EDI 834 Benefit Enrollment and Maintenance — Data Dictionary

This page explains the current 767-column All Fields Smart Mapping layout for supported X12 EDI 834 005010X220A1 files.

Use it to understand member enrollment, subscriber and dependent information, coverage elections, plan dates, providers, reporting categories, and coordination-of-benefits data.

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CSV/Excel mapping of the current 767 output columns and their EDI 834 sources. No PHI.

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Column Definitions

Applies to the Client-Side EDI 834 benefit enrollment and maintenance layout
ColumnEDI SourceDescription
File Name N/A (converter) Name of the input 834 EDI file. Useful when processing enrollments from multiple files.
ID N/A (converter) Stable row identifier assigned by the converter. This is not an EDI-native value.
Transaction Type ST01 / ST03 (normalized) Normalized transaction type. Use 834 when ST01 is 834 and the implementation reference identifies 005010X220A1.
Record Type N/A (converter; derived from INS/HD) Identifies the output row as Subscriber Coverage, Dependent Coverage, Subscriber Member Record, or Dependent Member Record.
Enrollment Detail Number N/A (converter) Sequential output-detail number within the ST/SE transaction.
Member Number N/A (converter) Sequential 2000 Member Level Detail occurrence number within the ST/SE transaction.
Coverage Number N/A (converter) Sequential 2300 Health Coverage occurrence number within the active member. Blank for a member-only row with no HD segment.
Member Type INS01 / INS02 (derived) Human-readable member type such as Subscriber, Spouse, Child, or Other Dependent.
Subscriber Indicator INS01 Indicates whether the member is the subscriber. Source values are normally Y for subscriber and N for dependent.
Subscriber Indicator Description INS01 code translation Human-readable subscriber or dependent interpretation of INS01.
Enrollment Action INS03 / INS04 (derived) Human-readable member-level maintenance action, such as add, change, cancel/terminate, reinstate, audit/compare, or correction.
Coverage Action HD01 / HD02 (derived) Human-readable coverage-level maintenance action. Blank for a member-only row without HD.
Enrollment Status INS05 / INS08 / INS09 (derived) Converter-generated convenience composite formatted as Benefit: <INS05 description>; Employment: <INS08 description>; Student: <INS09 description>. Optional blank parts are omitted; the separate raw code fields remain authoritative.
Coverage Type HD03 / HD04 (derived) Human-readable coverage product or insurance line, including the plan coverage description when supplied.
Has Coverage Detail 2300 HD presence (derived) Yes when the row represents a 2300 Health Coverage occurrence; No when the member has no HD and a member-only row is emitted.
Member Summary INS/REF/DTP/NM1/DMG (derived) Concise human-readable summary of the member relationship, maintenance action, status, identifiers, and key dates.
Coverage Summary HD/DTP/AMT/REF/IDC/2310/2320 (derived) Concise human-readable summary of the coverage action, insurance line, plan, coverage level, dates, amounts, provider, and COB details.
Coverage Source Loop 2000 or 2300 X12 loop represented by the row. Use 2300 for a coverage row and 2000 for a member-only row.
834 Transaction Control Number ST02 Transaction set control number assigned to the 834 enrollment transaction.
834 Implementation Guide Version ST03 Implementation convention reference for the transaction, normally 005010X220A1.
Transaction Set Purpose Code BGN01 Purpose code for the enrollment transaction.
Transaction Set Purpose Code Description BGN01 code translation Human-readable description of the BGN transaction set purpose code.
Transaction Set Reference Number BGN02 Sender-assigned reference number uniquely identifying the enrollment transaction.
Transaction Creation Date BGN03 Date the 834 transaction was created.
Transaction Creation Time BGN04 Time the 834 transaction was created.
Transaction Time Zone Code BGN05 Time zone code associated with the BGN creation time when supplied.
Transaction Time Zone Code Description BGN05 code translation Human-readable description of the BGN time zone code.
Original Transaction Reference Number BGN06 Reference number of the original transaction when this transaction relates to a prior transmission.
Transaction Action Code BGN08 Action code for the enrollment transmission, including full replacement when BGN08 is RX.
Transaction Action Code Description BGN08 code translation Human-readable description of the BGN action code.
Other BGN Data BGN09 only Current Smart Mapping compatibility field for BGN09. BGN07 and other unlisted BGN elements are not included in this field.
Transaction Reference Qualifier Header REF REF01 Qualifier identifying the transaction-level policy or reference reference in REF02.
Transaction Reference Qualifier Description Header REF REF01 code translation Human-readable description of the transaction-level policy or reference reference qualifier.
Transaction Reference ID Header REF REF02 Reference identifier for the transaction-level policy or reference. Preserve leading zeros and source formatting.
Transaction Reference Description Header REF REF03 Description associated with the transaction-level policy or reference reference when supplied.
All Transaction References All Header REF segments Serialized convenience representation of recognized transaction-level policy or reference REF segments in source order; not a complete X12 hierarchy.
Master Policy Number Header REF02 when REF01=38 Master policy number applying to the entire 834 transaction set when supplied.
Transaction Date Qualifier Header DTP DTP01 Qualifier identifying the type of transaction-level effective date or date range.
Transaction Date Qualifier Description Header DTP DTP01 code translation Human-readable description of the transaction-level effective date qualifier.
Transaction Date Format Header DTP DTP02 Format qualifier for the transaction-level effective date or date range.
Transaction Date/Range Header DTP DTP03 Date or date range for the transaction-level effective. Preserve the exact source string.
All Transaction Dates All Header DTP segments Serialized convenience representation of recognized transaction-level effective DTP segments in source order; not a complete X12 hierarchy.
File Effective Date Header DTP03 when DTP01=007 Transaction-level file effective date.
Report Start Date Header DTP03 when DTP01=090 Transaction-level report start date.
Report End Date Header DTP03 when DTP01=091 Transaction-level report end date.
File Maintenance Effective Date Header DTP03 when DTP01=303 Transaction-level maintenance effective date.
File Enrollment Date Header DTP03 when DTP01=382 Transaction-level enrollment date.
Payment Commencement Date Header DTP03 when DTP01=388 Transaction-level payment commencement date.
Transaction Quantity Qualifier Header QTY01 Qualifier identifying the transaction control total in QTY02.
Transaction Quantity Qualifier Description Header QTY01 code translation Human-readable description of the transaction quantity qualifier.
Transaction Quantity Header QTY02 Quantity or control total reported for the transaction.
Transaction Quantity Unit Header QTY03 composite Compatibility-only field for nonconforming trading-partner input. QTY03 is not used by X220A1; when nevertheless supplied the current mapper exposes its source value without asserting guide conformance.
Transaction Quantity Message Header QTY04 Compatibility-only field for nonconforming trading-partner input. QTY04 is not used by X220A1; when nevertheless supplied the current mapper exposes its source value without asserting guide conformance.
Reported Employee Total Header QTY02 when QTY01=ET Employee or subscriber total reported in the transaction control totals.
Reported Dependent Total Header QTY02 when QTY01=DT Dependent total reported in the transaction control totals.
Reported Member Total Header QTY02 when QTY01=TO Total member record count reported in the transaction control totals.
All Transaction Quantities All Header QTY segments Serialized convenience representation of recognized transaction-level QTY control totals in source order; not a complete X12 hierarchy.
Transaction Segment Count SE01 Number of segments reported from ST through SE, inclusive.
Transaction Trailer Control Number SE02 Transaction set control number from the SE trailer; should match ST02.
Functional Identifier Code GS01 Functional identifier code for the group containing the 834, normally BE.
Functional Group Sender Code GS02 Application sender code for the functional group containing the 834.
Functional Group Receiver Code GS03 Application receiver code for the functional group containing the 834.
Functional Group Creation Date GS04 Date the functional group containing the 834 was created.
Functional Group Creation Time GS05 Time the functional group containing the 834 was created.
834 Group Control Number GS06 Functional-group control number of the group containing the 834.
Responsible Agency Code GS07 Code identifying the standards organization responsible for the implementation guide, normally X.
834 Group Version GS08 Version, release, and implementation-guide identifier of the functional group containing the 834.
Functional Group Transaction Count GE01 Number of transaction sets reported in the functional-group trailer.
Functional Group Trailer Control Number GE02 Functional-group control number in GE; should match GS06.
Authorization Information Qualifier ISA01 Qualifier identifying the type of authorization information in ISA02.
Authorization Information ISA02 Authorization information from the interchange header. Preserve fixed-width source content according to existing privacy rules.
Security Information Qualifier ISA03 Qualifier identifying the type of security information in ISA04.
Security Information ISA04 Security information from the interchange header. Preserve fixed-width source content according to existing privacy rules.
Interchange Sender Qualifier ISA05 Qualifier identifying the type of interchange sender identifier used in ISA06.
Interchange Sender ID ISA06 Interchange sender identifier. Fixed-width ISA padding should be trimmed for display and export.
Interchange Receiver Qualifier ISA07 Qualifier identifying the type of interchange receiver identifier used in ISA08.
Interchange Receiver ID ISA08 Interchange receiver identifier. Fixed-width ISA padding should be trimmed for display and export.
Interchange Date ISA09 Date the interchange containing the 834 was created.
Interchange Time ISA10 Time the interchange containing the 834 was created.
Repetition Separator ISA11 Repetition separator defined by the interchange and used for repeated values where applicable.
Interchange Control Version ISA12 Interchange control version number.
Interchange Control Number ISA13 Interchange control number assigned to the interchange containing the 834.
Acknowledgment Requested ISA14 Indicates whether an interchange acknowledgment is requested.
Interchange Usage Indicator ISA15 Indicates whether the interchange is production, test, or information.
Component Element Separator ISA16 Component element separator defined by the interchange.
Interchange Functional Group Count IEA01 Number of functional groups reported in the interchange trailer.
Interchange Trailer Control Number IEA02 Interchange control number in IEA; should match ISA13.
Sponsor Entity Code 1000A N1*P5 N101 Entity Identifier Code from an N1 segment routed to the sponsor role because N101 is P5; routing is qualifier-based rather than position-based.
Sponsor Entity Code Description 1000A N1*P5 N101 code translation Human-readable description of the sponsor N101=P5 entity code.
Sponsor Name 1000A N102 Name of the sponsor or benefit plan sponsor.
Sponsor ID Qualifier 1000A N103 Qualifier identifying the sponsor or benefit plan sponsor identifier in N104.
Sponsor ID Qualifier Description 1000A N103 code translation Human-readable description of the sponsor or benefit plan sponsor identifier qualifier.
Sponsor ID 1000A N104 Identifier for the sponsor or benefit plan sponsor. Preserve leading zeros and other source formatting.
