| 1 | ▶provider_invoice_number | EI | Required | No | - |
| 1.1 | ├.entity_identifier | ST | Optional | No | - |
| 1.2 | ├.namespace_id | IS | Optional | No | - |
| 1.3 | ├.universal_id | ST | Optional | No | - |
| 1.4 | └.universal_id_type | ID | Optional | No | - |
| 2 | ▶payer_invoice_number | EI | Optional | No | - |
| 2.1 | ├.entity_identifier | ST | Optional | No | - |
| 2.2 | ├.namespace_id | IS | Optional | No | - |
| 2.3 | ├.universal_id | ST | Optional | No | - |
| 2.4 | └.universal_id_type | ID | Optional | No | - |
| 3 | ▶contract_agreement_number | EI | Optional | No | - |
| 3.1 | ├.entity_identifier | ST | Optional | No | - |
| 3.2 | ├.namespace_id | IS | Optional | No | - |
| 3.3 | ├.universal_id | ST | Optional | No | - |
| 3.4 | └.universal_id_type | ID | Optional | No | - |
| 4 | ▶invoice_control | CWE | Required | No | HL70553 |
| 4.1 | ├.identifier | ST | Optional | No | - |
| 4.2 | ├.text | ST | Optional | No | - |
| 4.3 | ├.name_of_coding_system | ID | Optional | No | - |
| 4.4 | ├.alternate_identifier | ST | Optional | No | - |
| 4.5 | ├.alternate_text | ST | Optional | No | - |
| 4.6 | ├.name_of_alternate_coding_system | ID | Optional | No | - |
| 4.7 | ├.coding_system_version_id | ST | Optional | No | - |
| 4.8 | ├.alternate_coding_system_version_id | ST | Optional | No | - |
| 4.9 | ├.original_text | ST | Optional | No | - |
| 4.10 | ├.second_alternate_identifier | ST | Optional | No | - |
| 4.11 | ├.second_alternate_text | ST | Optional | No | - |
| 4.12 | ├.name_of_second_alternate_coding_system | ID | Optional | No | - |
| 4.13 | ├.second_alternate_coding_system_version_id | ST | Optional | No | - |
| 4.14 | ├.coding_system_oid | ST | Optional | No | - |
| 4.15 | ├.value_set_oid | ST | Optional | No | - |
| 4.16 | ├.value_set_version_id | DTM | Optional | No | - |
| 4.17 | ├.alternate_coding_system_oid | ST | Optional | No | - |
| 4.18 | ├.alternate_value_set_oid | ST | Optional | No | - |
| 4.19 | ├.alternate_value_set_version_id | DTM | Optional | No | - |
| 4.20 | ├.second_alternate_coding_system_oid | ST | Optional | No | - |
| 4.21 | ├.second_alternate_value_set_oid | ST | Optional | No | - |
| 4.22 | └.second_alternate_value_set_version_id | DTM | Optional | No | - |
| 5 | ▶invoice_reason | CWE | Required | No | HL70554 |
| 5.1 | ├.identifier | ST | Optional | No | - |
| 5.2 | ├.text | ST | Optional | No | - |
| 5.3 | ├.name_of_coding_system | ID | Optional | No | - |
| 5.4 | ├.alternate_identifier | ST | Optional | No | - |
| 5.5 | ├.alternate_text | ST | Optional | No | - |
| 5.6 | ├.name_of_alternate_coding_system | ID | Optional | No | - |
| 5.7 | ├.coding_system_version_id | ST | Optional | No | - |
| 5.8 | ├.alternate_coding_system_version_id | ST | Optional | No | - |
| 5.9 | ├.original_text | ST | Optional | No | - |
| 5.10 | ├.second_alternate_identifier | ST | Optional | No | - |
| 5.11 | ├.second_alternate_text | ST | Optional | No | - |
| 5.12 | ├.name_of_second_alternate_coding_system | ID | Optional | No | - |
| 5.13 | ├.second_alternate_coding_system_version_id | ST | Optional | No | - |
| 5.14 | ├.coding_system_oid | ST | Optional | No | - |
| 5.15 | ├.value_set_oid | ST | Optional | No | - |
| 5.16 | ├.value_set_version_id | DTM | Optional | No | - |
| 5.17 | ├.alternate_coding_system_oid | ST | Optional | No | - |
| 5.18 | ├.alternate_value_set_oid | ST | Optional | No | - |
| 5.19 | ├.alternate_value_set_version_id | DTM | Optional | No | - |
