The GT1 segment contains guarantor (e.g., the person or the organization with financial responsibility for payment of a patient account) data for patient and insurance billing applications.
Figure 6-5. GT1 attributes
SEQ |
LEN |
DT |
OPT |
RP/# |
TBL# |
ITEM# |
ELEMENT NAME |
1 |
4 |
SI |
R |
00405 |
Set ID - GT1 |
||
2 |
59 |
CX |
O |
Y |
00406 |
Guarantor Number |
|
3 |
48 |
XPN |
R |
Y |
00407 |
Guarantor Name |
|
4 |
48 |
XPN |
O |
Y |
00408 |
Guarantor Spouse Name |
|
5 |
106 |
XAD |
O |
Y |
00409 |
Guarantor Address |
|
6 |
40 |
XTN |
O |
Y |
00410 |
Guarantor Ph Num-Home |
|
7 |
40 |
XTN |
O |
Y |
00411 |
Guarantor Ph Num-Business |
|
8 |
26 |
TS |
O |
00412 |
Guarantor Date/Time Of Birth |
||
9 |
1 |
IS |
O |
0001 |
00413 |
Guarantor Sex |
|
10 |
2 |
IS |
O |
0068 |
00414 |
Guarantor Type |
|
11 |
2 |
IS |
O |
0063 |
00415 |
Guarantor Relationship |
|
12 |
11 |
ST |
O |
00416 |
Guarantor SSN |
||
13 |
8 |
DT |
O |
00417 |
Guarantor Date - Begin |
||
14 |
8 |
DT |
O |
00418 |
Guarantor Date - End |
||
15 |
2 |
NM |
O |
00419 |
Guarantor Priority |
||
16 |
130 |
XPN |
O |
Y |
00420 |
Guarantor Employer Name |
|
17 |
106 |
XAD |
O |
Y |
00421 |
Guarantor Employer Address |
|
18 |
40 |
XTN |
O |
Y |
00422 |
Guarantor Employer Phone Number |
|
19 |
20 |
CX |
O |
Y |
00423 |
Guarantor Employee ID Number |
|
20 |
2 |
IS |
O |
0066 |
00424 |
Guarantor Employment Status |
|
21 |
130 |
XON |
O |
Y |
00425 |
Guarantor Organization Name |
|
22 |
1 |
ID |
O |
0136 |
00773 |
Guarantor Billing Hold Flag |
|
23 |
80 |
CE |
O |
00774 |
Guarantor Credit Rating Code |
||
24 |
26 |
TS |
O |
00775 |
Guarantor Death Date And Time |
||
25 |
1 |
ID |
O |
0136 |
00776 |
Guarantor Death Flag |
|
26 |
80 |
CE |
O |
0218 |
00777 |
Guarantor Charge Adjustment Code |
|
27 |
10 |
CP |
O |
00778 |
Guarantor Household Annual Income |
||
28 |
3 |
NM |
O |
00779 |
Guarantor Household Size |
||
29 |
20 |
CX |
O |
Y |
00780 |
Guarantor Employer ID Number |
|
30 |
1 |
IS |
O |
0002 |
00781 |
Guarantor Marital Status Code |
|
31 |
8 |
DT |
O |
00782 |
Guarantor Hire Effective Date |
||
32 |
8 |
DT |
O |
00783 |
Employment Stop Date |
||
33 |
2 |
IS |
O |
0223 |
00755 |
Living Dependency |
|
34 |
2 |
IS |
O |
0009 |
00145 |
Ambulatory Status |
|
35 |
4 |
IS |
O |
0171 |
00129 |
Citizenship |
|
36 |
60 |
CE |
O |
0296 |
00118 |
Primary Language |
|
37 |
2 |
IS |
O |
0220 |
00742 |
Living Arrangement |
|
38 |
80 |
CE |
O |
0215 |
00743 |
Publicity Indicator |
|
39 |
1 |
ID |
O |
0136 |
00744 |
Protection Indicator |
|
40 |
2 |
IS |
O |
0231 |
00745 |
Student Indicator |
|
41 |
3 |
IS |
O |
0006 |
00120 |
Religion |
|
42 |
48 |
XPN |
O |
00746 |
Mothers Maiden Name |
||
43 |
80 |
CE |
O |
0212 |
00739 |
Nationality |
|
44 |
3 |
IS |
O |
0189 |
00125 |
Ethnic Group |
|
45 |
48 |
XPN |
O |
Y |
00748 |
Contact Person Name |
|
46 |
40 |
XTN |
O |
Y |
00749 |
Contact Persons Telephone Number |
|
47 |
80 |
CE |
O |
0222 |
00747 |
Contact Reason |
|
48 |
2 |
IS |
O |
0063 |
00784 |
Contact Relationship |
|
49 |
20 |
ST |
O |
00785 |
Job Title |
||
50 |
20 |
JCC |
O |
00786 |
Job Code/Class |
||
51 |
130 |
XON |
O |
Y |
01232 |
Guarantor Employer's Organization Name |
|
52 |
2 |
IS |
O |
0310 |
00753 |
Handicap |
|
53 |
2 |
IS |
O |
0311 |
00752 |
Job Status |
|
54 |
50 |
FC |
O |
0064 |
01231 |
Guarantor Financial Class |
|
55 |
1 |
IS |
O |
0005 |
01292 |
Guarantor Race |
6.4.5.0 GT1 field definitions
Definition: GT1-1-set ID contains a number that identifies this transaction. For the first occurrence of the segment the sequence shall be 1, for the second occurrence it shall be 2, etc.
