namespace EdiFabric.Templates.Hipaa5010
{
using System;
using System.Collections.Generic;
using EdiFabric.Core.Annotations.Edi;
using EdiFabric.Core.Annotations.Validation;
using EdiFabric.Core.Model.Edi;
using EdiFabric.Core.Model.Edi.X12;
using EdiFabric.Core.Model.Edi.ErrorContexts;
///
/// Health Care Claim : Professional
///
[Serializable()]
[Message("X12", "005010X222A1", "837")]
public class TS837P : EdiMessage
{
///
/// Transaction Set Header
///
[Pos(1)]
public ST ST { get; set; }
///
/// Beginning of Hierarchical Transaction
///
[Required]
[Pos(2)]
public BHT_BeginningofHierarchicalTransaction_7 BHT_BeginningofHierarchicalTransaction { get; set; }
[Required]
[Pos(3)]
public All_NM1_837P_6 AllNM1 { get; set; }
///
/// Loop for Billing Provider Hierarchical Level
///
[Required]
[Pos(4)]
public List Loop2000A { get; set; }
///
/// Transaction Set Trailer
///
[Pos(5)]
public SE SE { get; set; }
}
[Serializable()]
[All()]
public class All_AMT_837P
{
///
/// Sales Tax Amount
///
[Pos(1)]
public AMT_SalesTaxAmount AMT_SalesTaxAmount { get; set; }
///
/// Postage Claimed Amount
///
[Pos(2)]
public AMT_PostageClaimedAmount AMT_PostageClaimedAmount { get; set; }
}
[Serializable()]
[All()]
public class All_AMT_837P_2
{
///
/// Coordination of Benefits (COB) Payer Paid Amount
///
[Pos(1)]
public AMT_CoordinationofBenefits AMT_CoordinationofBenefits_COB_PayerPaidAmount { get; set; }
///
/// Coordination of Benefits (COB) Total Non-covered Amount
///
[Pos(2)]
public AMT_CoordinationofBenefits_2 AMT_CoordinationofBenefits_COB_TotalNon_Amount { get; set; }
///
/// Remaining Patient Liability
///
[Pos(3)]
public AMT_RemainingPatientLiability AMT_RemainingPatientLiability { get; set; }
}
[Serializable()]
[All()]
public class All_CRC_837P
{
///
/// Ambulance Certification
///
[ListCount(3)]
[Pos(1)]
public List CRC_AmbulanceCertification { get; set; }
///
/// Hospice Employee Indicator
///
[Pos(2)]
public CRC_HospiceEmployeeIndicator CRC_HospiceEmployeeIndicator { get; set; }
///
/// Condition Indicator/Durable Medical Equipment
///
[Pos(3)]
public CRC_ConditionIndicator CRC_ConditionIndicator_DurableMedicalEquipment { get; set; }
}
[Serializable()]
[All()]
public class All_CRC_837P_2
{
///
/// Ambulance Certification
///
[ListCount(3)]
[Pos(1)]
public List CRC_AmbulanceCertification { get; set; }
///
/// Patient Condition Information: Vision
///
[ListCount(3)]
[Pos(2)]
public List CRC_PatientConditionInformation_Vision { get; set; }
///
/// Homebound Indicator
///
[Pos(3)]
public CRC_HomeboundIndicator CRC_HomeboundIndicator { get; set; }
///
/// EPSDT Referral
///
[Pos(4)]
public CRC_EPSDTReferral CRC_EPSDTReferral { get; set; }
}
[Serializable()]
[All()]
public class All_DTP_837P
{
///
/// Date - Service Date
///
[Required]
[Pos(1)]
public DTP_ClaimLevelServiceDate DTP_Date_ServiceDate { get; set; }
///
/// Date - Prescription Date
///
[Pos(2)]
public DTP_HearingandVisionPrescriptionDate DTP_Date_PrescriptionDate { get; set; }
///
/// DATE - Certification Revision/Recertification Date
///
[Pos(3)]
public DTP_CertificationRevision DTP_DATE_CertificationRevision_RecertificationDate { get; set; }
///
/// Date - Begin Therapy Date
///
[Pos(4)]
public DTP_BeginTherapyDate DTP_Date_BeginTherapyDate { get; set; }
///
/// Date - Last Certification Date
///
[Pos(5)]
public DTP_LastCertificationDate DTP_Date_LastCertificationDate { get; set; }
///
/// Date - Last Seen Date
///
[Pos(6)]
public DTP_LastSeenDate DTP_Date_LastSeenDate { get; set; }
///
/// Date - Test Date
///
[ListCount(2)]
[Pos(7)]
public List DTP_Date_TestDate { get; set; }
///
/// Date - Shipped Date
///
[Pos(8)]
public DTP_ShippedDate DTP_Date_ShippedDate { get; set; }
///
/// Date - Last X-ray Date
///
[Pos(9)]
public DTP_LastXrayDate DTP_Date_LastX_Date { get; set; }
///
/// Date - Initial Treatment Date
///
[Pos(10)]
public DTP_InitialTreatmentDate DTP_Date_InitialTreatmentDate { get; set; }
}
[Serializable()]
[All()]
public class All_DTP_837P_2
{
///
/// Date - Onset of Current Illness or Symptom
///
[Pos(1)]
public DTP_OnsetofCurrentIllnessorSymptom DTP_Date_OnsetofCurrentIllnessorSymptom { get; set; }
///
/// Date - Initial Treatment Date
///
[Pos(2)]
public DTP_InitialTreatmentDate DTP_Date_InitialTreatmentDate { get; set; }
///
/// Date - Last Seen Date
///
[Pos(3)]
public DTP_LastSeenDate DTP_Date_LastSeenDate { get; set; }
///
/// Date - Acute Manifestation
///
[Pos(4)]
public DTP_AcuteManifestation DTP_Date_AcuteManifestation { get; set; }
///
/// Date - Accident
///
[Pos(5)]
public DTP_AccidentDate_2 DTP_Date_Accident { get; set; }
///
/// Date - Last Menstrual Period
///
[Pos(6)]
public DTP_LastMenstrualPeriod DTP_Date_LastMenstrualPeriod { get; set; }
///
/// Date - Last X-ray Date
///
[Pos(7)]
public DTP_LastXrayDate DTP_Date_LastX_Date { get; set; }
///
/// Date - Hearing and Vision Prescription Date
///
[Pos(8)]
public DTP_HearingandVisionPrescriptionDate DTP_Date_HearingandVisionPrescriptionDate { get; set; }
///
/// Date - Disability Dates
///
[Pos(9)]
public DTP_DisabilityDates DTP_Date_DisabilityDates { get; set; }
///
/// Date - Last Worked
///
[Pos(10)]
public DTP_LastWorked DTP_Date_LastWorked { get; set; }
///
/// Date - Authorized Return to Work
///
[Pos(11)]
public DTP_AuthorizedReturntoWork DTP_Date_AuthorizedReturntoWork { get; set; }
///
/// Date - Admission
///
[Pos(12)]
public DTP_AdmissionDate_4 DTP_Date_Admission { get; set; }
///
/// Date - Discharge
///
[Pos(13)]
public DTP_Discharge DTP_Date_Discharge { get; set; }
