UB1
UB82 DATA
The UB1 segment contains data necessary to complete UB82 bills. Only UB82 data elements that do not exist in other HL7 defined segments will appear in this segment. Patient name and Date of
Birth are required for UB82 billing, however, they are included in the PID segment and therefore do not appear here.
RRequiredOOptionalCConditionalWWithdrawn|#Date/Time*Backward compat.+Filler
23
| C.Len | Element | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| 1 | ..4 | - | SI | O | 1 | - | 00459 | UB1-1 | SET ID - UB82 |
| 2 | ..1 | - | ST | O | 1 | - | 00279 | UB1-2 | BLOOD DEDUCTIBLE |
| 3 | ..2 | - | ST | O | 1 | - | 00396 | UB1-3 | BLOOD FURN.-PINTS OF (40) |
| 4 | ..2 | - | ST | O | 1 | - | 00397 | UB1-4 | BLOOD REPLACED-PINTS (41) |
| 5 | ..2 | - | ST | O | 1 | - | 00398 | UB1-5 | BLOOD NOT RPLCD-PINTS(42) |
| 6 | ..2 | - | ST | O | 1 | - | 00399 | UB1-6 | CO-INSURANCE DAYS (25) |
| 7 | ..2 | - | ID | O | 5 | 0043 | 00400 | UB1-7 | CONDITION CODE |
| 8 | ..3 | - | ST | O | 1 | - | 00405 | UB1-8 | COVERED DAYS - (23) |
| 9 | ..3 | - | ST | O | 1 | - | 00406 | UB1-9 | NON COVERED DAYS - (24) |
| 10 | ..12 | - | CM | O | 8 | - | 00407 | UB1-10 | VALUE AMOUNT & CODE |
| 11 | ..2 | - | ST | O | 1 | - | 00424 | UB1-11 | NUMBER OF GRACE DAYS (90) |
| 12 | ..2 | - | ID | O | 1 | - | 00425 | UB1-12 | SPEC. PROG. INDICATOR(44) |
| 13 | ..1 | - | ID | O | 1 | - | 00426 | UB1-13 | PSRO/UR APPROVAL IND. (87) |
| 14 | ..8 | - | DT | O | 1 | - | 00427 | UB1-14 | PSRO/UR APRVD STAY-FM(88) |
| 15 | ..8 | - | DT | O | 1 | - | 00428 | UB1-15 | PSRO/UR APRVD STAY-TO(89) |
| 16 | ..20 | - | ID | O | 5 | - | 00429 | UB1-16 | OCCURRENCE (28-32) |
| 17 | ..2 | - | ID | O | 1 | - | 00435 | UB1-17 | OCCURRENCE SPAN (33) |
| 18 | ..8 | - | DT | O | 1 | - | 00446 | UB1-18 | OCCURRENCE SPAN START DATE(33) |
| 19 | ..8 | - | DT | O | 1 | - | 00447 | UB1-19 | OCCUR. SPAN END DATE (33) |
| 20 | ..30 | - | ST | O | 1 | - | 00448 | UB1-20 | UB-82 LOCATOR 2 |
| 21 | ..7 | - | ST | O | 1 | - | 00449 | UB1-21 | UB-82 LOCATOR 9 |
| 22 | ..8 | - | ST | O | 1 | - | 00450 | UB1-22 | UB-82 LOCATOR 27 |
| 23 | ..17 | - | ST | O | 1 | - | 00451 | UB1-23 | UB-82 LOCATOR 45 |
Used In Message Structures