406 010	Location Identifier	AN	1-30	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 288 2310E N407 005	Country Subdivision Code	ID	1-3	S	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 290 2310F NM1 010	AMBULANCE DROP OFF LOCATION	N/A	1	S	1	N/A	999	IK304 = 4: "Loop Occurs Over Maximum Times"	Only one iteration 2310F.NM1 is allowed.
X222 290 2310F NM101 010	Entity Identifier Code	ID	2-3	R	N/A	45	999	IK304 = 2: "Unexpected segment"	2310F.NM101 must be present and a valid value.
X222 290 2310F NM102 010	Entity Type Qualifier	ID	1-1	R	N/A	2	999	IK403 = 1: "Required Data Element Missing"	2310F.NM102 must be present.
X222 290 2310F NM102 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2310F.NM102 must be "2".
X222 290 2310F NM103 010	Ambulance Drop Off Location	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2310F.NM103 must contain at least one non-space character.
X222 290 2310F NM103 020	N/A	AN	1-60	S	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2310F.NM103 must be 1 - 60 characters.
X222 290 2310F NM103 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 504: "Entity's Last Name" CSC 266 "Facility point of origin and destination - ambulance" EIC: 77 "Service Location"	N/A
X222 290 2310F NM103 040	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2310F.NM103 must be populated with accepted AN characters.
X222 290 2310F NM104 010	Name First	AN	1-35	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 290 2310F NM105 010	Name Middle	AN	1-25	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 290 2310F NM106 010	Name Prefix	AN	1-10	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 290 2310F NM107 010	Name Suffix	AN	1-10	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 290 2310F NM108 010	Identification Code Qualifier	ID	1-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 290 2310F NM109 010	Identification Code	AN	2-80	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 290 2310F NM110 010	Entity Relationship Code	ID	2-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 290 2310F NM111 010	Entity Identifier Code	ID	2-3	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 290 2310F NM112 010	Name Last or Organization Name	AN	1-60	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 292 2310F N3 010	AMBULANCE DROP OFF LOCATION ADDRESS	N/A	1	R	N/A	N/A	999	IK304 = I6: "Implementation Dependent Segment Missing"	If 2310F.NM1 is present, 2310F.N3 must be present.
X222 292 2310F N3 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2310F.N3 is allowed.
X222 292 2310F N301 010	Ambulance Drop Off Address Line	AN	1-55	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2310F.N301 must be present.
X222 292 2310F N301 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2310F.N301 must contain at least one non-space character.
X222 292 2310F N301 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2310F.N301 must be 1 - 55 characters.
X222 292 2310F N301 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 126: "Entity's Address" CSC 266 Facility point of origin and destination - ambulance EIC: 77 "Service Location"	N/A
X222 292 2310F N301 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2310F.N301 must be populated with accepted AN characters.
X222 292 2310F N302 020	Ambulance Drop Off Address Line	AN	1-55	S	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2310F.N302 must contain at least one non-space character.
X222 292 2310F N302 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2310F.N302 must be 1 - 55 characters.
X222 292 2310F N302 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 126: "Entity's Address" CSC 266 "Facility point of origin and destination - ambulance" EIC: 77 "Service Location"	N/A
X222 292 2310F N302 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2310F.N302 must be populated with accepted AN characters.
X222 293 2310F N4 010	AMBULANCE DROP OFF LOCATION CITY/STATE/ZIP	N/A	1	R	N/A	N/A	999	IK304 = I6: "Implementation Dependent Segment Missing"	If 2310F.NM1 is present, 2310F.N4 must be present.
X222 293 2310F N4 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2310F.N4 is allowed.
X222 293 2310F N401 010	Ambulance Drop Off City Name	AN	2-30	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2310F.N401 must be present.
X222 293 2310F N401 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2310F.N401 must contain at least two non-space characters.
X222 293 2310F N401 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 4: "Data Element Too Short" IK403 = 5: "Data Element Too Long"	2310F.N401 must be 2-30 characters.
X222 293 2310F N401 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 502: "Entity's City" CSC 266 "Facility point of origin and destination - ambulance" EIC: 77 "Service Location"	N/A
X222 293 2310F N401 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2310F.N401 must be populated with accepted AN characters.
X222 293 2310F N402 010	Ambulance Drop Off State or Province Code	ID	2-2	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2310F.N404 is not present, 2310F.N402 must be present.
X222 293 2310F N402 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 501: "Entity's State/Province" CSC 266 "Facility point of origin and destination - ambulance" EIC: 77 "Service Location"	2310F.N402 must be a valid State Code.
X222 293 2310F N403 010	Ambulance Drop Off Postal Zone ZIP Code	ID	3-15	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2310F.N404 is not present, 2310F.N403 must be present.
X222 293 2310F N403 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 500: "Entity's Postal/Zip Code" CSC 266 "Facility point of origin and destination - ambulance" EIC: 77 "Service Location"	2310F.N403 must be a valid Zip Code.
X222 293 2310F N404 010	Ambulance Drop Off Country Code	ID	2-3	S	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 293 2310F N405 010	Location Qualifier	ID	1-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 293 2310F N406 010	Location Identifier	AN	1-30	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 293 2310F N407 005	Country Subdivision Code	ID	1-3	S	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 295 2320 010	OTHER SUBSCRIBER LOOP	N/A	N/A	N/A	10	N/A	999	IK304 = 4: "Loop Occurs Over Maximum Times"	Up to ten iterations of the 2320 loop are allowed.
X222 295 2320 SBR 010	OTHER SUBSCRIBER INFORMATION	N/A	1	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2320.SBR is allowed.
X222 295 2320 SBR01 010	Payer Responsibility Sequence Number Code	ID	1-1	R	N/A	A, B, C, D, E, F, G, H, P, S, T, U	999	IK403 = 1: "Required Data Element Missing"	2320.SBR01 must be present.
X222 295 2320 SBR01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2320.SBR01 must be valid values.
X222 295 2320 SBR01 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	Each iteration of 2320.SBR01 must contain a different code value (each code value may appear in one and only one SBR01 element).
X222 295 2320 SBR01 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A6: "Acknowledgement/Rejected for Missing Information..." CSC 286: "Other payer's Explanation of Benefits/payment information"	If 2000B.SBR01 = "S", 2320.SBR01 ="P" must be present.
X222 295 2320 SBR02 010	Individual Relationship Code	ID	2-2	R	N/A	01, 18, 19, 20, 21, 39, 40, 53, G8	999	IK403 = 1: "Required Data Element Missing"	2320.SBR02 must be present.
X222 295 2320 SBR02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2320.SBR02 must be valid values.
X222 295 2320 SBR03 004	Insured Group or Policy Number	AN	1-50	S	N/A	N/A	999	IK403 = I13: "Implementation Dependent "Not Used" Data Element Present"	2320.SBR03 must not equal 2330A.NM109
X222 295 2320 SBR03 006	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A8: "Acknowledgement/Rejected for relational field in error" CSC 163: "Entity's Policy Number" CSC 732 "Information submitted inconsistent with billing guidelines." EIC: GB "Other Insured"	N/A
X222 295 2320 SBR03 010	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2320.SBR03 must contain at least one non-space character.
X222 295 2320 SBR03 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2320.SBR03 must be 1 - 50 characters.
X222 295 2320 SBR03 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 163: "Entity's policy number" EIC: GB "Other Insured"	N/A
X222 295 2320 SBR03 040	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2320.SBR03 must be populated with accepted AN characters.
X222 295 2320 SBR04 010	Other Insured Group Name	AN	1-60	S	N/A	N/A	999	IK403 = 10: "Exclusion Condition Violated"	If 2320.SBR03 is present, 2320.SBR04 must not be present.
X222 295 2320 SBR04 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2320SBR04 must contain at least one non-space character.
X222 295 2320 SBR04 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2320.SBR04 must be 1 - 60 characters.
X222 295 2320 SBR04 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 663: "Entity's Group Name" EIC: GB "Other Insured"	N/A
X222 295 2320 SBR04 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2320.SBR04 must be populated with accepted AN characters.
X222 295 2320 SBR05 020	Insurance Type Code	ID	1-3	S	N/A	12, 13, 14, 15, 16, 41, 42, 43, 47	999	IK403 = 7: "Invalid Code Value"	2320.SBR05 must be valid values.
X222 295 2320 SBR06 010	Coordination of Benefits Code	ID	1-1	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 295 2320 SBR07 010	Yes/No Condition or Response Code	ID	1-1	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 295 2320 SBR08 010	Employment Status Code	ID	2-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 295 2320 SBR09 010	Claim Filing Indicator Code	ID	1-2	S	N/A	11, 12, 13, 14, 15, 16, 17, AM, BL, CH, CI, DS, FI ,HM, LM, MA, MB, MC, OF, TV, VA, WC, ZZ	999	IK403 = 7: "Invalid Code Value"	2320.SBR09 must be valid values.
X222 295 2320 SBR09 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 480: "Entity's claim filing indicator." EIC: PR "Payer"	2320.SBR09 must not = "MA" or "MB".
X222 299 2320 CAS 010	CLAIM LEVEL ADJUSTMENTS	N/A	5	S	N/A	N/A	999	IK304 = I9: "Implementation Dependent "Not Used" Segment Present" OR IK304 = 2: "Unexpected Segment"	If 2320.CAS is present, 2320.SBR must be present.
X222 299 2320 CAS 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only five iterations of 2320.CAS are allowed.
X222 299 2320 CAS 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 41: Special handling required at payer site CSC 286: Other payer's Explanation of Benefits/payment information CSC 732: Information submitted inconsistent with billing guidelines	If 2000B.SBR01 = "P" then 2320.CAS must not be present.
X222 299 2320 CAS01 010	Claim Adjustment Group Code	ID	1-2	R	N/A	CO, CR, OA, PI, PR	999	CSC 41: Special handling required at payer site	2320.CAS01 must be present.
X222 299 2320 CAS01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	CSC 286: Other payer's Explanation of Benefits/payment information	2320.CAS01 must be valid values.
X222 299 2320 CAS01 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement /Rejected for Invalid Information..." CSC 521: "Adjustment Reason Code"	If 2320 CAS01 = "CR", "OA", or "PI": then 2320 CAS02 must not = 45, 2320.CAS05 must not = 45, 2320.CAS08 must not = 45, 2320.CAS11 must not = 45, 2320.CAS14 must not = 45, or 2320.CAS17 must not = 45.
X222 299 2320 CAS02 010	Adjustment Reason Code	ID	1-5	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2320.CAS02 must be present.
X222 299 2320 CAS02 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A8: "Acknowledgement/Rejected for relational field in error. CSC 521: Adjustment Reason Code CSC 516: Adjudication or Payment Date EIC: GB "Other Insured"	If 2330B.DTP03 with DTP01 = "573" is present, 2320.CAS02 must be a valid Claim Adjustment Reason Code on the date in 2330B.DTP03 when DTP01 = "573".
X222 299 2320 CAS02 025	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A8: "Acknowledgement/Rejected for relational field in error. CSC 521: Adjustment Reason Code CSC 516: Adjudication or Payment Date EIC: GB "Other Insured"	If 2330B.DTP03 with DTP01 = "573" is not present, 2320.CAS02 must be a valid Claim Adjustment Reason Code for the high/low date range of the 2430.DTP03s when DTP01 = "573".
X222 299 2320 CAS03 010	Adjustment Amount	R	1-18	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2320.CAS03 must be present.
X222 299 2320 CAS03 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2320.CAS03 must be numeric.
X222 299 2320 CAS03 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 694: "Amount must not be equal to zero" CSC 519: "Adjustment Amount" EIC: GB "Other Insured"	2320.CAS03 must not = 0.
X222 299 2320 CAS03 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 697: "Invalid Decimal Precision" CSC 519: "Adjustment Amount" EIC: GB "Other Insured"	2320.CAS03 is limited to 0, 1 or 2 decimal positions.
X222 299 2320 CAS03 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2320.CAS03 must be >= -99,999.99. and <= 99,999.99.
X222 299 2320 CAS03 060	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 519: "Adjustment Amount" EIC: GB "Other Insured"	N/A
X222 299 2320 CAS04 010	Adjustment Quantity	R	1-15	S	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2320.CAS04 must be 1-15 digits.
X222 299 2320 CAS04 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 519: "Adjustment Amount" EIC: GB "Other Insured"	N/A
X222 299 2320 CAS04 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 694: "Amount must not be equal to zero" CSC 520: "Adjustment Quantity" EIC: GB "Other Insured"	2320.CAS04 must not = 0.
X222 299 2320 CAS05 010	Adjustment Reason Code	ID	1-5	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2320.CAS05 is present, 2320.CAS02 must be present.
X222 299 2320 CAS05 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A8: "Acknowledgement/Rejected for relational field in error. CSC 521: Adjustment Reason Code CSC 516: Adjudication or Payment Date EIC: GB "Other Insured"	If 2330B.DTP03 with DTP01 = "573" is present, 2320.CAS05 must be a valid Claim Adjustment Reason Code on the date in 2330B.DTP03 when DTP01 = "573".
X222 299 2320 CAS05 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A8: "Acknowledgement/Rejected for relational field in error. CSC 521: Adjustment Reason Code CSC 516: Adjudication or Payment Date EIC: GB "Other Insured"	If 2330B.DTP03 with DTP01 = "573" is not present, 2320.CAS05 must be a valid Claim Adjustment Reason Code for the high/low date range of the 2430.DTP03s when DTP01 = "573".
X222 299 2320 CAS06 010	Adjustment Amount	R	1-18	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2320.CAS06 is present, 2320.CAS05 must be present.
X222 299 2320 CAS06 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2320.CAS06 must be numeric.
X222 299 2320 CAS06 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 694: "Amount must not be equal to zero" CSC 519: "Adjustment Amount" EIC: GB "Other Insured"	2320.CAS06 must not = 0.
X222 299 2320 CAS06 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 697: "Invalid Decimal Precision" CSC 519: "Adjustment Amount" EIC: GB "Other Insured"	2320.CAS06 is limited to 0, 1 or 2 decimal positions.
X222 299 2320 CAS06 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2320.CAS06 must be >= -99,999.99. and <= 99,999.99.
X222 299 2320 CAS06 060	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 519: "Adjustment Amount" EIC: GB "Other Insured"	N/A
X222 299 2320 CAS07 010	Adjustment Quantity	R	1-15	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2320.CAS07 is present, 2320.CAS05 must be present.
X222 299 2320 CAS07 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2320.CAS07 must be 1-15 digits.
X222 299 2320 CAS07 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 519: "Adjustment Amount" EIC: GB "Other Insured"	N/A
X222 299 2320 CAS07 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 694: "Amount must not be equal to zero" CSC 520: "Adjustment Quantity" EIC: GB "Other Insured"	2320.CAS07 must not = 0.
X222 299 2320 CAS08 010	Adjustment Reason Code	ID	1-5	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2320.CAS08 is present, 2320.CAS05 must be present.
X222 299 2320 CAS08 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A8: "Acknowledgement/Rejected for relational field in error. CSC 521: Adjustment Reason Code CSC 516: Adjudication or Payment Date EIC: GB "Other Insured"	If 2330B.DTP03 with DTP01 = "573" is present, 2320.CAS08 must be a valid Claim Adjustment Reason Code on the date in 2330B.DTP03 when DTP01 = "573".
X222 299 2320 CAS08 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A8: "Acknowledgement/Rejected for relational field in error. CSC 521: Adjustment Reason Code CSC 516: Adjudication or Payment Date EIC: GB "Other Insured"	If 2330B.DTP03 with DTP01 = "573" is not present, 2320.CAS08 must be a valid Claim Adjustment Reason Code for the high/low date range of the 2430.DTP03s when DTP01 = "573".
X222 299 2320 CAS09 010	Adjustment Amount	R	1-18	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2320.CAS09 is present, 2320.CAS08 must be present.
X222 299 2320 CAS09 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2320.CAS09 must be numeric.
X222 299 2320 CAS09 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 694: "Amount must not be equal to zero" CSC 519: "Adjustment Amount" EIC: GB "Other Insured"	2320.CAS09 must not = 0.
X222 299 2320 CAS09 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 697: "Invalid Decimal Precision" CSC 519: "Adjustment Amount" EIC: GB "Other Insured"	2320.CAS09 is limited to 0, 1 or 2 decimal positions.
X222 299 2320 CAS09 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2320.CAS09 must be >= -99,999.99. and <= 99,999.99.
X222 299 2320 CAS09 060	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 519: "Adjustment Amount" EIC: GB "Other Insured"	N/A
X222 299 2320 CAS10 010	Adjustment Quantity	R	1-15	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2320.CAS10 is present, 2320.CAS08 must be present.
X222 299 2320 CAS10 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2320.CAS10 must be 1-15 digits.
X222 299 2320 CAS10 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 519: "Adjustment Amount" EIC: GB "Other Insured"	N/A
X222 299 2320 CAS10 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 694: "Amount must not be equal to zero" CSC 520: "Adjustment Quantity" EIC: GB "Other Insured"	2320.CAS10 must not = 0.
X222 299 2320 CAS11 010	Adjustment Reason Code	ID	1-5	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2320.CAS11 is present, 2320.CAS08 must be present.
X222 299 2320 CAS11 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A8: "Acknowledgement/Rejected for relational field in error. CSC 521: Adjustment Reason Code CSC 516: Adjudication or Payment Date EIC: GB "Other Insured"	If 2330B.DTP03 with DTP01 = "573" is present, 2320.CAS11 must be a valid Claim Adjustment Reason Code on the date in 2330B.DTP03 when DTP01 = "573".
X222 299 2320 CAS11 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A8: "Acknowledgement/Rejected for relational field in error. CSC 521: Adjustment Reason Code CSC 516: Adjudication or Payment Date EIC: GB "Other Insured"	If 2330B.DTP03 with DTP01 = "573" is not present, 2320.CAS11 must be a valid Claim Adjustment Reason Code for the high/low date range of the 2430.DTP03s when DTP01 = "573".
X222 299 2320 CAS12 010	Adjustment Amount	R	1-18	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2320.CAS12 is present, 2320.CAS11 must be present.
X222 299 2320 CAS12 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2320.CAS12 must be numeric.
X222 299 2320 CAS12 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 694: "Amount must not be equal to zero" CSC 519: "Adjustment Amount" EIC: GB "Other Insured"	2320.CAS12 must not = 0.
X222 299 2320 CAS12 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 697: "Invalid Decimal Precision" CSC 519: "Adjustment Amount" EIC: GB "Other Insured"	2320.CAS12 is limited to 0, 1 or 2 decimal positions.
X222 299 2320 CAS12 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2320.CAS12 must be >= -99,999.99. and <= 99,999.99.
X222 299 2320 CAS12 060	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 519: "Adjustment Amount" EIC: GB "Other Insured"	N/A
X222 299 2320 CAS13 010	Adjustment Quantity	R	1-15	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2320.CAS13 is present, 2320.CAS11 must be present.
X222 299 2320 CAS13 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2320.CAS13 must be 1-15 digits.
X222 299 2320 CAS13 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 519: "Adjustment Amount" EIC: GB "Other Insured"	N/A
X222 299 2320 CAS13 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 694: "Amount must not be equal to zero" CSC 520: "Adjustment Quantity" EIC: GB "Other Insured"	2320.CAS13 must not = 0.
X222 299 2320 CAS14 010	Adjustment Reason Code	ID	1-5	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2320.CAS14 is present, 2320.CAS11 must be present.
X222 299 2320 CAS14 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A8: "Acknowledgement/Rejected for relational field in error. CSC 521: Adjustment Reason Code CSC 516: Adjudication or Payment Date EIC: GB "Other Insured"	If 2330B.DTP03 with DTP01 = "573" is present, 2320.CAS14 must be a valid Claim Adjustment Reason Code on the date in 2330B.DTP03 when DTP01 = "573".
X222 299 2320 CAS14 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A8: "Acknowledgement/Rejected for relational field in error. CSC 521: Adjustment Reason Code CSC 516: Adjudication or Payment Date EIC: GB "Other Insured"	If 2330B.DTP03 with DTP01 = "573" is not present, 2320.CAS14 must be a valid Claim Adjustment Reason Code for the high/low date range of the 2430.DTP03s when DTP01 = "573".
X222 299 2320 CAS15 010	Adjustment Amount	R	1-18	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2320.CAS15 is present, 2320.CAS14 must be present.
X222 299 2320 CAS15 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2320.CAS15 must be numeric.
X222 299 2320 CAS15 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 694: "Amount must not be equal to zero" CSC 519: "Adjustment Amount" EIC: GB "Other Insured"	2320.CAS15 must not = 0.
X222 299 2320 CAS15 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 697: "Invalid Decimal Precision" CSC 519: "Adjustment Amount" EIC: GB "Other Insured"	2320.CAS15 is limited to 0, 1 or 2 decimal positions.
X222 299 2320 CAS15 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2320.CAS15 must be >= -99,999.99. and <= 99,999.99.
X222 299 2320 CAS15 060	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 519: "Adjustment Amount" EIC: GB "Other Insured"	N/A
X222 299 2320 CAS16 010	Adjustment Quantity	R	1-15	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2320.CAS16 is present, 2320.CAS14 must be present.
X222 299 2320 CAS16 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2320.CAS16 must be 1-15 digits.
X222 299 2320 CAS16 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 519: "Adjustment Amount" EIC: GB "Other Insured"	N/A
X222 299 2320 CAS16 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 694: "Amount must not be equal to zero" CSC 520: "Adjustment Quantity" EIC: GB "Other Insured"	2320.CAS16 must not = 0.
X222 299 2320 CAS17 010	Adjustment Reason Code	ID	1-5	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2320.CAS17 is present, 2320.CAS14 must be present.
X222 299 2320 CAS17 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A8: "Acknowledgement/Rejected for relational field in error. CSC 521: Adjustment Reason Code CSC 516: Adjudication or Payment Date EIC: GB "Other Insured"	If 2330B.DTP03 with DTP01 = "573" is present, 2320.CAS17 must be a valid Claim Adjustment Reason Code on the date in 2330B.DTP03 when DTP01 = "573".
X222 299 2320 CAS17 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A8: "Acknowledgement/Rejected for relational field in error. CSC 521: Adjustment Reason Code CSC 516: Adjudication or Payment Date EIC: GB "Other Insured"	If 2330B.DTP03 with DTP01 = "573" is not present, 2320.CAS17 must be a valid Claim Adjustment Reason Code for the high/low date range of the 2430.DTP03s when DTP01 = "573".
X222 299 2320 CAS18 010	Adjustment Amount	R	1-18	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2320.CAS18 is present, 2320.CAS17 must be present.
X222 299 2320 CAS18 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2320.CAS18 must be numeric.
X222 299 2320 CAS18 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 694: "Amount must not be equal to zero" CSC 519: "Adjustment Amount" EIC: GB "Other Insured"	2320.CAS18 must not = 0.
X222 299 2320 CAS18 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 697: "Invalid Decimal Precision" CSC 519: "Adjustment Amount" EIC: GB "Other Insured"	2320.CAS18 is limited to 0, 1 or 2 decimal positions.
X222 299 2320 CAS18 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2320.CAS18 must be >= -99,999.99. and <= 99,999.99.
X222 299 2320 CAS18 060	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 519: "Adjustment Amount" EIC: GB "Other Insured"	N/A
X222 299 2320 CAS19 010	Adjustment Quantity	R	1-15	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2320.CAS19 is present, 2320.CAS17 must be present.
X222 299 2320 CAS19 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2320.CAS19 must be 1-15 digits.
X222 299 2320 CAS19 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 519: "Adjustment Amount" EIC: GB "Other Insured"	N/A
X222 299 2320 CAS19 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 694: "Amount must not be equal to zero" CSC 520: "Adjustment Quantity" EIC: GB "Other Insured"	2320.CAS19 must not = 0.
X222 305 2320 AMT 020	COB PAYER PAID AMOUNT	N/A	1	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2320.AMT with AMT01 = "D" is allowed.
X222 305 2320 AMT 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A6: "Acknowledgement/Rejected for Missing Information..." CSC 286: "Other payer's Explanation of Benefits/payment information"	If 2000B.SBR01 = "S" then one 2320 loop with an AMT segment with AMT01 = "D" must be present.
X222 305 2320 AMT 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 41: Special handling required at payer site CSC 286: Other payer's Explanation of Benefits/payment information CSC 732: Information submitted inconsistent with billing guidelines	If 2000B.SBR01 = "S" then only one iteration of 2320 loop containing an AMT with AMT01 equal to D is allowed.
X222 305 2320 AMT01 010	Amount Qualifier Code	ID	1-3	R	N/A	D	999	IK403 = 1: "Required Data Element Missing"	2320.AMT01 must be present.
X222 305 2320 AMT01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2320.AMT01 must be "D".
X222 305 2320 AMT01 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 41: Special handling required at payer site CSC 286: Other payer's Explanation of Benefits/payment information CSC 732: Information submitted inconsistent with billing guidelines	If 2000B.SBR01 = "P" then 2320.AMT01 =D must not be present.
X222 305 2320 AMT02 015	Payer Paid Amount	R	1-18	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2320.AMT02 must be present.
