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REMITT XML Format

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Jeff Buchbinder edited this page Nov 14, 2011 · 3 revisions

This document is meant to explain the REMITT XML Format, which is consumed by REMITT XSL transformations. It is broken down into the highest level elements, with explanations of those as well as the lower level elements.

Document Structure

The top level of a REMITT XML document is a remitt tag, with an optional doctype attribute. Any attributes of tags are denoted with an '@' symbol prefix (for example, @id denotes an attribute named id for that element). "Boolean" variables are given a 0 (false) or 1 (true) value.

XML Reference

Top Level Elements

  • global
  • billingcontact
  • billingservice
  • clearinghouse
  • procedure
  • patient
  • provider
  • facility
  • insured
  • payer
  • practice
  • diagnosis

global Element

  • generator
    • program: Name of the program generating this XML document.
    • version: Version of the program generating this XML document.
  • billinguid: Unique program-level identifier for the billing batch which is being processed. This is used in any return traffic from the REMITT server to identify the billing run with which this XML document is associated.
  • currentdate: The current date (date of XML generation) in the YYYY-MM-DD format.
  • currenttime
    • hour: Current numerical representation of the hour of the XML generation. (24 hour format)
    • minute: Current numerical representation of the minute of the XML generation.

diagnosis Element

  • @id: Unique diagnosis indentifier.
  • icd9code: ICD-9 diagnosis code for this diagnosis
  • icd10code: ICD-10 diagnosis code for this diagnosis
  • relatedtohcfa
  • isrelatedtoautoaccident (boolean): Is this diagnosis related to an automobile accident?
  • autoaccidentstate: United States state abbreviation. Should only be used if isrelatedtoautoaccident is 1.
  • isrelatedtootheraccident (boolean): Is this diagnosis related to another type of accident?
  • isrelatedtoemployment (boolean): Is this diagnosis related to an employment-related injury?
  • dateofonset (date sub-element): Date of onset of illness.
  • dateoffirstoccurrence (date sub-element): Date of first occurrence of symptoms.

facility Element

Denotes a place of service.

  • @id: Unique facility/place of service identifier.
  • name: Textual name of the facility.
  • address (address sub-element): Street/mailing address of the facility.
  • phone (phone sub-element): Telephone number for the facility.
  • description: Textual description of the target facility.
  • hcfacode:
  • x12code:
  • ein: Employer identification number. (only used in the United States)
  • npi: National Physician Identifier. (only used in the United States)
  • taxonomy
  • clia: CDC "CLIA" identifier

insured Element

  • @id: Unique insured person identifier
  • name (name sub-element): Name of insured/covered party.
  • address (address sub-element): Contact address of insured/covered party.
  • phone (phone sub-element): Contact phone number of insured/covered party.
  • dateofbirth (date sub-element): Date of birth of insured/covered party.
  • sex: Single lowercase letter indicating gender.
    • m == Male
    • f == Female
    • t == Transgendered
  • id: EMR/PM internal ID number for the insured/covered party.
  • planname: Textual name of the insurance plan.
  • instype: Type of insurance plan/coverage.
    • MG == Medigap
    • MP == Medicare Primary
    • SP == Supplemental
    • IP == Individual Policy
    • PP == Personal Policy
    • GP == Group Policy
    • LT == Litigation
    • AP == Auto Policy
    • LD == Long Term Disability
    • 12 == MC not Primary with Employer Plan
    • 13 == MC not Primary with ESRD
    • 14 == MC not Primary with No Fault
    • 15 == MC not Primary with WC
    • 16 == MC not Primary with PHS other Federal
    • 41 == MC not Primary with Black Lung
    • 42 == MC not Primary with VA
    • 43 == MC not Primary Disabled under 65 LGHP
    • 47 == MC not Primary with any Liability
    • OT == Other
  • groupname: Textual name of the insurance plan group.
  • groupnumber: Number of the insurance plan group.
  • isemployed (boolean): Is this insurance through an employer?
  • employername: Name of the related employer for this insurance plan. Only used if isemployed is 1.
  • isstudent (boolean): Is this insurance through a school?
  • schoolname: Name of the related school for this insurance plan. Only use if isstudent is 1.
  • isassigning

patient Element

  • @id: Unique patient identifier
  • name (name sub-element): Patient name.
  • address (address sub-element): Contact address for patient.
  • phone (phone sub-element): Contact phone number for patient.
  • sex: Single lowercase letter indicating gender.
    • m == Male
    • f == Female
    • t == Transgendered
  • socialsecuritynumber: Social security number (only required in United States)
  • isdead (boolean): Is the patient deceased?
  • dateofbirth (date sub-element): Date of patient birth.
  • dateofdeath (date sub-element): Date of patient death. (Not used unless isdead is 1)
  • issingle (boolean): Is the patient single?
  • ismarried (boolean): Is the patient married?
  • isdivorced (boolean): Is the patient divorced?
  • isseparated (boolean): Is the patient separated from his/her spouse?
  • iswidowed (boolean): Is the patient a widow/widower?
  • ismaritalotherhcfa (boolean): Does the patient have a marital status which is not single, married, divorced, separated or widowed?
  • isemployed (boolean): Is the patient employed?
  • isfulltimestudent (boolean): Is the patient a full-time student?
  • isparttimestudent (boolean): Is the patient a part-time student?
  • referringprovider: id of provider entity.
  • account: Internal EMR patient id.

