Optional_Optional_Coverage to be used for adjudication
Optional_Prior authorization reference number
Optional_Insurance instance identifier
OptionalbusinessAdditional provider contract number
OptionalclaimAdjudication results
Insurance information
OptionalextensionAdditional content defined by implementations
Coverage to be used for adjudication
OptionalidUnique id for inter-element referencing
OptionalidentifierPre-assigned Claim number
OptionalmodifierExtensions that cannot be ignored even if unrecognized
OptionalprePrior authorization reference number
Insurance instance identifier
Additional provider contract number