MEDRUC Medical resource usage and cost

D11 Healthcare (SWG)

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.

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Header

Position
Segment
Name
Max use

  1. To head, identify and specify a message.

    1. Data element S009/0057 is retained for upward compatibility. The use of
    S016 and/or S017 is encouraged in preference.
    2. The combination of the values carried in data elements 0062 and S009 shall
    be used to identify uniquely the message within its group (if used) or if
    not used, within its interchange, for the purpose of acknowledgement.

  2. To indicate the type and function of a message and to transmit the identifying number.

  3. To specify date, and/or time, or period.

  4. To specify a reference.

  5. To provide free form or coded text information.

  6. To specify currencies used in the transaction and relevant details for the rate of exchange.

  7. To provide control total.

  8. Segment group 1
    Repeat 9

    1. To specify a monetary amount.

    2. To specify relevant duty/tax/fee information.

  9. Segment group 2
    Repeat 999

    1. To specify information necessary to establish the identity of a party.

    2. To provide details relating to the sequence.

    3. To specify an address.

    4. To identify a person or a department to whom communication should be directed.

    5. To identify a communication number of a department or a person to whom communication should be directed.

    6. To specify a reference.

    7. To identify relationships between objects.

    8. To specify a nationality.

    9. To specify a language.

    10. To provide classification details relating to the activities of an organisation.

    11. To specify employment details.

    12. To specify the qualification of a person.

    13. To specify date, and/or time, or period.

    14. To specify the status of an object or service, including its category and the reason(s) for the status.

    15. To specify sector/subject requirements and conditions.

    16. To specify items of person demographic information.

    17. To identify an account and a related financial institution.

  10. Segment group 3
    Repeat 999

    1. To specify the agreement details.

    2. To provide details relating to the sequence.

    3. To specify a reference.

    4. To specify date, and/or time, or period.

    5. Segment group 4
      Repeat 99

      1. To describe the insurance cover.

      2. To provide free form or coded text information.

  11. Segment group 5
    Repeat 99

    1. To identify documents and details directly related to it.

    2. To specify date, and/or time, or period.

    3. Segment group 6
      Repeat 9

      1. To specify information necessary to establish the identity of a party.

      2. To specify an address.

      3. To specify the status of an object or service, including its category and the reason(s) for the status.

      4. To specify sector/subject requirements and conditions.

  12. Segment group 7
    Repeat 999

    1. Description of allocation of charges.

    2. To identify processing information.

    3. To specify a reference.

    4. To specify date, and/or time, or period.

    5. To provide free form or coded text information.

    6. To specify the agreement details.

    7. To identify documents and details directly related to it.

    8. Segment group 8
      Repeat 99

      1. To specify a monetary amount.

      2. To specify relevant duty/tax/fee information.

    9. Segment group 9
      Repeat 99

      1. To specify sector/subject requirements and conditions.

      2. To provide free form or coded text information.

    10. Segment group 10
      Repeat 999

      1. To specify information necessary to establish the identity of a party.

      2. To specify a reference.

      3. To specify an address.

      4. To identify a communication number of a department or a person to whom communication should be directed.

      5. To specify date, and/or time, or period.

      6. To specify items of person demographic information.

      7. To specify a discrete or non-discrete result as a value or value range.

      8. To specify a nationality.

      9. To specify a language.

      10. To specify handling and where necessary, notify hazards.

      11. To identify relationships between objects.

    11. Segment group 11
      Repeat 999

      1. To identify a process.

      2. To identify processing information.

      3. To specify the status of an object or service, including its category and the reason(s) for the status.

      4. To describe an item in either an industry or free format.

      5. To describe an item of clinical information.

      6. To specify information necessary to establish the identity of a party.

      7. To specify date, and/or time, or period.

      8. To specify a reference.

      9. To provide free form or coded text information.

      10. To specify a pertinent quantity.

      11. To specify percentage information.

      12. Segment group 12
        Repeat 99

        1. To specify attendance information relating to an individual.

        2. To identify a place or a location and/or related locations.

        3. To specify date, and/or time, or period.

        4. To specify a reference.

      13. Segment group 13
        Repeat 99

        1. To specify a monetary amount.

        2. To specify relevant duty/tax/fee information.

      14. Segment group 14
        Repeat 99

        1. To specify sector/subject requirements and conditions.

        2. To provide free form or coded text information.

      15. Segment group 15
        Repeat 999

        1. To specify a clinical intervention such as treatments and investigations.

        2. To identify processing information.

        3. To describe an item in either an industry or free format.

        4. To describe an item of clinical information.

        5. To specify information necessary to establish the identity of a party.

        6. To specify date, and/or time, or period.

        7. To specify a reference.

        8. To provide free form or coded text information.

        9. To specify a pertinent quantity.

        10. To specify percentage information.

        11. To describe the number and type of packages/physical units.

        12. Segment group 16
          Repeat 99

          1. To specify a monetary amount.

          2. To specify relevant duty/tax/fee information.

        13. Segment group 17
          Repeat 99

          1. To specify sector/subject requirements and conditions.

          2. To provide free form or coded text information.

        14. Segment group 18
          Repeat 99

          1. To identify a unit of equipment.

          2. To provide details relating to the sequence.

  13. Segment group 19
    Repeat 999

    1. To specify operational transport movement details for a goods item or equipment (which may differ from the contractual conditions).

    2. To provide details relating to the sequence.

    3. To identify processing information.

    4. To provide free form or coded text information.

    5. Segment group 20
      Repeat 999

      1. To specify information regarding the transport such as mode of transport, means of transport, its conveyance reference number and the identification of the means of transport.

        + 040 D5(040,030) If first, then all

      2. To identify processing information.

      3. To describe an item in either an industry or free format.

      4. To specify information necessary to establish the identity of a party.

      5. To specify a reference.

      6. To provide free form or coded text information.

      7. To describe an item of clinical information.

      8. To specify a pertinent quantity.

      9. Segment group 21
        Repeat 99

        1. To specify an address.

        2. To specify date, and/or time, or period.

      10. Segment group 22
        Repeat 99

        1. To specify the contract and carriage conditions and service and priority requirements for the transport.

        2. To provide free form or coded text information.

      11. Segment group 23
        Repeat 999

        1. To specify charges.

        2. To identify processing information.

        3. To describe an item in either an industry or free format.

        4. To specify date, and/or time, or period.

        5. To specify a reference.

        6. To provide free form or coded text information.

        7. To specify a pertinent quantity.

        8. To specify percentage information.

        9. Segment group 24
          Repeat 99

          1. To specify a monetary amount.

          2. To specify relevant duty/tax/fee information.

        10. Segment group 25
          Repeat 99

          1. To specify the contract and carriage conditions and service and priority requirements for the transport.

          2. To provide free form or coded text information.

  14. Segment group 26
    Repeat 9

    1. To specify results of the application of an authentication procedure.

    2. To specify date, and/or time, or period.

  15. To end and check the completeness of a message.

    1. 0062, the value shall be identical to the value in 0062 in the
    corresponding UNH segment.
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