EDI 148 Segments and Elements for the Report Of Injury, Illness Or Incident Standard


AgencySet IDFGTransaction DescriptionSubcommitteeStandard
ANSI148IJReport Of Injury, Illness Or Incident InsuranceDownload


Online EDI 148 Translation      More about 148s   148 Mapping Specs   Need Help?

Research and Development:
See the list of EDI 148 segments and elements in below data grid. The Jobisez.com site has an online translation tool that converts the EDI 148 (Report Of Injury, Illness Or Incident) document into a CSV file. If you are researching the 148s, you can view other trading partner's mapping specifications. You can also gain knowledge by researching all EDI document types. Jobisez LLC can also provide assistance if you need additional help.

Solutions:
Are you looking to trade the EDI 148 transaction with one of your trading partners? Do you need an EDI VAN Savings solution to exchange the 148? Or perhaps you would like to use a Cloud-Based application, so you can plug your 148 transaction directly into your ERP and TMS systems. Even small companies have the ability to trade the EDI 148 by using the EDI Mobile Device solution.


The EDI 148 Segments and Elements

SegmentDescriptionSectReqMax LoopMax UsagePos
BHTBeginning Of Hierarchical TransactionHM011
CURCurrencyHO012
QTYQuantity InformationHO013
REFReference InformationHO094
NM1Individual Or Organizational NameHO99999915
N2Additional Name InformationHO016
N3Party LocationHO027
N4Geographic LocationHO018
PERAdministrative Communications ContactHO039
ACTAccount IdentificationHO0910
DTPDate Or Time Or PeriodHO0911
DMGDemographic InformationHO0112
REFReference InformationHO0913
QTYQuantity InformationHO099999914
CRCConditions IndicatorHO099999915
HLHierarchical LevelDM999999116
CRIClaim Report InformationDO099999917
ACTAccount IdentificationDO0218
DTPDate Or Time Or PeriodDO099999919
CURCurrencyDO0120
AMTMonetary Amount InformationDO099999921
FCFinancial ContributionDO0222
REFReference InformationDO099999923
DMGDemographic InformationDO0124
QTYQuantity InformationDO099999925
CRCConditions IndicatorDO099999926
VEHVehicle InformationDO099999927
NM1Individual Or Organizational NameDO999128
N2Additional Name InformationDO0129
N3Party LocationDO0230
N4Geographic LocationDO0131
PERAdministrative Communications ContactDO0332
ACTAccount IdentificationDO0933
DTPDate Or Time Or PeriodDO0934
DMGDemographic InformationDO0135
REFReference InformationDO099999936
QTYQuantity InformationDO099999937
CRCConditions IndicatorDO099999938
ESIEmployment Status InformationDO99139
EMTEmploymentDO0140
TPBBusiness Professional TitleDO0141
DTPDate Or Time Or PeriodDO099999942
REFReference InformationDO099999943
QTYQuantity InformationDO099999944
NM1Individual Or Organizational NameDO0145
PERAdministrative Communications ContactDO099999946
CRCConditions IndicatorDO0947
LXTransaction Set Line NumberDO99148
AINIncomeDO0149
CURCurrencyDO0150
TXITax InformationDO0951
WSWork ScheduleDO09952
DTPDate Or Time Or PeriodDO099999953
QTYQuantity InformationDO0954
REFReference InformationDO099999955
LNLoan InformationDO999156
REFReference InformationDO099999957
VEHVehicle InformationDO999999158
N4Geographic LocationDO0159
PIDProduct/Item DescriptionDO099999960
AMTMonetary Amount InformationDO99161
PCTPercent AmountsDO0162
DTPDate Or Time Or PeriodDO099999963
NM1Individual Or Organizational NameDO999999164
DMGDemographic InformationDO0165
N3Party LocationDO0166
N4Geographic LocationDO0167
PERAdministrative Communications ContactDO0168
DTPDate Or Time Or PeriodDO099999969
REFReference InformationDO099999970
LSLoop HeaderDO0171
LXTransaction Set Line NumberDO999999172
IIIInformationDO999999173
IMPImpairment DetailDO0674
DTPDate Or Time Or PeriodDO099999975
CRCConditions IndicatorDO0976
QTYQuantity InformationDO099999977
REFReference InformationDO099999978
LMCode Source InformationDO999999179
LQIndustry Code IdentificationDM099999980
NM1Individual Or Organizational NameDO999181
N2Additional Name InformationDO0182
N3Party LocationDO0283
N4Geographic LocationDO0184
PERAdministrative Communications ContactDO0285
ACTAccount IdentificationDO0986
DTPDate Or Time Or PeriodDO099999987
