<identifier (ST)> ^ <text (ST)> ^ <name of coding system
(IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^
<name of alternate coding system (IS)>
Definition: This field indicates the type of religion practiced by the
insured. Refer to User-defined Table 0006 - Religion for suggested
values.
Components:
In Version 2.3, replaces the PN data type. <family name (FN)> ^
<given name (ST)> ^ <second and further given names or initials
thereof (ST)> ^ <suffix (e.g., JR or III) (ST)> ^ <prefix (e.g.,
DR) (ST)> ^ <degree (e.g., MD) (IS)> ^ <name type code (ID)
> ^ <name representation code (ID)> ^ <name context (CE)> ^
<name validity range (DR)> ^ <name assembly order (ID)>
Subcomponents of family name: <family name (ST)> & <own family
name prefix (ST)> & <own family name (ST)> & <family name
prefix from partner/spouse (ST)> & <family name from partner/spouse
(ST)>
Definition: This field indicates the insured's mother's maiden name.
Components:
<identifier (ST)> ^ <text (ST)> ^ <name of coding system
(IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^
<name of alternate coding system (IS)>
Definition: This field contains a code that identifies the nation or national
grouping to which the insured person belongs. This information 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 the suggested values in User-defined
Table 0212 - Nationality.
Components:
<identifier (ST)> ^ <text (ST)> ^ <name of coding system
(IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^
<name of alternate coding system (IS)>
Definition: This field indicates the insured's ethnic group. Refer to
User-defined Table 0189 - Ethnic group for suggested values. The second
triplet of the CE data type for ethnic group (alternate identifier, alternate
text, and name of alternate coding system) is reserved for governmentally
assigned codes. In the US, a current use is to report ethnicity in line with US
federal standards for Hispanic origin.
Components:
<identifier (ST)> ^ <text (ST)> ^ <name of coding system
(IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^
<name of alternate coding system (IS)>
Definition: This field contains the insured's marital status. Refer to
User-defined Table 0002 - Marital status for suggested values.
Definition: This field indicates the date on which the insured's employment with a particular employer began.
Definition: This field indicates the date on which the person's employment with a particular employer ended.
Definition: This field contains a descriptive name for the insured's occupation (for example, Sr. Systems Analyst, Sr. Accountant).
Components:
<job code (IS)> ^ <job class (IS)>
Definition: This field indicates a code that identifies the insured's job code
(for example, programmer, analyst, doctor, etc.). Refer to User-defined
Tables 0327 - Job code and 0328 - Employee classification for
suggested values.
Definition: This field indicates a code that identifies the insured's current job status. Refer to User-defined Table 0311 - Job status for values.
Components:
In Version 2.3, replaces the PN data type. <family name (FN)> ^
<given name (ST)> ^ <second and further given names or initials
thereof (ST)> ^ <suffix (e.g., JR or III) (ST)> ^ <prefix (e.g.,
DR) (ST)> ^ <degree (e.g., MD) (IS)> ^ <name type code (ID)
> ^ <name representation code (ID)> ^ <name context (CE)> ^
<name validity range (DR)> ^ <name assembly order (ID)>
Subcomponents of family name: <family name (ST)> & <own family
name prefix (ST)> & <own family name (ST)> & <family name
prefix from partner/spouse (ST)> & <family name from partner/spouse
(ST)>
Definition: This field contains the name of the contact person that should be
contacted at the insured's place of employment. (Joe Smith is the insured. He
works at GTE. Contact Sue Jones at GTE regarding Joe Smith's policy).
Multiple names for the same person may be sent in this sequence. 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 for Sue Jones who is the
contact person at GTE (Joe Smith's place of employment). Joe Smith is the
insured. Multiple phone numbers for the same contact person may be sent in
this sequence, not multiple contacts. The primary telephone number is assumed
to be in the first repetition. When no primary telephone number is sent, a
repeat delimiter must be present for the first repetition.
Definition: This field contains the reason(s) that Sue Jones should be contacted on behalf of Joe Smith, a GTE employer. Refer to User-defined Table 0222 - Contact reason for suggested values.
Components:
In Version 2.3, replaces the PN data type. <family name (FN)> ^
<given name (ST)> ^ <second and further given names or initials
thereof (ST)> ^ <suffix (e.g., JR or III) (ST)> ^ <prefix (e.g.,
DR) (ST)> ^ <degree (e.g., MD) (IS)> ^ <name type code (ID)
> ^ <name representation code (ID)> ^ <name context (CE)> ^
<name validity range (DR)> ^ <name assembly order (ID)>
Subcomponents of family name: <family name (ST)> & <own family
name prefix (ST)> & <own family name (ST)> & <family name
prefix from partner/spouse (ST)> & <family name from partner/spouse
(ST)>
Definition: This field contains the contact person for the insured.
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 for the contact person
for the insured. Multiple phone numbers for the same person may be sent in
this contact, not multiple contacts. 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.
Definition: This field contains the reason(s) the person should be contacted regarding the insured. Refer to User-defined Table 0222 - Contact reason for suggested values
Definition: This field indicates the date on which the insured's patient relationship (defined in IN1-17 - insured's relationship to patient) became effective (began).
Definition: This field indicates the date after which the relationship (defined in IN1-17 - insured's relationship to patient) is no longer effective.
Definition:
This field contains a user-defined code that specifies how the contact should
be used. Refer to User-defined Table 0232 - Insurance company
contact reason for suggested values.
Value |
Description |
|---|---|
01 |
Medicare claim status |
02 |
Medicaid claim status |
03 |
Name/address change |
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 person who should
be contacted at the insurance company for questions regarding an insurance
policy/claim, etc. Multiple phone numbers for the insurance company 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.
Definition:
This field contains a user-defined code designating the extent of the coverage
for a participating member (e.g., "single," "family," etc. Refer to
User-defined Table 0312 - Policy scope for suggested values.
Value |
Description |
|---|---|
No suggested values defined |
Definition:
This user-defined field identifies how the policy information got established.
Refer to User-defined Table 0313 - Policy source for suggested values.
Value |
Description |
|---|---|
No suggested values defined |
Components:
<ID (ST)> ^ <check digit (ST)> ^ <code identifying the check
digit scheme employed (ID)> ^ < assigning authority (HD)> ^
<identifier type code (ID)> ^ < assigning facility (HD) ^
<effective date (DT)> ^ <expiration date (DT)>
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 an identifying number assigned by the payor
for each individual covered by the insurance policy issued to the insured. For
example, each individual family member may have a different member number from
the insurance policy number issued to the head of household. The assigning
authority and identifier type code are strongly recommended for all CX data
types.
Components:
<identifier (ST)> ^ <text (ST)> ^ <name of coding system
(IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^
<name of alternate coding system (IS)>
Definition: This field specifies the relationship of the guarantor to the
insurance subscriber. Refer to User-defined Table 0063 - Relationship
for suggested values.
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: The value of this field represents the insured's telephone number.
Multiple phone numbers may be sent in this sequence. The primary telephone
number is assumed to be in the first repetition (PRN - Primary, PH -
Telephone). When the primary telephone number 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: The value of this field represents the insured's employer's
telephone number. Multiple phone numbers 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.
Components:
<identifier (ST)> ^ <text (ST)> ^ <name of coding system
(IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^
<name of alternate coding system (IS)>
Definition: This field indicates the military program for the handicapped in
which the patient is enrolled. Refer to User-defined Table 0343 -
Military handicapped program code for suggested values.
Value |
Description |
|---|---|
No suggested values defined |
Definition:
This field indicates whether charges should be suspended for a patient. Refer
to HL7 table 0136 - Yes/no indicator for valid values.
Y charges should be suspended
N charges should NOT be suspended
Definition:
This field indicates if the patient has reached the co-pay limit so that no
more co-pay charges should be calculated for the patient. Refer to HL7
table 0136 - Yes/no indicator for valid values.
Y the patient is at or exceeds the co-pay limit
N the patient is under the co-pay limit
Definition:
This field indicates if the patient has reached the stoploss limit established
in the Contract Master. Refer to HL7 table 0136 - Yes/no indicator for
valid values.
Y the patient has reached the stoploss limit
N the patient has not reached the stoploss limit
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)> ^ <name representation code
(ID)>
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 indicates the name of the insured if the
insured/subscriber is an organization. Multiple names for the insured may be
sent in this sequence, not multiple insured people. 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:
<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)> ^ <name representation code
(ID)>
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 indicates the name of the insured's employer, or the
organization that purchased the insurance for the insured, if the employer is
an organization. Multiple names and identifiers for the same organization may
be sent in this field, not multiple organizations. 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:
<identifier (ST)> ^ <text (ST)> ^ <name of coding system
(IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^
<name of alternate coding system (IS)>
Definition: Refer to User-defined Table 0005 - Race for suggested
values. The second triplet of the CE data type for race (alternate identifier,
alternate text, and name of alternate coding system) is reserved for
governmentally assigned codes.
Components:
<identifier (ST)> ^ <text (ST)> ^ <name of coding system
(IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^
<name of alternate coding system (IS)>
Definition: This field indicates the relationship of the patient to the
insured, as defined by HCFA or other regulatory agencies. Refer to
User-defined Table 0344 - Patient's relationship to insured for
suggested values. The UB codes listed may not represent a complete list; refer
to a UB specification for additional information.
Value |
Description |
|---|---|
01 |
Patient is insured |
02 |
Spouse |
03 |
Natural child/insured financial responsibility |
04 |
Natural child/Insured does not have financial responsibility |
05 |
Step child |
06 |
Foster child |
07 |
Ward of the court |
08 |
Employee |
09 |
Unknown |
10 |
Handicapped dependent |
11 |
Organ donor |
12 |
Cadaver donor |
13 |
Grandchild |
14 |
Niece/nephew |
15 |
Injured plaintiff |
16 |
Sponsored dependent |
17 |
Minor dependent of a minor dependent |
18 |
Parent |
19 |
Grandparent |
The
IN3 segment contains additional insurance information for certifying the need
for patient care. Fields used by this segment are defined by HCFA, or other
regulatory agencies.