Sponsor Relationship Code 1000A N105 Relationship code supplied for the sponsor or benefit plan sponsor when present.
Sponsor Relationship Code Description 1000A N105 code translation Human-readable description of the sponsor or benefit plan sponsor relationship code.
Sponsor Additional Entity Code 1000A N106 Additional Entity Identifier Code supplied for the sponsor or benefit plan sponsor when present.
Sponsor Additional Entity Code Description 1000A N106 code translation Human-readable description of the additional sponsor or benefit plan sponsor entity code.
Payer Entity Code 1000B N1*IN N101 Entity Identifier Code from an N1 segment routed to the payer role because N101 is IN; routing is qualifier-based rather than position-based.
Payer Entity Code Description 1000B N1*IN N101 code translation Human-readable description of the payer N101=IN entity code.
Payer Name 1000B N102 Name of the payer or insurer.
Payer ID Qualifier 1000B N103 Qualifier identifying the payer or insurer identifier in N104.
Payer ID Qualifier Description 1000B N103 code translation Human-readable description of the payer or insurer identifier qualifier.
Payer ID 1000B N104 Identifier for the payer or insurer. Preserve leading zeros and other source formatting.
Payer Relationship Code 1000B N105 Relationship code supplied for the payer or insurer when present.
Payer Relationship Code Description 1000B N105 code translation Human-readable description of the payer or insurer relationship code.
Payer Additional Entity Code 1000B N106 Additional Entity Identifier Code supplied for the payer or insurer when present.
Payer Additional Entity Code Description 1000B N106 code translation Human-readable description of the additional payer or insurer entity code.
TPA or Broker Entity Code 1000C N1*BO N101 Entity Identifier Code from an N1 segment routed to the TPA or broker role because N101 is BO; routing is qualifier-based rather than position-based.
TPA or Broker Entity Code Description 1000C N1*BO N101 code translation Human-readable description of the TPA or broker N101=BO entity code.
TPA or Broker Name 1000C N102 Name of the third-party administrator or broker.
TPA or Broker ID Qualifier 1000C N103 Qualifier identifying the third-party administrator or broker identifier in N104.
TPA or Broker ID Qualifier Description 1000C N103 code translation Human-readable description of the third-party administrator or broker identifier qualifier.
TPA or Broker ID 1000C N104 Identifier for the third-party administrator or broker. Preserve leading zeros and other source formatting.
TPA or Broker Relationship Code 1000C N105 Relationship code supplied for the third-party administrator or broker when present.
TPA or Broker Relationship Code Description 1000C N105 code translation Human-readable description of the third-party administrator or broker relationship code.
TPA or Broker Additional Entity Code 1000C N106 Additional Entity Identifier Code supplied for the third-party administrator or broker when present.
TPA or Broker Additional Entity Code Description 1000C N106 code translation Human-readable description of the additional third-party administrator or broker entity code.
TPA or Broker Account Number 1100C ACT01 Account number associated with the TPA or broker.
TPA or Broker Account Name 1100C ACT02 Name associated with the TPA or broker account.
TPA or Broker Account ID Qualifier 1100C ACT03 Qualifier identifying the account identifier in ACT04.
TPA or Broker Account ID Qualifier Description 1100C ACT03 code translation Human-readable description of the TPA or broker account identifier qualifier.
TPA or Broker Account ID 1100C ACT04 Identifier associated with the TPA or broker account.
TPA or Broker Additional Account Number 1100C ACT05 Additional account number associated with the TPA or broker when supplied.
TPA or Broker Account Number Qualifier 1100C ACT06 Qualifier identifying the type of additional account number.
TPA or Broker Account Number Qualifier Description 1100C ACT06 code translation Human-readable description of the additional account number qualifier.
TPA or Broker Account Description 1100C ACT07 Description of the TPA or broker account.
TPA or Broker Payment Method Code 1100C ACT08 Payment method type code for the account when supplied.
TPA or Broker Payment Method Code Description 1100C ACT08 code translation Human-readable description of the account payment method code.
TPA or Broker Account Benefit Status Code 1100C ACT09 Benefit status code associated with the account when supplied.
TPA or Broker Account Benefit Status Code Description 1100C ACT09 code translation Human-readable description of the account benefit status code.
All TPA or Broker Account Data All 1100C ACT segments Serialized convenience representation of recognized TPA or broker ACT account information in source order; not a complete X12 hierarchy.
Member Indicator 2000 INS01 Y/N indicator identifying the member as subscriber or dependent.
Member Indicator Description 2000 INS01 code translation Human-readable subscriber/dependent interpretation of INS01.
Individual Relationship Code 2000 INS02 Code identifying the member relationship to the subscriber.
Individual Relationship Code Description 2000 INS02 code translation Human-readable member relationship description.
Member Maintenance Type Code 2000 INS03 Member-level maintenance action code.
Member Maintenance Type Code Description 2000 INS03 code translation Human-readable description of the member maintenance type.
Member Maintenance Reason Code 2000 INS04 Reason code for the member-level maintenance action when supplied.
Member Maintenance Reason Code Description 2000 INS04 code translation Human-readable description of the member maintenance reason.
Benefit Status Code 2000 INS05 Code identifying the member benefit status.
Benefit Status Code Description 2000 INS05 code translation Human-readable description of the benefit status.
Medicare Plan Code 2000 INS06-1 Medicare plan code from the member Medicare-status composite when supplied.
Medicare Plan Code Description 2000 INS06-1 code translation Human-readable description of the Medicare plan code.
Medicare Eligibility Reason Code 2000 INS06-2 Medicare eligibility reason from the member Medicare-status composite when supplied.
Medicare Eligibility Reason Code Description 2000 INS06-2 code translation Human-readable description of the Medicare eligibility reason.
Other Medicare Status Data Not currently mapped (reserved compatibility field) Reserved compatibility column that remains blank in current Smart Mapping; no INS06 remainder is projected here.
COBRA Qualifying Event Code 2000 INS07 COBRA qualifying event code for the member when supplied.
COBRA Qualifying Event Code Description 2000 INS07 code translation Human-readable description of the COBRA qualifying event.
Employment Status Code 2000 INS08 Employment status code for the member.
Employment Status Code Description 2000 INS08 code translation Human-readable description of the member employment status.
Student Status Code 2000 INS09 Student status code for the member.
Student Status Code Description 2000 INS09 code translation Human-readable description of the member student status.
Handicap Indicator 2000 INS10 Indicator specifying whether the member is handicapped or disabled according to the source transaction.
Handicap Indicator Description 2000 INS10 code translation Human-readable description of the handicap indicator.
Member Death Date Format 2000 INS11 Format qualifier for the member death date in INS12.
Member Death Date 2000 INS12 Member death date when supplied. Preserve the source date string.
Member Confidentiality Code 2000 INS13 Confidentiality code associated with the member.
Member Confidentiality Code Description 2000 INS13 code translation Human-readable description of the member confidentiality code.
Member Birth Sequence Number 2000 INS17 Birth sequence number used to distinguish members in a multiple birth when supplied.
Other INS Data 2000 INS14-INS16 and remainder Partial indexed convenience representation of nonblank INS14 and later elements; it is not a complete INS remainder or hierarchy.
Subscriber Identifier 2000 REF02 when REF01=0F Subscriber identifier used to associate the member with the subscriber record. Preserve leading zeros.
Member Policy or Group Number 2000 REF02 when REF01=1L Group or policy number assigned by the payer to the group in which the member participates.
Member Supplemental Identifier Count Additional 2000 REF occurrence count Number of member supplemental identifier REF occurrences excluding dedicated subscriber and policy-number references.
Primary Member Supplemental Reference Qualifier 2000 supplemental REF01 Qualifier identifying the member supplemental identifier reference in REF02.
Primary Member Supplemental Reference Qualifier Description 2000 supplemental REF01 code translation Human-readable description of the member supplemental identifier reference qualifier.
Primary Member Supplemental Reference ID 2000 supplemental REF02 Reference identifier for the member supplemental identifier. Preserve leading zeros and source formatting.
Primary Member Supplemental Reference Description 2000 supplemental REF03 Description associated with the member supplemental identifier reference when supplied.
All Member Supplemental Identifiers All 2000 supplemental REF segments Serialized convenience representation of recognized member supplemental identifier REF segments in source order; not a complete X12 hierarchy.
All Member References All 2000 REF segments Serialized convenience representation of recognized member-level REF segments, including subscriber, policy, and supplemental identifiers, in source order; not a complete X12 hierarchy.
Primary Member Date Qualifier 2000 DTP01 Qualifier identifying the type of member-level date or date range.
Primary Member Date Qualifier Description 2000 DTP01 code translation Human-readable description of the member-level date qualifier.
Primary Member Date Format 2000 DTP02 Format qualifier for the member-level date or date range.
Primary Member Date/Range 2000 DTP03 Date or date range for the member-level. Preserve the exact source string.
All Member Dates All 2000 DTP segments Serialized convenience representation of recognized member-level DTP segments in source order; not a complete X12 hierarchy.
Member Received Date 2000 DTP03 when DTP01=050 Member-level received date or date range.
Member Retirement Date 2000 DTP03 when DTP01=286 Member-level retirement date or date range.
Disability Return-to-Work Date 2000 DTP03 when DTP01=296 Member-level disability return-to-work date or date range.
Last Day Worked 2000 DTP03 when DTP01=297 Member-level last day worked date or date range.
Member Enrollment Signature Date 2000 DTP03 when DTP01=300 Member-level enrollment signature date or date range.
COBRA Qualifying Event Date 2000 DTP03 when DTP01=301 Member-level COBRA qualifying event date or date range.
Member Maintenance Effective Date 2000 DTP03 when DTP01=303 Member-level maintenance effective date or date range.
Employment Begin Date 2000 DTP03 when DTP01=336 Member-level employment begin date or date range.
Employment End Date 2000 DTP03 when DTP01=337 Member-level employment end date or date range.
Medicare Begin Date 2000 DTP03 when DTP01=338 Member-level Medicare begin date or date range.
Medicare End Date 2000 DTP03 when DTP01=339 Member-level Medicare end date or date range.
COBRA Begin Date 2000 DTP03 when DTP01=340 Member-level COBRA begin date or date range.
COBRA End Date 2000 DTP03 when DTP01=341 Member-level COBRA end date or date range.
Education Begin Date 2000 DTP03 when DTP01=350 Member-level education begin date or date range.
Education End or Expected Graduation Date 2000 DTP03 when DTP01=351 Member-level education end or expected graduation date or date range.
Member Eligibility Begin Date 2000 DTP03 when DTP01=356 Member-level eligibility begin date or date range.
