|
  |
  |
  |
  |
  |
  |
  |
  |
  |
  |
  |
_Ref_ |
Id |
_________Element Name__________ |
Req |
Type |
Min/Max |
___Usage___ |
  |
  |
FA101 |
559 |
Agency Qualifier Code |
M |
ID |
2/2 |
Must use |
  |
  |
  |
  |
Description: Code identifying the agency assigning the code values |
  |
  |
  |
All valid standard codes are used. |
  |
FA102 |
1300 |
Service, Promotion, Allowance, or Charge Code |
O |
ID |
4/4 |
Used |
  |
  |
  |
  |
Description: Code identifying the service, promotion, allowance, or charge |
  |
  |
  |
All valid standard codes are used. |
  |
FA103 |
248 |
Allowance or Charge Indicator |
O |
ID |
1/1 |
Used |
  |
  |
  |
  |
Description: Code which indicates an allowance or charge for the service specified |
  |
  |
  |
All valid standard codes are used. |