SEQ |
LEN |
DT |
OPT |
RP/# |
TBL# |
ITEM# |
ELEMENT NAME |
|---|---|---|---|---|---|---|---|
1 |
4 |
SI |
R |
00502 |
Set ID - IN3 |
||
2 |
250 |
CX |
O |
00503 |
Certification Number |
||
3 |
250 |
XCN |
O |
Y |
00504 |
Certified By |
|
4 |
1 |
ID |
O |
0136 |
00505 |
Certification Required |
|
5 |
10 |
CM |
O |
0148 |
00506 |
Penalty |
|
6 |
26 |
TS |
O |
00507 |
Certification Date/Time |
||
7 |
26 |
TS |
O |
00508 |
Certification Modify Date/Time |
||
8 |
250 |
XCN |
O |
Y |
00509 |
Operator |
|
9 |
8 |
DT |
O |
00510 |
Certification Begin Date |
||
10 |
8 |
DT |
O |
00511 |
Certification End Date |
||
11 |
3 |
CM |
O |
0149 |
00512 |
Days |
|
12 |
250 |
CE |
O |
0233 |
00513 |
Non-Concur Code/Description |
|
13 |
26 |
TS |
O |
00514 |
Non-Concur Effective Date/Time |
||
14 |
250 |
XCN |
O |
Y |
0010 |
00515 |
Physician Reviewer |
15 |
48 |
ST |
O |
00516 |
Certification Contact |
||
16 |
250 |
XTN |
O |
Y |
00517 |
Certification Contact Phone Number |
|
17 |
250 |
CE |
O |
0345 |
00518 |
Appeal Reason |
|
18 |
250 |
CE |
O |
0346 |
00519 |
Certification Agency |
|
19 |
250 |
XTN |
O |
Y |
00520 |
Certification Agency Phone Number |
|
20 |
40 |
CM |
O |
Y |
0150/ 0136 |
00521 |
Pre-Certification Req/Window |
21 |
48 |
ST |
O |
00522 |
Case Manager |
||
22 |
8 |
DT |
O |
00523 |
Second Opinion Date |
||
23 |
1 |
IS |
O |
0151 |
00524 |
Second Opinion Status |
|
24 |
1 |
IS |
O |
Y |
0152 |
00525 |
Second Opinion Documentation Received |
25 |
250 |
XCN |
O |
Y |
0010 |
00526 |
Second Opinion Physician |
Definition: IN3-1 - Set ID - IN3 contains the number that identifies this transaction. For the first occurrence of the segment the sequence number shall be 1, for the second occurrence it shall be 2, etc. The set ID in the IN3 segment is used when there are multiple certifications for the insurance plan identified in IN1-2.
Components:
<ID (ST)> ^ <check digit (ST)> ^ <code identifying the check
digit scheme employed (ID)> ^ < assigning authority (HD)> ^
<identifier type code (ID)> ^ < assigning facility (HD) ^
<effective date (DT)> ^ <expiration date (DT)>
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 number assigned by the certification
agency. The assigning authority and identifier type code are strongly
recommended for all CX data types.
Components:
<ID number (ST)> ^ <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) (IS)> ^ <source
table (IS)> ^ <assigning authority (HD)> ^ <name type code(ID)>
^ <identifier check digit (ST)> ^ <code identifying the check digit
scheme employed (ID)> ^ <identifier type code (IS)> ^ <assigning
facility (HD)>^ <name representation code (ID)> ^ <name context
(CE)> ^ <name validity range (DR)>
Subcomponents of family name: <family name (ST)> & <own family
name prefix (ST)> & <own family name (ST)> & <family name
prefix from partner/spouse (ST)> & <family name from partner/spouse
(ST)>
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 party that approved the certification.
Multiple names and identifiers for the same person may be sent in this
sequence. 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.
Definition: This field indicates whether certification is required. Refer to HL7 table 0136 - Yes/no indicator for valid values.
Components:
<penalty type (IS)> ^ <penalty amount (NM)>
Definition: This field contains the penalty, in dollars or a percentage that
will be assessed if the pre-certification is not performed. Refer to
User-defined Table 0148 - Penalty type for suggested values.
Value |
Description |
|---|---|
AT |
Currency amount |
PC |
Percentage |
Definition: This field contains the date and time stamp that indicates when insurance was certified to exist for the patient.
Definition: This field contains the date/time that the certification was modified.
Components:
<ID number (ST)> ^ <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) (IS)> ^ <source
table (IS)> ^ <assigning authority (HD)> ^ <name type code(ID)>
^ <identifier check digit (ST)> ^ <code identifying the check digit
scheme employed (ID)> ^ <identifier type code (IS)> ^ <assigning
facility (HD)>^ <name representation code (ID)> ^ <name context
(CE)> ^ <name validity range (DR)>
Subcomponents of family name: <family name (ST)> & <own family
name prefix (ST)> & <own family name (ST)> & <family name
prefix from partner/spouse (ST)> & <family name from partner/spouse
(ST)>
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 party who is responsible for sending
this certification information. Multiple names for the same person may be sent
in this sequence. 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.
Definition: This field contains the date that this certification begins.
Definition: This field contains date that this certification ends.
Components:
<day type (IS)> ^ <number of days (NM)>
Definition: This field contains the number of days for which this
certification is valid. This field applies to denied, pending, or approved
days. Refer to User-defined Table 0149 - Day type for suggested values.
Value |
Description |
|---|---|
AP |
Approved |
DE |
Denied |
PE |
Pending |
Components:
<identifier (ST)> ^ <text (ST)> ^ <name of coding system
(IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^
<name of alternate coding system (IS)>
Definition: This field contains the non-concur code and description for a
denied request. Refer to User-defined Table 0233 - Non-concur
code/description for suggested values.
Value |
Description |
|---|---|
No suggested values defined |
Definition: This field contains the effective date of the non-concurrence classification.
Components:
<ID number (ST)> ^ <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) (IS)> ^ <source
table (IS)> ^ <assigning authority (HD)> ^ <name type code(ID)>
^ <identifier check digit (ST)> ^ <code identifying the check digit
scheme employed (ID)> ^ <identifier type code (IS)> ^ <assigning
facility (HD)>^ <name representation code (ID)> ^ <name context
(CE)> ^ <name validity range (DR)>
Subcomponents of family name: <family name (ST)> & <own family
name prefix (ST)> & <own family name (ST)> & <family name
prefix from partner/spouse (ST)> & <family name from partner/spouse
(ST)>
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 physician who works with and reviews cases
that are pending physician review for the certification agency. Multiple names
for the same person may be sent in this sequence. 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. Refer to
User-defined Table 0010 - Physician ID for suggested values.
Definition: This field contains the name of the party contacted at the certification agency who granted the certification and communicated the certification number.
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 phone number of the certification contact.
Multiple phone numbers for the same certification contact may be sent in this
sequence. The primary phone 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.
Components:
<identifier (ST)> ^ <text (ST)> ^ <name of coding system
(IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^
<name of alternate coding system (IS)>
Definition: This field contains the reason that an appeal was made on a
non-concur for certification. Refer to User-defined Table 0345 -
Appeal reason for suggested values.
Value |
Description |
|---|---|
No suggested values defined |
Components:
<identifier (ST)> ^ <text (ST)> ^ <name of coding system
(IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^
<name of alternate coding system (IS)>
Definition: This field contains the certification agency. Refer to
User-defined Table 0346 - Certification agency for suggested values.
Value |
Description |
|---|---|
No suggested values defined |
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 phone number of the certification agency.
Components:
<pre-certification patient type (IS)> ^ <pre-certification required
(ID)> ^ <pre-certification window (TS)>
Definition: This field indicates whether pre-certification is required for
particular patient types, and the time window for obtaining the certification.
The following components of this field are defined as follows:
* pre-certification patient type refers to User-defined Table 0150 -
Pre-certification patient type for suggested values
* pre-certification required refers to HL7 table 0136 - Yes/no indicator
for valid values
* pre-certification window is the amount of time required to attain
certification from arrival at the institution. Its format follows the time
stamp (TS) data type rules.
Value |
Description |
|---|---|
ER |
Emergency |
IPE |
Inpatient elective |
OPE |
Outpatient elective |
UR |
Urgent |
Definition: This field contains the name of the entity which is handling this particular patient's case (e.g., UR nurse, or a specific healthcare facility location).
Definition: This field contains the date that the second opinion was obtained.
Definition:
This field contains the code that represents the status of the second opinion.
Refer to User-defined Table 0151 - Second opinion status for suggested
values.
Value |
Description |
|---|---|
No suggested values defined |
Definition:
Use this field if accompanying documentation has been received by the
provider. Refer to User-defined Table 0152 - Second opinion documentation
received for suggested values.
Value |
Description |
|---|---|
No suggested values defined |
Components:
<ID number (ST)> ^ <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) (IS)> ^ <source
table (IS)> ^ <assigning authority (HD)> ^ <name type code(ID)>
^ <identifier check digit (ST)> ^ <code identifying the check digit
scheme employed (ID)> ^ <identifier type code (IS)> ^ <assigning
facility (HD)>^ <name representation code (ID)> ^ <name context
(CE)> ^ <name validity range (DR)>
Subcomponents of family name: <family name (ST)> & <own family
name prefix (ST)> & <own family name (ST)> & <family name
prefix from partner/spouse (ST)> & <family name from partner/spouse
(ST)>
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 an identifier and name of the physician who
provided the second opinion. Multiple names and identifiers for the same person
may be sent in this sequence. 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. Refer to User-defined Table 0010 -
Physician ID for suggested
values.
The
ACC segment contains patient information relative to an accident in which the
patient has been involved.
