MEDRUC Medical resource usage and cost
Joint Rapporteurs Message Design Group JM11
The MEDRUC message is sent from a party providing medical and related administrative services to a funding institution, allowing evaluation of the medical activity and justification for reimbursement. It can also be sent from a funding institution to another party in order to advise which reimbursements have been made.
The MEDRUC message can carry either initial specifications of used resources and costs, or modifications to specifications given in a previous message.
Typically, the MEDRUC message can be used between a healthcare service provider or an insurance company and another insurance company as well as between an insurance company and a healthcare service provider.
Header
- 0010Message headerMandatoryMax 1
To head, identify and specify a message.
1. Data element S009/0057 is retained for upward compatibility. The use ofS016 and/or S017 is encouraged in preference.2. The combination of the values carried in data elements 0062 and S009 shallbe used to identify uniquely the message within its group (if used) or ifnot used, within its interchange, for the purpose of acknowledgement. - 0020Beginning of messageMandatoryMax 1
To indicate the type and function of a message and to transmit the identifying number.
- 0030Date/time/periodConditionalMax 9
To specify date, and/or time, or period.
- 0040ReferenceConditionalMax 9
To specify a reference.
- 0050Free textConditionalMax 9
To provide free form or coded text information.
- 0060Control totalConditionalMax 9
To provide control total.
- Segment group 1Repeat 9
- 0080Monetary amountMandatoryMax 1
To specify a monetary amount.
- 0090Duty/tax/fee detailsConditionalMax 1
To specify relevant duty/tax/fee information.
- 0080Monetary amountMandatoryMax 1
- Segment group 2Repeat 999
- 0110Party identificationMandatoryMax 1
To specify information necessary to establish the identity of a party.
- 0120Sequence detailsConditionalMax 1
To provide details relating to the sequence.
- 0130AddressConditionalMax 9
To specify an address.
- 0140Contact informationConditionalMax 9
To identify a person or a department to whom communication should be directed.
- 0150Communication contactConditionalMax 9
To identify a communication number of a department or a person to whom communication should be directed.
- 0160ReferenceConditionalMax 99
To specify a reference.
- 0170LanguageConditionalMax 9
To specify a language.
- 0180Organisation classification detailsConditionalMax 1
To provide classification details relating to the activities of an organisation.
- 0190Employment detailsConditionalMax 9
To specify employment details.
- 0200QualificationConditionalMax 9
To specify the qualification of a person.
- 0210Date/time/periodConditionalMax 99
To specify date, and/or time, or period.
- 0220Requirements and conditionsConditionalMax 99
To specify sector/subject requirements and conditions.
- 0230Financial institution informationConditionalMax 9
To identify an account and a related financial institution.
- 0110Party identificationMandatoryMax 1
- Segment group 3Repeat 999
- 0250Agreement identificationMandatoryMax 1
To specify the agreement details.
- 0260Sequence detailsConditionalMax 1
To provide details relating to the sequence.
- 0270ReferenceConditionalMax 99
To specify a reference.
- 0280Date/time/periodConditionalMax 99
To specify date, and/or time, or period.
- Segment group 4Repeat 99
- 0300Insurance cover descriptionMandatoryMax 1
To describe the insurance cover.
- 0310Free textConditionalMax 9
To provide free form or coded text information.
- 0300Insurance cover descriptionMandatoryMax 1
- 0250Agreement identificationMandatoryMax 1
- Segment group 5Repeat 999
- 0330Financial charges allocationMandatoryMax 1
Description of allocation of charges.
- 0340General indicatorConditionalMax 1
To transmit a processing indicator.
Segment marked for deletion in the D.02B directory. - 0350ReferenceConditionalMax 99
To specify a reference.
- 0360Date/time/periodConditionalMax 99
To specify date, and/or time, or period.
- 0370Free textConditionalMax 99
To provide free form or coded text information.
- 0380Agreement identificationConditionalMax 99
To specify the agreement details.
- Segment group 6Repeat 99
- 0400Requirements and conditionsMandatoryMax 1
To specify sector/subject requirements and conditions.
- 0410Free textConditionalMax 9
To provide free form or coded text information.