X222 305 2320 AMT02 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2320 .AMT02 must be numeric.
X222 305 2320 AMT02 010	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2320.AMT02 must be >= 0 and <= 99,999.99.
X222 305 2320 AMT02 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 183: "Amount entity has paid" CSC 286: Other payer's Explanation of Benefits/payment information EIC: PR "Payer"	N/A
X222 305 2320 AMT02 050	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 697: "Invalid Decimal Precision" CSC 183: "Amount entity has paid" CSC 286: Other payer's Explanation of Benefits/payment information EIC: PR "Payer"	2320.AMT02 is limited to 0, 1 or 2 decimal positions.
X222 305 2320 AMT02 060	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 672: "Other Payer's payment information is out of balance" CSC 286: Other payer's Explanation of Benefits/payment information	2320 AMT02 must = the sum of all existing 2430.SVD02 payer paid amounts (when the value in 2430.SVD01 is the same as the value in 2330B.NM109) minus the sum of all claim level adjustments (2320 CAS adjustment amounts) for the same payer. NOTE: Perform this edit only when 2430SVD segments are present for this 2320-2330x iteration's payer.
X222 305 2320 AMT03 010	Credit/Debit Flag Code	ID	1-1	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 306 2320 AMT 020	COB TOTAL NON-COVERED AMOUNT	N/A	1	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2320.AMT with AMT01 = "A8" is allowed.
X222 306 2320 AMT01 010	Amount Qualifier Code	ID	1-3	R	N/A	A8	999	IK403 = 1: "Required Data Element Missing"	2320.AMT01 must be present.
X222 306 2320 AMT01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2320.AMT01 must be "A8".
X222 306 2320 AMT01 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 596: "Non-covered Charge Amount" EIC: GB "Other Insured"	2320 AMT01 = A8 must not be present
X222 306 2320 AMT02 005	Non-Covered Amount	R	1-18	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2320.AMT02 must be present.
X222 306 2320 AMT02 010	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2320 .AMT02 must be numeric.
X222 306 2320 AMT02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2320.AMT02 must be >= 0 and <= 99,999.99.
X222 306 2320 AMT02 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 596: "Non-covered Charge Amount" EIC: GB "Other Insured"	N/A
X222 306 2320 AMT02 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 697: "Invalid Decimal Precision" CSC 596: "Non-covered Charge Amount" EIC: GB "Other Insured"	2320.AMT02 is limited to 0, 1 or 2 decimal positions.
X222 306 2320 AMT03 010	Credit/Debit Flag Code	ID	1-1	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 307 2320 AMT 020	REMAINING PATIENT LIABILITY	N/A	1	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2320.AMT with AMT01 = "EAF" is allowed.
X222 307 2320 AMT 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A8: "Acknowledgement/Rejected for relational field in error" CSC 6: "Balance due from the subscriber". EIC: GB "Other Insured"	If 2430 AMT (EAF) is present for the same payer, the 2320 AMT (EAF) must not be present
X222 307 2320 AMT01 010	Amount Qualifier Code	ID	1-3	R	N/A	EAF	999	IK403 = 1: "Required Data Element Missing"	2320.AMT01 must be present.
X222 307 2320 AMT01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2320.AMT01 must be "EAF".
X222 307 2320 AMT02 002	Remaining Patient Liability Amount	R	1-18	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2320.AMT02 must be present.
X222 307 2320 AMT02 005	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2320.AMT02 must be numeric.
X222 307 2320 AMT02 010	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2320.AMT02 must be <= 99,999.99.
X222 307 2320 AMT02 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 6 Balance due from the subscriber. EIC: GB "Other Insured"	N/A
X222 307 2320 AMT02 025	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 697: "Invalid Decimal Precision" CSC 6 Balance due from the subscriber. EIC: GB "Other Insured"	2320.AMT02 is limited to 0, 1 or 2 decimal positions.
X222 307 2320 AMT03 010	Credit/Debit Flag Code	ID	1-1	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 308 2320 OI 010	OTHER INSURANCE COVERAGE INFORMATION	N/A	1	R	N/A	N/A	999	IK304 = I6: "Implementation Dependent Segment Missing"	If 2320.SBR is present, 2320.OI must be present.
X222 308 2320 OI 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2320.OI is allowed.
X222 308 2320 OI01 010	Claim Filing Indicator Code	ID	1-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 308 2320 OI02 010	Claim Submission Reason Code	ID	2-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 308 2320 OI03 010	Benefits Assignment Certification Indicator	ID	1-1	R	N/A	N, W, Y	999	IK403 = 1: "Required Data Element Missing"	2320.OI03 must be present.
X222 308 2320 OI03 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2320.OI03 must be valid values.
X222 308 2320 OI04 010	Patient Signature Source Code	ID	1-1	S	N/A	P	999	IK403 = 7: "Invalid Code Value"	2320.OI04 must be "P".
X222 308 2320 OI05 010	Provider Agreement Code	ID	1-1	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 308 2320 OI06 010	Release of Information Code	ID	1-1	R	N/A	I, Y	999	IK403 = 1: "Required Data Element Missing"	2320.OI06 must be present.
X222 308 2320 OI06 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2320.OI06 must be valid values.
X222 310 2320 MOA 020	OUTPATIENT ADJUDICATION INFORMATION	N/A	1	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2320.MOA is allowed on outpatient claims.
X222 310 2320 MOA01 010	Reimbursement Rate	R	1-10	S	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2320.MOA01 must be numeric.
X222 310 2320 MOA01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = I12: "Implementation Pattern Match Failure"	2320.MOA01 must be >= 0.0 and <= 1.0.
X222 310 2320 MOA01 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement /Rejected for Invalid Information..." CSC 697: "Invalid Decimal Precision" CSC 631: "Reimbursement Rate"	2320.MOA01 is limited to 0, 1 or 2 decimal positions.
X222 310 2320 MOA02 010	HCPCS Payable Amount	R	1-18	S	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2320.MOA02 must be numeric.
X222 310 2320 MOA02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2320.MOA02 must be >= 0 and <= 99,999.99.
X222 310 2320 MOA02 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 574: "HCPCS Payable Amount Home Health"	N/A
X222 310 2320 MOA02 050	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 697: "Invalid Decimal Precision" CSC 574: "HCPCS Payable Amount Home Health"	2320.MOA02 is limited to 0, 1 or 2 decimal positions.
X222 310 2320 MOA03 010	Remark Code	AN	1-50	S	N/A	N/A	277	CSCC A8: "Acknowledgement/Rejected for relational field in error." CSC 634: "Remark Code" CSC 516: "Adjudication or Payment Date" EIC: GB "Other Insured"	If 2330B.DTP03 with DTP01 = "573" is present, 2320.MOA03 must be a valid Remittance Advice Remark Code on the date in 2330B.DTP03 when DTP01 = "573".
X222 310 2320 MOA03 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A8: "Acknowledgement/Rejected for relational field in error." CSC 634: "Remark Code" CSC 516: "Adjudication or Payment Date" EIC: GB "Other Insured"	If 2330B.DTP03 with DTP01 = "573" is not present, 2320.MOA03 must be a valid Remittance Advice Remark Code for the high/low date range of the 2430.DTP03s when DTP01 = "573".
X222 310 2320 MOA04 010	Remark Code	AN	1-50	S	N/A	N/A	277	CSCC A8: "Acknowledgement/Rejected for relational field in error." CSC 634: "Remark Code" CSC 516: "Adjudication or Payment Date" EIC: GB "Other Insured"	If 2330B.DTP03 with DTP01 = "573" is present, 2320.MOA04 must be a valid Remittance Advice Remark Code on the date in 2330B.DTP03 when DTP01 = "573".
X222 310 2320 MOA04 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A8: "Acknowledgement/Rejected for relational field in error." CSC 634: "Remark Code" CSC 516: "Adjudication or Payment Date" EIC: GB "Other Insured"	If 2330B.DTP03 with DTP01 = "573" is not present, 2320.MOA04 must be a valid Remittance Advice Remark Code for the high/low date range of the 2430.DTP03s when DTP01 = "573".
X222 310 2320 MOA05 010	Remark Code	AN	1-50	S	N/A	N/A	277	CSCC A8: "Acknowledgement/Rejected for relational field in error." CSC 634: "Remark Code" CSC 516: "Adjudication or Payment Date" EIC: GB "Other Insured"	If 2330B.DTP03 with DTP01 = "573" is present, 2320.MOA05 must be a valid Remittance Advice Remark Code on the date in 2330B.DTP03 when DTP01 = "573".
X222 310 2320 MOA05 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A8: "Acknowledgement/Rejected for relational field in error." CSC 634: "Remark Code" CSC 516: "Adjudication or Payment Date" EIC: GB "Other Insured"	If 2330B.DTP03 with DTP01 = "573" is not present, 2320.MOA05 must be a valid Remittance Advice Remark Code for the high/low date range of the 2430.DTP03s when DTP01 = "573".
X222 310 2320 MOA06 010	Remark Code	AN	1-50	S	N/A	N/A	277	CSCC A8: "Acknowledgement/Rejected for relational field in error." CSC 634: "Remark Code" CSC 516: "Adjudication or Payment Date" EIC: GB "Other Insured"	If 2330B.DTP03 with DTP01 = "573" is present, 2320.MOA06 must be a valid Remittance Advice Remark Code on the date in 2330B.DTP03 when DTP01 = "573".
X222 310 2320 MOA06 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A8: "Acknowledgement/Rejected for relational field in error." CSC 634: "Remark Code" CSC 516: "Adjudication or Payment Date" EIC: GB "Other Insured"	If 2330B.DTP03 with DTP01 = "573" is not present, 2320.MOA06 must be a valid Remittance Advice Remark Code for the high/low date range of the 2430.DTP03s when DTP01 = "573".
X222 310 2320 MOA07 010	Remark Code	AN	1-50	S	N/A	N/A	277	CSCC A8: "Acknowledgement/Rejected for relational field in error." CSC 634: "Remark Code" CSC 516: "Adjudication or Payment Date" EIC: GB "Other Insured"	If 2330B.DTP03 with DTP01 = "573" is present, 2320.MOA07 must be a valid Remittance Advice Remark Code on the date in 2330B.DTP03 when DTP01 = "573".
X222 310 2320 MOA07 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A8: "Acknowledgement/Rejected for relational field in error." CSC 634: "Remark Code" CSC 516: "Adjudication or Payment Date" EIC: GB "Other Insured"	If 2330B.DTP03 with DTP01 = "573" is not present, 2320.MOA07 must be a valid Remittance Advice Remark Code for the high/low date range of the 2430.DTP03s when DTP01 = "573".
X222 310 2320 MOA08 010	End Stage Renal Disease Payment Amount	R	1-18	S	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2320 .MOA08 must be numeric.
X222 310 2320 MOA08 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2320.MOA08 must be >= 0 and <= 99,999.99.
X222 310 2320 MOA08 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 534: "Claim ESRD Payment Amount"	N/A
X222 310 2320 MOA08 050	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 697: "Invalid Decimal Precision" CSC 534: "Claim ESRD Payment Amount"	2320.MOA08 is limited to 0, 1 or 2 decimal positions.
X222 310 2320 MOA09 010	Non-Payable Professional Component Billed Amount	R	1-18	S	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2320 .MOA09 must be numeric.
X222 310 2320 MOA09 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2320.MOA09 must be >= 0 and <= 99,999.99.
X222 310 2320 MOA09 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 598: "Non-payable Professional Component Billed Amount"	N/A
X222 310 2320 MOA09 050	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 697: "Invalid Decimal Precision" CSC 598: "Non-payable Professional Component Billed Amount"	2320.MOA09 is limited to 0, 1 or 2 decimal positions.
X222 313 2330A NM1 010	OTHER SUBSCRIBER NAME	N/A	1	R	1	N/A	999	IK304 = I6: "Implementation Dependent Segment Missing"	If 2320SBR is present, 2330A.NM1 must be present.
X222 313 2330A NM1 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK304 = 4: "Loop Occurs Over Maximum Times"	Only one iteration of 2330A.NM1 is allowed.
X222 313 2330A NM101 010	Entity Identifier Code	ID	2-3	R	N/A	IL	999	IK304 = 2: "Unexpected segment"	2330A.NM101 must be present and a valid value.
X222 313 2330A NM102 010	Entity Type Qualifier	ID	1-1	R	N/A	1, 2	999	IK403 = 1: "Required Data Element Missing"	2330A.NM102 must be present.
X222 313 2330A NM102 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2330A.NM102 must be valid values.
X222 313 2330A NM103 010	Other Insured Last Name	AN	1-60	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2330AN.M103 must be present.
X222 313 2330A NM103 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2330A.NM103 must be 1 - 60 characters.
X222 313 2330A NM103 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 504: "Entity's Last Name" EIC: GB "Other Insured"	N/A
X222 313 2330A NM103 040	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2330A.NM103 must be populated with accepted AN characters.
X222 313 2330A NM103 060	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2330A.NM103 must contain at least one non-space character.
X222 313 2330A NM104 010	Other Insured First Name	AN	1-35	S	N/A	N/A	999	IK403 = I13: "Implementation Dependent "Not Used" Data Element Present"	If 2330A.NM102 is "2", 2330A.NM104 must not be present.
X222 313 2330A NM104 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2330A.NM104 must contain at least one non-space character.
X222 313 2330A NM104 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2330A.NM104 must be 1 - 35 characters.
X222 313 2330A NM104 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 505: "Entity's First Name" EIC: GB "Other Insured"	N/A
X222 313 2330A NM104 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2330A.NM104 must be populated with accepted AN characters.
X222 313 2330A NM105 010	Other Insured Middle Name	AN	1-25	S	N/A	N/A	999	IK403 = I13: "Implementation Dependent "Not Used" Data Element Present"	If 2330A.NM102 is "2", 2330A.NM105 must not be present.
X222 313 2330A NM105 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2330A.NM105 must contain at least one non-space character.
X222 313 2330A NM105 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2330A.NM105 must be 1 - 25 characters.
X222 313 2330A NM105 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 514: "Entity's Middle Name" EIC: GB "Other Insured"	N/A
X222 313 2330A NM105 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2330A.NM105 must be populated with accepted AN characters.
X222 313 2330A NM105 055	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement /Rejected for Invalid Information..." CSC 514: "Entity's Middle Name" EIC: GB "Other Insured"	The first position of 2330A.NM105 must be alphabetic (A...Z).
X222 313 2330A NM106 010	Name Prefix	AN	1-10	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 313 2330A NM107 010	Other Insured Name Suffix	AN	1-10	S	N/A	N/A	999	IK403 = I13: "Implementation Dependent "Not Used" Data Element Present"	If 2330A.NM102 is "2", 2330A.NM107 must not be present.
X222 313 2330A NM107 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2330A.NM107 must contain at least one non-space character.
X222 313 2330A NM107 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2330A.NM107 must be 1 - 10 characters.
X222 313 2330A NM107 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 125: "Entity's Name" EIC: GB "Other Insured"	N/A
X222 313 2330A NM107 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2330A.NM107 must be populated with accepted AN characters.
X222 313 2330A NM108 010	Identification Code Qualifier	ID	1-2	R	N/A	II, MI	999	IK403 = 1: "Required Data Element Missing"	2330A.NM108 must be present.
X222 313 2330A NM108 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2330A.NM108 must be valid values.
X222 313 2330A NM109 010	Other Insured Identifier	AN	2-80	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2330A.NM109 must be present.
X222 313 2330A NM109 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2330A.NM109 must contain at least two non-space characters.
X222 313 2330A NM109 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 4: "Data Element Too Short" IK403 = 5: "Data Element Too Long"	2330A.NM109 must be 2-80 characters.
X222 313 2330A NM109 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 153: "Entity's ID Number" EIC: GB "Other Insured"	N/A
X222 313 2330A NM109 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2330A.NM109 must be populated with accepted AN characters.
X222 313 2330A NM110 010	Entity Relationship Code	ID	2-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 313 2330A NM111 010	Entity Identifier Code	ID	2-3	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 313 2330A NM112 010	Name Last or Organization Name	AN	1-60	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 316 2330A N3 020	OTHER SUBSCRIBER ADDRESS	N/A	1	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2330A.N3 is allowed.
X222 316 2330A N301 010	Other Insured Address Line	AN	1-55	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2330A.N301 must be present.
X222 316 2330A N301 015	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2330A.N301 must contain at least one non-space character.
X222 316 2330A N301 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2330A.N301 must be 1 - 55 characters.
X222 316 2330A N301 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 503: "Entity's Street address" EIC: GB "Other Insured"	N/A
X222 316 2330A N301 040	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2330A.N301 must be populated with accepted AN characters.
X222 316 2330A N302 020	Other Insured Address Line	AN	1-55	S	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2330A.N302 must contain at least one non-space character.
X222 316 2330A N302 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2330A.N302 must be 1 - 55 characters.
X222 316 2330A N302 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 503: "Entity's Street address" EIC: GB "Other Insured"	N/A
X222 316 2330A N302 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2330A.N302 must be populated with accepted AN characters.
X222A1 020 2330A N4 010	OTHER SUBSCRIBER CITY/STATE/ZIP CODE	N/A	1	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2330A.N4 is allowed.
X222 317 2330A N401 010	Other Subscriber City Name	AN	2-30	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2330A.N401 must be present.
X222 317 2330A N401 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2330A.N401 must contain at least two non-space characters.
X222 317 2330A N401 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 4: "Data Element Too Short" IK403 = 5: "Data Element Too Long"	2330A.N401 must be 2-30 characters.
X222 317 2330A N401 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 502: "Entity's City" EIC: GB "Other Insured"	N/A
X222 317 2330A N401 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2330A.N401 must be populated with accepted AN characters.
X222 317 2330A N402 010	Other Subscriber State or Province Code	ID	2-2	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2330A.N404 is not present, 2330A.N402 must be present.
X222 317 2330A N402 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 501: "Entity's State/Province" EIC: GB "Other Insured"	2330A.N402 must be a valid State Code.
X222 317 2330A N403 010	Other Subscriber Postal Code	ID	3-15	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2330A.N404 is not present, 2330A.N403 must be present.
X222 317 2330A N403 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 500: "Entity's Postal/Zip Code" EIC: GB "Other Insured"	2330A.N403 must be a valid postal/zip Code when N404 equals US or blank.
X222 317 2330A N404 010	Other Subscriber Country code	ID	2-3	S	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 680: "Entity's Country" EIC: GB "Other Insured"	2330A.N404 must be a valid 2 character Country Code.
X222 317 2330A N405 010	Location Qualifier	ID	1-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 317 2330A N406 010	Location Identifier	AN	1-30	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 317 2330A N407 010	Country Subdivision Code	ID	1-3	S	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 695: "Entity's Country Subdivision Code" EIC: GB "Other Insured"	2330A.N407 must be a valid Country Subdivision Code.
X222 319 2330A REF 020	OTHER SUBSCRIBER SECONDARY IDENTIFICATION	N/A	1	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2330A.REF is allowed.
X222 319 2330A REF01 010	Reference Identification Qualifier	ID	2-3	R	N/A	SY	999	IK403 = 1: "Required Data Element Missing"	2330A.REF01 must be present.
X222 319 2330A REF01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2310A.REF01 must be "SY".
X222 319 2330A REF02 010	Other Insured Additional Identifier	AN	1-50	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2330A.REF02 must be present.
X222 319 2330A REF02 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 148: "Entity's Social Security Number" EIC: GB "Other Insured"	2330A.REF02 must be 9 digits, with no punctuation. The first 3 digits cannot be higher than 772, and digits 1-3, 4-5, and 6-9 cannot be zeros.
X222 319 2330A REF03 010	Description	AN	1-80	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 319 2330A REF04 010	REFERENCE IDENTIFIER	N/A	N/A	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 320 2330B NM1 010	OTHER PAYER NAME	N/A	1	R	1	N/A	999	IK304 = I6: "Implementation Dependent Segment Missing"	Per Payer, If 2320.SBR is present, 2330B.NM1 must be present.
X222 320 2330B NM1 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK304 = 4: "Loop Occurs Over Maximum Times"	Per Payer, Only one iteration of 2330B.NM1 is allowed.
X222 320 2330B NM101 010	Entity Identifier Code	ID	2-3	R	N/A	PR	999	IK304 = 2: "Unexpected segment"	2330B.NM101 must be present and a valid value.
X222 320 2330B NM102 010	Entity Type Qualifier	ID	1-1	R	N/A	2	999	IK403 = 1: "Required Data Element Missing"	2330B.NM102 must be present.
X222 320 2330B NM102 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2330B.NM102 must be "2".
X222 320 2330B NM103 010	Other Payer Last or Organization Name	AN	1-60	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2330B.NM103 must be present.
X222 320 2330B NM103 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2330B.NM103 must contain at least one non-space character.
X222 320 2330B NM103 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2300B.NM103 must be 1 - 60 characters.
X222 320 2330B NM103 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 504: "Entity's Last Name" CSC 286: Other payer's Explanation of Benefits/payment information EIC: PR "Payer"	N/A
X222 320 2330B NM103 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2330B.NM103 must be populated with accepted AN characters.
X222 320 2330B NM104 010	Name First	AN	1-35	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 320 2330B NM105 010	Name Middle	AN	1-25	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 320 2330B NM106 010	Name Prefix	AN	1-10	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 320 2330B NM107 010	Name Suffix	AN	1-10	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 320 2330B NM108 010	Identification Code Qualifier	ID	1-2	R	N/A	PI, XV	999	IK403 = 1: "Required Data Element Missing"	2330B.NM108 must be present.
X222 320 2330B NM108 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2330B.NM108 must be valid values.
X222 320 2330B NM109 010	Other Payer Primary Identifier	AN	2-80	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2330B.NM109 must be present.
X222 320 2330B NM109 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = I12: "Implementation Pattern Match Failure"	2330B.NM109 must = 2430.SVD01.
X222 320 2330B NM110 010	Entity Relationship Code	ID	2-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 320 2330B NM111 010	Entity Identifier Code	ID	2-3	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 320 2330B NM112 010	Name Last or Organization Name	AN	1-60	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 322 2330B N3 020	OTHER PAYER ADDRESS	N/A	1	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2330B.N3 is allowed.
X222 322 2330B N301 010	Other Payer Address Line	AN	1-55	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2330B.N301 must be present.
X222 322 2330B N301 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2330B.N301 must contain at least one non-space character.
X222 322 2330B N301 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2330B.N301 must be 1 - 55 characters.
X222 322 2330B N301 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 503: "Entity's Street address" CSC 286: Other payer's Explanation of Benefits/payment information EIC: PR "Payer"	N/A
X222 322 2330B N301 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2330B.N301 must be populated with accepted AN characters.
X222 322 2330B N302 020	Other Payer Address Line	AN	1-55	S	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2330B.N302 must contain at least one non-space character.
X222 322 2330B N302 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2330B.N302 must be 1 - 55 characters.
X222 322 2330B N302 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 503: "Entity's Street address" CSC 286: Other payer's Explanation of Benefits/payment information EIC: PR "Payer"	N/A
X222 322 2330B N302 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2330B.N302 must be populated with accepted AN characters.
X222A1 021 2330B N4 010	OTHER PAYER CITY/STATE/ZIP CODE	N/A	1	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2330B.N4 is allowed.
X222 323 2330B N401 010	Other Payer City Name	AN	2-30	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2330B.N401 must be present.
X222 323 2330B N401 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2330B.N401 must contain at least two non-space characters.
X222 323 2330B N401 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 4: "Data Element Too Short" IK403 = 5: "Data Element Too Long"	2330B.N401 must be 2-30 characters.
X222 323 2330B N401 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 502: "Entity's City" CSC 286: Other payer's Explanation of Benefits/payment information EIC: PR "Payer"	N/A
X222 323 2330B N401 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2330B.N401 must be populated with accepted AN characters.
X222 323 2330B N402 010	Other Payer State or Province Code	ID	2-2	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2330B.N404 is not present, 2330B.N402 must be present.
X222 323 2330B N402 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 501: "Entity's State/Province" CSC 286: Other payer's Explanation of Benefits/payment information EIC: PR "Payer"	2330B.N402 must be a valid State Code.
X222 323 2330B N403 010	Other Payer Postal Code	ID	3-15	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2330B.N404 is not present, 2330B.N403 must be present.
X222 323 2330B N403 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 500: "Entity's Postal/Zip Code" CSC 286: Other payer's Explanation of Benefits/payment information EIC: PR "Payer"	2330B.N403 must be a valid Zip Code when N404 is US or blank.
X222 323 2330B N404 020	Other Payer Country Code	ID	2-3	S	N/A	N/A	277	CSCC A7: "Acknowledgement /Rejected for Invalid Information..." CSC 680: "Entity's Country" CSC 286: Other payer's Explanation of Benefits/payment information EIC: PR "Payer"	2330B.N404 must be a valid 2 character Country Code.