Member Eligibility End Date 2000 DTP03 when DTP01=357 Member-level eligibility end date or date range.
Member Entity Code 2100A NM101 Entity Identifier Code for the member.
Member Entity Code Description 2100A NM101 code translation Human-readable description of the member entity code.
Member Entity Type 2100A NM102 Entity type qualifier indicating whether the member is a person or organization.
Member Last Name or Organization Name 2100A NM103 Last name or organization name of the member.
Member First Name 2100A NM104 First name of the member when the entity is a person.
Member Middle Name 2100A NM105 Middle name or initial of the member when supplied.
Member Name Prefix 2100A NM106 Name prefix of the member when supplied.
Member Name Suffix 2100A NM107 Name suffix of the member when supplied.
Member ID Qualifier 2100A NM108 Qualifier identifying the member identifier in NM109.
Member ID Qualifier Description 2100A NM108 code translation Human-readable description of the member identifier qualifier.
Member ID 2100A NM109 Identifier for the member. Preserve leading zeros and other source formatting.
Member Relationship Code 2100A NM110 Entity relationship code for the member when supplied.
Member Relationship Code Description 2100A NM110 code translation Human-readable description of the member relationship code.
Member Additional Entity Code 2100A NM111 Additional Entity Identifier Code for the member when supplied.
Member Additional Entity Code Description 2100A NM111 code translation Human-readable description of the additional member entity code.
Member Additional Last Name or Organization Name 2100A NM112 Additional last name or organization name for the member when supplied.
Member Full Name 2100A NM103-NM107 (derived) Human-readable full name assembled from the member name components without changing the source fields.
Member Contact Function Code First 2100A PER01 Code identifying the function of the member contact.
Member Contact Function Code Description First 2100A PER01 code translation Human-readable description of the member contact function.
Member Contact Name First 2100A PER02 Name of the member contact.
Member Communication Qualifier 1 First 2100A PER03 Qualifier identifying communication value 1 in PER04.
Member Communication Qualifier 1 Description First 2100A PER03 code translation Human-readable description of communication qualifier 1.
Member Communication Value 1 First 2100A PER04 Phone number, email address, or other communication value 1 for the member.
Member Communication Qualifier 2 First 2100A PER05 Qualifier identifying communication value 2 in PER06.
Member Communication Qualifier 2 Description First 2100A PER05 code translation Human-readable description of communication qualifier 2.
Member Communication Value 2 First 2100A PER06 Phone number, email address, or other communication value 2 for the member.
Member Communication Qualifier 3 First 2100A PER07 Qualifier identifying communication value 3 in PER08.
Member Communication Qualifier 3 Description First 2100A PER07 code translation Human-readable description of communication qualifier 3.
Member Communication Value 3 First 2100A PER08 Phone number, email address, or other communication value 3 for the member.
Member Contact Inquiry Reference First 2100A PER09 Contact inquiry reference for the member when supplied.
All Member Contacts All 2100A PER segments Serialized convenience representation of recognized member contact segments in source order; not a complete X12 hierarchy.
Member Residence Address Line 1 2100A N301 First address line for the member residence.
Member Residence Address Line 2 2100A N302 Second address line for the member residence.
Member Residence City 2100A N401 City for the member residence.
Member Residence State or Province 2100A N402 State or province code for the member residence.
Member Residence Postal Code 2100A N403 Postal code for the member residence. Preserve leading zeros.
Member Residence Country Code 2100A N404 Country code for the member residence when supplied.
Member Residence Location Qualifier 2100A N405 Qualifier identifying the location identifier in N406.
Member Residence Location Qualifier Description 2100A N405 code translation Human-readable description of the member residence location qualifier.
Member Residence Location ID 2100A N406 Location identifier for the member residence.
Member Residence Country Subdivision Code 2100A N407 Country subdivision code for the member residence when supplied.
Member Residence Formatted Address 2100A N3/N4 (derived) Human-readable address assembled from the member residence address fields without changing the source values.
Member Demographic Date Format 2100A DMG01 Format qualifier for the member birth date in DMG02.
Member Birth Date 2100A DMG02 Member date of birth. Preserve the exact source value and treat it as date-only data.
Member Gender Code 2100A DMG03 Member gender code.
Member Gender Code Description 2100A DMG03 code translation Human-readable description of the member gender code.
Member Marital Status Code 2100A DMG04 Member marital status code when supplied.
Member Marital Status Code Description 2100A DMG04 code translation Human-readable description of the member marital status code.
Primary Race or Ethnicity Code 2100A DMG05-1 First race or ethnicity code from the repeating DMG05 composite.
Primary Race or Ethnicity Description 2100A DMG05-1 code translation Human-readable description of the primary race or ethnicity code.
Race or Ethnicity Code Count 2100A DMG05 repeat count Number of race or ethnicity codes reported in DMG05.
All Race or Ethnicity Codes All 2100A DMG05 repetitions Serialized convenience representation of recognized DMG05 race or ethnicity repetitions in source order.
Member Citizenship Status Code 2100A DMG06 Member citizenship status code when supplied.
Member Citizenship Status Code Description 2100A DMG06 code translation Human-readable description of the member citizenship status code.
Member Country Code 2100A DMG07 Country code associated with the member demographic information.
Demographic Verification Basis Code 2100A DMG08 Code identifying the basis used to verify demographic information.
Demographic Verification Basis Code Description 2100A DMG08 code translation Human-readable description of the demographic verification basis code.
Demographic Quantity 2100A DMG09 Demographic quantity supplied in DMG09 when present.
Demographic Code List Qualifier 2100A DMG10 Code list qualifier associated with the demographic industry code in DMG11.
Demographic Industry Code 2100A DMG11 Industry code associated with the demographic code list qualifier.
Other Member Demographic Data Not currently mapped (reserved compatibility field) Reserved compatibility column that remains blank in current Smart Mapping; no DMG remainder is projected here.
Employment Class Code 1 2100A EC01 Employment class code 1 for the member.
Employment Class Code 1 Description 2100A EC01 code translation Human-readable description of employment class code 1.
Employment Class Code 2 2100A EC02 Employment class code 2 for the member.
Employment Class Code 2 Description 2100A EC02 code translation Human-readable description of employment class code 2.
Employment Class Code 3 2100A EC03 Employment class code 3 for the member.
Employment Class Code 3 Description 2100A EC03 code translation Human-readable description of employment class code 3.
Employment Class Percentage 2100A EC04 Percentage associated with the employment class information when supplied.
Employment Class Information Status Code 2100A EC05 Information status code for the employment class data.
Employment Class Information Status Code Description 2100A EC05 code translation Human-readable description of the employment-class information status.
Employment Occupation Code 2100A EC06 Occupation code associated with the employment class information.
Employment Occupation Code Description 2100A EC06 code translation Human-readable description of the employment occupation code when a scoped translation is available.
All Employment Class Data All 2100A EC segments Serialized convenience representation of recognized member employment-class segments in source order; not a complete X12 hierarchy.
Income Frequency Code 2100A ICM01 Frequency at which the member income or wages are reported.
Income Frequency Code Description 2100A ICM01 code translation Human-readable description of the income frequency code.
Member Income Amount 2100A ICM02 Monetary amount of member income or wages.
Member Work Hours 2100A ICM03 Quantity of work hours associated with the reported income.
Member Work Location ID 2100A ICM04 Location identifier associated with the member income record.
Member Salary Grade 2100A ICM05 Salary grade associated with the member income record.
Member Income Currency Code 2100A ICM06 Currency code for the member income amount when supplied.
Member Amount Count 2100A AMT occurrence count Number of member-level monetary amount segments.
Primary Member Amount Qualifier 2100A AMT01 Qualifier identifying the primary member-level amount in AMT02.
Primary Member Amount Qualifier Description 2100A AMT01 code translation Human-readable description of the primary member amount qualifier.
Primary Member Amount 2100A AMT02 Primary member-level monetary amount.
All Member Amounts All 2100A AMT segments Serialized convenience representation of recognized member-level amount qualifiers and values in source order; not a complete X12 hierarchy.
Member Health-Related Code 2100A HLH01 Code indicating a specific health situation such as tobacco use or substance abuse.
Member Health-Related Code Description 2100A HLH01 code translation Human-readable description of the member health-related code.
Member Height 2100A HLH02 Member height, reported in inches under the X220A1 implementation.
Member Weight 2100A HLH03 Member weight value from HLH03.
Member Additional Weight 2100A HLH04 Additional weight value from HLH04 when supplied.
Member Health Description 2100A HLH05 Free-form member health description.
Member Current Health Code 2100A HLH06 Current health code for the member when supplied.
Member Current Health Code Description 2100A HLH06 code translation Human-readable description of the member current-health code.
Member Current Health Description 2100A HLH07 Free-form description associated with the current health code.
Member Language Count 2100A LUI occurrence count Number of language-use segments reported for the member.
Primary Language Code Qualifier 2100A LUI01 Qualifier identifying the language code source used in LUI02.
Primary Language Code Qualifier Description 2100A LUI01 code translation Human-readable description of the language code qualifier.
Primary Language Code 2100A LUI02 Primary language code for the member.
Primary Language Description 2100A LUI03 Language description when supplied.
Primary Language Use Indicator 2100A LUI04 Indicator describing how the member uses the language.
Primary Language Use Indicator Description 2100A LUI04 code translation Human-readable description of the language-use indicator.
Primary Language Proficiency Indicator 2100A LUI05 Indicator describing the member language proficiency.
Primary Language Proficiency Indicator Description 2100A LUI05 code translation Human-readable description of the language-proficiency indicator.
All Member Languages All 2100A LUI segments Serialized convenience representation of recognized member language segments in source order; not a complete X12 hierarchy.
Incorrect Member Entity Code 2100B NM101 Entity Identifier Code for the previous or incorrect member.
Incorrect Member Entity Code Description 2100B NM101 code translation Human-readable description of the previous or incorrect member entity code.
Incorrect Member Entity Type 2100B NM102 Entity type qualifier indicating whether the previous or incorrect member is a person or organization.
Incorrect Member Last Name or Organization Name 2100B NM103 Last name or organization name of the previous or incorrect member.
Incorrect Member First Name 2100B NM104 First name of the previous or incorrect member when the entity is a person.
Incorrect Member Middle Name 2100B NM105 Middle name or initial of the previous or incorrect member when supplied.
Incorrect Member Name Prefix 2100B NM106 Name prefix of the previous or incorrect member when supplied.
Incorrect Member Name Suffix 2100B NM107 Name suffix of the previous or incorrect member when supplied.