///
/// Date - Assumed and Relinquished Care Dates
///
[ListCount(2)]
[Pos(14)]
public List DTP_Date_AssumedandRelinquishedCareDates { get; set; }
///
/// Property and Casualty Date of First Contact
///
[Pos(15)]
public DTP_PropertyandCasualtyDateofFirstContact DTP_PropertyandCasualtyDateofFirstContact { get; set; }
///
/// Date - Repricer Received Date
///
[Pos(16)]
public DTP_RepricerReceivedDate DTP_Date_RepricerReceivedDate { get; set; }
}
[Serializable()]
[All()]
public class All_HI_837P
{
///
/// Health Care Diagnosis Code
///
[Required]
[Pos(1)]
public HI_DependentHealthCareDiagnosisCode HI_HealthCareDiagnosisCode { get; set; }
///
/// Anesthesia Related Procedure
///
[Pos(2)]
public HI_AnesthesiaRelatedProcedure HI_AnesthesiaRelatedProcedure { get; set; }
///
/// Condition Information
///
[ListCount(2)]
[Pos(3)]
public List HI_ConditionInformation { get; set; }
}
[Serializable()]
[All()]
public class All_NM1_837P
{
///
/// Loop for Billing Provider Name
///
[Required]
[Pos(1)]
public Loop_2010AA_837P Loop2010AA { get; set; }
///
/// Loop for Pay-to Address Name
///
[Pos(2)]
public Loop_2010AB_837P Loop2010AB { get; set; }
///
/// Loop for Pay-To Plan Name
///
[Pos(3)]
public Loop_2010AC_837P Loop2010AC { get; set; }
}
[Serializable()]
[All()]
public class All_NM1_837P_2
{
///
/// Loop for Subscriber Name
///
[Required]
[Pos(1)]
public Loop_2010BA_837P Loop2010BA { get; set; }
///
/// Loop for Payer Name
///
[Required]
[Pos(2)]
public Loop_2010BB_837P Loop2010BB { get; set; }
}
[Serializable()]
[All()]
public class All_NM1_837P_3
{
///
/// Loop for Referring Provider Name
///
[ListCount(2)]
[Pos(1)]
public List Loop2310A { get; set; }
///
/// Loop for Rendering Provider Name
///
[Pos(2)]
public Loop_2310B_837P Loop2310B { get; set; }
///
/// Loop for Service Facility Location Name
///
[Pos(3)]
public Loop_2310C_837P Loop2310C { get; set; }
///
/// Loop for Supervising Provider Name
///
[Pos(4)]
public Loop_2310D_837P Loop2310D { get; set; }
///
/// Loop for Ambulance Pick-up Location
///
[Pos(5)]
public Loop_2310E_837P Loop2310E { get; set; }
///
/// Loop for Ambulance Drop-off Location
///
[Pos(6)]
public Loop_2310F_837P Loop2310F { get; set; }
}
[Serializable()]
[All()]
public class All_NM1_837P_4
{
///
/// Loop for Other Subscriber Name
///
[Required]
[Pos(1)]
public Loop_2330A_837P Loop2330A { get; set; }
///
/// Loop for Other Payer Name
///
[Required]
[Pos(2)]
public Loop_2330B_837P Loop2330B { get; set; }
///
/// Loop for Other Payer Referring Provider
///
[ListCount(2)]
[Pos(3)]
public List Loop2330C { get; set; }
///
/// Loop for Other Payer Rendering Provider
///
[Pos(4)]
public Loop_2330D_837P Loop2330D { get; set; }
///
/// Loop for Other Payer Service Facility Location
///
[Pos(5)]
public Loop_2330E_837P Loop2330E { get; set; }
///
/// Loop for Other Payer Supervising Provider
///
[Pos(6)]
public Loop_2330F_837P Loop2330F { get; set; }
///
/// Loop for Other Payer Billing Provider
///
[Pos(7)]
public Loop_2330G_837P Loop2330G { get; set; }
}
[Serializable()]
[All()]
public class All_NM1_837P_5
{
///
/// Loop for Rendering Provider Name
///
[Pos(1)]
public Loop_2420A_837P Loop2420A { get; set; }
///
/// Loop for Purchased Service Provider Name
///
[Pos(2)]
public Loop_2420B_837P Loop2420B { get; set; }
///
/// Loop for Service Facility Location
///
[Pos(3)]
public Loop_2420C_837P Loop2420C { get; set; }
///
/// Loop for Supervising Provider Name
///
[Pos(4)]
public Loop_2420D_837P Loop2420D { get; set; }
///
/// Loop for Ordering Provider Name
///
[Pos(5)]
public Loop_2420E_837P Loop2420E { get; set; }
///
/// Loop for Referring Provider Name
///
[ListCount(2)]
[Pos(6)]
public List Loop2420F { get; set; }
///
/// Loop for Ambulance Pick-up Location
///
[Pos(7)]
public Loop_2420G_837P Loop2420G { get; set; }
///
/// Loop for Ambulance Drop-off Location
///
[Pos(8)]
public Loop_2420H_837P Loop2420H { get; set; }
}
[Serializable()]
[All()]
public class All_NM1_837P_6
{
///
/// Loop for Submitter Name
///
[Required]
[Pos(1)]
public Loop_1000A_837P Loop1000A { get; set; }
///
/// Loop for Receiver Name
///
[Required]
[Pos(2)]
public Loop_1000B_837P Loop1000B { get; set; }
}
[Serializable()]
[All()]
public class All_NTE_837P
{
///
/// Line Note
///
[Pos(1)]
public NTE_LineNote NTE_LineNote { get; set; }
///
/// Third Party Organization Notes
///
[Pos(2)]
public NTE_ThirdPartyOrganizationNotes NTE_ThirdPartyOrganizationNotes { get; set; }
}
[Serializable()]
[All()]
public class All_PWK_837P
{
///
/// Line Supplemental Information
///
[ListCount(10)]
[Pos(1)]
public List PWK_LineSupplementalInformation { get; set; }
///
/// Durable Medical Equipment Certificate of Medical Necessity Indicator
///
[Pos(2)]
public PWK_DurableMedicalEquipmentCertificateofMedicalNecessityIndicator PWK_DurableMedicalEquipmentCertificateofMedicalNecessityIndicator { get; set; }
}
[Serializable()]
[All()]
public class All_QTY_837P
{
///
/// Ambulance Patient Count
///
[Pos(1)]
public QTY_AmbulancePatientCount QTY_AmbulancePatientCount { get; set; }
///
/// Obstetric Anesthesia Additional Units
///
[Pos(2)]
public QTY_ObstetricAnesthesiaAdditionalUnits QTY_ObstetricAnesthesiaAdditionalUnits { get; set; }
}
[Serializable()]
[All()]
public class All_REF_837P
{
///
/// Other Payer Secondary Identifier
///
[ListCount(2)]
[Pos(1)]
public List REF_OtherPayerSecondaryIdentifier { get; set; }
///
/// Other Payer Prior Authorization Number
///
[Pos(2)]
public REF_OtherPayerPriorAuthorizationNumber REF_OtherPayerPriorAuthorizationNumber { get; set; }
