PM1.1_Health_Plan_IDSequential Number: 1
Description: Health Plan ID
Data Type: CWE
Item ID: 368
Table: 0072
PM1.2_Insurance_Company_IDSequential Number: 2
Description: Insurance Company ID
Data Type: CX
Item ID: 428
PM1.3_Insurance_Company_NameSequential Number: 3
Description: Insurance Company Name
Data Type: XON
Item ID: 429
PM1.4_Insurance_Company_AddressSequential Number: 4
Description: Insurance Company Address
Data Type: XAD
Item ID: 430
PM1.5_Insurance_Co_Contact_PersonSequential Number: 5
Description: Insurance Co Contact Person
Data Type: XPN
Item ID: 431
PM1.6_Insurance_Co_Phone_NumberSequential Number: 6
Description: Insurance Co Phone Number
Data Type: XTN
Item ID: 432
Sequential Number: 7
Description: Group Number
Data Type: ST
Item ID: 433
PM1.8_Group_NameSequential Number: 8
Description: Group Name
Data Type: XON
Item ID: 434
Sequential Number: 9
Description: Plan Effective Date
Data Type: DT
Item ID: 437
Sequential Number: 10
Description: Plan Expiration Date
Data Type: DT
Item ID: 438
Sequential Number: 11
Description: Patient DOB Required
Data Type: ID
Item ID: 3454
Table: 0136
Sequential Number: 12
Description: Patient Gender Required
Data Type: ID
Item ID: 3455
Table: 0136
Sequential Number: 13
Description: Patient Relationship Required
Data Type: ID
Item ID: 3456
Table: 0136
Sequential Number: 14
Description: Patient Signature Required
Data Type: ID
Item ID: 3457
Table: 0136
Sequential Number: 15
Description: Diagnosis Required
Data Type: ID
Item ID: 3458
Table: 0136
Sequential Number: 16
Description: Service Required
Data Type: ID
Item ID: 3459
Table: 0136
Sequential Number: 17
Description: Patient Name Required
Data Type: ID
Item ID: 3460
Table: 0136
Sequential Number: 18
Description: Patient Address Required
Data Type: ID
Item ID: 3461
Table: 0136
Sequential Number: 19
Description: Subscribers Name Required
Data Type: ID
Item ID: 3462
Table: 0136
Sequential Number: 20
Description: Workman's Comp Indicator
Data Type: ID
Item ID: 3463
Table: 0136
Sequential Number: 21
Description: Bill Type Required
Data Type: ID
Item ID: 3464
Table: 0136
Sequential Number: 22
Description: Commercial Carrier Name and Address Required
Data Type: ID
Item ID: 3465
Table: 0136
Sequential Number: 23
Description: Policy Number Pattern
Data Type: ST
Item ID: 3466
Sequential Number: 24
Description: Group Number Pattern
Data Type: ST
Item ID: 3467
any