| 5.20 | ├.second_alternate_coding_system_oid | ST | Optional | No | - |
| 5.21 | ├.second_alternate_value_set_oid | ST | Optional | No | - |
| 5.22 | └.second_alternate_value_set_version_id | DTM | Optional | No | - |
| 6 | ▶invoice_type | CWE | Required | No | HL70555 |
| 6.1 | ├.identifier | ST | Optional | No | - |
| 6.2 | ├.text | ST | Optional | No | - |
| 6.3 | ├.name_of_coding_system | ID | Optional | No | - |
| 6.4 | ├.alternate_identifier | ST | Optional | No | - |
| 6.5 | ├.alternate_text | ST | Optional | No | - |
| 6.6 | ├.name_of_alternate_coding_system | ID | Optional | No | - |
| 6.7 | ├.coding_system_version_id | ST | Optional | No | - |
| 6.8 | ├.alternate_coding_system_version_id | ST | Optional | No | - |
| 6.9 | ├.original_text | ST | Optional | No | - |
| 6.10 | ├.second_alternate_identifier | ST | Optional | No | - |
| 6.11 | ├.second_alternate_text | ST | Optional | No | - |
| 6.12 | ├.name_of_second_alternate_coding_system | ID | Optional | No | - |
| 6.13 | ├.second_alternate_coding_system_version_id | ST | Optional | No | - |
| 6.14 | ├.coding_system_oid | ST | Optional | No | - |
| 6.15 | ├.value_set_oid | ST | Optional | No | - |
| 6.16 | ├.value_set_version_id | DTM | Optional | No | - |
| 6.17 | ├.alternate_coding_system_oid | ST | Optional | No | - |
| 6.18 | ├.alternate_value_set_oid | ST | Optional | No | - |
| 6.19 | ├.alternate_value_set_version_id | DTM | Optional | No | - |
| 6.20 | ├.second_alternate_coding_system_oid | ST | Optional | No | - |
| 6.21 | ├.second_alternate_value_set_oid | ST | Optional | No | - |
| 6.22 | └.second_alternate_value_set_version_id | DTM | Optional | No | - |
| 7 | invoice_date_time | DTM | Required | No | - |
| 8 | ▶invoice_amount | CP | Required | No | - |
| 8.1 | ├.price | MO | Optional | No | - |
| 8.2 | ├.price_type | ID | Optional | No | - |
| 8.3 | ├.from_value | NM | Optional | No | - |
| 8.4 | ├.to_value | NM | Optional | No | - |
| 8.5 | ├.range_units | CWE | Optional | No | - |
| 8.6 | └.range_type | ID | Optional | No | - |
| 9 | payment_terms | ST | Optional | No | - |
| 10 | ▶provider_organization | XON | Required | No | - |
| 10.1 | ├.organization_name | ST | Optional | No | - |
| 10.2 | ├.organization_name_type_code | CWE | Optional | No | - |
| 10.3 | ├.id_number | NM | Optional | No | - |
| 10.4 | ├.identifier_check_digit | ST | Optional | No | - |
| 10.5 | ├.check_digit_scheme | ID | Optional | No | - |
| 10.6 | ├.assigning_authority | HD | Optional | No | - |
| 10.7 | ├.identifier_type_code | ID | Optional | No | - |
| 10.8 | ├.assigning_facility | HD | Optional | No | - |
| 10.9 | ├.name_representation_code | ID | Optional | No | - |
| 10.10 | └.organization_identifier | ST | Optional | No | - |
| 11 | ▶payer_organization | XON | Required | No | - |
| 11.1 | ├.organization_name | ST | Optional | No | - |
| 11.2 | ├.organization_name_type_code | CWE | Optional | No | - |
| 11.3 | ├.id_number | NM | Optional | No | - |
| 11.4 | ├.identifier_check_digit | ST | Optional | No | - |
| 11.5 | ├.check_digit_scheme | ID | Optional | No | - |
| 11.6 | ├.assigning_authority | HD | Optional | No | - |
| 11.7 | ├.identifier_type_code | ID | Optional | No | - |
| 11.8 | ├.assigning_facility | HD | Optional | No | - |
| 11.9 | ├.name_representation_code | ID | Optional | No | - |
| 11.10 | └.organization_identifier | ST | Optional | No | - |
| 12 | ▶attention | XCN | Optional | No | - |
| 12.1 | ├.person_identifier | ST | Optional | No | - |