///
/// Other Payer Referral Number
///
[Pos(3)]
public REF_OtherPayerReferralNumber REF_OtherPayerReferralNumber { get; set; }
///
/// Other Payer Claim Adjustment Indicator
///
[Pos(4)]
public REF_OtherPayerClaimAdjustmentIndicator REF_OtherPayerClaimAdjustmentIndicator { get; set; }
///
/// Other Payer Claim Control Number
///
[Pos(5)]
public REF_OtherPayerClaimControlNumber REF_OtherPayerClaimControlNumber { get; set; }
}
[Serializable()]
[All()]
public class All_REF_837P_2
{
///
/// Repriced Line Item Reference Number
///
[Pos(1)]
public REF_RepricedLineItemReferenceNumber REF_RepricedLineItemReferenceNumber { get; set; }
///
/// Adjusted Repriced Line Item Reference Number
///
[Pos(2)]
public REF_AdjustedRepricedLineItemReferenceNumber REF_AdjustedRepricedLineItemReferenceNumber { get; set; }
///
/// Prior Authorization
///
[ListCount(5)]
[Pos(3)]
public List REF_PriorAuthorization { get; set; }
///
/// Line Item Control Number
///
[Pos(4)]
public REF_LineItemControlNumber REF_LineItemControlNumber { get; set; }
///
/// Mammography Certification Number
///
[Pos(5)]
public REF_MammographyCertificationNumber REF_MammographyCertificationNumber { get; set; }
///
/// Clinical Laboratory Improvement Amendment (CLIA) Number
///
[Pos(6)]
public REF_ClinicalLaboratoryImprovementAmendment REF_ClinicalLaboratoryImprovementAmendment_CLIA_Number { get; set; }
///
/// Referring Clinical Laboratory Improvement Amendment (CLIA) Facility Identification
///
[Pos(7)]
public REF_ReferringClinicalLaboratoryImprovementAmendment REF_ReferringClinicalLaboratoryImprovementAmendment_CLIA_FacilityIdentification { get; set; }
///
/// Immunization Batch Number
///
[Pos(8)]
public REF_ImmunizationBatchNumber REF_ImmunizationBatchNumber { get; set; }
///
/// Referral Number
///
[ListCount(5)]
[Pos(9)]
public List REF_ReferralNumber { get; set; }
}
[Serializable()]
[All()]
public class All_REF_837P_3
{
///
/// Pay-To Plan Secondary Identification
///
[Pos(1)]
public REF_Pay REF_Pay_ToPlanSecondaryIdentification { get; set; }
///
/// Pay-To Plan Tax Identification Number
///
[Required]
[Pos(2)]
public REF_BillingProviderTaxIdentification_2 REF_Pay_ToPlanTaxIdentificationNumber { get; set; }
}
[Serializable()]
[All()]
public class All_REF_837P_4
{
///
/// Subscriber Secondary Identification
///
[Pos(1)]
public REF_OtherSubscriberSecondaryIdentification REF_SubscriberSecondaryIdentification { get; set; }
///
/// Property and Casualty Claim Number
///
[Pos(2)]
public REF_PropertyandCasualtyClaimNumber REF_PropertyandCasualtyClaimNumber { get; set; }
}
[Serializable()]
[All()]
public class All_REF_837P_5
{
///
/// Payer Secondary Identification
///
[ListCount(3)]
[Pos(1)]
public List REF_PayerSecondaryIdentification { get; set; }
///
/// Billing Provider Secondary Identification
///
[ListCount(2)]
[Pos(2)]
public List REF_BillingProviderSecondaryIdentification { get; set; }
}
[Serializable()]
[All()]
public class All_REF_837P_6
{
///
/// Service Authorization Exception Code
///
[Pos(1)]
public REF_ServiceAuthorizationExceptionCode REF_ServiceAuthorizationExceptionCode { get; set; }
///
/// Mandatory Medicare (Section 4081) Crossover Indicator
///
[Pos(2)]
public REF_MandatoryMedicare REF_MandatoryMedicare_Section4081_CrossoverIndicator { get; set; }
///
/// Mammography Certification Number
///
[Pos(3)]
public REF_MammographyCertificationNumber REF_MammographyCertificationNumber { get; set; }
///
/// Referral Number
///
[Pos(4)]
public REF_OtherPayerReferralNumber REF_ReferralNumber { get; set; }
///
/// Prior Authorization
///
[Pos(5)]
public REF_OtherPayerPriorAuthorizationNumber REF_PriorAuthorization { get; set; }
///
/// Payer Claim Control Number
///
[Pos(6)]
public REF_OtherPayerClaimControlNumber REF_PayerClaimControlNumber { get; set; }
///
/// Clinical Laboratory Improvement Amendment (CLIA) Number
///
[Pos(7)]
public REF_ClinicalLaboratoryImprovementAmendment REF_ClinicalLaboratoryImprovementAmendment_CLIA_Number { get; set; }
///
/// Repriced Claim Number
///
[Pos(8)]
public REF_RepricedClaimNumber REF_RepricedClaimNumber { get; set; }
///
/// Adjusted Repriced Claim Number
///
[Pos(9)]
public REF_AdjustedRepricedClaimNumber REF_AdjustedRepricedClaimNumber { get; set; }
///
/// Investigational Device Exemption Number
///
[Pos(10)]
public REF_InvestigationalDeviceExemptionNumber REF_InvestigationalDeviceExemptionNumber { get; set; }
///
/// Claim Identifier For Transmission Intermediaries
///
[Pos(11)]
public REF_ClaimIdentificationNumberForClearinghousesandOtherTransmissionIntermediaries REF_ClaimIdentifierForTransmissionIntermediaries { get; set; }
///
/// Medical Record Number
///
[Pos(12)]
public REF_MedicalRecordNumber REF_MedicalRecordNumber { get; set; }
///
/// Demonstration Project Identifier
///
[Pos(13)]
public REF_DemonstrationProjectIdentifier REF_DemonstrationProjectIdentifier { get; set; }
///
/// Care Plan Oversight
///
[Pos(14)]
public REF_CarePlanOversight REF_CarePlanOversight { get; set; }
}
[Serializable()]
[All()]
public class All_REF_837P_7
{
///
/// Property and Casualty Claim Number
///
[Pos(1)]
public REF_PropertyandCasualtyClaimNumber REF_PropertyandCasualtyClaimNumber { get; set; }
///
/// Property and Casualty Patient Identifier
///
[Pos(2)]
public REF_PropertyandCasualtyPatientIdentifier REF_PropertyandCasualtyPatientIdentifier { get; set; }
}
[Serializable()]
[All()]
public class All_REF_837P_8
{
///
/// Billing Provider Tax Identification
///
[Required]
[Pos(1)]