SEQ |
LEN |
DT |
OPT |
RP/# |
TBL# |
ITEM# |
ELEMENT NAME |
|---|---|---|---|---|---|---|---|
1 |
26 |
TS |
O |
00527 |
Accident Date/Time |
||
2 |
250 |
CE |
O |
0050 |
00528 |
Accident Code |
|
3 |
25 |
ST |
O |
00529 |
Accident Location |
||
4 |
250 |
CE |
O |
0347 |
00812 |
Auto Accident State |
|
5 |
1 |
ID |
O |
0136 |
00813 |
Accident Job Related Indicator |
|
6 |
12 |
ID |
O |
0136 |
00814 |
Accident Death Indicator |
|
7 |
250 |
XCN |
O |
00224 |
Entered By |
||
8 |
25 |
ST |
O |
01503 |
Accident Description |
||
9 |
80 |
ST |
O |
01504 |
Brought In By |
||
10 |
1 |
ID |
O |
0136 |
01505 |
Police Notified Indicator |
Definition: This field contains the date/time of the accident.
Components:
<identifier (ST)> ^ <text (ST)> ^ <name of coding system
(IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^
<name of alternate coding system (IS)>
Definition: This field contains the type of accident. Refer to
User-defined Table 0050 - Accident code for suggested values. ICD
accident codes are recommended.
Value |
Description |
|---|---|
No suggested values defined |
Definition: This field contains the location of the accident.
Components:
<identifier (ST)> ^ <text (ST)> ^ <name of coding system
(IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^
<name of alternate coding system (IS)>
Definition: This field specifies the state in which the auto accident
occurred. (HCFA 1500 requirement in the US.) Refer to User-defined
Table 0347 - Auto accident state for suggested values.
Value |
Description |
|---|---|
No suggested values defined |
Definition:
This field indicates if the accident was related to a job. Refer to HL7
table 0136 - Yes/no indicator for valid values.
Y the accident was job related
N the accident was not job related
Definition:
This field indicates whether or not a patient has died as a result of an
accident. Refer to HL7 table 0136 - Yes/no indicator for valid
values.
Y the patient has died as a result of an accident
N the patient has not died as a result of an accident
Components:
<ID number (ST)> ^ <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)> ^ <source
table (IS)> ^ <assigning authority (HD)> ^ <name type code (ID)>
^ <identifier check digit (ST)> ^ <code identifying the check digit
scheme employed (ID)> ^ <identifier type code (IS)> ^ <assigning
facility (HD)> ^ <name context (CE)> ^ <name validity range
(DR)>
Subcomponents of family name: <family name (ST)> & <own family
name prefix (ST)> & <own family name (ST)> & <family name
prefix from partner/spouse (ST)> & <family name from partner/spouse
(ST)>
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 identifies the person entering the accident information.
Definition: Description of the accident.
Definition: This field identifies the person or organization that brought in the patient.
Definition:
This field indicates if the police were notified. Refer to HL7 Table 0136
- Yes/No indicator for valid values.
"Y" the police were notified
"N" the police were not notified.
The
UB1 segment contains the data necessary to complete UB82 bills. Only UB82
fields that do not exist in other HL7 defined segments appear in this segment.
Patient Name and Date of Birth are required for UB82 billing; however, they are
included in the PID segment and therefore do not appear here. The UB codes
listed as examples are not an exhaustive or current list. Refer to a UB
specification for additional information.
The Uniform Billing segments are specific to the US and may not be
implemented in non-US systems.
SEQ |
LEN |
DT |
OPT |
RP/# |
TBL# |
ITEM# |
ELEMENT NAME |
|---|---|---|---|---|---|---|---|
1 |
4 |
SI |
O |
00530 |
Set ID - UB1 |
||
2 |
1 |
NM |
B |
00531 |
Blood Deductible (43) |
||
3 |
2 |
NM |
O |
00532 |
Blood Furnished-Pints Of (40) |
||
4 |
2 |
NM |
O |
00533 |
Blood Replaced-Pints (41) |
||
5 |
2 |
NM |
O |
00534 |
Blood Not Replaced-Pints(42) |
||
6 |
2 |
NM |
O |
00535 |
Co-Insurance Days (25) |
||
7 |
14 |
IS |
O |
Y/5 |
0043 |
00536 |
Condition Code (35-39) |
8 |
3 |
NM |
O |
00537 |
Covered Days - (23) |
||
9 |
3 |
NM |
O |
00538 |
Non Covered Days - (24) |
||
10 |
12 |
CM |
O |
Y/8 |
0153 |
00539 |
Value Amount & Code (46-49) |
11 |
2 |
NM |
O |
00540 |
Number Of Grace Days (90) |
||
12 |
250 |
CE |
O |
0348 |
00541 |
Special Program Indicator (44) |
|
13 |
250 |
CE |
O |
0349 |
00542 |
PSRO/UR Approval Indicator (87) |
|
14 |
8 |
DT |
O |
00543 |
PSRO/UR Approved Stay-Fm (88) |
||
15 |
8 |
DT |
O |
00544 |
PSRO/UR Approved Stay-To (89) |
||
16 |
20 |
CM |
O |
Y/5 |
0350 |
00545 |
Occurrence (28-32) |
17 |
250 |
CE |
O |
0351 |
00546 |
Occurrence Span (33) |
|
18 |
8 |
DT |
O |
00547 |
Occur Span Start Date(33) |
||
19 |
8 |
DT |
O |
00548 |
Occur Span End Date (33) |
||
20 |
30 |
ST |
B |
00549 |
UB-82 Locator 2 |
||
21 |
7 |
ST |
B |
00550 |
UB-82 Locator 9 |
||
22 |
8 |
ST |
B |
00551 |
UB-82 Locator 27 |
||
23 |
17 |
ST |
B |
00552 |
UB-82 Locator 45 |
Definition: This field contains the number that identifies this transaction. For the first occurrence of the segment the sequence number shall be 1, for the second occurrence it shall be 2, etc.
Definition: This field has been retained for backward compatibility only. Use IN2-21 - blood deductible instead of this field, as the blood deductible can be associated with the specific insurance plan via that segment. This field is defined by HCFA or other regulatory agencies.
Definition: This field identifies the amount of blood furnished to the patient for this visit. The (40) indicates the corresponding UB82 field number. This field is defined by HCFA or other regulatory agencies.
Definition: This field contains UB82 Field 41. This field is defined by HCFA or other regulatory agencies.
Definition: This field contains the blood not replaced, as measured in pints. UB82 Field 42. This field is defined by HCFA or other regulatory agencies.
Definition: This field contains UB82 Field 25. This field is defined by HCFA or other regulatory agencies.
Definition:
The code in this field repeats five times. UB82 Fields (35), (36), (37),
(38), and (39). Refer to User-defined Table 0043 - Condition code for
suggested values. The UB codes listed as examples are not an exhaustive or
current list; refer to a UB specification for additional information. This
field is defined by HCFA or other regulatory agencies.
Value |
Description |
|---|---|
01 |
Military service related |
02 |
Condition is employment related |
03 |
Patient covered by insurance not reflected here |
04 |
HMO enrollee |
05 |
Lien has been filed |
06 |
ESRD patient in first 18 months of entitlement covered by employer group health insurance |
07 |
Treatment of non-terminal condition for hospice patient |
08 |
Beneficiary would not provide information concerning other insurance coverage |
09 |
Neither patient nor spouse is employed |
10 |
Patient and/or spouse is employed but no EGHP exists |
11 |
Disabled beneficiary but no LGHP |
12 ... 16 |
Payer codes. |
18 |
Maiden name retained |
19 |
Child retains mother's name |
20 |
Beneficiary requested billing |
21 |
Billing for Denial Notice |
26 |
VA eligible patient chooses to receive services in a Medicare certified facility |
27 |
Patient referred to a sole community hospital for a diagnostic laboratory test |
28 |
Patient and/or spouse's EGHP is secondary to Medicare |
29 |
Disabled beneficiary and/or family member's LGHP is secondary to Medicare |
31 |
Patient is student (full time-day) |
32 |
Patient is student (cooperative/work study program) |
33 |
Patient is student (full time-night) |
34 |
Patient is student (Part time) |
36 |
General care patient in a special unit |
37 |
Ward accommodation as patient request |
38 |
Semi-private room not available |
39 |
Private room medically necessary |
40 |
Same day transfer |
41 |
Partial hospitalization |
46 |
Non-availability statement on file |
48 |
Psychiatric residential treatment centers for children and adolescents |
55 |
SNF bed not available |
56 |
Medical appropriateness |
57 |
SNF readmission |
60 |
Day outlier |
61 |
Cost outlier |
62 |
Payer code |
66 |
Provider does not wish cost outlier payment |
67 |
Beneficiary elects not to use life time reserve (LTR) days |
68 |
Beneficiary elects to use life time reserve (LTR) days |
70 |
Self-administered EPO |
71 |
Full care in unit |
72 |
Self-care in unit |
73 |
Self-care training |
74 |
Home |
75 |
Home - 100% reimbursement |
76 |
Back-up in facility dialysis |
77 |
Provider accepts or is obligated/required due to a contractual arrangement or law to accept payment by a primary payer as payment in full |
78 |
New coverage not implemented by HMO |
79 |
Corf services provided off-site |
80 |
Pregnant |
Definition: This field contains UB82 Field 23. This field is defined by HCFA or other regulatory agencies.
Definition: This field contains UB82 Field 24. This field is defined by HCFA or other regulatory agencies.
Components:
<value code (IS)> ^ <value amount (NM)>
Definition: The pair in this field can repeat up to eight times (46A, 47A,
48A, 49A, 46B, 47B, 48B, and 49B). Refer to User-defined Table 0153 - Value
code for suggested values. The UB codes listed as examples are not an
exhaustive or current list; refer to a UB specification for additional
information. This field is defined by HCFA or other regulatory agencies.