Incorrect Member ID Qualifier 2100B NM108 Qualifier identifying the previous or incorrect member identifier in NM109.
Incorrect Member ID Qualifier Description 2100B NM108 code translation Human-readable description of the previous or incorrect member identifier qualifier.
Incorrect Member ID 2100B NM109 Identifier for the previous or incorrect member. Preserve leading zeros and other source formatting.
Incorrect Member Relationship Code 2100B NM110 Entity relationship code for the previous or incorrect member when supplied.
Incorrect Member Relationship Code Description 2100B NM110 code translation Human-readable description of the previous or incorrect member relationship code.
Incorrect Member Additional Entity Code 2100B NM111 Additional Entity Identifier Code for the previous or incorrect member when supplied.
Incorrect Member Additional Entity Code Description 2100B NM111 code translation Human-readable description of the additional previous or incorrect member entity code.
Incorrect Member Additional Last Name or Organization Name 2100B NM112 Additional last name or organization name for the previous or incorrect member when supplied.
Incorrect Member Full Name 2100B NM103-NM107 (derived) Human-readable full name assembled from the previous or incorrect member name components without changing the source fields.
Incorrect Member Demographic Date Format 2100B DMG01 Format qualifier for the previous or incorrect member birth date.
Incorrect Member Birth Date 2100B DMG02 Previous or incorrect member birth date supplied for a correction transaction.
Incorrect Member Gender Code 2100B DMG03 Previous or incorrect member gender code supplied for a correction transaction.
Incorrect Member Gender Code Description 2100B DMG03 code translation Human-readable description of the previous or incorrect gender code.
Other Incorrect Member Demographic Data Not currently mapped (reserved compatibility field) Reserved compatibility column that remains blank in current Smart Mapping; no previous or incorrect DMG remainder is projected here.
Member Mailing Address Entity Entity Code 2100C NM101 Entity Identifier Code for the member mailing-address entity.
Member Mailing Address Entity Entity Code Description 2100C NM101 code translation Human-readable description of the member mailing-address entity entity code.
Member Mailing Address Entity Entity Type 2100C NM102 Entity type qualifier indicating whether the member mailing-address entity is a person or organization.
Member Mailing Address Entity Last Name or Organization Name 2100C NM103 Last name or organization name of the member mailing-address entity.
Member Mailing Address Entity First Name 2100C NM104 First name of the member mailing-address entity when the entity is a person.
Member Mailing Address Entity Middle Name 2100C NM105 Middle name or initial of the member mailing-address entity when supplied.
Member Mailing Address Entity Name Prefix 2100C NM106 Name prefix of the member mailing-address entity when supplied.
Member Mailing Address Entity Name Suffix 2100C NM107 Name suffix of the member mailing-address entity when supplied.
Member Mailing Address Entity ID Qualifier 2100C NM108 Qualifier identifying the member mailing-address entity identifier in NM109.
Member Mailing Address Entity ID Qualifier Description 2100C NM108 code translation Human-readable description of the member mailing-address entity identifier qualifier.
Member Mailing Address Entity ID 2100C NM109 Identifier for the member mailing-address entity. Preserve leading zeros and other source formatting.
Member Mailing Address Entity Relationship Code 2100C NM110 Entity relationship code for the member mailing-address entity when supplied.
Member Mailing Address Entity Relationship Code Description 2100C NM110 code translation Human-readable description of the member mailing-address entity relationship code.
Member Mailing Address Entity Additional Entity Code 2100C NM111 Additional Entity Identifier Code for the member mailing-address entity when supplied.
Member Mailing Address Entity Additional Entity Code Description 2100C NM111 code translation Human-readable description of the additional member mailing-address entity entity code.
Member Mailing Address Entity Additional Last Name or Organization Name 2100C NM112 Additional last name or organization name for the member mailing-address entity when supplied.
Member Mailing Address Entity Full Name 2100C NM103-NM107 (derived) Human-readable full name assembled from the member mailing-address entity name components without changing the source fields.
Member Mailing Address Line 1 2100C N301 First address line for the member mailing address.
Member Mailing Address Line 2 2100C N302 Second address line for the member mailing address.
Member Mailing City 2100C N401 City for the member mailing address.
Member Mailing State or Province 2100C N402 State or province code for the member mailing address.
Member Mailing Postal Code 2100C N403 Postal code for the member mailing address. Preserve leading zeros.
Member Mailing Country Code 2100C N404 Country code for the member mailing address when supplied.
Member Mailing Location Qualifier 2100C N405 Qualifier identifying the location identifier in N406.
Member Mailing Location Qualifier Description 2100C N405 code translation Human-readable description of the member mailing address location qualifier.
Member Mailing Location ID 2100C N406 Location identifier for the member mailing address.
Member Mailing Country Subdivision Code 2100C N407 Country subdivision code for the member mailing address when supplied.
Member Mailing Formatted Address 2100C N3/N4 (derived) Human-readable address assembled from the member mailing address address fields without changing the source values.
Member Employer Entity Code 2100D NM101 Entity Identifier Code for the member employer.
Member Employer Entity Code Description 2100D NM101 code translation Human-readable description of the member employer entity code.
Member Employer Entity Type 2100D NM102 Entity type qualifier indicating whether the member employer is a person or organization.
Member Employer Last Name or Organization Name 2100D NM103 Last name or organization name of the member employer.
Member Employer First Name 2100D NM104 First name of the member employer when the entity is a person.
Member Employer Middle Name 2100D NM105 Middle name or initial of the member employer when supplied.
Member Employer Name Prefix 2100D NM106 Name prefix of the member employer when supplied.
Member Employer Name Suffix 2100D NM107 Name suffix of the member employer when supplied.
Member Employer ID Qualifier 2100D NM108 Qualifier identifying the member employer identifier in NM109.
Member Employer ID Qualifier Description 2100D NM108 code translation Human-readable description of the member employer identifier qualifier.
Member Employer ID 2100D NM109 Identifier for the member employer. Preserve leading zeros and other source formatting.
Member Employer Relationship Code 2100D NM110 Entity relationship code for the member employer when supplied.
Member Employer Relationship Code Description 2100D NM110 code translation Human-readable description of the member employer relationship code.
Member Employer Additional Entity Code 2100D NM111 Additional Entity Identifier Code for the member employer when supplied.
Member Employer Additional Entity Code Description 2100D NM111 code translation Human-readable description of the additional member employer entity code.
Member Employer Additional Last Name or Organization Name 2100D NM112 Additional last name or organization name for the member employer when supplied.
Member Employer Full Name 2100D NM103-NM107 (derived) Human-readable full name assembled from the member employer name components without changing the source fields.
Member Employer Contact Function Code First 2100D PER01 Code identifying the function of the member employer contact.
Member Employer Contact Function Code Description First 2100D PER01 code translation Human-readable description of the member employer contact function.
Member Employer Contact Name First 2100D PER02 Name of the member employer contact.
Member Employer Communication Qualifier 1 First 2100D PER03 Qualifier identifying communication value 1 in PER04.
Member Employer Communication Qualifier 1 Description First 2100D PER03 code translation Human-readable description of communication qualifier 1.
Member Employer Communication Value 1 First 2100D PER04 Phone number, email address, or other communication value 1 for the member employer.
Member Employer Communication Qualifier 2 First 2100D PER05 Qualifier identifying communication value 2 in PER06.
Member Employer Communication Qualifier 2 Description First 2100D PER05 code translation Human-readable description of communication qualifier 2.
Member Employer Communication Value 2 First 2100D PER06 Phone number, email address, or other communication value 2 for the member employer.
Member Employer Communication Qualifier 3 First 2100D PER07 Qualifier identifying communication value 3 in PER08.
Member Employer Communication Qualifier 3 Description First 2100D PER07 code translation Human-readable description of communication qualifier 3.
Member Employer Communication Value 3 First 2100D PER08 Phone number, email address, or other communication value 3 for the member employer.
Member Employer Contact Inquiry Reference First 2100D PER09 Contact inquiry reference for the member employer when supplied.
All Member Employer Contacts All 2100D PER segments Serialized convenience representation of recognized member employer contact segments in source order; not a complete X12 hierarchy.
Member Employer Address Line 1 2100D N301 First address line for the member employer.
Member Employer Address Line 2 2100D N302 Second address line for the member employer.
Member Employer City 2100D N401 City for the member employer.
Member Employer State or Province 2100D N402 State or province code for the member employer.
Member Employer Postal Code 2100D N403 Postal code for the member employer. Preserve leading zeros.
Member Employer Country Code 2100D N404 Country code for the member employer when supplied.
Member Employer Location Qualifier 2100D N405 Qualifier identifying the location identifier in N406.
Member Employer Location Qualifier Description 2100D N405 code translation Human-readable description of the member employer location qualifier.
Member Employer Location ID 2100D N406 Location identifier for the member employer.
Member Employer Country Subdivision Code 2100D N407 Country subdivision code for the member employer when supplied.
Member Employer Formatted Address 2100D N3/N4 (derived) Human-readable address assembled from the member employer address fields without changing the source values.
Member School Entity Code 2100E NM101 Entity Identifier Code for the member school.
Member School Entity Code Description 2100E NM101 code translation Human-readable description of the member school entity code.
Member School Entity Type 2100E NM102 Entity type qualifier indicating whether the member school is a person or organization.
Member School Last Name or Organization Name 2100E NM103 Last name or organization name of the member school.
Member School First Name 2100E NM104 First name of the member school when the entity is a person.
Member School Middle Name 2100E NM105 Middle name or initial of the member school when supplied.
Member School Name Prefix 2100E NM106 Name prefix of the member school when supplied.
Member School Name Suffix 2100E NM107 Name suffix of the member school when supplied.
Member School ID Qualifier 2100E NM108 Qualifier identifying the member school identifier in NM109.
Member School ID Qualifier Description 2100E NM108 code translation Human-readable description of the member school identifier qualifier.
Member School ID 2100E NM109 Identifier for the member school. Preserve leading zeros and other source formatting.
Member School Relationship Code 2100E NM110 Entity relationship code for the member school when supplied.
Member School Relationship Code Description 2100E NM110 code translation Human-readable description of the member school relationship code.
Member School Additional Entity Code 2100E NM111 Additional Entity Identifier Code for the member school when supplied.
Member School Additional Entity Code Description 2100E NM111 code translation Human-readable description of the additional member school entity code.
Member School Additional Last Name or Organization Name 2100E NM112 Additional last name or organization name for the member school when supplied.
Member School Full Name 2100E NM103-NM107 (derived) Human-readable full name assembled from the member school name components without changing the source fields.
Member School Contact Function Code First 2100E PER01 Code identifying the function of the member school contact.