X222 323 2330B N405 010	Location Qualifier	ID	1-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 323 2330B N406 010	Location Identifier	AN	1-30	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 323 2330B N407 010	Country Subdivision Code	ID	1-3	S	N/A	N/A	277	CSCC A7: "Acknowledgement /Rejected for Invalid Information..." CSC 695: "Entity's Country Subdivision Code" CSC 286: Other payer's Explanation of Benefits/payment information EIC: PR "Payer"	2330B.N407 must be a valid Country Subdivision Code.
X222 325 2330B DTP 020	DATE - CLAIM CHECK OR REMITTANCE DATE	N/A	1	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Per Payer, Only one iteration of 2330B.DTP is allowed.
X222 325 2330B DTP 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK304 = 2: "Unexpected Segment"	Per Payer, If 2330B.NM1 is present and 2430.DTP with DTP01 = "573" is not present, 2330B.DTP may be present.
X222 325 2330B DTP01 010	Date Time Qualifier	ID	3-3	R	N/A	573	999	IK403 = 1: "Required Data Element Missing"	2330B.DTP01 must be present.
X222 325 2330B DTP01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2330B.DTP01 must be "573".
X222 325 2330B DTP02 010	Date Time Period Format Qualifier	ID	2-3	R	N/A	D8	999	IK403 = 1: "Required Data Element Missing"	2330B.DTP02 must be present.
X222 325 2330B DTP02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2330B.DTP02 must be "D8".
X222 325 2330B DTP03 010	Adjudication or Payment Date	AN	1-35	R	N/A	CCYYMMDD	999	IK403 = 8: "Invalid Date"	2330B.DTP03 must a valid date in CCYYMMDD format.
X222 325 2330B DTP03 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 510: "Future date" CSC 516 "Adjudication or Payment Date"	2330B.DTP03 must not be a future date.
X222 326 2330B REF 020	OTHER PAYER SECONDARY IDENTIFICATION	N/A	2	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only two iterations of 2330B.REF with 2330B.REF01 = "2U", "EI", "FY" or "NF" are allowed.
X222 326 2330B REF01 010	Reference Identification Qualifier	ID	2-3	R	N/A	2U, EI, FY, NF	999	IK403 = 1: "Required Data Element Missing"	2330B.REF01 must be present.
X222 326 2330B REF01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2330B.REF01 must be valid values.
X222 326 2330B REF02 010	Other Payer Secondary Identifier	AN	1-50	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2330B.REF02 must be present.
X222 326 2330B REF02 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 128: "Entity's tax id" CSC 286: Other payer's Explanation of Benefits/payment information EIC: PR "Payer"	If 2330B.REF01 = "EI", 2330B.REF02 must be 9 digits with no punctuation. Cannot be zeros.
X222 326 2330B REF02 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	If 2330B.REF01 = "2U", "FY" or "NF", 2330B.REF02 must be must be 1 - 50 characters.
X222 326 2330B REF02 035	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 128: "Entity's tax id" CSC 286: Other payer's Explanation of Benefits/payment information EIC: PR "Payer"	N/A
X222 326 2330B REF02 040	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	If 2330B.REF01 = "2U", "FY" or "NF", 2330B.REF02 must be populated with accepted AN characters.
X222 326 2330B REF02 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	If 2330B.REF01 = "2U", "FY" or "NF", 2330B.REF02 must contain at least one non-space character.
X222 326 2330B REF03 010	Description	AN	1-80	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 326 2330B REF04 010	REFERENCE IDENTIFIER	N/A	N/A	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 328 2330B REF 020	OTHER PAYER PRIOR AUTHORIZATION	N/A	2	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2330B.REF with REF01 = "G1" is allowed.
X222 328 2330B REF01 010	Reference Identification Qualifier	ID	2-3	R	N/A	G1	999	IK403 = 1: "Required Data Element Missing"	2330B.REF01 must be present.
X222 328 2330B REF01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2330B.REF01 must be "G1".
X222 328 2330B REF02 010	Other Payer Prior Authorization Number	AN	1-50	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2330B.REF02 must be present.
X222 328 2330B REF02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2330B.REF02 must be 1 - 50 characters.
X222 328 2330B REF02 025	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 252: "Entity's authorization/certification number" EIC: PR "Payer"	N/A
X222 328 2330B REF02 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2330B.REF02 must be populated with accepted AN characters.
X222 328 2330B REF02 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2330B.REF02 must contain at least one non-space character.
X222 328 2330B REF03 010	Description	AN	1-80	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 328 2330B REF04 010	REFERENCE IDENTIFIER	N/A	N/A	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 329 2330B REF 020	OTHER PAYER REFERRAL NUMBER	N/A	1	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2330B.REF with REF01 = "9F" is allowed.
X222 329 2330B REF01 010	Reference Identification Qualifier	ID	2-3	R	N/A	9F	999	IK403 = 1: "Required Data Element Missing"	2330B.REF01 must be present.
X222 329 2330B REF01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2330B.REF01 must be "9F".
X222 329 2330B REF02 010	Other Payer Referral Number	AN	1-50	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2330B.REF02 must be present.
X222 329 2330B REF02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2330B.REF02 must be 1 - 50 characters.
X222 329 2330B REF02 025	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 761: "Entity's referral number" EIC: PR "Payer"	N/A
X222 329 2330B REF02 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2330B.REF02 must be populated with accepted AN characters.
X222 329 2330B REF02 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2330B.REF02 must contain at least one non-space character.
X222 329 2330B REF03 010	Description	AN	1-80	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 329 2330B REF04 010	REFERENCE IDENTIFIER	N/A	N/A	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 330 2330B REF 020	OTHER PAYER CLAIM ADJUSTMENT INDICATOR	N/A	1	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2330B.REF with REF01 = "T4" is allowed.
X222 330 2330B REF01 010	Reference Identification Qualifier	ID	2-3	R	N/A	T4	999	IK403 = 1: "Required Data Element Missing"	2330B.REF01 must be present.
X222 330 2330B REF01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2330B.REF01 must be "T4".
X222 330 2330B REF02 010	Other Payer Claim Adjustment Indicator	AN	1-50	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2330B.REF02 must be present.
X222 330 2330B REF02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2330B.REF02 must be "Y".
X222 330 2330B REF03 010	Description	AN	1-80	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 330 2330B REF04 010	REFERENCE IDENTIFIER	N/A	N/A	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 331 2330B REF 020	OTHER PAYER CLAIM CONTROL NUMBER	N/A	1	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2330B.REF with REF01 = "F8" is allowed.
X222 331 2330B REF01 010	Reference Identification Qualifier	ID	2-3	R	N/A	F8	999	IK403 = 1: "Required Data Element Missing"	2330B.REF01 must be present.
X222 331 2330B REF01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2330B.REF01 must be "F8".
X222 331 2330B REF02 010	Other Payer Claim Control Number	AN	1-50	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2330B.REF02 must be present.
X222 331 2330B REF02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2330B.REF02 must be 1 - 50 characters.
X222 331 2330B REF02 025	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 464: "Payer Assigned Claim Control Number" CSC 286: Other payer's Explanation of Benefits/payment information	N/A
X222 331 2330B REF02 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2330B.REF02 must be populated with accepted AN characters.
X222 331 2330B REF02 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2330B.REF02 must contain at least one non-space character.
X222 331 2330B REF03 010	Description	AN	1-80	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 331 2330B REF04 010	REFERENCE IDENTIFIER	N/A	N/A	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 332 2330C NM1 020	OTHER PAYER REFERRING PROVIDER	N/A	1	S	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 732: "Information submitted inconsistent with billing guidelines." CSC 562: "Entity's National Provider Identifier (NPI)." EIC: DN "Referring Provider"	Segment must not be present.
X222 334 2330C REF 010	OTHER PAYER REFERRING PROVIDER SECONDARY IDENTIFIER	N/A	3	R	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 732: "Information submitted inconsistent with billing guidelines." CSC 560: "Entity's Additional/Secondary Identifier." EIC: DN "Referring Provider"	2330C.REF must not be present.
X222 336 2330D NM1 010	OTHER PAYER RENDERING PROVIDER	N/A	1	S	1	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 732: "Information submitted inconsistent with billing guidelines." CSC 562: "Entity's National Provider Identifier (NPI)." EIC: 82 "Rendering Provider"	Segment must not be present.
X222 338 2330D REF 010	OTHER PAYER RENDERING PROVIDER SECONDARY IDENTIFICATION	N/A	3	R	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 732: "Information submitted inconsistent with billing guidelines." CSC 560: "Entity's Additional/Secondary Identifier." EIC: 82 "Rendering Provider"	2330D.REF must not be present.
X222 340 2330E NM1 010	OTHER PAYER SERVICE FACILITY LOCATION	N/A	1	S	1	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 732: "Information submitted inconsistent with billing guidelines." CSC 562: "Entity's National Provider Identifier (NPI)." EIC: 77 "Service Location"	Segment must not be present.
X222 342 2330E REF 010	OTHER PAYER SERVICE FACILITY LOCATION SECONDARY IDENTIFIER	N/A	3	R	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 732: "Information submitted inconsistent with billing guidelines." CSC 560: "Entity's Additional/Secondary Identifier." EIC: 77 "Service Location"	2330E.REF must not be present.
X222 343 2330F NM1 010	OTHER PAYER SUPERVISING PROVIDER	N/A	1	S	1	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 732: "Information submitted inconsistent with billing guidelines." CSC 562: "Entity's National Provider Identifier (NPI)." EIC: DQ "Supervising Physician"	Segment must not be present.
X222 345 2330F REF 010	OTHER PAYER SUPERVISING PROVIDER SECONDARY IDENTIFICATION	N/A	3	R	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 732: "Information submitted inconsistent with billing guidelines." CSC 560: "Entity's Additional/Secondary Identifier." EIC: DQ "Supervising Physician"	2330F.REF must not be present.
X222 347 2330G NM1 010	OTHER PAYER BILLING PROVIDER	N/A	1	S	1	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 732: "Information submitted inconsistent with billing guidelines." CSC 562: "Entity's National Provider Identifier (NPI)." EIC: 85 "Billing Provider"	Segment must not be present.
X222 349 2330G REF 010	OTHER PAYER BILLING PROVIDER SECONDARY IDENTIFICATION	N/A	2	R	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 732: "Information submitted inconsistent with billing guidelines." CSC 560: "Entity's Additional/Secondary Identifier." EIC: 85 "Billing Provider"	2330G.REF must not be present.
X222 350 2400 Line Loop 010	Service Line Loop	N/A	N/A	N/A	50	N/A	999	IK304 = 4: "Loop Occurs Over Maximum Times"	Only fifty iterations of the 2400 loop are allowed.
X222 350 2400 LX 010	SERVICE LINE	N/A	1	R	N/A	N/A	999	IK304 = 3: "Required Segment Missing"	2400.LX must be present.
X222 350 2400 LX 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2400.LX is allowed.
X222 350 2400 LX01 010	Assigned Number	N0	1-6	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2400.LX01 must be present.
X222 350 2400 LX01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2400.LX01 must be numeric.
X222 350 2400 LX01 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = I12: "Implementation Pattern Match Failure"	2400.LX01 must be must be > 0 and <= 50.
X222 350 2400 LX01 040	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = I12: "Implementation Pattern Match Failure"	The first 2400.LX01 must be "1".
X222 350 2400 LX01 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = I12: "Implementation Pattern Match Failure"	Subsequent 2400.LX01 values must increment by 1.
X222 351 2400 SV1 010	PROFESSIONAL SERVICE	N/A	1	R	N/A	N/A	999	IK304 = 3: "Required Segment Missing"	2400.SV1 must be present.
X222 351 2400 SV1 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2400.SV1 is allowed.
X222 351 2400 SV101-1 010	Product or Service ID Qualifier	ID	2-2	R	N/A	ER, HC, IV, WK	999	IK403 = 1: "Required Data Element Missing"	2400.SV101-1 must be present.
X222 351 2400 SV101-1 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2400.SV101-1 must be "HC".
X222 351 2400 SV101-2 010	Procedure Code	AN	1-48	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2400.SV101-2 must be present.
X222 351 2400 SV101-2 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 507: "HCPCS"	When 2400.SV101-1 = "HC", 2400.SV101-2 must be a valid HCPCS Code on the date in 2400.DTP03 when DTP01 = "472".
X222 351 2400 SV101-2 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 507: "HCPCS"	When 2400.SV101-1 = "HC", 2400.SV101-2 must be a valid HCPCS Code on the date in 2400.DTP03 when DTP01 = "472". OR When 2400.SV101-1 = "HC", 2400.SV101-2 must be a 5 character alphanumeric value.
X222 351 2400 SV101-3 010	Procedure Modifier	AN	2-2	S	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 453: "Procedure Code Modifier(s) for Service(s) Rendered"	2400.SV101-3 must be valid procedure modifier on the date in 2400.DTP03 when DTP01 = "472".
X222 351 2400 SV101-3 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 453: "Procedure Code Modifier(s) for Service(s) Rendered"	2400.SV101-3 must be valid procedure modifier on the date in 2400.DTP03 when DTP01 = "472".
X222 351 2400 SV101-3 030	N/A	AN	2-2	S	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 453: "Procedure Code Modifier(s) for Service(s) Rendered"	The procedure code modifiers in SV101 must not be duplicated within the same detail service line.
X222 351 2400 SV101-4 010	Procedure Modifier	AN	2-2	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2400.SV101-4 is present, 2400.SV101-3 must be present.
X222 351 2400 SV101-4 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 453: "Procedure Code Modifier(s) for Service(s) Rendered"	2400.SV101-4 must be valid procedure modifier on the date in 2400.DTP03 when DTP01 = "472".
X222 351 2400 SV101-5 010	Procedure Modifier	AN	2-2	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2400.SV101-5 is present, 2400.SV101-4 must be present.
X222 351 2400 SV101-5 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 453: "Procedure Code Modifier(s) for Service(s) Rendered"	2400.SV101-5 must be valid procedure modifier on the date in 2400.DTP03 when DTP01 = "472".
X222 351 2400 SV101-6 010	Procedure Modifier	AN	2-2	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2400.SV101-6 is present, 2400.SV101-5 must be present.
X222 351 2400 SV101-6 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 453: "Procedure Code Modifier(s) for Service(s) Rendered"	2400.SV101-6 must be valid procedure modifier on the date in 2400.DTP03 when DTP01 = "472".
X222 351 2400 SV101-7 010	Description	AN	1-80	S	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2400.SV101-7 must contain at least one non-space character.
X222 351 2400 SV101-7 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A8: "Acknowledgement/Rejected for relational field in error" CSC 306 Detailed description of service	2400.SV101-7 must be present. when 2400.SV101-2 is present on the table of procedure codes that require a description.
X222 351 2400 SV101-7 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2400.SV101-7 must be 1 - 80 characters.
X222 351 2400 SV101-7 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 306 Detailed description of service	N/A
X222 351 2400 SV101-7 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2400.SV101-7 must be populated with accepted AN characters.
X222 351 2400 SV101-8 010	Product/Service ID	AN	1-48	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 351 2400 SV102 010	Line Item Charge Amount	R	1-18	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2400.SV102 must be present.
X222 351 2400 SV102 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2400.SV102 must be numeric.
X222 351 2400 SV102 025	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2400.SV102 must be <= 99,999.99.
X222 351 2400 SV102 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 583: "Line Item Charge Amount"	N/A
X222 351 2400 SV102 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 693: "Amount must be greater than or equal to zero" CSC 583: "Line Item Charge Amount"	2400.SV102 must be >= 0
X222 351 2400 SV102 050	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 697: "Invalid Decimal Precision" CSC 583: "Line Item Charge Amount"	2400.SV102 is limited to 0, 1 or 2 decimal positions.
X222 351 2400 SV102 060	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 400: "Claim is out of balance: CSC 583:"Line Item Charge Amount" CSC 643: "Service Line Paid Amount"	SV102 must = the sum of all payer amounts paid found in 2430 SVD02 and the sum of all line adjustments found in 2430 CAS Adjustment Amounts.
X222 351 2400 SV103 010	Unit or Basis for Measurement Code	ID	2-2	R	N/A	MJ, UN	999	IK403 = 1: "Required Data Element Missing"	2400.SV103 must be present.
X222 351 2400 SV103 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 732: "Information submitted inconsistent with billing guidelines." CSC 659: "Unit or Basis for Measurement Code.	2400.SV103 must be "MJ" when SV101-3, SV101-4, SV101-5, or SV101-6 is an anesthesia modifier (AA, AD, QK, QS, QX, QY or QZ). Otherwise, must be "UN".
X222 351 2400 SV104 010	Service Unit Count	R	1-15	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2400.SV104 must be present.
X222 351 2400 SV104 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2400.SV104 must be numeric.
X222 351 2400 SV104 043	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2400.SV104 must be 1-8 digits and limited to 0, 1, 2, or 3 decimal positions.
X222 351 2400 SV104 047	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 476: "Missing or invalid units of service"	If 2400.SV103 = "UN", 2400.SV104 must be > 0 and <= 9,999.9.
X222 351 2400 SV104 048	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 251: "Total anesthesia minutes"	If 2400.SV103 = "MJ", 2400.SV104 must be > 0 and <= 9,999.
X222 351 2400 SV105 010	Place of Service Code	AN	1-2	S	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 249: "Place of service"	2400.SV105 must be a valid Place of Service Code on the date in BHT04.
X222 351 2400 SV106 010	Service Type Code	ID	1-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 351 2400 SV107-1 010	Diagnosis Code Pointer	N0	1-2	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2400.SV107-1 must be present.
X222 351 2400 SV107-1 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 477: "Diagnosis code pointer is missing or invalid"	2400.SV107-1 must be >= 1 and <= 12.
X222 351 2400 SV107-1 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 477: "Diagnosis code pointer is missing or invalid"	There must be a corresponding diagnosis code in 2300.HI where HI01-1 is "ABK" or "BK" for the pointer value entered. Example 1: if 2400.SV107-1 = 3, when 2300.HI01-1 with "BK" or "ABK", 2300.HI03-2 must be populated. Example 2: if 2400.SV107-1 = 5, when 2300.HI01-1 with "BK" or "ABK", 2300.HI05-2 must be populated.
X222 351 2400 SV107-1 050	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 477: "Diagnosis code pointer is missing or invalid"	The Diagnosis code Pointers in SV107-1 thru SV107-4 must not be duplicated within the same detail service line.
X222 351 2400 SV107-2 030	Diagnosis Code Pointer	N0	1-2	S	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 477: "Diagnosis code pointer is missing or invalid"	2400.SV107-2 must be >= 1 and <= 12.
X222 351 2400 SV107-2 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 477: "Diagnosis code pointer is missing or invalid"	There must be a corresponding diagnosis code in 2300.HI where HI01-1 is "ABK" or "BK" for the pointer value entered. Example 1: if 2400.SV107-1 = 3, when 2300.HI01-1 with "BK" or "ABK", 2300.HI03-2 must be populated. Example 2: if 2400.SV107-1 = 5, when 2300.HI01-1 with "BK" or "ABK", 2300.HI05-2 must be populated.
X222 351 2400 SV107-3 010	Diagnosis Code Pointer	N0	1-2	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	SV107-3 can only be present if 2400.SV107-2 is present.
X222 351 2400 SV107-3 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 477: "Diagnosis code pointer is missing or invalid"	2400.SV107-3 must be >= 1 and <= 12.
X222 351 2400 SV107-3 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 477: "Diagnosis code pointer is missing or invalid"	There must be a corresponding diagnosis code in 2300.HI where HI01-1 is "ABK" or "BK" for the pointer value entered. Example 1: if 2400.SV107-1 = 3, when 2300.HI01-1 with "BK" or "ABK", 2300.HI03-2 must be populated. Example 2: if 2400.SV107-1 = 5, when 2300.HI01-1 with "BK" or "ABK", 2300.HI05-2 must be populated.
X222 351 2400 SV107-4 010	Diagnosis Code Pointer	N0	1-2	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	SV107-4 can only be present if 2400.SV107-3 is present.
X222 351 2400 SV107-4 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 477: "Diagnosis code pointer is missing or invalid"	2400.SV107-4 must be >= 1 and <= 12.
X222 351 2400 SV107-4 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 477: "Diagnosis code pointer is missing or invalid"	There must be a corresponding diagnosis code in 2300.HI where HI01-1 is "ABK" or "BK" for the pointer value entered. Example 1: if 2400.SV107-1 = 3, when 2300.HI01-1 with "BK" or "ABK", 2300.HI03-2 must be populated. Example 2: if 2400.SV107-1 = 5, when 2300.HI01-1 with "BK" or "ABK", 2300.HI05-2 must be populated.
X222 351 2400 SV108 010	Monetary Amount	R	1-18	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 351 2400 SV109 010	Emergency Indicator	ID	1-1	S	N/A	Y	999	IK403 = 7: "Invalid Code Value"	2400.SV109 must be "Y'".
X222 351 2400 SV110 010	Multiple Procedure Code	ID	1-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 351 2400 SV111 010	EPSDT Indicator	ID	1-1	S	N/A	Y	999	IK403 = 7: "Invalid Code Value"	2400.SV111 must be "Y'".
X222 351 2400 SV112 010	Family Planning Indicator	ID	1-1	S	N/A	Y	999	IK403 = 7: "Invalid Code Value"	2400.SV112 must be "Y'".
X222 351 2400 SV113 010	Review Code	ID	1-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 351 2400 SV114 010	National or Local Assigned Review Value	AN	1-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 351 2400 SV115 010	Co-Pay Status Code	ID	1-1	S	N/A	0	999	IK403 = 7: "Invalid Code Value"	2400.SV115 must be "0".
X222 351 2400 SV116 010	Health Care Professional Shortage Area Code	ID	1-1	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 351 2400 SV117 010	Reference Identification	AN	1-50	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 351 2400 SV118 010	Postal Code	ID	3-15	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 351 2400 SV119 010	Monetary Amount	R	1-18	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 351 2400 SV120 010	Level of Care Code	ID	1-1	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 351 2400 SV121 010	Provider Agreement Code	ID	1-1	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 359 2400 SV5 010	DURABLE MEDICAL EQUIPMENT SERVICE	N/A	1	S	N/A	N/A	999	IK304 = I9: "Implementation Dependent "Not Used" Segment Present"	2400.SV5 must not be present.
X222 359 2400 SV501-3 010	Procedure Modifier	AN	2-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 359 2400 SV501-4 010	Procedure Modifier	AN	2-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 359 2400 SV501-5 010	Procedure Modifier	AN	2-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 359 2400 SV501-6 010	Procedure Modifier	AN	2-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 359 2400 SV501-7 010	Description	AN	1-80	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 359 2400 SV501-8 010	Product/Service ID	AN	1-48	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 359 2400 SV504 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 697: "Invalid Decimal Precision" CSC 185: "Rental price for durable medical equipment"	N/A
X222 359 2400 SV504 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 185: "Rental price for durable medical equipment"	N/A
X222 359 2400 SV505 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 697: "Invalid Decimal Precision" CSC 184: "Purchase price for the rented durable medical equipment"	N/A
X222 359 2400 SV505 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 184: "Purchase price for the rented durable medical equipment"	N/A
X222 359 2400 SV507 010	Prognosis Code	ID	1-1	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 362 2400 PWK 010	LINE SUPPLEMENTAL INFORMATION	N/A	10	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only ten iterations of 2400.PWK are allowed.
X222 362 2400 PWK01 010	Attachment Report Type Code	ID	2-2	R	N/A	03, 04, 05, 06, 07, 08, 09, 10, 11, 13, 15, 21, A3, A4, AM, AS, B2, B3, B4, BR, BS, BT, CB, CK, CT, D2, DA, DB, DG, DJ, DS, EB, HC, HR, I5, IR, LA, M1, MT, NN, OB, OC, OD, OE, OX, OZ, P4, P5, PE, PN, PO, PQ, PY, PZ, RB, RR, RT, RX, SG, V5, XP	999	IK403 = 1: "Required Data Element Missing"	2400.PWK01 must be present.
X222 362 2400 PWK01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2400.PWK01 must be valid values.
X222 362 2400 PWK02 010	Attachment Transmission Code	ID	1-2	R	N/A	AA, BM, EL, EM, FT, FX	999	IK403 = 1: "Required Data Element Missing"	2400.PWK02 must be present.
X222 362 2400 PWK02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2400.PWK02 must be valid values.
X222 362 2400 PWK03 010	Report Copies Needed	N0	1-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 362 2400 PWK04 010	Entity Identifier Code	ID	2-3	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 362 2400 PWK05 010	Identification Code Qualifier	ID	1-2	S	N/A	AC	999	IK403 = 2: "Conditional Required Data Element Missing"	When 2400.PWK05 is present, 2400.PWK02 must be "BM", "EL", "EM", "FX" or "FT" .
X222 362 2400 PWK05 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2400.PWK05 must be "AC".
X222 362 2400 PWK06 010	Identification Code	AN	2-80	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	When 2400.PWK06 is present, 2400.PWK02 must be "BM", "EL", "EM", "FX" or "FT" .
X222 362 2400 PWK06 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2400.PWK06 must contain at least two non-space characters.
X222 362 2400 PWK06 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 4: "Data Element Too Short" IK403 = 5: "Data Element Too Long"	2400.PWK06 must be 2-50 characters.