Value |
Description |
|---|---|
01 |
Most common semi-private rate |
02 |
Hospital has no semi-private rooms |
04 |
Inpatient professional component charges which are combined billed |
05 |
Professional component included in charges and also billed separate to carrier |
06 |
Medicare blood deductible |
08 |
Medicare life time reserve amount in the first calendar year |
09 |
Medicare co-insurance amount in the first calendar year |
10 |
Lifetime reserve amount in the second calendar year |
11 |
Co-insurance amount in the second calendar year |
12 |
Working aged beneficiary/spouse with employer group health plan |
13 |
ESRD beneficiary in a Medicare coordination period with an employer group health plan |
14 |
No Fault including auto/other |
15 |
Worker's Compensation |
16 |
PHS, or other federal agency |
17 |
Payer code |
21 |
Catastrophic |
22 |
Surplus |
23 |
Recurring monthly incode |
24 |
Medicaid rate code |
30 |
Pre-admission testing |
31 |
Patient liability amount |
37 |
Pints of blood furnished |
38 |
Blood deductible pints |
39 |
Pints of blood replaced |
40 |
New coverage not implemented by HMO (for inpatient service only) |
41 |
Black lung |
42 |
VA |
43 |
Disabled beneficiary under age 64 with LGHP |
44 |
Amount provider agreed to accept from primary payer when this amount is less than charges but higher than payment received,, then a Medicare secondary payment is due |
45 |
Accident hour |
46 |
Number of grace days |
47 |
Any liability insurance |
48 |
Hemoglobin reading |
49 |
Hematocrit reading |
50 |
Physical therapy visits |
51 |
Occupational therapy visits |
52 |
Speech therapy visits |
53 |
Cardiac rehab visits |
56 |
Skilled nurse - home visit hours |
57 |
Home health aide - home visit hours |
58 |
Arterial blood gas |
59 |
Oxygen saturation |
60 |
HHA branch MSA |
67 |
Peritoneal dialysis |
68 |
EPO-drug |
70 ... 72 |
Payer codes |
75 ... 79 |
Payer codes |
80 |
Psychiatric visits |
81 |
Visits subject to co-payment |
A1 |
Deductible payer A |
A2 |
Coinsurance payer A |
A3 |
Estimated responsibility payer A |
X0 |
Service excluded on primary policy |
X4 |
Supplemental coverage |
Definition: This field contains UB82 Field 90. This field is defined by HCFA or other regulatory agencies.
Components:
<identifier (ST)> ^ <text (ST)> ^ <name of coding system
(IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^
<name of alternate coding system (IS)>
Definition: This field contains the special program indicator. UB82 Field 44.
This field is defined by HCFA or other regulatory agencies. Refer to
User-defined Table 0348 - Special program indicator for suggested
values. The UB codes listed as examples are not an exhaustive or current list;
refer to a UB specification for additional information
Value |
Description |
|---|---|
01 |
EPSDT-CHAP |
02 |
Physically handicapped children's program |
03 |
Special federal funding |
04 |
Family planning |
05 |
Disability |
06 |
PPV/Medicare 100% payment |
07 |
Induced abortion-danger to life |
08 |
Induced abortion victim rape/incest |
Components:
<identifier (ST)> ^ <text (ST)> ^ <name of coding system
(IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^
<name of alternate coding system (IS)>
Definition: This field contains the PSRO/UR approval indicator. UB82 field
87. This field is defined by HCFA or other regulatory agencies. Refer to
User-defined Table 0349 - PSRO/UR approval indicator for suggested
values. The UB codes listed as examples are not an exhaustive or current list;
refer to a UB specification for additional information.
Value |
Description |
|---|---|
1 |
Approved by the PSRO/UR as billed |
2 |
Automatic approval as billed based on focused review |
3 |
Partial approval |
4 |
Admission denied |
5 |
Postpayment review applicable |
Definition: This field contains the PSRO/UR approved stay date (from). UB82 Field 88. This field is defined by HCFA or other regulatory agencies.
Definition: This field contains the PSRO/UR approved stay date (to). UB82 Field 89. This field is defined by HCFA or other regulatory agencies.
Components:
<occurrence code (IS)> ^ <occurrence date (DT)>
Definition: The set of values in this field can repeat up to five times. UB82
Fields 28-32. This field is defined by HCFA or other regulatory agencies.
Refer to User-defined Table 0350 - Occurrence code (see UB2-7) for
suggested values. Refer to a UB specification for additional information.
Components:
<identifier (ST)> ^ <text (ST)> ^ <name of coding system
(IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^
<name of alternate coding system (IS)>
Definition: UB82 Field 33. This field is defined by HCFA or other regulatory
agencies. Refer to User-defined Table 0351 - Occurrence span in
UB2-8 for suggested values. The UB codes listed as examples are not an
exhaustive or current list; refer to a UB specification for additional
information.
Definition: This field contains the occurrence span start date. UB82 Field 33. This field is defined by HCFA or other regulatory agencies.
Definition: This field contains the occurrence span end date. UB82 Field 33. This field is defined by HCFA or other regulatory agencies.
Definition: Defined by UB-82 HCFA specification and maintained for backward-compatibility.
Definition: Defined by UB-82 HCFA specification and maintained for backward-compatibility.
Definition: Defined by UB-82 HCFA specification and maintained for backward-compatibility.
Definition: Defined by UB-82 HCFA specification and maintained for backward-compatibility.
The
UB2 segment contains data necessary to complete UB92 bills. Only UB82 and
UB92 fields that do not exist in other HL7 defined segments appear in this
segment. Just as with the UB82 billing, Patient Name and Date of Birth are
required; they are included in the PID segment and therefore do not appear
here. When the field locators are different on the UB92, as compared to the
UB82, the element is listed with its new location in parentheses ( ). The UB
codes listed as examples are not an exhaustive or current list; refer to a UB
specification for additional information.
The Uniform Billing segments are specific to the US and may not be
implemented in non-US systems.
SEQ |
LEN |
DT |
OPT |
RP/# |
TBL# |
ITEM# |
ELEMENT NAME |
|---|---|---|---|---|---|---|---|
1 |
4 |
SI |
O |
00553 |
Set ID - UB2 |
||
2 |
3 |
ST |
O |
00554 |
Co-Insurance Days (9) |
||
3 |
2 |
IS |
O |
Y/7 |
0043 |
00555 |
Condition Code (24-30) |
4 |
3 |
ST |
O |
00556 |
Covered Days (7) |
||
5 |
4 |
ST |
O |
00557 |
Non-Covered Days (8) |
||
6 |
11 |
CM |
O |
Y/12 |
0153 |
00558 |
Value Amount & Code |
7 |
11 |
CM |
O |
Y/8 |
0350 |
00559 |
Occurrence Code & Date (32-35) |
8 |
28 |
CM |
O |
Y/2 |
0351 |
00560 |
Occurrence Span Code/Dates (36) |
9 |
29 |
ST |
O |
Y/2 |
00561 |
UB92 Locator 2 (State) |
|
10 |
12 |
ST |
O |
Y/2 |
00562 |
UB92 Locator 11 (State) |
|
11 |
5 |
ST |
O |
00563 |
UB92 Locator 31 (National) |
||
12 |
23 |
ST |
O |
Y/3 |
00564 |
Document Control Number |
|
13 |
4 |
ST |
O |
Y/23 |
00565 |
UB92 Locator 49 (National) |
|
14 |
14 |
ST |
O |
Y/5 |
00566 |
UB92 Locator 56 (State) |
|
15 |
27 |
ST |
O |
00567 |
UB92 Locator 57 (National) |
||
16 |
2 |
ST |
O |
Y/2 |
00568 |
UB92 Locator 78 (State) |
|
17 |
3 |
NM |
O |
00815 |
Special Visit Count |
Definition: This field contains the number that identifies this transaction. For the first occurrence of the segment the sequence number shall be 1, for the second occurrence it shall be 2, etc.
Definition: This field contains UB92 field 9. This field is defined by HCFA or other regulatory agencies.
Definition: The code in this field can repeat up to seven times. UB92 fields 24-30. Refer to User-defined Table 0043 - Condition code for suggested values. The UB codes listed as examples are not an exhaustive or current list; refer to a UB specification for additional information. This field is defined by HCFA or other regulatory agencies.
Definition: This field contains UB92 field 7. This field is defined by HCFA or other regulatory agencies.
Definition: This field contains UB92 field 8. This field is defined by HCFA or other regulatory agencies.
Components:
<value code (IS)> ^ <value amount (NM)>
Definition: The pair in this field can repeat up to twelve times. UB92 fields
39a, 39b, 39c, 39d, 40a, 40b, 40c, 40d, 41a, 41b, 41c, and 41d. Refer to
User-defined Table 0153 - Value code for suggested values. The UB codes
listed as examples are not an exhaustive or current list; refer to a UB
specification for additional information. This field is defined by HCFA or
other regulatory agencies.
Components:
<occurrence code (CE) > ^ <occurrence date (DT)>
Subcomponents of occurrence code: <identifier(ST)> & <name of
coding system (IS)> & <alternate identifier (ST)> &
<alternate text (ST)> & <name of alternate coding system
(ST)>
Definition: The set of values in this field can repeat up to eight times.
UB92 fields 32a, 32b, 33a, 33b, 34a, 34b, 35a, and 35b. This field is defined
by HCFA or other regulatory agencies. Refer to User-defined Table 0350 -
Occurrence code for suggested values. The UB codes listed as examples are
not an exhaustive or current list; refer to a UB specification for additional
information.
