import { ClaimAddress } from './ClaimAddress';
import { ClaimDate } from './ClaimDate';
import { ClaimDatePeriod } from './ClaimDatePeriod';
import { ClaimDateWithQualifier } from './ClaimDateWithQualifier';
import { ClaimId } from './ClaimId';
import { ClaimName } from './ClaimName';
export interface ClaimCMS1500 {
    _1_insuranceProgram: 'MEDICARE' | 'MEDICAID' | 'TRICARE' | 'CHAMPVA' | 'GROUP_HEALTH_PLAN' | 'FECA_BLK_LUNG' | 'OTHER';
    _1a_insuredIdNumber: string;
    _2_patientName: ClaimName;
    _3_patientBirthDate: ClaimDate;
    _3_patientSex: 'M' | 'F';
    _4_insuredName?: ClaimName;
    _5_patientAddress: ClaimAddress;
    _6_patientRelationshipToInsured?: 'Self' | 'Spouse' | 'Child' | 'Other';
    _7_insuredAddress?: ClaimAddress;
    _9_otherInsuredName?: ClaimName;
    _9a_otherInsuredPolicyOrGroupNumber?: string;
    _9d_otherInsuredInsurancePlanNameOrProgramName?: string;
    _10_patientConditionRelations?: {
        _a_employment?: boolean;
        _b_autoAccident?: boolean;
        _b_autoAccidentState?: string;
        _c_otherAccident?: boolean;
    };
    _10d_claimCodes?: string[];
    _11_insuredPolicyGroupOrFecaNumber?: string;
    _11a_insuredDateOfBirth?: ClaimDate;
    _11a_insuredSex?: 'M' | 'F';
    _11b_otherClaimId?: string;
    _11c_insurancePlanNameOrProgramName?: string;
    _11d_anotherHealthBenefitPlan: boolean;
    _12_patientSignedDate?: ClaimDate;
    _14_dateOfCurrentIllness?: ClaimDateWithQualifier;
    _15_otherDate?: ClaimDateWithQualifier;
    _16_patientUnableToWorkPeriod?: ClaimDatePeriod;
    _17_referringProvider: {
        qualifier: string;
        name: ClaimName;
        _a_otherId?: ClaimId;
        _b_npiId: string;
    };
    _18_hospitalizationDates?: ClaimDatePeriod;
    _19_additionalClaimInformation?: string;
    _20_outsideLab?: {
        purchased?: boolean;
        charges?: number;
    };
    _21_diagnosis: {
        icdIndicator: string;
        codes: string[];
    };
    _22_resubmission?: {
        code: string;
        originalReferenceNumber: string;
    };
    _23_priorAuthorizationNumber?: string;
    _24_services: {
        _a_datesOfService: ClaimDatePeriod;
        _b_placeOfService: string;
        _c_emergency?: boolean;
        _d_procedures: {
            cptOrHcpcs: string;
            modifiers?: string[];
        };
        _e_diagnosisPointer: string;
        _f_charges: number;
        _g_daysOrUnits: number;
        _h_epsdtAndFamilyPlan?: {
            epsdt?: string;
            familyPlan?: boolean;
        };
        _j_renderingProviderId: {
            otherId?: ClaimId;
            npiId: string;
        };
        supplementalInformation?: string;
    }[];
    _25_federalTaxIdNumber: {
        value: string;
        type: 'SSN' | 'EIN';
    };
    _26_patientAccountNumber?: string;
    _27_acceptAssignment?: boolean;
    _28_totalCharge: number;
    _29_amountPaid?: number;
    _31_physicianSignedDate: ClaimDate;
    _32_serviceFacilityLocationInfo: {
        name: string;
        address: ClaimAddress;
        _a_npiId?: string;
        _b_otherId?: ClaimId;
    };
    _33_billingProviderInfoAndPhone: {
        name: string;
        address: ClaimAddress;
        _a_npiId: string;
        _b_otherId?: ClaimId;
    };
}