Code identifying type of claim

Code identifying reason for claim submission

Code indicating a Yes or No condition or response

OI03 is the assignment of benefits indicator. A "Y" value indicates insured or authorized person authorizes benefits to be assigned to the provider; an "N" value indicates benefits have not been assigned to the provider.

Code indicating how the patient or subscriber authorization signatures were obtained and how they are being retained by the provider

Code indicating the type of agreement under which the provider is submitting this claim

Code indicating whether the provider has on file a signed statement by the patient authorizing the release of medical data to other organizations