X222 362 2400 PWK06 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 489: "Attachment Control Number"	N/A
X222 362 2400 PWK06 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2400.PWK06 must be populated with accepted AN characters.
X222 362 2400 PWK07 010	Description	AN	1-80	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 362 2400 PWK08 010	ACTIONS INDICATED	N/A	N/A	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 362 2400 PWK09 010	Request Category Code	ID	1-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 366 2400 PWK 010	DURABLE MEDICAL EQUIPMENT CERTIFICATE OF MEDICAL NECESSITY INDICATOR	N/A	1	S	N/A	N/A	999	IK304 = I9: "Implementation Dependent "Not Used" Segment Present"	2400.PWK must not be present when 2400.PWK01 = CT and 2400.PWK02 = AB, AD, AF, AG, or NS.
X222 366 2400 PWK01 010	Attachment Report Type Code	ID	2-2	R	N/A	CT	999	IK403 = 1: "Required Data Element Missing"	Must not be present.
X222 366 2400 PWK01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	Must not be present.
X222 366 2400 PWK02 010	Attachment Transmission Code	ID	1-2	R	N/A	AB, AD, AF, AG, NS	999	IK403 = 1: "Required Data Element Missing"	Must not be present.
X222 366 2400 PWK02 015	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = I6: "Code Value Not Used in Implementation"	2400.PWK02 must not contain AB, AD, AF, AG, or NS
X222 366 2400 PWK02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	Must not be present.
X222 366 2400 PWK03 010	Report Copies Needed	N0	1-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 366 2400 PWK04 010	Entity Identifier Code	ID	2-3	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 366 2400 PWK05 010	Identification Code Qualifier	ID	1-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 366 2400 PWK06 010	Identification Code	AN	2-80	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 366 2400 PWK07 010	Description	AN	1-80	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 366 2400 PWK08 010	ACTIONS INDICATED	N/A	N/A	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 366 2400 PWK09 010	Request Category Code	ID	1-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 368 2400 CR1 010	AMBULANCE TRANSPORT INFORMATION	N/A	1	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2400.CR1 is allowed.
X222 368 2400 CR101 010	Unit or Basis for Measurement Code	ID	2-2	S	N/A	LB	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2400.CR102 is present, 2400.CR101 must be present.
X222 368 2400 CR101 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2400.CR101 must be valid values.
X222 368 2400 CR102 010	Patient Weight	R	1-10	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2400.CR101 is present, then 2400.CR102 must be present.
X222 368 2400 CR102 015	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2300.CR102 must be >0 and <= 9,999.99.
X222 368 2400 CR102 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 337: "Ambulance certification/documentation" CSC 273: Weight	N/A
X222 368 2400 CR103 010	Ambulance Transport Code	ID	1-1	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 368 2400 CR104 010	Ambulance Transport Reason Code	ID	1-1	R	N/A	A, B, C, D, E	999	IK403 = 1: "Required Data Element Missing"	2400.CR104 must be present.
X222 368 2400 CR104 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2400.CR104 must be valid values.
X222 368 2400 CR105 010	Unit or Basis for Measurement Code	ID	2-2	R	N/A	DH	999	IK403 = 1: "Required Data Element Missing"	2400.CR105 must be present.
X222 368 2400 CR105 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2400.CR105 must be "DH".
X222 368 2400 CR106 010	Transport Distance	R	1-15	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2400.CR106 must be present.
X222 368 2400 CR106 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2400.CR106 must be numeric.
X222 368 2400 CR106 035	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2400.CR106 must be >=0 and <= 9999.
X222 368 2400 CR106 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 267 "Number of miles patient was transported"	N/A
X222 368 2400 CR107 010	Address Information	AN	1-55	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 368 2400 CR108 010	Address Information	AN	1-55	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 368 2400 CR109 010	Round Trip Purpose Description	AN	1-80	S	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2400.CR109 must be 1 - 80 characters.
X222 368 2400 CR109 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 337: "Ambulance certification/documentation"	N/A
X222 368 2400 CR109 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2400.CR109 must be populated with accepted AN characters.
X222 368 2400 CR109 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2400.CR109 must contain at least one non-space character.
X222 368 2400 CR110 010	Stretcher Purpose Description	AN	1-80	S	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2400.CR110 must contain at least one non-space character.
X222 368 2400 CR110 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2400.CR110 must be 1 - 80 characters.
X222 368 2400 CR110 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 711:: "Stretcher Purpose:	N/A
X222 368 2400 CR110 040	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2400.CR110 must be populated with accepted AN characters.
X222 371 2400 CR3 010	DURABLE MEDICAL EQUIPMENT CERTIFICATION	N/A	1	S	N/A	N/A	999	IK304 = I9: "Implementation Dependent "Not Used" Segment Present"	2400.CR3 must not be present.
X222 371 2400 CR303 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 352: "Duration of treatment plan"	N/A
X222 371 2400 CR304 010	Insulin Dependent Code	ID	1-1	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 371 2400 CR305 010	Description	AN	1-80	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 373 2400 CRC 010	AMBULANCE CERTIFICATION	N/A	N/A	N/A	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only three iterations of 2400.CRC with CRC01 = "07", "70", or "09" are allowed.
X222 373 2400 CRC 030	N/A	N/A	3	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only three iterations of 2400.CRC with CRC01 = "07" are allowed.
X222 373 2400 CRC01 010	Code Category	ID	2-2	R	N/A	07	999	IK403 = 1: "Required Data Element Missing"	2400.CRC01 must be present.
X222 373 2400 CRC01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2400.CRC01 must be "07".
X222 373 2400 CRC02 010	Certification Condition Indicator	ID	1-1	R	N/A	N, Y	999	IK403 = 1: "Required Data Element Missing"	2400.CRC02 must be present.
X222 373 2400 CRC02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2400.CRC02 must be valid values.
X222 373 2400 CRC03 010	Condition Code	ID	2-3	R	N/A	01, 04, 05, 06, 07, 08, 09, 12	999	IK403 = 1: "Required Data Element Missing"	2400.CRC03 must be present.
X222 373 2400 CRC03 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2400.CRC03 must be valid values.
X222 373 2400 CRC04 010	Condition Code	ID	2-3	S	N/A	01, 04, 05, 06, 07, 08, 09, 12	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2400.CRC04 is present, 2400.CRC03 must be present.
X222 373 2400 CRC04 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2400.CRC04 must be valid values.
X222 373 2400 CRC05 010	Condition Code	ID	2-3	S	N/A	01, 04, 05, 06, 07, 08, 09, 12	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2400.CRC05 is present, 2400.CRC04 must be present.
X222 373 2400 CRC05 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2400.CRC05 must be valid values.
X222 373 2400 CRC06 010	Condition Code	ID	2-3	S	N/A	01, 04, 05, 06, 07, 08, 09, 12	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2400.CRC06 is present, 2400.CRC05 must be present.
X222 373 2400 CRC06 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2400.CRC06 must be valid values.
X222 373 2400 CRC07 010	Condition Code	ID	2-3	S	N/A	01, 04, 05, 06, 07, 08, 09, 12	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2400.CRC07 is present, 2400.CRC06 must be present.
X222 373 2400 CRC07 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2400.CRC07 must be valid values.
X222 376 2400 CRC 015	HOSPICE EMPLOYEE INDICATOR	N/A	1	S	N/A	N/A	277	CSCC A8: "Acknowledgement/Rejected for relational field in error." CSC 21 "Missing or invalid information." CSC 747: "Hospice Employee Indicator"	If 2300.CLM05-1 = "34" or 2400.SV105 = "34", 2400.CRC with CRC01 = "70" must be present.
X222 376 2400 CRC 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2400.CRC with CRC01 = "70" is allowed.
X222 376 2400 CRC01 010	Code Category	ID	2-2	R	N/A	70	999	IK403 = 1: "Required Data Element Missing"	2400.CRC01 must be present.
X222 376 2400 CRC01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2400.CRC01 must be "70".
X222 376 2400 CRC02 010	Hospice Employed Provider Indicator	ID	1-1	R	N/A	N, Y	999	IK403 = 1: "Required Data Element Missing"	2400.CRC02 must be present.
X222 376 2400 CRC02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2400.CRC02 must be valid values.
X222 376 2400 CRC03 010	Condition Indicator	ID	2-3	R	N/A	65	999	IK403 = 1: "Required Data Element Missing"	2400.CRC03 must be present.
X222 376 2400 CRC03 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2400.CRC03 must be "65".
X222 376 2400 CRC04 010	Condition Indicator	ID	2-3	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 376 2400 CRC05 010	Condition Indicator	ID	2-3	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 376 2400 CRC06 010	Condition Indicator	ID	2-3	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 376 2400 CRC07 010	Condition Indicator	ID	2-3	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 378 2400 CRC 010	CONDITION INDICATOR/ DURABLE MEDICAL EQUIPMENT	N/A	1	S	N/A	N/A	999	IK304 = I9: "Implementation Dependent "Not Used" Segment Present"	2400.CRC must not be present.
X222 378 2400 CRC05 010	Condition Indicator	ID	2-3	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 378 2400 CRC06 010	Condition Indicator	ID	2-3	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 378 2400 CRC07 010	Condition Indicator	ID	2-3	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 380 2400 DTP 010	DATE - SERVICE DATE	N/A	1	R	N/A	N/A	999	IK304 = 3: "Required Segment Missing"	2400.DTP with DTP01 = "472" must be present.
X222 380 2400 DTP 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2400.DTP with DTP01 = "472" is allowed.
X222 380 2400 DTP01 010	Date Time Qualifier	ID	3-3	R	N/A	472	999	IK403 = 1: "Required Data Element Missing"	2400.DTP01 must be present.
X222 380 2400 DTP01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2400.DTP01 must be "472".
X222 380 2400 DTP02 010	Date Time Period Format Qualifier	ID	2-3	R	N/A	D8, RD8	999	IK403 = 1: "Required Data Element Missing"	2400.DTP02 must be present.
X222 380 2400 DTP02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2400.DTP02 must be valid values.
X222 380 2400 DTP03 010	Service Date	AN	1-35	R	N/A	CCYYMMDD, CCYYMMDDCCYYMMDD	999	IK403 = 1: "Required Data Element Missing"	2400.DTP03 must be present.
X222 380 2400 DTP03 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 8: "Invalid Date"	If 2400.DTP02 is D8, then 2400.DTP03 must be a valid date in the format of CCYYMMDD.
X222 380 2400 DTP03 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 8: "Invalid Date"	If 2400.DTP02 is RD8, then 2400.DTP03 must be a valid date in the format of CCYYMMDD-CCYYMMDD.
X222 380 2400 DTP03 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 510: "Future date" CSC 187: "Date(s) of service"	If 2400.DTP02 is D8, 2400.DTP03 must not be a future date.
X222 380 2400 DTP03 050	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 510: "Future date" CSC 187: "Date(s) of service"	If 2400.DTP02 is RD8, 2400.DTP03 must not be a future date.
X222 380 2400 DTP03 060	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 187: "Date(s) of service"	If 2400.DTP02 is RD8, the first date listed in 2400.DTP03 must be a date prior or equal to the second date listed in 2400.DTP03.
X222 382 2400 DTP 010	DATE - PRESCRIPTION DATE	N/A	1	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2400.DTP with DTP01 = "471" is allowed.
X222 382 2400 DTP01 010	Date Time Qualifier	ID	3-3	R	N/A	471	999	IK403 = 1: "Required Data Element Missing"	2400.DTP01 must be present.
X222 382 2400 DTP01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2400.DTP01 must be "471".
X222 382 2400 DTP02 010	Date Time Period Format Qualifier	ID	2-3	R	N/A	D8	999	IK403 = 1: "Required Data Element Missing"	2400.DTP02 must be present.
X222 382 2400 DTP02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2400.DTP02 must be "D8".
X222 382 2400 DTP03 010	Prescription Date	AN	1-35	R	N/A	CCYYMMDD	999	IK403 = 8: "Invalid Date"	2400.DTP03 must be a valid date in the format of CCYYMMDD.
X222 382 2400 DTP03 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 510: "Future date" CSC 214: "Original date of prescription/orders/referral."	2400.DTP03 must not be a future date.
X222 383 2400 DTP 010	DATE - CERTIFICATION REVISION/RECERTIFICATION DATE	N/A	1	S	N/A	N/A	999	IK304 = I9: "Implementation Dependent "Not Used" Segment Present"	2400.DTP with DTP01 = "607" must not be present.
X222 384 2400 DTP 010	DATE - BEGIN THERAPY DATE	N/A	1	S	N/A	N/A	999	IK304 = I9: "Implementation Dependent "Not Used" Segment Present"	2400.DTP with DTP01 = "463" must not be present.
X222 385 2400 DTP 010	DATE - LAST CERTIFICATION DATE	N/A	1	S	N/A	N/A	999	IK304 = I9: "Implementation Dependent "Not Used" Segment Present"	2400.DTP with DTP01 = "461" must not be present.
X222 386 2400 DTP 010	DATE - DATE LAST SEEN	N/A	1	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2400.DTP with DTP01 = "304" is allowed.
X222 386 2400 DTP01 010	Date Time Qualifier	ID	3-3	R	N/A	304	999	IK403 = 1: "Required Data Element Missing"	2400.DTP01 must be present.
X222 386 2400 DTP01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2400.DTP01 must be "304".
X222 386 2400 DTP02 010	Date Time Period Format Qualifier	ID	2-3	R	N/A	D8	999	IK403 = 1: "Required Data Element Missing"	2400.DTP02 must be present.
X222 386 2400 DTP02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2400.DTP02 must be "D8".
X222 386 2400 DTP03 010	Last Seen Date	AN	1-35	R	N/A	CCYYMMDD	999	IK403 = 8: "Invalid Date"	2400.DTP03 must be a valid date in the format of CCYYMMDD.
X222 386 2400 DTP03 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 510: "Future date" CSC 757 "Last Seen Date"	2400.DTP03 must not be a future date.
X222 387 2400 DTP 010	DATE - TEST DATE	N/A	2	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only two iterations of 2400.DTP with DTP01 = "738" or "739" are allowed.
X222 387 2400 DTP01 010	Date Time Qualifier	ID	3-3	R	N/A	738, 739	999	IK403 = 1: "Required Data Element Missing"	2400.DTP01 must be present.
X222 387 2400 DTP01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2400.DTP01 must be valid values.
X222 387 2400 DTP02 010	Date Time Period Format Qualifier	ID	2-3	R	N/A	D8	999	IK403 = 1: "Required Data Element Missing"	2400.DTP02 must be present.
X222 387 2400 DTP02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2400.DTP02 must be "D8".
X222 387 2400 DTP03 010	Test Performed Date	AN	1-35	R	N/A	CCYYMMDD	999	IK403 = 8: "Invalid Date"	2400.DTP03 must be a valid date in the format of CCYYMMDD.
X222 387 2400 DTP03 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 510: "Future date" CSC 653 "Test Performed Date"	2400.DTP03 must not be a future date.
X222 388 2400 DTP 010	DATE - SHIPPED DATE	N/A	1	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2400.DTP with DTP01 = "011" is allowed.
X222 388 2400 DTP01 010	Date Time Qualifier	ID	3-3	R	N/A	011	999	IK403 = 1: "Required Data Element Missing"	2400.DTP01 must be present.
X222 388 2400 DTP01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2400.DTP01 must be "011".
X222 388 2400 DTP02 010	Date Time Period Format Qualifier	ID	2-3	R	N/A	D8	999	IK403 = 1: "Required Data Element Missing"	2400.DTP02 must be present.
X222 388 2400 DTP02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2400.DTP02 must be "D8".
X222 388 2400 DTP03 010	Shipped Date	AN	1-35	R	N/A	CCYYMMDD	999	IK403 = 8: "Invalid Date"	2400.DTP03 must be a valid date in the format of CCYYMMDD.
X222 389 2400 DTP 010	DATE - LAST X-RAY	N/A	1	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2400.DTP with DTP01 = "455" is allowed.
X222 389 2400 DTP01 010	Date Time Qualifier	ID	3-3	R	N/A	455	999	IK403 = 1: "Required Data Element Missing"	2400.DTP01 must be present.
X222 389 2400 DTP01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2400.DTP01 must be "455".
X222 389 2400 DTP02 010	Date Time Period Format Qualifier	ID	2-3	R	N/A	D8	999	IK403 = 1: "Required Data Element Missing"	2400.DTP02 must be present.
X222 389 2400 DTP02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2400.DTP02 must be "D8".
X222 389 2400 DTP03 010	Last X-Ray Date	AN	1-35	R	N/A	CCYYMMDD	999	IK403 = 8: "Invalid Date"	2400.DTP03 must be a valid date in the format of CCYYMMDD.
X222 389 2400 DTP03 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 510: "Future date" CSC 210 "Date of the Last X-ray"	2400.DTP03 must not be a future date.
X222 390 2400 DTP 010	DATE - INITIAL TREATMENT DATE	N/A	1	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2400.DTP with DTP01 = "454" is allowed.
X222 390 2400 DTP01 010	Date Time Qualifier	ID	3-3	R	N/A	454	999	IK403 = 1: "Required Data Element Missing"	2400.DTP01 must be present.
X222 390 2400 DTP01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2400.DTP01 must be "454".
X222 390 2400 DTP02 010	Date Time Period Format Qualifier	ID	2-3	R	N/A	D8	999	IK403 = 1: "Required Data Element Missing"	2400.DTP02 must be present.
X222 390 2400 DTP02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2400.DTP02 must be "D8".
X222 390 2400 DTP03 010	Initial Treatment Date	AN	1-35	R	N/A	CCYYMMDD	999	IK403 = 8: "Invalid Date"	2400.DTP03 must be a valid date in the format of CCYYMMDD.
X222 390 2400 DTP03 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 510: "Future date" CSC 701 "Initial Treatment Date"	2400.DTP03 must not be a future date.
X222 391 2400 QTY 010	AMBULANCE PATIENT COUNT	N/A	1	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2400.DTP with QTY01 = "PT" is allowed.
X222 391 2400 QTY01 010	Quantity Qualifier	ID	2-2	R	N/A	PT	999	IK403 = 1: "Required Data Element Missing"	2400.QTY01 must be present.
X222 391 2400 QTY01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2400.QTY01 must be "PT".
X222 391 2400 QTY02 010	Ambulance Patient Count	R	1-15	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2400.QTY02 must be present.
X222 391 2400 QTY02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2400.QTY02 must be numeric.
X222 391 2400 QTY02 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = I12: "Implementation Pattern Match Failure"	2400.QTY02 must be > 1.
X222 391 2400 QTY02 035	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2400.QTY02 must be 1 - 2 digits.
X222 391 2400 QTY02 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system"	N/A
X222 391 2400 QTY03 010	COMPOSITE UNIT OF MEASURE	N/A	N/A	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 391 2400 QTY04 010	Free-Form Message	AN	1-30	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 392 2400 QTY 010	OBSTETRIC ANESTHESIA ADDITIONAL UNITS	N/A	1	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2400.DTP with QTY01 = "FL" is allowed.
X222 392 2400 QTY01 010	Quantity Qualifier	ID	2-2	R	N/A	FL	999	IK403 = 1: "Required Data Element Missing"	2400.QTY01 must be present.
X222 392 2400 QTY01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2400.QTY01 must be "FL".
X222 392 2400 QTY02 010	Obstetric Additional Units	R	1-15	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2400.QTY02 must be present.
X222 392 2400 QTY02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2400.QTY02 must be numeric.
X222 392 2400 QTY02 035	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2400.QTY02 must be > 0 and <= 99.
X222 392 2400 QTY02 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 712:: "Obstetric Additional Units"	N/A
X222 392 2400 QTY03 010	COMPOSITE UNIT OF MEASURE	N/A	N/A	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 392 2400 QTY04 010	Fee-Form Message	AN	1-30	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 393 2400 MEA 010	TEST RESULTS	N/A	5	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only five iterations of 2400.MEA are allowed.
X222 393 2400 MEA01 010	Measurement Reference Identification Code	ID	2-2	R	N/A	OG, TR	999	IK403 = 1: "Required Data Element Missing"	2400.MEA01 must be present.
X222 393 2400 MEA01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2400.MEA01 must be valid values.
X222 393 2400 MEA02 010	Measurement Qualifier	ID	1-3	R	N/A	HT, R1, R2, R3, R4	999	IK403 = 1: "Required Data Element Missing"	2400.MEA02 must be present.
X222 393 2400 MEA02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2400.MEA02 must be valid values.
X222 393 2400 MEA03 010	Test Result	R	1-20	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2400.MEA03 must be present.
X222 393 2400 MEA03 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2400.MEA03 must be numeric.
X222 393 2400 MEA03 025	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2400.MEA03 must be >= 0 and <= 99.9.
X222 393 2400 MEA03 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 300 "Lab/test report/notes/results"	N/A
X222 393 2400 MEA03 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 697: "Invalid Decimal Precision" CSC 300 "Lab/test report/notes/results"	2400.MEA03 is limited to 1 decimal position.
X222 393 2400 MEA04 010	COMPOSITE UNIT OF MEASURE	N/A	N/A	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 393 2400 MEA05 010	Range Minimum	R	1-20	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 393 2400 MEA06 010	Range Maximum	R	1-20	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 393 2400 MEA07 010	Measurement Significance Code	ID	2-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 393 2400 MEA08 010	Measurement Attribute Code	ID	2-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 393 2400 MEA09 010	Surface/Layer/Position Code	ID	2-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 393 2400 MEA10 010	Measurement Method or Device	ID	2-4	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 393 2400 MEA11 010	Code List Qualifier Code	ID	1-3	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 393 2400 MEA12 010	Industry Code	AN	1-30	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 395 2400 CN1 010	CONTRACT INFORMATION	N/A	1	S	N/A	N/A	999	IK304 = I9: "Implementation Dependent "Not Used" Segment Present"	Must not be present.
X222 397 2400 REF 010	REPRICED LINE ITEM REFERENCE NUMBER	N/A	1	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2400.REF with REF01 = "9B" is allowed.
X222 397 2400 REF01 010	Reference Identification Qualifier	ID	2-3	R	N/A	9B	999	IK403 = 1: "Required Data Element Missing"	2400.REF01 must be present.
X222 397 2400 REF01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2400.REF01 must be "9B".
X222 397 2400 REF02 010	Repriced Line Item Reference Number	AN	1-50	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2400.REF02 must be present.
X222 397 2400 REF02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2400.REF02 must contain at least one non-space character.
X222 397 2400 REF02 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2400.REF02 must be 1-50 characters.
X222 397 2400 REF02 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 636: "Repriced Line Item Reference Number"	N/A
X222 397 2400 REF02 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2400.REF02 must be populated with accepted AN characters.
X222 397 2400 REF03 010	Description	AN	1-80	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 397 2400 REF04 010	REFERENCE IDENTIFIER	N/A	N/A	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 398 2400 REF 010	ADJUSTED REPRICED LINE ITEM REFERENCE NUMBER	N/A	1	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2400.REF with REF01 = "9D" is allowed.
X222 398 2400 REF01 010	Reference Identification Qualifier	ID	2-3	R	N/A	9D	999	IK403 = 1: "Required Data Element Missing"	2400.REF01 must be present.
X222 398 2400 REF01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2400.REF01 must be "9D".
X222 398 2400 REF02 010	Adjusted Repriced Line Item Reference Number	AN	1-50	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2400.REF02 must be present.
X222 398 2400 REF02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2400.REF02 must contain at least one non-space character.
X222 398 2400 REF02 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2400.REF02 must be 1-50 characters.
X222 398 2400 REF02 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 518: "Adjusted Repriced Line item Reference Number"	N/A
X222 398 2400 REF02 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2400.REF02 must be populated with accepted AN characters.
X222 398 2400 REF03 010	Description	AN	1-80	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 398 2400 REF04 010	REFERENCE IDENTIFIER	N/A	N/A	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 399 2400 REF 010	PRIOR AUTHORIZATION	N/A	5	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only five iterations of 2400.REF with REF01 = "G1" are allowed.
X222 399 2400 REF01 010	Reference Identification Qualifier	ID	2-3	R	N/A	G1	999	IK403 = 1: "Required Data Element Missing"	2400.REF01 must be present.
X222 399 2400 REF01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2400.REF01 must be "G1".
X222 399 2400 REF02 010	Prior Authorization or Referral Number	AN	1-50	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2400.REF02 must be present.
X222 399 2400 REF02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2400.REF02 must contain at least one non-space character.
X222 399 2400 REF02 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2400.REF02 must be 1 - 50 characters.
X222 399 2400 REF02 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 252: "Entity's authorization/certification number" EIC: PR "Payer"	N/A
X222 399 2400 REF02 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2400.REF02 must be populated with accepted AN characters.
X222 399 2400 REF03 010	Description	AN	1-80	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 399 2400 REF04-1 010	Reference Identifier Qualifier	ID	2-3	R	N/A	2U	999	IK403 = 7: "Invalid Code Value"	2400.REF04-1 must be "2U".
X222 399 2400 REF04-2 010	Other Payer Primary Identifier	AN	1-50	R	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2400.REF04-1 is present, 2400.REF04-2 must be present.