| 12.2 | ├.family_name | FN | Optional | No | - |
| 12.3 | ├.given_name | ST | Optional | No | - |
| 12.4 | ├.second_and_further_given_names_or_initials_thereof | ST | Optional | No | - |
| 12.5 | ├.suffix | ST | Optional | No | - |
| 12.6 | ├.prefix | ST | Optional | No | - |
| 12.7 | ├.degree | ST | Optional | No | - |
| 12.8 | ├.source_table | CWE | Optional | No | - |
| 12.9 | ├.assigning_authority | HD | Optional | No | - |
| 12.10 | ├.name_type_code | ID | Optional | No | - |
| 12.11 | ├.identifier_check_digit | ST | Optional | No | - |
| 12.12 | ├.check_digit_scheme | ID | Optional | No | - |
| 12.13 | ├.identifier_type_code | ID | Optional | No | - |
| 12.14 | ├.assigning_facility | HD | Optional | No | - |
| 12.15 | ├.name_representation_code | ID | Optional | No | - |
| 12.16 | ├.name_context | CWE | Optional | No | - |
| 12.17 | ├.name_validity_range | DR | Optional | No | - |
| 12.18 | ├.name_assembly_order | ID | Optional | No | - |
| 12.19 | ├.effective_date | DTM | Optional | No | - |
| 12.20 | ├.expiration_date | DTM | Optional | No | - |
| 12.21 | ├.professional_suffix | ST | Optional | No | - |
| 12.22 | ├.assigning_jurisdiction | CWE | Optional | No | - |
| 12.23 | ├.assigning_agency_or_department | CWE | Optional | No | - |
| 12.24 | ├.security_check | ST | Optional | No | - |
| 12.25 | └.security_check_scheme | ID | Optional | No | - |
| 13 | last_invoice_indicator | ID | Optional | No | HL70136 |
| 14 | invoice_booking_period | DTM | Optional | No | - |
| 15 | origin | ST | Optional | No | - |
| 16 | ▶invoice_fixed_amount | CP | Optional | No | - |
| 16.1 | ├.price | MO | Optional | No | - |
| 16.2 | ├.price_type | ID | Optional | No | - |
| 16.3 | ├.from_value | NM | Optional | No | - |
| 16.4 | ├.to_value | NM | Optional | No | - |
| 16.5 | ├.range_units | CWE | Optional | No | - |
| 16.6 | └.range_type | ID | Optional | No | - |
| 17 | ▶special_costs | CP | Optional | No | - |
| 17.1 | ├.price | MO | Optional | No | - |
| 17.2 | ├.price_type | ID | Optional | No | - |
| 17.3 | ├.from_value | NM | Optional | No | - |
| 17.4 | ├.to_value | NM | Optional | No | - |
| 17.5 | ├.range_units | CWE | Optional | No | - |
| 17.6 | └.range_type | ID | Optional | No | - |
| 18 | ▶amount_for_doctors_treatment | CP | Optional | No | - |
| 18.1 | ├.price | MO | Optional | No | - |
| 18.2 | ├.price_type | ID | Optional | No | - |
| 18.3 | ├.from_value | NM | Optional | No | - |
| 18.4 | ├.to_value | NM | Optional | No | - |
| 18.5 | ├.range_units | CWE | Optional | No | - |
| 18.6 | └.range_type | ID | Optional | No | - |
| 19 | ▶responsible_physician | XCN | Optional | No | - |
| 19.1 | ├.person_identifier | ST | Optional | No | - |
| 19.2 | ├.family_name | FN | Optional | No | - |
| 19.3 | ├.given_name | ST | Optional | No | - |
| 19.4 | ├.second_and_further_given_names_or_initials_thereof | ST | Optional | No | - |
| 19.5 | ├.suffix | ST | Optional | No | - |
| 19.6 | ├.prefix | ST | Optional | No | - |
| 19.7 | ├.degree | ST | Optional | No | - |
| 19.8 | ├.source_table | CWE | Optional | No | - |
| 19.9 | ├.assigning_authority | HD | Optional | No | - |
| 19.10 | ├.name_type_code | ID | Optional | No | - |
| 19.11 | ├.identifier_check_digit | ST | Optional | No | - |
| 19.12 | ├.check_digit_scheme | ID | Optional | No | - |
| 19.13 | ├.identifier_type_code | ID | Optional | No | - |
| 19.14 | ├.assigning_facility | HD | Optional | No | - |
| 19.15 | ├.name_representation_code | ID | Optional | No | - |