DMGDemographic InformationDO0188
REFReference InformationDO099999989
CRCConditions IndicatorDO099999990
LELoop TrailerDO0191
CFICompensation Financial InformationDO999192
CURCurrencyDO0193
AMTMonetary Amount InformationDO0994
DTPDate Or Time Or PeriodDO099999995
QTYQuantity InformationDO099999996
RELRelationshipDO03097
REFReference InformationDO0998
CRCConditions IndicatorDO099999999
AD1Adjustment AmountDO9991100
DTPDate Or Time Or PeriodDO0999999101
REFReference InformationDO0999999102
NM1Individual Or Organizational NameDO9991103
N2Additional Name InformationDO01104
N3Party LocationDO02105
N4Geographic LocationDO01106
PERAdministrative Communications ContactDO02107
ACTAccount IdentificationDO09108
DTPDate Or Time Or PeriodDO09109
DMGDemographic InformationDO01110
REFReference InformationDO09111
GRIStatistical Government InformationSO099112


SegmentElementDescriptionReqMin LengthMax LengthType
BHT1Hierarchical Structure CodeM44ID
BHT2Transaction Set Purpose CodeM22ID
BHT3Reference IdentificationO150AN
BHT4DateO88DT
BHT5TimeO48TM
BHT6Transaction Type CodeO22ID
CUR1Entity Identifier CodeM23ID
CUR2Currency CodeM33ID
CUR3Exchange RateO410R
CUR4Entity Identifier CodeO23ID
CUR5Currency CodeO33ID
CUR6Currency Market/Exchange CodeO33ID
CUR7Date/Time QualifierC33ID
CUR8DateO88DT
CUR9TimeO48TM
CUR10Date/Time QualifierC33ID
CUR11DateC88DT
CUR12TimeC48TM
CUR13Date/Time QualifierC33ID
CUR14DateC88DT
CUR15TimeC48TM
CUR16Date/Time QualifierC33ID
CUR17DateC88DT
CUR18TimeC48TM
CUR19Date/Time QualifierC33ID
CUR20DateC88DT
CUR21TimeC48TM
QTY1Quantity QualifierM22ID
QTY2QuantityC115R
QTY3Unit Or Basis For Measurement CodeO22ID
QTY4ExponentO115R
QTY5MultiplierO110R
QTY6Unit Or Basis For Measurement CodeO22ID
QTY7ExponentO115R
QTY8MultiplierO110R
QTY9Unit Or Basis For Measurement CodeO22ID
QTY10ExponentO115R
QTY11MultiplierO110R
QTY12Unit Or Basis For Measurement CodeO22ID
QTY13ExponentO115R
QTY14MultiplierO110R
QTY15Unit Or Basis For Measurement CodeO22ID
QTY16ExponentO115R
QTY17MultiplierO110R
QTY18Free-Form InformationC130AN
REF1Reference Identification QualifierM23ID
REF2Reference IdentificationC150AN
REF3DescriptionC180AN
REF4Reference Identification QualifierO23ID
REF5Reference IdentificationO150AN
REF6Reference Identification QualifierO23ID
REF7Reference IdentificationO150AN
REF8Reference Identification QualifierO23ID
REF9Reference IdentificationO150AN
NM11Entity Identifier CodeM23ID
NM12Entity Type QualifierM11ID
NM13Name Last Or Organization NameC160AN
NM14Name FirstO135AN
NM15Name MiddleO125AN
NM16Name PrefixO110AN
NM17Name SuffixO110AN
NM18Identification Code QualifierC12ID
NM19Identification CodeC280AN
NM110Entity Relationship CodeC22ID
NM111Entity Identifier CodeO23ID
NM112Name Last Or Organization NameO160AN
N21NameM160AN
N22NameO160AN
N31Address InformationM155AN
N32Address InformationO155AN
N41City NameO230AN
N42State Or Province CodeC22ID
N43Postal CodeO315ID
N44Country CodeC23ID
N45Location QualifierC12ID
N46Location IdentifierO130AN
N47Country Subdivision CodeC13ID
PER1Contact Function CodeM22ID
PER2NameO160AN
PER3Communication Number QualifierC22ID
PER4Communication NumberC1256AN
PER5Communication Number QualifierC22ID
PER6Communication NumberC1256AN
PER7Communication Number QualifierC22ID
PER8Communication NumberC1256AN
PER9Contact Inquiry ReferenceO120AN
ACT1Account NumberM135AN
ACT2NameO160AN
ACT3Identification Code QualifierC12ID
ACT4Identification CodeC280AN
ACT5Account Number QualifierC13ID
ACT6Account NumberC135AN
ACT7DescriptionO180AN
ACT8Payment Method Type CodeO12ID
ACT9Benefit Status CodeO11ID
DTP1Date/Time QualifierM33ID
DTP2Date Time Period Format QualifierM23ID
DTP3Date Time PeriodM135AN
DMG1Date Time Period Format QualifierC23ID
DMG2Date Time PeriodC135AN
DMG3Gender CodeO11ID
DMG4Marital Status CodeO11ID
DMG5Race Or Ethnicity CodeC11ID
DMG6Code List Qualifier CodeC13ID
DMG7Industry CodeC130AN
DMG8Citizenship Status CodeO12ID
DMG9Country CodeO23ID
DMG10Basis Of Verification CodeO12ID
DMG11QuantityO115R
DMG12Code List Qualifier CodeC13ID
DMG13Industry CodeC130AN
REF1Reference Identification QualifierM23ID
REF2Reference IdentificationC150AN
REF3DescriptionC180AN
REF4Reference Identification QualifierO23ID
