HIPAA Reference ASC X12N/005010A1 UB-04 Transaction Set/Loop/ Data Form Segment ID/Code Value/ Element # Data Element Name Locator Reference Designator OP8001 Record Type NA NA NA OP8002 Sequence NA NA NA OP8003 Patient Control Number 3A 26 837/2300/CLM/01 OP8004 Attending Provider NPI 76 24J 837/2310A/NM1/71/1/XX/09 OP8005 Operating Provider NPI 77 24J 837/2310B/NM1/72/1/XX/09 OP8006 Attending Provider Last 76 NA Name OP8007 Attending Provider First 76 NA 837/2310A/NM1/71/1/04 Name OP8008 Attending Provider Middle 76 NA 837/2310A/NM1/71/1/05 Initial OP8009 Operating Provider Last 77 NA Name OP8010 Operating Provider First 77 NA 837/2310B/NM1/72/1/04 Name OP8011 Operating Provider Middle 77 NA 837/2310B/NM1/72/1/05 Initial HIPAA Reference ASC X12N/005010A1 UB-04 Transaction Set/Loop/ Data Form Segment ID/Code Value/ Element # Data Element Name Locator Reference Designator OP9001 Record Type NA NA NA
Data Element # Data Element Name UB-04 Form Locator HIPAA Reference ASC X12N/005010A1 Transaction Set/Loop/ Segment ID/Code Value/ Reference Designator OP8001 Record Type NA NA NA OP8002 Sequence NA NA NA OP8003 Patient Control Number 3A 26 837/2300/CLM/01 OP8004 Attending Provider NPI 76 24J 837/2310A/NM1/71/1/XX/09 OP8005 Operating Provider NPI 77 24J 837/2310B/NM1/72/1/XX/09 OP8006 Attending Provider Last Name 76 NA OP8007 Attending Provider First Name 76 NA 837/2310A/NM1/71/1/04 OP8008 Attending Provider Middle Initial 76 NA 837/2310A/NM1/71/1/05 OP8009 Operating Provider Last Name 77 NA OP8010 Operating Provider First Name 77 NA 837/2310B/NM1/72/1/04 OP8011 Operating Provider Middle Initial 77 NA 837/2310B/NM1/72/1/05 Data Element # Data Element Name UB-04 Form Locator HIPAA Reference ASC X12N/005010A1 Transaction Set/Loop/ Segment ID/Code Value/ Reference Designator OP9001 Record Type NA NA NA