public REF_BillingProviderTaxIdentification REF_BillingProviderTaxIdentification { get; set; }
///
/// Billing Provider UPIN/License Information
///
[ListCount(2)]
[Pos(2)]
public List REF_BillingProviderUPIN_LicenseInformation { get; set; }
}
///
/// Loop for Submitter Name
///
[Serializable()]
[Group(typeof(NM1_InformationReceiverName_4))]
public class Loop_1000A_837P
{
///
/// Submitter Name
///
[Required]
[Pos(1)]
public NM1_InformationReceiverName_4 NM1_SubmitterName { get; set; }
///
/// Submitter EDI Contact Information
///
[Required]
[ListCount(2)]
[Pos(2)]
public List PER_SubmitterEDIContactInformation { get; set; }
}
///
/// Loop for Receiver Name
///
[Serializable()]
[Group(typeof(NM1_ReceiverName))]
public class Loop_1000B_837P
{
///
/// Receiver Name
///
[Required]
[Pos(1)]
public NM1_ReceiverName NM1_ReceiverName { get; set; }
}
///
/// Loop for Billing Provider Hierarchical Level
///
[Serializable()]
[Group(typeof(HL_BillingProviderHierarchicalLevel))]
public class Loop_2000A_837P
{
///
/// Billing Provider Hierarchical Level
///
[Required]
[Pos(1)]
public HL_BillingProviderHierarchicalLevel HL_BillingProviderHierarchicalLevel { get; set; }
///
/// Billing Provider Specialty Information
///
[Pos(2)]
public PRV_BillingProviderSpecialtyInformation PRV_BillingProviderSpecialtyInformation { get; set; }
///
/// Foreign Currency Information
///
[Pos(3)]
public CUR_ForeignCurrencyInformation_3 CUR_ForeignCurrencyInformation { get; set; }
[Required]
[Pos(4)]
public All_NM1_837P AllNM1 { get; set; }
///
/// Loop for Subscriber Hierarchical Level
///
[Required]
[Pos(5)]
public List Loop2000B { get; set; }
}
///
/// Loop for Subscriber Hierarchical Level
///
[Serializable()]
[Group(typeof(HL_SubscriberHierarchicalLevel))]
public class Loop_2000B_837P
{
///
/// Subscriber Hierarchical Level
///
[Required]
[Pos(1)]
public HL_SubscriberHierarchicalLevel HL_SubscriberHierarchicalLevel { get; set; }
///
/// Subscriber Information
///
[Required]
[Pos(2)]
public SBR_SubscriberInformation SBR_SubscriberInformation { get; set; }
///
/// Patient Information
///
[Pos(3)]
public PAT_PatientInformation_3 PAT_PatientInformation { get; set; }
[Required]
[Pos(4)]
public All_NM1_837P_2 AllNM1 { get; set; }
///
/// Loop for Claim Information
///
[ListCount(100)]
[Pos(5)]
public List Loop2300 { get; set; }
///
/// Loop for Patient Hierarchical Level
///
[Pos(6)]
public List Loop2000C { get; set; }
}
///
/// Loop for Patient Hierarchical Level
///
[Serializable()]
[Group(typeof(HL_DependentLevel))]
public class Loop_2000C_837P
{
///
/// Patient Hierarchical Level
///
[Required]
[Pos(1)]
public HL_DependentLevel HL_PatientHierarchicalLevel { get; set; }
///
/// Patient Information
///
[Required]
[Pos(2)]
public PAT_PatientInformation PAT_PatientInformation { get; set; }
///
/// Loop for Patient Name
///
[Required]
[Pos(3)]
public Loop_2010CA_837P Loop2010CA { get; set; }
///
/// Loop for Claim Information
///
[Required]
[ListCount(100)]
[Pos(4)]
public List Loop2300 { get; set; }
}
///
/// Loop for Billing Provider Name
///
[Serializable()]
[Group(typeof(NM1_BillingProviderName_2))]
public class Loop_2010AA_837P
{
///
/// Billing Provider Name
///
[Required]
[Pos(1)]
public NM1_BillingProviderName_2 NM1_BillingProviderName { get; set; }
///
/// Billing Provider Address
///
[Required]
[Pos(2)]
public N3_AdditionalPatientInformationContactAddress N3_BillingProviderAddress { get; set; }
///
/// Billing Provider City, State, ZIP Code
///
[Required]
[Pos(3)]
public N4_AdditionalPatientInformationContactCity N4_BillingProviderCity_State_ZIPCode { get; set; }
[Required]
[Pos(4)]
public All_REF_837P_8 AllREF { get; set; }
///
/// Billing Provider Contact Information
///
[ListCount(2)]
[Pos(5)]
public List PER_BillingProviderContactInformation { get; set; }
}
///
/// Loop for Pay-to Address Name
///
[Serializable()]
[Group(typeof(NM1_Pay))]
public class Loop_2010AB_837P
{
///
/// Pay-to Address Name
///
[Required]
[Pos(1)]
public NM1_Pay NM1_Pay_AddressName { get; set; }
///
/// Pay-To Address - ADDRESS
///
[Required]
[Pos(2)]
public N3_AdditionalPatientInformationContactAddress N3_Pay_ToAddress_ADDRESS { get; set; }
///
/// Pay-to Address City, State, ZIP Code
///
[Required]
[Pos(3)]
public N4_AdditionalPatientInformationContactCity N4_Pay_AddressCity_State_ZIPCode { get; set; }
}
///
/// Loop for Pay-To Plan Name
///
[Serializable()]
[Group(typeof(NM1_Pay_3))]
public class Loop_2010AC_837P
{
///
/// Pay-To Plan Name
///
[Required]
[Pos(1)]
public NM1_Pay_3 NM1_Pay_ToPlanName { get; set; }
///
/// Pay-To Plan Address
///
[Required]
[Pos(2)]
public N3_AdditionalPatientInformationContactAddress N3_Pay_ToPlanAddress { get; set; }
///
/// Pay-To Plan City, State, ZIP Code
///
[Required]
[Pos(3)]
public N4_AdditionalPatientInformationContactCity N4_Pay_ToPlanCity_State_ZIPCode { get; set; }
[Required]
[Pos(4)]
public All_REF_837P_3 AllREF { get; set; }
}
///
/// Loop for Subscriber Name
///
[Serializable()]
[Group(typeof(NM1_SubscriberName_5))]
public class Loop_2010BA_837P
{
///
/// Subscriber Name
///
[Required]
[Pos(1)]
public NM1_SubscriberName_5 NM1_SubscriberName { get; set; }
///
/// Subscriber Address
///
[Pos(2)]
public N3_AdditionalPatientInformationContactAddress N3_SubscriberAddress { get; set; }
///
/// Subscriber City, State, ZIP Code
///
[Pos(3)]
public N4_AdditionalPatientInformationContactCity N4_SubscriberCity_State_ZIPCode { get; set; }
///
/// Subscriber Demographic Information
///
[Pos(4)]