REF5Reference IdentificationO150AN
REF6Reference Identification QualifierO23ID
REF7Reference IdentificationO150AN
REF8Reference Identification QualifierO23ID
REF9Reference IdentificationO150AN
QTY1Quantity QualifierM22ID
QTY2QuantityC115R
QTY3Unit Or Basis For Measurement CodeO22ID
QTY4ExponentO115R
QTY5MultiplierO110R
QTY6Unit Or Basis For Measurement CodeO22ID
QTY7ExponentO115R
QTY8MultiplierO110R
QTY9Unit Or Basis For Measurement CodeO22ID
QTY10ExponentO115R
QTY11MultiplierO110R
QTY12Unit Or Basis For Measurement CodeO22ID
QTY13ExponentO115R
QTY14MultiplierO110R
QTY15Unit Or Basis For Measurement CodeO22ID
QTY16ExponentO115R
QTY17MultiplierO110R
QTY18Free-Form InformationC130AN
CRC1Code CategoryM22ID
CRC2Yes/No Condition Or Response CodeM11ID
CRC3Condition IndicatorM23ID
CRC4Condition IndicatorO23ID
CRC5Condition IndicatorO23ID
CRC6Condition IndicatorO23ID
CRC7Condition IndicatorO23ID
HL1Hierarchical Id NumberM112AN
HL2Hierarchical Parent Id NumberO112AN
HL3Hierarchical Level CodeM12ID
HL4Hierarchical Child CodeO11ID
CRI1Maintenance Type CodeC33ID
CRI2Claim Status CodeO12ID
CRI3Maintenance Reason CodeO23ID
CRI4Yes/No Condition Or Response CodeO11ID
CRI5Frequency CodeO11ID
CRI6Claim Filing Indicator CodeM12ID
CRI7Date Time Period Format QualifierC23ID
CRI8Date Time PeriodC135AN
CRI9Adjustment Reason Code CharacteristicO12ID
CRI10Late Reason CodeO22ID
CRI11Condition IndicatorO23ID
ACT1Account NumberM135AN
ACT2NameO160AN
ACT3Identification Code QualifierC12ID
ACT4Identification CodeC280AN
ACT5Account Number QualifierC13ID
ACT6Account NumberC135AN
ACT7DescriptionO180AN
ACT8Payment Method Type CodeO12ID
ACT9Benefit Status CodeO11ID
DTP1Date/Time QualifierM33ID
DTP2Date Time Period Format QualifierM23ID
DTP3Date Time PeriodM135AN
CUR1Entity Identifier CodeM23ID
CUR2Currency CodeM33ID
CUR3Exchange RateO410R
CUR4Entity Identifier CodeO23ID
CUR5Currency CodeO33ID
CUR6Currency Market/Exchange CodeO33ID
CUR7Date/Time QualifierC33ID
CUR8DateO88DT
CUR9TimeO48TM
CUR10Date/Time QualifierC33ID
CUR11DateC88DT
CUR12TimeC48TM
CUR13Date/Time QualifierC33ID
CUR14DateC88DT
CUR15TimeC48TM
CUR16Date/Time QualifierC33ID
CUR17DateC88DT
CUR18TimeC48TM
CUR19Date/Time QualifierC33ID
CUR20DateC88DT
CUR21TimeC48TM
AMT1Amount Qualifier CodeM13ID
AMT2Monetary AmountM118R
AMT3Credit/Debit Flag CodeO11ID
FC1Contribution CodeM22ID
FC2Percentage As DecimalO110R
FC3Monetary AmountO118R
FC4NumberO19N0
FC5Yes/No Condition Or Response CodeO11ID
REF1Reference Identification QualifierM23ID
REF2Reference IdentificationC150AN
REF3DescriptionC180AN
REF4Reference Identification QualifierO23ID
REF5Reference IdentificationO150AN
REF6Reference Identification QualifierO23ID
REF7Reference IdentificationO150AN
REF8Reference Identification QualifierO23ID
REF9Reference IdentificationO150AN
DMG1Date Time Period Format QualifierC23ID
DMG2Date Time PeriodC135AN
DMG3Gender CodeO11ID
DMG4Marital Status CodeO11ID
DMG5Race Or Ethnicity CodeC11ID
DMG6Code List Qualifier CodeC13ID
DMG7Industry CodeC130AN
DMG8Citizenship Status CodeO12ID
DMG9Country CodeO23ID
DMG10Basis Of Verification CodeO12ID
DMG11QuantityO115R
DMG12Code List Qualifier CodeC13ID
DMG13Industry CodeC130AN
QTY1Quantity QualifierM22ID
QTY2QuantityC115R
QTY3Unit Or Basis For Measurement CodeO22ID
QTY4ExponentO115R
QTY5MultiplierO110R
QTY6Unit Or Basis For Measurement CodeO22ID
QTY7ExponentO115R
QTY8MultiplierO110R
QTY9Unit Or Basis For Measurement CodeO22ID
QTY10ExponentO115R
QTY11MultiplierO110R
QTY12Unit Or Basis For Measurement CodeO22ID
QTY13ExponentO115R
QTY14MultiplierO110R
QTY15Unit Or Basis For Measurement CodeO22ID
QTY16ExponentO115R
QTY17MultiplierO110R
QTY18Free-Form InformationC130AN
CRC1Code CategoryM22ID
CRC2Yes/No Condition Or Response CodeM11ID
CRC3Condition IndicatorM23ID
CRC4Condition IndicatorO23ID
CRC5Condition IndicatorO23ID
CRC6Condition IndicatorO23ID
CRC7Condition IndicatorO23ID
VEH1Assigned NumberO16N0
VEH2Vehicle Identification NumberO130AN
VEH3YearO44N0
VEH4Agency Qualifier CodeC22ID
VEH5Reference IdentificationC150AN
VEH6Reference IdentificationO150AN
VEH7Reference IdentificationC150AN
VEH8LengthO18R8
VEH9Reference IdentificationO150AN
VEH10State Or Province CodeO22ID
