|
GS Field |
Description |
Value |
|
GS01 |
Functional Identifier Code See the Functional Identification Code Table below to select the correct code. |
Code from table below |
|
GS02 |
Application Sender’s Code |
Copy code from ISA06 |
|
GS03 |
Application Receiver’s Code |
660537624 |
|
GS04 |
Date (format: CCYYMMDD) |
CCYYMMDD |
|
GS05 |
Time (format: HHMM) |
HHMM |
|
GS06 |
Group Control Number. Provider must enter their group control number |
|
|
GS07 |
Responsible Agency Code |
X |
|
GS08 |
Version / Release / Industry Identifier Code |
Code from table below |
Note: GS06 must be entered by the provider.
|
Transaction Set
Identifier Code (ST01) |
Description |
GS01 |
GS08 |
|
270 |
Eligibility Request |
HS |
004010X092A1 |
|
271 |
Eligibility Response |
HB |
004010X092A1 |
|
276 |
Claim Status Request |
HR |
004010X093A1 |
|
277 |
Claim Status Response |
HN |
004010X093A1 |
|
278 |
Services Review Request |
HI |
004010X094A1 |
|
820 |
Payment Order/Remittance Advice |
RA |
004010X061A1 |
|
834 |
Benefit Enrollment and Maintenance |
BE |
004010X095A1 |
|
835 |
Health Care Claim Payment Advice |
HP |
004010X091A1 |
|
837 |
Health Care Claim: Institutional |
HC |
004010X096A1 |
|
837 |
Health Care Claim: Dental |
HC |
004010X097A1 |
|
837 |
Health Care Claim: Professional |
HC |
004010X098A1 |