Appendix E - Data Element Glossary

Data Element Name Index

This section contains an alphabetic listing of data elements used in this implementation guide. Consult the X12N Data Element Dictionary for a complete list of all X12N Data Elements. Data element names in normal type are generic ASC X12 names. Italic type indicates a health care industry defined name.

Legend

Industry Name
Industry name definition.
800 - Transaction Set ID and Name
H=Header, D=Detail, S=Summary | Loop ID | Reference Designator | Composite ID-Position in Composite | X12 Data Element Number
 
Accident Date
Date of the accident related to charges or to the patient's current condition, diagnosis, or treatment referenced in the transaction.
278 - Health Care Services Review Request
D | 2000E | DTP03 | - | 1251
278 - Health Care Services Review Response Review
D | 2000E | DTP03 | - | 1251
 
Action Code
Code indicating type of action
278 - Health Care Services Review Response Review
D | 2000E | HCR01 | - | 306
D | 2000F | HCR01 | - | 306
 
Additional Patient Information Address Line
Street address to which additional patient information is to be routed.
278 - Health Care Services Review Response Review
D | 2010EB | N301 | - | 166
D | 2010EB | N302 | - | 166
 
Additional Patient Information Contact City Name
The city name of the Additional Patient Information Contact.
278 - Health Care Services Review Response Review
D | 2010EB | N401 | - | 19
 
Additional Patient Information Contact Communication Number
Communication number to which additional patient information is to be routed.
278 - Health Care Services Review Response Review
D | 2010EB | PER04 | - | 364
D | 2010EB | PER06 | - | 364
D | 2010EB | PER08 | - | 364
 
Additional Patient Information Contact Country Code
The country code in the address of the Additional Patient Information Contact.
278 - Health Care Services Review Response Review
D | 2010EB | N404 | - | 26
 
Additional Patient Information Contact Country Subdivision Code
The country subdivision code in the address of the Additional Patient Information Contact.
278 - Health Care Services Review Response Review
D | 2010EB | N407 | - | 1715
 
Additional Patient Information Contact Name
Specific contact name to whom additional patient information is to be routed.
278 - Health Care Services Review Response Review
D | 2010EB | PER02 | - | 93
 
Additional Patient Information Contact Postal Zone or ZIP Code
The postal code in the address of the Additional Patient Information Contact.
278 - Health Care Services Review Response Review
D | 2010EB | N403 | - | 116
 
Additional Patient Information Contact State Code
Code identifying the state or province in the address of the Additional Patient Information Contact.
278 - Health Care Services Review Response Review
D | 2010EB | N402 | - | 156
 
Additional Patient Information First Name
First name of person to whom additional patient information is to be routed.
278 - Health Care Services Review Response Review
D | 2010EB | NM104 | - | 1036
 
Additional Patient Information Identifier
Identifier of the entity to which additional patient information is to be routed.
278 - Health Care Services Review Response Review
D | 2010EB | NM109 | - | 67
 
Additional Patient Information Last or Organizational Name
Last name of person or organization name to which additional patient information is to be routed.
278 - Health Care Services Review Response Review
D | 2010EB | NM103 | - | 1035
 
Additional Patient Information Middle Name
Middle name of person to whom additional patient information is to be routed.
278 - Health Care Services Review Response Review
D | 2010EB | NM105 | - | 1037
 
Additional Patient Information Name Suffix
Name suffix of person to whom additional patient information is to be routed.
278 - Health Care Services Review Response Review
D | 2010EB | NM107 | - | 1039
 
Additional Service Information Contact City Name
The city name of the Additional Service Information Contact.
278 - Health Care Services Review Response Review
D | 2010FB | N401 | - | 19
 
Additional Service Information Contact Country Code
The country code in the address of the Additional Service Information Contact.
278 - Health Care Services Review Response Review
D | 2010FB | N404 | - | 26
 
Additional Service Information Contact Country Subdivision Code
The country subdivision in the address of the Additional Service Information Contact.
278 - Health Care Services Review Response Review
D | 2010FB | N407 | - | 1715
 
Additional Service Information Contact Postal Zone or ZIP Code
The postal code in the address of the Additional Service Information Contact.
278 - Health Care Services Review Response Review
D | 2010FB | N403 | - | 116
 
Additional Service Information Contact State Code
Code identifying the state or province in the address of the Additional Service Information Contact.
278 - Health Care Services Review Response Review
D | 2010FB | N402 | - | 156
 
Administrative Reference Number
Unique reference number assigned by the UMO to this service review.
278 - Health Care Services Review Response Review
D | 2000E | REF02 | - | 127
D | 2000F | REF02 | - | 127
 
Admission Source Code
Code indicating the source of this admission.
278 - Health Care Services Review Response Review
D | 2000E | CL102 | - | 1314
 
Admission Type Code
Code indicating the priority of this admission.
278 - Health Care Services Review Response Review
D | 2000E | CL101 | - | 1315
 
Ambulance Transport Code
Code indicating the type of ambulance transport.
278 - Health Care Services Review Request
D | 2000E | CR103 | - | 1316
278 - Health Care Services Review Response Review
D | 2000E | CR103 | - | 1316
 
Ambulance Transport Reason Code
Code indicating the reason for ambulance transport.
278 - Health Care Services Review Request
D | 2000E | CR104 | - | 1317
 
Arterial Blood Gas Quantity
The Arterial Blood Gas test results breathing room air (furnish results of recent hospital tests).
278 - Health Care Services Review Request
D | 2000E | CR510 | - | 380
 
Attachment Control Number
Identification number of attachment related to the claim.
278 - Health Care Services Review Request
D | 2000E | PWK06 | - | 67
D | 2000F | PWK06 | - | 67
278 - Health Care Services Review Response Review
D | 2000E | PWK06 | - | 67
D | 2000F | PWK06 | - | 67
 
Attachment Description
Free-form text describing attachments related to the claim.
278 - Health Care Services Review Request
D | 2000E | PWK07 | - | 352
D | 2000F | PWK07 | - | 352
278 - Health Care Services Review Response Review
D | 2000E | PWK07 | - | 352
D | 2000F | PWK07 | - | 352
 
Attachment Report Type Code
Code to specify the type of attachment that is related to the claim.
278 - Health Care Services Review Request
D | 2000E | PWK01 | - | 755
D | 2000F | PWK01 | - | 755
278 - Health Care Services Review Response Review
D | 2000E | PWK01 | - | 755
D | 2000F | PWK01 | - | 755
 
Birth Sequence Number
A number indicating the order of birth for the identified person in relationship to family members with the same date of birth.
278 - Health Care Services Review Request
D | 2010D | INS17 | - | 1470
278 - Health Care Services Review Response Review
D | 2010D | INS17 | - | 1470
 
Certification Condition Indicator
Code indicating whether or not the condition codes apply to the patient or another entity.
278 - Health Care Services Review Request
D | 2000E | CRC02 | - | 1073
D | 2000E | CRC02 | - | 1073
D | 2000E | CRC02 | - | 1073
D | 2000E | CRC02 | - | 1073
D | 2000E | CRC02 | - | 1073
D | 2000E | CRC02 | - | 1073
D | 2000E | CRC02 | - | 1073
 
Certification Effective Date
The date when the certification takes effect or the date range within which the certification is effective.
278 - Health Care Services Review Response Review
D | 2000E | DTP03 | - | 1251
D | 2000F | DTP03 | - | 1251
 
Certification Expiration Date
Date on which the certification will expire.
278 - Health Care Services Review Response Review
D | 2000E | DTP03 | - | 1251
D | 2000F | DTP03 | - | 1251
 
Certification Issue Date
The date when the certification was issued.
278 - Health Care Services Review Response Review
D | 2000E | DTP03 | - | 1251
D | 2000F | DTP03 | - | 1251
 
Certification Type Code
Code indicating the type of certification.
278 - Health Care Services Review Request
D | 2000E | UM02 | - | 1322
D | 2000E | CR608 | - | 1322
D | 2000F | UM02 | - | 1322
278 - Health Care Services Review Response Review
D | 2000E | UM02 | - | 1322
D | 2000E | CR608 | - | 1322
D | 2000F | UM02 | - | 1322
 
Code Category
Specifies the situation or category to which the code applies.
278 - Health Care Services Review Request
D | 2000E | CRC01 | - | 1136
D | 2000E | CRC01 | - | 1136
D | 2000E | CRC01 | - | 1136
D | 2000E | CRC01 | - | 1136
D | 2000E | CRC01 | - | 1136
D | 2000E | CRC01 | - | 1136
D | 2000E | CRC01 | - | 1136
 
Code List Qualifier Code
Code identifying a specific industry code list.
278 - Health Care Services Review Request
D | 2000F | TOO01 | - | 1270
D | 2000F | DN206 | - | 1270
278 - Health Care Services Review Response Review
D | 2000F | HI01 | C022-01 | 1270
D | 2000F | HI02 | C022-01 | 1270
D | 2000F | HI03 | C022-01 | 1270
D | 2000F | HI04 | C022-01 | 1270
D | 2000F | HI05 | C022-01 | 1270
D | 2000F | HI06 | C022-01 | 1270
D | 2000F | HI07 | C022-01 | 1270
D | 2000F | HI08 | C022-01 | 1270
D | 2000F | HI09 | C022-01 | 1270
D | 2000F | HI10 | C022-01 | 1270
D | 2000F | HI11 | C022-01 | 1270
D | 2000F | HI12 | C022-01 | 1270
D | 2000F | TOO01 | - | 1270
D | 2000F | DN206 | - | 1270
 
Communication Number Qualifier
Code identifying the type of communication number.
278 - Health Care Services Review Request
D | 2010B | PER03 | - | 365
D | 2010B | PER05 | - | 365
D | 2010B | PER07 | - | 365
D | 2010EA | PER03 | - | 365
D | 2010EA | PER05 | - | 365
D | 2010EA | PER07 | - | 365
D | 2010F | PER03 | - | 365
D | 2010F | PER05 | - | 365
D | 2010F | PER07 | - | 365
278 - Health Care Services Review Response Review
D | 2010A | PER03 | - | 365
D | 2010A | PER05 | - | 365
D | 2010A | PER07 | - | 365
D | 2010EA | PER03 | - | 365
D | 2010EA | PER05 | - | 365
D | 2010EA | PER07 | - | 365
D | 2010EB | PER03 | - | 365
D | 2010EB | PER05 | - | 365
D | 2010EB | PER07 | - | 365
D | 2010FA | PER03 | - | 365
D | 2010FA | PER05 | - | 365
D | 2010FA | PER07 | - | 365
D | 2010FB | PER03 | - | 365
D | 2010FB | PER05 | - | 365
D | 2010FB | PER07 | - | 365
 
Complication Indicator
A code to indicate whether the Patient's condition is Complicated or Uncomplicated.
278 - Health Care Services Review Request
D | 2000E | CR209 | - | 1073
 
Condition Code
Code(s) used to identify condition(s) relating to this bill or relating to the patient.
278 - Health Care Services Review Request
D | 2000E | CRC03 | - | 1321
D | 2000E | CRC04 | - | 1321
D | 2000E | CRC05 | - | 1321
D | 2000E | CRC06 | - | 1321
D | 2000E | CRC07 | - | 1321
D | 2000E | CRC03 | - | 1321
D | 2000E | CRC04 | - | 1321
D | 2000E | CRC05 | - | 1321
D | 2000E | CRC06 | - | 1321
D | 2000E | CRC07 | - | 1321
D | 2000E | CRC03 | - | 1321
D | 2000E | CRC04 | - | 1321
D | 2000E | CRC05 | - | 1321
D | 2000E | CRC06 | - | 1321
D | 2000E | CRC07 | - | 1321
D | 2000E | CRC03 | - | 1321
D | 2000E | CRC04 | - | 1321
D | 2000E | CRC05 | - | 1321
D | 2000E | CRC06 | - | 1321
D | 2000E | CRC07 | - | 1321
D | 2000E | CRC03 | - | 1321
D | 2000E | CRC04 | - | 1321
D | 2000E | CRC05 | - | 1321
D | 2000E | CRC06 | - | 1321
D | 2000E | CRC07 | - | 1321
D | 2000E | CRC03 | - | 1321
D | 2000E | CRC04 | - | 1321
D | 2000E | CRC05 | - | 1321
D | 2000E | CRC06 | - | 1321
D | 2000E | CRC07 | - | 1321
D | 2000E | CRC03 | - | 1321
D | 2000E | CRC04 | - | 1321
D | 2000E | CRC05 | - | 1321
D | 2000E | CRC06 | - | 1321
D | 2000E | CRC07 | - | 1321
 
