ITC Institutional claim
ITC Institutional claim
Position
Element
Name
Type
Requirement
Min
Max
Repeat
010
Invoice type
Composite (composite)
Mandatory
1
010
Invoice type code
String (AN)
Mandatory
1
3
-
Code specifying the type of invoice.
020
Frequency code
String (AN)
Conditional
1
3
-
Code specifying the rate of recurrence.
020
Quantity
String (AN)
Mandatory
1
35
-
Alphanumeric representation of a quantity.
030
Admission
Composite (composite)
Mandatory
1
010
Admission type description code
String (AN)
Conditional
1
3
-
Code specifying the type of admission.
020
Admission source code
String (AN)
Conditional
1
3
-
Code specifying the source of admission.
040
Discharge type description code
String (AN)
Mandatory
1
3
-
Code specifying the type of discharge.
050
Basis of service information
Composite (composite)
Conditional
9
010
Service basis code qualifier
String (AN)
Mandatory
1
3
-
Code qualifying the basis on which a service is performed.
020
Product identifier
String (AN)
Mandatory
1
35
-
To identify a product.
030
Code list identification code
String (AN)
Conditional
1
17
-
Code identifying a user or association maintained code list.
040
Date or time or period value
String (AN)
Conditional
1
35
-
The value of a date, a date and time, a time or of a period in a specified representation.
050
Date or time or period format code
String (AN)
Conditional
1
3
-
Code specifying the representation of a date, time or period.
060
Monetary amount
Numeric (N)
Conditional
1
35
-
To specify a monetary amount.