271–5010 Health Care Eligibility Benefit Response- Loop 2000A and 2100A Information Source Name

        

Use the Information Source Level HL to identify the original entity who responded  i.e Insurance Company

Hierarchical ID Number
A unique number assigned by the sender to identify a particular data segment in a hierarchical structure.

HL01 shall contain a unique alphanumeric number for each occurrence  of the HL segment in the transaction set. For example, HL01 could be used to indicate the number of occurrences of the HL segment, in which case the value of HL01 would be “1" for the initial HL segment and would be incremented by one in each subsequent HL segment within the transaction. HL01 must begin with “1" and be incremented by one each time an HL is used in the transaction. Only numeric values are allowed in HL01.

Loop	Seg ID	Segment Name	Format	Length	Ref#	Req	Value
2000A	HL	Billing Hierarchical Level		2		R	HL
		Element Separator	AN	1			*
	HL01	Hierarchical ID Number	AN	1/12	628	R	1
		Element Separator	AN	1			*
	HL02	Hierarchical Parent ID Number	0	1/12	734	Not Used
		Element Separator	AN	1			*
	HL03	Hierarchical Level Code	ID	1/2	735	R	20  (Information Source)
		Segment Terminator					~
	HL04	Hierarchical Child Code	ID	1/1	736	R	1
		Segment End					~

 

Loop 2100A Information Source Name

Seg ID	Segment Name	Format	Length	Ref#	Req	Value
NM1	Information Source Name	ID	3		R	NM1
	Element Separator	AN	1			*
NM101	Entity Identifier Code	ID	2/3	98	R	See below for Set of values
	Element Separator	AN	1			*
NM102	Entity Type qualifier	ID	1/1	1065	R	2 (See below for more Information)
	Element Separator	AN	1			*
NM103	Name Last or Organization Name	AN	1/60	1035	R	Insurance Name
	Element Separator	AN	1			*
NM104	Name First	AN	1/35	1036	Not used
	Element Separator	AN	1			*
NM105	Name Middle	AN	1/25	1037	Not Used
	Element Separator	AN	1			*
NM106	Name Prefix	AN	1/10	1038	Not used
	Element Separator	AN	1			*
NM107	Name Suffix	AN	1/10	1039	Not Used
	Element Separator	AN	1			*
NM108	Identification code Qualifier	ID	1/2	66	R	See below for Set of values
	Element Separator	AN	1			*
NM109	Identification code	AN	2/80	67	R	ID Value
	Segment Terminator					~

 

NM101 - Entity Identifier Code

Code List

Code	Definition
2B	Third Party Administrator
36	Employer
GP	Gateway Provider
P5	Plan Sponsor
PR	Payer

 

NM102 - Entity Type Qualifier

Code qualifying the type of entity

Code	Definition
1	Person
2	Non-Person Entity

 

NM108 – Identification Code Qualifier

Code List

Code	Definition
24	Employer Identification Number
46	Electronic Transmitter Identification Number (ETIN)
FI	Federal TaxPayers Identification Number
NI	National Association of Insurance Commissioners Identification
PI	Payor Identification
XV	Plan ID
XX	National Provider Identifier

Loop 2100A Information EDI Contact Information

Loop	Seg ID	Segment Name	Format	Length	Ref#	Req	Value
Header	PER	Submitter EDI Contact Information	ID	3		R	PER
		Element Separator	AN	1			*
	PER01	Contact Function Code	ID	2/2	366	R	IC
		Element Separator	AN	1			*
	PER02	Name	AN	1/60	93	R	contact Person Name for EDI Transmission issues.
		Element Separator	AN	1			*
	PER03	Communication Number qualifier	ID	2/2	365	R	See below for more information
		Element Separator	AN	1			*
	PER04	Communication Number	AN	1/256	364	R	Print Complete number including country code or area code when applicable.
		Element Separator	AN	1			*
	PER05	Communication Number qualifier	ID	2/2	365	R	See below for more information
		Element Separator	AN	1			*
	PER06	Communication Number	AN	1/256	364	R	Print Complete number including country code or area code when applicable.
	PER07	Communication Number qualifier	ID	2/2	365	R	See below for more information
		Element Separator	AN	1			*
	PER08	Communication Number	AN	1/256	364	R	Print Complete number including country code or area code when applicable.
		Segment Terminator					~

 

Communication Number qualifier

Code identifying the type of communication number.

Code	Definition
ED	Electronic data interchange Access Number.
EM	Electronic Mail
EX	Telephone Extension
FX	Facsimile
TE	Telephone.

 

Sample :
HL*1**20*1
NM1*PR*2*CGLIC*****FI*06-0303370
PER*IC**TE*8002446224*UR*cignaforhcp.cigna.com

        

Questions or feedback are always welcome. You can email me at vbsenthilinnet@gmail.com.