Contact Function Code
Code identifying the major duty or responsibility of the person or group named.
278 - Health Care Services Review Request
D | 2010B | PER01 | - | 366
D | 2010EA | PER01 | - | 366
D | 2010F | PER01 | - | 366
278 - Health Care Services Review Response Review
D | 2010A | PER01 | - | 366
D | 2010EA | PER01 | - | 366
D | 2010EB | PER01 | - | 366
D | 2010FA | PER01 | - | 366
D | 2010FB | PER01 | - | 366
 
Country Code
Code indicating the geographic location.
278 - Health Care Services Review Request
D | 2000E | UM05 | C024-05 | 26
 
Current Health Condition Code
Code indicating current condition of the individual.
278 - Health Care Services Review Request
D | 2000E | UM07 | - | 1213
 
Daily Oxygen Use Count
Number of times per day that the patient must use oxygen.
278 - Health Care Services Review Request
D | 2000E | CR507 | - | 380
278 - Health Care Services Review Response Review
D | 2000E | CR507 | - | 380
 
Date Time Period Format Qualifier
Code indicating the date format, time format, or date and time format.
278 - Health Care Services Review Request
D | 2010C | DMG01 | - | 1250
D | 2010D | DMG01 | - | 1250
D | 2000E | DTP02 | - | 1250
D | 2000E | DTP02 | - | 1250
D | 2000E | DTP02 | - | 1250
D | 2000E | DTP02 | - | 1250
D | 2000E | DTP02 | - | 1250
D | 2000E | DTP02 | - | 1250
D | 2000E | DTP02 | - | 1250
D | 2000E | HI01 | C022-03 | 1250
D | 2000E | HI02 | C022-03 | 1250
D | 2000E | HI03 | C022-03 | 1250
D | 2000E | HI04 | C022-03 | 1250
D | 2000E | HI05 | C022-03 | 1250
D | 2000E | HI06 | C022-03 | 1250
D | 2000E | HI07 | C022-03 | 1250
D | 2000E | HI08 | C022-03 | 1250
D | 2000E | HI09 | C022-03 | 1250
D | 2000E | HI10 | C022-03 | 1250
D | 2000E | HI11 | C022-03 | 1250
D | 2000E | HI12 | C022-03 | 1250
D | 2000E | CR603 | - | 1250
D | 2000E | CR615 | - | 1250
D | 2010EC | DTP02 | - | 1250
D | 2000F | DTP02 | - | 1250
D | 2000F | HI01 | C022-03 | 1250
D | 2000F | HI02 | C022-03 | 1250
D | 2000F | HI03 | C022-03 | 1250
D | 2000F | HI04 | C022-03 | 1250
D | 2000F | HI05 | C022-03 | 1250
D | 2000F | HI06 | C022-03 | 1250
D | 2000F | HI07 | C022-03 | 1250
D | 2000F | HI08 | C022-03 | 1250
D | 2000F | HI09 | C022-03 | 1250
D | 2000F | HI10 | C022-03 | 1250
D | 2000F | HI11 | C022-03 | 1250
D | 2000F | HI12 | C022-03 | 1250
278 - Health Care Services Review Response Review
D | 2010C | DMG01 | - | 1250
D | 2010D | DMG01 | - | 1250
D | 2000E | DTP02 | - | 1250
D | 2000E | DTP02 | - | 1250
D | 2000E | DTP02 | - | 1250
D | 2000E | DTP02 | - | 1250
D | 2000E | DTP02 | - | 1250
D | 2000E | DTP02 | - | 1250
D | 2000E | DTP02 | - | 1250
D | 2000E | DTP02 | - | 1250
D | 2000E | DTP02 | - | 1250
D | 2000E | DTP02 | - | 1250
D | 2000E | HI01 | C022-03 | 1250
D | 2000E | HI02 | C022-03 | 1250
D | 2000E | HI03 | C022-03 | 1250
D | 2000E | HI04 | C022-03 | 1250
D | 2000E | HI05 | C022-03 | 1250
D | 2000E | HI06 | C022-03 | 1250
D | 2000E | HI07 | C022-03 | 1250
D | 2000E | HI08 | C022-03 | 1250
D | 2000E | HI09 | C022-03 | 1250
D | 2000E | HI10 | C022-03 | 1250
D | 2000E | HI11 | C022-03 | 1250
D | 2000E | HI12 | C022-03 | 1250
D | 2000E | CR603 | - | 1250
D | 2000F | DTP02 | - | 1250
D | 2000F | DTP02 | - | 1250
D | 2000F | DTP02 | - | 1250
D | 2000F | DTP02 | - | 1250
D | 2000F | HI01 | C022-03 | 1250
D | 2000F | HI02 | C022-03 | 1250
D | 2000F | HI03 | C022-03 | 1250
D | 2000F | HI04 | C022-03 | 1250
D | 2000F | HI05 | C022-03 | 1250
D | 2000F | HI06 | C022-03 | 1250
D | 2000F | HI07 | C022-03 | 1250
D | 2000F | HI08 | C022-03 | 1250
D | 2000F | HI09 | C022-03 | 1250
D | 2000F | HI10 | C022-03 | 1250
D | 2000F | HI11 | C022-03 | 1250
D | 2000F | HI12 | C022-03 | 1250
 
Date Time Qualifier
Code specifying the type of date or time or both date and time.
278 - Health Care Services Review Request
D | 2000E | DTP01 | - | 374
D | 2000E | DTP01 | - | 374
D | 2000E | DTP01 | - | 374
D | 2000E | DTP01 | - | 374
D | 2000E | DTP01 | - | 374
D | 2000E | DTP01 | - | 374
D | 2000E | DTP01 | - | 374
D | 2010EC | DTP01 | - | 374
D | 2000F | DTP01 | - | 374
D | 2000F | DRA09 | - | 374
278 - Health Care Services Review Response Review
D | 2000E | DTP01 | - | 374
D | 2000E | DTP01 | - | 374
D | 2000E | DTP01 | - | 374
D | 2000E | DTP01 | - | 374
D | 2000E | DTP01 | - | 374
D | 2000E | DTP01 | - | 374
D | 2000E | DTP01 | - | 374
D | 2000E | DTP01 | - | 374
D | 2000E | DTP01 | - | 374
D | 2000E | DTP01 | - | 374
D | 2000F | DTP01 | - | 374
D | 2000F | DTP01 | - | 374
D | 2000F | DTP01 | - | 374
D | 2000F | DTP01 | - | 374
D | 2000F | DRA09 | - | 374
 
Delay Reason Code
Code indicating the reason why a request was delayed.
278 - Health Care Services Review Request
D | 2000E | UM10 | - | 1514
 
Delivery Frequency Code
Code which specifies frequency by which services can be performed.
278 - Health Care Services Review Request
D | 2000E | HSD07 | - | 678
D | 2000F | HSD07 | - | 678
278 - Health Care Services Review Response Review
D | 2000E | HSD07 | - | 678
D | 2000F | HSD07 | - | 678
 
Delivery Pattern Time Code
Code which specifies the time delivery pattern of the services.
278 - Health Care Services Review Request
D | 2000E | HSD08 | - | 679
D | 2000F | HSD08 | - | 679
278 - Health Care Services Review Response Review
D | 2000E | HSD08 | - | 679
D | 2000F | HSD08 | - | 679
 
Demonstration Project Identifier
Identification number for a Medicare demonstration project.
278 - Health Care Services Review Request
D | 2000E | REF02 | - | 127
278 - Health Care Services Review Response Review
D | 2000E | REF02 | - | 127
 
Dependent Address Line
The street address of the patient.
278 - Health Care Services Review Request
D | 2010D | N301 | - | 166
D | 2010D | N302 | - | 166
278 - Health Care Services Review Response Review
D | 2010D | N301 | - | 166
D | 2010D | N302 | - | 166
 
Dependent Birth Date
The date of birth of the dependent.
278 - Health Care Services Review Request
D | 2010D | DMG02 | - | 1251
278 - Health Care Services Review Response Review
D | 2010D | DMG02 | - | 1251
 
Dependent City Name
The city name of the patient.
278 - Health Care Services Review Request
D | 2010D | N401 | - | 19
278 - Health Care Services Review Response Review
D | 2010D | N401 | - | 19
 
Dependent Country Code
Country code of the dependent.
278 - Health Care Services Review Request
D | 2010D | N404 | - | 26
278 - Health Care Services Review Response Review
D | 2010D | N404 | - | 26
 
Dependent Country Subdivision Code
The country subdivision code of the dependent.
278 - Health Care Services Review Request
D | 2010D | N407 | - | 1715
278 - Health Care Services Review Response Review
D | 2010D | N407 | - | 1715
 
Dependent First Name
The first name of the dependent.
278 - Health Care Services Review Request
D | 2010D | NM104 | - | 1036
278 - Health Care Services Review Response Review
D | 2010D | NM104 | - | 1036
 
Dependent Gender Code
A code indicating the gender of the dependent.
278 - Health Care Services Review Request
D | 2010D | DMG03 | - | 1068
278 - Health Care Services Review Response Review
D | 2010D | DMG03 | - | 1068
 
Dependent Last Name
The last name of the dependent.
278 - Health Care Services Review Request
D | 2010D | NM103 | - | 1035
278 - Health Care Services Review Response Review
D | 2010D | NM103 | - | 1035
 
Dependent Middle Name
The middle name of the dependent.
278 - Health Care Services Review Request
D | 2010D | NM105 | - | 1037
278 - Health Care Services Review Response Review
D | 2010D | NM105 | - | 1037
 
Dependent Name Suffix
A suffix following the name, including the generation of the patient, such as I, II, III, Jr, Sr.
278 - Health Care Services Review Request
D | 2010D | NM107 | - | 1039
278 - Health Care Services Review Response Review
D | 2010D | NM107 | - | 1039
 
Dependent Postal Zone or ZIP Code
The zip code of the dependent.
278 - Health Care Services Review Request
D | 2010D | N403 | - | 116
278 - Health Care Services Review Response Review
D | 2010D | N403 | - | 116
 
Dependent Primary Identifier
Identifies the code number by which the dependent is known.
278 - Health Care Services Review Response Review
D | 2010D | NM109 | - | 67
 
Dependent State Code
The state postal code of the dependent.
278 - Health Care Services Review Request
D | 2010D | N402 | - | 156
278 - Health Care Services Review Response Review
D | 2010D | N402 | - | 156
 
Dependent Supplemental Identifier
Identifies another or additional distinguishing code number associated with the dependent.
278 - Health Care Services Review Request
D | 2010D | REF02 | - | 127
278 - Health Care Services Review Response Review
D | 2010D | REF02 | - | 127
 
Description
A free-form description to clarify the related data elements and their content.
278 - Health Care Services Review Request
D | 2000F | SV307 | - | 352
 