public DMG_PatientDemographicInformation DMG_SubscriberDemographicInformation { get; set; }
[Pos(5)]
public All_REF_837P_4 AllREF { get; set; }
///
/// Property and Casualty Subscriber Contact Information
///
[Pos(6)]
public PER_PropertyandCasualtyPatientContactInformation PER_PropertyandCasualtySubscriberContactInformation { get; set; }
}
///
/// Loop for Payer Name
///
[Serializable()]
[Group(typeof(NM1_OtherPayerName))]
public class Loop_2010BB_837P
{
///
/// Payer Name
///
[Required]
[Pos(1)]
public NM1_OtherPayerName NM1_PayerName { get; set; }
///
/// Payer Address
///
[Pos(2)]
public N3_AdditionalPatientInformationContactAddress N3_PayerAddress { get; set; }
///
/// Payer City, State, ZIP Code
///
[Pos(3)]
public N4_AdditionalPatientInformationContactCity N4_PayerCity_State_ZIPCode { get; set; }
[Pos(4)]
public All_REF_837P_5 AllREF { get; set; }
}
///
/// Loop for Patient Name
///
[Serializable()]
[Group(typeof(NM1_PatientName_3))]
public class Loop_2010CA_837P
{
///
/// Patient Name
///
[Required]
[Pos(1)]
public NM1_PatientName_3 NM1_PatientName { get; set; }
///
/// Patient Address
///
[Required]
[Pos(2)]
public N3_AdditionalPatientInformationContactAddress N3_PatientAddress { get; set; }
///
/// Patient City, State, ZIP Code
///
[Required]
[Pos(3)]
public N4_AdditionalPatientInformationContactCity N4_PatientCity_State_ZIPCode { get; set; }
///
/// Patient Demographic Information
///
[Required]
[Pos(4)]
public DMG_PatientDemographicInformation DMG_PatientDemographicInformation { get; set; }
[Pos(5)]
public All_REF_837P_7 AllREF { get; set; }
///
/// Property and Casualty Patient Contact Information
///
[Pos(6)]
public PER_PropertyandCasualtyPatientContactInformation PER_PropertyandCasualtyPatientContactInformation { get; set; }
}
///
/// Loop for Claim Information
///
[Serializable()]
[Group(typeof(CLM_ClaimInformation_2))]
public class Loop_2300_837P
{
///
/// Claim Information
///
[Required]
[Pos(1)]
public CLM_ClaimInformation_2 CLM_ClaimInformation { get; set; }
[Pos(2)]
public All_DTP_837P_2 AllDTP { get; set; }
///
/// Claim Supplemental Information
///
[ListCount(10)]
[Pos(3)]
public List PWK_ClaimSupplementalInformation { get; set; }
///
/// Contract Information
///
[Pos(4)]
public CN1_ContractInformation_2 CN1_ContractInformation { get; set; }
///
/// Patient Amount Paid
///
[Pos(5)]
public AMT_PatientAmountPaid AMT_PatientAmountPaid { get; set; }
[Pos(6)]
public All_REF_837P_6 AllREF { get; set; }
///
/// File Information
///
[ListCount(10)]
[Pos(7)]
public List K3_FileInformation { get; set; }
///
/// Claim Note
///
[Pos(8)]
public NTE_ClaimNote_2 NTE_ClaimNote { get; set; }
///
/// Ambulance Transport Information
///
[Pos(9)]
public CR1_AmbulanceTransportInformation CR1_AmbulanceTransportInformation { get; set; }
///
/// Spinal Manipulation Service Information
///
[Pos(10)]
public CR2_SpinalManipulationServiceInformation CR2_SpinalManipulationServiceInformation { get; set; }
[Pos(11)]
public All_CRC_837P_2 AllCRC { get; set; }
[Required]
[Pos(12)]
public All_HI_837P AllHI { get; set; }
///
/// Claim Pricing/Repricing Information
///
[Pos(13)]
public HCP_ClaimPricing HCP_ClaimPricing_RepricingInformation { get; set; }
[Pos(14)]
public All_NM1_837P_3 AllNM1 { get; set; }
///
/// Loop for Other Subscriber Information
///
[ListCount(10)]
[Pos(15)]
public List Loop2320 { get; set; }
///
/// Loop for Service Line Number
///
[Required]
[ListCount(50)]
[Pos(16)]
public List Loop2400 { get; set; }
}
///
/// Loop for Claim Information
///
[Serializable()]
[Group(typeof(CLM_ClaimInformation_2))]
public class Loop_2300_837P_2
{
///
/// Claim Information
///
[Required]
[Pos(1)]
public CLM_ClaimInformation_2 CLM_ClaimInformation { get; set; }
[Pos(2)]
public All_DTP_837P_2 AllDTP { get; set; }
///
/// Claim Supplemental Information
///
[ListCount(10)]
[Pos(3)]
public List PWK_ClaimSupplementalInformation { get; set; }
///
/// Contract Information
///
[Pos(4)]
public CN1_ContractInformation_2 CN1_ContractInformation { get; set; }
///
/// Patient Amount Paid
///
[Pos(5)]
public AMT_PatientAmountPaid AMT_PatientAmountPaid { get; set; }
[Pos(6)]
public All_REF_837P_6 AllREF { get; set; }
///
/// File Information
///
[ListCount(10)]
[Pos(7)]
public List K3_FileInformation { get; set; }
///
/// Claim Note
///
[Pos(8)]
public NTE_ClaimNote_2 NTE_ClaimNote { get; set; }
///
/// Ambulance Transport Information
///
[Pos(9)]
public CR1_AmbulanceTransportInformation CR1_AmbulanceTransportInformation { get; set; }
///
/// Spinal Manipulation Service Information
///
[Pos(10)]
public CR2_SpinalManipulationServiceInformation CR2_SpinalManipulationServiceInformation { get; set; }
[Pos(11)]
public All_CRC_837P_2 AllCRC { get; set; }
[Required]
[Pos(12)]
public All_HI_837P AllHI { get; set; }
///
/// Claim Pricing/Repricing Information
///
[Pos(13)]
public HCP_ClaimPricing HCP_ClaimPricing_RepricingInformation { get; set; }
[Pos(14)]
public All_NM1_837P_3 AllNM1 { get; set; }
///
/// Loop for Other Subscriber Information
///
[ListCount(10)]
[Pos(15)]
public List Loop2320 { get; set; }
///
/// Loop for Service Line Number
///
[Required]
[ListCount(50)]
[Pos(16)]
public List Loop2400 { get; set; }
}
///
/// Loop for Referring Provider Name
///
[Serializable()]
[Group(typeof(NM1_ReferringProviderName))]
public class Loop_2310A_837P
{
///
/// Referring Provider Name
///
[Required]
[Pos(1)]
public NM1_ReferringProviderName NM1_ReferringProviderName { get; set; }
///
/// Referring Provider Secondary Identification
///
[ListCount(3)]
[Pos(2)]