Value |
Description |
|---|---|
01 |
Auto accident |
02 |
No fault insurance involved-including auto accident/other |
03 |
Accident/tort liability |
04 |
Accident/employment related |
05 |
Other accident |
06 |
Crime victim |
09 |
Start of infertility treatment cycle |
10 |
Last menstrual period |
11 |
Onset of symptoms/illness |
12 |
Date of onset for a chronically dependent individual |
17 |
Date outpatient occupational therapy plan established or last reviewed |
18 |
Date of retirement patient/beneficiary |
19 |
Date of retirement spouse |
20 |
Guarantee of payment began |
21 |
UR notice received |
22 |
Date active care ended |
24 |
Date insurance denied |
25 |
Date benefits terminated by primary payor |
26 |
Date SNF bed available |
27 |
Date home health plan established |
28 |
Spouse's date of birth |
29 |
Date outpatient physical therapy plan established or last reviewed |
30 |
Date outpatient speech pathology plan established or last reviewed |
31 |
Date beneficiary notified of intent to bill (accommodations) |
32 |
Date beneficiary notified of intent to bill (procedures or treatments) |
33 |
First day of the Medicare coordination period for ESRD beneficiaries covered by EGHP |
34 |
Date of election of extended care facilities |
35 |
Date treatment started for P.T. |
36 |
Date of inpatient hospital discharge for covered transplant patients |
37 |
Date of inpatient hospital discharge for non-covered transplant patient |
40 |
Scheduled date of admission |
41 |
Date of first test for pre-admission testing |
42 |
Date of discharge |
43 |
Scheduled date of canceled surgery |
44 |
Date treatment started for O.T. |
45 |
Date treatment started for S.T. |
46 |
Date treatment started for cardiac rehab. |
47 ... 49 |
Payer codes |
50 |
Date lien released |
51 |
Date treatment started for psychiatric care |
70 ... 99 |
Occurrence span codes and dates |
A1 |
Birthdate - insured A |
A2 |
Effective date - insured A policy |
A3 |
Benefits exhausted payer A |
Components:
<occurrence span code (CE)> ^ <occurrence span start date (DT)> ^
<occurrence span stop date (DT)>
Subcomponents of occurrence span code: <identifier(ST)> &
<name of coding system (IS)> & <alternate identifier (ST)>
& <alternate text (ST)> & <name of alternate coding system
(ST)>
Definition: This field can repeat up to two times. UB92 field 36a, 36b. This
field is defined by HCFA or other regulatory agencies. Refer to
User-defined Table 0351 - Occurrence span for suggested values. The
UB codes listed as examples are not an exhaustive or current list; refer to a
UB specification for additional information.
Value |
Description |
|---|---|
70 |
Qualifying stay dates for SNF |
71 |
Prior stay dates |
72 |
First/last visit |
73 |
Benefit eligibility period |
74 |
Non-covered level of care |
75 |
SNF level of care |
76 |
Patient liability |
77 |
Provider liability period |
78 |
SNF prior stay dates |
79 |
Payer code |
M0 |
PSRO/UR approved stay dates |
Definition: The value in this field may repeat up to two times.
Definition: The value in this field may repeat up to two times.
Definition: Defined by HCFA or other regulatory agencies.
Definition: This field contains the number assigned by payor that is used for rebilling/adjustment purposes. It may repeat up to three times. Refer UB92 field 37
Definition: This field is defined by HCFA or other regulatory agencies. This field may repeat up to twenty-three times.
Definition: This field may repeat up to five times.
Definition: Defined by UB-92 HCFA specification.
Definition: This field may repeat up to two times.
Definition: This field contains the total number of special therapy visits.
This
segment was created to communicate patient abstract information used for
billing and reimbursement purposes. "Abstract" is a condensed form of medical
history created for analysis, care planning, etc.
SEQ |
LEN |
DT |
OPT |
RP/# |
TBL# |
ITEM# |
ELEMENT NAME |
|---|---|---|---|---|---|---|---|
1 |
250 |
XCN |
O |
0010 |
01514 |
Discharge Care Provider |
|
2 |
250 |
CE |
O |
0069 |
01515 |
Transfer Medical Service Code |
|
3 |
250 |
CE |
O |
0421 |
01516 |
Severity of Illness Code |
|
4 |
26 |
TS |
O |
01517 |
Date/Time of Attestation |
||
5 |
250 |
XCN |
O |
01518 |
Attested By |
||
6 |
250 |
CE |
O |
0422 |
01519 |
Triage Code |
|
7 |
26 |
TS |
O |
01520 |
Abstract Completion Date/Time |
||
8 |
250 |
XCN |
O |
01521 |
Abstracted By |
||
9 |
250 |
CE |
O |
0423 |
01522 |
Case Category Code |
|
10 |
1 |
ID |
O |
0136 |
01523 |
Caesarian Section Indicator |
|
11 |
250 |
CE |
O |
0424 |
01524 |
Gestation Category Code |
|
12 |
3 |
NM |
O |
01525 |
Gestation Period - Weeks |
||
13 |
250 |
CE |
O |
0425 |
01526 |
Newborn Code |
|
14 |
1 |
ID |
O |
0136 |
01527 |
Stillborn Indicator |
Components:
<ID number (ST)> ^ <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) (IS)> ^ <source
table (IS)> ^ <assigning authority (HD)> ^ <name type code(ID)>
^ <identifier check digit (ST)> ^ <code identifying the check digit
scheme employed (ID)> ^ <identifier type code (IS)> ^ <assigning
facility (HD)>^ <name representation code (ID)> ^ <name context
(CE)> ^ <name validity range (DR)>
Subcomponents of family name: <family name (ST)> & <own family
name prefix (ST)> & <own family name (ST)> & <family name
prefix from partner/spouse (ST)> & <family name from partner/spouse
(ST)>
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: Identification number of the provider responsible for the discharge
of the patient from his/her care. Refer to User-defined Table 0010 -
Physician ID for suggested values.
Components:
<identifier (ST)> ^ <text (ST)> ^ <name of coding system
(IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^
<name of alternate coding system (IS)>
Definition: Medical code representing the patient's medical services when they
are transferred. Refer to User-defined Table 0069 - Hospital service
for suggested values
Values |
Description |
|---|---|
MED |
Medical Service |
SUR |
Surgical Service |
URO |
Urology Service |
PUL |
Pulmonary Service |
CAR |
Cardiac Service |
Components:
<identifier (ST)> ^ <text (ST)> ^ <name of coding system
(IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^
<name of alternate coding system (IS)>
Definition: Code representing the ranking of a patient's illness. Refer to
User-defined Table 0421 - Severity of ill
ness
code for suggested values.
Values |
Description |
|---|---|
MI |
Mild |
MO |
Moderate |
SE |
Severe |
Definition: Date/time that the medical record was reviewed and accepted.
Components:
<ID number (ST)> ^ <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) (IS)> ^ <source
table (IS)> ^ <assigning authority (HD)> ^ <name type code(ID)>
^ <identifier check digit (ST)> ^ <code identifying the check digit
scheme employed (ID)> ^ <identifier type code (IS)> ^ <assigning
facility (HD)>^ <name representation code (ID)> ^ <name context
(CE)> ^ <name validity range (DR)>
Subcomponents of family name: <family name (ST)> & <own family
name prefix (ST)> & <own family name (ST)> & <family name
prefix from partner/spouse (ST)> & <family name from partner/spouse
(ST)>
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: Identification number of the person (usually a provider) who
reviewed and accepted the abstract of the medical record.
Components:
<identifier (ST)> ^ <text (ST)> ^ <name of coding system
(IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^
<name of alternate coding system (IS)>
Definition: Code representing a patient's prioritization within the context of
this abstract. Refer to User-defined Table 0422 - Triage code for
suggested values.
Values |
Description |
|---|---|
1 |
Non-acute |
2 |
Acute |
3 |
Urgent |
4 |
Severe |
5 |
Dead on Arrival (DOA) |
99 |
Other |
Definition: Date/time the abstraction was completed.
Components:
<ID number (ST)> ^ <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) (IS)> ^ <source
table (IS)> ^ <assigning authority (HD)> ^ <name type code(ID)>
^ <identifier check digit (ST)> ^ <code identifying the check digit
scheme employed (ID)> ^ <identifier type code (IS)> ^ <assigning
facility (HD)>^ <name representation code (ID)> ^ <name context
(CE)> ^ <name validity range (DR)>
Subcomponents of family name: <family name (ST)> & <own family
name prefix (ST)> & <own family name (ST)> & <family name
prefix from partner/spouse (ST)> & <family name from partner/spouse
(ST)>
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: Identification number of the person completing the Abstract.
Components:
<identifier (ST)> ^ <text (ST)> ^ <name of coding system
(IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^
<name of alternate coding system (IS)>
Definition: Code indicating the reason a non- urgent patient presents to the
Emergency Room for treatment instead of a clinic or physician office. Refer to
User-defined
Table 0423 - Case category code for suggested values.
Values |
Description |
|---|---|
D |
Doctor's Office Closed |
Definition:
Indicates if the delivery was by Caesarian Section. Refer to HL7 table 0136
- Yes/no indicator for valid values.
Y Delivery was by Caesarian Section.
N Delivery was not by Caesarian Section.
Components:
<identifier (ST)> ^ <text (ST)> ^ <name of coding system
(IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^
<name of alternate coding system (IS)>
Definition: The gestation category code is used to indicate the status of the
birth in relation to the gestation. Refer to User-defined Table 0424 -
Gestation category code for suggested values.
Values |
Description |
|---|---|
1 |
Premature / Pre-term |
2 |
Full Term |
3 |
Overdue / Post-term |
Definition: Newborn's gestation period expressed as a number of weeks.
Components:
<identifier (ST)> ^ <text (ST)> ^ <name of coding system
(IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^
<name of alternate coding system (IS)>
Definition: The newborn code is used to indicate whether the baby was born in
or out of the facility. Refer to User-defined Table 0425 - Newborn code
for suggested values.
Values |
Description |
|---|---|
5 |
Born at home |
3 |
Born en route |
1 |
Born in facility |
4 |
Other |
2 |
Transfer in |
Definition:
Indicates whether or not a newborn was stillborn. Refer to HL7 table 0136 -
Yes/no indicator for valid values.
Y Stillborn.
N Not stillborn.
The
BLC segment contains data necessary to communicate patient abstract blood
information used for billing and reimbursement purposes. This segment is
repeating to report blood product codes and the associated blood units.
SEQ |
LEN |
DT |
OPT |
RP/# |
TBL# |
ITEM# |
ELEMENT NAME |
|---|---|---|---|---|---|---|---|
1 |
250 |
CE |
O |
0426 |
01528 |
Blood Product Code |
|
2 |
83 |
CQ |
O |
01529 |
Blood Amount |
Components:
<identifier (ST)> ^ <text (ST)> ^ <name of coding system
(IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^
<name of alternate coding system (IS)>
Definition: This field reports the blood product code. Refer to
User-defined Table 0426 - Blood product code for suggested values.