Diagnosis Code
An ICD-9-CM Diagnosis Code identifying a diagnosed medical condition.
278 - Health Care Services Review Request
D | 2000E | HI01 | C022-02 | 1271
D | 2000E | HI02 | C022-02 | 1271
D | 2000E | HI03 | C022-02 | 1271
D | 2000E | HI04 | C022-02 | 1271
D | 2000E | HI05 | C022-02 | 1271
D | 2000E | HI06 | C022-02 | 1271
D | 2000E | HI07 | C022-02 | 1271
D | 2000E | HI08 | C022-02 | 1271
D | 2000E | HI09 | C022-02 | 1271
D | 2000E | HI10 | C022-02 | 1271
D | 2000E | HI11 | C022-02 | 1271
D | 2000E | HI12 | C022-02 | 1271
D | 2000F | HI01 | C022-02 | 1271
D | 2000F | HI02 | C022-02 | 1271
D | 2000F | HI03 | C022-02 | 1271
D | 2000F | HI04 | C022-02 | 1271
D | 2000F | HI05 | C022-02 | 1271
D | 2000F | HI06 | C022-02 | 1271
D | 2000F | HI07 | C022-02 | 1271
D | 2000F | HI08 | C022-02 | 1271
D | 2000F | HI09 | C022-02 | 1271
D | 2000F | HI10 | C022-02 | 1271
D | 2000F | HI11 | C022-02 | 1271
D | 2000F | HI12 | C022-02 | 1271
278 - Health Care Services Review Response Review
D | 2000E | HI01 | C022-02 | 1271
D | 2000E | HI02 | C022-02 | 1271
D | 2000E | HI03 | C022-02 | 1271
D | 2000E | HI04 | C022-02 | 1271
D | 2000E | HI05 | C022-02 | 1271
D | 2000E | HI06 | C022-02 | 1271
D | 2000E | HI07 | C022-02 | 1271
D | 2000E | HI08 | C022-02 | 1271
D | 2000E | HI09 | C022-02 | 1271
D | 2000E | HI10 | C022-02 | 1271
D | 2000E | HI11 | C022-02 | 1271
D | 2000E | HI12 | C022-02 | 1271
D | 2000F | HI01 | C022-02 | 1271
D | 2000F | HI02 | C022-02 | 1271
D | 2000F | HI03 | C022-02 | 1271
D | 2000F | HI04 | C022-02 | 1271
D | 2000F | HI05 | C022-02 | 1271
D | 2000F | HI06 | C022-02 | 1271
D | 2000F | HI07 | C022-02 | 1271
D | 2000F | HI08 | C022-02 | 1271
D | 2000F | HI09 | C022-02 | 1271
D | 2000F | HI10 | C022-02 | 1271
D | 2000F | HI11 | C022-02 | 1271
D | 2000F | HI12 | C022-02 | 1271
 
Diagnosis Code Pointer
A pointer to the claim diagnosis code in the order of importance to this service.
278 - Health Care Services Review Request
D | 2000F | SV107 | - | 1328
D | 2000F | SV311 | - | 1328
278 - Health Care Services Review Response Review
D | 2000F | SV107 | - | 1328
 
Diagnosis Date
Date the diagnosis was established or recorded.
278 - Health Care Services Review Request
D | 2000E | HI01 | C022-04 | 1251
D | 2000E | HI02 | C022-04 | 1251
D | 2000E | HI03 | C022-04 | 1251
D | 2000E | HI04 | C022-04 | 1251
D | 2000E | HI05 | C022-04 | 1251
D | 2000E | HI06 | C022-04 | 1251
D | 2000E | HI07 | C022-04 | 1251
D | 2000E | HI08 | C022-04 | 1251
D | 2000E | HI09 | C022-04 | 1251
D | 2000E | HI10 | C022-04 | 1251
D | 2000E | HI11 | C022-04 | 1251
D | 2000E | HI12 | C022-04 | 1251
D | 2000F | HI01 | C022-04 | 1251
D | 2000F | HI02 | C022-04 | 1251
D | 2000F | HI03 | C022-04 | 1251
D | 2000F | HI04 | C022-04 | 1251
D | 2000F | HI05 | C022-04 | 1251
D | 2000F | HI06 | C022-04 | 1251
D | 2000F | HI07 | C022-04 | 1251
D | 2000F | HI08 | C022-04 | 1251
D | 2000F | HI09 | C022-04 | 1251
D | 2000F | HI10 | C022-04 | 1251
D | 2000F | HI11 | C022-04 | 1251
D | 2000F | HI12 | C022-04 | 1251
278 - Health Care Services Review Response Review
D | 2000E | HI01 | C022-04 | 1251
D | 2000E | HI02 | C022-04 | 1251
D | 2000E | HI03 | C022-04 | 1251
D | 2000E | HI04 | C022-04 | 1251
D | 2000E | HI05 | C022-04 | 1251
D | 2000E | HI06 | C022-04 | 1251
D | 2000E | HI07 | C022-04 | 1251
D | 2000E | HI08 | C022-04 | 1251
D | 2000E | HI09 | C022-04 | 1251
D | 2000E | HI10 | C022-04 | 1251
D | 2000E | HI11 | C022-04 | 1251
D | 2000E | HI12 | C022-04 | 1251
D | 2000F | HI01 | C022-04 | 1251
D | 2000F | HI02 | C022-04 | 1251
D | 2000F | HI03 | C022-04 | 1251
D | 2000F | HI04 | C022-04 | 1251
D | 2000F | HI05 | C022-04 | 1251
D | 2000F | HI06 | C022-04 | 1251
D | 2000F | HI07 | C022-04 | 1251
D | 2000F | HI08 | C022-04 | 1251
D | 2000F | HI09 | C022-04 | 1251
D | 2000F | HI10 | C022-04 | 1251
D | 2000F | HI11 | C022-04 | 1251
D | 2000F | HI12 | C022-04 | 1251
 
Diagnosis Type Code
Code identifying the type of diagnosis.
278 - Health Care Services Review Request
D | 2000E | HI01 | C022-01 | 1270
D | 2000E | HI02 | C022-01 | 1270
D | 2000E | HI03 | C022-01 | 1270
D | 2000E | HI04 | C022-01 | 1270
D | 2000E | HI05 | C022-01 | 1270
D | 2000E | HI06 | C022-01 | 1270
D | 2000E | HI07 | C022-01 | 1270
D | 2000E | HI08 | C022-01 | 1270
D | 2000E | HI09 | C022-01 | 1270
D | 2000E | HI10 | C022-01 | 1270
D | 2000E | HI11 | C022-01 | 1270
D | 2000E | HI12 | C022-01 | 1270
D | 2000F | HI01 | C022-01 | 1270
D | 2000F | HI02 | C022-01 | 1270
D | 2000F | HI03 | C022-01 | 1270
D | 2000F | HI04 | C022-01 | 1270
D | 2000F | HI05 | C022-01 | 1270
D | 2000F | HI06 | C022-01 | 1270
D | 2000F | HI07 | C022-01 | 1270
D | 2000F | HI08 | C022-01 | 1270
D | 2000F | HI09 | C022-01 | 1270
D | 2000F | HI10 | C022-01 | 1270
D | 2000F | HI11 | C022-01 | 1270
D | 2000F | HI12 | C022-01 | 1270
278 - Health Care Services Review Response Review
D | 2000E | HI01 | C022-01 | 1270
D | 2000E | HI02 | C022-01 | 1270
D | 2000E | HI03 | C022-01 | 1270
D | 2000E | HI04 | C022-01 | 1270
D | 2000E | HI05 | C022-01 | 1270
D | 2000E | HI06 | C022-01 | 1270
D | 2000E | HI07 | C022-01 | 1270
D | 2000E | HI08 | C022-01 | 1270
D | 2000E | HI09 | C022-01 | 1270
D | 2000E | HI10 | C022-01 | 1270
D | 2000E | HI11 | C022-01 | 1270
D | 2000E | HI12 | C022-01 | 1270
D | 2000F | HI01 | C022-01 | 1270
D | 2000F | HI02 | C022-01 | 1270
D | 2000F | HI03 | C022-01 | 1270
D | 2000F | HI04 | C022-01 | 1270
D | 2000F | HI05 | C022-01 | 1270
D | 2000F | HI06 | C022-01 | 1270
D | 2000F | HI07 | C022-01 | 1270
D | 2000F | HI08 | C022-01 | 1270
D | 2000F | HI09 | C022-01 | 1270
D | 2000F | HI10 | C022-01 | 1270
D | 2000F | HI11 | C022-01 | 1270
D | 2000F | HI12 | C022-01 | 1270
 
Dosage Form Code
Code indicating the form in which the drug is dispensed.
278 - Health Care Services Review Request
D | 2000F | DRA14 | - | 1330
278 - Health Care Services Review Response Review
D | 2000F | DRA14 | - | 1330
 
Drug Authorization Question/Answer
Questions and Answers to determine medical necessity of a drug or drug therapy.
278 - Health Care Services Review Request
D | 2000F | DRA11 | - | 933
278 - Health Care Services Review Response Review
D | 2000F | DRA11 | - | 933
 
Drug Name
Self-contained, full drug name, strength and form.
278 - Health Care Services Review Request
D | 2000F | DRA01 | - | 352
278 - Health Care Services Review Response Review
D | 2000F | DRA01 | - | 352
 
Drug Therapy Type
Type of therapy for treatment of the condition.
278 - Health Care Services Review Request
D | 2000F | DRA02 | - | 1322
278 - Health Care Services Review Response Review
D | 2000F | DRA02 | - | 1322
 
EPSDT Indicator
An indicator of whether or not Early and Periodic Screening for Diagnosis and Treatment of children services are involved with this detail line.
278 - Health Care Services Review Request
D | 2000F | SV111 | - | 1073
278 - Health Care Services Review Response Review
D | 2000F | SV111 | - | 1073
 
ESRD Certification Date
Date on which the patient was certified to have End Stage Renal Disease.
278 - Health Care Services Review Request
D | 2000F | DRA10 | - | 373
278 - Health Care Services Review Response Review
D | 2000F | DRA10 | - | 373
 
ESRD Indicator
Code specifying whether a patient has been certified to have End Stage Renal Disease.
278 - Health Care Services Review Request
D | 2000F | DRA08 | - | 1073
278 - Health Care Services Review Response Review
D | 2000F | DRA08 | - | 1073
 
Employment Status Code
A code used to define the employment status of the individual covered by this insurance payer.
278 - Health Care Services Review Request
D | 2010C | INS08 | - | 584
278 - Health Care Services Review Response Review
D | 2010C | INS08 | - | 584
 
Entity Identifier Code
Code identifying an organizational entity, a physical location, property or an individual.
278 - Health Care Services Review Request
D | 2010A | NM101 | - | 98
D | 2010B | NM101 | - | 98
D | 2010C | NM101 | - | 98
D | 2010D | NM101 | - | 98
D | 2010EA | NM101 | - | 98
D | 2010EB | NM101 | - | 98
D | 2010EC | NM101 | - | 98
D | 2010F | NM101 | - | 98
278 - Health Care Services Review Response Review
D | 2010A | NM101 | - | 98
D | 2010B | NM101 | - | 98
D | 2010C | NM101 | - | 98
D | 2010D | NM101 | - | 98
D | 2010EA | NM101 | - | 98
D | 2010EB | NM101 | - | 98
D | 2010EC | NM101 | - | 98
D | 2010FA | NM101 | - | 98
D | 2010FB | NM101 | - | 98
 
Entity Type Qualifier
Code qualifying the type of entity.
278 - Health Care Services Review Request
D | 2010A | NM102 | - | 1065
D | 2010B | NM102 | - | 1065
D | 2010C | NM102 | - | 1065
D | 2010D | NM102 | - | 1065
D | 2010EA | NM102 | - | 1065
D | 2010EB | NM102 | - | 1065
D | 2010EC | NM102 | - | 1065
D | 2010F | NM102 | - | 1065
278 - Health Care Services Review Response Review
D | 2010A | NM102 | - | 1065
D | 2010B | NM102 | - | 1065
D | 2010C | NM102 | - | 1065
D | 2010D | NM102 | - | 1065
D | 2010EA | NM102 | - | 1065
D | 2010EB | NM102 | - | 1065
D | 2010EC | NM102 | - | 1065
D | 2010FA | NM102 | - | 1065
D | 2010FB | NM102 | - | 1065
 
Equipment Reason Description
Free-form description of the reason for the equipment.
278 - Health Care Services Review Request
D | 2000E | CR505 | - | 352
 
Estimated Birth Date
Date delivery is expected.
278 - Health Care Services Review Request
D | 2000E | DTP03 | - | 1251
278 - Health Care Services Review Response Review
D | 2000E | DTP03 | - | 1251
 
Facility Code Qualifier
Code identifying the type of facility referenced.
278 - Health Care Services Review Request
D | 2000E | UM04 | C023-02 | 1332
D | 2000F | UM04 | C023-02 | 1332
278 - Health Care Services Review Response Review
D | 2000E | UM04 | C023-02 | 1332
D | 2000F | UM04 | C023-02 | 1332
 
