ENT

Individual Remittance

Pos: 010	Max: 1
Detail - Optional
Loop: 2000B	Elements: 4

Ref

Id

Element Name

Req

Type

Min/Max

Usage

ENT01

554

Assigned Number
Description: Number assigned for differentiation within a transaction set

O

N0

1/6

Required

ENT02

98

Entity Identifier Code
Description: Code identifying an organizational entity, a physical location, property or an individual

C

ID

2/3

Required

Code

Name

2J

Individual

ENT03

66

Identification Code Qualifier
Description: Code designating the system/method of code structure used for Identification Code (67)

C

ID

1/2

Required

Code

Name

34

Social Security Number

EI

Employee Identification Number

ZZ

Mutually Defined

The value ‘ZZ’, when used in this data element shall be defined as “HIPAA Individual Identifier” once this identifier has been adopted. Under the Health Insurance Portability and Accountability Act of 1996, the Secretary of the Department of Health and Human Services must adopt a standard individual identifier for use in this transaction. This code is required under HIPAA.

ENT04

67

Identification Code
Description: Code identifying a party or other code
Health Care Industry: Receiver’s Individual Identifier
This is the identification number of the individual used by the receiver.

C

AN

2/80

Required

1.

P020304 - If either ENT02,ENT03,ENT04 is present, then all are required

2.

P050607 - If either ENT05,ENT06,ENT07 is present, then all are required

3.

P0809 - If either ENT08,ENT09 is present, then all are required

1.

This segment allows for the grouping of data by entity/entities at or within a master/masters. A master (e.g., an organization) can be comprised of numerous subgroups (e.g., entities). This master may send grouped data to another master (e.g., an organization) which is comprised of one or more entities. Groupings are as follows:

2.

(1) Single/Single: Only ENT01 is necessary, because there is a single entity (the sending master) communicating with a single entity (the receiving master).

3.

(2) Single/Multiple: ENT05, ENT06, and ENT07 would be used to identify the entities within the receiving master. The sending master is a single entity, so no other data elements need be used.

4.

(3) Multiple/Single: ENT02, ENT03, and ENT04 would be used to identify the entities within the sending master. The receiving master is a single entity, so no other data elements need be used.

5.

(4) Multiple/Multiple: ENT02, ENT03, and ENT04 would be used to identify the entities within the sending master. ENT05, ENT06, and ENT07 would be used to identify the entities within the receiving master.

6.

This segment also allows for the transmission of a unique reference number that is meaningful between the entities.

Notes:

1. This segment is used to start Table 2 (Detail Remittance Information), and to provide remittance line items that pertain to an individual enrolled in a group plan. The following N1, RMR and ADX information relays payment information pertaining to this individual.

Example:

ENT*1*2J*34*030668776~