Member School Contact Function Code Description First 2100E PER01 code translation Human-readable description of the member school contact function.
Member School Contact Name First 2100E PER02 Name of the member school contact.
Member School Communication Qualifier 1 First 2100E PER03 Qualifier identifying communication value 1 in PER04.
Member School Communication Qualifier 1 Description First 2100E PER03 code translation Human-readable description of communication qualifier 1.
Member School Communication Value 1 First 2100E PER04 Phone number, email address, or other communication value 1 for the member school.
Member School Communication Qualifier 2 First 2100E PER05 Qualifier identifying communication value 2 in PER06.
Member School Communication Qualifier 2 Description First 2100E PER05 code translation Human-readable description of communication qualifier 2.
Member School Communication Value 2 First 2100E PER06 Phone number, email address, or other communication value 2 for the member school.
Member School Communication Qualifier 3 First 2100E PER07 Qualifier identifying communication value 3 in PER08.
Member School Communication Qualifier 3 Description First 2100E PER07 code translation Human-readable description of communication qualifier 3.
Member School Communication Value 3 First 2100E PER08 Phone number, email address, or other communication value 3 for the member school.
Member School Contact Inquiry Reference First 2100E PER09 Contact inquiry reference for the member school when supplied.
All Member School Contacts All 2100E PER segments Serialized convenience representation of recognized member school contact segments in source order; not a complete X12 hierarchy.
Member School Address Line 1 2100E N301 First address line for the member school.
Member School Address Line 2 2100E N302 Second address line for the member school.
Member School City 2100E N401 City for the member school.
Member School State or Province 2100E N402 State or province code for the member school.
Member School Postal Code 2100E N403 Postal code for the member school. Preserve leading zeros.
Member School Country Code 2100E N404 Country code for the member school when supplied.
Member School Location Qualifier 2100E N405 Qualifier identifying the location identifier in N406.
Member School Location Qualifier Description 2100E N405 code translation Human-readable description of the member school location qualifier.
Member School Location ID 2100E N406 Location identifier for the member school.
Member School Country Subdivision Code 2100E N407 Country subdivision code for the member school when supplied.
Member School Formatted Address 2100E N3/N4 (derived) Human-readable address assembled from the member school address fields without changing the source values.
Custodial Parent Entity Code 2100F NM101 Entity Identifier Code for the custodial parent.
Custodial Parent Entity Code Description 2100F NM101 code translation Human-readable description of the custodial parent entity code.
Custodial Parent Entity Type 2100F NM102 Entity type qualifier indicating whether the custodial parent is a person or organization.
Custodial Parent Last Name or Organization Name 2100F NM103 Last name or organization name of the custodial parent.
Custodial Parent First Name 2100F NM104 First name of the custodial parent when the entity is a person.
Custodial Parent Middle Name 2100F NM105 Middle name or initial of the custodial parent when supplied.
Custodial Parent Name Prefix 2100F NM106 Name prefix of the custodial parent when supplied.
Custodial Parent Name Suffix 2100F NM107 Name suffix of the custodial parent when supplied.
Custodial Parent ID Qualifier 2100F NM108 Qualifier identifying the custodial parent identifier in NM109.
Custodial Parent ID Qualifier Description 2100F NM108 code translation Human-readable description of the custodial parent identifier qualifier.
Custodial Parent ID 2100F NM109 Identifier for the custodial parent. Preserve leading zeros and other source formatting.
Custodial Parent Relationship Code 2100F NM110 Entity relationship code for the custodial parent when supplied.
Custodial Parent Relationship Code Description 2100F NM110 code translation Human-readable description of the custodial parent relationship code.
Custodial Parent Additional Entity Code 2100F NM111 Additional Entity Identifier Code for the custodial parent when supplied.
Custodial Parent Additional Entity Code Description 2100F NM111 code translation Human-readable description of the additional custodial parent entity code.
Custodial Parent Additional Last Name or Organization Name 2100F NM112 Additional last name or organization name for the custodial parent when supplied.
Custodial Parent Full Name 2100F NM103-NM107 (derived) Human-readable full name assembled from the custodial parent name components without changing the source fields.
Custodial Parent Contact Function Code First 2100F PER01 Code identifying the function of the custodial parent contact.
Custodial Parent Contact Function Code Description First 2100F PER01 code translation Human-readable description of the custodial parent contact function.
Custodial Parent Contact Name First 2100F PER02 Name of the custodial parent contact.
Custodial Parent Communication Qualifier 1 First 2100F PER03 Qualifier identifying communication value 1 in PER04.
Custodial Parent Communication Qualifier 1 Description First 2100F PER03 code translation Human-readable description of communication qualifier 1.
Custodial Parent Communication Value 1 First 2100F PER04 Phone number, email address, or other communication value 1 for the custodial parent.
Custodial Parent Communication Qualifier 2 First 2100F PER05 Qualifier identifying communication value 2 in PER06.
Custodial Parent Communication Qualifier 2 Description First 2100F PER05 code translation Human-readable description of communication qualifier 2.
Custodial Parent Communication Value 2 First 2100F PER06 Phone number, email address, or other communication value 2 for the custodial parent.
Custodial Parent Communication Qualifier 3 First 2100F PER07 Qualifier identifying communication value 3 in PER08.
Custodial Parent Communication Qualifier 3 Description First 2100F PER07 code translation Human-readable description of communication qualifier 3.
Custodial Parent Communication Value 3 First 2100F PER08 Phone number, email address, or other communication value 3 for the custodial parent.
Custodial Parent Contact Inquiry Reference First 2100F PER09 Contact inquiry reference for the custodial parent when supplied.
All Custodial Parent Contacts All 2100F PER segments Serialized convenience representation of recognized custodial parent contact segments in source order; not a complete X12 hierarchy.
Custodial Parent Address Line 1 2100F N301 First address line for the custodial parent.
Custodial Parent Address Line 2 2100F N302 Second address line for the custodial parent.
Custodial Parent City 2100F N401 City for the custodial parent.
Custodial Parent State or Province 2100F N402 State or province code for the custodial parent.
Custodial Parent Postal Code 2100F N403 Postal code for the custodial parent. Preserve leading zeros.
Custodial Parent Country Code 2100F N404 Country code for the custodial parent when supplied.
Custodial Parent Location Qualifier 2100F N405 Qualifier identifying the location identifier in N406.
Custodial Parent Location Qualifier Description 2100F N405 code translation Human-readable description of the custodial parent location qualifier.
Custodial Parent Location ID 2100F N406 Location identifier for the custodial parent.
Custodial Parent Country Subdivision Code 2100F N407 Country subdivision code for the custodial parent when supplied.
Custodial Parent Formatted Address 2100F N3/N4 (derived) Human-readable address assembled from the custodial parent address fields without changing the source values.
Responsible Person Entity Code 2100G NM101 Entity Identifier Code for the responsible person.
Responsible Person Entity Code Description 2100G NM101 code translation Human-readable description of the responsible person entity code.
Responsible Person Entity Type 2100G NM102 Entity type qualifier indicating whether the responsible person is a person or organization.
Responsible Person Last Name or Organization Name 2100G NM103 Last name or organization name of the responsible person.
Responsible Person First Name 2100G NM104 First name of the responsible person when the entity is a person.
Responsible Person Middle Name 2100G NM105 Middle name or initial of the responsible person when supplied.
Responsible Person Name Prefix 2100G NM106 Name prefix of the responsible person when supplied.
Responsible Person Name Suffix 2100G NM107 Name suffix of the responsible person when supplied.
Responsible Person ID Qualifier 2100G NM108 Qualifier identifying the responsible person identifier in NM109.
Responsible Person ID Qualifier Description 2100G NM108 code translation Human-readable description of the responsible person identifier qualifier.
Responsible Person ID 2100G NM109 Identifier for the responsible person. Preserve leading zeros and other source formatting.
Responsible Person Relationship Code 2100G NM110 Entity relationship code for the responsible person when supplied.
Responsible Person Relationship Code Description 2100G NM110 code translation Human-readable description of the responsible person relationship code.
Responsible Person Additional Entity Code 2100G NM111 Additional Entity Identifier Code for the responsible person when supplied.
Responsible Person Additional Entity Code Description 2100G NM111 code translation Human-readable description of the additional responsible person entity code.
Responsible Person Additional Last Name or Organization Name 2100G NM112 Additional last name or organization name for the responsible person when supplied.
Responsible Person Full Name 2100G NM103-NM107 (derived) Human-readable full name assembled from the responsible person name components without changing the source fields.
Responsible Person Contact Function Code First 2100G PER01 Code identifying the function of the responsible person contact.
Responsible Person Contact Function Code Description First 2100G PER01 code translation Human-readable description of the responsible person contact function.
Responsible Person Contact Name First 2100G PER02 Name of the responsible person contact.
Responsible Person Communication Qualifier 1 First 2100G PER03 Qualifier identifying communication value 1 in PER04.
Responsible Person Communication Qualifier 1 Description First 2100G PER03 code translation Human-readable description of communication qualifier 1.
Responsible Person Communication Value 1 First 2100G PER04 Phone number, email address, or other communication value 1 for the responsible person.
Responsible Person Communication Qualifier 2 First 2100G PER05 Qualifier identifying communication value 2 in PER06.
Responsible Person Communication Qualifier 2 Description First 2100G PER05 code translation Human-readable description of communication qualifier 2.
Responsible Person Communication Value 2 First 2100G PER06 Phone number, email address, or other communication value 2 for the responsible person.
Responsible Person Communication Qualifier 3 First 2100G PER07 Qualifier identifying communication value 3 in PER08.
Responsible Person Communication Qualifier 3 Description First 2100G PER07 code translation Human-readable description of communication qualifier 3.
Responsible Person Communication Value 3 First 2100G PER08 Phone number, email address, or other communication value 3 for the responsible person.
Responsible Person Contact Inquiry Reference First 2100G PER09 Contact inquiry reference for the responsible person when supplied.
All Responsible Person Contacts All 2100G PER segments Serialized convenience representation of recognized responsible person contact segments in source order; not a complete X12 hierarchy.
Responsible Person Address Line 1 2100G N301 First address line for the responsible person.
Responsible Person Address Line 2 2100G N302 Second address line for the responsible person.
Responsible Person City 2100G N401 City for the responsible person.
Responsible Person State or Province 2100G N402 State or province code for the responsible person.
Responsible Person Postal Code 2100G N403 Postal code for the responsible person. Preserve leading zeros.
Responsible Person Country Code 2100G N404 Country code for the responsible person when supplied.
Responsible Person Location Qualifier 2100G N405 Qualifier identifying the location identifier in N406.