Components: <ID (ST)> ^ <check digit (ST)> ^ <code identifying the check digit scheme employed (ID)> ^ <assigning authority (HD)> ^ <identifier type code (IS)> ^ <assigning facility (HD)
Subcomponents of assigning authority: <namespace ID (IS)> & <universal ID (ST)> & <universal ID type (ID)
Subcomponents of assigning facility: <namespace ID (IS)> & <universal ID (ST)> & <universal ID type (ID)
Definition: This field contains the primary identifier, or other identifiers, assigned to the guarantor.
Components: <family name (ST)> ^ <given name (ST)> ^ <middle initial or name (ST)> ^ <suffix (e.g., JR or III) (ST)> ^ <prefix (e.g., DR) (ST)> ^ <degree (e.g., MD) (ST)>^ <name type code (ID) >
Definition: This field contains the name of the guarantor Multiple names for the same guarantor may be sent in this field. The legal name is assumed to be in the first repetition. When the legal name is not sent, a repeat delimiter must be sent first for the first repetition. The components for this data type are described in Chapter 2.
Beginning with Version 2.3, if the guarantor is an organization , send a null value ("") in GT1-3-guarantor person name and put the organization name in GT1-21-guarantor organization name. Either guarantor person name or guarantor organization name is required.
Components: <family name (ST)> ^ <given name (ST)> ^ <middle initial or name (ST)> ^ <suffix (e.g., JR or III) (ST)> ^ <prefix (e.g., DR) (ST)> ^ <degree (e.g., MD) (ST)>^ <name type code (ID) >
Definition: This field contains the name of the guarantors spouse Multiple names for the same guarantor spouse may be sent in this field. The legal name is assumed to be in the first repetition. When the legal name is not sent, a repeat delimiter must be sent first for the first repetition. The components for this data type are described in Chapter 2.
Components: <street address (ST)> ^ <other designation (ST)> ^ <city (ST)> ^ <state or province (ST)> ^ <zip or postal code(ST)> ^ <country (ID)> ^ < address type (ID)> ^ <other geographic designation (ST)>^ <county/parish code (IS)> ^ <census tract (IS)>
Definition: This field contains the guarantors address. Multiple addresses for the same person may be sent in this field. The mailing address is assumed to be in the first repetition. When the mailing address is not sent, a repeat delimiter must be sent first for the first repetition.
components: [NNN] [(999)]999-9999 [X99999] [B99999] [C any text] ^<telecommunication use code (ID)> ^ <telecommunication equipment type (ID)>^ <email address (ST)> ^ <country code (NM)> ^ <area/city code (NM)> ^ <phone number (NM)> ^ <extension (NM)> ^ <any text (ST)>
Definition: This field contains the guarantors home phone number. All personal phone numbers for the guarantor may be sent in this field. The primary telephone number is assumed to be in the first repetition. When the primary telephone number is not sent, a repeat delimiter must be sent first for the first repetition. The components for this data type are described in Chapter 2.
Components: [NNN] [(999)]999-9999 [X99999] [B99999] [C any text] ^<telecommunication use code (ID)> ^ <telecommunication equipment type (ID)>^ <email address (ST)> ^ <country code (NM)> ^ <area/city code (NM)> ^ <phone number (NM)> ^ <extension (NM)> ^ <any text (ST)>
Definition: This field contains the guarantors business phone number. All business phone numbers for the guarantor may be sent in this field. The primary telephone number is assumed to be in the first repetition. When the primary telephone number is not sent, a repeat delimiter must be sent first for the first repetition. The components for this data type are described in Chapter 2.
Definition: This field contains the guarantors date of birth.