VEH11Location IdentifierO130AN
VEH12Yes/No Condition Or Response CodeO11ID
VEH13AmountO115N2
VEH14Yes/No Condition Or Response CodeO11ID
VEH15AmountO115N2
VEH16Action CodeO12ID
VEH17Country CodeO23ID
VEH18NameC160AN
VEH19Country CodeC23ID
NM11Entity Identifier CodeM23ID
NM12Entity Type QualifierM11ID
NM13Name Last Or Organization NameC160AN
NM14Name FirstO135AN
NM15Name MiddleO125AN
NM16Name PrefixO110AN
NM17Name SuffixO110AN
NM18Identification Code QualifierC12ID
NM19Identification CodeC280AN
NM110Entity Relationship CodeC22ID
NM111Entity Identifier CodeO23ID
NM112Name Last Or Organization NameO160AN
N21NameM160AN
N22NameO160AN
N31Address InformationM155AN
N32Address InformationO155AN
N41City NameO230AN
N42State Or Province CodeC22ID
N43Postal CodeO315ID
N44Country CodeC23ID
N45Location QualifierC12ID
N46Location IdentifierO130AN
N47Country Subdivision CodeC13ID
PER1Contact Function CodeM22ID
PER2NameO160AN
PER3Communication Number QualifierC22ID
PER4Communication NumberC1256AN
PER5Communication Number QualifierC22ID
PER6Communication NumberC1256AN
PER7Communication Number QualifierC22ID
PER8Communication NumberC1256AN
PER9Contact Inquiry ReferenceO120AN
ACT1Account NumberM135AN
ACT2NameO160AN
ACT3Identification Code QualifierC12ID
ACT4Identification CodeC280AN
ACT5Account Number QualifierC13ID
ACT6Account NumberC135AN
ACT7DescriptionO180AN
ACT8Payment Method Type CodeO12ID
ACT9Benefit Status CodeO11ID
DTP1Date/Time QualifierM33ID
DTP2Date Time Period Format QualifierM23ID
DTP3Date Time PeriodM135AN
DMG1Date Time Period Format QualifierC23ID
DMG2Date Time PeriodC135AN
DMG3Gender CodeO11ID
DMG4Marital Status CodeO11ID
DMG5Race Or Ethnicity CodeC11ID
DMG6Code List Qualifier CodeC13ID
DMG7Industry CodeC130AN
DMG8Citizenship Status CodeO12ID
DMG9Country CodeO23ID
DMG10Basis Of Verification CodeO12ID
DMG11QuantityO115R
DMG12Code List Qualifier CodeC13ID
DMG13Industry CodeC130AN
REF1Reference Identification QualifierM23ID
REF2Reference IdentificationC150AN
REF3DescriptionC180AN
REF4Reference Identification QualifierO23ID
REF5Reference IdentificationO150AN
REF6Reference Identification QualifierO23ID
REF7Reference IdentificationO150AN
REF8Reference Identification QualifierO23ID
REF9Reference IdentificationO150AN
QTY1Quantity QualifierM22ID
QTY2QuantityC115R
QTY3Unit Or Basis For Measurement CodeO22ID
QTY4ExponentO115R
QTY5MultiplierO110R
QTY6Unit Or Basis For Measurement CodeO22ID
QTY7ExponentO115R
QTY8MultiplierO110R
QTY9Unit Or Basis For Measurement CodeO22ID
QTY10ExponentO115R
QTY11MultiplierO110R
QTY12Unit Or Basis For Measurement CodeO22ID
QTY13ExponentO115R
QTY14MultiplierO110R
QTY15Unit Or Basis For Measurement CodeO22ID
QTY16ExponentO115R
QTY17MultiplierO110R
QTY18Free-Form InformationC130AN
CRC1Code CategoryM22ID
CRC2Yes/No Condition Or Response CodeM11ID
CRC3Condition IndicatorM23ID
CRC4Condition IndicatorO23ID
CRC5Condition IndicatorO23ID
CRC6Condition IndicatorO23ID
CRC7Condition IndicatorO23ID
ESI1Yes/No Condition Or Response CodeM11ID
ESI2Yes/No Condition Or Response CodeO11ID
ESI3Yes/No Condition Or Response CodeO11ID
ESI4TimeO48TM
ESI5QuantityO115R
ESI6Employment Status CodeC22ID
ESI7Work Intensity CodeO11ID
ESI8Reason Stopped Work CodeO22ID
ESI9Status Reason CodeO33ID
EMT1Code List Qualifier CodeC13ID
EMT2Industry CodeC130AN
EMT3State Or Province CodeO22ID
EMT4Identification CodeO280AN
EMT5DescriptionO180AN
EMT6Yes/No Condition Or Response CodeO11ID
EMT7Yes/No Condition Or Response CodeO11ID
EMT8Yes/No Condition Or Response CodeO11ID
TPB1Business Professional Title CodeC13ID
TPB2Free-Form Message TextC1264AN
TPB3Agency Qualifier CodeC22ID
TPB4Source SubqualifierO115AN
DTP1Date/Time QualifierM33ID
DTP2Date Time Period Format QualifierM23ID
DTP3Date Time PeriodM135AN
REF1Reference Identification QualifierM23ID
REF2Reference IdentificationC150AN
REF3DescriptionC180AN
REF4Reference Identification QualifierO23ID
REF5Reference IdentificationO150AN
REF6Reference Identification QualifierO23ID
REF7Reference IdentificationO150AN
REF8Reference Identification QualifierO23ID
REF9Reference IdentificationO150AN
QTY1Quantity QualifierM22ID
QTY2QuantityC115R
QTY3Unit Or Basis For Measurement CodeO22ID
QTY4ExponentO115R