Facility Type Code
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.
278 - Health Care Services Review Request
D | 2000E | UM04 | C023-01 | 1331
D | 2000F | UM04 | C023-01 | 1331
278 - Health Care Services Review Response Review
D | 2000E | UM04 | C023-01 | 1331
D | 2000F | UM04 | C023-01 | 1331
 
Follow-up Action Code
Code identifying follow-up actions allowed.
278 - Health Care Services Review Response Review
D | 2000A | AAA04 | - | 889
D | 2010A | AAA04 | - | 889
D | 2010B | AAA04 | - | 889
D | 2010C | AAA04 | - | 889
D | 2010D | AAA04 | - | 889
D | 2000E | AAA04 | - | 889
D | 2010EA | AAA04 | - | 889
D | 2010EC | AAA04 | - | 889
D | 2000F | AAA04 | - | 889
D | 2010FA | AAA04 | - | 889
 
Free Form Message Text
Text used to convey information related to the transaction.
278 - Health Care Services Review Request
D | 2000E | MSG01 | - | 933
D | 2000F | MSG01 | - | 933
278 - Health Care Services Review Response Review
D | 2000E | MSG01 | - | 933
D | 2000F | MSG01 | - | 933
 
Hierarchical Child Code
Code indicating if there are hierarchical child data segments subordinate to the level being described.
278 - Health Care Services Review Request
D | 2000A | HL04 | - | 736
D | 2000B | HL04 | - | 736
D | 2000C | HL04 | - | 736
D | 2000D | HL04 | - | 736
D | 2000E | HL04 | - | 736
D | 2000F | HL04 | - | 736
278 - Health Care Services Review Response Review
D | 2000A | HL04 | - | 736
D | 2000B | HL04 | - | 736
D | 2000C | HL04 | - | 736
D | 2000D | HL04 | - | 736
D | 2000E | HL04 | - | 736
D | 2000F | HL04 | - | 736
 
Hierarchical ID Number
A unique number assigned by the sender to identify a particular data segment in a hierarchical structure.
278 - Health Care Services Review Request
D | 2000A | HL01 | - | 628
D | 2000B | HL01 | - | 628
D | 2000C | HL01 | - | 628
D | 2000D | HL01 | - | 628
D | 2000E | HL01 | - | 628
D | 2000F | HL01 | - | 628
278 - Health Care Services Review Response Review
D | 2000A | HL01 | - | 628
D | 2000B | HL01 | - | 628
D | 2000C | HL01 | - | 628
D | 2000D | HL01 | - | 628
D | 2000E | HL01 | - | 628
D | 2000F | HL01 | - | 628
 
Hierarchical Level Code
Code defining the characteristic of a level in a hierarchical structure.
278 - Health Care Services Review Request
D | 2000A | HL03 | - | 735
D | 2000B | HL03 | - | 735
D | 2000C | HL03 | - | 735
D | 2000D | HL03 | - | 735
D | 2000E | HL03 | - | 735
D | 2000F | HL03 | - | 735
278 - Health Care Services Review Response Review
D | 2000A | HL03 | - | 735
D | 2000B | HL03 | - | 735
D | 2000C | HL03 | - | 735
D | 2000D | HL03 | - | 735
D | 2000E | HL03 | - | 735
D | 2000F | HL03 | - | 735
 
Hierarchical Parent ID Number
Identification number of the next higher hierarchical data segment that the data segment being described is subordinate to.
278 - Health Care Services Review Request
D | 2000B | HL02 | - | 734
D | 2000C | HL02 | - | 734
D | 2000D | HL02 | - | 734
D | 2000E | HL02 | - | 734
D | 2000F | HL02 | - | 734
278 - Health Care Services Review Response Review
D | 2000B | HL02 | - | 734
D | 2000C | HL02 | - | 734
D | 2000D | HL02 | - | 734
D | 2000E | HL02 | - | 734
D | 2000F | HL02 | - | 734
 
Hierarchical Structure Code
Code indicating the hierarchical application structure of a transaction set that utilizes the HL segment to define the structure of the transaction set
278 - Health Care Services Review Request
H | | BHT01 | - | 1005
278 - Health Care Services Review Response Review
H | | BHT01 | - | 1005
 
Home Health Certification Period
Certification period for home health care covered by this plan of treatment.
278 - Health Care Services Review Request
D | 2000E | CR604 | - | 1251
278 - Health Care Services Review Response Review
D | 2000E | CR604 | - | 1251
 
Home Health Start Date
Date Home Health services are scheduled or are anticipated to start.
278 - Health Care Services Review Request
D | 2000E | CR602 | - | 373
278 - Health Care Services Review Response Review
D | 2000E | CR602 | - | 373
 
Identification Code Qualifier
Code designating the system/method of code structure used for Identification Code (67).
278 - Health Care Services Review Request
D | 2010A | NM108 | - | 66
D | 2010B | NM108 | - | 66
D | 2010C | NM108 | - | 66
D | 2000E | PWK05 | - | 66
D | 2010EA | NM108 | - | 66
D | 2000F | PWK05 | - | 66
D | 2010F | NM108 | - | 66
278 - Health Care Services Review Response Review
D | 2010A | NM108 | - | 66
D | 2010B | NM108 | - | 66
D | 2010C | NM108 | - | 66
D | 2010D | NM108 | - | 66
D | 2000E | PWK05 | - | 66
D | 2010EA | NM108 | - | 66
D | 2010EB | NM108 | - | 66
D | 2000F | PWK05 | - | 66
D | 2010FA | NM108 | - | 66
D | 2010FB | NM108 | - | 66
 
Implant Date
Date of the surgical implant
278 - Health Care Services Review Request
D | 2000F | CR804 | - | 373
278 - Health Care Services Review Response Review
D | 2000F | CR804 | - | 373
 
Implant Leads Remain in Patient Indicator
NEED DEFINITION.
278 - Health Care Services Review Request
D | 2000F | CR808 | - | 1073
 
Implant Status Code
Code identifying the status of implant components
278 - Health Care Services Review Request
D | 2000F | CR802 | - | 1404
278 - Health Care Services Review Response Review
D | 2000F | CR802 | - | 1404
 
Implant Type Code
Code identifying implant components
278 - Health Care Services Review Request
D | 2000F | CR801 | - | 1403
278 - Health Care Services Review Response Review
D | 2000F | CR801 | - | 1403
 
Implementation Guide Version Name
Name of the referenced implementation guide version.
278 - Health Care Services Review Request
H | | ST03 | - | 1705
278 - Health Care Services Review Response Review
H | | ST03 | - | 1705
 
Individual Relationship Code
Code indicating the relationship between two individuals or entities.
278 - Health Care Services Review Request
D | 2010C | INS02 | - | 1069
D | 2010D | INS02 | - | 1069
278 - Health Care Services Review Response Review
D | 2010C | INS02 | - | 1069
D | 2010D | INS02 | - | 1069
 
Insured Indicator
Indicates whether the insured is the subscriber or a dependent.
278 - Health Care Services Review Request
D | 2010C | INS01 | - | 1073
D | 2010D | INS01 | - | 1073
278 - Health Care Services Review Response Review
D | 2010C | INS01 | - | 1073
D | 2010D | INS01 | - | 1073
 
LOINC Code
Logical Observation Identifier Names and Codes (LOINC) codes.
278 - Health Care Services Review Response Review
D | 2000F | HI01 | C022-02 | 1271
D | 2000F | HI02 | C022-02 | 1271
D | 2000F | HI03 | C022-02 | 1271
D | 2000F | HI04 | C022-02 | 1271
D | 2000F | HI05 | C022-02 | 1271
D | 2000F | HI06 | C022-02 | 1271
D | 2000F | HI07 | C022-02 | 1271
D | 2000F | HI08 | C022-02 | 1271
D | 2000F | HI09 | C022-02 | 1271
D | 2000F | HI10 | C022-02 | 1271
D | 2000F | HI11 | C022-02 | 1271
D | 2000F | HI12 | C022-02 | 1271
 
Last Admission Period
Admission date of the most recent inpatient stay.
278 - Health Care Services Review Request
D | 2000E | CR616 | - | 1251
 
Last Menstrual Period Date
The date of the last menstrual period (LMP).
278 - Health Care Services Review Request
D | 2000E | DTP03 | - | 1251
278 - Health Care Services Review Response Review
D | 2000E | DTP03 | - | 1251
 
Last Visit Date
Date the patient was last seen by the physician.
278 - Health Care Services Review Request
D | 2000E | CR613 | - | 373
 
Level of Service Code
Code specifying the level of service rendered.
278 - Health Care Services Review Request
D | 2000E | UM06 | - | 1338
278 - Health Care Services Review Response Review
D | 2000E | UM06 | - | 1338
 
License Number State Code
The State Postal Code of a jurisdiction-assigned license number.
278 - Health Care Services Review Request
D | 2010EA | REF03 | - | 352
D | 2010F | REF03 | - | 352
278 - Health Care Services Review Response Review
D | 2010EA | REF03 | - | 352
D | 2010FA | REF03 | - | 352
 
Location Category Code
The type of facility or place identifying where the patient will be transported to, or from.
278 - Health Care Services Review Request
D | 2010EB | NM111 | - | 98
278 - Health Care Services Review Response Review
D | 2010EC | NM111 | - | 98
 
Manufacturer Identification
Identification number for the manufacturer.
278 - Health Care Services Review Request
D | 2000F | CR805 | - | 127
278 - Health Care Services Review Response Review
D | 2000F | CR805 | - | 127
 
Medicare Coverage Indicator
A code indicating the Medicare coverage exists.
278 - Health Care Services Review Request
D | 2000E | CR607 | - | 1073
278 - Health Care Services Review Response Review
D | 2000E | CR607 | - | 1073
 
Model Number
Model identifier assigned by the manufacturer.
278 - Health Care Services Review Request
D | 2000F | CR806 | - | 127
278 - Health Care Services Review Response Review
D | 2000F | CR806 | - | 127
 
National Drug Code or Device Identifier of the Unique Device Identifier
The national drug identification number assigned by the Food and Drug Administration (FDA), or the unique product identification number or Device Identifier of the Unique Device Identifier that unambiguously identifies a medical/surgical device.
278 - Health Care Services Review Request
D | 2000F | DRA03 | C003-02 | 234
278 - Health Care Services Review Response Review
D | 2000F | DRA03 | C003-02 | 234
 
National Drug Unit Count
The dispensing quantity, based upon the unit of measure as defined by the National Drug Code.
278 - Health Care Services Review Request
D | 2000F | DRA05 | - | 380
278 - Health Care Services Review Response Review
D | 2000F | DRA05 | - | 380
 
Nursing Home Level of Care
Code specifying the level of care provided by a nursing home facility.
278 - Health Care Services Review Request
D | 2000F | SV120 | - | 1337
D | 2000F | SV210 | - | 1337
278 - Health Care Services Review Response Review
D | 2000F | SV120 | - | 1337
D | 2000F | SV210 | - | 1337
 
Nursing Home Residential Status Code
Code specifying the status of a nursing home resident at the time of service.
278 - Health Care Services Review Request
D | 2000E | CL104 | - | 1345
D | 2000F | SV209 | - | 1345
 
Onset Date
Date of onset of indicated patient condition.
278 - Health Care Services Review Request
D | 2000E | DTP03 | - | 1251
278 - Health Care Services Review Response Review
D | 2000E | DTP03 | - | 1251
 
Oral Cavity Designation Code
Code identifying an oral cavity involved in the service.
278 - Health Care Services Review Request
D | 2000F | SV304 | C006-01 | 1361
D | 2000F | SV304 | C006-02 | 1361
D | 2000F | SV304 | C006-03 | 1361
D | 2000F | SV304 | C006-04 | 1361
D | 2000F | SV304 | C006-05 | 1361
278 - Health Care Services Review Response Review
D | 2000F | SV304 | C006-01 | 1361
D | 2000F | SV304 | C006-02 | 1361
D | 2000F | SV304 | C006-03 | 1361
D | 2000F | SV304 | C006-04 | 1361
D | 2000F | SV304 | C006-05 | 1361
 