Responsible Person Location Qualifier Description 2100G N405 code translation Human-readable description of the responsible person location qualifier.
Responsible Person Location ID 2100G N406 Location identifier for the responsible person.
Responsible Person Country Subdivision Code 2100G N407 Country subdivision code for the responsible person when supplied.
Responsible Person Formatted Address 2100G N3/N4 (derived) Human-readable address assembled from the responsible person address fields without changing the source values.
Drop-Off Location Entity Code 2100H NM101 Entity Identifier Code for the drop-off location.
Drop-Off Location Entity Code Description 2100H NM101 code translation Human-readable description of the drop-off location entity code.
Drop-Off Location Entity Type 2100H NM102 Entity type qualifier indicating whether the drop-off location is a person or organization.
Drop-Off Location Last Name or Organization Name 2100H NM103 Last name or organization name of the drop-off location.
Drop-Off Location First Name 2100H NM104 First name of the drop-off location when the entity is a person.
Drop-Off Location Middle Name 2100H NM105 Middle name or initial of the drop-off location when supplied.
Drop-Off Location Name Prefix 2100H NM106 Name prefix of the drop-off location when supplied.
Drop-Off Location Name Suffix 2100H NM107 Name suffix of the drop-off location when supplied.
Drop-Off Location ID Qualifier 2100H NM108 Qualifier identifying the drop-off location identifier in NM109.
Drop-Off Location ID Qualifier Description 2100H NM108 code translation Human-readable description of the drop-off location identifier qualifier.
Drop-Off Location ID 2100H NM109 Identifier for the drop-off location. Preserve leading zeros and other source formatting.
Drop-Off Location Relationship Code 2100H NM110 Entity relationship code for the drop-off location when supplied.
Drop-Off Location Relationship Code Description 2100H NM110 code translation Human-readable description of the drop-off location relationship code.
Drop-Off Location Additional Entity Code 2100H NM111 Additional Entity Identifier Code for the drop-off location when supplied.
Drop-Off Location Additional Entity Code Description 2100H NM111 code translation Human-readable description of the additional drop-off location entity code.
Drop-Off Location Additional Last Name or Organization Name 2100H NM112 Additional last name or organization name for the drop-off location when supplied.
Drop-Off Location Full Name 2100H NM103-NM107 (derived) Human-readable full name assembled from the drop-off location name components without changing the source fields.
Drop-Off Location Address Line 1 2100H N301 First address line for the drop-off location.
Drop-Off Location Address Line 2 2100H N302 Second address line for the drop-off location.
Drop-Off Location City 2100H N401 City for the drop-off location.
Drop-Off Location State or Province 2100H N402 State or province code for the drop-off location.
Drop-Off Location Postal Code 2100H N403 Postal code for the drop-off location. Preserve leading zeros.
Drop-Off Location Country Code 2100H N404 Country code for the drop-off location when supplied.
Drop-Off Location Location Qualifier 2100H N405 Qualifier identifying the location identifier in N406.
Drop-Off Location Location Qualifier Description 2100H N405 code translation Human-readable description of the drop-off location location qualifier.
Drop-Off Location Location ID 2100H N406 Location identifier for the drop-off location.
Drop-Off Location Country Subdivision Code 2100H N407 Country subdivision code for the drop-off location when supplied.
Drop-Off Location Formatted Address 2100H N3/N4 (derived) Human-readable address assembled from the drop-off location address fields without changing the source values.
Disability Count 2200 DSB occurrence count Number of disability-information loop occurrences for the member.
Primary Disability Type Code 2200 DSB01 Disability type code for the primary disability occurrence.
Primary Disability Type Code Description 2200 DSB01 code translation Human-readable description of the disability type code.
Primary Disability Quantity 2200 DSB02 Quantity reported for the primary disability occurrence when supplied.
Primary Disability Occupation Code 2200 DSB03 Occupation code associated with the primary disability occurrence.
Primary Disability Occupation Code Description 2200 DSB03 code translation Human-readable description of the disability occupation code when available.
Primary Disability Work Intensity Code 2200 DSB04 Work intensity code associated with the primary disability occurrence.
Primary Disability Work Intensity Code Description 2200 DSB04 code translation Human-readable description of the disability work-intensity code.
Primary Disability Product Option Code 2200 DSB05 Product option code associated with the primary disability occurrence.
Primary Disability Product Option Code Description 2200 DSB05 code translation Human-readable description of the disability product option code.
Primary Disability Monetary Amount 2200 DSB06 Monetary amount associated with the primary disability occurrence when supplied.
Primary Disability Medical Code Qualifier 2200 DSB07 Qualifier identifying the medical code in DSB08.
Primary Disability Medical Code Qualifier Description 2200 DSB07 code translation Human-readable description of the disability medical-code qualifier.
Primary Disability Medical Code 2200 DSB08 Medical code value associated with the primary disability occurrence.
Primary Disability Date Qualifier 2200 DTP01 Qualifier identifying the type of disability eligibility date or date range.
Primary Disability Date Qualifier Description 2200 DTP01 code translation Human-readable description of the disability eligibility date qualifier.
Primary Disability Date Format 2200 DTP02 Format qualifier for the disability eligibility date or date range.
Primary Disability Date/Range 2200 DTP03 Date or date range for the disability eligibility. Preserve the exact source string.
All Disability Dates All 2200 DTP segments Serialized convenience representation of recognized disability eligibility DTP segments in source order; not a complete X12 hierarchy.
All Disabilities All 2200 DSB/DTP loops Serialized convenience representation of recognized disability occurrences and their dates in source order; not a complete X12 hierarchy.
Coverage Maintenance Type Code 2300 HD01 Coverage-level maintenance action code.
Coverage Maintenance Type Code Description 2300 HD01 code translation Human-readable description of the coverage maintenance type.
Coverage Maintenance Reason Code 2300 HD02 Reason code for the coverage-level maintenance action when supplied.
Coverage Maintenance Reason Code Description 2300 HD02 code translation Human-readable description of the coverage maintenance reason.
Insurance Line Code 2300 HD03 Code identifying the insurance line or benefit product, such as health, dental, vision, life, or disability.
Insurance Line Code Description 2300 HD03 code translation Human-readable code label, including PRA = Practitioners and PDG = Prescription drug. Unknown source codes remain in Insurance Line Code and receive an Unknown (<code>) label rather than being discarded.
Plan Coverage Description 2300 HD04 Description or identifier of the plan or coverage product.
Coverage Level Code 2300 HD05 Code identifying the level of coverage provided, such as employee only, employee and spouse, or family.
Coverage Level Code Description 2300 HD05 code translation Human-readable description of the coverage level code.
Collateral Dependent Count 2300 HD06 Compatibility-only field for nonconforming trading-partner input. HD06 is not used by X220A1; when nevertheless supplied the current mapper exposes its source value without asserting guide conformance.
Sponsored Dependent Count 2300 HD07 Compatibility-only field for nonconforming trading-partner input. HD07 is not used by X220A1; when nevertheless supplied the current mapper exposes its source value without asserting guide conformance.
Underwriting Decision Code 2300 HD08 Compatibility-only field for nonconforming trading-partner input. HD08 is not used by X220A1; when nevertheless supplied the current mapper exposes its source value without asserting guide conformance.
Underwriting Decision Code Description 2300 HD08 code translation Compatibility-only readable label for HD08 when the current code table recognizes a nonconforming source value.
Late Enrollment Indicator 2300 HD09 Compatibility-only field for nonconforming trading-partner input. HD09 is not used by X220A1; when nevertheless supplied the current mapper exposes its source value without asserting guide conformance.
Late Enrollment Indicator Description 2300 HD09 code translation Compatibility-only Yes/No interpretation of a nonconforming HD09 source value.
Other HD Data 2300 HD10-HD11 and remainder Partial indexed convenience representation of nonblank HD10 and later elements; it is not a complete HD remainder or hierarchy.
Coverage Date Count 2300 DTP occurrence count Number of health coverage date segments associated with this HD occurrence.
Primary Coverage Date Qualifier 2300 DTP01 Qualifier identifying the type of health coverage date or date range.
Primary Coverage Date Qualifier Description 2300 DTP01 code translation Human-readable description of the health coverage date qualifier.
Primary Coverage Date Format 2300 DTP02 Format qualifier for the health coverage date or date range.
Primary Coverage Date/Range 2300 DTP03 Date or date range for the health coverage. Preserve the exact source string.
All Coverage Dates All 2300 DTP segments Serialized convenience representation of recognized health coverage DTP segments in source order; not a complete X12 hierarchy.
Coverage Enrollment Signature Date 2300 DTP03 when DTP01=300 Coverage-level enrollment signature date or date range.
Coverage Maintenance Effective Date 2300 DTP03 when DTP01=303 Coverage-level maintenance effective date or date range.
Premium Paid Through Date 2300 DTP03 when DTP01=343 Coverage-level premium paid-to-date end date or date range.
Benefit Begin Date 2300 DTP03 when DTP01=348 Coverage-level benefit begin date or date range.
Benefit End Date 2300 DTP03 when DTP01=349 Coverage-level benefit end date or date range.
Last Premium Paid Date 2300 DTP03 when DTP01=543 Coverage-level last premium paid date or date range.
Previous Coverage Period 2300 DTP03 when DTP01=695 Coverage-level previous coverage period source value. DTP02 identifies whether DTP03 is a single date (D8) or range (RD8); the source string is not expanded into separate dates.
Coverage Amount Count 2300 AMT occurrence count Number of coverage-level monetary amount segments associated with this HD occurrence.
Primary Coverage Amount Qualifier 2300 AMT01 Qualifier identifying the primary coverage amount in AMT02.
Primary Coverage Amount Qualifier Description 2300 AMT01 code translation Human-readable description of the primary coverage amount qualifier.
Primary Coverage Amount 2300 AMT02 Primary monetary amount associated with the coverage.
Copayment Amount 2300 AMT02 when AMT01=C1 Copayment amount associated with the coverage when reported.
Deductible Amount 2300 AMT02 when AMT01=D2 Deductible amount associated with the coverage when reported.
Coinsurance Amount 2300 AMT02 when AMT01=B9 Coinsurance selection or actual amount associated with the coverage when reported.
Premium Amount 2300 AMT02 when AMT01=P3 Premium amount associated with the coverage when reported.
Spend-Down Amount 2300 AMT02 when AMT01=R Spend-down amount associated with the coverage when reported.
All Coverage Amounts All 2300 AMT segments Serialized convenience representation of recognized coverage amount qualifiers and values in source order; not a complete X12 hierarchy.
Coverage Reference Count 2300 REF occurrence count Number of coverage-level policy or reference segments associated with the HD occurrence.
