admissionperiod | Admission Period | Dates corresponding with the admission and discharge of the beneficiary to a facility |
pointoforigin | Point Of Origin | UB-04 Source of Admission (FL-15) identifies the place where the patient was identified as needing admission to a facility. |
admtype | Admission Type | UB-04 Priority of the admission (FL-14) indicates, for example, an admission type of elective indicates that the patient's condition permitted time for medical services to be scheduled. |
brandgenericindicator | Brand Generic Indicator | NCPDP code indicating whether the plan adjudicated the claim as a brand or generic drug. |
clmrecvddate | Claim Received Date | Date the claim was received by the payer. |
compoundcode | Compound Code | NCPDP code indicating whether or not the prescription is a compound. |
dawcode | DAW (Dispense As Written) Code | NCPDP code indicating the prescriber's instruction regarding substitution of generic equivalents or order to dispense the specific prescribed medication. |
dayssupply | Days Supply | NCPDP value indicating the Number of days supply of medication dispensed by the pharmacy. |
discharge-status | Discharge Status | UB-04 Discharge Status (FL-17) indicates the patient’s status as of the discharge date for a facility stay. |
drg | DRG | DRG (Diagnosis Related Group), including the code system, the DRG version and the code value |
refillnum | Refill Number | NCPDP value indicating the number fill of the current dispensed supply (0, 1, 2, etc.) |
refillsauthorized | Refills Authorized | NCPDP value indicating the number of refills authorized by the subscriber (0, 1, 2, etc.) |
rxorigincode | Rx Origin Code | NCPDP code indicating whether the prescription was transmitted as an electronic prescription, by phone, by fax, or as a written paper copy. |
servicefacility | Service Facility | The facility where the service occurred. Examples include hospitals, nursing homes, laboratories or homeless shelters. |
typeofbill | Type of Bill | UB-04 Type of Bill (FL-04) provides specific information for payer purposes. |
medicalrecordnumber | Medical Record Number | Patient Medical Record Number associated with the specific claim. |
patientaccountnumber | Patient Account Number | Patient Account Number associated with the specific claim. |
orthodontics | Orthodontics | Orthodontics treatment indicator. |
prosthesis | Prosthesis | Prosthesis replacement indicator. |
additionalbodysite | Additional Body Site | Additional tooth number or oral cavity. Additional body sites are specific to line item and have to be linked by ExplanationOfBenefit.item.informationSequence. |
missingtoothnumber | Missing Tooth Number | Missing tooth number. |
patientweight | Patient Weight | Patient weight (for transportation services) |
ambulancetransportreason | Ambulance Transport Reason | Reason ambulance transport was needed (for transportation services) |
transportationdistance | Transportation Distance | Distance traveled (for transportation services) |
roudtrippurpose | Round Trip Purpose | Reason for round trip (for transportation services) |
stretcherpurpose | Stretcher Purpose | Purpose of using a stretcher (for transportation services) |
pickuplocation | Pick-up Location | Patient pick-up Location (for transportation services) |
dropofflocation | Drop-off Location | Patient drop-off location (for transportation services) |