UB1
UB1 - UB82 data segment
The UB1 segment contains the data necessary to complete UB82 bills. Only UB82 fields that do not exist in other HL7 defined segments appear in this segment. Patient Name and Date of Birth are required for UB82 billing; however, they are included in the PID segment and therefore do not appear here. The UB codes listed as examples are not an exhaustive or current list. Refer to a UB specification for additional information.
Figure 6-10. UB1 attributes
RRequiredOOptionalCConditionalWWithdrawn|#Date/Time*Backward compat.+Filler
23
| C.Len | Element | v2.3 | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| 1 | ..4 | - | SI | O | 1 | - | 00530 | UB1-1 | Set ID - UB1 | |
| 2 | ..1 | - | NM | B | 1 | - | 00531 | UB1-2 | Blood Deductible (43) | Optionality |
| 3 | ..2 | - | NM | O | 1 | - | 00532 | UB1-3 | Blood Furnished-Pints Of (40) | Name |
| 4 | ..2 | - | NM | O | 1 | - | 00533 | UB1-4 | Blood Replaced-Pints (41) | Name |
| 5 | ..2 | - | NM | O | 1 | - | 00534 | UB1-5 | Blood Not Replaced-Pints(42) | Name |
| 6 | ..2 | - | NM | O | 1 | - | 00535 | UB1-6 | Co-Insurance Days (25) | Name |
| 7 | ..14 | - | IS | O | 5 | 0043 | 00536 | UB1-7 | Condition Code (35-39) | Length |
| 8 | ..3 | - | NM | O | 1 | - | 00537 | UB1-8 | Covered Days - (23) | Name |
| 9 | ..3 | - | NM | O | 1 | - | 00538 | UB1-9 | Non Covered Days - (24) | Name |
| 10 | ..12 | - | UVC | O | 8 | 0153 | 00539 | UB1-10 | Value Amount & Code (46-49) | Data Type |
| 11 | ..2 | - | NM | O | 1 | - | 00540 | UB1-11 | Number Of Grace Days (90) | |
| 12 | ..60 | - | CE_0348 | O | 1 | 0348 | 00541 | UB1-12 | Special Program Indicator (44) | 3 |
| 13 | ..60 | - | CE_0349 | O | 1 | 0349 | 00542 | UB1-13 | PSRO/UR Approval Indicator (87) | 2 |
| 14 | ..8 | - | DT | O | 1 | - | 00543 | UB1-14 | PSRO/UR Approved Stay-Fm (88) | Name |
| 15 | ..8 | - | DT | O | 1 | - | 00544 | UB1-15 | PSRO/UR Approved Stay-To (89) | Name |
| 16 | ..20 | - | OCD | O | 5 | 0350 | 00545 | UB1-16 | Occurrence (28-32) | 3 |
| 17 | ..60 | - | CE_0351 | O | 1 | 0351 | 00546 | UB1-17 | Occurrence Span (33) | 3 |
| 18 | ..8 | - | DT | O | 1 | - | 00547 | UB1-18 | Occur Span Start Date(33) | |
| 19 | ..8 | - | DT | O | 1 | - | 00548 | UB1-19 | Occur Span End Date (33) | |
| 20 | ..30 | - | ST | O | 1 | - | 00549 | UB1-20 | UB-82 Locator 2 | Name |
| 21 | ..7 | - | ST | O | 1 | - | 00550 | UB1-21 | UB-82 Locator 9 | Name |
| 22 | ..8 | - | ST | O | 1 | - | 00551 | UB1-22 | UB-82 Locator 27 | Name |
| 23 | ..17 | - | ST | O | 1 | - | 00552 | UB1-23 | UB-82 Locator 45 | Name |
13