UB1

UB82

The UB1 segment contains data specific to the United States. 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.

Attention: UB1-2 was deprecated as of v2.3 and the detail was withdrawn and removed from the standard as of v 2.6.

23
C.LenElementv2.6
1--SIW1-00530UB1-1Set ID - UB12
2---W1-00531UB1-2Blood Deductible
3---W1-00532UB1-3Blood Furnished-Pints3
4---W1-00533UB1-4Blood Replaced-Pints3
5---W1-00534UB1-5Blood Not Replaced-Pints3
6---W1-00535UB1-6Co-Insurance Days2
7---W5-00536UB1-7Condition Code3
8---W1-00537UB1-8Covered Days2
9---W1-00538UB1-9Non Covered Days2
10---W8-00539UB1-10Value Amount & Code2
11---W1-00540UB1-11Number Of Grace Days3
12---W1-00541UB1-12Special Program Indicator4
13---W1-00542UB1-13PSRO/UR Approval Indicator4
14---W1-00543UB1-14PSRO/UR Approved Stay-Fm3
15---W1-00544UB1-15PSRO/UR Approved Stay-To3
16---W5-00545UB1-16Occurrence2
17---W1-00546UB1-17Occurrence Span3
18---W1-00547UB1-18Occur Span Start Date2
19---W1-00548UB1-19Occur Span End Date2
20---W1-00549UB1-20UB-82 Locator 22
21---W1-00550UB1-21UB-82 Locator 92
22---W1-00551UB1-22UB-82 Locator 272
23---W1-00552UB1-23UB-82 Locator 452
5