QTY5MultiplierO110R
QTY6Unit Or Basis For Measurement CodeO22ID
QTY7ExponentO115R
QTY8MultiplierO110R
QTY9Unit Or Basis For Measurement CodeO22ID
QTY10ExponentO115R
QTY11MultiplierO110R
QTY12Unit Or Basis For Measurement CodeO22ID
QTY13ExponentO115R
QTY14MultiplierO110R
QTY15Unit Or Basis For Measurement CodeO22ID
QTY16ExponentO115R
QTY17MultiplierO110R
QTY18Free-Form InformationC130AN
NM11Entity Identifier CodeM23ID
NM12Entity Type QualifierM11ID
NM13Name Last Or Organization NameC160AN
NM14Name FirstO135AN
NM15Name MiddleO125AN
NM16Name PrefixO110AN
NM17Name SuffixO110AN
NM18Identification Code QualifierC12ID
NM19Identification CodeC280AN
NM110Entity Relationship CodeC22ID
NM111Entity Identifier CodeO23ID
NM112Name Last Or Organization NameO160AN
PER1Contact Function CodeM22ID
PER2NameO160AN
PER3Communication Number QualifierC22ID
PER4Communication NumberC1256AN
PER5Communication Number QualifierC22ID
PER6Communication NumberC1256AN
PER7Communication Number QualifierC22ID
PER8Communication NumberC1256AN
PER9Contact Inquiry ReferenceO120AN
CRC1Code CategoryM22ID
CRC2Yes/No Condition Or Response CodeM11ID
CRC3Condition IndicatorM23ID
CRC4Condition IndicatorO23ID
CRC5Condition IndicatorO23ID
CRC6Condition IndicatorO23ID
CRC7Condition IndicatorO23ID
LX1Assigned NumberM16N0
AIN1Type Of Income CodeM22ID
AIN2Frequency CodeM11ID
AIN3Monetary AmountM118R
AIN4QuantityO115R
AIN5Yes/No Condition Or Response CodeO11ID
AIN6Reference IdentificationO150AN
AIN7Amount Qualifier CodeO13ID
AIN8Tax Treatment CodeO11ID
AIN9Earnings Rate Of PayC115R
AIN10Unit Or Basis For Measurement CodeC22ID
AIN11QuantityC115R
AIN12Industry CodeO130AN
AIN13DescriptionO180AN
CUR1Entity Identifier CodeM23ID
CUR2Currency CodeM33ID
CUR3Exchange RateO410R
CUR4Entity Identifier CodeO23ID
CUR5Currency CodeO33ID
CUR6Currency Market/Exchange CodeO33ID
CUR7Date/Time QualifierC33ID
CUR8DateO88DT
CUR9TimeO48TM
CUR10Date/Time QualifierC33ID
CUR11DateC88DT
CUR12TimeC48TM
CUR13Date/Time QualifierC33ID
CUR14DateC88DT
CUR15TimeC48TM
CUR16Date/Time QualifierC33ID
CUR17DateC88DT
CUR18TimeC48TM
CUR19Date/Time QualifierC33ID
CUR20DateC88DT
CUR21TimeC48TM
TXI1Tax Type CodeM22ID
TXI2Monetary AmountC118R
TXI3Percentage As DecimalC110R
TXI4Tax Jurisdiction Code QualifierC22ID
TXI5Tax Jurisdiction CodeC110AN
TXI6Tax Exempt CodeC11ID
TXI7Relationship CodeO11ID
TXI8Dollar Basis For PercentO19R9
TXI9Tax Identification NumberO120AN
TXI10Assigned IdentificationO120AN
WS1Ship/Delivery Or Calendar Pattern CodeM12ID
WS2TimeO48TM
WS3TimeO48TM
DTP1Date/Time QualifierM33ID
DTP2Date Time Period Format QualifierM23ID
DTP3Date Time PeriodM135AN
QTY1Quantity QualifierM22ID
QTY2QuantityC115R
QTY3Unit Or Basis For Measurement CodeO22ID
QTY4ExponentO115R
QTY5MultiplierO110R
QTY6Unit Or Basis For Measurement CodeO22ID
QTY7ExponentO115R
QTY8MultiplierO110R
QTY9Unit Or Basis For Measurement CodeO22ID
QTY10ExponentO115R
QTY11MultiplierO110R
QTY12Unit Or Basis For Measurement CodeO22ID
QTY13ExponentO115R
QTY14MultiplierO110R
QTY15Unit Or Basis For Measurement CodeO22ID
QTY16ExponentO115R
QTY17MultiplierO110R
QTY18Free-Form InformationC130AN
REF1Reference Identification QualifierM23ID
REF2Reference IdentificationC150AN
REF3DescriptionC180AN
REF4Reference Identification QualifierO23ID
REF5Reference IdentificationO150AN
REF6Reference Identification QualifierO23ID
REF7Reference IdentificationO150AN
REF8Reference Identification QualifierO23ID
REF9Reference IdentificationO150AN
LN1Reference IdentificationM150AN
LN2Monetary AmountM118R
LN3Date Time Period Format QualifierC23ID
LN4Date Time PeriodC135AN
LN5Frequency CodeC11ID
LN6Monetary AmountC118R
LN7Percentage As DecimalO110R
LN8Yes/No Condition Or Response CodeO11ID
LN9Loan Purpose CodeO22ID
LN10Loan Payment Type CodeO22ID
LN11Loan Rate Type CodeO11ID
REF1Reference Identification QualifierM23ID
REF2Reference IdentificationC150AN
REF3DescriptionC180AN
REF4Reference Identification QualifierO23ID
REF5Reference IdentificationO150AN
REF6Reference Identification QualifierO23ID
REF7Reference IdentificationO150AN
REF8Reference Identification QualifierO23ID
REF9Reference IdentificationO150AN
VEH1Assigned NumberO16N0
VEH2Vehicle Identification NumberO130AN