Other UMO Denial Date
Date the other UMO denied the authorization request.
278 - Health Care Services Review Request
D | 2010EC | DTP03 | - | 1251
 
Other UMO Denial Reason
Reason code for why the other UMO denied the authorization request.
278 - Health Care Services Review Request
D | 2010EC | REF02 | - | 127
D | 2010EC | REF04 | C040-02 | 127
D | 2010EC | REF04 | C040-04 | 127
 
Other UMO Name
Name of other UMO.
278 - Health Care Services Review Request
D | 2010EC | NM103 | - | 1035
 
Oxygen Delivery System Code
Code to indicate if a particular form of delivery was prescribed.
278 - Health Care Services Review Request
D | 2000E | CR517 | - | 1382
278 - Health Care Services Review Response Review
D | 2000E | CR517 | - | 1382
 
Oxygen Equipment Type Code
Code indicating the specific type of equipment prescribed for the delivery of oxygen.
278 - Health Care Services Review Request
D | 2000E | CR503 | - | 1348
D | 2000E | CR504 | - | 1348
D | 2000E | CR518 | - | 1348
278 - Health Care Services Review Response Review
D | 2000E | CR503 | - | 1348
D | 2000E | CR504 | - | 1348
D | 2000E | CR518 | - | 1348
 
Oxygen Flow Rate
The oxygen flow rate in liters per minute.
278 - Health Care Services Review Request
D | 2000E | CR506 | - | 380
278 - Health Care Services Review Response Review
D | 2000E | CR506 | - | 380
 
Oxygen Saturation Quantity
The oxygen saturation (oximetry) test results.
278 - Health Care Services Review Request
D | 2000E | CR511 | - | 380
 
Oxygen Test Condition Code
Code indicating the conditions under which a patient was tested.
278 - Health Care Services Review Request
D | 2000E | CR512 | - | 1349
 
Oxygen Test Findings Code
Code indicating the findings of oxygen tests performed on a patient.
278 - Health Care Services Review Request
D | 2000E | CR513 | - | 1350
D | 2000E | CR514 | - | 1350
D | 2000E | CR515 | - | 1350
 
Oxygen Use Period Hour Count
Number of hours per period of oxygen use.
278 - Health Care Services Review Request
D | 2000E | CR508 | - | 380
278 - Health Care Services Review Response Review
D | 2000E | CR508 | - | 380
 
Pacemaker Returned to Manufacturer Indicator
NEED DEFINITION.
278 - Health Care Services Review Request
D | 2000F | CR809 | - | 1073
 
Patient Condition Code
Code indicating the condition of the patient.
278 - Health Care Services Review Request
D | 2000E | CR208 | - | 1342
 
Patient Condition Description
Free-form description of the patient's condition.
278 - Health Care Services Review Request
D | 2000E | CR210 | - | 352
D | 2000E | CR211 | - | 352
 
Patient Event Provider Address Line
Address line in the mailing address of the provider to whom the patient has been or will be referred for this patient event.
278 - Health Care Services Review Request
D | 2010EA | N301 | - | 166
D | 2010EA | N302 | - | 166
278 - Health Care Services Review Response Review
D | 2010EA | N301 | - | 166
D | 2010EA | N302 | - | 166
 
Patient Event Provider City Name
Name of the city in the mailing address of the provider to whom the patient has been or will be referred for this patient event.
278 - Health Care Services Review Request
D | 2010EA | N401 | - | 19
278 - Health Care Services Review Response Review
D | 2010EA | N401 | - | 19
 
Patient Event Provider Contact Communications Number
Complete patient event provider contact communications number, including country or area code when applicable.
278 - Health Care Services Review Request
D | 2010EA | PER04 | - | 364
D | 2010EA | PER06 | - | 364
D | 2010EA | PER08 | - | 364
278 - Health Care Services Review Response Review
D | 2010EA | PER04 | - | 364
D | 2010EA | PER06 | - | 364
D | 2010EA | PER08 | - | 364
 
Patient Event Provider Contact Name
Name of the person, group, or organization to contact at the entity where the patient event has or will occur.
278 - Health Care Services Review Request
D | 2010EA | PER02 | - | 93
278 - Health Care Services Review Response Review
D | 2010EA | PER02 | - | 93
 
Patient Event Provider Country Code
Code indicating the country in the mailing address of the provider to whom the patient has been or will be referred for the patient event.
278 - Health Care Services Review Request
D | 2010EA | N404 | - | 26
278 - Health Care Services Review Response Review
D | 2010EA | N404 | - | 26
 
Patient Event Provider Country Subdivision Code
The country subdivision code of the patient event provider.
278 - Health Care Services Review Request
D | 2010EA | N407 | - | 1715
278 - Health Care Services Review Response Review
D | 2010EA | N407 | - | 1715
 
Patient Event Provider First Name
First name of the provider to whom the patient has been or will be referred for the patient event.
278 - Health Care Services Review Request
D | 2010EA | NM104 | - | 1036
278 - Health Care Services Review Response Review
D | 2010EA | NM104 | - | 1036
 
Patient Event Provider Identifier
Code uniquely identifying the provider to whom the patient has been or will be referred for the patient event.
278 - Health Care Services Review Request
D | 2010EA | NM109 | - | 67
278 - Health Care Services Review Response Review
D | 2010EA | NM109 | - | 67
 
Patient Event Provider Last or Organization Name
Last name or organization name of the provider to whom the patient has been or will be referred for the patient event.
278 - Health Care Services Review Request
D | 2010EA | NM103 | - | 1035
278 - Health Care Services Review Response Review
D | 2010EA | NM103 | - | 1035
 
Patient Event Provider Middle Name
Middle name or middle initial name of the provider to whom the patient has been or will be referred for the patient event.
278 - Health Care Services Review Request
D | 2010EA | NM105 | - | 1037
278 - Health Care Services Review Response Review
D | 2010EA | NM105 | - | 1037
 
Patient Event Provider Name Suffix
Suffix to the name of the provider to whom the patient has been or will be referred for the patient event.
278 - Health Care Services Review Request
D | 2010EA | NM107 | - | 1039
278 - Health Care Services Review Response Review
D | 2010EA | NM107 | - | 1039
 
Patient Event Provider Postal Zone or ZIP Code
Code indicating the postal code in the mailing address of the provider to whom the patient has been or will be referred for the patient event.
278 - Health Care Services Review Request
D | 2010EA | N403 | - | 116
278 - Health Care Services Review Response Review
D | 2010EA | N403 | - | 116
 
Patient Event Provider State Code
Code indicating the state or province in the mailing address of the provider to whom the patient has been or will be referred for the patient event.
278 - Health Care Services Review Request
D | 2010EA | N402 | - | 156
278 - Health Care Services Review Response Review
D | 2010EA | N402 | - | 156
 
Patient Event Provider Supplemental Identifier
Supplemental identification information about the provider to whom the patient has been or will be referred for the patient event.
278 - Health Care Services Review Request
D | 2010EA | REF02 | - | 127
278 - Health Care Services Review Response Review
D | 2010EA | REF02 | - | 127
 
Patient Event Trace Number
Unique number assigned by the provider to identify the patient event for reconciliation of the response to an internal system.
278 - Health Care Services Review Request
D | 2000E | TRN02 | - | 127
278 - Health Care Services Review Response Review
D | 2000E | TRN02 | - | 127
 
Patient Event Transport Country Code
Country Code from which the patient is being transported or the country code to which the patient is being transported.
278 - Health Care Services Review Request
D | 2010EB | N404 | - | 26
D | 2010F | N408 | - | 1702
278 - Health Care Services Review Response Review
D | 2010EC | N404 | - | 26
 
Patient Event Transport Location Address Line
Street address from which the patient is being transported or the street address to which the patient is being transported.
278 - Health Care Services Review Request
D | 2010EB | N301 | - | 166
D | 2010EB | N302 | - | 166
278 - Health Care Services Review Response Review
D | 2010EC | N301 | - | 166
D | 2010EC | N302 | - | 166
 
Patient Event Transport Location City Name
City from which the patient is being transported or the city to which the patient is being transported.
278 - Health Care Services Review Request
D | 2010EB | N401 | - | 19
278 - Health Care Services Review Response Review
D | 2010EC | N401 | - | 19
 
Patient Event Transport Location Name
Name of location for which the patient is being transported.
278 - Health Care Services Review Request
D | 2010EB | NM103 | - | 1035
278 - Health Care Services Review Response Review
D | 2010EC | NM103 | - | 1035
 
Patient Event Transport Location Postal Zone or ZIP Code
Zip Code from which the patient is being transported or the Zip Code to which the patient is being transported.
278 - Health Care Services Review Request
D | 2010EB | N403 | - | 116
278 - Health Care Services Review Response Review
D | 2010EC | N403 | - | 116
 
Patient Event Transport Location State or Province Code
State Postal Code or Province Code from which the patient is being transported or the State Postal Code or Province Code to which the patient is being transported.
278 - Health Care Services Review Request
D | 2010EB | N402 | - | 156
278 - Health Care Services Review Response Review
D | 2010EC | N402 | - | 156
 
Patient Location Code
Code identifying the location where the patient receives medical treatment.
278 - Health Care Services Review Request
D | 2000E | CR617 | - | 1384
 
Patient Status Code
A code indicating the patient's status at the date of admission, outpatient service, or start of care.
278 - Health Care Services Review Response Review
D | 2000E | CL103 | - | 1352
 
Patient Weight
Weight of the patient at time of treatment or transport.
278 - Health Care Services Review Request
D | 2000E | CR102 | - | 81
 
Period Count
Total number of periods.
278 - Health Care Services Review Request
D | 2000E | HSD06 | - | 616
D | 2000F | HSD06 | - | 616
278 - Health Care Services Review Response Review
D | 2000E | HSD06 | - | 616
D | 2000F | HSD06 | - | 616
 
Physician Contact Date
Date of the home health agency's most recent contact with the physician.
278 - Health Care Services Review Request
D | 2000E | CR614 | - | 373
 
Physician Order Date
Date the agency received the verbal orders from the physician for start of care.
278 - Health Care Services Review Request
D | 2000E | CR612 | - | 373
 
Portable Oxygen System Flow Rate
Oxygen flow rate for a portable oxygen system in liters per minute.
278 - Health Care Services Review Request
D | 2000E | CR516 | - | 380
278 - Health Care Services Review Response Review
D | 2000E | CR516 | - | 380
 
Pre-Defined Question Indicator
An indicator that provides the question from a predefined set of questions.
278 - Health Care Services Review Request
D | 2000F | DRA13 | C060-01 | 350
278 - Health Care Services Review Response Review
D | 2000F | DRA13 | C060-01 | 350
 
Pre-Defined Question Response
A response that provides the answer to a predefined question.
278 - Health Care Services Review Request
D | 2000F | DRA13 | C060-02 | 1073
278 - Health Care Services Review Response Review
D | 2000F | DRA13 | C060-02 | 1073
 
Previous Administrative Reference Number
Unique reference number previously assigned by the UMO to this service review.
278 - Health Care Services Review Request
D | 2000E | REF02 | - | 127
D | 2000F | REF02 | - | 127
 
Previous Review Authorization Number
Unique authorization number previously assigned by the UMO to this service review.
278 - Health Care Services Review Request
D | 2000E | REF02 | - | 127
D | 2000F | REF02 | - | 127
278 - Health Care Services Review Response Review
D | 2000E | REF02 | - | 127
D | 2000F | REF02 | - | 127
 
Procedure Code
Code identifying the procedure, product or service.
278 - Health Care Services Review Request
D | 2000F | SV101 | C003-02 | 234
D | 2000F | SV101 | C003-08 | 234
D | 2000F | SV202 | C003-02 | 234
D | 2000F | SV202 | C003-08 | 234
D | 2000F | SV301 | C003-02 | 234
D | 2000F | SV301 | C003-08 | 234
278 - Health Care Services Review Response Review
D | 2000F | SV101 | C003-02 | 234
D | 2000F | SV101 | C003-08 | 234
D | 2000F | SV202 | C003-02 | 234
D | 2000F | SV202 | C003-08 | 234
D | 2000F | SV301 | C003-02 | 234
D | 2000F | SV301 | C003-08 | 234
 