X222 399 2400 REF04-2 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = I12: "Implementation Pattern Match Failure"	2400.REF04-2 must = 2330B.NM109
X222 399 2400 REF04-3 010	Reference Identification Qualifier	ID	2-3	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 399 2400 REF04-4 010	Reference Identification	AN	1-50	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 399 2400 REF04-5 010	Reference Identification Qualifier	ID	2-3	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 399 2400 REF04-6 010	Reference Identification	AN	1-50	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 401 2400 REF 010	LINE ITEM CONTROL NUMBER	N/A	1	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2400.REF with REF01 = "6R" is allowed.
X222 401 2400 REF01 010	Reference Identification Qualifier	ID	2-3	R	N/A	6R	999	IK403 = 1: "Required Data Element Missing"	2400.REF01 must be present.
X222 401 2400 REF01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2400.REF01 must be "6R".
X222 401 2400 REF02 010	Line Item Control Number	AN	1-50	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2400.REF02 must be present.
X222 401 2400 REF02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2400.REF02 must contain at least one non-space character.
X222 401 2400 REF02 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2400.REF02 must be 1 - 30 characters.
X222 401 2400 REF02 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 584: "Line Item Control Number"	N/A
X222 401 2400 REF02 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2400.REF02 must be populated with accepted AN characters.
X222 401 2400 REF02 070	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 584: "Line Item Control Number"	2400.REF02 must be unique within a single iteration of 2300.CLM01.
X222 401 2400 REF03 010	Description	AN	1-80	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 401 2400 REF04 010	REFERENCE IDENTIFIER	N/A	N/A	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 403 2400 REF 010	MAMMOGRAPHY CERTIFICATION NUMBER	N/A	1	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2400.REF with REF01 = "EW" is allowed.
X222 403 2400 REF01 010	Reference identification Qualifier	ID	2-3	R	N/A	EW	999	IK403 = 1: "Required Data Element Missing"	2400.REF01 must be present.
X222 403 2400 REF01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2400.REF01 must be "EW".
X222 403 2400 REF02 010	Mammography Certification Number	AN	1-50	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2400.REF02 must be present.
X222 403 2400 REF02 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 252: "Entity's authorization/certification number" EIC: MSC "Mammography Screening Center"	N/A
X222 403 2400 REF02 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2400.REF02 must be populated with accepted AN characters.
X222 403 2400 REF02 070	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 252: "Entity's authorization/certification number" EIC: MSC "Mammography Screening Center"	2400.REF02 must be a valid Mammography Certification Number.
X222 403 2400 REF03 010	Description	AN	1-80	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 403 2400 REF04 010	REFERENCE IDENTIFIER	N/A	N/A	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 404 2400 REF 010	CLINICAL LABORATORY IMPROVEMENT AMENDMENT (CLIA) IDENTIFICATION	N/A	1	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2400.REF with REF01 = "X4" is allowed.
X222 404 2400 REF01 010	Reference Identification Qualifier	ID	2-3	R	N/A	X4	999	IK403 = 1: "Required Data Element Missing"	2400.REF01 must be present.
X222 404 2400 REF01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2400.REF01 must be "X4".
X222 404 2400 REF02 010	Clinical Laboratory Improvement Amendment Number	AN	1-50	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2400.REF02 must be present.
X222 404 2400 REF02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2400.REF02 must contain at least one non-space character.
X222 404 2400 REF02 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2400.REF02 must be 1 - 50 characters.
X222 404 2400 REF02 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 544: "Clinical Laboratory Improvement Amendment"	N/A
X222 404 2400 REF02 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2400.REF02 must be populated with accepted AN characters.
X222 404 2400 REF02 070	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 544: "Clinical Laboratory Improvement Amendment"	When 2400.REF01 = 'X4', 2400.REF02 must be a 10 character alphanumeric value and the third position = D
X222 404 2400 REF03 010	Description	AN	1-80	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 404 2400 REF04 010	REFERENCE IDENTIFIER	N/A	N/A	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 405 2400 REF 020	Referring Clinical Laboratory Improvement Amendment (CLIA) Facility Identification	N/A	1	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2400.REF with REF01 = "F4" is allowed.
X222 405 2400 REF01 010	Reference Identification Qualifier	ID	2-3	R	N/A	F4	999	IK403 = 1: "Required Data Element Missing"	2400.REF01 must be present.
X222 405 2400 REF01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2400.REF01 must be "F4".
X222 405 2400 REF02 010	Referring CLIA Number	AN	1-50	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2400.REF02 must be present.
X222 405 2400 REF02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2400.REF02 must be 1 - 50 characters.
X222 405 2400 REF02 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 544: "Clinical Laboratory Improvement Amendment"	N/A
X222 405 2400 REF02 040	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2400.REF02 must be populated with accepted AN characters.
X222 405 2400 REF02 060	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2400.REF02 must contain at least one non-space character.
X222 405 2400 REF02 070	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 630: "Referring CLIA Number"	When 2400.REF01 = 'F4', 2400.REF02 must be a 10 character alphanumeric value and the third position = D
X222 405 2400 REF03 010	Description	AN	1-80	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 405 2400 REF04 010	REFERENCE IDENTIFIER	N/A	N/A	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 406 2400 REF 010	IMMUNIZATION BATCH NUMBER	N/A	1	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2400.REF with REF01 = "BT" is allowed.
X222 406 2400 REF01 010	Reference Identification Qualifier	ID	2-3	R	N/A	BT	999	IK403 = 1: "Required Data Element Missing"	2400.REF01 must be present.
X222 406 2400 REF01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2400.REF01 must be "BT".
X222 406 2400 REF02 010	Immunization Batch Number	AN	1-50	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2400.REF02 must be present.
X222 406 2400 REF02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2400.REF02 must contain at least one non-space character.
X222 406 2400 REF02 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2400.REF02 must be 1 - 50 characters.
X222 406 2400 REF02 035	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 576: "Immunization Batch Number"	N/A
X222 406 2400 REF02 040	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2400.REF02 must be populated with accepted AN characters.
X222 406 2400 REF02 050	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 576: "Immunization Batch Number"	N/A
X222 406 2400 REF03 010	Description	AN	1-80	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 406 2400 REF04 010	REFERENCE IDENTIFIER	N/A	N/A	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 407 2400 REF 010	REFERRAL NUMBER	N/A	5	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only five iterations of 2400.REF with REF01 = "9F" are allowed.
X222 407 2400 REF01 010	Reference Identification Qualifier	ID	2-3	R	N/A	9F	999	IK403 = 1: "Required Data Element Missing"	2400.REF01 must be present.
X222 407 2400 REF01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2400.REF01 must be "9F".
X222 407 2400 REF02 010	Referral Number	AN	1-50	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2400.REF02 must be present.
X222 407 2400 REF02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2400.REF02 must contain at least one non-space character.
X222 407 2400 REF02 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2400.REF02 must be 1 - 50 characters.
X222 407 2400 REF02 035	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 761: "Entity's referral number" EIC: PR "Payer"	N/A
X222 407 2400 REF02 040	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2400.REF02 must be populated with accepted AN characters.
X222 407 2400 REF03 010	Description	AN	1-80	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 407 2400 REF04-1 010	Reference Identifier Qualifier	ID	2-3	R	N/A	2U	999	IK403 = 7: "Invalid Code Value"	2400.REF04-1 must be "2U".
X222 407 2400 REF04-2 010	Other Payer Primary Identifier	AN	1-50	R	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2400.REF04-1 is present, 2400.REF04-2 must be present.
X222 407 2400 REF04-2 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = I12: "Implementation Pattern Match Failure"	2400.REF04-2 must = 2330B.NM109
X222 407 2400 REF04-3 010	Reference Identification Qualifier	ID	2-3	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 407 2400 REF04-4 010	Reference Identification	AN	1-50	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 407 2400 REF04-5 010	Reference Identification Qualifier	ID	2-3	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 407 2400 REF04-6 010	Reference Identification	AN	1-50	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 409 2400 AMT 010	SALES TAX AMOUNT	N/A	1	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2400.AMT with AMT01 = "T" is allowed.
X222 409 2400 AMT01 010	Amount Qualifier Code	ID	1-3	R	N/A	T	999	IK403 = 1: "Required Data Element Missing"	2400.AMT01 must be present.
X222 409 2400 AMT01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2400.AMT01 must be "T".
X222 409 2400 AMT02 010	Sales Tax Amount	R	1-18	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2400.AMT02 must be present.
X222 409 2400 AMT02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2400.AMT02 must be numeric.
X222 409 2400 AMT02 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2400.AMT02 Must be <= 99,999.99.
X222 409 2400 AMT02 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 645: "Service Tax Amount"	N/A
X222 409 2400 AMT02 050	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 697: "Invalid Decimal Precision" CSC 645: "Service Tax Amount"	2400.AMT02 is limited to 0, 1 or 2 decimal positions.
X222 409 2400 AMT03 010	Credit/Debit Flag Code	ID	1-1	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 410 2400 AMT 010	POSTAGE CLAIMED AMOUNT	N/A	1	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2400.AMT with AMT01 = "F4" is allowed.
X222 410 2400 AMT01 010	Amount Qualifier Code	ID	1-3	R	N/A	F4	999	IK403 = 1: "Required Data Element Missing"	2400.AMT01 must be present.
X222 410 2400 AMT01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2400.AMT01 must be "F4".
X222 410 2400 AMT02 010	Postage Claimed Amount	R	1-18	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2400.AMT02 must be present.
X222 410 2400 AMT02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2400.AMT02 must be numeric.
X222 410 2400 AMT02 025	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2400.AMT02 Must be <= 99,999.99.
X222 410 2400 AMT02 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 617: "Postage Claimed Amount"	N/A
X222 410 2400 AMT02 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 697: "Invalid Decimal Precision" CSC 617: "Postage Claimed Amount"	2400.AMT02 is limited to 0, 1 or 2 decimal positions.
X222 410 2400 AMT03 010	Credit/Debit Flag Code	ID	1-1	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 411 2400 K3 010	FILE INFORMATION	N/A	10	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only ten iterations of 2400.K3 are allowed.
X222 411 2400 K301 010	Fixed Format Information	AN	1-80	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2400.K301 must be present.
X222 411 2400 K301 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2400.K301 must be 1 - 80 characters
X222 411 2400 K301 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 569: "Fixed Format Information"	N/A
X222 411 2400 K301 040	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2400.K301 must be populated with accepted AN characters.
X222 411 2400 K301 060	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2400.K301 must contain at least one non-space character.
X222 411 2400 K302 010	Record Format Code	ID	1-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 411 2400 K303 010	COMPOSITE UNIT OF MEASURE	N/A	N/A	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 413 2400 NTE 020	LINE NOTE	N/A	1	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2400.NTE with NTE01 = "ADD" or "DCP"is allowed.
X222 413 2400 NTE01 010	Note Reference Code	ID	3-3	R	N/A	ADD, DCP	999	IK403 = 1: "Required Data Element Missing"	2400.NTE01 must be present.
X222 413 2400 NTE01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2400.NTE01 must be valid values.
X222 413 2400 NTE02 010	Line Note Text	AN	1-80	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2400.NTE02 must be present.
X222 413 2400 NTE02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2400.NTE02 must contain at least one non-space character.
X222 413 2400 NTE02 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2400.NTE02 must be 1 - 80 characters.
X222 413 2400 NTE02 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 586: "Line Note Text"	N/A
X222 413 2400 NTE02 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2400.NTE02 must be populated with accepted AN characters.
X222 414 2400 NTE 010	THIRD PARTY ORGANIZATION NOTE	N/A	1	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2400.NTE with NTE01 = "TPO" is allowed.
X222 414 2400 NTE01 010	Third Party Organization Notes	ID	3-3	R	N/A	TPO	999	IK403 = 1: "Required Data Element Missing"	2400.NTE01 must be present.
X222 414 2400 NTE01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2400.NTE01 must be "TPO".
X222 414 2400 NTE02 010	Line Note Text	AN	1-80	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2400.NTE02 must be present.
X222 414 2400 NTE02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2400.NTE02 must contain at least one non-space character.
X222 414 2400 NTE02 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2400.NTE02 must be 1 - 80 characters.
X222 414 2400 NTE02 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 586: "Line Note Text" EIC: TU "Third Party Repricing Organization (TPO)"	N/A
X222 414 2400 NTE02 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2400.NTE02 must be populated with accepted AN characters.
X222 415 2400 PS1 015	PURCHASED SERVICE INFORMATION	N/A	1	S	N/A	N/A	277	CSCC A8: "Acknowledgement/Rejected for relational field in error." CSC 21: "Missing or invalid information." CSC 124: "Entity's name, address, phone and id number. " EIC: QB "Purchased Service Provider"	If 2420B.NM1 with NM101 = "QB" is present, 2400.PS1 must be present.
X222 415 2400 PS1 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2400.PS1 is allowed.
X222 415 2400 PS101 010	Purchased Service Provider Identifier	AN	1-50	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2400.PS101 must be present.
X222 415 2400 PS101 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = I12: "Implementation Pattern Match Failure"	2400.PS101 must = 2420B.NM109 or 2420B.REF02
X222 415 2400 PS102 005	Purchased Service Charge Amount	R	1-18	R	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2400.PS102 must be > 0 and <= 99,999.99.
X222 415 2400 PS102 010	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 469: "Purchase Service Charge"	N/A
X222 415 2400 PS103 010	State or Province Code	ID	2-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 416 2400 HCP 005	LINE PRICING REPRICING INFORMATION	N/A	1	S	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 732: "Information submitted inconsistent with billing guidelines." CSC 64: "Re-pricing information."	Segment must not be present.
X222 423 2410 LIN 010	DRUG IDENTIFICATION	N/A	1	S	1	N/A	999	IK304 = 4: "Loop Occurs Over Maximum Times"	Only one iteration of 2410.LIN is allowed.
X222 423 2410 LIN01 010	Assigned Identification	AN	1-20	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222A1 023 2410 LIN02 010	Product or Service ID Qualifier	ID	2-2	R	N/A	N4, EN, EO, HI, ON, UK, UP	999	IK403 = 1: "Required Data Element Missing"	2410.LIN02 must be present.
X222 423 2410 LIN02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2410.LIN02 must be "N4".
X222 423 2410 LIN03 010	National Drug Code	AN	1-48	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2410.LIN03 must be present.
X222 423 2410 LIN03 025	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 218 NDC Number	2410.LIN03 must be 11 bytes alpha-numeric
X222 423 2410 LIN04 010	Product/Service ID Qualifier	ID	2-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 423 2410 LIN05 010	Product/Service ID	AN	1-48	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 423 2410 LIN06 010	Product/Service ID Qualifier	ID	2-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 423 2410 LIN07 010	Product/Service ID	AN	1-48	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 423 2410 LIN08 010	Product/Service ID Qualifier	ID	2-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 423 2410 LIN09 010	Product/Service ID	AN	1-48	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 423 2410 LIN10 010	Product/Service ID Qualifier	ID	2-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 423 2410 LIN11 010	Product/Service ID	AN	1-48	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 423 2410 LIN12 010	Product/Service ID Qualifier	ID	2-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 423 2410 LIN13 010	Product/Service ID	AN	1-48	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 423 2410 LIN14 010	Product/Service ID Qualifier	ID	2-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 423 2410 LIN15 010	Product/Service ID	AN	1-48	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 423 2410 LIN16 010	Product/Service ID Qualifier	ID	2-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 423 2410 LIN17 010	Product/Service ID	AN	1-48	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 423 2410 LIN18 010	Product/Service ID Qualifier	ID	2-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 423 2410 LIN19 010	Product/Service ID	AN	1-48	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 423 2410 LIN20 010	Product/Service ID Qualifier	ID	2-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 423 2410 LIN21 010	Product/Service ID	AN	1-48	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 423 2410 LIN22 010	Product/Service ID Qualifier	ID	2-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 423 2410 LIN23 010	Product/Service ID	AN	1-48	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 423 2410 LIN24 010	Product/Service ID Qualifier	ID	2-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 423 2410 LIN25 010	Product/Service ID	AN	1-48	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 423 2410 LIN26 010	Product/Service ID Qualifier	ID	2-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 423 2410 LIN27 010	Product/Service ID	AN	1-48	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 423 2410 LIN28 010	Product/Service ID Qualifier	ID	2-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 423 2410 LIN29 010	Product/Service ID	AN	1-48	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 423 2410 LIN30 010	Product/Service ID Qualifier	ID	2-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 423 2410 LIN31 010	Product/Service ID	AN	1-48	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 426 2410 CTP 010	DRUG PRICING	N/A	1	R	N/A	N/A	999	IK304 = I6: "Implementation Dependent Segment Missing"	If 2410.LIN is present, 2410.CTP must be present.
X222 426 2410 CTP 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2410.CTP is allowed.
X222 426 2410 CTP01 010	Class of Trade Code	ID	2-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 426 2410 CTP02 010	Price Identifier Code	ID	3-3	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 426 2410 CTP03 010	Unit Price	R	1-17	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 426 2410 CTP04 010	National Drug Unit Count	R	1-15	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2410.CTP04 must be present.
X222 426 2410 CTP04 015	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2410.CTP04 must be > 0 and <= 9,999,999.999.
X222 426 2410 CTP04 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 216 "Drug information"	N/A
X222 426 2410 CTP04 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 697: "Invalid Decimal Precision" CSC 216 "Drug information"	2410.CTP04 is limited to 3 decimal positions.
X222 426 2410 CTP05-1 010	Unit or Basis For Measurement Code	ID	2-2	R	N/A	F2, GR, ME, ML, UN	999	IK403 = 1: "Required Data Element Missing"	2410. CTP05-1 must be present.
X222 426 2410 CTP05-1 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2410.CTP05-1 must be valid values.
X222 426 2410 CTP05-1 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 659 "Unit or Basis for Measurement Code" CSC 218 ("NDC number")	N/A
X222 426 2410 CTP05-2 010	Exponent	R	1-15	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 426 2410 CTP05-3 010	Multiplier	R	1-10	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 426 2410 CTP05-4 010	Unit or Basis For Measurement Code	ID	2-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 426 2410 CTP05-5 010	Exponent	R	1-15	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 426 2410 CTP05-6 010	Multiplier	R	1-10	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 426 2410 CTP05-7 010	Unit or Basis For Measurement Code	ID	2-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 426 2410 CTP05-8 010	Exponent	R	1-15	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 426 2410 CTP05-9 010	Multiplier	R	1-10	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 426 2410 CTP05-10 010	Unit or Basis For Measurement Code	ID	2-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 426 2410 CTP05-11 010	Exponent	R	1-15	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 426 2410 CTP05-12 010	Multiplier	R	1-10	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 426 2410 CTP05-13 010	Unit or Basis For Measurement Code	ID	2-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 426 2410 CTP05-14 010	Exponent	R	1-15	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 426 2410 CTP05-15 010	Multiplier	R	1-10	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 426 2410 CTP06 010	Price Multiplier Qualifier	ID	3-3	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 426 2410 CTP07 010	Multiplier	R	1-10	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 426 2410 CTP08 010	Monetary Amount	R	1-18	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 426 2410 CTP09 010	Basis of Unit Price Code	ID	2-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 426 2410 CTP10 010	Condition Value	AN	1-10	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 426 2410 CTP11 010	Multiple Price Quantity	N0	1-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 428 2410 REF 020	PRESCRIPTION OR COMPOUND DRUG ASSOCIATION NUMBER	N/A	1	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2410.REF is allowed.
X222 428 2410 REF 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 219: "Prescription number."	If SV101-3, SV101-4,SV101-5 or SV101-6 are = "J1", 2410.REF with REF01 = "XZ" must be present.
X222 428 2410 REF01 010	Reference Identification Qualifier	ID	2-3	R	N/A	VY, XZ	999	IK403 = 1: "Required Data Element Missing"	2410.REF01 must be present.
X222 428 2410 REF01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2410.REF01 must be valid values.
X222 428 2410 REF02 010	Prescription Number	AN	1-50	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2410.REF02 must be present.
X222 428 2410 REF02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2410.REF02 must be at least one non-space character
X222 428 2410 REF02 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2410.REF02 must be 1 - 50 characters.
X222 428 2410 REF02 035	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 219: "Prescription number"	N/A
X222 428 2410 REF02 040	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2410.REF02 must be populated with accepted AN characters.
X222 428 2410 REF03 010	Description	AN	1-80	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 428 2410 REF04 010	REFERENCE IDENTIFIER	N/A	N/A	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 430 2420A NM1 010	RENDERING PROVIDER NAME	N/A	1	S	1	N/A	999	IK304 = 4: "Loop Occurs Over Maximum Times"	Only one iteration of 2420A.NM1 is allowed.
X222 430 2420A NM101 010	Entity Identifier Code	ID	2-3	R	N/A	82	999	IK304 = 2: "Unexpected segment"	2420A.NM101 must be present and a valid value.
X222 430 2420A NM102 010	Entity Type Qualifier	ID	1-1	R	N/A	1,2	999	IK403 = 1: "Required Data Element Missing"	2420A.NM102 must be present.
X222 430 2420A NM102 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2420A.NM102 must be valid values.
X222 430 2420A NM103 010	Rendering Provider Last or Organization Name	AN	1-60	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2420A.NM103 must be present.
X222 430 2420A NM103 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2420A.NM103 must contain at least one non-space character.
X222 430 2420A NM103 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2420A.NM103 must be 1 - 60 characters.
X222 430 2420A NM103 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 504: "Entity's Last Name" EIC: 82 "Rendering Provider"	N/A
X222 430 2420A NM103 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2420A.NM103 must be populated with accepted AN characters.
X222 430 2420A NM104 010	Rendering Provider First Name	AN	1-35	S	N/A	N/A	999	IK403 = I13: "Implementation Dependent "Not Used" Data Element Present"	If 2420A.NM102 is "2", 2420A.NM104 must not be present.
X222 430 2420A NM104 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2420A.NM104 must contain at least one non-space character.
X222 430 2420A NM104 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2420A.NM104 must be 1 - 35 characters.
X222 430 2420A NM104 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 505: "Entity's First Name" EIC: 82 "Rendering Provider"	N/A
X222 430 2420A NM104 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2420A.NM104 must be populated with accepted AN characters.
X222 430 2420A NM105 010	Rendering Provider Middle Name	AN	1-25	S	N/A	N/A	999	IK403 = I13: "Implementation Dependent "Not Used" Data Element Present"	If 2420A.NM102 is "2", 2420A.NM105 must not be present.
X222 430 2420A NM105 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2420A.NM105 must contain at least one non-space character.
X222 430 2420A NM105 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2420A.NM105 must be 1 - 25 characters.
X222 430 2420A NM105 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 514: "Entity's Middle Name" EIC: 82 "Rendering Provider"	N/A
X222 430 2420A NM105 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2420A.NM105 must be populated with accepted AN characters.
X222 430 2420A NM105 055	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement /Rejected for Invalid Information..." CSC 514: "Entity's Middle Name" EIC: 82 "Rendering Provider"	The first position of 2420A.NM105 must be alphabetic (A...Z).
X222 430 2420A NM106 010	Name Prefix	AN	1-10	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 430 2420A NM107 010	Rendering Provider Name Suffix	AN	1-10	S	N/A	N/A	999	IK403 = I13: "Implementation Dependent "Not Used" Data Element Present"	If 2420A.NM102 is "2", 2420A.NM107 must not be present.
X222 430 2420A NM107 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2420A.NM107 must be 1 - 10 characters.
X222 430 2420A NM107 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 125: "Entity's Name" EIC: 82 "Rendering Provider"	N/A
X222 430 2420A NM107 040	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2420A.NM107 must be populated with accepted AN characters.
X222 430 2420A NM108 010	Identification Code Qualifier	ID	1-2	S	N/A	XX	277	CSCC A8: "Acknowledgement/Rejected for relational field in error" CSC 745: "Identifier Qualifier" CSC 562: "Entity's National Provider Identifier (NPI)" EIC: 82 "Rendering Provider"	2420A.NM108 must not be present when 2300.REF with REF01 = "P4" and REF02 is a valid VA identifier.
X222 430 2420A NM108 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A6: "Acknowledgement/Rejected for Missing Information..." CSC 745: "Identifier Qualifier" CSC 562: "Entity's National Provider Identifier (NPI)" EIC: 82 "Rendering Provider"	2420A.NM108 must be present.
X222 430 2420A NM108 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2420A.NM108 must be "XX".
X222 430 2420A NM109 010	Rendering Provider Identifier	AN	2-80	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2420A.NM108 is present, 2420A.NM109 must be present.
X222 430 2420A NM109 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 562: "Entity's National Provider Identifier (NPI)" EIC: 82 "Rendering Provider"	2420A.NM109 must be valid according to the NPI algorithm.
X222 430 2420A NM109 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 562: "Entity's National Provider Identifier (NPI)" EIC: 82 "Rendering Provider"	2420A.NM109 must be a valid NPI on the Crosswalk when evaluated with 1000B.NM109, except when 2300.REF with REF01 = "P4" and REF02 = "82".