| 19.16 | ├.name_context | CWE | Optional | No | - |
| 19.17 | ├.name_validity_range | DR | Optional | No | - |
| 19.18 | ├.name_assembly_order | ID | Optional | No | - |
| 19.19 | ├.effective_date | DTM | Optional | No | - |
| 19.20 | ├.expiration_date | DTM | Optional | No | - |
| 19.21 | ├.professional_suffix | ST | Optional | No | - |
| 19.22 | ├.assigning_jurisdiction | CWE | Optional | No | - |
| 19.23 | ├.assigning_agency_or_department | CWE | Optional | No | - |
| 19.24 | ├.security_check | ST | Optional | No | - |
| 19.25 | └.security_check_scheme | ID | Optional | No | - |
| 20 | ▶cost_center | CX | Optional | No | - |
| 20.1 | ├.id_number | ST | Optional | No | - |
| 20.2 | ├.identifier_check_digit | ST | Optional | No | - |
| 20.3 | ├.check_digit_scheme | ID | Optional | No | - |
| 20.4 | ├.assigning_authority | HD | Optional | No | - |
| 20.5 | ├.identifier_type_code | ID | Optional | No | - |
| 20.6 | ├.assigning_facility | HD | Optional | No | - |
| 20.7 | ├.effective_date | DT | Optional | No | - |
| 20.8 | ├.expiration_date | DT | Optional | No | - |
| 20.9 | ├.assigning_jurisdiction | CWE | Optional | No | - |
| 20.10 | ├.assigning_agency_or_department | CWE | Optional | No | - |
| 20.11 | ├.security_check | ST | Optional | No | - |
| 20.12 | └.security_check_scheme | ID | Optional | No | - |
| 21 | ▶invoice_prepaid_amount | CP | Optional | No | - |
| 21.1 | ├.price | MO | Optional | No | - |
| 21.2 | ├.price_type | ID | Optional | No | - |
| 21.3 | ├.from_value | NM | Optional | No | - |
| 21.4 | ├.to_value | NM | Optional | No | - |
| 21.5 | ├.range_units | CWE | Optional | No | - |
| 21.6 | └.range_type | ID | Optional | No | - |
| 22 | ▶total_invoice_amount_without_prepaid_amount | CP | Optional | No | - |
| 22.1 | ├.price | MO | Optional | No | - |
| 22.2 | ├.price_type | ID | Optional | No | - |
| 22.3 | ├.from_value | NM | Optional | No | - |
| 22.4 | ├.to_value | NM | Optional | No | - |
| 22.5 | ├.range_units | CWE | Optional | No | - |
| 22.6 | └.range_type | ID | Optional | No | - |
| 23 | ▶total_amount_of_vat | CP | Optional | No | - |
| 23.1 | ├.price | MO | Optional | No | - |
| 23.2 | ├.price_type | ID | Optional | No | - |
| 23.3 | ├.from_value | NM | Optional | No | - |
| 23.4 | ├.to_value | NM | Optional | No | - |
| 23.5 | ├.range_units | CWE | Optional | No | - |
| 23.6 | └.range_type | ID | Optional | No | - |
| 24 | vat_rates_applied | NM | Optional | Yes | - |
| 25 | ▶benefit_group | CWE | Required | No | HL70556 |
| 25.1 | ├.identifier | ST | Optional | No | - |
| 25.2 | ├.text | ST | Optional | No | - |
| 25.3 | ├.name_of_coding_system | ID | Optional | No | - |
| 25.4 | ├.alternate_identifier | ST | Optional | No | - |
| 25.5 | ├.alternate_text | ST | Optional | No | - |
| 25.6 | ├.name_of_alternate_coding_system | ID | Optional | No | - |
| 25.7 | ├.coding_system_version_id | ST | Optional | No | - |
| 25.8 | ├.alternate_coding_system_version_id | ST | Optional | No | - |
| 25.9 | ├.original_text | ST | Optional | No | - |
| 25.10 | ├.second_alternate_identifier | ST | Optional | No | - |
| 25.11 | ├.second_alternate_text | ST | Optional | No | - |
| 25.12 | ├.name_of_second_alternate_coding_system | ID | Optional | No | - |
| 25.13 | ├.second_alternate_coding_system_version_id | ST | Optional | No | - |
| 25.14 | ├.coding_system_oid | ST | Optional | No | - |
| 25.15 | ├.value_set_oid | ST | Optional | No | - |
| 25.16 | ├.value_set_version_id | DTM | Optional | No | - |