Primary Coverage Reference Qualifier 2300 REF01 Qualifier identifying the health coverage policy reference in REF02.
Primary Coverage Reference Qualifier Description 2300 REF01 code translation Human-readable description of the health coverage policy reference qualifier.
Primary Coverage Reference ID 2300 REF02 Reference identifier for the health coverage policy. Preserve leading zeros and source formatting.
Primary Coverage Reference Description 2300 REF03 Description associated with the health coverage policy reference when supplied.
All Coverage References All 2300 REF segments Serialized convenience representation of recognized health coverage policy REF segments in source order; not a complete X12 hierarchy.
Coverage Policy Number 2300 REF02 when REF01=1L Group or policy number associated with the specific health coverage occurrence.
Coverage Client Reporting Category 2300 REF02 when REF01=17 Client reporting category associated with the health coverage occurrence.
Coverage Prior Coverage Months Not currently mapped (reserved compatibility field) Reserved compatibility column that remains blank in current Smart Mapping. Previous or prior coverage period data is projected separately from coverage-level DTP*695 into Previous Coverage Period.
Identification Card Request Count 2300 IDC occurrence count Number of identification-card request segments associated with this coverage.
Primary ID Card Plan Coverage Description 2300 IDC01 Plan coverage description or number for the primary identification-card request.
Primary ID Card Type Code 2300 IDC02 Code identifying the type of identification card requested.
Primary ID Card Type Code Description 2300 IDC02 code translation Human-readable description of the identification-card type code.
Primary ID Card Quantity 2300 IDC03 Number of identification cards requested for the primary card request.
Primary ID Card Action Code 2300 IDC04 Action code for the primary identification-card request.
Primary ID Card Action Code Description 2300 IDC04 code translation Human-readable description of the identification-card action code.
All Identification Card Requests All 2300 IDC segments Serialized convenience representation of recognized identification-card requests in source order; not a complete X12 hierarchy.
Provider Count 2310 LX occurrence count Number of provider-information occurrences associated with the coverage.
Primary Provider Sequence Number First 2310 LX01 Assigned sequence number of the primary provider occurrence.
Primary Provider Entity Code First 2310 NM101 Entity Identifier Code for the provider.
Primary Provider Entity Code Description First 2310 NM101 code translation Human-readable description of the provider entity code.
Primary Provider Entity Type First 2310 NM102 Entity type qualifier indicating whether the provider is a person or organization.
Primary Provider Last Name or Organization Name First 2310 NM103 Last name or organization name of the provider.
Primary Provider First Name First 2310 NM104 First name of the provider when the entity is a person.
Primary Provider Middle Name First 2310 NM105 Middle name or initial of the provider when supplied.
Primary Provider Name Prefix First 2310 NM106 Name prefix of the provider when supplied.
Primary Provider Name Suffix First 2310 NM107 Name suffix of the provider when supplied.
Primary Provider ID Qualifier First 2310 NM108 Qualifier identifying the provider identifier in NM109.
Primary Provider ID Qualifier Description First 2310 NM108 code translation Human-readable description of the provider identifier qualifier.
Primary Provider ID First 2310 NM109 Identifier for the provider. Preserve leading zeros and other source formatting.
Primary Provider Relationship Code First 2310 NM110 Entity relationship code for the provider when supplied.
Primary Provider Relationship Code Description First 2310 NM110 code translation Human-readable description of the provider relationship code.
Primary Provider Additional Entity Code First 2310 NM111 Additional Entity Identifier Code for the provider when supplied.
Primary Provider Additional Entity Code Description First 2310 NM111 code translation Human-readable description of the additional provider entity code.
Primary Provider Additional Last Name or Organization Name First 2310 NM112 Additional last name or organization name for the provider when supplied.
Primary Provider Full Name First 2310 NM103-NM107 (derived) Human-readable full name assembled from the provider name components without changing the source fields.
Primary Provider Address Line 1 First 2310 N301 First address line for the provider.
Primary Provider Address Line 2 First 2310 N302 Second address line for the provider.
Primary Provider City First 2310 N401 City for the provider.
Primary Provider State or Province First 2310 N402 State or province code for the provider.
Primary Provider Postal Code First 2310 N403 Postal code for the provider. Preserve leading zeros.
Primary Provider Country Code First 2310 N404 Country code for the provider when supplied.
Primary Provider Location Qualifier First 2310 N405 Qualifier identifying the location identifier in N406.
Primary Provider Location Qualifier Description First 2310 N405 code translation Human-readable description of the provider location qualifier.
Primary Provider Location ID First 2310 N406 Location identifier for the provider.
Primary Provider Country Subdivision Code First 2310 N407 Country subdivision code for the provider when supplied.
Primary Provider Formatted Address First 2310 N3/N4 (derived) Human-readable address assembled from the provider address fields without changing the source values.
Primary Provider Contact Function Code First 2310 PER01 Code identifying the function of the provider contact.
Primary Provider Contact Function Code Description First 2310 PER01 code translation Human-readable description of the provider contact function.
Primary Provider Contact Name First 2310 PER02 Name of the provider contact.
Primary Provider Communication Qualifier 1 First 2310 PER03 Qualifier identifying communication value 1 in PER04.
Primary Provider Communication Qualifier 1 Description First 2310 PER03 code translation Human-readable description of communication qualifier 1.
Primary Provider Communication Value 1 First 2310 PER04 Phone number, email address, or other communication value 1 for the provider.
Primary Provider Communication Qualifier 2 First 2310 PER05 Qualifier identifying communication value 2 in PER06.
Primary Provider Communication Qualifier 2 Description First 2310 PER05 code translation Human-readable description of communication qualifier 2.
Primary Provider Communication Value 2 First 2310 PER06 Phone number, email address, or other communication value 2 for the provider.
Primary Provider Communication Qualifier 3 First 2310 PER07 Qualifier identifying communication value 3 in PER08.
Primary Provider Communication Qualifier 3 Description First 2310 PER07 code translation Human-readable description of communication qualifier 3.
Primary Provider Communication Value 3 First 2310 PER08 Phone number, email address, or other communication value 3 for the provider.
Primary Provider Contact Inquiry Reference First 2310 PER09 Contact inquiry reference for the provider when supplied.
All Primary Provider Contacts All First 2310 PER segments Serialized convenience representation of recognized provider contact segments in source order; not a complete X12 hierarchy.
Primary Provider Change Action Code First 2310 PLA01 Action code for a provider assignment change.
Primary Provider Change Action Code Description First 2310 PLA01 code translation Human-readable description of the provider change action code.
Primary Provider Change Entity Code First 2310 PLA02 Entity Identifier Code for the provider being changed.
Primary Provider Change Entity Code Description First 2310 PLA02 code translation Human-readable description of the provider change entity code.
Primary Provider Effective Date First 2310 PLA03 Effective date of the provider change.
Primary Provider Effective Time First 2310 PLA04 Compatibility-only field for nonconforming trading-partner input. PLA04 is not used by X220A1; when nevertheless supplied the current mapper exposes its source value without asserting guide conformance.
Primary Provider Change Reason Code First 2310 PLA05 Maintenance reason code for the provider change.
Primary Provider Change Reason Code Description First 2310 PLA05 code translation Human-readable description of the provider change reason code.
All Providers All 2310 LX/NM1/N3/N4/PER/PLA loops Serialized convenience representation of recognized LX/NM1/N3/N4/PER/PLA provider segments associated with the coverage in source order; unrecognized content is not part of this field.
COB Count 2320 COB occurrence count Number of coordination-of-benefits occurrences associated with the coverage.
Primary COB Payer Responsibility Code First 2320 COB01 Code identifying whether the other payer is primary, secondary, tertiary, or unknown.
Primary COB Payer Responsibility Code Description First 2320 COB01 code translation Human-readable description of the COB payer responsibility sequence.
Primary COB Member Group or Policy Number First 2320 COB02 Member group or policy number for the other coverage.
Primary COB Code First 2320 COB03 Code identifying the coordination-of-benefits condition.
Primary COB Code Description First 2320 COB03 code translation Human-readable description of the coordination-of-benefits code.
Primary COB Service Type Codes First 2320 COB04 repetitions Service type codes to which the coordination-of-benefits information applies, preserved in source order.
Primary COB Reference Count First 2320 REF occurrence count Number of COB reference segments in the primary COB occurrence.
Primary COB Reference Qualifier First 2320 REF01 Qualifier identifying the coordination-of-benefits reference in REF02.
Primary COB Reference Qualifier Description First 2320 REF01 code translation Human-readable description of the coordination-of-benefits reference qualifier.
Primary COB Reference ID First 2320 REF02 Reference identifier for the coordination-of-benefits. Preserve leading zeros and source formatting.
Primary COB Reference Description First 2320 REF03 Description associated with the coordination-of-benefits reference when supplied.
All Primary COB References All First 2320 REF segments Serialized convenience representation of recognized coordination-of-benefits REF segments in source order; not a complete X12 hierarchy.
Primary COB Date Count First 2320 DTP occurrence count Number of COB date segments in the primary COB occurrence.
Primary COB Date Qualifier First 2320 DTP01 Qualifier identifying the type of coordination-of-benefits date or date range.
Primary COB Date Qualifier Description First 2320 DTP01 code translation Human-readable description of the coordination-of-benefits date qualifier.
Primary COB Date Format First 2320 DTP02 Format qualifier for the coordination-of-benefits date or date range.
Primary COB Date/Range First 2320 DTP03 Date or date range for the coordination-of-benefits. Preserve the exact source string.
All Primary COB Dates All First 2320 DTP segments Serialized convenience representation of recognized coordination-of-benefits DTP segments in source order; not a complete X12 hierarchy.
Primary COB Coverage Begin Date First 2320 DTP03 when DTP01=344 Beginning date of the other coverage when reported.
Primary COB Coverage End Date First 2320 DTP03 when DTP01=345 Ending date of the other coverage when reported.
Primary COB Related Entity Count First 2320 / 2330 occurrence count Number of 2330 related-entity occurrences within the primary COB loop.
Primary COB Related Entity Entity Code First 2330 NM101 Entity Identifier Code for the COB related entity.
Primary COB Related Entity Entity Code Description First 2330 NM101 code translation Human-readable description of the COB related entity entity code.
Primary COB Related Entity Entity Type First 2330 NM102 Entity type qualifier indicating whether the COB related entity is a person or organization.
Primary COB Related Entity Last Name or Organization Name First 2330 NM103 Last name or organization name of the COB related entity.
Primary COB Related Entity First Name First 2330 NM104 First name of the COB related entity when the entity is a person.
