ADT Segments (HL7 Data Transmission Guide - Appendix B)

1 ADT Segments (HL7 Data Transmission Guide - Appendix B)BHSB atch Header SegmentHL7 Standard Version Document Number Len DT Rep Sup Element Name Seq Description Lookup Batch Field SeparatorYesThe character representing the separator between Segment ID and the first real field (BHS-2). Serves as the separator and defines the character to be used as a separator for the rest of the message. Recommended value is | (ASCII 124). 1 1 1ST Batch Encoding CharactersYesFour characters in the following order: component separator, repetition separator, escape character and subcomponent separator. Recommended values are ^~\& (ASCII 94, 126, 92 and 38, respectively). 2 1 3ST Batch Sending ApplicationYesUniquely identifies the sending application.

2 For RPMS sites, the value will be "RPMS"; for non-RPMS site, it will be the name of the application. 3 1 15ST Batch Sending FacilityYesContains the address of one of several occurrences of the same application within the sending system. 4 1 20ST Batch Receiving ApplicationYesUniquely identifies the receiving applications among all other applications. This will be "DW1." 5 1 15ST Batch Receiving FacilityYesIdentifies the receiving application among multiple instances of the application running on behalf of different organizations. Constant value is "IHS." 6 1 20ST Batch Creation Date/TimeYesDate export was run. Format CCYYMMDD. If the export runs over multiple days, this is the date the export started.

3 7 1 26TS Batch SecurityNoIn some applications of HL7, this field is used to implement security features. Its use is not yet further specified. 8 1 40ST Batch Name/ID/TypeYesThis field can be used by the application processing the batch, and can have extra components if needed. For RPMS sites, this will be the batch log IEN from RPMS. 9 1 20ST Batch CommentYesThis is a comment field not further defined in the HL7 protocol. For DW1 purposes, this will be the name of the exporting box's site. 10 1 30ST Batch Control IDYesUniquely identifies a particular batch concatenating the values of BHS-4 and BHS-9. This can be echoed back in BHS-12 if an answering batch is needed. 11 1 20ST Reference Batch Control IDNoThis has a value only if the batch is repeated.

4 It is the BHS-11 value in the original batch that is being repeated. 12 1 20 STPage 1 of 50 Date generated: 3/29/2018DA100 Official Product of Documatron for DW1 BHSB atch Header SegmentBTSB atch Trailer SegmentHL7 Standard Version Document Number Len DT Rep Sup Element Name Seq Description Lookup Batch Message CountYesCount of registration and visit messages (not including header and trailer messages) contained in this export. 1 1 10ST Batch CommentYes 2 1 80 STYB atch TotalsYes 3 1 100 NMPage 2 of 50 Date generated: 3/29/2018DA100 Official Product of Documatron for DW1 BTSB atch Trailer SegmentDG1 Diagnosis SegmentHL7 Standard Version Document Number Len DT Rep Sup Element Name Seq Description Lookup Set ID - DG1 YesFor the first occurrence, the sequence number is 1; for the second occurrence, the sequence number is 2, and so on.

5 The first occurrence is considered the "primary" diagnosis. 1 1 2SI Diagnosis Coding MethodNoICD Coding method (not used - revision method transmitted as 3rd component of each ICD code element) 2 1 2ID Diagnosis Code - DG1 YesNationally recognized standard code set. Required only for non-dental direct encounters. Minimum of one value Codes (Industry SCS) 3 1 8CE ICD Diagnosis DescriptionNoICD code description 3 2 250ST ICD DX RevisionYesICD Coding standard revision used for this diagnosis code, such as ICD-9 or ICD-10. Values I9 or I10. 3 3 3ST Diagnosis DescriptionNo 4 1 40ST Diagnosis Date/TimeNo 5 1 26TS Diagnosis TypeNo 6 1 2IS Major Diagnostic CategoryNo 7 1 250CE Diagnostic Related GroupNo 8 1 250CE DRG Approval IndicatorNo 9 1 1ID DRG Grouper Review CodeNo 10 1 2IS Outlier TypeNo 11 1 250CE Outlier DaysNo 12 1 3NM Outlier CostNo 13 1 12CP Grouper Version And TypeNo 14 1 4ST Diagnosis PriorityNo 15 1 2 IDYD iagnosing ClinicianNo 16 1 250 XCN Diagnosis ClassificationNo 17 1 3IS Confidential IndicatorNo 18 1 1ID Attestation Date/TimeNo 19 1 26 TSPage 3 of 50 Date generated.