Value |
Description |
|---|---|
CRYO |
Cryoprecipitated AHF |
CRYOP |
Pooled Cryopecipitate |
FFP |
Fresh Frozen Plasma |
FFPTH |
Fresh Frozen Plasma - Thawed |
PC |
Packed Cells |
PCA |
Autologous Packed Cells |
PCNEO |
Packed Cells - Neonatal |
PCW |
Washed Packed Cells |
PLT |
Platelet Concentrate |
PLTNEO |
Reduced Volume Platelets |
PLTP |
Pooled Platelets |
PLTPH |
Platelet Pheresis |
PLTPHLR |
Leukoreduced Platelet Pheresis |
RWB |
Reconstituted Whole Blood |
WBA |
Autologous Whole Blood |
Components:
<quantity (NM)> ^ <units (CE)>
Subcomponents of units: <identifier (ST)> & <test (ST)>
& <name of coding system (IS)> & <alternate identifier
(ST)> & <alternate text (ST)> & <name of alternate coding
system (ST)>
Definition: This field indicates the quantity and units administered for the
blood code identified in field 1, for example, 2^pt. Standard ISO or ANSI
units, as defined in Chapter 7 are recommended.
The
RMI segment is used to report an occurrence of an incident event pertaining or
attaching to a patient encounter.
SEQ |
LEN |
DT |
OPT |
RP/# |
TBL# |
ITEM# |
ELEMENT NAME |
|---|---|---|---|---|---|---|---|
1 |
250 |
CE |
O |
0427 |
01530 |
Risk Management Incident Code |
|
2 |
26 |
TS |
O |
01531 |
Date/Time Incident |
||
3 |
250 |
CE |
O |
0428 |
01533 |
Incident Type Code |
Components:
<identifier (ST)> ^ <text (ST)> ^ <name of coding system
(IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^
<name of alternate coding system (IS)>
Definition: A code depicting the incident that occurred during a patient's
stay. Refer to User-defined Table 0427 - Risk management incident code
for suggested values.
Values |
Description |
|---|---|
B |
Body fluid exposure |
C |
Contaminated Substance |
D |
Diet Errors |
E |
Equipment problem |
F |
Patient fell (not from bed) |
H |
Patient fell from bed |
I |
Infusion error |
J |
Foreign object left during surgery |
K |
Sterile precaution violated |
P |
Procedure error |
R |
Pharmaceutical error |
S |
Suicide Attempt |
T |
Transfusion error |
O |
Other |
Definition: This field contains the date and time the Risk Management Incident identified in RMI-1 - Risk management incident code occurred.
Components:
<identifier (ST)> ^ <text (ST)> ^ <name of coding system
(IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^
<name of alternate coding system (IS)>
Definition: A code depicting a classification of the incident type. Refer to
User-defined Table 0428 - Incident type code for suggested values.
Values |
Description |
|---|---|
P |
Preventable |
U |
User Error |
O |
Other |
These
fields are used in grouping and reimbursement for HCFA APCs. Please refer to
the "Outpatient Prospective Payment System Final Rule" ("OPPS Final Rule")
issued by HCFA.
The GP1 segment is specific to the US and may not be implemented in non-US
systems.
SEQ |
LEN |
DT |
OPT |
RP/# |
TBL# |
ITEM# |
ELEMENT NAME |
|---|---|---|---|---|---|---|---|
1 |
3 |
IS |
R |
0455 |
01599 |
Type of Bill Code |
|
2 |
3 |
IS |
O |
Y |
0456 |
01600 |
Revenue Code |
3 |
1 |
IS |
O |
0457 |
01601 |
Overall Claim Disposition Code |
|
4 |
2 |
IS |
O |
Y |
0458 |
01602 |
OCE Edits per Visit Code |
5 |
12 |
CP |
O |
00387 |
Outlier Cost |
Definition:
This field is the same as UB92 Form Locator 4 "Type of Bill". Refer to Us
er-defined
Table
0455
- Type
of
bi
ll
code for suggested values. The UB codes listed as examples are not an
exhaustive or current list; refer to a UB specification for additional
information. This field is defined by HCFA or other regulatory agencies. It
is a code indicating the specific type of bill with digit 1 showing type of
facility, digit 2 showing bill classification, and digit 3 showing
frequency.
Values |
Description |
|---|---|
131 |
Hospital - Outpatient - Admit thru Discharge Claim |
141 |
Hospital - Other - Admit thru Discharge Claim |
... |
Definition:
This field is the same as UB92 Form Locator 42 "Revenue Code". Refer to
User-
defined
Table 0456 - Revenue code for suggested values. This field identifies
revenue codes that are not linked to a HCPCS/CPT code. It is used for claiming
for non-medical services such as telephone, TV or cafeteria charges, etc.
There can be many per visit or claim. This field is defined by HCFA or other
regulatory agencies.
There can also be a revenue code linked to a HCPCS/CPT code. These are found
in GP2-1 - Revenue code. Refer to UB92 specifications.
Values |
Description |
|---|---|
260 |
IV Therapy |
280 |
Oncology |
301 |
Lab/Chemistry |
991 |
Cafeteria /Guest Tray |
993 |
Telephone/Telegraph |
994 |
TV/Radio |
... |
Definition:
This field identifies the final status of the claim. The codes listed as
examples are not an exhaustive or current list, refer to OPPS Final Rule.
Refer to User-define
d
Table 04
57
- Overall claim disposition code for suggested values. This field is
defined by HCFA or other regulatory agencies.
Values |
Description |
|---|---|
0 |
No edits present on claim |
1 |
Only edits present are for line item denial or rejection |
2 |
Multiple-day claim with one or more days denied or rejected |
3 |
Claim denied, rejected, suspended or returned to provider with only post payment edits |
4 |
Claim denied, rejected, suspended or returned to provider with only pre payment edits |
Definition:
This field contains the edits that result from processing the HCPCS/CPT
procedures for a record after evaluating all the codes, revenue codes, and
modifiers. The codes listed as examples are not an exhaustive or current list,
refer to OPPS Final Rule. OCE edits also exist at the pre-procedure level.
Refer to User-defined Table 0458 - OCE edit code for suggested values.
This field is defined by HCFA or other regulatory agencies.
Values |
Description |
|---|---|
1 |
Invalid diagnosis code |
2 |
Diagnosis and age conflict |
3 |
Diagnosis and sex conflict |
4 |
Medicare secondary payer alert |
5 |
E-code as reason for visit |
6 |
Invalid procedure code |
7 |
Procedure and age conflict |
8 |
Procedure and sex conflict |
9 |
Nov-covered service |
10 |
Non-covered service submitted for verification of denial (condition code 21 from header information on claim) |
11 |
Non-covered service submitted for FI review (condition code 20 from header information on claim) |
12 |
Questionable covered service |
13 |
Additional payment for service not provided by Medicare |
14 |
Code indicates a site of service not included in OPPS |
15 |
Service unit out of range for procedure |
16 |
Multiple bilateral procedures without modifier 50 (see Appendix A) |
17 |
Multiple bilateral procedures with modifier 50 (see Appendix A) |
18 |
Inpatient procedure |
19 |
Mutually exclusive procedure that is not allowed even if appropriate modifier present |
20 |
Component of a comprehensive procedure that is not allowed even if appropriate modifier present |
21 |
Medical visit on same day as a type "T" or "S" procedure without modifier 25 (see Appendix B) |
22 |
Invalid modifier |
23 |
Invalid date |
24 |
Date out of OCE range |
25 |
Invalid age |
26 |
Invalid sex |
27 |
Only incidental services reported |
28 |
Code not recognized by Medicare; alternate code for same service available |
29 |
Partial hospitalization service for non-mental health diagnosis |
30 |
Insufficient services on day of partial hospitalization |
31 |
Partial hospitalization on same day as ECT or type "T" procedure |
32 |
Partial hospitalization claim spans 3 or less days with in-sufficient services, or ECT or significant procedure on at least one of the days |
33 |
Partial hospitalization claim spans more than 3 days with insufficient number of days having mental health services |
34 |
Partial hospitalization claim spans more than 3 days with insufficient number of days meeting partial hospitalization criteria |
35. |
Only activity therapy and/or occupational therapy services provided |
36. |
Extensive mental health services provided on day of ECT or significant procedure |
37 |
Terminated bilateral procedure or terminated procedure with units greater than one |
38. |
Inconsistency between implanted device and implantation procedure |
39. |
Mutually exclusive procedure that would be allowed if appropriate modifier were present |
40. |
Component of a comprehensive procedure that would be allowed if appropriate modifier were present |
41. |
Invalid revenue code |
42. |
Multiple medical visits on same day with same revenue code without condition code G0 (see Appendix B) |
... |
Components:
<price (MO)> ^ <price type (ID)> ^ <from value (NM)> ^
<to value (NM)> ^ <range units (CE)> ^ <range type
(ID)>
Subcomponents of price: <quantity (NM)> & <denomination
(ID)>
Subcomponents of range units: <identifier (ST)> & <text
(ST)> & <name of coding system (IS)> & <alternate
identifier (ID)> & <alternate text (ST)> & <name of
alternate coding system (ST)>
Definition: This field contains the amount that exceeds the outlier limitation
as defined by APC regulations. This field is analogous to DRG-7 - Outlier
cost however the definition in this field note supersedes the DRG-7
definition.
This
segment is used for items that pertain to each HCPC/CPT line item.
The GP2 segment is specific to the US and may not be implemented in non-US
systems.
SEQ |
LEN |
DT |
OPT |
RP/# |
TBL# |
ITEM# |
ELEMENT NAME |
|---|---|---|---|---|---|---|---|
1 |
3 |
IS |
O |
0456 |
01600 |
Revenue Code |
|
2 |
7 |
NM |
O |
01604 |
Number of Service Units |
||
3 |
12 |
CP |
O |
|
01605 |
Charge |
|
4 |
1 |
IS |
O |
0459 |
01606 |
Reimbursement Action Code |
|
5 |
1 |
IS |
O |
0460 |
01607 |
Denial or Rejection Code |
|
6 |
3 |
IS |
O |
Y |
0458 |
01608 |
OCE Edit Code |
7 |
250 |
CE |
O |
0466 |
01609 |
Ambulatory Payment Classification Code |
|
8 |
1 |
IS |
O |
Y |
0467 |
01610 |
Modifier Edit Code |
9 |
1 |
IS |
O |
0468 |
01611 |
Payment Adjustment Code |
|
10 |
1 |
IS |
O |
0469 |
01617 |
Packaging Status Code |
|
11 |
12 |
CP |
O |
01618 |
Expected HCFA Payment Amount |
||
12 |
2 |
IS |
O |
0470 |
01619 |
Reimbursement Type Code |
|
13 |
12 |
CP |
O |
01620 |
Co-Pay Amount |
||
14 |
4 |
NM |
O |
01621 |
Pay Rate per Service Unit |
Definition: This field identifies a specific ancillary service for each HCPC/CPT This field is the same as UB92 Form Locator 42 "Revenue Code". Refer to User-defined Table 0456 - Rev enue code for suggested values. This field is defined by HCFA or other regulatory agencies.
