UB1

UB82 data

...

2.2Nov1994

2.3Apr1997

2.3.1May1999

...

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.

Figure 6-10. UB1 attributes

RRequiredOOptionalCConditionalWWithdrawn|#Date/Time*Backward compat.+Filler

		C.Len						Element		v2.2
1	..4	-	SI	O	1	-	00530	UB1-1	Set ID - UB1	2
2	..1	-	NM	O	1	-	00531	UB1-2	Blood Deductible (43)	3
3	..2	-	NM	O	1	-	00532	UB1-3	Blood Furnished Pints Of (40)	2
4	..2	-	NM	O	1	-	00533	UB1-4	Blood Replaced Pints (41)	2
5	..2	-	NM	O	1	-	00534	UB1-5	Blood Not Replaced Pints(42)	2
6	..2	-	NM	O	1	-	00535	UB1-6	Co Insurance Days (25)	2
7	..2	-	IS	O	5	0043	00536	UB1-7	Condition Code (35-39)	3
8	..3	-	NM	O	1	-	00537	UB1-8	Covered Days (23)	2
9	..3	-	NM	O	1	-	00538	UB1-9	Non Covered Days (24)	2
10	..12	-	CM_UVC	O	8	0153	00539	UB1-10	Value Amount & Code (46-49)	2
11	..2	-	NM	O	1	-	00540	UB1-11	Number Of Grace Days (90)	2
12	..60	-	CE	O	1	-	00541	UB1-12	Spec Program Indicator (44)	4
13	..60	-	ID	O	1	-	00542	UB1-13	PSRO/UR Approval Indicator (87)	3
14	..8	-	DT	O	1	-	00543	UB1-14	PSRO/UR Approved Stay Fm (88)	2
15	..8	-	DT	O	1	-	00544	UB1-15	PSRO/UR Approved Stay To (89)	2
16	..20	-	CM_OCD	O	5	-	00545	UB1-16	Occurrence (28 32)	2
17	..2	-	ID	O	1	-	00546	UB1-17	Occurrence Span (33)	2
18	..8	-	DT	O	1	-	00547	UB1-18	Occur Span Start Date(33)	2
19	..8	-	DT	O	1	-	00548	UB1-19	Occur Span End Date (33)	2
20	..30	-	ST	O	1	-	00549	UB1-20	UB 82 Locator 2	2
21	..7	-	ST	O	1	-	00550	UB1-21	UB 82 Locator 9	2
22	..8	-	ST	O	1	-	00551	UB1-22	UB 82 Locator 27	2
23	..17	-	ST	O	1	-	00552	UB1-23	UB 82 Locator 45	2