X222 430 2420A NM109 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 562: "Entity's National Provider Identifier (NPI)" EIC: 82 "Rendering Provider"	The first position of 2420A.NM109 must be a "1".
X222 430 2420A NM110 010	Entity Relationship Code	ID	2-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 430 2420A NM111 010	Entity Identifier Code	ID	2-3	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 430 2420A NM112 010	Name Last or Organization Name	AN	1-60	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 433 2420A PRV 020	RENDERING PROVIDER SPECIALTY INFORMATION	N/A	1	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2420A.PRV is allowed.
X222 433 2420A PRV01 010	Provider Code	ID	1-3	R	N/A	PE	999	IK403 = 1: "Required Data Element Missing"	2420A.PRV01 must be present
X222 433 2420A PRV01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2420A.PRV01 must be "PE".
X222 433 2420A PRV02 010	Reference Identification Qualifier	ID	2-3	R	N/A	PXC	999	IK403 = 1: "Required Data Element Missing"	2420A.PRV02 must be present.
X222 433 2420A PRV02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2420A.PRV02 must be "PXC".
X222 433 2420A PRV03 010	Provider Taxonomy Code	AN	1-50	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2420A.PRV03 must be present.
X222 433 2420A PRV03 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 145: "Entity's specialty/taxonomy code" EIC: 82 "Rendering Provider"	2420A.PRV03 must be valid Taxonomy Code
X222 433 2420A PRV04 010	State or Province Code	ID	2-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 433 2420A PRV05 010	PROVIDER SPECIALTY INFORMATION	N/A	N/A	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 433 2420A PRV06 010	Provider Organization Code	ID	3-3	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 434 2420A REF 010	RENDERING PROVIDER SECONDARY IDENTIFICATION	N/A	20	S	N/A	N/A	999	IK304 = I9: "Implementation Dependent "Not Used" Segment Present"	If 2420A.NM1 is present and 2420A.NM109 is not present, 2420A.REF with REF01 = "0B", "1G", "G2" or "LU" may be present.
X222 434 2420A REF 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 732: "Information submitted inconsistent with billing guidelines." CSC 560: "Entity's Additional/Secondary Identifier." EIC: 82 "Rendering Provider"	Only four iterations of 2420A.REF with REF01 = "1G", "0B", "G2" or "LU" are allowed.
X222 434 2420A REF 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK304 = I9: "Implementation Dependent "Not Used" Segment Present"	2420A.REF must not be present.
X222 434 2420A REF01 010	Reference Identification Qualifier	ID	2-3	R	N/A	0B, 1G, G2, LU	999	IK403 = 1: "Required Data Element Missing"	2420A.REF01 must be present.
X222 434 2420A REF01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2420A.REF01 must be valid values.
X222 434 2420A REF02 010	Rendering Provider Secondary Identifier	AN	1-50	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2420A.REF02 must be present.
X222 434 2420A REF02 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 133: "Entity's UPIN" CSC 560: "Entity's Additional/Secondary Identifier" EIC: 82 "Rendering Provider"	When 2420A.REF01 = "1G", 2420A.REF02 must be in format ANNNNN or AAANNN (where A is an alpha character and N is a numeric digit).
X222 434 2420A REF02 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	When 2420A.REF01 = "0B", "G2" or "LU", 2420A.REF02 must be 1 - 50 characters.
X222 434 2420A REF02 035	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 560: "Entity's Additional/Secondary Identifier" EIC: 82 "Rendering Provider"	N/A
X222 434 2420A REF02 040	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	When 2420A.REF01 = "0B", "G2" or "LU", 2420A.REF02 must be populated with accepted AN characters.
X222 434 2420A REF02 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	When 2420A.REF01 = "0B", "G2" or "LU", 2420A.REF02 must contain at least one non-space character.
X222 434 2420A REF03 010	Description	AN	1-80	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 434 2420A REF04-1 010	Reference Identifier Qualifier	ID	2-3	R	N/A	2U	999	IK403 = 7: "Invalid Code Value"	2420A.REF04-1 must be "2U".
X222 434 2420A REF04-2 010	Other Payer Primary Identifier	AN	1-50	R	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2420A.REF04-1 is present, 2420A.REF04-2 must be present.
X222 434 2420A REF04-2 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = I12: "Implementation Pattern Match Failure"	2420A,REF04-2 must = 2330B.NM109.
X222 434 2420A REF04-3 010	Reference Identification Qualifier	ID	2-3	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 434 2420A REF04-4 010	Reference Identification	AN	1-50	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 434 2420A REF04-5 010	Reference Identification Qualifier	ID	2-3	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 434 2420A REF04-6 010	Reference Identification	AN	1-50	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 436 2420B NM1 015	PURCHASED SERVICE PROVIDER NAME	N/A	1	S	1	N/A	277	CSCC A8: "Acknowledgement/Rejected for relational field in error." CSC 21: "Missing or invalid information." CSC 125: "Entity's name." EIC: QB "Purchased Service Provider"	If 2400.PS1 is present, 2420B.NM1 with NM101 = "QB" must be present.
X222 436 2420B NM1 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK304 = 4: "Loop Occurs Over Maximum Times"	Only one iteration of 2420B.NM1 is allowed.
X222 436 2420B NM101 010	Entity Identifier Code	ID	2-3	R	N/A	QB	999	IK304 = 2: "Unexpected segment"	2420B.NM101 must be present and a valid value.
X222 436 2420B NM102 010	Entity Type Qualifier	ID	1-1	R	N/A	1, 2	999	IK403 = 1: "Required Data Element Missing"	2420B.NM102 must be present.
X222 436 2420B NM102 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2420B.NM102 must be valid values.
X222 436 2420B NM103 010	Name Last or Organization Name	AN	1-60	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 436 2420B NM104 010	Name First	AN	1-35	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 436 2420B NM104 020	Name Middle	AN	1-25	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 436 2420B NM106 010	Name Prefix	AN	1-10	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 436 2420B NM107 010	Name Suffix	AN	1-10	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 436 2420B NM108 010	Identification Code Qualifier	ID	1-2	S	N/A	XX	277	CSCC A8: "Acknowledgement/Rejected for relational field in error" CSC 745: "Identifier Qualifier" CSC 562: "Entity's National Provider Identifier (NPI)" EIC: QB "Purchased Service Provider"	2420B.NM108 must not be present when 2300.REF with REF01 = "P4" and REF02 is a valid VA identifier".
X222 436 2420B NM108 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A6: "Acknowledgement/Rejected for Missing Information..." CSC 745: "Identifier Qualifier" CSC 562: "Entity's National Provider Identifier (NPI)" EIC: QB "Purchased Service Provider"	2420B.NM108 must be present.
X222 436 2420B NM108 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2420B.NM108 must be "XX".
X222 436 2420B NM109 010	Purchased Service Provider Identifier	AN	2-80	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2420B.NM108 is present, 2420B.NM109 must be present.
X222 436 2420B NM109 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 562: "Entity's National Provider Identifier (NPI)" EIC: QB "Purchased Service Provider"	2420B.NM109 must be valid according to the NPI algorithm.
X222 436 2420B NM109 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 562: "Entity's National Provider Identifier (NPI)" EIC: QB "Purchased Service Provider"	The first position of 2420B.NM109 must be a "1".
X222 436 2420B NM110 010	Entity Relationship Code	ID	2-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 436 2420B NM111 010	Entity Identifier Code	ID	2-3	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 436 2420B NM112 010	Name Last or Organization Name	AN	1-60	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 439 2420B REF 010	PURCHASED SERVICE PROVIDER SECONDARY IDENTIFICATION	N/A	20	S	N/A	N/A	999	IK304 = I9: "Implementation Dependent "Not Used" Segment Present"	If 2420B.NM1 is present and 2420B.NM109 is not present, 2420B.REF with REF01 = "1G" may be present.
X222 439 2420B REF 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 732: "Information submitted inconsistent with billing guidelines." CSC 560: "Entity's Additional/Secondary Identifier." EIC: QB "Purchased Service Provider"	Only one iteration of 2420B.REF with REF01 = "1G" is allowed.
X222 439 2420B REF 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK304 = I9: "Implementation Dependent "Not Used" Segment Present"	2420B.REF must not be present.
X222 439 2420B REF01 010	Reference Identification Qualifier	ID	2-3	R	N/A	0B, 1G, G2	999	IK403 = 1: "Required Data Element Missing"	2420B.REF01 must be present
X222 439 2420B REF01 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 732: "Information submitted inconsistent with billing guidelines." CSC 560: "Entity's Additional/Secondary Identifier." EIC: QB "Purchased Service Provider"	2420B.REF01 must be "1G".
X222 439 2420B REF02 010	Purchased Service Provider Secondary Identifier	AN	1-50	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2420B.REF02 must be present.
X222 439 2420B REF02 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 133: "Entity's UPIN" EIC: QB "Purchased Service Provider"	2420B.REF02 must be in format ANNNNN or AAANNN (where A is an alpha character and N is a numeric digit).
X222 439 2420B REF03 010	Description	AN	1-80	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 439 2420B REF04 010	Reference Identifier Qualifier	N/A	N/A	N/A	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 441 2420C NM1 010	SERVICE FACILITY LOCATION NAME	N/A	1	S	1	N/A	999	IK304 = 4: "Loop Occurs Over Maximum Times"	Only one iteration of 2420C.NM1 is allowed.
X222 441 2420C NM101 010	Entity Identifier Code	ID	2-3	R	N/A	77	999	IK304 = 2: "Unexpected segment"	2420C.NM101 must be present and a valid value.
X222 441 2420C NM102 010	Entity Type Qualifier	ID	1-1	R	N/A	2	999	IK403 = 1: "Required Data Element Missing"	2420C.NM102 must be present.
X222 441 2420C NM102 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2420C.NM102 must be "2".
X222 441 2420C NM103 010	Laboratory or Facility Name	AN	1-60	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2420C.NM103 must be present.
X222 441 2420C NM103 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2420C.NM103 must be at least one non-space character
X222 441 2420C NM103 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2420C.NM103 must be 1 - 50 characters.
X222 441 2420C NM103 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 504: "Entity's Last Name" EIC: 77 "Service Location"	N/A
X222 441 2420C NM103 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2420C.NM103 must be populated with accepted AN characters.
X222 441 2420C NM104 010	Name First	AN	1-35	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 441 2420C NM105 010	Name Middle	AN	1-25	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 441 2420C NM106 010	Name Prefix	AN	1-10	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 441 2420C NM107 010	Name Suffix	AN	1-10	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 441 2420C NM108 010	Identification Code Qualifier	ID	1-2	S	N/A	XX	999	IK403 = 7: "Invalid Code Value"	2420C.NM108 must be "XX".
X222 441 2420C NM109 010	Laboratory or Facility Primary Identifier	AN	2-80	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2420C.NM108 is present, 2420C.NM109 must be present.
X222 441 2420C NM109 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 562: "Entity's National Provider Identifier (NPI)" EIC: 77 "Service Location"	2420C.NM109 must be valid according to the NPI algorithm.
X222 441 2420C NM109 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 562: "Entity's National Provider Identifier (NPI)" EIC: 77 "Service Location"	The first position of 2420C.NM109 must be a "1".
X222 441 2420C NM110 010	Entity Relationship Code	ID	2-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 441 2420C NM111 010	Entity Identifier Code	ID	2-3	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 441 2420C NM112 010	Name Last or Organization Name	AN	1-60	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 444 2420C N3 010	SERVICE FACILITY LOCATION ADDRESS	N/A	1	R	N/A	N/A	999	IK304 = I6: "Implementation Dependent Segment Missing"	If 2420C.NM1 is present, 2420C.N3 must be present.
X222 444 2420C N3 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2420C.N3 is allowed.
X222 444 2420C N301 010	Laboratory or Facility Address Line	AN	1-55	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2420C.N301 must be present.
X222 444 2420C N301 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2420C.N301 must contain at least one non-space character.
X222 444 2420C N301 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2420C.N301 must be 1 - 55 characters.
X222 444 2420C N301 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 503: "Entity's Street address" EIC: 77 "Service Location"	N/A
X222 444 2420C N301 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2420C.N301 must be populated with accepted AN characters.
X222 444 2420C N302 020	Laboratory or Facility Address Line	AN	1-55	S	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2420C.N302 must contain at least one non-space character.
X222 444 2420C N302 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2420C.N302 must be 1 - 55 characters.
X222 444 2420C N302 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 503: "Entity's Street address" EIC: 77 "Service Location"	N/A
X222 444 2420C N302 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2420C.N302 must be populated with accepted AN characters.
X222 445 2420C N4 010	SERVICE FACILITY LOCATION CITY/STATE/ZIP	N/A	1	R	N/A	N/A	999	IK304 = I6: "Implementation Dependent Segment Missing"	If 2420C.NM1 is present, 2420C.N4 must be present.
X222 445 2420C N4 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2420C.N4 is allowed.
X222 445 2420C N401 010	Laboratory or Facility City Name	AN	2-30	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2420C.N401 must be present.
X222 445 2420C N401 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2420C.N401 must contain at least two non-space characters.
X222 445 2420C N401 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 4: "Data Element Too Short" IK403 = 5: "Data Element Too Long"	2420C.N401 must be 2-30 characters.
X222 445 2420C N401 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 502: "Entity's City" EIC: 77 "Service Location"	N/A
X222 445 2420C N401 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2420C.N401 must be populated with accepted AN characters.
X222 445 2420C N402 010	Laboratory or Facility State or Province Code	ID	2-2	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2420C.N404 is not present, 2420C.N402 must be present.
X222 445 2420C N402 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 501: "Entity's State/Province" EIC: 77 "Service Location"	2420C.N402 must be a valid State Code.
X222 445 2420C N403 010	Laboratory or Facility Postal Zone or ZIP Code	ID	3-15	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2420C.N404 is not present, 2420C.N403 must be present.
X222 445 2420C N403 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 500: "Entity's Postal/Zip Code" EIC: 77 "Service Location"	2420C.N403 must be a valid 9 digit Zip Code.
X222 445 2420C N404 010	Service Facility Location Country Code	ID	2-3	S	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 445 2420C N405 010	Location Qualifier	ID	1-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 445 2420C N406 010	Location Identifier	AN	1-30	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 445 2420C N407 005	Country Subdivision Code	ID	1-3	S	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 447 2420C REF 010	SERVICE FACILITY LOCATION SECONDARY IDENTIFICATION	N/A	3	S	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 732: "Information submitted inconsistent with billing guidelines." CSC 560: "Entity's Additional/Secondary Identifier." EIC: 77 "Service Location"	2420C.REF must not be present.
X222 449 2420D NM1 010	SUPERVISING PROVIDER NAME	N/A	1	S	1	N/A	999	IK304 = 4: "Loop Occurs Over Maximum Times"	Only one iteration of 2420D.NM1 is allowed.
X222 449 2420D NM1 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK304 = I6: "Implementation Dependent Segment Missing"	If2420D.NM1 is present, 2310D.NM1 must be present
X222 449 2420D NM101 010	Entity Identifier Code	ID	2-3	R	N/A	DQ	999	IK304 = 2: "Unexpected segment"	2420D.NM101 must be present and a valid value.
X222 449 2420D NM102 010	Entity Type Qualifier	ID	1-1	R	N/A	1	999	IK403 = 1: "Required Data Element Missing"	2420D.NM102 must be present.
X222 449 2420D NM102 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2420D.NM102 must be "1".
X222 449 2420D NM103 010	Supervising Provider Last Name	AN	1-60	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2420D.NM103 must be present.
X222 449 2420D NM103 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2420D.NM103 must contain at least one non-space character.
X222 449 2420D NM103 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2420D.NM103 must be 1 - 60 characters.
X222 449 2420D NM103 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 504: "Entity's Last Name" EIC: DQ "Supervising Provider"	N/A
X222 449 2420D NM103 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2420D.NM103 must be populated with accepted AN characters.
X222 449 2420D NM104 010	Supervising Provider Name First	AN	1-35	S	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2420D.NM104 must contain at least one non-space character.
X222 449 2420D NM104 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2420D.NM104 must be 1 - 35 characters.
X222 449 2420D NM104 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 505: "Entity's First Name" EIC: DQ "Supervising Provider"	N/A
X222 449 2420D NM104 040	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2420D.NM104 must be populated with accepted AN characters.
X222 449 2420D NM105 010	Supervising Provider Middle Name or Initial	AN	1-25	S	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2420D.NM105 must contain at least one non-space character.
X222 449 2420D NM105 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2420D.NM105 must be 1 - 25 characters.
X222 449 2420D NM105 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 514: "Entity's Middle Name" EIC: DQ "Supervising Provider"	N/A
X222 449 2420D NM105 040	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2420D.NM105 must be populated with accepted AN characters.
X222 449 2420D NM105 045	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement /Rejected for Invalid Information..." CSC 514: "Entity's Middle Name" EIC: DQ "Supervising Provider"	The first position of 2420D.NM105 must be alphabetic (A...Z).
X222 449 2420D NM106 010	Name Prefix	AN	1-10	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 449 2420D NM107 010	Supervising Provider Name Suffix	AN	1-10	S	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2420D.NM107 must contain at least one non-space character.
X222 449 2420D NM107 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2420D.NM107 must be 1 -10 characters.
X222 449 2420D NM107 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 125: "Entity's Name" EIC: DQ "Supervising Provider"	N/A
X222 449 2420D NM107 040	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2420D.NM107 must be populated with accepted AN characters.
X222 449 2420D NM108 010	Identification Code Qualifier	ID	1-2	S	N/A	XX	277	CSCC A8: "Acknowledgement/Rejected for relational field in error." CSC 745: "Identifier Qualifier" CSC 562: "Entity's National Provider Identifier (NPI)" EIC: DQ "Supervising Provider"	2420D.NM108 must not be present when 2300.REF with REF01 = "P4" and REF02 is a valid VA identifier".
X222 449 2420D NM108 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A6: "Acknowledgement/Rejected for Missing Information..." CSC 745: "Identifier Qualifier" CSC 562: "Entity's National Provider Identifier (NPI)" EIC: DQ "Supervising Provider"	2420D.NM108 must be present.
X222 449 2420D NM108 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2420D.NM108 must be "XX".
X222 449 2420D NM109 010	Supervising Provider Identifier	AN	2-80	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2420D.NM108 is present, 2420D.NM109 must be present.
X222 449 2420D NM109 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 562: "Entity's National Provider Identifier (NPI)" EIC: DQ "Supervising Provider"	2420D.NM109 must be valid according to the NPI algorithm.
X222 449 2420D NM109 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 562: "Entity's National Provider Identifier (NPI)" EIC: DQ "Supervising Provider"	The first position of 2420D.NM109 must be a "1".
X222 449 2420D NM110 010	Entity Relationship Code	ID	2-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 449 2420D NM111 010	Entity Identifier Code	ID	2-3	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 449 2420D NM112 010	Name Last or Organization Name	AN	1-60	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 452 2420D REF 010	SUPERVISING PROVIDER SECONDARY IDENTIFICATION	N/A	20	S	N/A	N/A	999	IK304 = I9: "Implementation Dependent "Not Used" Segment Present"	If 2420D.NM1 is present and 2420D.NM109 is not present, 2420D.REF with REF01 = "0B", "1G" or "LU" may be present.
X222 452 2420D REF 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 732: "Information submitted inconsistent with billing guidelines." CSC 560: "Entity's Additional/Secondary Identifier." EIC: DQ "Supervising Provider"	Only three iterations of 2420D.REF with REF01 = "0B", "1G" or "LU" are allowed
X222 452 2420D REF 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK304 = I9: "Implementation Dependent "Not Used" Segment Present"	2420D.REF must not be present.
X222 452 2420D REF01 010	Reference Identification Qualifier	ID	2-3	R	N/A	0B, 1G, G2, LU	999	IK403 = 1: "Required Data Element Missing"	2420D.REF01 must be present.
X222 452 2420D REF01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2420D.REF01 must be valid values.
X222 452 2420D REF02 010	Supervising Provider Secondary Identifier	AN	1-50	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2420D.REF02 must be present.
X222 452 2420D REF02 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 133: "Entity's UPIN" CSC 560 : "Entity's Additional/Secondary Identifier" EIC: DQ "Supervising Provider"	When 2420D.REF01 = "1G", 2420D.REF02 must be in format ANNNNN or AAANNN (where A is an alpha character and N is a numeric digit).
X222 452 2420D REF02 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	When 2420D.REF01 = "0B" or "LU", 2420D.REF02 must contain at least one non-space character.
X222 452 2420D REF02 040	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	When 2420D.REF01 = "0B" or "LU", 2420D.REF02 must be 1 - 50 characters.
X222 452 2420D REF02 050	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 560 : "Entity's Additional/Secondary Identifier" EIC: DQ "Supervising Provider"	N/A
X222 452 2420D REF02 060	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	When 2420D.REF01 = "0B" or "LU", 2420D.REF02 must be populated with accepted AN characters.
X222 452 2420D REF03 010	Description	AN	1-80	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 452 2420D REF04-1 015	Reference Identifier Qualifier	ID	2-3	R	N/A	2U	999	IK403 = 1: "Required Data Element Missing"	If 2420D.REF01 = "LU", 2420D.REF04-1 must be present.
X222 452 2420D REF04-1 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2420D.REF04-1 must be "2U".
X222 452 2420D REF04-2 010	Other Payer Primary Identifier	AN	1-50	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	If 2420D.REF04-1 is present, 2420D.REF04-2 must be present.
X222 452 2420D REF04-2 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = I12: "Implementation Pattern Match Failure"	2420D,REF04-2 must = 2330B.NM109.
X222 452 2420D REF04-3 010	Reference Identification Qualifier	ID	2-3	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 452 2420D REF04-4 010	Reference Identification	AN	1-50	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 452 2420D REF04-5 010	Reference Identification Qualifier	ID	2-3	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 452 2420D REF04-6 010	Reference Identification	AN	1-50	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 454 2420E NM1 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK304 = 4: "Loop Occurs Over Maximum Times"	Only one iteration of 2420E.NM1 is allowed.
X222 454 2420E NM101 010	Entity Identifier Code	ID	2-3	R	N/A	DK	999	IK304 = 2: "Unexpected segment"	2420E.NM101 must be present and a valid value.
X222 454 2420E NM102 010	Entity Type Qualifier	ID	1-1	R	N/A	1	999	IK403 = 1: "Required Data Element Missing"	2420E.NM102 must be present.
X222 454 2420E NM102 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2420E.NM102 must be "1".
X222 454 2420E NM103 010	Ordering Provider Last Name	AN	1-60	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2420E.NM103 must be present.
X222 454 2420E NM103 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2420E.NM103 must contain at least one non-space character.
X222 454 2420E NM103 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2420E.NM103 must be 1 - 60 characters.
X222 454 2420E NM103 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 504: "Entity's Last Name" EIC: DK "Ordering Physician"	N/A
X222 454 2420E NM103 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2420E.NM103 must be populated with accepted AN characters.
X222 454 2420E NM104 010	Ordering Provider First Name	AN	1-35	S	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2420E.NM104 must contain at least one non-space character.
X222 454 2420E NM104 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2420E.NM104 must be 1 - 35 characters.
X222 454 2420E NM104 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 505: "Entity's First Name" EIC: DK "Ordering Physician"	N/A
X222 454 2420E NM104 040	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2420E.NM104 must be populated with accepted AN characters.
X222 454 2420E NM105 010	Ordering Provider Middle Name or Initial	AN	1-25	S	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2420E.NM105 must contain at least one non-space character.
X222 454 2420E NM105 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2420E.NM105 must be 1 - 25 characters.
X222 454 2420E NM105 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 514: "Entity's Middle Name" EIC: DK "Ordering Physician"	N/A
X222 454 2420E NM105 040	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2420E.NM105 must be populated with accepted AN characters.
X222 454 2420E NM105 045	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement /Rejected for Invalid Information..." CSC 514: "Entity's Middle Name" EIC: DK "Ordering Physician"	The first position of 2420E.NM105 must be alphabetic (A...Z).
X222 454 2420E NM106 010	Name Prefix	AN	1-10	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 454 2420E NM107 010	Ordering Provider Name Suffix	AN	1-10	S	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2420E.NM107 must contain at least one non-space character.
X222 454 2420E NM107 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2420E.NM107 must be 1 -10 characters.
X222 454 2420E NM107 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 125: "Entity's Name" EIC: DK "Ordering Physician"	N/A
X222 454 2420E NM107 040	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2420E.NM107 must be populated with accepted AN characters.
X222 454 2420E NM108 010	Identification Code Qualifier	ID	1-2	S	N/A	XX	277	CSCC A8: "Acknowledgement/Rejected for relational field in error" CSC 745: "Identifier Qualifier" CSC 562: "Entity's National Provider Identifier (NPI)" EIC: DK "Ordering Physician"	2420E.NM108 must not be present when 2300.REF with REF01 = "P4" and REF02 is a valid VA identifier".
X222 454 2420E NM108 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A6: "Acknowledgement/Rejected for Missing Information..." CSC 745: "Identifier Qualifier" CSC 562: "Entity's National Provider Identifier (NPI)" EIC: DK "Ordering Physician"	2420E.NM108 must be present.