Procedure Code Description
Description clarifying the Product/Service Procedure Code and related data elements.
278 - Health Care Services Review Request
D | 2000F | SV101 | C003-07 | 352
D | 2000F | SV202 | C003-07 | 352
D | 2000F | SV301 | C003-07 | 352
278 - Health Care Services Review Response Review
D | 2000F | SV101 | C003-07 | 352
D | 2000F | SV202 | C003-07 | 352
D | 2000F | SV301 | C003-07 | 352
 
Procedure Modifier
This identifies special circumstances related to the performance of the service.
278 - Health Care Services Review Request
D | 2000F | SV101 | C003-03 | 1339
D | 2000F | SV101 | C003-04 | 1339
D | 2000F | SV101 | C003-05 | 1339
D | 2000F | SV101 | C003-06 | 1339
D | 2000F | SV101 | C003-09 | 1339
D | 2000F | SV101 | C003-10 | 1339
D | 2000F | SV101 | C003-11 | 1339
D | 2000F | SV101 | C003-12 | 1339
D | 2000F | SV202 | C003-03 | 1339
D | 2000F | SV202 | C003-04 | 1339
D | 2000F | SV202 | C003-05 | 1339
D | 2000F | SV202 | C003-06 | 1339
D | 2000F | SV202 | C003-09 | 1339
D | 2000F | SV202 | C003-10 | 1339
D | 2000F | SV202 | C003-11 | 1339
D | 2000F | SV202 | C003-12 | 1339
D | 2000F | SV301 | C003-03 | 1339
D | 2000F | SV301 | C003-04 | 1339
D | 2000F | SV301 | C003-05 | 1339
D | 2000F | SV301 | C003-06 | 1339
D | 2000F | SV301 | C003-09 | 1339
D | 2000F | SV301 | C003-10 | 1339
D | 2000F | SV301 | C003-11 | 1339
D | 2000F | SV301 | C003-12 | 1339
278 - Health Care Services Review Response Review
D | 2000F | SV101 | C003-03 | 1339
D | 2000F | SV101 | C003-04 | 1339
D | 2000F | SV101 | C003-05 | 1339
D | 2000F | SV101 | C003-06 | 1339
D | 2000F | SV101 | C003-09 | 1339
D | 2000F | SV101 | C003-10 | 1339
D | 2000F | SV101 | C003-11 | 1339
D | 2000F | SV101 | C003-12 | 1339
D | 2000F | SV202 | C003-03 | 1339
D | 2000F | SV202 | C003-04 | 1339
D | 2000F | SV202 | C003-05 | 1339
D | 2000F | SV202 | C003-06 | 1339
D | 2000F | SV202 | C003-09 | 1339
D | 2000F | SV202 | C003-10 | 1339
D | 2000F | SV202 | C003-11 | 1339
D | 2000F | SV202 | C003-12 | 1339
D | 2000F | SV301 | C003-03 | 1339
D | 2000F | SV301 | C003-04 | 1339
D | 2000F | SV301 | C003-05 | 1339
D | 2000F | SV301 | C003-06 | 1339
D | 2000F | SV301 | C003-09 | 1339
D | 2000F | SV301 | C003-10 | 1339
D | 2000F | SV301 | C003-11 | 1339
D | 2000F | SV301 | C003-12 | 1339
 
Product or Service ID Qualifier
Code identifying the type/source of the descriptive number used in Product/Service ID (234).
278 - Health Care Services Review Request
D | 2000E | CR610 | - | 235
D | 2000F | SV101 | C003-01 | 235
D | 2000F | SV202 | C003-01 | 235
D | 2000F | SV301 | C003-01 | 235
D | 2000F | DRA03 | C003-01 | 235
278 - Health Care Services Review Response Review
D | 2000F | SV101 | C003-01 | 235
D | 2000F | SV202 | C003-01 | 235
D | 2000F | SV301 | C003-01 | 235
D | 2000F | DRA03 | C003-01 | 235
 
Prognosis Code
Code indicating physician's prognosis for the patient.
278 - Health Care Services Review Request
D | 2000E | UM08 | - | 923
D | 2000E | CR601 | - | 923
278 - Health Care Services Review Response Review
D | 2000E | CR601 | - | 923
 
Proposed or Actual Admission Date
Requested or actual date of admission to a healthcare facility.
278 - Health Care Services Review Request
D | 2000E | DTP03 | - | 1251
278 - Health Care Services Review Response Review
D | 2000E | DTP03 | - | 1251
 
Proposed or Actual Discharge Date
Requested or actual date of discharge from a healthcare facility.
278 - Health Care Services Review Request
D | 2000E | DTP03 | - | 1251
278 - Health Care Services Review Response Review
D | 2000E | DTP03 | - | 1251
 
Proposed or Actual Event Date
Requested or actual date of the patient event.
278 - Health Care Services Review Request
D | 2000E | DTP03 | - | 1251
278 - Health Care Services Review Response Review
D | 2000E | DTP03 | - | 1251
 
Proposed or Actual Service Date
Requested or actual date of service.
278 - Health Care Services Review Request
D | 2000F | DTP03 | - | 1251
278 - Health Care Services Review Response Review
D | 2000F | DTP03 | - | 1251
 
Prosthesis, Crown, or Inlay Code
Code Specifying the Placement Status for the Dental Work.
278 - Health Care Services Review Request
D | 2000F | SV305 | - | 1358
278 - Health Care Services Review Response Review
D | 2000F | SV305 | - | 1358
 
Provider Code
Code identifying the type of provider.
278 - Health Care Services Review Request
D | 2010B | PRV01 | - | 1221
D | 2010EA | PRV01 | - | 1221
D | 2010F | PRV01 | - | 1221
278 - Health Care Services Review Response Review
D | 2010B | PRV01 | - | 1221
D | 2010EA | PRV01 | - | 1221
D | 2010FA | PRV01 | - | 1221
 
Provider Taxonomy Code
Code designating the provider type, classification, and specialization.
278 - Health Care Services Review Request
D | 2010B | PRV03 | - | 127
D | 2010EA | PRV03 | - | 127
D | 2010F | PRV03 | - | 127
278 - Health Care Services Review Response Review
D | 2010B | PRV03 | - | 127
D | 2010EA | PRV03 | - | 127
D | 2010FA | PRV03 | - | 127
 
Quantity
Numeric value of quantity.
278 - Health Care Services Review Request
D | 2000F | DRA12 | - | 380
278 - Health Care Services Review Response Review
D | 2000F | DRA12 | - | 380
 
Quantity Qualifier
Code specifying the type of quantity.
278 - Health Care Services Review Request
D | 2000E | HSD01 | - | 673
D | 2000F | HSD01 | - | 673
278 - Health Care Services Review Response Review
D | 2000E | HSD01 | - | 673
D | 2000F | HSD01 | - | 673
 
Reference Identification
The identification value assigned by the sender for this particular transaction.
278 - Health Care Services Review Request
D | 2010EC | REF04 | C040-06 | 127
 
Reference Identification Qualifier
Code qualifying the reference identification.
278 - Health Care Services Review Request
D | 2010B | REF01 | - | 128
D | 2010B | PRV02 | - | 128
D | 2010C | REF01 | - | 128
D | 2010D | REF01 | - | 128
D | 2000E | REF01 | - | 128
D | 2000E | REF01 | - | 128
D | 2000E | REF01 | - | 128
D | 2010EA | REF01 | - | 128
D | 2010EA | PRV02 | - | 128
D | 2010EC | REF01 | - | 128
D | 2010EC | REF04 | C040-01 | 128
D | 2010EC | REF04 | C040-03 | 128
D | 2010EC | REF04 | C040-05 | 128
D | 2000F | REF01 | - | 128
D | 2000F | REF01 | - | 128
D | 2010F | REF01 | - | 128
D | 2010F | PRV02 | - | 128
278 - Health Care Services Review Response Review
D | 2010B | REF01 | - | 128
D | 2010B | PRV02 | - | 128
D | 2010C | REF01 | - | 128
D | 2010D | REF01 | - | 128
D | 2000E | REF01 | - | 128
D | 2000E | REF01 | - | 128
D | 2000E | REF01 | - | 128
D | 2010EA | REF01 | - | 128
D | 2010EA | PRV02 | - | 128
D | 2000F | REF01 | - | 128
D | 2000F | REF01 | - | 128
D | 2010FA | REF01 | - | 128
D | 2010FA | PRV02 | - | 128
 
Reject Reason Code
Code assigned by issuer to identify reason for rejection.
278 - Health Care Services Review Response Review
D | 2000A | AAA03 | - | 901
D | 2010A | AAA03 | - | 901
D | 2010B | AAA03 | - | 901
D | 2010C | AAA03 | - | 901
D | 2010D | AAA03 | - | 901
D | 2000E | AAA03 | - | 901
D | 2010EA | AAA03 | - | 901
D | 2010EC | AAA03 | - | 901
D | 2000F | AAA03 | - | 901
D | 2010FA | AAA03 | - | 901
 
Related Causes Code
Code identifying an accompanying cause of an illness, injury, or an accident.
278 - Health Care Services Review Request
D | 2000E | UM05 | C024-01 | 1362
D | 2000E | UM05 | C024-02 | 1362
 
Release of Information Code
Code indicating whether the provider has on file a signed statement permitting the release of medical data to other organizations.
278 - Health Care Services Review Request
D | 2000E | UM09 | - | 1363
 
Report Transmission Code
Code defining timing, transmission method or format by which reports are to be sent.
278 - Health Care Services Review Request
D | 2000E | PWK02 | - | 756
D | 2000F | PWK02 | - | 756
278 - Health Care Services Review Response Review
D | 2000E | PWK02 | - | 756
D | 2000F | PWK02 | - | 756
 
Request Category Code
Code indicating a type of request.
278 - Health Care Services Review Request
D | 2000E | UM01 | - | 1525
D | 2000F | UM01 | - | 1525
278 - Health Care Services Review Response Review
D | 2000E | UM01 | - | 1525
D | 2000F | UM01 | - | 1525
 
Requester Address Line
Address line in the address of the requester.
278 - Health Care Services Review Request
D | 2010B | N301 | - | 166
D | 2010B | N302 | - | 166
 
Requester City Name
Name of the city in the address of the requester.
278 - Health Care Services Review Request
D | 2010B | N401 | - | 19
 
Requester Contact Communication Number
Complete requester contact communications number, including country or area code when applicable.
278 - Health Care Services Review Request
D | 2010B | PER04 | - | 364
D | 2010B | PER06 | - | 364
D | 2010B | PER08 | - | 364
 
Requester Contact Name
Name identifying the requester's contact person.
278 - Health Care Services Review Request
D | 2010B | PER02 | - | 93
 
Requester Country Code
Code identifying the country in the address of the requester.
278 - Health Care Services Review Request
D | 2010B | N404 | - | 26
 
Requester Country Subdivision Code
Country subdivison code of the requester.
278 - Health Care Services Review Request
D | 2010B | N407 | - | 1715
 
Requester First Name
First name of the requester of a health care services review.
278 - Health Care Services Review Request
D | 2010B | NM104 | - | 1036
278 - Health Care Services Review Response Review
D | 2010B | NM104 | - | 1036
 
Requester Identifier
Code uniquely identifying the provider requesting the services review to the payer, regulatory authority, or other authorized body or agency.
278 - Health Care Services Review Request
D | 2010B | NM109 | - | 67
278 - Health Care Services Review Response Review
D | 2010B | NM109 | - | 67
 
Requester Last or Organization Name
Last name or organization name of the requester of a health care services review.
278 - Health Care Services Review Request
D | 2010B | NM103 | - | 1035
278 - Health Care Services Review Response Review
D | 2010B | NM103 | - | 1035
 
Requester Middle Name
Middle name or middle initial of the requester of a health care services review.
278 - Health Care Services Review Request
D | 2010B | NM105 | - | 1037
278 - Health Care Services Review Response Review
D | 2010B | NM105 | - | 1037
 