Definition: This field contains the guarantors gender. Refer to user-defined table 0001 - Sex for valid values.
Definition: This field indicates the type of guarantor, e.g., individual, institution, etc. Refer to user-defined table 0068 - Guarantor type for suggested values.
Definition: This field indicates the relationship of the guarantor with the patient, e.g., parent, child, etc. Refer to user-defined table 0063 - Relationship for suggested values.
Definition: This field contains the guarantors social security number.
Definition: This field contains the date that the guarantor becomes responsible for the patients account.
Definition: This field contains the date that the guarantor stops being responsible for the patients account.
Definition: This field is used to determine the order in which the guarantors are responsible for the patients account. "1" = primary guarantor, "2" = secondary guarantor, etc.
Components: <family name (ST)> ^ <given name (ST)> ^ <middle initial or name (ST)> ^ <suffix (e.g., JR or III) (ST)> ^ <prefix (e.g., DR) (ST)> ^ <degree (e.g., MD) (ST)>^ <name type code (ID) >
Definition: This field contains the name of the guarantors employer, if the employer is a person. When the guarantors employer is an organization, use GT1-51-guarantor employers organization name Multiple names for the same person may be sent in this field, not multiple employers. The legal name must be sent first in the repetition. When the legal name is not sent, a repeat delimiter must be sent first for the first repetition. The components for this data type are described in Chapter 2.
Components: <street address (ST)> ^ <other designation (ST)> ^ <city (ST)> ^ <state or province (ST)> ^ <zip or postal code(ST)> ^ <country (ID)> ^ < address type (ID)> ^ <other geographic designation (ST)> ^ <county/parish code (IS)> ^ <census tract (IS)>
Definition: This field contains the guarantors employers address. Multiple addresses for the same employer may be sent in this field. The mailing address must be sent first in the repetition. When the mailing address is not sent, a repeat delimiter must be sent first for the first repetition.
Components: [NNN] [(999)]999-9999 [X99999] [B99999] [C any text] ^<telecommunication use code (ID)> ^ <telecommunication equipment type (ID)>^ <email address (ST)> ^ <country code (NM)> ^ <area/city code (NM)> ^ <phone number (NM)> ^ <extension (NM)> ^ <any text (ST)>
Definition: This field contains the guarantors employers phone number. Multiple phone numbers for the same employer. The primary telephone number must be sent first in the sequence. When the primary telephone number is not sent, a repeat delimiter must be sent first for the first repetition. The components for this data type are described in Chapter 2.
Components: <ID (ST)> ^ <check digit (ST)> ^ <code identifying the check digit scheme employed (ID)> ^ <assigning authority (HD)> ^ <identifier type code (IS)> ^ <assigning facility (HD)
Subcomponents of assigning authority: <namespace ID (IS)> & <universal ID (ST)> & <universal ID type (ID)
Subcomponents of assigning facility: <namespace ID (IS)> & <universal ID (ST)> & <universal ID type (ID)
Definition: This field contains the guarantors employee number.
Definition: This field contains the code that indicates the guarantors employment status, e.g., full time, part time, self-employed, etc. Refer to user-defined table 0066 - Employment status for suggested values.
Components: <organization name (ST)> ^ <organization name type code (ID)> ^ <ID number (ID)> ^ <check digit (NM)> ^ < check digit scheme (ID)> ^ <assigning authority (HD)> ^ <identifier type code (ID)> ^ <assigning facility ID (HD)>
Subcomponents of assigning authority: <namespace ID (IS)> & <universal ID (ST)> & <universal ID type (ID)
Subcomponents of assigning facility: <namespace ID (IS)> & <universal ID (ST)> & <universal ID type (ID)
Definition: This field contains the name of the guarantor when the guarantor is an organization. Multiple names for the same guarantor may be sent in this field, not multiple guarantors. The legal name is assumed to be in the first repetition. When the legal name is not sent, a repeat delimiter must be sent first for the first repetition. The components for this data type are described in Chapter 2.
Beginning with Version 2.3, if the guarantor is a person, send a null value ("") in GT1-21-guarantor organization name and put the person name in GT1-3-guarantor person name. Either guarantor person name or guarantor organization name is required.
Definition: Refer to HL7 table 0136 - Yes/no indicator for valid values. This field indicates whether or not a system should suppress printing of the guarantors bills.
Y a system should suppress printing of guarantors bills
N a system should not suppress printing of guarantors bills
Components: <identifier (ST)> ^ <text (ST)> ^ <name of coding system (ST)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^ <name of alternate coding system (ST)>
Definition: This field contains the guarantors credit rating.
