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Copy pathX214-payer-response-multiple-responders.json
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639 lines (639 loc) · 18.1 KB
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"identificationType" : "NPI",
"identifier" : "1222334499",
"lastNameOrOrgName" : "REED",
"firstName" : "IVAN",
"nameSuffix" : "MD"
},
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"actionType" : "REJECT",
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"entityCode" : "85",
"entityRole" : "BILLING_PROVIDER"
} ]
} ],
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},
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"hierarchicalStructureCode" : "0085",
"purposeCode" : "08",
"creationDate" : "2023-03-21",
"creationTime" : "10:25:00",
"claimOrEncounterIdentifierType" : "RECEIPT_ACK_ADVICE",
"traceIdentifier" : "00911232",
"transactionSetIdentifierCode" : "277",
"implementationConventionReference" : "005010X214",
"receiptDate" : "2023-03-20",
"processDate" : "2023-03-21",
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"url" : "file:/edi-samples/edi_files/277/X214-payer-response-multiple-responders.edi",
"lastModifiedDateTime" : "2026-06-27T09:24:51.831-04:00"
},
"sender" : {
"entityRole" : "PAYER",
"entityType" : "BUSINESS",
"identificationType" : "PAYOR_ID",
"identifier" : "OIC02",
"lastNameOrOrgName" : "OUR INSURANCE COMPANY"
},
"creationDateTime" : "2023-03-21T10:25:00"
},
"receiver" : {
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"entityType" : "INDIVIDUAL",
"identificationType" : "ETIN",
"identifier" : "S00005",
"lastNameOrOrgName" : "KING",
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},
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"actionType" : "ACCEPT",
"chargeAmount" : 455.00,
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"entityCode" : "PR",
"entityRole" : "PAYER"
} ]
} ],
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"rejectedAmount" : 300.00
}
}
]