VEH3YearO44N0
VEH4Agency Qualifier CodeC22ID
VEH5Reference IdentificationC150AN
VEH6Reference IdentificationO150AN
VEH7Reference IdentificationC150AN
VEH8LengthO18R8
VEH9Reference IdentificationO150AN
VEH10State Or Province CodeO22ID
VEH11Location IdentifierO130AN
VEH12Yes/No Condition Or Response CodeO11ID
VEH13AmountO115N2
VEH14Yes/No Condition Or Response CodeO11ID
VEH15AmountO115N2
VEH16Action CodeO12ID
VEH17Country CodeO23ID
VEH18NameC160AN
VEH19Country CodeC23ID
N41City NameO230AN
N42State Or Province CodeC22ID
N43Postal CodeO315ID
N44Country CodeC23ID
N45Location QualifierC12ID
N46Location IdentifierO130AN
N47Country Subdivision CodeC13ID
PID1Item Description TypeM11ID
PID2Product/Process Characteristic CodeO23ID
PID3Agency Qualifier CodeC22ID
PID4Product Description CodeC112AN
PID5DescriptionC180AN
PID6Surface/Layer/Position CodeO22ID
PID7Source SubqualifierO115AN
PID8Yes/No Condition Or Response CodeO11ID
PID9Language CodeO23ID
AMT1Amount Qualifier CodeM13ID
AMT2Monetary AmountM118R
AMT3Credit/Debit Flag CodeO11ID
PCT1Percent QualifierM12ID
PCT2Percentage As DecimalM110R
DTP1Date/Time QualifierM33ID
DTP2Date Time Period Format QualifierM23ID
DTP3Date Time PeriodM135AN
NM11Entity Identifier CodeM23ID
NM12Entity Type QualifierM11ID
NM13Name Last Or Organization NameC160AN
NM14Name FirstO135AN
NM15Name MiddleO125AN
NM16Name PrefixO110AN
NM17Name SuffixO110AN
NM18Identification Code QualifierC12ID
NM19Identification CodeC280AN
NM110Entity Relationship CodeC22ID
NM111Entity Identifier CodeO23ID
NM112Name Last Or Organization NameO160AN
DMG1Date Time Period Format QualifierC23ID
DMG2Date Time PeriodC135AN
DMG3Gender CodeO11ID
DMG4Marital Status CodeO11ID
DMG5Race Or Ethnicity CodeC11ID
DMG6Code List Qualifier CodeC13ID
DMG7Industry CodeC130AN
DMG8Citizenship Status CodeO12ID
DMG9Country CodeO23ID
DMG10Basis Of Verification CodeO12ID
DMG11QuantityO115R
DMG12Code List Qualifier CodeC13ID
DMG13Industry CodeC130AN
N31Address InformationM155AN
N32Address InformationO155AN
N41City NameO230AN
N42State Or Province CodeC22ID
N43Postal CodeO315ID
N44Country CodeC23ID
N45Location QualifierC12ID
N46Location IdentifierO130AN
N47Country Subdivision CodeC13ID
PER1Contact Function CodeM22ID
PER2NameO160AN
PER3Communication Number QualifierC22ID
PER4Communication NumberC1256AN
PER5Communication Number QualifierC22ID
PER6Communication NumberC1256AN
PER7Communication Number QualifierC22ID
PER8Communication NumberC1256AN
PER9Contact Inquiry ReferenceO120AN
DTP1Date/Time QualifierM33ID
DTP2Date Time Period Format QualifierM23ID
DTP3Date Time PeriodM135AN
REF1Reference Identification QualifierM23ID
REF2Reference IdentificationC150AN
REF3DescriptionC180AN
REF4Reference Identification QualifierO23ID
REF5Reference IdentificationO150AN
REF6Reference Identification QualifierO23ID
REF7Reference IdentificationO150AN
REF8Reference Identification QualifierO23ID
REF9Reference IdentificationO150AN
LS1Loop Identifier CodeM14AN
LX1Assigned NumberM16N0
III1Code List Qualifier CodeC13ID
III2Industry CodeC130AN
III3Code CategoryO22ID
III4Free-Form Message TextC1264AN
III5QuantityC115R
III6Unit Or Basis For Measurement CodeO22ID
III7ExponentO115R
III8MultiplierO110R
III9Unit Or Basis For Measurement CodeO22ID
III10ExponentO115R
III11MultiplierO110R
III12Unit Or Basis For Measurement CodeO22ID
III13ExponentO115R
III14MultiplierO110R
III15Unit Or Basis For Measurement CodeO22ID
III16ExponentO115R
III17MultiplierO110R
III18Unit Or Basis For Measurement CodeO22ID
III19ExponentO115R
III20MultiplierO110R
III21Surface/Layer/Position CodeO22ID
III22Surface/Layer/Position CodeO22ID
III23Surface/Layer/Position CodeO22ID
IMP1Part Of Body CodeM22ID
IMP2Percentage As DecimalO110R
DTP1Date/Time QualifierM33ID
DTP2Date Time Period Format QualifierM23ID
DTP3Date Time PeriodM135AN
CRC1Code CategoryM22ID
CRC2Yes/No Condition Or Response CodeM11ID
CRC3Condition IndicatorM23ID
CRC4Condition IndicatorO23ID
CRC5Condition IndicatorO23ID
CRC6Condition IndicatorO23ID
CRC7Condition IndicatorO23ID
QTY1Quantity QualifierM22ID
QTY2QuantityC115R
QTY3Unit Or Basis For Measurement CodeO22ID
QTY4ExponentO115R
QTY5MultiplierO110R
QTY6Unit Or Basis For Measurement CodeO22ID
