OTI - |
Other insurance |
| Function: | To provide payer, insured, and payment information when benefits are being coordinated between third party benefit carriers. | |
| This segment also occurs in the following versions of this standard: D99B, D00A, D00B, D01A, D01B, D01C, D02A, D02B, D03A, D03B, D04A, D04B | ||
| Pos | Segment | M/C | Repeat | Repr. | Notes | ||
|---|---|---|---|---|---|---|---|
| 010 | E206 | OBJECT IDENTIFICATION | M | 5 | |||
| 7402 | Object identifier | M | an..35 | ||||
| 7405 | Object identification code qualifier | C | an..3 | ||||
| 4405 | Status description code | C | an..3 | ||||
| 020 | 9645 | Payer responsibility level code | M | 1 | an..3 | ||
| 030 | E507 | DATE/TIME/PERIOD | C | 2 | |||
| 2005 | Date or time or period function code qualifier | M | an..3 | ||||
| 2380 | Date or time or period text | C | an..35 | ||||
| 2379 | Date or time or period format code | C | an..3 | ||||
| 040 | 5267 | Service type code | C | 10 | an..3 | ||
| 050 | 5004 | Monetary amount | C | 4 | n..35 | ||
| 060 | E030 | ADJUSTMENT INFORMATION | C | 15 | |||
| 9619 | Adjustment category code | M | an..3 | ||||
| 4465 | Adjustment reason description code | M | an..3 | ||||
| 5004 | Monetary amount | C | n..35 | ||||
| 070 | 4497 | Insurance cover type code | C | 1 | an..3 | ||
| 080 | 9143 | Relationship description code | C | 1 | an..3 | ||
| 090 | 9607 | Yes or no indicator code | C | 1 | an..3 | ||
| Pos | Position |
|---|---|
| M/C | Mandatory or Conditional |
| Repr. | Representation (Data or Content Type) |
| Segment OTI is used in the following messages: | |||||||
|---|---|---|---|---|---|---|---|
| IHCLME | |||||||