public List REF_ReferringProviderSecondaryIdentification { get; set; }
}
///
/// Loop for Rendering Provider Name
///
[Serializable()]
[Group(typeof(NM1_RenderingProviderName))]
public class Loop_2310B_837P
{
///
/// Rendering Provider Name
///
[Required]
[Pos(1)]
public NM1_RenderingProviderName NM1_RenderingProviderName { get; set; }
///
/// Rendering Provider Specialty Information
///
[Pos(2)]
public PRV_RenderingProviderSpecialtyInformation PRV_RenderingProviderSpecialtyInformation { get; set; }
///
/// Rendering Provider Secondary Identification
///
[ListCount(4)]
[Pos(3)]
public List REF_RenderingProviderSecondaryIdentification { get; set; }
}
///
/// Loop for Service Facility Location Name
///
[Serializable()]
[Group(typeof(NM1_ServiceFacilityLocation))]
public class Loop_2310C_837P
{
///
/// Service Facility Location Name
///
[Required]
[Pos(1)]
public NM1_ServiceFacilityLocation NM1_ServiceFacilityLocationName { get; set; }
///
/// Service Facility Location Address
///
[Required]
[Pos(2)]
public N3_AdditionalPatientInformationContactAddress N3_ServiceFacilityLocationAddress { get; set; }
///
/// Service Facility Location City, State, ZIP Code
///
[Required]
[Pos(3)]
public N4_AdditionalPatientInformationContactCity N4_ServiceFacilityLocationCity_State_ZIPCode { get; set; }
///
/// Service Facility Location Secondary Identification
///
[ListCount(3)]
[Pos(4)]
public List REF_ServiceFacilityLocationSecondaryIdentification { get; set; }
///
/// Service Facility Contact Information
///
[Pos(5)]
public PER_PropertyandCasualtyPatientContactInformation PER_ServiceFacilityContactInformation { get; set; }
}
///
/// Loop for Supervising Provider Name
///
[Serializable()]
[Group(typeof(NM1_SupervisingProviderName))]
public class Loop_2310D_837P
{
///
/// Supervising Provider Name
///
[Required]
[Pos(1)]
public NM1_SupervisingProviderName NM1_SupervisingProviderName { get; set; }
///
/// Supervising Provider Secondary Identification
///
[ListCount(4)]
[Pos(2)]
public List REF_SupervisingProviderSecondaryIdentification { get; set; }
}
///
/// Loop for Ambulance Pick-up Location
///
[Serializable()]
[Group(typeof(NM1_AmbulancePick))]
public class Loop_2310E_837P
{
///
/// Ambulance Pick-up Location
///
[Required]
[Pos(1)]
public NM1_AmbulancePick NM1_AmbulancePick_Location { get; set; }
///
/// Ambulance Pick-up Location Address
///
[Required]
[Pos(2)]
public N3_AdditionalPatientInformationContactAddress N3_AmbulancePick_LocationAddress { get; set; }
///
/// Ambulance Pick-up Location City, State, Zip Code
///
[Required]
[Pos(3)]
public N4_AdditionalPatientInformationContactCity N4_AmbulancePick_LocationCity_State_ZipCode { get; set; }
}
///
/// Loop for Ambulance Drop-off Location
///
[Serializable()]
[Group(typeof(NM1_AmbulanceDrop))]
public class Loop_2310F_837P
{
///
/// Ambulance Drop-off Location
///
[Required]
[Pos(1)]
public NM1_AmbulanceDrop NM1_AmbulanceDrop_Location { get; set; }
///
/// Ambulance Drop-off Location Address
///
[Required]
[Pos(2)]
public N3_AdditionalPatientInformationContactAddress N3_AmbulanceDrop_LocationAddress { get; set; }
///
/// Ambulance Drop-off Location City, State, Zip Code
///
[Required]
[Pos(3)]
public N4_AdditionalPatientInformationContactCity N4_AmbulanceDrop_LocationCity_State_ZipCode { get; set; }
}
///
/// Loop for Other Subscriber Information
///
[Serializable()]
[Group(typeof(SBR_OtherSubscriberInformation))]
public class Loop_2320_837P
{
///
/// Other Subscriber Information
///
[Required]
[Pos(1)]
public SBR_OtherSubscriberInformation SBR_OtherSubscriberInformation { get; set; }
///
/// Claim Level Adjustments
///
[ListCount(5)]
[Pos(2)]
public List CAS_ClaimLevelAdjustments { get; set; }
[Pos(3)]
public All_AMT_837P_2 AllAMT { get; set; }
///
/// Other Insurance Coverage Information
///
[Required]
[Pos(4)]
public OI_OtherInsuranceCoverageInformation_2 OI_OtherInsuranceCoverageInformation { get; set; }
///
/// Outpatient Adjudication Information
///
[Pos(5)]
public MOA_OutpatientAdjudicationInformation MOA_OutpatientAdjudicationInformation { get; set; }
[Required]
[Pos(6)]
public All_NM1_837P_4 AllNM1 { get; set; }
}
///
/// Loop for Other Subscriber Name
///
[Serializable()]
[Group(typeof(NM1_OtherSubscriberName))]
public class Loop_2330A_837P
{
///
/// Other Subscriber Name
///
[Required]
[Pos(1)]
public NM1_OtherSubscriberName NM1_OtherSubscriberName { get; set; }
///
/// Other Subscriber Address
///
[Pos(2)]
public N3_AdditionalPatientInformationContactAddress N3_OtherSubscriberAddress { get; set; }
///
/// Other Subscriber City, State, ZIP Code
///
[Pos(3)]
public N4_AdditionalPatientInformationContactCity N4_OtherSubscriberCity_State_ZIPCode { get; set; }
///
/// Other Subscriber Secondary Identification
///
[Pos(4)]
public REF_OtherSubscriberSecondaryIdentification REF_OtherSubscriberSecondaryIdentification { get; set; }
}
///
/// Loop for Other Payer Name
///
[Serializable()]
[Group(typeof(NM1_OtherPayerName))]
public class Loop_2330B_837P
{
///
/// Other Payer Name
///
[Required]
[Pos(1)]
public NM1_OtherPayerName NM1_OtherPayerName { get; set; }
///
/// Other Payer Address
///
[Pos(2)]
public N3_AdditionalPatientInformationContactAddress N3_OtherPayerAddress { get; set; }
///
/// Other Payer City, State, ZIP Code
///
[Pos(3)]
public N4_AdditionalPatientInformationContactCity N4_OtherPayerCity_State_ZIPCode { get; set; }
///
/// Claim Check or Remittance Date
///
[Pos(4)]
public DTP_ClaimCheckOrRemittanceDate DTP_ClaimCheckorRemittanceDate { get; set; }
[Pos(5)]
