| Element/Gruppe | No/Code | Beschreibung | Opt/Mand. |
|---|
| Gruppe | E206 | The identification of an object. | Mandatory |
| Element | 9645 | Code specifying the level of responsibility of a payer. | Mandatory |
| Gruppe | E507 | Date and/or time, or period relevant to the specified date/time/period type. | Optional |
| Element | 5267 | Code specifying the type of service. | Optional |
| Element | 5004 | To specify a monetary amount. | Optional |
| Gruppe | E030 | To identify the adjustment category, reason and related monetary amount. | Optional |
| Element | 4497 | Code specifying the meaning of the insurance cover. | Optional |
| Element | 9143 | Code specifying a relationship. | Optional |
| Element | 9607 | Code specifying either a yes or no. | Optional |