X222 454 2420E NM108 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2420E.NM108 must be "XX".
X222 454 2420E NM109 010	Ordering Provider Identifier	AN	2-80	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2420E.NM108 is present, 2420E.NM109 must be present.
X222 454 2420E NM109 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 562: "Entity's National Provider Identifier (NPI)" EIC: DK "Ordering Physician"	2420E.NM109 must be valid according to the NPI algorithm.
X222 454 2420E NM109 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 562: "Entity's National Provider Identifier (NPI)" EIC: DK "Ordering Physician"	The first position of 2420E.NM109 must be a "1".
X222 454 2420E NM110 010	Entity Relationship Code	ID	2-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 454 2420E NM111 010	Entity Identifier Code	ID	2-3	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 454 2420E NM112 010	Name Last or Organization Name	AN	1-60	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 457 2420E N3 020	ORDERING PROVIDER ADDRESS	N/A	1	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2420E.N3 is allowed.
X222 457 2420E N301 010	Ordering Provider Address Line	AN	1-55	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2420E.N301 must be present.
X222 457 2420E N301 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2420E.N301 must contain at least one non-space character.
X222 457 2420E N301 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	Location.N301 must be 1 - 55 characters.
X222 457 2420E N301 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 503: "Entity's Street address" EIC: DK "Ordering Physician"	N/A
X222 457 2420E N301 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2420E.N301 must be populated with accepted AN characters.
X222 457 2420E N302 020	Ordering Provider Address Line	AN	1-55	S	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2420E.N302 must contain at least one non-space character.
X222 457 2420E N302 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2420E.N302 must be 1 - 55 characters.
X222 457 2420E N302 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 503: "Entity's Street address" EIC: DK "Ordering Physician"	N/A
X222 457 2420E N302 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2420E.N302 must be populated with accepted AN characters.
X222A1 024 2420E N4 010	ORDERING PROVIDER CITY/STATE/ZIP CODE	N/A	1	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2420E.N4 is allowed.
X222 458 2420E N401 010	Ordering Provider City Name	AN	2-30	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2420E.N401 must be present.
X222 458 2420E N401 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2420E.N401 must contain at least two non-space characters.
X222 458 2420E N401 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 4: "Data Element Too Short" IK403 = 5: "Data Element Too Long"	2420E.N401 must be 2-30 characters.
X222 458 2420E N401 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 502: "Entity's City" EIC: DK "Ordering Physician"	N/A
X222 458 2420E N401 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2420E.N401 must be populated with accepted AN characters.
X222 458 2420E N402 010	Ordering Provider State or Province Code	ID	2-2	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2420E.N404 is not present, 2420E.N402 must be present.
X222 458 2420E N402 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 501: "Entity's State/Province" EIC: DK "Ordering Physician"	2420E.N402 must be a valid State Code.
X222 458 2420E N403 010	Ordering Provider Postal Zone or ZIP Code	ID	3-15	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2420E.N404 is not present, 2420E.N403 must be present.
X222 458 2420E N403 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 500: "Entity's Postal/Zip Code" EIC: DK "Ordering Physician"	2420E.N403 must be a valid Zip Code.
X222 458 2420E N404 010	Ordering Provider Country Code	ID	2-3	S	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 458 2420E N405 010	Location Qualifier	ID	1-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 458 2420E N406 010	Location Identifier	AN	1-30	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 458 2420E N407 005	Country Subdivision Code	ID	1-3	S	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 460 2420E REF 010	ORDERING PROVIDER SECONDARY IDENTIFICATION	N/A	20	S	N/A	N/A	999	IK304 = I9: "Implementation Dependent "Not Used" Segment Present"	If 2420E.NM1 is present, 2420E.REF may be present.
X222 460 2420E REF 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 732: "Information submitted inconsistent with billing guidelines." CSC 560: "Entity's Additional/Secondary Identifier." EIC: DK "Ordering Physician"	Only one iterations of 2420E.REF are allowed.
X222 460 2420E REF 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK304 = I9: "Implementation Dependent "Not Used" Segment Present"	2420E.REF must not be present.
X222 460 2420E REF01 010	Reference Identification Qualifier	ID	2-3	R	N/A	0B, 1G, G2	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 732: "Information submitted inconsistent with billing guidelines." CSC 560: "Entity's Additional/Secondary Identifier." EIC: DK "Ordering Physician"	2420E.REF01 must be "1G".
X222 460 2420E REF02 010	Ordering Provider Secondary Identifier	AN	1-50	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2420E.REF02 must be present.
X222 460 2420E REF02 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 133: "Entity's UPIN" CSC 560: "Entity's Additional/Secondary Identifier" EIC: DK "Ordering Physician"	2420E.REF02 must be in format ANNNNN or AAANNN (where A is an alpha character and N is a numeric digit).
X222 460 2420E REF03 010	Description	AN	1-80	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 460 2420E REF04 010	Reference Identifier	N/A	N/A	S	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 462 2420E PER 020	ORDERING PROVIDER CONTACT INFORMATION	N/A	1	S	N/A	N/A	999	IK304 = I6: "Implementation Dependent Segment Missing"	If 2400.CR3 is present, 2420E.PER must be present.
X222 462 2420E PER 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2420E.PER is allowed.
X222 462 2420E PER01 010	Contact Function Code	ID	2-2	R	N/A	1C	999	IK403 = 1: "Required Data Element Missing"	2420E.PER01 must be present.
X222 462 2420E PER01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2420E.PER01 must be "IC".
X222 462 2420E PER02 010	Ordering Provider Contact Name	AN	1-60	S	N/A	N/A	999	IK403 = I9: "Implementation Dependent Data Element Missing"	2420E.PER02 must be present.
X222 462 2420E PER02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2420E.PER02 must contain at least one non-space character.
X222 462 2420E PER02 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2420E.PER02 must be 1 - 60 characters.
X222 462 2420E PER02 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 561: "Entity's Contact Name" EIC: DK "Ordering Physician"	N/A
X222 462 2420E PER02 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2420E.PER02 must be populated with accepted AN characters.
X222 462 2420E PER03 010	Communication Number Qualifier	ID	2-2	R	N/A	EM, FX, TE	999	IK403 = 1: "Required Data Element Missing"	2420E.PER03 must be present.
X222 462 2420E PER03 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2420E.PER03 must be valid values.
X222 462 2420E PER04 010	Communication Number	AN	1-256	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2420E.PER04 must be present.
X222 462 2420E PER04 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2420E.PER04 must contain at least one non-space character.
X222 462 2420E PER04 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2420E.PER04 must be 1 - 256 characters.
X222 462 2420E PER04 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 127: "Entity's Communication Number" EIC: DK "Ordering Physician"	N/A
X222 462 2420E PER04 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2420E.PER04 must be populated with accepted AN characters.
X222 462 2420E PER04 070	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 127: "Entity's Communication Number" EIC: DK "Ordering Physician"	2420E.PER04 must be populated with exactly ten numeric characters when 2420E.PER03 equals FX or TE.
X222 462 2420E PER05 010	Communication Number Qualifier	ID	2-2	S	N/A	EM, EX, FX, TE	999	IK403 = 7: "Invalid Code Value"	2420E.PER05 must be valid values.
X222 462 2420E PER05 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	If 2420E.PER05 is "EX", 2420E.PER03 must be "TE".
X222 462 2420E PER06 010	Communication Number	AN	1-256	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2420E.PER06 is present, 2420E.PER05 must be present.
X222 462 2420E PER06 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2420E.PER06 must contain at least one non-space character.
X222 462 2420E PER06 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2420E.PER06 must be 1 - 256 characters.
X222 462 2420E PER06 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 127: "Entity's Communication Number" EIC: DK "Ordering Physician"	N/A
X222 462 2420E PER06 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2420E.PER06 must be populated with accepted AN characters.
X222 462 2420E PER06 070	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 127: "Entity's Communication Number" EIC: DK "Ordering Physician"	2420E.PER06 must be populated with exactly ten numeric characters when 2420E.PER05 equals FX or TE.
X222 462 2420E PER07 010	Communication Number Qualifier	ID	2-2	S	N/A	EM, EX, FX, TE	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2420E.PER07 is present, 2420E.PER05 must be present.
X222 462 2420E PER07 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2420E.PER07 must be valid values.
X222 462 2420E PER07 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	If 2420E.PER07 is "EX", 2420E.PER05 must be "TE".
X222 462 2420E PER08 010	Communication Number	AN	1-256	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2420E.PER08 is present, 2420E.PER07 must be present.
X222 462 2420E PER08 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2420E.PER08 must contain at least one non-space character.
X222 462 2420E PER08 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2420E.PER08 must be 1 - 256 characters.
X222 462 2420E PER08 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 127: "Entity's Communication Number" EIC: DK "Ordering Physician"	N/A
X222 462 2420E PER08 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2420E.PER08 must be populated with accepted AN characters.
X222 462 2420E PER08 070	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 127: "Entity's Communication Number" EIC: DK "Ordering Physician"	2420E.PER08 must be populated with exactly ten numeric characters when 2420E.PER07 equals FX or TE.
X222 462 2420E PER09 010	Contact Inquiry Reference	AN	1-20	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 465 2420F Referring Loop 010	REFERRING PROVIDER NAME Loop	N/A	N/A	N/A	2	N/A	999	IK304 = 4: "Loop Occurs Over Maximum Times"	Only two iterations of 2420F are allowed.
X222 465 2420F NM1 010	REFERRING PROVIDER NAME	N/A	1	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2420F.NM1 is allowed.
X222 465 2420F NM1 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK304 = I6: "Implementation Dependent Segment Missing"	If2420F.NM1 is present, 2310A.NM1 must be present
X222 465 2420F NM101 010	Entity Identifier Code	ID	2-3	R	N/A	DN, P3	999	IK304 = 2: "Unexpected segment"	2420F.NM101 must be present and a valid value.
X222 465 2420F NM101 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	For the first iteration of the 2420F loop, 2420F.NM101 must be "DN".
X222 465 2420F NM101 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	For the second iteration of the 2420F loop, 2420F.NM101 must be "P3".
X222 465 2420F NM102 010	Entity Type Qualifier	ID	1-1	R	N/A	1	999	IK403 = 1: "Required Data Element Missing"	2420F.NM102 must be present.
X222 465 2420F NM102 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2420F.NM102 must be "1".
X222 465 2420F NM103 010	Referring Provider Last Name	AN	1-60	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2420F.NM103 must be present.
X222 465 2420F NM103 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2420F.NM103 must contain at least one non-space character.
X222 465 2420F NM103 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2420F.NM103 must be 1 - 60 characters.
X222 465 2420F NM103 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 504: "Entity's Last Name" EIC: DN "Referring Provider"	N/A
X222 465 2420F NM103 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2420F.NM103 must be populated with accepted AN characters.
X222 465 2420F NM104 010	Referring Provider First Name	AN	1-35	S	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2420F.NM104 must contain at least one non-space character.
X222 465 2420F NM104 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2420F.NM104 must be 1 - 35 characters.
X222 465 2420F NM104 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 505: "Entity's First Name" EIC: DN "Referring Provider"	N/A
X222 465 2420F NM104 040	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2420F.NM104 must be populated with accepted AN characters.
X222 465 2420F NM105 010	Referring Provider Middle Name or Initial	AN	1-25	S	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2420F.NM105 must contain at least one non-space character.
X222 465 2420F NM105 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2420F.NM105 must be 1 - 25 characters.
X222 465 2420F NM105 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 514: "Entity's Middle Name" EIC: DN "Referring Provider"	N/A
X222 465 2420F NM105 040	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2420F.NM105 must be populated with accepted AN characters.
X222 465 2420F NM105 045	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement /Rejected for Invalid Information..." CSC 514: "Entity's Middle Name" EIC: DN "Referring Provider"	The first position of 2420F.NM105 must be alphabetic (A...Z).
X222 465 2420F NM106 010	Name Prefix	AN	1-10	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 465 2420F NM107 010	Referring Provider Name Suffix	AN	1-10	S	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2420F.NM107 must contain at least one non-space character.
X222 465 2420F NM107 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2420F.NM107 must be 1 - 10 characters.
X222 465 2420F NM107 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 125: "Entity's Name" EIC: DN "Referring Provider"	N/A
X222 465 2420F NM107 040	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2420F.NM107 must be populated with accepted AN characters.
X222 465 2420F NM108 010	Identification Code Qualifier	ID	1-2	S	N/A	XX	277	CSCC A8: "Acknowledgement/Rejected for relational field in error." CSC 745: "Identifier Qualifier" CSC 562: "Entity's National Provider Identifier (NPI)" EIC: DN "Referring Provider"	2420F.NM108 must not be present when 2300.REF with REF01 = "P4" and REF02 is a valid VA identifier".
X222 465 2420F NM108 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A6: "Acknowledgement/Rejected for Missing Information..." CSC 745: "Identifier Qualifier" CSC 562: "Entity's National Provider Identifier (NPI)" EIC: DN "Referring Provider"	2420F.NM108 must be present.
X222 465 2420F NM108 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2420F.NM108 must be "XX".
X222 465 2420F NM109 010	Referring Provider Identifier	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 562: "Entity's National Provider Identifier (NPI)" EIC: DN "Referring Provider"	2420F.NM109 must be valid according to the NPI algorithm.
X222 465 2420F NM109 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 562: "Entity's National Provider Identifier (NPI)" EIC: DN "Referring Provider"	The first position of 2420F.NM109 must be a "1".
X222 465 2420F NM110 010	Entity Relationship Code	ID	2-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 465 2420F NM111 010	Entity Identifier Code	ID	2-3	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 465 2420F NM112 010	Name Last or Organization Name	AN	1-60	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 468 2420F REF 010	REFERRING PROVIDER SECONDARY IDENTIFICATION	N/A	20	S	N/A	N/A	999	IK304 = I9: "Implementation Dependent "Not Used" Segment Present"	If 2420F.NM1 is present and 2420F.NM109 is not present, 2420F.REF must be present.
X222 468 2420F REF 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 732: "Information submitted inconsistent with billing guidelines." CSC 560: "Entity's Additional/Secondary Identifier." EIC: DN "Referring Provider"	Only one iteration of 2420F.REF is allowed
X222 468 2420F REF 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK304 = I9: "Implementation Dependent "Not Used" Segment Present"	2420F.REF must not be present.
X222 468 2420F REF01 010	Reference Identification Qualifier	ID	2-3	R	N/A	0B, 1G, G2	999	IK403 = 1: "Required Data Element Missing"	2420F.REF01 must be present.
X222 468 2420F REF01 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 732: "Information submitted inconsistent with billing guidelines." CSC 560: "Entity's Additional/Secondary Identifier." EIC: DN "Referring Provider"	2420E.REF01 must be"1G".
X222 468 2420F REF02 010	Referring Provider Secondary Identifier	AN	1-50	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2420F.REF02 must be present.
X222 468 2420F REF02 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 133: "Entity's UPIN" 560 Entity's Additional/Secondary Identifier EIC: DN "Referring Provider"	2420F.REF02 must be in format ANNNNN or AAANNN (where A is an alpha character and N is a numeric digit).
X222 468 2420F REF03 010	Description	AN	1-80	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 468 2420F REF04 010	Reference Qualifier	N/A	N/A	S	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 470 2420G NM1 010	AMBULANCE PICK UP LOCATION	N/A	1	S	1	N/A	999	IK304 = 4: "Loop Occurs Over Maximum Times"	Only one iteration of 2420G.NM1 is allowed.
X222 470 2420G NM1 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK304 = I6: "Implementation Dependent Segment Missing"	If2420G.NM1 is present, 2310E.NM1 must be present
X222 470 2420G NM101 010	Entity Identifier Code	ID	2-3	R	N/A	PW	999	IK304 = 2: "Unexpected segment"	2420G.NM101 must be present.
X222 470 2420G NM102 010	Entity Type Qualifier	ID	1-1	R	N/A	2	999	IK403 = 1: "Required Data Element Missing"	2420G.NM102 must be present.
X222 470 2420G NM102 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2420G.NM102 must be "2".
X222 470 2420G NM103 010	Name Last or Organization Name	AN	1-60	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 470 2420G NM104 010	Name First	AN	1-35	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 470 2420G NM105 010	Name Middle	AN	1-25	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 470 2420G NM106 010	Name Prefix	AN	1-10	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 470 2420G NM107 010	Name Suffix	AN	1-10	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 470 2420G NM108 010	Identification Code Qualifier	ID	1-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 470 2420G NM109 010	Identification Code	AN	2-80	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 470 2420G NM110 010	Entity Relationship Code	ID	2-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 470 2420G NM111 010	Entity Identifier Code	ID	2-3	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 470 2420G NM112 010	Name Last or Organization Name	AN	1-60	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 472 2420G N3 010	AMBULANCE PICK UP LOCATION ADDRESS	N/A	1	R	N/A	N/A	999	IK304 = I6: "Implementation Dependent Segment Missing"	If 2420G.NM1 is present, 2420G.N3 must be present.
X222 472 2420G N3 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2420G.N3 is allowed.
X222 472 2420G N301 010	Ambulance Pick Up Address Line	AN	1-55	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2420G.N301 must be present.
X222 472 2420G N301 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2420G.N301 must contain at least one non-space character.
X222 472 2420G N301 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2420G.N301 must be 1 - 55 characters.
X222 472 2420G N301 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 503: "Entity's Street address" CSC 266: "Facility point of origin and destination - ambulance" EIC: 77 "Service Location"	N/A
X222 472 2420G N301 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2420G.N301 must be populated with accepted AN characters.
X222 472 2420G N302 020	Ambulance Pick Up Address Line	AN	1-55	S	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2420G.N302 must contain at least one non-space character.
X222 472 2420G N302 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2420G.N302 must be 1 - 55 characters.
X222 472 2420G N302 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 503: "Entity's Street address" CSC 266: "Facility point of origin and destination - ambulance" EIC: 77 "Service Location"	N/A
X222 472 2420G N302 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2420G.N302 must be populated with accepted AN characters.
X222 473 2420G N4 010	AMBULANCE PICK UP LOCATION CITY/STATE/ZIP	N/A	1	R	N/A	N/A	999	IK304 = I6: "Implementation Dependent Segment Missing"	If 2420G.NM1 is present, 2420G.N4 must be present.
X222 473 2420G N4 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2420G.N4 is allowed.
X222 473 2420G N401 010	Ambulance Pick Up City Name	AN	2-30	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2420G.N401 must be present.
X222 473 2420G N401 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2420G.N401 must contain at least two non-space characters.
X222 473 2420G N401 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 4: "Data Element Too Short" IK403 = 5: "Data Element Too Long"	2420G.N401 must be 2-30 characters.
X222 473 2420G N401 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 502: "Entity's City" CSC 266: "Facility point of origin and destination - ambulance" EIC: 77 "Service Location"	N/A
X222 473 2420G N401 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2420G.N401 must be populated with accepted AN characters.
X222 473 2420G N402 010	Ambulance Pick Up State or Province Code	ID	2-2	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2420G.N404 is not present, 2420G.N402 must be present.
X222 473 2420G N402 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 501: "Entity's State/Province" CSC 266: "Facility point of origin and destination - ambulance" EIC: 77 "Service Location"	2420G.N402 must be a valid State Code.
X222 473 2420G N403 010	Ambulance Pick Up Postal Zone ZIP Code	ID	3-15	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2420G.N404 is not present, 2420G.N403 must be present.
X222 473 2420G N403 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 500: "Entity's Postal/Zip Code" CSC 266: "Facility point of origin and destination - ambulance" EIC: 77 "Service Location"	2420G.N403 must be a valid Zip Code.
X222 473 2420G N404 010	Ambulance Pick Up Country Code	ID	2-3	S	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 473 2420G N405 010	Location Qualifier	ID	1-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 473 2420G N406 010	Location Identifier	AN	1-30	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 473 2420G N407 005	Country Subdivision Code	ID	1-3	S	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 475 2420H NM1 010	AMBULANCE DROP OFF LOCATION	N/A	1	S	1	N/A	999	IK304 = 4: "Loop Occurs Over Maximum Times"	Only one iteration of 2420H.NM1 is allowed.
X222 475 2420H NM1 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK304 = I6: "Implementation Dependent Segment Missing"	If2420H.NM1 is present, 2310F.NM1 must be present
X222 475 2420H NM101 010	Entity Identifier Code	ID	2-3	R	N/A	45	999	IK304 = 2: "Unexpected segment"	2420H.NM101 must be present.
X222 475 2420H NM102 010	Entity Type Qualifier	ID	1-1	R	N/A	2	999	IK403 = 1: "Required Data Element Missing"	2420H.NM102 must be present.
X222 475 2420H NM102 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2420H.NM102 must be "2".
X222 475 2420H NM103 010	Ambulance Drop Off Location	AN	1-60	S	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2420H.NM103 must contain at least one non-space character.
X222 475 2420H NM103 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2420H.NM103 must be 1 - 60 characters
X222 475 2420H NM103 025	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 504: "Entity's Last Name" CSC 266: "Facility point of origin and destination - ambulance" EIC: 77 "Service Location"	N/A
X222 475 2420H NM103 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2420H.NM103 must be populated with accepted AN characters.
X222 475 2420H NM104 010	Name First	AN	1-35	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 475 2420H NM105 010	Name Middle	AN	1-25	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 475 2420H NM106 010	Name Prefix	AN	1-10	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 475 2420H NM107 010	Name Suffix	AN	1-10	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 475 2420H NM108 010	Identification Code Qualifier	ID	1-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 475 2420H NM109 010	Identification Code	AN	2-80	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 475 2420H NM110 010	Entity Relationship Code	ID	2-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 475 2420H NM111 010	Entity Identifier Code	ID	2-3	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 475 2420H NM112 010	Name Last or Organization Name	AN	1-60	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 477 2420H N3 010	AMBULANCE DROP OFF LOCATION ADDRESS	N/A	1	R	N/A	N/A	999	IK304 = I6: "Implementation Dependent Segment Missing"	If 2420H.NM1 is present, 2420H.N3 must be present.
X222 477 2420H N3 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2420H.N3 is allowed.
X222 477 2420H N301 010	Ambulance Drop Off Address Line	AN	1-55	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2420H.N301 must be present.
X222 477 2420H N301 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2420H.N301 must contain at least one non-space character.
X222 477 2420H N301 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2420H.N301 must be 1 - 55 characters.
X222 477 2420H N301 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 503: "Entity's Street address" CSC 266: "Facility point of origin and destination - ambulance" EIC: 77 "Service Location"	N/A
X222 477 2420H N301 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2420H.N301 must be populated with accepted AN characters.
X222 477 2420H N302 020	Ambulance Drop Off Address Line	AN	1-55	S	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2420H.N302 must contain at least one non-space character.
X222 477 2420H N302 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2420H.N302 must be 1 - 55 characters.
X222 477 2420H N302 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 503: "Entity's Street address" CSC 266: "Facility point of origin and destination - ambulance" EIC: 77 "Service Location"	N/A
X222 477 2420H N302 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2420H.N302 must be populated with accepted AN characters.
X222 478 2420H N4 010	AMBULANCE DROP OFF LOCATION CITY/STATE/ZIP	N/A	1	R	N/A	N/A	999	IK304 = I6: "Implementation Dependent Segment Missing"	If 2420H.NM1 is present, 2420H.N4 must be present.
X222 478 2420H N4 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2420H.N4 is allowed.
X222 478 2420H N401 010	Ambulance Drop Off City Name	AN	2-30	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2420H.N401 must be present.
X222 478 2420H N401 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2420H.N401 must contain at least two non-space characters.
X222 478 2420H N401 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 4: "Data Element Too Short" IK403 = 5: "Data Element Too Long"	2420H.N401 must be 2-30 characters.
X222 478 2420H N401 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 502: "Entity's City" CSC 266: "Facility point of origin and destination - ambulance" EIC: 77 "Service Location"	N/A
X222 478 2420H N401 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2420H.N401 must be populated with accepted AN characters.
X222 478 2420H N402 010	Ambulance Drop Off State or Province Code	ID	2-2	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2420H.N404 is not present, 2420H.N402 must be present.
X222 478 2420H N402 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 501: "Entity's State/Province" CSC 266: "Facility point of origin and destination - ambulance" EIC: 77 "Service Location"	2420H.N402 must be a valid State Code.
X222 478 2420H N403 010	Ambulance Drop Off Postal Zone ZIP Code	ID	3-15	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2420H.N404 is not present, 2420H.N403 must be present.
X222 478 2420H N403 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 500: "Entity's Postal/Zip Code" CSC 266: "Facility point of origin and destination - ambulance" EIC: 77 "Service Location"	2420H.N403 must be a valid Zip Code.
X222 478 2420H N404 010	Ambulance Drop Off Country Code	ID	2-3	S	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 478 2420H N405 010	Location Qualifier	ID	1-2	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 478 2420H N406 010	Location Identifier	AN	1-30	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 478 2420H N407 005	Country Subdivision Code	ID	1-3	S	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 480 2430 010	Line Adjudication Loop	N/A	N/A	N/A	15	N/A	999	IK304 = 4: "Loop Occurs Over Maximum Times"	Only fifteen iterations of 2430 are allowed.
