OI Other Health Insurance Information

To specify information associated with other health insurance coverage

Position
Element
Name
Type
Requirement
Min
Max
Repeat
OI-01
Claim Filing Indicator Code
Identifier (ID)
Optional
1
2
-
Code identifying type of claim
OI-02
Claim Submission Reason Code
Identifier (ID)
Optional
2
2
-
Code identifying reason for claim submission
OI-03
Yes/No Condition or Response Code
Identifier (ID)
Optional
1
1
-
Code indicating a Yes or No condition or response
OI03 is the assignment of benefits indicator. A "Y" value indicates insured or authorized person authorizes benefits to be assigned to the provider; an "N" value indicates benefits have not been assigned to the provider.
OI-04
Patient Signature Source Code
Identifier (ID)
Optional
1
1
-
Code indicating how the patient or subscriber authorization signatures were obtained and how they are being retained by the provider
OI-05
Provider Agreement Code
Identifier (ID)
Optional
1
1
-
Code indicating the type of agreement under which the provider is submitting this claim
OI-06
Release of Information Code
Identifier (ID)
Optional
1
1
-
Code indicating whether the provider has on file a signed statement by the patient authorizing the release of medical data to other organizations

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