QTY7ExponentO115R
QTY8MultiplierO110R
QTY9Unit Or Basis For Measurement CodeO22ID
QTY10ExponentO115R
QTY11MultiplierO110R
QTY12Unit Or Basis For Measurement CodeO22ID
QTY13ExponentO115R
QTY14MultiplierO110R
QTY15Unit Or Basis For Measurement CodeO22ID
QTY16ExponentO115R
QTY17MultiplierO110R
QTY18Free-Form InformationC130AN
REF1Reference Identification QualifierM23ID
REF2Reference IdentificationC150AN
REF3DescriptionC180AN
REF4Reference Identification QualifierO23ID
REF5Reference IdentificationO150AN
REF6Reference Identification QualifierO23ID
REF7Reference IdentificationO150AN
REF8Reference Identification QualifierO23ID
REF9Reference IdentificationO150AN
LM1Agency Qualifier CodeM22ID
LM2Source SubqualifierO115AN
LQ1Code List Qualifier CodeO13ID
LQ2Industry CodeC130AN
NM11Entity Identifier CodeM23ID
NM12Entity Type QualifierM11ID
NM13Name Last Or Organization NameC160AN
NM14Name FirstO135AN
NM15Name MiddleO125AN
NM16Name PrefixO110AN
NM17Name SuffixO110AN
NM18Identification Code QualifierC12ID
NM19Identification CodeC280AN
NM110Entity Relationship CodeC22ID
NM111Entity Identifier CodeO23ID
NM112Name Last Or Organization NameO160AN
N21NameM160AN
N22NameO160AN
N31Address InformationM155AN
N32Address InformationO155AN
N41City NameO230AN
N42State Or Province CodeC22ID
N43Postal CodeO315ID
N44Country CodeC23ID
N45Location QualifierC12ID
N46Location IdentifierO130AN
N47Country Subdivision CodeC13ID
PER1Contact Function CodeM22ID
PER2NameO160AN
PER3Communication Number QualifierC22ID
PER4Communication NumberC1256AN
PER5Communication Number QualifierC22ID
PER6Communication NumberC1256AN
PER7Communication Number QualifierC22ID
PER8Communication NumberC1256AN
PER9Contact Inquiry ReferenceO120AN
ACT1Account NumberM135AN
ACT2NameO160AN
ACT3Identification Code QualifierC12ID
ACT4Identification CodeC280AN
ACT5Account Number QualifierC13ID
ACT6Account NumberC135AN
ACT7DescriptionO180AN
ACT8Payment Method Type CodeO12ID
ACT9Benefit Status CodeO11ID
DTP1Date/Time QualifierM33ID
DTP2Date Time Period Format QualifierM23ID
DTP3Date Time PeriodM135AN
DMG1Date Time Period Format QualifierC23ID
DMG2Date Time PeriodC135AN
DMG3Gender CodeO11ID
DMG4Marital Status CodeO11ID
DMG5Race Or Ethnicity CodeC11ID
DMG6Code List Qualifier CodeC13ID
DMG7Industry CodeC130AN
DMG8Citizenship Status CodeO12ID
DMG9Country CodeO23ID
DMG10Basis Of Verification CodeO12ID
DMG11QuantityO115R
DMG12Code List Qualifier CodeC13ID
DMG13Industry CodeC130AN
REF1Reference Identification QualifierM23ID
REF2Reference IdentificationC150AN
REF3DescriptionC180AN
REF4Reference Identification QualifierO23ID
REF5Reference IdentificationO150AN
REF6Reference Identification QualifierO23ID
REF7Reference IdentificationO150AN
REF8Reference Identification QualifierO23ID
REF9Reference IdentificationO150AN
CRC1Code CategoryM22ID
CRC2Yes/No Condition Or Response CodeM11ID
CRC3Condition IndicatorM23ID
CRC4Condition IndicatorO23ID
CRC5Condition IndicatorO23ID
CRC6Condition IndicatorO23ID
CRC7Condition IndicatorO23ID
LE1Loop Identifier CodeM14AN
CFI1Code CategoryM22ID
CFI2Adjustment Reason CodeO22ID
CFI3Adjustment Reason Code CharacteristicO12ID
CFI4Maintenance Type CodeO33ID
CFI5Frequency CodeO11ID
CFI6Settlement Type CodeO12ID
CFI7Late Reason CodeO22ID
CUR1Entity Identifier CodeM23ID
CUR2Currency CodeM33ID
CUR3Exchange RateO410R
CUR4Entity Identifier CodeO23ID
CUR5Currency CodeO33ID
CUR6Currency Market/Exchange CodeO33ID
CUR7Date/Time QualifierC33ID
CUR8DateO88DT
CUR9TimeO48TM
CUR10Date/Time QualifierC33ID
CUR11DateC88DT
CUR12TimeC48TM
CUR13Date/Time QualifierC33ID
CUR14DateC88DT
CUR15TimeC48TM
CUR16Date/Time QualifierC33ID
CUR17DateC88DT
CUR18TimeC48TM
CUR19Date/Time QualifierC33ID
CUR20DateC88DT
CUR21TimeC48TM
AMT1Amount Qualifier CodeM13ID
AMT2Monetary AmountM118R
AMT3Credit/Debit Flag CodeO11ID
DTP1Date/Time QualifierM33ID
DTP2Date Time Period Format QualifierM23ID
DTP3Date Time PeriodM135AN
QTY1Quantity QualifierM22ID
QTY2QuantityC115R
QTY3Unit Or Basis For Measurement CodeO22ID
QTY4ExponentO115R
QTY5MultiplierO110R
QTY6Unit Or Basis For Measurement CodeO22ID
QTY7ExponentO115R
QTY8MultiplierO110R
QTY9Unit Or Basis For Measurement CodeO22ID
QTY10ExponentO115R