payer Element

  • @id: Unique payer identifier
  • name: Textual name of payer/insurance company.
  • address (address sub-element): Address of payer/insurance company, primary contact information.
  • phone (phone sub-element): Phone number of payer/insurance company, primary contact information.
  • x12claimtype: By default, this should be HM.
  • x12id: X12 identifier for this provider.
  • ismedicare (boolean): Is this payer/insurance company associated with Medicare?
  • ischampus (boolean): Is this payer/insurance company associated with Champus?
  • ischampusva (boolean): Is this payer/insurance company associated with Champus VA?
  • ismedicaid (boolean): Is this payer/insurance company associated with Medicaid?
  • isbcbs (boolean): Is this payer/insurance company associated with Blue Cross/Blue Shield?
  • isfeca (boolean): Is this payer/insurance company associated with FECA?
  • isotherhcfa (boolean): Is this payer/insurance company not associated with Medicare, Champus, Champus VA, Medicaid, Blue Cross/Blue Shield or FECA?

practice Element

  • @id: Unique practice identifier
  • id: Repeatable element containing payer IDs used for physicians/providers in this practice.
    • @payer: Identifier for payer element.
    • @physician: Identifier for provider element.
  • groupid: Repeatable element containing payer group IDs used for physicians/providers in this practice.
    • @payer: Identifier for payer element.
    • @physician: Identifier for provider element.
  • name: Textual name of physician/provider practice.
  • address (address sub-element): Address for physician/provider practice.
  • phone (phone sub-element): Phone contact for physician/provider practice.
  • ein: Employer identification number. (only used in the United States)
  • npi: National Physician Identifier. (only used in the United States)

procedure Element

  • @id: Unique procedure identifier
  • cpt4code: CPT-4 code
  • cpt5code: CPT-5 code
  • cptdescription: Textual description of CPT code.
  • cptcob:
  • cptcharges: Original charges.
  • allowcharges: Allowed charges from the original charges.
  • comment: Free-form textual comment.
  • pripay: id of payer entity, representing the primary payer for this procedure.
  • pripaydt (date sub-element): Date which payment was remitted from the payer described in pripay.
  • pripayname:
  • patpay:
  • patpaydt (date sub-element):
  • copay: Amount of co-payment received. Should be 0 if none has been received at the time of generation.
  • copaydt (date sub-element):
  • payhistory:
  • cptcount:
  • cptemergency (boolean):
  • cptepsdt (boolean):
  • cptmodifier:
  • cptmodifier2:
  • cptmodifier3:
  • cptunits:
  • weightgrams:
  • diagnosiskey: id of diagnosis entity.
  • patientkey: id of patient entity.
  • insuredkey: id of insured entity.
  • payerkey: id of payer entity.
  • secondinsuredkey: id of insured entity.
  • secondpayerkey: id of payer entity.
  • otherinsuredkey: id of insured entity.
  • medicaidresubmissioncode:
  • medicaidoriginalreference:
  • hcfalocaluse19:
  • hcfalocaluse10d:
  • hcfalocaluse24k:
  • amountpaid:
  • providerkey: id of provider entity.
  • referringproviderkey: id of provider entity.
  • facilitykey: id of facility entity.
  • practicekey: id of practice entity.
  • typeofservice:
  • priorauth:
  • isoutsidelab:
  • outsidelabcharges:
  • dateofservicestart (date sub-element):
  • dateofserviceend (date sub-element):
  • aging:
  • ishospitalized (boolean):
  • dateofhospitalstart (date sub-element):
  • dateofhospitalend (date sub-element):

provider Element

  • @id: Unique provider identifier
  • name (name sub-element): Textual name of provider/physician.
  • address (address sub-element): Contact address for provider/physician.
  • phone (phone sub-element): Phone contact number for provider/physician.
  • socialsecuritynumber: Social security number. (only used in the United States)
  • tin: Tax ID number.
  • ipn: UPIN ("unique provider identification number")
  • clia: CDC "CLIA" identifier
  • dea: Drug Enforcement Angency identifier. (only used in the United States)
  • npi: National Physician Identifier. (only used in the United States)

Sub elements

address Sub-element

  • streetaddress: Full street address with house/business number.
  • city: City.
  • state: State or province. Usually a two or three digit representation.
  • zipcode: Postal code.

date Sub-element

  • year: Year, four digit representation.
  • month: Month, two digit representation.
  • day: Day of the month, two digit representation.

name Sub-element

  • first: Given ("first") name.
  • middle: Middle (second given) name.
  • last: Surname ("last") name.

phone Sub-element

  • country: Telephone country code. (example: 1 for the United States)
  • area: In-country area code. (example: 860 or 203 for Connecticut in the United States)
  • number: Local phone number.
  • extension: Extension from a PBX, if one exists.
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