Requester Name Suffix
Suffix to the name of the requester of a health care services review.
278 - Health Care Services Review Request
D | 2010B | NM107 | - | 1039
278 - Health Care Services Review Response Review
D | 2010B | NM107 | - | 1039
 
Requester Postal Zone or ZIP Code
Postal code in the address of the requester.
278 - Health Care Services Review Request
D | 2010B | N403 | - | 116
 
Requester State or Province Code
Code identifying the state or province in the address of the requester.
278 - Health Care Services Review Request
D | 2010B | N402 | - | 156
 
Requester Supplemental Identifier
Supplemental identification information about the requester.
278 - Health Care Services Review Request
D | 2010B | REF02 | - | 127
278 - Health Care Services Review Response Review
D | 2010B | REF02 | - | 127
 
Respiratory Therapist Order Text
Free-form description of the respiratory therapist's orders.
278 - Health Care Services Review Request
D | 2000E | CR509 | - | 352
278 - Health Care Services Review Response Review
D | 2000E | CR509 | - | 352
 
Response Contact Address Line
The address line of the person or organization designated to receive the requested information.
278 - Health Care Services Review Response Review
D | 2010FB | N301 | - | 166
D | 2010FB | N302 | - | 166
 
Response Contact Communication Number
Complete contact communications number, including country or area code when applicable, for the entity that is the designated recipient of requested additional information.
278 - Health Care Services Review Response Review
D | 2010FB | PER04 | - | 364
D | 2010FB | PER06 | - | 364
D | 2010FB | PER08 | - | 364
 
Response Contact First Name
First name of the individual that is the designated recipient of requested additional information.
278 - Health Care Services Review Response Review
D | 2010FB | NM104 | - | 1036
 
Response Contact Identifier
Code uniquely identifying the entity that is the designated recipient of requested additional information.
278 - Health Care Services Review Response Review
D | 2010FB | NM109 | - | 67
 
Response Contact Last or Organization Name
Last name or organization name of the entity that is the designated recipient of requested additional information.
278 - Health Care Services Review Response Review
D | 2010FB | NM103 | - | 1035
 
Response Contact Middle Name
Middle name or middle initial of the individual that is the designated recipient of requested additional information.
278 - Health Care Services Review Response Review
D | 2010FB | NM105 | - | 1037
 
Response Contact Name
The name of the person or organization designated to receive the requested information.
278 - Health Care Services Review Response Review
D | 2010FB | PER02 | - | 93
 
Response Contact Name Suffix
Suffix to the name of the individual that is the designated recipient of requested additional information.
278 - Health Care Services Review Response Review
D | 2010FB | NM107 | - | 1039
 
Review Decision Reason Code
Code identifying the reason for this review outcome.
278 - Health Care Services Review Response Review
D | 2000E | HCR03 | - | 1271
D | 2000F | HCR03 | - | 1271
 
Review Identification Number
Authorization number assigned by the UMO to the service review.
278 - Health Care Services Review Response Review
D | 2000E | HCR02 | - | 127
D | 2000F | HCR02 | - | 127
 
Round Trip Purpose Description
Free-form description of the purpose of the ambulance transport round trip.
278 - Health Care Services Review Request
D | 2000E | CR109 | - | 352
 
Sample Selection Modulus
To specify the sampling frequency in terms of a modulus of the Unit of Measure, e.g., every fifth bag, every 1.5 minutes.
278 - Health Care Services Review Request
D | 2000E | HSD04 | - | 1167
D | 2000F | HSD04 | - | 1167
278 - Health Care Services Review Response Review
D | 2000E | HSD04 | - | 1167
D | 2000F | HSD04 | - | 1167
 
Self Administered Drug Indicator
An indicator to indicate whether a drug can be self administered by a patient.
278 - Health Care Services Review Request
D | 2000F | DRA07 | - | 1073
278 - Health Care Services Review Response Review
D | 2000F | DRA07 | - | 1073
 
Serial Number
Unique device/part identifier assigned by the manufacturer.
278 - Health Care Services Review Request
D | 2000F | CR807 | - | 127
278 - Health Care Services Review Response Review
D | 2000F | CR807 | - | 127
 
Service Line Amount
Charges related to this service.
278 - Health Care Services Review Request
D | 2000F | SV102 | - | 782
D | 2000F | SV203 | - | 782
D | 2000F | SV302 | - | 782
278 - Health Care Services Review Response Review
D | 2000F | SV102 | - | 782
D | 2000F | SV203 | - | 782
D | 2000F | SV302 | - | 782
 
Service Line Rate
Payment rate that applies to the service line.
278 - Health Care Services Review Request
D | 2000F | SV206 | - | 1371
278 - Health Care Services Review Response Review
D | 2000F | SV206 | - | 1371
 
Service Line Revenue Code
UB92 Revenue Code pertaining to the service line.
278 - Health Care Services Review Request
D | 2000F | SV201 | - | 234
278 - Health Care Services Review Response Review
D | 2000F | SV201 | - | 234
 
Service Provider Address Line
Address line in the mailing address of the provider to whom the patient has been or will be referred for service.
278 - Health Care Services Review Request
D | 2010F | N301 | - | 166
D | 2010F | N302 | - | 166
278 - Health Care Services Review Response Review
D | 2010FA | N301 | - | 166
D | 2010FA | N302 | - | 166
 
Service Provider City Name
Name of the city in the mailing address of the provider to whom the patient has been or will be referred for service.
278 - Health Care Services Review Request
D | 2010F | N401 | - | 19
278 - Health Care Services Review Response Review
D | 2010FA | N401 | - | 19
 
Service Provider Contact Communication Number
Complete service provider contact communications number, including country or area code when applicable.
278 - Health Care Services Review Request
D | 2010F | PER04 | - | 364
D | 2010F | PER06 | - | 364
D | 2010F | PER08 | - | 364
278 - Health Care Services Review Response Review
D | 2010FA | PER04 | - | 364
D | 2010FA | PER06 | - | 364
D | 2010FA | PER08 | - | 364
 
Service Provider Contact Name
Name of person, group, or organization to contact at the entity providing service or at the entity that may provide service.
278 - Health Care Services Review Request
D | 2010F | PER02 | - | 93
278 - Health Care Services Review Response Review
D | 2010FA | PER02 | - | 93
 
Service Provider Country Code
Code indicating the country in the mailing address of the provider to whom the patient has been or will be referred for service.
278 - Health Care Services Review Request
D | 2010F | N404 | - | 26
278 - Health Care Services Review Response Review
D | 2010FA | N404 | - | 26
 
Service Provider Country Subdivision Code
The country subdivision code of the service provider.
278 - Health Care Services Review Request
D | 2010F | N407 | - | 1715
278 - Health Care Services Review Response Review
D | 2010FA | N407 | - | 1715
 
Service Provider First Name
First name of the provider to whom the patient has been or will be referred for service or the provider that performed the service.
278 - Health Care Services Review Request
D | 2010F | NM104 | - | 1036
278 - Health Care Services Review Response Review
D | 2010FA | NM104 | - | 1036
 
Service Provider Identifier
Code uniquely identifying the provider to whom the patient has been or will be referred for service or the provider that performed the service or where the service was performed.
278 - Health Care Services Review Request
D | 2010F | NM109 | - | 67
278 - Health Care Services Review Response Review
D | 2010FA | NM109 | - | 67
 
Service Provider Last or Organization Name
Last name or organization name of the provider to whom the patient has been or will be referred for service or the provider that performed the service or where the service was performed.
278 - Health Care Services Review Request
D | 2010F | NM103 | - | 1035
278 - Health Care Services Review Response Review
D | 2010FA | NM103 | - | 1035
 
Service Provider Middle Name
Middle name or middle initial of the provider to whom the patient has been or will be referred for service or the provider that performed the service.
278 - Health Care Services Review Request
D | 2010F | NM105 | - | 1037
278 - Health Care Services Review Response Review
D | 2010FA | NM105 | - | 1037
 
Service Provider Name Suffix
Suffix to the name of the provider to whom the patient has been or will be referred for service or the provider that performed the service.
278 - Health Care Services Review Request
D | 2010F | NM107 | - | 1039
278 - Health Care Services Review Response Review
D | 2010FA | NM107 | - | 1039
 
Service Provider Postal Zone or ZIP Code
Code indicating the postal code in the mailing address of the provider to whom the patient has been or will be referred for service.
278 - Health Care Services Review Request
D | 2010F | N403 | - | 116
278 - Health Care Services Review Response Review
D | 2010FA | N403 | - | 116
 
Service Provider State or Province Code
Code indicating the state or province in the mailing address of the provider to whom the patient has been or will be referred for service.
278 - Health Care Services Review Request
D | 2010F | N402 | - | 156
278 - Health Care Services Review Response Review
D | 2010FA | N402 | - | 156
 
Service Provider Supplemental Identifier
Supplemental identification information about the provider to whom the patient has been or will be referred for service.
278 - Health Care Services Review Request
D | 2010F | REF02 | - | 127
278 - Health Care Services Review Response Review
D | 2010FA | REF02 | - | 127
 
Service Trace Number
Unique number assigned by the provider to identify a request for reconciliation of the response to an internal system.
278 - Health Care Services Review Request
D | 2000F | TRN02 | - | 127
278 - Health Care Services Review Response Review
D | 2000F | TRN02 | - | 127
 
Service Type Code
Code identifying the classification of service.
278 - Health Care Services Review Request
D | 2000E | UM03 | - | 1271
D | 2000F | UM03 | - | 1271
278 - Health Care Services Review Response Review
D | 2000E | UM03 | - | 1271
D | 2000F | UM03 | - | 1271
 
Service Unit Count
The quantity of units, times, days, visits, services, or treatments for the service described by the HCPCS codes, revenue code or procedure code.
278 - Health Care Services Review Request
D | 2000E | HSD02 | - | 380
D | 2000F | SV104 | - | 380
D | 2000F | SV205 | - | 380
D | 2000F | SV306 | - | 380
D | 2000F | HSD02 | - | 380
278 - Health Care Services Review Response Review
D | 2000E | HSD02 | - | 380
D | 2000F | SV104 | - | 380
D | 2000F | SV205 | - | 380
D | 2000F | SV306 | - | 380
D | 2000F | HSD02 | - | 380
 
Sig
An abbreviation for "signatura," Latin for "Mark thou". The Sig contains the instructions explaining how the patient is to take the medication. It must be legible, unambiguous, and complete to ensure the prescriber's instructions for use of the product are understood.
278 - Health Care Services Review Request
D | 2000F | DRA06 | - | 933
278 - Health Care Services Review Response Review
D | 2000F | DRA06 | - | 933
 
State or Province Code
Code (Standard State/Province) as defined by appropriate government agency.
278 - Health Care Services Review Request
D | 2000E | UM05 | C024-04 | 156
 
Stretcher Purpose Description
Free-form description of the purpose of the use of a stretcher during ambulance service.
278 - Health Care Services Review Request
D | 2000E | CR110 | - | 352
 
Subluxation Level Code
Code identifying the specific level of subluxation.
278 - Health Care Services Review Request
D | 2000E | CR203 | - | 1367
D | 2000E | CR204 | - | 1367
278 - Health Care Services Review Response Review
D | 2000E | CR203 | - | 1367
D | 2000E | CR204 | - | 1367
 
Submitter Transaction Identifier
Trace or control number assigned by the originator of the transaction.
278 - Health Care Services Review Request
H | | BHT03 | - | 127
278 - Health Care Services Review Response Review
H | | BHT03 | - | 127
 
Subscriber Address Line
Address line of the current mailing address of the insured individual or subscriber to the coverage.
278 - Health Care Services Review Request
D | 2010C | N301 | - | 166
D | 2010C | N302 | - | 166
278 - Health Care Services Review Response Review
D | 2010C | N301 | - | 166
D | 2010C | N302 | - | 166
 
Subscriber Birth Date
The date of birth of the subscriber to the indicated coverage or policy.
278 - Health Care Services Review Request
D | 2010C | DMG02 | - | 1251
278 - Health Care Services Review Response Review
D | 2010C | DMG02 | - | 1251
 
