UB1
UB82
The UB1 segment contains data specific to the United States; other realms may choose to implement using regional code sets. Only billing/claims fields that do not exist in other HL7 defined segments appear in this segment. The codes listed as examples are not an exhaustive or current list.
Prior to V2.6, this segment was published as a UB-82 specific segment, but has been widely implemented for usage with UB-82 and/or UB-92 data. With the publication of the UB-92 (in 1992) and the HIPAA requirements in the US (2004), this segment is technically no longer applicable for the UB-82 which is no longer in use. However, the segment is often used internally to message data from a patient registration to a patient accounting system. It has been 'generalized' in V2.6 for wider applicability.
RRequiredOOptionalCConditionalWWithdrawn|#Date/Time*Backward compat.+Filler
23
| C.Len | Element | v2.5 | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| 1 | ..4 | - | SI | O | 1 | - | 00530 | UB1-1 | Set ID - UB1 | |
| 2 | - | - | - | W | 1 | - | 00531 | UB1-2 | Blood Deductible | 4 |
| 3 | ..2 | - | NM | O | 1 | - | 00532 | UB1-3 | Blood Furnished-Pints | Name |
| 4 | ..2 | - | NM | O | 1 | - | 00533 | UB1-4 | Blood Replaced-Pints | Name |
| 5 | ..2 | - | NM | O | 1 | - | 00534 | UB1-5 | Blood Not Replaced-Pints | Name |
| 6 | - | - | NM | B | 1 | - | 00535 | UB1-6 | Co-Insurance Days | 3 |
| 7 | - | - | IS | B | 5 | 0043 | 00536 | UB1-7 | Condition Code | 4 |
| 8 | - | - | NM | B | 1 | - | 00537 | UB1-8 | Covered Days | 3 |
| 9 | - | - | NM | B | 1 | - | 00538 | UB1-9 | Non Covered Days | 3 |
| 10 | - | - | UVC | B | 8 | - | 00539 | UB1-10 | Value Amount & Code | 4 |
| 11 | ..2 | - | NM | O | 1 | - | 00540 | UB1-11 | Number Of Grace Days | Name |
| 12 | ..250 | - | CWE | O | 1 | 0348 | 00541 | UB1-12 | Special Program Indicator | 2 |
| 13 | ..250 | - | CWE | O | 1 | 0349 | 00542 | UB1-13 | PSRO/UR Approval Indicator | 2 |
| 14 | ..8 | - | DT | O | 1 | - | 00543 | UB1-14 | PSRO/UR Approved Stay-Fm | Name |
| 15 | ..8 | - | DT | O | 1 | - | 00544 | UB1-15 | PSRO/UR Approved Stay-To | Name |
| 16 | - | - | OCD | B | 5 | - | 00545 | UB1-16 | Occurrence | 4 |
| 17 | - | - | CWE | B | 1 | 0351 | 00546 | UB1-17 | Occurrence Span | 4 |
| 18 | - | - | DT | B | 1 | - | 00547 | UB1-18 | Occur Span Start Date | 3 |
| 19 | - | - | DT | B | 1 | - | 00548 | UB1-19 | Occur Span End Date | 3 |
| 20 | - | - | ST | B | 1 | - | 00549 | UB1-20 | UB-82 Locator 2 | Length |
| 21 | - | - | ST | B | 1 | - | 00550 | UB1-21 | UB-82 Locator 9 | Length |
| 22 | - | - | ST | B | 1 | - | 00551 | UB1-22 | UB-82 Locator 27 | Length |
| 23 | - | - | ST | B | 1 | - | 00552 | UB1-23 | UB-82 Locator 45 | Length |
6