Definition: This field contains the quantitative count of units for each HCPC/CPT. This field is the same as UB92 Form Locator 46 "Units of Service". This field is defined by HCFA or other regulatory agencies.
Definition:
This field contains the amount charged for the specific individual line item
(HCPC/CPT). This field is the same as UB92 Form Locator 56. This field is
defined by HCFA or other regulatory agencies.
Components: <price (MO)> ^ <price type (ID)> ^ <from value
(NM)> ^ <to value (NM)> ^ <range units (CE)> ^ <range type
(ID)>
Subcomponents of price: <quantity (NM)> & <denomination
(ID)>
Subcomponents of range units: <identifier (ST)> & <text
(ST)> & <name of coding system (IS)> & <alternate
identifier (ID)> & <alternate text (ST)> & <name of
alternate coding system (ST)>
Definition:
This field identifies the action to be taken during reimbursement
calculations. If valued, this code overrides the value in GP2-6 - OCE edit
code. Refer to Us
er-defined
Table 0459 - Reimbursement Action Code for suggested values. This field is
defined by HCFA or other regulatory agencies
Value |
Description |
|---|---|
0 |
OCE line item denial or rejection is not ignored |
1 |
OCE line item denial or rejection is ignored |
2 |
External line item denial. Line item is denied even if no OCE edits |
3 |
External line item rejection. Line item is rejected even if no OCE edits |
Definition:
This field determines the OCE status of the line item. Refer to
User-defined table 0460 - Denial or rejection code for suggested values.
This field is defined by HCFA or other regulatory agencies
Value |
Description |
|---|---|
0 |
Line item not denied or rejected |
1 |
Line item denied or rejected |
2 |
Line item is on a multiple-day claim. The line item is not denied or rejected, but occurs on a day that has been denied or rejected. |
Definition: This field contains the edit that results from the processing of HCPCS/CPT procedures for a line item HCPCS/CPT, after evaluating all the codes, revenue codes, and modifiers. Refer to User-defined table 0458 - OCE edit code for suggested values.
Components:
<identifier (ST)> ^ <text (ST)> ^ <name of coding system
(IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^
<name of alternate coding system (ST)>
Definition: This field contains the derived APC code. This is the APC code
used for payment, which is the same as the assigned APC, for all situations
except partial hospitalization. If partial hospitalization is billed in this
visit, the assigned APC will differ from the APC used for payment. Partial
hospitalization is the only time an assigned APC differs from the APC used for
payment. The payment APC is used for billing and should be displayed in this
field. The first component contains the APC identifier. The second component
reports the text description for the APC group. Refer to User-defined table
0466 - Ambulatory payment classification code for suggested values. This
field is defined by HCFA or other regulatory agencies
Value |
Description |
|---|---|
031 |
Dental procedures |
163 |
Excision/biopsy |
181 |
Level 1 skin repair. |
... |
Definition:
This field contains calculated edits of the modifiers for each line or
HCPCS/CPT. This field can be repeated up to five times, one edit for each of
the modifiers present. This field relates to the values in PR1-16 -
Procedure code modifier. Each repetition corresponds positionally to the
order of the PR1-16 modifier codes. If no modifier code exists, use the code
"U" (modifier edit code unknown) as a placeholder. The repetitions of Modifier
Edit Codes must match the repetitions of Procedure Code Modifiers. For
example, if PR1-16 - Procedure code modifier reports ...|01~02~03~04|...
as modifier codes, and modifier code 03 modifier status code is unknown,
GP2-8 - Modifier edit code would report ...|1~1~U~1|... Refer to
User-defined table 0467 -
Modifier
edit code for suggested values. This field is defined by HCFA or other
regulatory agencies
Value |
Description |
|---|---|
0 |
Modifier does NOT exist |
1 |
Modifier present, no errors |
2 |
Modifier invalid |
3 |
Modifier NOT approved for ASC/HOPD use |
4 |
Modifier approved for ASC/HOPD use, inappropriate for code |
U |
Modifer edit code unknown |
Definition:
This field contains any payment adjustment due to drugs or medical devices.
Refer to User-defined Table 0468 - Payment adjustment code for suggested
values. This field is defined by HCFA or other regulatory agencies
Value |
Description |
|---|---|
1 |
No payment adjustment |
2 |
Designated current drug or biological payment adjustment applies to APC (status indicator G) |
3 |
Designated new device payment adjustment applies to APC (status indicator H) |
4 |
Designated new drug or new biological payment adjustment applies to APC (status indicator J) |
5 |
Deductible not applicable (specific list of HCPCS codes) |
Definition:
This field contains the packaging status of the service. A status indicator of
N may accompany this, unless it is part of a partial hospitalization. Refer to
User defined (HCFA) Table 0469 - Packaging status code for suggested
values. This field is defined by HCFA or other regulatory agencies
Value |
Description |
|---|---|
0 |
Not packaged |
1 |
Packaged service (status indicator N, or no HCPCS code and certain revenue codes) |
2 |
Packaged as part of partial hospitalization per diem or daily mental health service per diem |
Definition:
This field contains the calculated dollar amount that HCFA is expected to pay
for the line item.
Components: <price (MO)> ^ <price type (ID)> ^ <from value
(NM)> ^ <to value (NM)> ^ <range units (CE)> ^ <range type
(ID)>
Subcomponents of price: <quantity (NM)> & <denomination
(ID)>
Subcomponents of range units: <identifier (ST)> & <text
(ST)> & <name of coding system (IS)> & <alternate
identifier (ID)> & <alternate text (ST)> & <name of
alternate coding system (ST)>
Definition:
This field contains the fee schedule reimbursement type applied to the line
item. Refer to User define
d
Table 0470 - Reimbursement type code for suggested values. This field is
defined by HCFA or other regulatory agencies.
Value |
Description |
|---|---|
OPPS |
Outpatient Prospective Payment System |
Pckg |
Packaged APC |
Lab |
Clinical Laboratory APC |
Thrpy |
Therapy APC |
DME |
Durable Medical Equipment |
EPO |
Epotein |
Mamm |
Screening Mammography APC |
PartH |
Partial Hospitalization APC |
Crnl |
Corneal Tissue APC |
NoPay |
This APC is not paid |
Definition:
This field contains the patient's Co-pay amount for the line item.
Components: <price (MO)> ^ <price type (ID)> ^ <from value
(NM)> ^ <to value (NM)> ^ <range units (CE)> ^ <range type
(ID)>
Subcomponents of price: <quantity (NM)> & <denomination
(ID)>
Subcomponents of range units: <identifier (ST)> & <text
(ST)> & <name of coding system (IS)> & <alternate
identifier (ID)> & <alternate text (ST)> & <name of
alternate coding system (ST)>
Definition: This field contains the calculated rate, or multiplying factor, for each service unit for the line item.
MSH|^~\&|PATA|01|PATB|01|19930908135031||BAR^P01|641|P|2.4|000000000000001|<cr>
EVN|P01|1993090813503||<cr>
PID|1||8064993^^^PATA1^MR^A~6045681^^^PATA1^BN^A~123456789ABC^^^US^NI~123456789^^^USSSA^SS||SMITH^PAT^J^^^||19471007|F||1|1234
FANNIN^^HOUSTON^TX^77030^USA|HAR||||S||6045681<cr>
GT1|001||JOHNSON^SAM^J||8339 MORVEN RD^^BALTIMORE^MD^
21234^US|||||||193-22-1876<cr>
NK1|001|SMITH^WILLIAM|F|522 MAIN ST^^CUMBERLAND^MD
^28765^US|(301)555-2134<cr>
IN1|001|A357|1234|BCMD||||| 132987<cr>
A patient has been registered by the ADT system (PATA) and notification is sent
to the Patient Billing system (PATB). The patient's name is Pat J. Smith, a
female Caucasian, born on October 7, 1947. Living at 1234 Fannin, Houston,
TX.
Ms. Smith's medical record number is 8064993 and her billing number is 6045681.
Her national identifier is 123456789ABC. Her social security number, assigned
by the U.S. Social Security Administration, is 123456789. Ms. Smith has
provided her father's name and address for next of kin. Ms. Smith is insured
under plan ID A357 with an insurance company known to both systems as BCMD,
with a company ID of 1234.
MSH|^~\&|PATA|01|PATB|01|19930908135031||DFT^P03|641|P|2.4|000000000000001|<cr>
EVN|P03|1993090813503||<cr>
PID||0008064993^^^ENT^PE|0008064993^^^PAT^MR||0006045681^^^PATA^AN|SMITH^PAT^J^^^|19471007|F||1|1234
FANNIN^^HOUSTON^TX^77030^USA|HAR||||S||6045681^^^PATA^AN<cr>
FT1|1|||19950715|19950716|CG|B1238^BIOPSY-SKIN^SYSTEMA|||1|||ONC|A357||||||P8765^KILDARE^BEN<cr>
A patient has been registered by the ADT system (PATA) and notification is sent
to the Patient Billing system (PATB). The patient's name is Pat J. Smith, a
female Caucasian, born on October 7, 1947. Living at 1234 Fannin, Houston,
TX.
Ms. Smith's patient number is 8064993 and her billing number is 6045681. This
transaction is posting a charge for a skin biopsy to her account.
