Loop ID Reference Name Codes Notes/Comments Category (Transaction Set) will cause the transaction to be rejected. ST02 Transaction Control Set Contractor will reject an 6 interchange (transmission) that is not submitted with unique values in the ST02 (Transaction Set Control Number) elements. BHT02 Transaction Set Purpose Code 00 Transaction Set Purpose 6 Code (BHT02) must equal '00' (ORIGINAL). BHT06 Claim/Encounter Identifier CH Claim or Encounter 6 Indicator (BHT06) must equal 'CH' (CHARGEABLE). 1000A NM109 Submitter ID Contractor will reject an 5 interchange (transmission) that is submitted with a submitter identification number that is not authorized for electronic claim submission. 1000B NM103 Receiver Name Contractor will reject an 5 interchange (transmission) that is not submitted with a valid carrier name (NM1). 2000B HL04 Hierarchical Child Code 0 The value accepted is 6 “0”. Submission of will “1” cause your file to reject. 2000B SBR01 Payer Responsibility Sequence P, S The values accepted are 6 Number Code and Submission of “P” “S”. other values will cause your claim to reject. 2000B SBR02, Subscriber Information For Medicare, the 6 SBR09 subscriber is always the same as the patient (SBR02=18, SBR09=MB). The Patient Hierarchical Level (2000C loop) is not used. 2000B PAT08 Patient Weight The maximum number of 2 characters to be submitted in the patient weight field is four characters to the left of the decimal and two
Loop ID Reference Name Codes Notes/Comments Category (Transaction Set) will cause the transaction to be rejected. ST02 Transaction Control Set Contractor will reject an interchange (transmission) that is not submitted with unique values in the ST02 (Transaction Set Control Number) elements. 6 BHT02 Transaction Set Purpose Code 00 Transaction Set Purpose Code (BHT02) must equal '00' (ORIGINAL). 6 BHT06 Claim/Encounter Identifier CH Claim or Encounter Indicator (BHT06) must equal 'CH' (CHARGEABLE). 6 1000A NM109 Submitter ID Contractor will reject an interchange (transmission) that is submitted with a submitter identification number that is not authorized for electronic claim submission. 5 1000B NM103 Receiver Name Contractor will reject an interchange (transmission) that is not submitted with a valid carrier name (NM1). 5 2000B HL04 Hierarchical Child Code 0 The value accepted is “0”. Submission of “1” will cause your file to reject. 6 2000B SBR01 Payer Responsibility Sequence Number Code P, S The values accepted are “P” and “S”. Submission of other values will cause your claim to reject. 6 2000B SBR02, SBR09 Subscriber Information For Medicare, the subscriber is always the same as the patient (SBR02=18, SBR09=MB). The Patient Hierarchical Level (2000C loop) is not used. 6 2000B PAT08 Patient Weight The maximum number of characters to be submitted in the patient weight field is four characters to the left of the decimal and two 2