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6.4.5 GT1 - guarantor segment

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

Mother’s 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 Person’s 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

6.4.5.1 Set ID - GT1 (SI) 00405

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.

6.4.5.2 Guarantor number (CX) 00406

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.

6.4.5.3 Guarantor name (XPN) 00407

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.

6.4.5.4 Guarantor spouse name (XPN) 00408

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’s 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.

6.4.5.5 Guarantor address (XAD) 00409

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 guarantor’s 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.

6.4.5.6 Guarantor ph num - home (XTN) 00410 C

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 guarantor’s 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.

6.4.5.7 Guarantor ph num - business (XTN) 00411

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 guarantor’s 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.

6.4.5.8 Guarantor date and time of birth (TS) 00412

Definition: This field contains the guarantor’s date of birth.

6.4.5.9 Guarantor sex (IS) 00413

Definition: This field contains the guarantor’s gender. Refer to user-defined table 0001 - Sex for valid values.

6.4.5.10 Guarantor type (IS) 00414

Definition: This field indicates the type of guarantor, e.g., individual, institution, etc. Refer to user-defined table 0068 - Guarantor type for suggested values.

6.4.5.11 Guarantor relationship (IS) 00415

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.

6.4.5.12 Guarantor SSN (ST) 00416

Definition: This field contains the guarantor’s social security number.

6.4.5.13 Guarantor date - begin (DT) 00417

Definition: This field contains the date that the guarantor becomes responsible for the patient’s account.

6.4.5.14 Guarantor date - end (DT) 00418

Definition: This field contains the date that the guarantor stops being responsible for the patient’s account.

6.4.5.15 Guarantor priority (NM) 00419

Definition: This field is used to determine the order in which the guarantors are responsible for the patient’s account. "1" = primary guarantor, "2" = secondary guarantor, etc.

6.4.5.16 Guarantor employer name (XPN) 00420

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’s employer, if the employer is a person. When the guarantor’s employer is an organization, use GT1-51-guarantor employer’s 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.

6.4.5.17 Guarantor employer address (XAD) 00421

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 guarantor’s employer’s 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.

6.4.5.18 Guarantor employer phone number (XTN) 00422

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 guarantor’s employer’s 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.

6.4.5.19 Guarantor employee ID number (CX) 00423

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 guarantor’s employee number.

6.4.5.20 Guarantor employment status (IS) 00424

Definition: This field contains the code that indicates the guarantor’s employment status, e.g., full time, part time, self-employed, etc. Refer to user-defined table 0066 - Employment status for suggested values.

6.4.5.21 Guarantor organization name (XON) 00425

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.

6.4.5.22 Guarantor billing hold flag (ID) 00773

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 guarantor’s bills.

Y a system should suppress printing of guarantor’s bills

N a system should not suppress printing of guarantor’s bills

6.4.5.23 Guarantor credit rating code (CE) 00774

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 guarantor’s credit rating.

6.4.5.24 Guarantor death date and time (TS) 00775

Definition: This field is used to indicate the date and time on which the guarantor’s death occurred.

6.4.5.25 Guarantor death flag (ID) 00776

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

6.4.5.26 Guarantor charge adjustment code (CE) 00777

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 guarantor’s charges. For example, when the hospital agrees to adjust this guarantor’s 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.

6.4.5.27 Guarantor household annual income (CP) 00778

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 guarantor’s household.

6.4.5.28 Guarantor household size (NM) 00779

Definition: This field specifies the number of people living at the guarantor’s primary residence.

6.4.5.29 Guarantor employer identification number (CX) 00780

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 guarantor’s 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).

6.4.5.30 Guarantor marital status code (IS) 00781

Definition: This field contains the marital status of the guarantor. Refer to user-defined table 0002 - Marital status for suggested values.

6.4.5.31 Guarantor hire effective date (DT) 00782

Definition: This field contains the date that the guarantor’s employment began.

6.4.5.32 Guarantor employment stop date (DT) 00783

Definition: This field indicates the date on which the guarantor’s employment with a particular employer ended.

6.4.5.33 Living dependency (IS) 00755

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

6.4.5.34 Ambulatory status code (IS) 00145

Definition: Identifies the transient state of mobility for the guarantor. Refer to user-defined table 0009 - Ambulatory status for suggested values.

6.4.5.35 Citizenship (IS) 00129

Definition: This field contains the code to identify the guarantor’s citizenship. HL7 recommends using ISO table 3166 as the suggested values in user-defined table 0171 -Citizenship.

6.4.5.36 Primary language (CE) 00118

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 guarantor’s primary speaking language. HL7 recommends using ISO table 639 as the suggested values in user-defined table 0296 - Language.

6.4.5.37 Living arrangement (IS) 00742

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

6.4.5.38 Publicity indicator (CE) 00743

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.

6.4.5.39 Protection indicator (ID) 00744

Definition: This field identifies the guarantor’s 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

6.4.5.40 Student indicator (IS) 00745

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

6.4.5.41 Religion (IS) 00120

Definition: This field indicates the type of religion practiced by the guarantor. Refer to user-defined table 0006 - Religion for suggested values.

6.4.5.42 Mother’s maiden name (XPN) 00746

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 guarantor’s mother’s maiden name.

6.4.5.43 Nationality (CE) 00739

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 person’s 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.

6.4.5.44 Ethnic group (IS) 00125

Definition: This field contains the guarantor’s 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.

6.4.5.45 Contact person name (XPN) 00748

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 guarantor’s 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.

6.4.5.46 Contact person phone number (XTN) 00749

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.

6.4.5.47 Contact reason (CE) 00747

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.

6.4.5.48 Contact relationship code (IS) 00784

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.

6.4.5.49 Job title (ST) 00785

Definition: This field contains a descriptive name of the guarantor’s occupation (e.g., Sr. Systems Analyst, Sr. Accountant).

6.4.5.50 Job code/class (JCC) 00786

Components: <job code (IS)> ^ <job class (IS)>

Definition: This field contains the guarantor’s job code and employee classification. Refer to user-defined tables 0327 - Job code and 0328 - Job class for suggested values.

6.4.5.51 Guarantor employer's organization name (XON) 01232

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’s employer when the guarantor’s 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.

6.4.5.52 Handicap (IS) 00753

Definition: This field contains a code to describe the guarantor's disability. Refer to user-defined table 0310 - Handicap for suggested values.

6.4.5.53 Job status (IS) 00752

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.

6.4.5.54 Guarantor financial class (FC) 01231

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 guarantor’s 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.

6.4.5.55 Guarantor race (IS) 01292

Definition: This field refers to the guarantor’s race. Refer to user-defined table 0005 - Race for suggested values.

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