Definition: This field is used to indicate the date and time on which the guarantors death occurred.
Definition: This field indicates whether or not the guarantor is deceased. Refer to HL7 table 0136 - Yes/no indicator for valid values.
Y the guarantor is deceased
N the guarantor is living
Components: <identifier (ST)> ^ <text (ST)> ^ <name of coding system (ST)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^ <name of alternate coding system (ST)>
Definition: This field contains user-defined code that indicates which adjustments should be made to this guarantors charges. For example, when the hospital agrees to adjust this guarantors charges to a sliding scale. Refer to user-defined table 0218 - Charge adjustment for suggested values.
Example: This field would contain the value used for sliding-fee scale processing.
Components: <price (MO)> ^ <price type (ID)> ^ <from value (NM)> ^ <to value (NM)> ^ <range units (CE)> ^ <range type (ID)>
Definition: This field contains the combined annual income of all members of the guarantors household.
Definition: This field specifies the number of people living at the guarantors primary residence.
Components: <ID (ST)> ^ <check digit (ST)> ^ <code identifying the check digit scheme employed (ID)> ^ <assigning authority (HD)> ^ <identifier type code (IS)> ^ <assigning facility (HD)
Subcomponents of assigning authority: <namespace ID (IS)> & <universal ID (ST)> & <universal ID type (ID)
Subcomponents of assigning facility: <namespace ID (IS)> & <universal ID (ST)> & <universal ID type (ID)
Definition: This is a code that uniquely identifies the guarantors employer when the employer is a person. It may be a user-defined code or a code defined by a government agency (Federal Tax ID#).
When further breakdowns of employer information are needed, such as a division or plant, it is recommended that the coding scheme incorporate the relationships (e.g., define separate codes for each division).
Definition: This field contains the marital status of the guarantor. Refer to user-defined table 0002 - Marital status for suggested values.
Definition: This field contains the date that the guarantors employment began.
Definition: This field indicates the date on which the guarantors employment with a particular employer ended.
Definition: Identifies the specific living conditions of the guarantor. Refer to user-defined table 0223 - Living dependency for suggested values.
User-defined Table 0223 - Living dependency
Value |
Description |
D |
Spouse dependent |
M |
Medical Supervision Required |
S |
Small children |
WU |
Walk up |
CB |
Common Bath |
Definition: Identifies the transient state of mobility for the guarantor. Refer to user-defined table 0009 - Ambulatory status for suggested values.
Definition: This field contains the code to identify the guarantors citizenship. HL7 recommends using ISO table 3166 as the suggested values in user-defined table 0171 -Citizenship.
Components: <identifier (ST)> ^ <text (ST)> ^ <name of coding system (ST)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^ <name of alternate coding system (ST)>
Definition: This field identifies the guarantors primary speaking language. HL7 recommends using ISO table 639 as the suggested values in user-defined table 0296 - Language.
Definition: This field identifies the situation in which the person lives at his residential address. Refer to the user-defined table 0220- Living arrangement for suggested values.
User-defined Table 0220 - Living arrangement
Value |
Description |
A |
Alone |
F |
Family |
I |
Institution |
R |
Relative |
U |
Unknown |
S |
Spouse Only |
Components: <identifier (ST)> ^ <text (ST)> ^ <name of coding system (ST)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^ <name of alternate coding system (ST)>
Definition: This field contains a user-defined code indicating what level of publicity is allowed (e.g., No Publicity, Family Only) for a guarantor. Refer to user-defined table 0215 - Publicity indicator for suggested values.
Definition: This field identifies the guarantors protection, which determines whether or not access to information about this enrollee should be restricted from users who do not have adequate authority. Refer to HL7 table 0136 - Yes/no indicator for valid values.
Y restrict access
N do not restrict access
Definition: This field indicates whether the guarantor is currently a student or not, and whether the patient is a full-time or part-time student. This field does not indicate the degree level (high school, college) of the student, or his/her field of study (accounting, engineering, etc.). Refer to user-defined table 0231- Student status for suggested values.
User-defined Table 0231 - Student status
Values |
Description |
F |
Full-time student |
P |
Part-time student |
N |
Not a student |
Definition: This field indicates the type of religion practiced by the guarantor. Refer to user-defined table 0006 - Religion for suggested values.
Components: <family name (ST)> ^ <given name (ST)> ^ <middle initial or name (ST)> ^ <suffix (e.g., JR or III) (ST)> ^ <prefix (e.g., DR) (ST)> ^ <degree (e.g., MD) (ST)>^ <name type code (ID) >
Definition: This field indicates the guarantors mothers maiden name.