MSH|^~\&|UREV||PATB||||BAR^P05|MSG0018|P|2.4<cr>
EVN|P05|1993090813503
PID|||125976||JOHNSON^SAM^J|||||||||||||125976011<cr>
UB1|1|1|5|3|1||39|||01^500.00|||1|19880501|19880507|10^19880501<cr>
Utilization review sends data for Patient Billing to the Patient Accounting
system. The patient's insurance program has a 1-pint deductible for blood; the
patient received five pints of blood, and three pints were replaced, with one
pint not yet replaced.
The patient has been assigned to a medically necessary private room (UB
condition code 39). The hospital's most common semi-private rate is $500.00
(UB value code 01.)
The services provided for the period 05/01/88 through 05/07/88 are fully
approved (PSRO/UR Approval Code 1). The patient's hospitalization is the
result of an auto accident (UB occurrence code 01.)
MSH|^~\&|UREV||PATB||||BAR^P05|MSG0018|P|2.4<cr>
EVN|P05|1993090813503
PID|||125976||JOHNSON^SAM^J|||||||||||||125976011<cr>
DG1|001|I9|1550|MAL NEO LIVER, PRIMARY|19880501103005|F<cr>
DRG|203|19880501103010|Y||D|5<cr>
The DG1 segment contains the information that the patient was diagnosed on May
1 as having a malignancy of the hepatobiliary system or pancreas (ICD9 code
1550). In the DRG segment, the patient has been assigned a Diagnostic Related
Group (DRG) of 203 (corresponding to the ICD9 code of 1550). Also, the patient
has been approved for an additional five days (five-day outlier).
The Set-ID used to be needed to identify whether or not a record was to be used for deletion, update, or cancellation. This information was redundant since the event type indicates this fact. Consequently, the Set-ID is now only used to identify a segment.
None.
If included here, the order level data is global across all FT1 segments. The ORC, OBR, NTE, OBX, and NTE segments are not required in the P03 since this is a financial message.[2] If included here, the order level data is specific to the FT1 in whose hierarchy it is embedded. The ORC, OBR, NTE, OBX, and NTE segments are not required in the P03 since this is a financial message.[3] If included here, this diagnosis data is specific to the FT1 in whose hierarchy it is embedded.[4] If included here, this guarantor data is specific to the FT1 in whose hierarchy it is embedded.[5] If included here, this insurance data is specific to the FT1 in whose hierarchy it is embedded.[6] If included here, this diagnosis data is global across all FT1s.[7] If included here, this guarantor data is global across all FT1s.[8] If included here, this insurance data is global across all FT1s.


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dataPicture
A tool that generates image from various formatted data.
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Environment.ResultMultiPlayers module¶
ResultMultiPlayers.ResultMultiPlayers class to wrap the simulation results, for the multi-players case.
-
class
Environment.ResultMultiPlayers.
ResultMultiPlayers
(nbArms, horizon, nbPlayers, means=None)[source]¶ Bases:
object
ResultMultiPlayers accumulators, for the multi-players case.
-
choices
= None¶ Store all the choices of all the players
-
rewards
= None¶ Store all the rewards of all the players, to compute the mean
-
pulls
= None¶ Store the pulls of all the players
-
allPulls
= None¶ Store all the pulls of all the players
-
collisions
= None¶ Store the collisions on all the arms
-
running_time
= None¶ Store the running time of the experiment
-
memory_consumption
= None¶ Store the memory consumption of the experiment
-
__dict__
= mappingproxy({'__module__': 'Environment.ResultMultiPlayers', '__doc__': ' ResultMultiPlayers accumulators, for the multi-players case. ', '__init__': <function ResultMultiPlayers.__init__>, 'store': <function ResultMultiPlayers.store>, '__dict__': <attribute '__dict__' of 'ResultMultiPlayers' objects>, '__weakref__': <attribute '__weakref__' of 'ResultMultiPlayers' objects>})¶
-
__module__
= 'Environment.ResultMultiPlayers'¶
-
__weakref__
¶ list of weak references to the object (if defined)
-


Logan Rogers
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Attestation proofs can be verified independently from any
OpenTimestamps server or facility. The same is not true for
the submission receipt, which can only be upgraded to proof
using the OpenTimestamps calendar(s) used for submission.
The user is responsible to store both the stamped document
(which has never been shared with the OpenTimestamps servers)
and its attestation proof (which technically might be stored
by the OpenTimestamps servers).
While the OpenTimestamps
protocol is blockchain agnostic,
a timestamp is as reliable as the used blockchain:
-
very reliable when using Bitcoin
because that blockchain is secured by huge
computational power (proof-of-work);
-
much less reliable with other public
permissionless blockchains;
-
when used with a private permissioned blockchain
its reliability depends on the trustworthiness
of the chain governance: in this case a traditional
certification authority is probably better.
It should be obvious, but it is worth mentioning that
timestamping (using the OpenTimestamps protocol or any
alternative approach):
-
can be selectively revealed to show convenient
evidence and hiding inconvenient evidence (e.g.
timestamping a bet on a given outcome and its
opposite, later revealing only the realized one);
-
does not prove authorship (that should be
proved using a digital signature);
-
can be repudiated if not digitally signed
-
does not ensure veracity, validity, correctness,
or accuracy of the timestamped document.


--- layout: post title: Storyboards close up date: '2017-10-21T11:30:25+02:00' categories: - Storyboards - Sketches picture_url: https://film-Storyboards.tumblr.com/post/166641957723/Storyboards-close-up ---


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--- layout: post title: 'BenQ''s iF concept' date: 2006-10-29 00:00:00 categories: interfaces-&-interaction mobile ---
BenQ's iF concept: "The little surfaces that Gabriel White has devoted an entire blog to are about to get a little bigger as the screen expands to fill the front of the device. The history of buttons is about to get a virtual chapter as we chuck out those tiny QWERTY thumb boards. The tactile issues will get sorted and someone will liberate us from fingerprint smudges and scratched screens. The touch screen is finally developing to match the physicality of human hands. Maybe we're reaching the tipping point for convergence."
Over the years I've developed an allergy to reading about "concept phones" but this is still quite neat IMHO.


| Home | Libraries | People | FAQ | More |
boost::graph_traits<mpi::graph_communicator> — Traits structure that allows a communicator with graph topology to be view as a graph by the Boost Graph Library.
// In header: <boost/mpi/graph_communicator.hpp> struct graph_traits<mpi::graph_communicator> { // types typedef int vertex_descriptor; typedef std::pair< int, int > edge_descriptor; typedef directed_tag directed_category; typedef disallow_parallel_edge_tag edge_parallel_category; typedef unspecified out_edge_iterator; typedef int degree_size_type; typedef unspecified adjacency_iterator; typedef counting_iterator< int > vertex_iterator; typedef int vertices_size_type; typedef unspecified edge_iterator; typedef int edges_size_type; // public static functions static vertex_descriptor null_vertex() ; };
The specialization of graph_traits
for an MPI communicator allows a communicator with graph topology to be viewed as a graph. An MPI communicator with graph topology meets the requirements of the Graph, Incidence Graph, Adjacency Graph, Vertex List Graph, and Edge List Graph concepts from the Boost Graph Library.


|
MNN
1.0
|
#include <HalideRuntime.h>
Public 成员函数 | |
| HALIDE_ATTRIBUTE_ALIGN (1) uint8_t code | |
| HALIDE_ATTRIBUTE_ALIGN (1) uint8_t bits | |
| HALIDE_ATTRIBUTE_ALIGN (2) uint16_t lanes | |
A runtime tag for a type in the halide type system. Can be ints, unsigned ints, or floats of various bit-widths (the 'bits' field). Can also be vectors of the same (by setting the 'lanes' field to something larger than one). This struct should be exactly 32-bits in size.
| halide_type_t::HALIDE_ATTRIBUTE_ALIGN | ( | 1 | ) |
The basic type code: signed integer, unsigned integer, or floating point.
| halide_type_t::HALIDE_ATTRIBUTE_ALIGN | ( | 1 | ) |
The number of bits of precision of a single scalar value of this type.
| halide_type_t::HALIDE_ATTRIBUTE_ALIGN | ( | 2 | ) |
How many elements in a vector. This is 1 for scalar types.


Woman barred from every shop in England except a Tesco Metro in Swindon
A prolific shoplifter has been banned from going into every single shop across England apart from a Tesco Metro.
Anna Burns, 33, took a suitcase with her to Swindon Crown Court yesterday, expecting that she would be jailed.
However, Judge Peter Crabtree told her that he was going to look at all options and released her with strict conditions.
She can only use the NHS Walk-in Centre near her home and Tesco in The Parade, Swindon.
 That may be custody but I will look at all options.’
She appeared before Magistrates on Saturday following her latest haul of £347 in goods from M&S and and Sainsbury’s.
The court heard that she was already wanted by the court after failing to turn up for an earlier hearing.
Advertisement Advertisement
She was in court recently for stealing mascara from Boots, watches from Argos, clothes from Mothercare and food and drink from Costa.
But during the hearing she complained that she was unwell and was bailed to the end of the week so that she could go to a nearby walk-in centre.
She went there with a probation officer but after being told she would have to wait half an hour Burns said she wanted to go home to charge her phone so that she could call an ambulance.
Judge Crabtree told her: ‘Make sure you are here. I think you’ve managed to get here once out of about a dozen occasions on time.’
On Saturday, November 16, she appeared in the dock at Swindon Magistrates’ Court, where she pleaded guilty to stealing £307-worth of goods from Marks and Spencer’s and £40-worth from Sainsbury’s.
Got a story for Metro.co.uk?
Get in touch with our news team by emailing us at<EMAIL_ADDRESS>For more stories like this, check our news page.


However, this cannot be the case. It cannot benefit a person to do evil, and since there is no hope for them to be rehabilitated and stop doing evil, there can be no benefit for them.
Furthermore, they would appear not to have the right to stay in jail, for this would imply that they have the right to life. However this cannot be the case because as Locke, the creator of the concept of natural rights, states that people, upon violating the social contract and doing evil, forfeit their rights.
Thus, such people gain no benefit and have no right to stay in jail.


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