public All_REF_837P AllREF { get; set; }
}
///
/// Loop for Other Payer Referring Provider
///
[Serializable()]
[Group(typeof(NM1_OtherPayerReferringProvider))]
public class Loop_2330C_837P
{
///
/// Other Payer Referring Provider
///
[Required]
[Pos(1)]
public NM1_OtherPayerReferringProvider NM1_OtherPayerReferringProvider { get; set; }
///
/// Other Payer Referring Provider Secondary Identification
///
[Required]
[ListCount(3)]
[Pos(2)]
public List REF_OtherPayerReferringProviderSecondaryIdentification { get; set; }
}
///
/// Loop for Other Payer Rendering Provider
///
[Serializable()]
[Group(typeof(NM1_OtherPayerRenderingProvider_2))]
public class Loop_2330D_837P
{
///
/// Other Payer Rendering Provider
///
[Required]
[Pos(1)]
public NM1_OtherPayerRenderingProvider_2 NM1_OtherPayerRenderingProvider { get; set; }
///
/// Other Payer Rendering Provider Secondary Identification
///
[Required]
[ListCount(3)]
[Pos(2)]
public List REF_OtherPayerRenderingProviderSecondaryIdentification { get; set; }
}
///
/// Loop for Other Payer Service Facility Location
///
[Serializable()]
[Group(typeof(NM1_OtherPayerServiceFacilityLocation))]
public class Loop_2330E_837P
{
///
/// Other Payer Service Facility Location
///
[Required]
[Pos(1)]
public NM1_OtherPayerServiceFacilityLocation NM1_OtherPayerServiceFacilityLocation { get; set; }
///
/// Other Payer Service Facility Location Secondary Identification
///
[Required]
[ListCount(3)]
[Pos(2)]
public List REF_OtherPayerServiceFacilityLocationSecondaryIdentification { get; set; }
}
///
/// Loop for Other Payer Supervising Provider
///
[Serializable()]
[Group(typeof(NM1_OtherPayerSupervisingProvider))]
public class Loop_2330F_837P
{
///
/// Other Payer Supervising Provider
///
[Required]
[Pos(1)]
public NM1_OtherPayerSupervisingProvider NM1_OtherPayerSupervisingProvider { get; set; }
///
/// Other Payer Supervising Provider Secondary Identification
///
[Required]
[ListCount(3)]
[Pos(2)]
public List REF_OtherPayerSupervisingProviderSecondaryIdentification { get; set; }
}
///
/// Loop for Other Payer Billing Provider
///
[Serializable()]
[Group(typeof(NM1_OtherPayerBillingProvider))]
public class Loop_2330G_837P
{
///
/// Other Payer Billing Provider
///
[Required]
[Pos(1)]
public NM1_OtherPayerBillingProvider NM1_OtherPayerBillingProvider { get; set; }
///
/// Other Payer Billing Provider Secondary Identification
///
[Required]
[ListCount(2)]
[Pos(2)]
public List REF_OtherPayerBillingProviderSecondaryIdentification { get; set; }
}
///
/// Loop for Service Line Number
///
[Serializable()]
[Group(typeof(LX_HeaderNumber))]
public class Loop_2400_837P
{
///
/// Service Line Number
///
[Required]
[Pos(1)]
public LX_HeaderNumber LX_ServiceLineNumber { get; set; }
///
/// Professional Service
///
[Required]
[Pos(2)]
public SV1_ProfessionalService SV1_ProfessionalService { get; set; }
///
/// Durable Medical Equipment Service
///
[Pos(3)]
public SV5_DurableMedicalEquipmentService SV5_DurableMedicalEquipmentService { get; set; }
[Pos(4)]
public All_PWK_837P AllPWK { get; set; }
///
/// Ambulance Transport Information
///
[Pos(5)]
public CR1_AmbulanceTransportInformation CR1_AmbulanceTransportInformation { get; set; }
///
/// Durable Medical Equipment Certification
///
[Pos(6)]
public CR3_DurableMedicalEquipmentCertification CR3_DurableMedicalEquipmentCertification { get; set; }
[Pos(7)]
public All_CRC_837P AllCRC { get; set; }
[Required]
[Pos(8)]
public All_DTP_837P AllDTP { get; set; }
[Pos(9)]
public All_QTY_837P AllQTY { get; set; }
///
/// Test Result
///
[ListCount(5)]
[Pos(10)]
public List MEA_TestResult { get; set; }
///
/// Contract Information
///
[Pos(11)]
public CN1_ContractInformation_2 CN1_ContractInformation { get; set; }
[Pos(12)]
public All_REF_837P_2 AllREF { get; set; }
[Pos(13)]
public All_AMT_837P AllAMT { get; set; }
///
/// File Information
///
[ListCount(10)]
[Pos(14)]
public List K3_FileInformation { get; set; }
[Pos(15)]
public All_NTE_837P AllNTE { get; set; }
///
/// Purchased Service Information
///
[Pos(16)]
public PS1_PurchasedServiceInformation PS1_PurchasedServiceInformation { get; set; }
///
/// Line Pricing/Repricing Information
///
[Pos(17)]
public HCP_LinePricing_3 HCP_LinePricing_RepricingInformation { get; set; }
///
/// Loop for Drug Identification
///
[Pos(18)]
public Loop_2410_837P Loop2410 { get; set; }
[Pos(19)]
public All_NM1_837P_5 AllNM1 { get; set; }
///
/// Loop for Line Adjudication Information
///
[ListCount(15)]
[Pos(20)]
public List Loop2430 { get; set; }
///
/// Loop for Form Identification Code
///
[Pos(21)]
public List Loop2440 { get; set; }
}
///
/// Loop for Drug Identification
///
[Serializable()]
[Group(typeof(LIN_DrugIdentification_2))]
public class Loop_2410_837P
{
///
/// Drug Identification
///
[Required]
[Pos(1)]
public LIN_DrugIdentification_2 LIN_DrugIdentification { get; set; }
///
/// Drug Quantity
///
[Required]
[Pos(2)]
public CTP_DrugQuantity CTP_DrugQuantity { get; set; }
///
/// Prescription or Compound Drug Association Number
///
[Pos(3)]
public REF_PrescriptionorCompoundDrugAssociationNumber REF_PrescriptionorCompoundDrugAssociationNumber { get; set; }
}
///
/// Loop for Rendering Provider Name
///
[Serializable()]
[Group(typeof(NM1_RenderingProviderName))]
public class Loop_2420A_837P
{
///
/// Rendering Provider Name
///
[Required]
[Pos(1)]
public NM1_RenderingProviderName NM1_RenderingProviderName { get; set; }
///
/// Rendering Provider Specialty Information
///
[Pos(2)]