QTY11MultiplierO110R
QTY12Unit Or Basis For Measurement CodeO22ID
QTY13ExponentO115R
QTY14MultiplierO110R
QTY15Unit Or Basis For Measurement CodeO22ID
QTY16ExponentO115R
QTY17MultiplierO110R
QTY18Free-Form InformationC130AN
REL1Individual Relationship CodeM22ID
REL2NumberO19N0
REF1Reference Identification QualifierM23ID
REF2Reference IdentificationC150AN
REF3DescriptionC180AN
REF4Reference Identification QualifierO23ID
REF5Reference IdentificationO150AN
REF6Reference Identification QualifierO23ID
REF7Reference IdentificationO150AN
REF8Reference Identification QualifierO23ID
REF9Reference IdentificationO150AN
CRC1Code CategoryM22ID
CRC2Yes/No Condition Or Response CodeM11ID
CRC3Condition IndicatorM23ID
CRC4Condition IndicatorO23ID
CRC5Condition IndicatorO23ID
CRC6Condition IndicatorO23ID
CRC7Condition IndicatorO23ID
AD11Adjustment Reason CodeM22ID
AD12Monetary AmountO118R
AD13Adjustment Reason Code CharacteristicO12ID
AD14Frequency CodeO11ID
AD15Late Reason CodeO22ID
DTP1Date/Time QualifierM33ID
DTP2Date Time Period Format QualifierM23ID
DTP3Date Time PeriodM135AN
REF1Reference Identification QualifierM23ID
REF2Reference IdentificationC150AN
REF3DescriptionC180AN
REF4Reference Identification QualifierO23ID
REF5Reference IdentificationO150AN
REF6Reference Identification QualifierO23ID
REF7Reference IdentificationO150AN
REF8Reference Identification QualifierO23ID
REF9Reference IdentificationO150AN
NM11Entity Identifier CodeM23ID
NM12Entity Type QualifierM11ID
NM13Name Last Or Organization NameC160AN
NM14Name FirstO135AN
NM15Name MiddleO125AN
NM16Name PrefixO110AN
NM17Name SuffixO110AN
NM18Identification Code QualifierC12ID
NM19Identification CodeC280AN
NM110Entity Relationship CodeC22ID
NM111Entity Identifier CodeO23ID
NM112Name Last Or Organization NameO160AN
N21NameM160AN
N22NameO160AN
N31Address InformationM155AN
N32Address InformationO155AN
N41City NameO230AN
N42State Or Province CodeC22ID
N43Postal CodeO315ID
N44Country CodeC23ID
N45Location QualifierC12ID
N46Location IdentifierO130AN
N47Country Subdivision CodeC13ID
PER1Contact Function CodeM22ID
PER2NameO160AN
PER3Communication Number QualifierC22ID
PER4Communication NumberC1256AN
PER5Communication Number QualifierC22ID
PER6Communication NumberC1256AN
PER7Communication Number QualifierC22ID
PER8Communication NumberC1256AN
PER9Contact Inquiry ReferenceO120AN
ACT1Account NumberM135AN
ACT2NameO160AN
ACT3Identification Code QualifierC12ID
ACT4Identification CodeC280AN
ACT5Account Number QualifierC13ID
ACT6Account NumberC135AN
ACT7DescriptionO180AN
ACT8Payment Method Type CodeO12ID
ACT9Benefit Status CodeO11ID
DTP1Date/Time QualifierM33ID
DTP2Date Time Period Format QualifierM23ID
DTP3Date Time PeriodM135AN
DMG1Date Time Period Format QualifierC23ID
DMG2Date Time PeriodC135AN
DMG3Gender CodeO11ID
DMG4Marital Status CodeO11ID
DMG5Race Or Ethnicity CodeC11ID
DMG6Code List Qualifier CodeC13ID
DMG7Industry CodeC130AN
DMG8Citizenship Status CodeO12ID
DMG9Country CodeO23ID
DMG10Basis Of Verification CodeO12ID
DMG11QuantityO115R
DMG12Code List Qualifier CodeC13ID
DMG13Industry CodeC130AN
REF1Reference Identification QualifierM23ID
REF2Reference IdentificationC150AN
REF3DescriptionC180AN
REF4Reference Identification QualifierO23ID
REF5Reference IdentificationO150AN
REF6Reference Identification QualifierO23ID
REF7Reference IdentificationO150AN
REF8Reference Identification QualifierO23ID
REF9Reference IdentificationO150AN
GRI1Reported Data Id CodeM16AN
GRI2Reported Data ResponseC110AN
GRI3Quantity QualifierO22ID
GRI4QuantityC115R
GRI5Amount Qualifier CodeO13ID
GRI6Monetary AmountC118R
GRI7Percent QualifierO12ID
GRI8Percent, Integer FormatC13N0
GRI9Date/Time QualifierO33ID
GRI10DateC88DT
GRI11DescriptionO180AN


Official Definition:
Data contents of the Report of Injury, Illness or Incident Transaction Set (148) for use within the context of an Electronic Data Interchange (EDI) environment. The transaction set can be used to report information pertaining to an injury, illness or incident to entities interested in the information for statistical, legal, and claims and risk management processing requirements.



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