- 0400Requirements and conditionsMandatoryMax 1
- Segment group 7Repeat 999
- 0430Party identificationMandatoryMax 1
To specify information necessary to establish the identity of a party.
- 0440ReferenceConditionalMax 99
To specify a reference.
- 0450AddressConditionalMax 9
To specify an address.
- 0460Communication contactConditionalMax 9
To identify a communication number of a department or a person to whom communication should be directed.
- 0470Date/time/periodConditionalMax 99
To specify date, and/or time, or period.
- 0480Person demographic informationConditionalMax 1
To specify items of person demographic information.
- 0490NationalityConditionalMax 9
To specify a nationality.
- 0500LanguageConditionalMax 9
To specify a language.
- 0510Handling instructionsConditionalMax 9
To specify handling and where necessary, notify hazards.
- 0520RelationshipConditionalMax 1
To identify relationships between objects.
- 0430Party identificationMandatoryMax 1
- Segment group 8Repeat 999
- 0540Process identificationMandatoryMax 1
To identify a process.
- 0550General indicatorConditionalMax 1
To transmit a processing indicator.
Segment marked for deletion in the D.02B directory. - 0560Item descriptionConditionalMax 9
To describe an item in either an industry or free format.
- 0570Clinical informationConditionalMax 99
To describe an item of clinical information.
- 0580Party identificationConditionalMax 99
To specify information necessary to establish the identity of a party.
- 0590Date/time/periodConditionalMax 99
To specify date, and/or time, or period.
- 0600ReferenceConditionalMax 99
To specify a reference.
- 0610Free textConditionalMax 99
To provide free form or coded text information.
- 0620QuantityConditionalMax 99
To specify a pertinent quantity.
- 0630Percentage detailsConditionalMax 99
To specify percentage information.
- Segment group 9Repeat 99
- 0650AttendanceMandatoryMax 1
To specify attendance information relating to an individual.
- 0660Place/location identificationConditionalMax 9
To identify a place or a location and/or related locations.
- 0670Date/time/periodConditionalMax 9
To specify date, and/or time, or period.
- 0680ReferenceConditionalMax 9
To specify a reference.
- 0650AttendanceMandatoryMax 1
- Segment group 10Repeat 99
- 0700Monetary amountMandatoryMax 1
To specify a monetary amount.
- 0710Duty/tax/fee detailsConditionalMax 1
To specify relevant duty/tax/fee information.
- 0700Monetary amountMandatoryMax 1
- Segment group 11Repeat 99
- 0730Requirements and conditionsMandatoryMax 1
To specify sector/subject requirements and conditions.
- 0740Free textConditionalMax 9
To provide free form or coded text information.
- 0730Requirements and conditionsMandatoryMax 1
- Segment group 12Repeat 999
- 0760Clinical interventionMandatoryMax 1
To specify a clinical intervention such as treatments and investigations.
- 0770General indicatorConditionalMax 1
To transmit a processing indicator.
Segment marked for deletion in the D.02B directory. - 0780Item descriptionConditionalMax 9
To describe an item in either an industry or free format.
- 0790Clinical informationConditionalMax 99
To describe an item of clinical information.
- 0800Party identificationConditionalMax 99
To specify information necessary to establish the identity of a party.
- 0810Date/time/periodConditionalMax 99
To specify date, and/or time, or period.
- 0820ReferenceConditionalMax 99
To specify a reference.
- 0830Free textConditionalMax 99
To provide free form or coded text information.
- 0840QuantityConditionalMax 99
To specify a pertinent quantity.
- 0850Percentage detailsConditionalMax 99
To specify percentage information.
- 0860PackageConditionalMax 9
To describe the number and type of packages/physical units.
- Segment group 13Repeat 99
- 0880Monetary amountMandatoryMax 1
To specify a monetary amount.
- 0890Duty/tax/fee detailsConditionalMax 1
To specify relevant duty/tax/fee information.
- 0880Monetary amountMandatoryMax 1
- Segment group 14Repeat 99
- 0910Requirements and conditionsMandatoryMax 1
To specify sector/subject requirements and conditions.