public PRV_RenderingProviderSpecialtyInformation PRV_RenderingProviderSpecialtyInformation { get; set; }
///
/// Rendering Provider Secondary Identification
///
[ListCount(20)]
[Pos(3)]
public List REF_RenderingProviderSecondaryIdentification { get; set; }
}
///
/// Loop for Purchased Service Provider Name
///
[Serializable()]
[Group(typeof(NM1_PurchasedServiceProviderName))]
public class Loop_2420B_837P
{
///
/// Purchased Service Provider Name
///
[Required]
[Pos(1)]
public NM1_PurchasedServiceProviderName NM1_PurchasedServiceProviderName { get; set; }
///
/// Purchased Service Provider Secondary Identification
///
[ListCount(20)]
[Pos(2)]
public List REF_PurchasedServiceProviderSecondaryIdentification { get; set; }
}
///
/// Loop for Service Facility Location
///
[Serializable()]
[Group(typeof(NM1_ServiceFacilityLocation))]
public class Loop_2420C_837P
{
///
/// Service Facility Location
///
[Required]
[Pos(1)]
public NM1_ServiceFacilityLocation NM1_ServiceFacilityLocation { get; set; }
///
/// Service Facility Location Address
///
[Required]
[Pos(2)]
public N3_AdditionalPatientInformationContactAddress N3_ServiceFacilityLocationAddress { get; set; }
///
/// Service Facility Location City, State, ZIP Code
///
[Required]
[Pos(3)]
public N4_AdditionalPatientInformationContactCity N4_ServiceFacilityLocationCity_State_ZIPCode { get; set; }
///
/// Service Facility Location Secondary Identification
///
[ListCount(3)]
[Pos(4)]
public List REF_ServiceFacilityLocationSecondaryIdentification { get; set; }
}
///
/// Loop for Supervising Provider Name
///
[Serializable()]
[Group(typeof(NM1_SupervisingProviderName))]
public class Loop_2420D_837P
{
///
/// Supervising Provider Name
///
[Required]
[Pos(1)]
public NM1_SupervisingProviderName NM1_SupervisingProviderName { get; set; }
///
/// Supervising Provider Secondary Identification
///
[ListCount(20)]
[Pos(2)]
public List REF_SupervisingProviderSecondaryIdentification { get; set; }
}
///
/// Loop for Ordering Provider Name
///
[Serializable()]
[Group(typeof(NM1_OrderingProviderName))]
public class Loop_2420E_837P
{
///
/// Ordering Provider Name
///
[Required]
[Pos(1)]
public NM1_OrderingProviderName NM1_OrderingProviderName { get; set; }
///
/// Ordering Provider Address
///
[Pos(2)]
public N3_AdditionalPatientInformationContactAddress N3_OrderingProviderAddress { get; set; }
///
/// Ordering Provider City, State, ZIP Code
///
[Pos(3)]
public N4_AdditionalPatientInformationContactCity N4_OrderingProviderCity_State_ZIPCode { get; set; }
///
/// Ordering Provider Secondary Identification
///
[ListCount(20)]
[Pos(4)]
public List REF_OrderingProviderSecondaryIdentification { get; set; }
///
/// Ordering Provider Contact Information
///
[Pos(5)]
public PER_BillingProviderContactInformation PER_OrderingProviderContactInformation { get; set; }
}
///
/// Loop for Referring Provider Name
///
[Serializable()]
[Group(typeof(NM1_ReferringProviderName))]
public class Loop_2420F_837P
{
///
/// Referring Provider Name
///
[Required]
[Pos(1)]
public NM1_ReferringProviderName NM1_ReferringProviderName { get; set; }
///
/// Referring Provider Secondary Identification
///
[ListCount(20)]
[Pos(2)]
public List REF_ReferringProviderSecondaryIdentification { get; set; }
}
///
/// Loop for Ambulance Pick-up Location
///
[Serializable()]
[Group(typeof(NM1_AmbulancePick))]
public class Loop_2420G_837P
{
///
/// Ambulance Pick-up Location
///
[Required]
[Pos(1)]
public NM1_AmbulancePick NM1_AmbulancePick_Location { get; set; }
///
/// Ambulance Pick-up Location Address
///
[Required]
[Pos(2)]
public N3_AdditionalPatientInformationContactAddress N3_AmbulancePick_LocationAddress { get; set; }
///
/// Ambulance Pick-up Location City, State, Zip Code
///
[Required]
[Pos(3)]
public N4_AdditionalPatientInformationContactCity N4_AmbulancePick_LocationCity_State_ZipCode { get; set; }
}
///
/// Loop for Ambulance Drop-off Location
///
[Serializable()]
[Group(typeof(NM1_AmbulanceDrop))]
public class Loop_2420H_837P
{
///
/// Ambulance Drop-off Location
///
[Required]
[Pos(1)]
public NM1_AmbulanceDrop NM1_AmbulanceDrop_Location { get; set; }
///
/// Ambulance Drop-off Location Address
///
[Required]
[Pos(2)]
public N3_AdditionalPatientInformationContactAddress N3_AmbulanceDrop_LocationAddress { get; set; }
///
/// Ambulance Drop-off Location City, State, Zip Code
///
[Required]
[Pos(3)]
public N4_AdditionalPatientInformationContactCity N4_AmbulanceDrop_LocationCity_State_ZipCode { get; set; }
}
///
/// Loop for Line Adjudication Information
///
[Serializable()]
[Group(typeof(SVD_LineAdjudicationInformation))]
public class Loop_2430_837P
{
///
/// Line Adjudication Information
///
[Required]
[Pos(1)]
public SVD_LineAdjudicationInformation SVD_LineAdjudicationInformation { get; set; }
///
/// Line Adjustment
///
[ListCount(5)]
[Pos(2)]
public List CAS_LineAdjustment { get; set; }
///
/// Line Check or Remittance Date
///
[Required]
[Pos(3)]
public DTP_ClaimCheckOrRemittanceDate DTP_LineCheckorRemittanceDate { get; set; }
///
/// Remaining Patient Liability
///
[Pos(4)]
public AMT_RemainingPatientLiability AMT_RemainingPatientLiability { get; set; }
}
///
/// Loop for Form Identification Code
///
[Serializable()]
[Group(typeof(LQ_FormIdentificationCode))]
public class Loop_2440_837P
{
///
/// Form Identification Code
///
[Required]
[Pos(1)]
public LQ_FormIdentificationCode LQ_FormIdentificationCode { get; set; }
///
/// Supporting Documentation
///
[Required]
[ListCount(99)]
[Pos(2)]
public List FRM_SupportingDocumentation { get; set; }
}
}