|
Code
|
Display
|
Definition
|
|
admissionperiod
|
Admission Period |
Dates corresponding with the admission and discharge of the beneficiary to a facility |
|
pointoforigin
|
Point Of Origin |
UB-04 Source of Admission (FL-15) identifies the place where the patient was identified as needing admission to a facility. |
|
admtype
|
Admission Type |
UB-04 Priority of the admission (FL-14) indicates, for example, an admission type of elective indicates that the patient's condition permitted time for medical services to be scheduled. |
|
brandgenericindicator
|
Brand Generic Indicator |
NCPDP code indicating whether the plan adjudicated the claim as a brand or generic drug. |
|
clmrecvddate
|
Claim Received Date |
Date the claim was received by the payer. |
|
compoundcode
|
Compound Code |
NCPDP code indicating whether or not the prescription is a compound. |
|
dawcode
|
DAW (Dispense As Written) Code |
NCPDP code indicating the prescriber's instruction regarding substitution of generic equivalents or order to dispense the specific prescribed medication. |
|
dayssupply
|
Days Supply |
NCPDP value indicating the Number of days supply of medication dispensed by the pharmacy. |
|
discharge-status
|
Discharge Status |
UB-04 Discharge Status (FL-17) indicates the patient’s status as of the discharge date for a facility stay. |
|
drg
|
DRG |
DRG (Diagnosis Related Group), including the code system, the DRG version and the code value |
|
refillnum
|
Refill Number |
NCPDP value indicating the number fill of the current dispensed supply (0, 1, 2, etc.) |
|
refillsauthorized
|
Refills Authorized |
NCPDP value indicating the number of refills authorized by the subscriber (0, 1, 2, etc.) |
|
rxorigincode
|
Rx Origin Code |
NCPDP code indicating whether the prescription was transmitted as an electronic prescription, by phone, by fax, or as a written paper copy. |
|
servicefacility
|
Service Facility |
The facility where the service occurred. Examples include hospitals, nursing homes, laboratories or homeless shelters. |
|
typeofbill
|
Type of Bill |
UB-04 Type of Bill (FL-04) provides specific information for payer purposes. |
|
medicalrecordnumber
|
Medical Record Number |
Patient Medical Record Number associated with the specific claim. |
|
patientaccountnumber
|
Patient Account Number |
Patient Account Number associated with the specific claim. |
|
orthodontics
|
Orthodontics |
Orthodontics treatment indicator. |
|
prosthesis
|
Prosthesis |
Prosthesis replacement indicator. |
|
additionalbodysite
|
Additional Body Site |
Additional tooth number or oral cavity. Additional body sites are specific to line item and have to be linked by ExplanationOfBenefit.item.informationSequence. |
|
missingtoothnumber
|
Missing Tooth Number |
Missing tooth number. |
|
patientweight
|
Patient Weight |
Patient weight (for transportation services) |
|
ambulancetransportreason
|
Ambulance Transport Reason |
Reason ambulance transport was needed (for transportation services) |
|
transportationdistance
|
Transportation Distance |
Distance traveled (for transportation services) |
|
roudtrippurpose
|
Round Trip Purpose |
Reason for round trip (for transportation services) |
|
stretcherpurpose
|
Stretcher Purpose |
Purpose of using a stretcher (for transportation services) |
|
pickuplocation
|
Pick-up Location |
Patient pick-up Location (for transportation services) |
|
dropofflocation
|
Drop-off Location |
Patient drop-off location (for transportation services) |