| 25.17 | ├.alternate_coding_system_oid | ST | Optional | No | - |
| 25.18 | ├.alternate_value_set_oid | ST | Optional | No | - |
| 25.19 | ├.alternate_value_set_version_id | DTM | Optional | No | - |
| 25.20 | ├.second_alternate_coding_system_oid | ST | Optional | No | - |
| 25.21 | ├.second_alternate_value_set_oid | ST | Optional | No | - |
| 25.22 | └.second_alternate_value_set_version_id | DTM | Optional | No | - |
| 26 | provider_tax_id | ST | Optional | No | - |
| 27 | payer_tax_id | ST | Optional | No | - |
| 28 | ▶provider_tax_status | CWE | Optional | No | HL70572 |
| 28.1 | ├.identifier | ST | Optional | No | - |
| 28.2 | ├.text | ST | Optional | No | - |
| 28.3 | ├.name_of_coding_system | ID | Optional | No | - |
| 28.4 | ├.alternate_identifier | ST | Optional | No | - |
| 28.5 | ├.alternate_text | ST | Optional | No | - |
| 28.6 | ├.name_of_alternate_coding_system | ID | Optional | No | - |
| 28.7 | ├.coding_system_version_id | ST | Optional | No | - |
| 28.8 | ├.alternate_coding_system_version_id | ST | Optional | No | - |
| 28.9 | ├.original_text | ST | Optional | No | - |
| 28.10 | ├.second_alternate_identifier | ST | Optional | No | - |
| 28.11 | ├.second_alternate_text | ST | Optional | No | - |
| 28.12 | ├.name_of_second_alternate_coding_system | ID | Optional | No | - |
| 28.13 | ├.second_alternate_coding_system_version_id | ST | Optional | No | - |
| 28.14 | ├.coding_system_oid | ST | Optional | No | - |
| 28.15 | ├.value_set_oid | ST | Optional | No | - |
| 28.16 | ├.value_set_version_id | DTM | Optional | No | - |
| 28.17 | ├.alternate_coding_system_oid | ST | Optional | No | - |
| 28.18 | ├.alternate_value_set_oid | ST | Optional | No | - |
| 28.19 | ├.alternate_value_set_version_id | DTM | Optional | No | - |
| 28.20 | ├.second_alternate_coding_system_oid | ST | Optional | No | - |
| 28.21 | ├.second_alternate_value_set_oid | ST | Optional | No | - |
| 28.22 | └.second_alternate_value_set_version_id | DTM | Optional | No | - |
| 29 | ▶payer_tax_status | CWE | Optional | No | HL70572 |
| 29.1 | ├.identifier | ST | Optional | No | - |
| 29.2 | ├.text | ST | Optional | No | - |
| 29.3 | ├.name_of_coding_system | ID | Optional | No | - |
| 29.4 | ├.alternate_identifier | ST | Optional | No | - |
| 29.5 | ├.alternate_text | ST | Optional | No | - |
| 29.6 | ├.name_of_alternate_coding_system | ID | Optional | No | - |
| 29.7 | ├.coding_system_version_id | ST | Optional | No | - |
| 29.8 | ├.alternate_coding_system_version_id | ST | Optional | No | - |
| 29.9 | ├.original_text | ST | Optional | No | - |
| 29.10 | ├.second_alternate_identifier | ST | Optional | No | - |
| 29.11 | ├.second_alternate_text | ST | Optional | No | - |
| 29.12 | ├.name_of_second_alternate_coding_system | ID | Optional | No | - |
| 29.13 | ├.second_alternate_coding_system_version_id | ST | Optional | No | - |
| 29.14 | ├.coding_system_oid | ST | Optional | No | - |
| 29.15 | ├.value_set_oid | ST | Optional | No | - |
| 29.16 | ├.value_set_version_id | DTM | Optional | No | - |
| 29.17 | ├.alternate_coding_system_oid | ST | Optional | No | - |
| 29.18 | ├.alternate_value_set_oid | ST | Optional | No | - |
| 29.19 | ├.alternate_value_set_version_id | DTM | Optional | No | - |
| 29.20 | ├.second_alternate_coding_system_oid | ST | Optional | No | - |
| 29.21 | ├.second_alternate_value_set_oid | ST | Optional | No | - |
| 29.22 | └.second_alternate_value_set_version_id | DTM | Optional | No | - |
| 30 | sales_tax_id | ST | Optional | No | - |