QTY

Claim Supplemental Information Quantity

Pos: 064

Max: 15

Detail - Optional

Loop: 2100

Elements: 2

User Option (Usage): Situational

To specify quantity information

Element Summary:

	Ref	Id	Element Name	Req	Type	Min/Max	Usage
	QTY01	673	Quantity Qualifier Description: Code specifying the type of quantity	M	ID	2/2	Required

	Code	Name
	CA	Covered - Actual
	CD	Co-insured - Actual
	LA	Life-time Reserve - Actual
	LE	Life-time Reserve - Estimated
	NA	Number of Non-covered Days
	NE	Non-Covered - Estimated
	NR	Not Replaced Blood Units
	OU	Outlier Days
	PS	Prescription
	VS	Visits
	ZK	Federal Medicare or Medicaid Payment Mandate - Category 1
	ZL	Federal Medicare or Medicaid Payment Mandate - Category 2
	ZM	Federal Medicare or Medicaid Payment Mandate - Category 3
	ZN	Federal Medicare or Medicaid Payment Mandate - Category 4
	ZO	Federal Medicare or Medicaid Payment Mandate - Category 5

QTY02

380

Quantity
Description: Numeric value of quantity
Industry: Claim Supplemental Information Quantity

1/15

Required

1.	R0204 - At least one of QTY02,QTY04 is required
2.	E0204 - Only one of QTY02,QTY04 may be presented

1.	QTY04 is used when the quantity is non-numeric.

Notes:

1. Use this segment to convey information only. It is not part of the financial balancing of the 835.
2. Use this segment only when the value of specific quantities identified in the QTY01 qualifier are Non-zero.

Example:

QTY*ZK*3~