- 0920Free textConditionalMax 9
To provide free form or coded text information.
- 0910Requirements and conditionsMandatoryMax 1
- Segment group 15Repeat 99
- 0940Equipment detailsMandatoryMax 1
To identify a unit of equipment.
- 0950Sequence detailsConditionalMax 1
To provide details relating to the sequence.
- 0940Equipment detailsMandatoryMax 1
- 0760Clinical interventionMandatoryMax 1
- 0540Process identificationMandatoryMax 1
- 0330Financial charges allocationMandatoryMax 1
- Segment group 16Repeat 999
- 0970Transport movement detailsMandatoryMax 1
To specify operational transport movement details for a goods item or equipment (which may differ from the contractual conditions).
- 0980Sequence detailsConditionalMax 1
To provide details relating to the sequence.
- 0990General indicatorConditionalMax 1
To transmit a processing indicator.
Segment marked for deletion in the D.02B directory. - 1000Free textConditionalMax 99
To provide free form or coded text information.
- Segment group 17Repeat 999
- 1020Details of transportMandatoryMax 1
To specify the transport details such as mode of transport, means of transport, its conveyance reference number and the identification of the means of transport. The segment may be pointed to by the TPL segment.
- 1030General indicatorConditionalMax 1
To transmit a processing indicator.
Segment marked for deletion in the D.02B directory. - 1040Item descriptionConditionalMax 9
To describe an item in either an industry or free format.
- 1050Party identificationConditionalMax 99
To specify information necessary to establish the identity of a party.
- 1060ReferenceConditionalMax 99
To specify a reference.
- 1070Free textConditionalMax 99
To provide free form or coded text information.
- 1080Clinical informationConditionalMax 99
To describe an item of clinical information.
- 1090QuantityConditionalMax 99
To specify a pertinent quantity.
- Segment group 18Repeat 99
- 1110AddressMandatoryMax 1
To specify an address.
- 1120Date/time/periodConditionalMax 9
To specify date, and/or time, or period.
- 1110AddressMandatoryMax 1
- Segment group 19Repeat 99
- 1140Transport service requirementsMandatoryMax 1
To specify the contract and carriage conditions and service and priority requirements for the transport.
- 1150Free textConditionalMax 9
To provide free form or coded text information.
- 1140Transport service requirementsMandatoryMax 1
- Segment group 20Repeat 999
- 1170Transport charge/rate calculationsMandatoryMax 1
To specify charges.
- 1180General indicatorConditionalMax 1
To transmit a processing indicator.
Segment marked for deletion in the D.02B directory. - 1190Item descriptionConditionalMax 9
To describe an item in either an industry or free format.
- 1200Date/time/periodConditionalMax 99
To specify date, and/or time, or period.
- 1210ReferenceConditionalMax 99
To specify a reference.
- 1220Free textConditionalMax 99
To provide free form or coded text information.
- 1230QuantityConditionalMax 99
To specify a pertinent quantity.
- 1240Percentage detailsConditionalMax 99
To specify percentage information.
- Segment group 21Repeat 99
- 1260Monetary amountMandatoryMax 1
To specify a monetary amount.
- 1270Duty/tax/fee detailsConditionalMax 1
To specify relevant duty/tax/fee information.
- 1260Monetary amountMandatoryMax 1
- Segment group 22Repeat 99
- 1290Transport service requirementsMandatoryMax 1
To specify the contract and carriage conditions and service and priority requirements for the transport.
- 1300Free textConditionalMax 9
To provide free form or coded text information.
- 1290Transport service requirementsMandatoryMax 1
- 1170Transport charge/rate calculationsMandatoryMax 1
- 1020Details of transportMandatoryMax 1
- 0970Transport movement detailsMandatoryMax 1
- Segment group 23Repeat 9
- 1320Authentication resultMandatoryMax 1
To specify results of the application of an authentication procedure.
- 1330Date/time/periodConditionalMax 9
To specify date, and/or time, or period.
- 1320Authentication resultMandatoryMax 1
- 1340Message trailerMandatoryMax 1
To end and check the completeness of a message.
1. 0062, the value shall be identical to the value in 0062 in thecorresponding UNH segment.