PM1

Payer Master File

The Technical Steward for the PM1 segment is Orders and Observations.

The PM1 segment contains per insurance company (payer) the policies specific to their organization. Trailing this segment in the message structure are either the Limited Coverage Policy or the Approved Coverage Policy. If an insurance company is listed they have limited coverage. Note, the first 10 fields come directly from the IN1 segment.

24
C.LenElement
1--CWER1007200368PM1-1Health Plan ID
2--CXR*-00428PM1-2Insurance Company ID
3--XONO*-00429PM1-3Insurance Company Name
4--XADO*-00430PM1-4Insurance Company Address
5--XPNO*-00431PM1-5Insurance Co Contact Person
6--XTNO*-00432PM1-6Insurance Co Phone Number
7-12=STO1-00433PM1-7Group Number
8--XONO*-00434PM1-8Group Name
9--DTO1-00437PM1-9Plan Effective Date
10--DTO1-00438PM1-10Plan Expiration Date
11--IDO1013603454PM1-11Patient DOB Required
12--IDO1013603455PM1-12Patient Gender Required
13--IDO1013603456PM1-13Patient Relationship Required
14--IDO1013603457PM1-14Patient Signature Required
15--IDO1013603458PM1-15Diagnosis Required
16--IDO1013603459PM1-16Service Required
17--IDO1013603460PM1-17Patient Name Required
18--IDO1013603461PM1-18Patient Address Required
19--IDO1013603462PM1-19Subscribers Name Required
20--IDO1013603463PM1-20Workman's Comp Indicator
21--IDO1013603464PM1-21Bill Type Required
22--IDO1013603465PM1-22Commercial Carrier Name and Address Required
23--STO1-03466PM1-23Policy Number Pattern
24--STO1-03467PM1-24Group Number Pattern
Used In Message Structures