6 3/29/2018DA100 Official Product of Documatron for DW1DG1 Diagnosis SegmentEVNE vent Type SegmentHL7 Standard Version Document Number Len DT Rep Sup Element Name Seq Description Lookup Event Type CodeYesRetained for backward compatibility only. IHS recommends using the second component of MSH-9 to transmit the event type code information. 1 1 3ID Recorded Date/TimeYesDuplicates MSH-7. 2 1 26TS Date/Time Planned EventNo 3 1 26TS Event Reason CodeNo 4 1 3 ISYO perator IDNo 5 1 250 XCN Event OccurredNo 6 1 26TS Event FacilityNo 7 1 180 HDPage 4 of 50 Date generated: 3/29/2018DA100 Official Product of Documatron for DW1 EVNE vent Type SegmentIN1 Insurance SegmentHL7 Standard Version Document Number Len DT Rep Sup Element Name Seq Description Lookup Set ID - IN1 YesFor the first occurrence, the sequence number is 1; for the second occurrence, the sequence number is 2, and so on.

7 1 1 4SI Insurance Plan IDNoSending application's Insurance Plan ID. 2 1 250 ISYI nsurance Company IDYesInsurance company's EIN. 3 1 11 CXYI nsurance Company NameYesInsurance Company Category Codes (OIT SCS) 4 1 3IS YesInsurance Company Name. 4 2 50 STYI nsurance Company AddressNo 5 1 250 XADYI nsurance Co Contact PersonNo 6 1 250 XPNYI nsurance Co Phone NumberNo 7 1 250 XTN Group NumberYes 8 1 12 STYG roup NameNo 9 1 250 XONYI nsured's Group Emp IDNo 10 1 250 CXYI nsured's Group Emp NameNo 11 1 250 XON Plan Effective DateYesFor Medicaid and Medicare this will be the eligibility date; for private insurance this will be the effective date. 12 1 8DT Plan Expiration DateYesFor Medicaid and Medicare this will be the eligibility end date; for private insurance this will be the expiration date.

8 13 1 8DT Authorization InformationNo 14 1 250CM Plan TypeYesMedicaid State Of (SCB) 15 1 2IS YesMedicaid Plan Name. 15 2 30 ISYName Of InsuredYesLast Name. 16 1 30ST YesFirst Name. 16 2 30ST YesMiddle Initial or Name. 16 3 30ST Insured's Relationship To PatientYesPatient's relationship to insured ( self, spouse, etc.). The description associated with the X12 Relation to Insured code set is preferred. 17 1 17IS Insured's Date Of BirthNo 18 1 26 TSPage 5 of 50 Date generated: 3/29/2018DA100 Official Product of Documatron for DW1IN1 Insurance SegmentIN1 Insurance SegmentHL7 Standard Version Document Number Len DT Rep Sup Element Name Seq Description LookupYInsured's AddressNo 19 1 250 XAD Assignment Of BenefitsNo 20 1 2IS Coordination Of BenefitsNo 21 1 2IS Coord Of Ben.

9 PriorityNo 22 1 2ST Notice Of Admission FlagNo 23 1 1ID Notice Of Admission DateNo 24 1 8DT Report Of Eligibility FlagNo 25 1 1ID Report Of Eligibility DateNo 26 1 8DT Release Information CodeNo 27 1 2IS Pre-Admit Cert (PAC)No 28 1 15ST Verification Date/TimeNo 29 1 26 TSYV erification ByNo 30 1 250 XCN Type Of Agreement CodeNo 31 1 2IS Billing StatusNo 32 1 2IS Lifetime Reserve DaysNo 33 1 4NM Delay Before DayNo 34 1 4NM Company Plan CodeNo 35 1 8IS Policy NumberNo 36 1 15ST Policy DeductibleNo 37 1 12CP Policy Limit - AmountNo 38 1 12CP Policy Limit - DaysNo 39 1 4NM Room Rate - Semi-PrivateNo 40 1 12CP Room Rate - PrivateNo 41 1 12CP Insured's Employment StatusNo 42 1 250 CEPage 6 of 50 Date generated.

10 3/29/2018DA100 Official Product of Documatron for DW1IN1 Insurance SegmentIN1 Insurance SegmentHL7 Standard Version Document Number Len DT Rep Sup Element Name Seq Description Lookup Insured's Administrative SexNo 43 1 1 ISYI nsured's Employer's AddressNo 44 1 250 XAD Verification StatusNo 45 1 2ST Prior Insurance Plan IDNo 46 1 8IS Coverage TypeYesFor Medicare and Railroad: A or B; for Medicaid: value must be 1 or 2 chars; not applicable for private. 47 1 2IS HandicapNo 48 1 2 ISYI nsured's ID NumberYesPolicy Number. 49 1 30CX YesPrefix / Suffix. 49 2 3 CXPage 7 of 50 Date generated: 3/29/2018DA100 Official Product of Documatron for DW1IN1 Insurance SegmentMSAM essage Acknowledgement SegmentHL7 Standard Version Document Number Len DT Rep Sup Element Name Seq Description Lookup Acknowledgment CodeYesCA = Application Accept, CE = Application Error, CR = Application Reject.