Components: <identifier (ST)> ^ <text (ST)> ^ <name of coding system (ST)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^ <name of alternate coding system (ST)>
Definition: This field contains a code that identifies the nation or national grouping to which the person belongs. This may be different from a persons citizenship in countries in which multiple nationalities are recognized (for example, Spain: Basque, Catalan, etc.). HL7 recommends using ISO table 3166 as suggested values in user-defined table 0212 - Nationality.
Definition: This field contains the guarantors ethnic or race group. ERISA has a published list of ethnic classifications that may be used by local agreement at a site. Refer to user-defined table 0189 - Ethnic group for suggested values.
Components: <family name (ST)> ^ <given name (ST)> ^ <middle initial or name (ST)> ^ <suffix (e.g., JR or III) (ST)> ^ <prefix (e.g., DR) (ST)> ^ <degree (e.g., MD) (ST)>^ <name type code (ID) >
Definition: This field contains the name of the person who should be contacted regarding the guarantor bills, etc. This may be someone other than the guarantor. (Contact guarantors wife regarding all bills - guarantor lives out of country). The components for this data type are described in Chapter 2.
This is a repeating field that allows for multiple names for the same person. The legal name is assumed to be in the first repetition. When the legal name is not sent, a repeat delimiter must be sent first for the first repetition.
Components: [NNN] [(999)]999-9999 [X99999] [B99999] [C any text] ^<telecommunication use code (ID)> ^ <telecommunication equipment type (ID)>^ <email address (ST)> ^ <country code (NM)> ^ <area/city code (NM)> ^ <phone number (NM)> ^ <extension (NM)> ^ <any text (ST)>
Definition: This field contains the telephone number of the guarantor (person) to contact regarding guarantor bills, etc. Multiple phone numbers for that person may be sent in this sequence. The primary telephone number is assumed to be in the first repetition. When the primary telephone number is not sent, a repeat delimiter must be sent first for the first repetition. The components for this data type are described in Chapter 2.
Components: <identifier (ST)> ^ <text (ST)> ^ <name of coding system (ST)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^ <name of alternate coding system (ST)>
Definition: This field contains a user-defined code that identifies the reason for contacting the guarantor, for example, to phone the guarantor if payments are late. Refer to user-defined table 0222 - Contact reason for suggested values.
Definition: Identifies the guarantor relationship to the contact person specified above. Some examples of the relationship between the guarantor and the guarantor contact person might include wife, attorney, power of attorney, self, and organization. Refer to user-defined table 0063 - Relationship for suggested values.
Definition: This field contains a descriptive name of the guarantors occupation (e.g., Sr. Systems Analyst, Sr. Accountant).
Components: <job code (IS)> ^ <job class (IS)>
Definition: This field contains the guarantors job code and employee classification. Refer to user-defined tables 0327 - Job code and 0328 - Job class for suggested values.
Components: <organization name (ST)> ^ <organization name type code (ID)> ^ <ID number (ID)> ^ <check digit (NM)> ^ < check digit scheme (ID)> ^ <assigning authority (HD)> ^ <identifier type code (ID)> ^ <assigning facility ID (HD)>
Subcomponents of assigning authority: <namespace ID (IS)> & <universal ID (ST)> & <universal ID type (ID)
Subcomponents of assigning facility: <namespace ID (IS)> & <universal ID (ST)> & <universal ID type (ID)
Definition: This field contains the name of the guarantors employer when the guarantors employer is an organization. When the guarantor's employer is a person, use GT1-16 guarantor employer name. Multiple names for the same guarantor may be sent in this field. The legal name is assumed to be in the first repetition. When the legal name is not sent, a repeat delimiter must be sent first for the first repetition. The components of this data type are described in Chapter 2.
Definition: This field contains a code to describe the guarantor's disability. Refer to user-defined table 0310 - Handicap for suggested values.
Definition: This field contains a code that identifies the guarantor's current job status, for example, part time/workers comp, full time/leave of absence, full time/suspended. Refer to user-defined table 0311 - Job status for suggested values.
Components: <financial class (IS)> ^ <effective date (TS)>
Definition: This field contains the financial class (FC) assigned to the guarantor for the purpose of identifying sources of reimbursement. It can be different than that of the patient. When the FC of the guarantor is different than the FC of the patient, and the guarantors coverage for that patient has been exhausted, the source of reimbursement falls back onto the FC of the patient. Refer to user-defined table 0064 - Financial class for suggested values.
Definition: This field refers to the guarantors race. Refer to user-defined table 0005 - Race for suggested values.