知行 EDI 规范查询平台™
Segment
X12 EDI Release 00403
UMHealth Care Services Review Information
To specify health care services review information
Elements
  • UM011525Request Category Code
    ID
    M必须(Mandatory)

    Code indicating a type of request

    Codes (7)
  • UM021322Certification Type Code
    ID
    O可选(Optional)

    Code indicating the type of certification

    Codes (14)
  • UM031365Service Type Code
    ID
    O可选(Optional)

    Code identifying the classification of service

    Codes (168)
  • UM04C023Health Care Service Location InformationO可选(Optional)
    133113321325
    • UM04011331Facility Code Value
      AN
      M必须(Mandatory)
      Min 0 / Max 2

      Code identifying the type of facility where services were performed; the first and second positions of the Uniform Bill Type code or the Place of Service code from the Electronic Media Claims National Standard Format

    • UM04021332Facility Code Qualifier
      ID
      O可选(Optional)

      Code identifying the type of facility referenced

      Codes (2)
    • UM04031325Claim Frequency Type Code
      ID
      O可选(Optional)
      Min 1 / Max 1

      Code specifying the frequency of the claim; this is the third position of the Uniform Billing Claim Form Bill Type

  • UM05C024Related Causes InformationO可选(Optional)
    13621362136215626
    • UM05011362Related-Causes Code
      ID
      M必须(Mandatory)

      Code identifying an accompanying cause of an illness, injury or an accident

      Codes (6)
    • UM05021362Related-Causes Code
      ID
      O可选(Optional)

      Code identifying an accompanying cause of an illness, injury or an accident

      Codes (6)
    • UM05031362Related-Causes Code
      ID
      O可选(Optional)

      Code identifying an accompanying cause of an illness, injury or an accident

      Codes (6)
    • UM0504156State or Province Code
      ID
      O可选(Optional)
      Min 2 / Max 2

      Code (Standard State/Province) as defined by appropriate government agency

    • UM050526Country Code
      ID
      O可选(Optional)
      Min 2 / Max 3

      Code identifying the country

  • UM061338Level of Service Code
    ID
    O可选(Optional)

    Code specifying the level of service rendered

    Codes (17)
  • UM071213Current Health Condition Code
    ID
    O可选(Optional)

    Code indicating current health condition of the individual

    Codes (13)
  • UM08923Prognosis Code
    ID
    O可选(Optional)

    Code indicating physician's prognosis for the patient

    Codes (8)
  • UM091363Release of Information Code
    ID
    O可选(Optional)

    Code indicating whether the provider has on file a signed statement by the patient authorizing the release of medical data to other organizations

    Codes (6)
  • UM101514Delay Reason Code
    ID
    O可选(Optional)

    Code indicating the reason why a request was delayed

    Codes (14)
知行 EDI 规范查询平台™ 2023 - 3.1.18
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