Subscriber City Name
The City Name of the insured individual or subscriber to the coverage.
278 - Health Care Services Review Request
D | 2010C | N401 | - | 19
278 - Health Care Services Review Response Review
D | 2010C | N401 | - | 19
 
Subscriber Country Code
The code identifying the country of the insured or subscriber address.
278 - Health Care Services Review Request
D | 2010C | N404 | - | 26
278 - Health Care Services Review Response Review
D | 2010C | N404 | - | 26
 
Subscriber Country Subdivision Code
The country subdivision code of the insured or subscriber address.
278 - Health Care Services Review Request
D | 2010C | N407 | - | 1715
278 - Health Care Services Review Response Review
D | 2010C | N407 | - | 1715
 
Subscriber First Name
The first name of the insured individual or subscriber to the coverage.
278 - Health Care Services Review Request
D | 2010C | NM104 | - | 1036
278 - Health Care Services Review Response Review
D | 2010C | NM104 | - | 1036
 
Subscriber Gender Code
Code indicating the sex of the subscriber to the indicated coverage or policy.
278 - Health Care Services Review Request
D | 2010C | DMG03 | - | 1068
278 - Health Care Services Review Response Review
D | 2010C | DMG03 | - | 1068
 
Subscriber Last Name
The surname of the insured individual or subscriber to the coverage.
278 - Health Care Services Review Request
D | 2010C | NM103 | - | 1035
278 - Health Care Services Review Response Review
D | 2010C | NM103 | - | 1035
 
Subscriber Middle Name or Initial
The middle name or initial of the subscriber to the indicated coverage or policy.
278 - Health Care Services Review Request
D | 2010C | NM105 | - | 1037
278 - Health Care Services Review Response Review
D | 2010C | NM105 | - | 1037
 
Subscriber Name Prefix
The name prefix of the subscriber to the indicated coverage or policy.
278 - Health Care Services Review Request
D | 2010C | NM106 | - | 1038
278 - Health Care Services Review Response Review
D | 2010C | NM106 | - | 1038
 
Subscriber Name Suffix
Suffix of the insured individual or subscriber to the coverage.
278 - Health Care Services Review Request
D | 2010C | NM107 | - | 1039
278 - Health Care Services Review Response Review
D | 2010C | NM107 | - | 1039
 
Subscriber Postal Zone or ZIP Code
The ZIP Code of the insured individual or subscriber to the coverage.
278 - Health Care Services Review Request
D | 2010C | N403 | - | 116
278 - Health Care Services Review Response Review
D | 2010C | N403 | - | 116
 
Subscriber Primary Identifier
Primary identification number of the subscriber to the coverage.
278 - Health Care Services Review Request
D | 2010C | NM109 | - | 67
278 - Health Care Services Review Response Review
D | 2010C | NM109 | - | 67
 
Subscriber State Code
The State Postal Code of the insured individual or subscriber to the coverage.
278 - Health Care Services Review Request
D | 2010C | N402 | - | 156
278 - Health Care Services Review Response Review
D | 2010C | N402 | - | 156
 
Subscriber Supplemental Identifier
Identifies another or additional distinguishing code number associated with the subscriber.
278 - Health Care Services Review Request
D | 2010C | REF02 | - | 127
278 - Health Care Services Review Response Review
D | 2010C | REF02 | - | 127
 
Surgery Date
Requested, anticipated, or actual date of surgery.
278 - Health Care Services Review Request
D | 2000E | CR609 | - | 373
 
Surgical Procedure Code
Code describing the surgical procedure most relevant to the care being rendered.
278 - Health Care Services Review Request
D | 2000E | CR611 | - | 1137
 
Time Period Qualifier
Code defining the type of time period.
278 - Health Care Services Review Request
D | 2000E | HSD05 | - | 615
D | 2000F | HSD05 | - | 615
278 - Health Care Services Review Response Review
D | 2000E | HSD05 | - | 615
D | 2000F | HSD05 | - | 615
 
Tooth Code
An indication of the tooth on which services were performed or will be performed.
278 - Health Care Services Review Request
D | 2000F | TOO02 | - | 1271
278 - Health Care Services Review Response Review
D | 2000F | TOO02 | - | 1271
 
Tooth Number
Standard identification number of a tooth.
278 - Health Care Services Review Request
D | 2000F | DN201 | - | 127
278 - Health Care Services Review Response Review
D | 2000F | DN201 | - | 127
 
Tooth Status Code
Code specifying the status of a tooth
278 - Health Care Services Review Request
D | 2000F | DN202 | - | 1368
278 - Health Care Services Review Response Review
D | 2000F | DN202 | - | 1368
 
Tooth Surface Code
The surface(s) of the tooth on which services were performed or will be performed.
278 - Health Care Services Review Request
D | 2000F | TOO03 | C005-01 | 1369
D | 2000F | TOO03 | C005-02 | 1369
D | 2000F | TOO03 | C005-03 | 1369
D | 2000F | TOO03 | C005-04 | 1369
D | 2000F | TOO03 | C005-05 | 1369
278 - Health Care Services Review Response Review
D | 2000F | TOO03 | C005-01 | 1369
D | 2000F | TOO03 | C005-02 | 1369
D | 2000F | TOO03 | C005-03 | 1369
D | 2000F | TOO03 | C005-04 | 1369
D | 2000F | TOO03 | C005-05 | 1369
 
Trace Assigning Entity Additional Identifier
Additional identifier for the entity assigning the trace number.
278 - Health Care Services Review Request
D | 2000E | TRN04 | - | 127
D | 2000F | TRN04 | - | 127
278 - Health Care Services Review Response Review
D | 2000E | TRN04 | - | 127
D | 2000F | TRN04 | - | 127
 
Trace Assigning Entity Identifier
Identifies the organization assigning the trace number.
278 - Health Care Services Review Request
D | 2000E | TRN03 | - | 509
D | 2000F | TRN03 | - | 509
278 - Health Care Services Review Response Review
D | 2000E | TRN03 | - | 509
D | 2000F | TRN03 | - | 509
 
Trace Type Code
Code identifying the type of re-association which needs to be performed.
278 - Health Care Services Review Request
D | 2000E | TRN01 | - | 481
D | 2000F | TRN01 | - | 481
278 - Health Care Services Review Response Review
D | 2000E | TRN01 | - | 481
D | 2000F | TRN01 | - | 481
 
Transaction Segment Count
A tally of all segments between the ST and the SE segments including the ST and SE segments.
278 - Health Care Services Review Request
D | | SE01 | - | 96
278 - Health Care Services Review Response Review
D | | SE01 | - | 96
 
Transaction Set Control Number
The unique identification number within a transaction set.
278 - Health Care Services Review Request
H | | ST02 | - | 329
D | | SE02 | - | 329
278 - Health Care Services Review Response Review
H | | ST02 | - | 329
D | | SE02 | - | 329
 
Transaction Set Creation Date
Identifies the date the submitter created the transaction.
278 - Health Care Services Review Request
H | | BHT04 | - | 373
278 - Health Care Services Review Response Review
H | | BHT04 | - | 373
 
Transaction Set Creation Time
Time file is created for transmission.
278 - Health Care Services Review Request
H | | BHT05 | - | 337
278 - Health Care Services Review Response Review
H | | BHT05 | - | 337
 
Transaction Set Identifier Code
Code uniquely identifying a Transaction Set.
278 - Health Care Services Review Request
H | | ST01 | - | 143
278 - Health Care Services Review Response Review
H | | ST01 | - | 143
 
Transaction Set Purpose Code
Code identifying purpose of transaction set.
278 - Health Care Services Review Request
H | | BHT02 | - | 353
278 - Health Care Services Review Response Review
H | | BHT02 | - | 353
 
Transaction Type Code
Code specifying the type of transaction.
278 - Health Care Services Review Request
H | | BHT06 | - | 640
278 - Health Care Services Review Response Review
H | | BHT06 | - | 640
 
Transport Distance
Distance traveled during the ambulance transport.
278 - Health Care Services Review Request
D | 2000E | CR106 | - | 380
278 - Health Care Services Review Response Review
D | 2000E | CR106 | - | 380
 
Treatment Count
Total number of treatments in the series.
278 - Health Care Services Review Request
D | 2000E | CR202 | - | 380
278 - Health Care Services Review Response Review
D | 2000E | CR202 | - | 380
 
Treatment Series Number
Number this treatment is in the series of services.
278 - Health Care Services Review Request
D | 2000E | CR201 | - | 609
278 - Health Care Services Review Response Review
D | 2000E | CR201 | - | 609
 
Unit or Basis for Measurement Code
Code specifying the units in which a value is being expressed, or manner in which a measurement has been taken.
278 - Health Care Services Review Request
D | 2000E | HSD03 | - | 355
D | 2000E | CR101 | - | 355
D | 2000E | CR105 | - | 355
D | 2000F | SV103 | - | 355
D | 2000F | SV204 | - | 355
D | 2000F | DRA04 | - | 355
D | 2000F | HSD03 | - | 355
278 - Health Care Services Review Response Review
D | 2000E | HSD03 | - | 355
D | 2000E | CR105 | - | 355
D | 2000F | SV103 | - | 355
D | 2000F | SV204 | - | 355
D | 2000F | DRA04 | - | 355
D | 2000F | HSD03 | - | 355
 
Utilization Management Organization (UMO) Contact Communication Number
Complete UMO contact communications number, including country or area code when applicable.
278 - Health Care Services Review Response Review
D | 2010A | PER04 | - | 364
D | 2010A | PER06 | - | 364
D | 2010A | PER08 | - | 364
 
Utilization Management Organization (UMO) Contact Name
Name identifying the UMO's contact person.
278 - Health Care Services Review Response Review
D | 2010A | PER02 | - | 93
 
Utilization Management Organization (UMO) First Name
First name of the individual, such as the primary care provider, associated with the request for a health care services review.
278 - Health Care Services Review Request
D | 2010A | NM104 | - | 1036
278 - Health Care Services Review Response Review
D | 2010A | NM104 | - | 1036
 
Utilization Management Organization (UMO) Identifier
Code uniquely identifying the Utilization Management Organization (UMO).
278 - Health Care Services Review Request
D | 2010A | NM109 | - | 67
278 - Health Care Services Review Response Review
D | 2010A | NM109 | - | 67
 
Utilization Management Organization (UMO) Last or Organization Name
Name of the Utilization Management Organization (UMO) or last name of the party associated with the request for a health care services review.
278 - Health Care Services Review Request
D | 2010A | NM103 | - | 1035
278 - Health Care Services Review Response Review
D | 2010A | NM103 | - | 1035
 
Utilization Management Organization (UMO) Middle Name
Middle name or middle initial of the individual, such as the primary care provider, associated with the request for a health care services review.
278 - Health Care Services Review Request
D | 2010A | NM105 | - | 1037
278 - Health Care Services Review Response Review
D | 2010A | NM105 | - | 1037
 
Utilization Management Organization (UMO) Name Suffix
Suffix to the name of the individual, such as the primary care provider, associated with the request for a health care services review.
278 - Health Care Services Review Request
D | 2010A | NM107 | - | 1039
278 - Health Care Services Review Response Review
D | 2010A | NM107 | - | 1039
 
Valid Request Indicator
Code indicating if the information request or portion of the request is valid or invalid.
278 - Health Care Services Review Response Review
D | 2000A | AAA01 | - | 1073
D | 2010A | AAA01 | - | 1073
D | 2010B | AAA01 | - | 1073
D | 2010C | AAA01 | - | 1073
D | 2010D | AAA01 | - | 1073
D | 2000E | AAA01 | - | 1073
D | 2010EA | AAA01 | - | 1073
D | 2010EC | AAA01 | - | 1073
D | 2000F | AAA01 | - | 1073
D | 2010FA | AAA01 | - | 1073
 
Warranty Expiration Date
Date of warranty expiration.
278 - Health Care Services Review Request
D | 2000F | CR803 | - | 373
278 - Health Care Services Review Response Review
D | 2000F | CR803 | - | 373
 
X-ray Availability Indicator
Indicates if X-Rays are on file for chiropractor spinal manipulation.
278 - Health Care Services Review Request
D | 2000E | CR212 | - | 1073