Primary COB Related Entity Middle Name First 2330 NM105 Middle name or initial of the COB related entity when supplied.
Primary COB Related Entity Name Prefix First 2330 NM106 Name prefix of the COB related entity when supplied.
Primary COB Related Entity Name Suffix First 2330 NM107 Name suffix of the COB related entity when supplied.
Primary COB Related Entity ID Qualifier First 2330 NM108 Qualifier identifying the COB related entity identifier in NM109.
Primary COB Related Entity ID Qualifier Description First 2330 NM108 code translation Human-readable description of the COB related entity identifier qualifier.
Primary COB Related Entity ID First 2330 NM109 Identifier for the COB related entity. Preserve leading zeros and other source formatting.
Primary COB Related Entity Relationship Code First 2330 NM110 Entity relationship code for the COB related entity when supplied.
Primary COB Related Entity Relationship Code Description First 2330 NM110 code translation Human-readable description of the COB related entity relationship code.
Primary COB Related Entity Additional Entity Code First 2330 NM111 Additional Entity Identifier Code for the COB related entity when supplied.
Primary COB Related Entity Additional Entity Code Description First 2330 NM111 code translation Human-readable description of the additional COB related entity entity code.
Primary COB Related Entity Additional Last Name or Organization Name First 2330 NM112 Additional last name or organization name for the COB related entity when supplied.
Primary COB Related Entity Full Name First 2330 NM103-NM107 (derived) Human-readable full name assembled from the COB related entity name components without changing the source fields.
Primary COB Related Entity Address Line 1 First 2330 N301 First address line for the COB related entity.
Primary COB Related Entity Address Line 2 First 2330 N302 Second address line for the COB related entity.
Primary COB Related Entity City First 2330 N401 City for the COB related entity.
Primary COB Related Entity State or Province First 2330 N402 State or province code for the COB related entity.
Primary COB Related Entity Postal Code First 2330 N403 Postal code for the COB related entity. Preserve leading zeros.
Primary COB Related Entity Country Code First 2330 N404 Country code for the COB related entity when supplied.
Primary COB Related Entity Location Qualifier First 2330 N405 Qualifier identifying the location identifier in N406.
Primary COB Related Entity Location Qualifier Description First 2330 N405 code translation Human-readable description of the COB related entity location qualifier.
Primary COB Related Entity Location ID First 2330 N406 Location identifier for the COB related entity.
Primary COB Related Entity Country Subdivision Code First 2330 N407 Country subdivision code for the COB related entity when supplied.
Primary COB Related Entity Formatted Address First 2330 N3/N4 (derived) Human-readable address assembled from the COB related entity address fields without changing the source values.
Primary COB Related Entity Contact Function Code First 2330 PER01 Code identifying the function of the COB related entity contact.
Primary COB Related Entity Contact Function Code Description First 2330 PER01 code translation Human-readable description of the COB related entity contact function.
Primary COB Related Entity Contact Name First 2330 PER02 Name of the COB related entity contact.
Primary COB Related Entity Communication Qualifier 1 First 2330 PER03 Qualifier identifying communication value 1 in PER04.
Primary COB Related Entity Communication Qualifier 1 Description First 2330 PER03 code translation Human-readable description of communication qualifier 1.
Primary COB Related Entity Communication Value 1 First 2330 PER04 Phone number, email address, or other communication value 1 for the COB related entity.
Primary COB Related Entity Communication Qualifier 2 First 2330 PER05 Qualifier identifying communication value 2 in PER06.
Primary COB Related Entity Communication Qualifier 2 Description First 2330 PER05 code translation Human-readable description of communication qualifier 2.
Primary COB Related Entity Communication Value 2 First 2330 PER06 Phone number, email address, or other communication value 2 for the COB related entity.
Primary COB Related Entity Communication Qualifier 3 First 2330 PER07 Qualifier identifying communication value 3 in PER08.
Primary COB Related Entity Communication Qualifier 3 Description First 2330 PER07 code translation Human-readable description of communication qualifier 3.
Primary COB Related Entity Communication Value 3 First 2330 PER08 Phone number, email address, or other communication value 3 for the COB related entity.
Primary COB Related Entity Contact Inquiry Reference First 2330 PER09 Contact inquiry reference for the COB related entity when supplied.
All Primary COB Related Entity Contacts All First 2330 PER segments Serialized convenience representation of recognized COB related-entity contact segments in source order; not a complete X12 hierarchy.
All Primary COB Related Entities All 2330 loops in first 2320 Serialized convenience representation of recognized related entities in the primary COB occurrence; not a complete X12 hierarchy.
All Coordination of Benefits All 2320 COB/REF/DTP and 2330 NM1/N3/N4/PER loops Serialized convenience representation of recognized COB and related-entity segments associated with the coverage in source order; unrecognized content is not part of this field.
Reporting Category Loop Start ID LS01 Loop identifier from LS that begins the member reporting-category section when present.
Reporting Category Loop End ID LE01 Loop identifier from LE that ends the member reporting-category section when present; should match LS01.
Reporting Category Count 2700 LX occurrence count Number of member reporting-category occurrences associated with the member.
Primary Reporting Category Sequence Number First 2700 LX01 Assigned sequence number of the primary member reporting-category occurrence.
Primary Reporting Category Entity Code First 2750 N101 Entity Identifier Code for the reporting category.
Primary Reporting Category Entity Code Description First 2750 N101 code translation Human-readable description of the reporting-category entity code.
Primary Reporting Category Name First 2750 N102 Name or value identifying the primary member reporting category.
Primary Reporting Category ID Qualifier First 2750 N103 Qualifier identifying the reporting category identifier in N104 when supplied.
Primary Reporting Category ID Qualifier Description First 2750 N103 code translation Human-readable description of the reporting-category identifier qualifier.
Primary Reporting Category ID First 2750 N104 Identifier for the primary reporting category when supplied.
Primary Reporting Category Relationship Code First 2750 N105 Relationship code associated with the reporting category when supplied.
Primary Reporting Category Relationship Code Description First 2750 N105 code translation Human-readable description of the reporting-category relationship code.
Primary Reporting Category Additional Entity Code First 2750 N106 Additional Entity Identifier Code for the reporting category when supplied.
Primary Reporting Category Additional Entity Code Description First 2750 N106 code translation Human-readable description of the additional reporting-category entity code.
Primary Reporting Category Reference Qualifier First 2750 REF01 Qualifier identifying the member reporting category reference in REF02.
Primary Reporting Category Reference Qualifier Description First 2750 REF01 code translation Human-readable description of the member reporting category reference qualifier.
Primary Reporting Category Reference ID First 2750 REF02 Reference identifier for the member reporting category. Preserve leading zeros and source formatting.
Primary Reporting Category Reference Description First 2750 REF03 Description associated with the member reporting category reference when supplied.
All Primary Reporting Category References All First 2750 REF segments Serialized convenience representation of recognized member reporting-category REF segments in source order; not a complete X12 hierarchy.
Primary Reporting Category Date Qualifier First 2750 DTP01 Qualifier identifying the type of member reporting category date or date range.
Primary Reporting Category Date Qualifier Description First 2750 DTP01 code translation Human-readable description of the member reporting category date qualifier.
Primary Reporting Category Date Format First 2750 DTP02 Format qualifier for the member reporting category date or date range.
Primary Reporting Category Date/Range First 2750 DTP03 Date or date range for the member reporting category. Preserve the exact source string.
All Primary Reporting Category Dates All First 2750 DTP segments Serialized convenience representation of recognized member reporting-category DTP segments in source order; not a complete X12 hierarchy.
All Reporting Categories All 2700 LX / 2750 N1/REF/DTP loops Serialized convenience representation of recognized member-owned reporting-category occurrences in source order; unrecognized content is not part of this field.
Other Member-Level Segments Unmapped/remainder segments within active 2000-2200 member context Partial serialization of segments the current parser classifies as unmapped inside the active member context; it does not represent every unlisted member element or a complete hierarchy.
Other Coverage-Level Segments Unmapped/remainder segments within active 2300-2330 coverage context Partial serialization of segments the current parser classifies as unmapped inside the active coverage context; it does not represent every unlisted coverage element or a complete hierarchy.
Other Reporting-Category Segments Unmapped/remainder segments within active 2700/2750 context Partial serialization of segments the current parser classifies as unmapped inside the active reporting-category context; it does not represent every unlisted element or a complete hierarchy.
Other Transaction Segments Unmapped/remainder segments within ST/SE Partial serialization of transaction segments the current parser classifies as unmapped; it does not represent every unsupported element or a complete hierarchy.
Raw Member Loop Active 2000 member-context flattened serialization Browser-local flattened segment serialization of the active member context for audit and parser troubleshooting. It is not a complete hierarchical export and follows Smart Mapping de-identification when enabled.
Raw Coverage Loop Active 2300 coverage-context flattened serialization Browser-local flattened segment serialization of the active coverage context represented by the row. It is not a complete hierarchical export and is blank on member-only rows.

Support and row-grain notes

  • Supported implementation: Smart Mapping recognizes an ST01=834 transaction when ST03 is exactly 005010X220A1, or when ST03 is blank and the enclosing GS08 is exactly 005010X220A1. Other versions are outside this mapper's support boundary and should be inspected in Raw segments mode.
  • All Fields boundary: All Fields means this current 767-column projection, not every possible X12 segment, element, loop, implementation, or companion-guide extension. There is no separate 834 Key Fields schema.
  • Row grain: each HD health-coverage occurrence produces a distinct row and repeats its owning transaction/member context. An INS member with no HD produces one member-only fallback row, with Has Coverage Detail = No and blank coverage fields.
  • Party routing: sponsor, payer, and TPA/broker values are routed by N101 role code (P5, IN, and BO), not by N1 segment position.
  • Scope: member and coverage DTP/REF fields remain separate, DTP*695 populates Previous Coverage Period, and reporting-category loops are member-owned even though member values repeat across HD rows.
  • Convenience fields: descriptions identify direct source values, code translations, converter-generated values, compatibility-only fields, and partial serialized representations. Fields beginning with “All,” “Other,” or “Raw” are bounded convenience projections, not a complete or lossless X12 hierarchy. Provider, COB, and reporting fields cover the recognized subsets stated in their source descriptions.
  • Codes: source code columns remain authoritative. Known values receive readable labels; unknown values are retained and labeled as unknown rather than silently discarded.
  • Privacy modes: De-identify PHI applies to Smart Mapping output and its preview/editor/download reprojections. Raw segments mode retains the original EDI and is not de-identified.
Parse an EDI 834 into structured fields.
Browse the other Client-Side EDI data maps and tutorials.