X222 480 2430 SVD 010	LINE ADJUDICATION INFORMATION	N/A	1	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2430.SVD is allowed.
X222 480 2430 SVD01 010	Other Payer Primary Identifier	AN	2-80	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2430.SVD01 must be present.
X222 480 2430 SVD01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = I12: "Implementation Pattern Match Failure"	2430.SVD01 must = 2330B.NM109 (for the same payer).
X222 480 2430 SVD02 010	Service Line Paid Amount	R	1-18	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2430.SVD02 must be present.
X222 480 2430 SVD02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2430.SVD02 must be numeric.
X222 480 2430 SVD02 040	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2430.SVD02 must be >= 0 and <= 99,999.99.
X222 480 2430 SVD02 050	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system"	N/A
X222 480 2430 SVD02 060	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 697: "Invalid Decimal Precision" CSC 643: "Service Line Paid Amount"	2430.SVD02 is limited to 0, 1 or 2 decimal positions.
X222 480 2430 SVD03-1 010	Product or Service ID Qualifier	ID	2-2	R	N/A	ER, HC, IV, WK	999	IK403 = 1: "Required Data Element Missing"	2430.SVD03-1 must be present.
X222 480 2430 SVD03-1 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 732: "Information submitted inconsistent with billing guidelines." CSC 745: "Identifier Qualifier." CSC 507: "HCPCS"	2430.SVD03-1 must be "HC".
X222 480 2430 SVD03-2 010	Procedure Code	AN	1-48	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2430.SVD03-2 must be present.
X222 480 2430 SVD03-2 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 507: "HCPCS" CSC 710:: "Line Adjudication Information"	When 2430.SVD03-1 = "HC", 2430.SVD03-2 must be a valid HCPCS Code on the date in 2400.DTP03 when DTP01 = "472".
X222 480 2430 SVD03-3 010	Procedure Modifier	AN	2-2	S	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 453: "Procedure Code Modifier(s) for Service(s) Rendered" CSC 710:: "Line Adjudication Information"	2430.SVD03-3 must be valid procedure modifier.
X222 480 2430 SVD03-3 020	N/A	AN	2-2	S	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 453: "Procedure Code Modifier(s) for Service(s) Rendered"	The procedure code modifiers in SVD03 must not be duplicated within the same detail service line.
X222 480 2430 SVD03-4 010	Procedure Modifier	AN	2-2	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	2430.SVD03-4 is present, 2430.SVD03-3 must be present.
X222 480 2430 SVD03-4 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 453: "Procedure Code Modifier(s) for Service(s) Rendered" CSC 710:: "Line Adjudication Information"	2430.SVD03-4 must be valid procedure modifier.
X222 480 2430 SVD03-5 010	Procedure Modifier	AN	2-2	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	2430.SVD03-5 is present, 2430.SVD03-4 must be present.
X222 480 2430 SVD03-5 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 453: "Procedure Code Modifier(s) for Service(s) Rendered" CSC 710:: "Line Adjudication Information"	2430.SVD03-5 must be valid procedure modifier.
X222 480 2430 SVD03-6 010	Procedure Modifier	AN	2-2	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	2430.SVD03-6 is present, 2430.SVD03-5 must be present.
X222 480 2430 SVD03-6 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 453: "Procedure Code Modifier(s) for Service(s) Rendered" CSC 710:: "Line Adjudication Information"	2430.SVD03-6 must be valid procedure modifier.
X222 480 2430 SVD03-7 010	Procedure Code Description	AN	1-80	S	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2430.SVD03-7 must contain at least one non-space character.
X222 480 2430 SVD03-7 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2430.SVD03-7 must be 1 - 80 characters.
X222 480 2430 SVD03-7 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 306: "Detailed description of service" CSC 710:: "Line Adjudication Information"	N/A
X222 480 2430 SVD03-7 040	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2430.SVD03-7 must be populated with accepted AN characters.
X222 480 2430 SVD03-8 010	Product/Service ID	AN	1-48	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 480 2430 SVD04 010	Product or Service ID	AN	1-48	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 480 2430 SVD05 010	Paid Service Unit Count	R	1-15	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2430.SVD05 must be present.
X222 480 2430 SVD05 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2430.SVD05 must be numeric.
X222 480 2430 SVD05 035	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2430.SVD05 must be >= 0 and <= 9,999.9.
X222 480 2430 SVD05 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement /Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 608: "Paid Service Unit Count" CSC 710: "Line Adjudication Information"	N/A
X222 480 2430 SVD06 010	Bundled or Unbundled Line Number	N0	1-6	S	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2430.SVD06 must be numeric.
X222 480 2430 SVD06 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2430.SVD06 must be a integer (whole number).
X222 480 2430 SVD06 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2430.SVD06 must 1 - 6 digits.
X222 480 2430 SVD06 035	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system"	N/A
X222 484 2430 CAS 010	LINE ADJUSTMENT	N/A	5	S	N/A	N/A	999	IK304 = I9: "Implementation Dependent "Not Used" Segment Present" OR IK304 = 2: "Unexpected Segment"	If 2430.CAS is present, 2430.SVD must be present.
X222 484 2430 CAS 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only five iterations of 2430.CAS are allowed.
X222 484 2430 CAS 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 41: Special handling required at payer site CSC 286: Other payer's Explanation of Benefits/payment information CSC 732: Information submitted inconsistent with billing guidelines	If 2000B.SBR01 = "P" then 2430.CAS must not be present.
X222 484 2430 CAS01 010	Claim Adjustment Group Code	ID	1-2	R	N/A	CO, CR, OA, PI, PR	999	IK403 = 1: "Required Data Element Missing"	2430.CAS01 must be present.
X222 484 2430 CAS01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2430.CAS01 must be valid values.
X222 484 2430 CAS01 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement /Rejected for Invalid Information..." CSC 521: "Adjustment Reason Code"	If 2430 CAS01 = "CR", "OA", or "PI": then 2430 CAS02 must not = 45, 2430 CAS05 must not = 45, 2430 CAS08 must not = 45, 2430 CAS11 must not = 45, 2430 CAS14 must not = 45, or 2430 CAS17 must not = 45.
X222 484 2430 CAS02 010	Adjustment Reason Code	ID	1-5	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2430.CAS02 must be present.
X222 484 2430 CAS02 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A8: "Acknowledgement/Rejected for relational field in error. CSC 521: Adjustment Reason Code CSC 516: Adjudication or Payment Date EIC: GB "Other Insured"	2430.CAS02 must be a valid Claim Adjustment Reason Code on the date in 2430.DTP03 when DTP01 = "573".
X222 484 2430 CAS03 010	Adjustment Amount	R	1-18	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2430.CAS03 must be present.
X222 484 2430 CAS03 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2430.CAS03 must be numeric.
X222 484 2430 CAS03 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 694: "Amount must not be equal to zero" CSC 519: "Adjustment Amount" EIC: GB "Other Insured"	2430.CAS03 must not = 0.
X222 484 2430 CAS03 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 697: "Invalid Decimal Precision" CSC 519: "Adjustment Amount" EIC: GB "Other Insured"	2430.CAS03 is limited to 0, 1 or 2 decimal positions.
X222 484 2430 CAS03 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2430.CAS03 must be >= -99,999.99 and <= 99,999.99.
X222 484 2430 CAS03 060	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 519: "Adjustment Amount" EIC: GB "Other Insured"	N/A
X222 484 2430 CAS04 010	Adjustment Quantity	R	1-15	S	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2320.CAS04 must be 1-15 digits.
X222 484 2430 CAS04 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 519: "Adjustment Amount" EIC: GB "Other Insured"	N/A
X222 484 2430 CAS04 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 694: "Amount must not be equal to zero" CSC 520: "Adjustment Quantity" EIC: GB "Other Insured"	2430.CAS04 must not = 0.
X222 484 2430 CAS05 010	Adjustment Reason Code	ID	1-5	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2430.CAS05 is present, 2430.CAS02 must be present.
X222 484 2430 CAS05 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A8: "Acknowledgement/Rejected for relational field in error. CSC 521: Adjustment Reason Code CSC 516: Adjudication or Payment Date EIC: GB "Other Insured"	2430.CAS05 must be a valid Claim Adjustment Reason Code on the date in 2430.DTP03 when DTP01 = "573".
X222 484 2430 CAS06 010	Adjustment Amount	R	1-18	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2430.CAS05 is present, 2430.CAS06 must be present.
X222 484 2430 CAS06 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2430.CAS06 must be numeric.
X222 484 2430 CAS06 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 694: "Amount must not be equal to zero" CSC 519: "Adjustment Amount" EIC: GB "Other Insured"	2430.CAS06 must not = 0.
X222 484 2430 CAS06 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 697: "Invalid Decimal Precision" CSC 519: "Adjustment Amount" EIC: GB "Other Insured"	2430.CAS06 is limited to 0, 1 or 2 decimal positions.
X222 484 2430 CAS06 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2430.CAS06 must be >= -99,999.99. and <= 99,999.99.
X222 484 2430 CAS06 060	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 519: "Adjustment Amount" EIC: GB "Other Insured"	N/A
X222 484 2430 CAS07 010	Adjustment Quantity	R	1-15	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2430.CAS07 is present, 2430.CAS05 must be present.
X222 484 2430 CAS07 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2320.CAS07 must be 1-15 digits.
X222 484 2430 CAS07 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 519: "Adjustment Amount" EIC: GB "Other Insured"	N/A
X222 484 2430 CAS07 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 694: "Amount must not be equal to zero" CSC 520: "Adjustment Quantity" EIC: GB "Other Insured"	2430.CAS07 must not = 0.
X222 484 2430 CAS08 010	Adjustment Reason Code	ID	1-5	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2430.CAS08 is present, 2430.CAS05 must be present.
X222 484 2430 CAS08 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A8: "Acknowledgement/Rejected for relational field in error. CSC 521: Adjustment Reason Code CSC 516: Adjudication or Payment Date EIC: GB "Other Insured"	2430.CAS08 must be a valid Claim Adjustment Reason Code on the date in 2430.DTP03 when DTP01 = "573".
X222 484 2430 CAS09 010	Adjustment Amount	R	1-18	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2430.CAS08 is present, 2430.CAS09 must be present.
X222 484 2430 CAS09 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2430.CAS09 must be numeric.
X222 484 2430 CAS09 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 694: "Amount must not be equal to zero" CSC 519: "Adjustment Amount" EIC: GB "Other Insured"	2430.CAS09 must not = 0.
X222 484 2430 CAS09 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 697: "Invalid Decimal Precision" CSC 519: "Adjustment Amount" EIC: GB "Other Insured"	2430.CAS09 is limited to 0, 1 or 2 decimal positions.
X222 484 2430 CAS09 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2430.CAS09 must be >= -99,999.99. and <= 99,999.99.
X222 484 2430 CAS09 060	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 519: "Adjustment Amount" EIC: GB "Other Insured"	N/A
X222 484 2430 CAS10 010	Adjustment Quantity	R	1-15	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2430.CAS10 is present, 2430.CAS08 must be present.
X222 484 2430 CAS10 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2320.CAS10 must be 1-15 digits.
X222 484 2430 CAS10 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 519: "Adjustment Amount" EIC: GB "Other Insured"	N/A
X222 484 2430 CAS10 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 694: "Amount must not be equal to zero" CSC 520: "Adjustment Quantity" EIC: GB "Other Insured"	2430.CAS10 must not = 0.
X222 484 2430 CAS11 010	Adjustment Reason Code	ID	1-5	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2430.CAS11 is present, 2430.CAS08 must be present.
X222 484 2430 CAS11 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A8: "Acknowledgement/Rejected for relational field in error. CSC 521: Adjustment Reason Code CSC 516: Adjudication or Payment Date EIC: GB "Other Insured"	2430.CAS011 must be a valid Claim Adjustment Reason Code on the date in 2430.DTP03 when DTP01 = "573".
X222 484 2430 CAS12 010	Adjustment Amount	R	1-18	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2430.CAS11 is present, 2430.CAS12 must be present.
X222 484 2430 CAS12 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2430.CAS12 must be numeric.
X222 484 2430 CAS12 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 694: "Amount must not be equal to zero" CSC 519: "Adjustment Amount" EIC: GB "Other Insured"	2430.CAS12 must not = 0.
X222 484 2430 CAS12 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 697: "Invalid Decimal Precision" CSC 519: "Adjustment Amount" EIC: GB "Other Insured"	2430.CAS12 is limited to 0, 1 or 2 decimal positions.
X222 484 2430 CAS12 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2430.CAS12 must be >= -99,999.99. and <= 99,999.99.
X222 484 2430 CAS12 060	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 519: "Adjustment Amount" EIC: GB "Other Insured"	N/A
X222 484 2430 CAS13 010	Adjustment Quantity	R	1-15	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2430.CAS13 is present, 2430.CAS11 must be present.
X222 484 2430 CAS13 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2320.CAS13 must be 1-15 digits.
X222 484 2430 CAS13 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 519: "Adjustment Amount" EIC: GB "Other Insured"	N/A
X222 484 2430 CAS13 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 694: "Amount must not be equal to zero" CSC 520: "Adjustment Quantity" EIC: GB "Other Insured"	2430.CAS13 must not = 0.
X222 484 2430 CAS14 010	Adjustment Reason Code	ID	1-5	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2430.CAS14 is present, 2430.CAS11 must be present.
X222 484 2430 CAS14 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A8: "Acknowledgement/Rejected for relational field in error. CSC 521: Adjustment Reason Code CSC 516: Adjudication or Payment Date EIC: GB "Other Insured"	2430.CAS014 must be a valid Claim Adjustment Reason Code on the date in 2430.DTP03 when DTP01 = "573".
X222 484 2430 CAS15 010	Adjustment Amount	R	1-18	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2430.CAS14 is present, 2430.CAS15 must be present.
X222 484 2430 CAS15 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2430.CAS15 must be numeric.
X222 484 2430 CAS15 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 694: "Amount must not be equal to zero" CSC 519: "Adjustment Amount" EIC: GB "Other Insured"	2430.CAS15 must not = 0.
X222 484 2430 CAS15 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 697: "Invalid Decimal Precision" CSC 519: "Adjustment Amount" EIC: GB "Other Insured"	2430.CAS15 is limited to 0, 1 or 2 decimal positions.
X222 484 2430 CAS15 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2430.CAS15 must be >= -99,999.99. and <= 99,999.99.
X222 484 2430 CAS15 060	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 519: "Adjustment Amount" EIC: GB "Other Insured"	N/A
X222 484 2430 CAS16 010	Adjustment Quantity	R	1-15	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2430.CAS16 is present, 2430.CAS14 must be present.
X222 484 2430 CAS16 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2320.CAS16 must be 1-15 digits.
X222 484 2430 CAS16 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 519: "Adjustment Amount" EIC: GB "Other Insured"	N/A
X222 484 2430 CAS16 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 694: "Amount must not be equal to zero" CSC 520: "Adjustment Quantity" EIC: GB "Other Insured"	2430.CAS16 must not = 0.
X222 484 2430 CAS17 010	Adjustment Reason Code	ID	1-5	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2430.CAS17 is present, 2430.CAS14 must be present.
X222 484 2430 CAS17 020	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A8: "Acknowledgement/Rejected for relational field in error. CSC 521: Adjustment Reason Code CSC 516: Adjudication or Payment Date EIC: GB "Other Insured"	2430.CAS017 must be a valid Claim Adjustment Reason Code on the date in 2430.DTP03 when DTP01 = "573".
X222 484 2430 CAS18 010	Adjustment Amount	R	1-18	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2430.CAS17 is present, 2430.CAS18 must be present.
X222 484 2430 CAS18 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2430.CAS18 must be numeric.
X222 484 2430 CAS18 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 694: "Amount must not be equal to zero" CSC 519: "Adjustment Amount" EIC: GB "Other Insured"	2430.CAS18 must not = 0.
X222 484 2430 CAS18 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 697: "Invalid Decimal Precision" CSC 519: "Adjustment Amount" EIC: GB "Other Insured"	2430.CAS18 is limited to 0, 1 or 2 decimal positions.
X222 484 2430 CAS18 050	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2430.CAS18 must be >= -99,999.99. and <= 99,999.99.
X222 484 2430 CAS18 060	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 519: "Adjustment Amount" EIC: GB "Other Insured"	N/A
X222 484 2430 CAS19 010	Adjustment Quantity	R	1-15	S	N/A	N/A	999	IK403 = 2: "Conditional Required Data Element Missing"	If 2430.CAS19 is present, 2430.CAS17 must be present.
X222 484 2430 CAS19 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2320.CAS19 must be 1-15 digits.
X222 484 2430 CAS19 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 519: "Adjustment Amount" EIC: GB "Other Insured"	N/A
X222 484 2430 CAS19 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 694: "Amount must not be equal to zero" CSC 520: "Adjustment Quantity" EIC: GB "Other Insured"	2430.CAS19 must not = 0.
X222 490 2430 DTP 010	LINE CHECK OR REMITTANCE DATE	N/A	1	R	N/A	N/A	999	IK304 = I6: "Implementation Dependent Segment Missing"	Per Payer, If 2430.SVD is present, 2430.DTP must be present.
X222 490 2430 DTP 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Per Payer, Only one iteration of 2430.DTP is allowed.
X222 490 2430 DTP01 010	Date Time Qualifier	ID	3-3	R	N/A	573	999	IK403 = 1: "Required Data Element Missing"	2430.DTP01 must be present.
X222 490 2430 DTP01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2430.DTP01 must be "573".
X222 490 2430 DTP02 010	Date Time Period Format Qualifier	ID	2-3	R	N/A	D8	999	IK403 = 1: "Required Data Element Missing"	2430.DTP02 must be present.
X222 490 2430 DTP02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2430.DTP02 must be "D8".
X222 490 2430 DTP03 010	Adjudication or Payment Date	AN	1-35	R	N/A	CCYYMMDD	999	IK403 = 1: "Required Data Element Missing"	2430.DTP03 must be present.
X222 490 2430 DTP03 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 8: "Invalid Date"	2430.DTP03 must be a valid date in the format of CCYYMMDD.
X222 490 2430 DTP03 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 510: "Future date" CSC 516 "Adjudication or Payment Date"	2430.DTP03 must not be a future date.
X222 491 2430 AMT 020	REMAINING PATIENT LIABILITY	N/A	1	S	N/A	N/A	999	IK304 = 5: "Segment Exceeds Maximum Use"	Only one iteration of 2430.AMT is allowed.
X222 491 2430 AMT 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A8: "Acknowledgement/Rejected for relational field in error" CSC 6: "Balance due from the subscriber". EIC: GB "Other Insured"	If 2320 AMT (EAF) is present for the same payer, the 2430 AMT (EAF) must not be present
X222 491 2430 AMT01 010	Amount Qualifier Code	ID	1-3	R	N/A	EAF	999	IK403 = 1: "Required Data Element Missing"	2430.AMT01 must be present.
X222 491 2430 AMT01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 7: "Invalid Code Value"	2430.AMT01 must be "EAF".
X222 491 2430 AMT02 005	Remaining Patient Liability Amount	R	1-18	R	N/A	N/A	999	IK403 = 1: "Required Data Element Missing"	2430.AMT02 must be present.
X222 491 2430 AMT02 010	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 6: "Invalid Character in Data Element"	2430.AMT02 must be numeric.
X222 491 2430 AMT02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK403 = 5: "Data Element Too Long"	2430.AMT02 must be <= 99,999.99.
X222 491 2430 AMT02 030	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 512: "Length invalid for receiver's application system" CSC 6: "Balance due from the subscriber" EIC: GB "Other Insured"	N/A
X222 491 2430 AMT02 040	N/A	N/A	N/A	N/A	N/A	N/A	277	CSCC A7: "Acknowledgement/Rejected for Invalid Information..." CSC 697: "Invalid Decimal Precision" CSC 6: "Balance due from the subscriber" EIC: GB "Other Insured"	2430.AMT02 is limited to 0, 1 or 2 decimal positions.
X222 491 2430 AMT03 010	Credit/Debit Flag Code	ID	1-1	N/U	N/A	N/A	999	IK403 = I10: "Implementation "Not Used" Element Present"	Must not be present.
X222 492 2440 LQ 010	Form Identification Form Loop	N/A	N/A	N/A	>1	N/A	N/A	N/A	N/A
X222 492 2440 LQ 015	FORM IDENTIFICATION CODE	N/A	1	S	1	N/A	999	IK304 = I9: "Implementation Dependent "Not Used" Segment Present"	2440.LQ must not be present.
X222 494 2440 FRM 005	SUPPORTING DOCUMENTATION	N/A	99	R	N/A	N/A	999	IK304 = I9: "Implementation Dependent "Not Used" Segment Present"	2440.FRM must not be present.
X222 496 SE 010	TRANSACTION SET TRAILER	N/A	1	R	>1	N/A	999	IK502 = 2: "Transaction Set Trailer Missing".	SE must be present.
X222 496 SE01 010	Transaction Segment Count	N0	1-10	R	N/A	N/A	999	IK502 = 4: "Number of Included Segments Does Not Match Actual Count".	SE01 must be present.
X222 496 SE01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK502 = 4: "Number of Included Segments Does Not Match Actual Count".	SE01 must be numeric.
X222 496 SE01 030	N/A	N/A	N/A	N/A	N/A	N/A	999	IK502 = 4: "Number of Included Segments Does Not Match Actual Count".	SE01 must equal the transaction segment count.
X222 496 SE01 040	N/A	N/A	N/A	N/A	N/A	N/A	999	IK502 = 4: "Number of Included Segments Does Not Match Actual Count".	SE01 must be > 0.
X222 496 SE02 010	Transaction Set Control Number	AN	4-9	R	N/A	N/A	999	IK502 = 3: "Transaction Set Control Number in Header and Trailer Do Not Match".	SE02 must be present.
X222 496 SE02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	IK502 = 3: "Transaction Set Control Number in Header and Trailer Do Not Match".	SE02 must = ST02.
X222 C8 GE 010	Functional Group Trailer	N/A	1	R	N/A	N/A	999	AK905 = 3: "Functional Group Trailer Missing"	GE must be present.
X222 C8 GE01 010	Number of Transaction Sets Included	N0	1-6	R	N/A	N/A	999	AK905 = 5: "Number of Included Transaction Sets Does Not Match Actual Count".	GE01 must be present.
X222 C8 GE01 020	N/A	N/A	N/A	N/A	N/A	N/A	999	AK905 = 5: "Number of Included Transaction Sets Does Not Match Actual Count".	GE01 must be numeric.
X222 C8 GE01 030	N/A	N/A	N/A	N/A	N/A	N/A	999	AK905 = 5: "Number of Included Transaction Sets Does Not Match Actual Count".	GE01 must equal the number of transaction sets included in the functional group.
X222 C8 GE01 040	N/A	N/A	N/A	N/A	N/A	N/A	999	AK905 = 5: "Number of Included Transaction Sets Does Not Match Actual Count".	GE01 must be > 0.
X222 C8 GE02 010	Group Control Number	N0	1-9	R	N/A	N/A	999	AK905 = 4: "Group Control Number in the Functional Group Header and Trailer Do Not Agree".	GE02 must be present.
X222 C8 GE02 020	N/A	N/A	N/A	N/A	N/A	N/A	999	AK905 = 4: "Group Control Number in the Functional Group Header and Trailer Do Not Agree".	GE02 must = GS06.
X222 C10 IEA 010	Interchange Control Header	N/A	1	R	N/A	N/A	TA1	TA105 = 022: "Invalid Control Structure" OR TA105 = 023: "Improper (Premature) End-of-File (Transmission)"OR TA105: 024 "Invalid Interchange Content".	IEA must be present.
X222 C3 IEA 015	N/A	N/A	N/A	N/A	N/A	N/A	TA1	TA105 = 022: "Invalid Control Structure" -OR- TA105 = 023: "Improper (Premature) End-of-File (Transmission)" -OR- TA105: 024 "Invalid Interchange Content".	Only one iteration of IEA is allowed.
X222 C10 IEA01 020	N/A	N/A	N/A	N/A	N/A	N/A	TA1	TA105 = 021: "Invalid Number of Included Groups Value".	IEA01 must be numeric.
X222 C10 IEA01 030	N/A	N/A	N/A	N/A	N/A	N/A	TA1	TA105 = 021: "Invalid Number of Included Groups Value".	IEA01 must equal the number of functional groups included in the interchange.
X222 C10 IEA01 040	N/A	N/A	N/A	N/A	N/A	N/A	TA1	TA105 = 021: "Invalid Number of Included Groups Value".	IEA01 must be > 0.
X222 C10 IEA02 010	Interchange Control Number	N0	9-9	R	N/A	N/A	TA1	TA105 = 001: "The Interchange Control Number in the Header and Trailer Do Not Match".	IEA02 must be present.
X222 C10 IEA02 020	N/A	N/A	N/A	N/A	N/A	N/A	TA1	TA105 = 001: "The Interchange Control Number in the Header and Trailer Do Not Match".	IEA02 must = ISA13

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