MEDRUC Medical resource usage and cost
TBG10 Healthcare
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.
- 0060CurrenciesConditionalMax 1
To specify currencies used in the transaction and relevant details for the rate of exchange.
- 0070Control totalConditionalMax 9
To provide control total.
- Segment group 1Repeat 9
- 0090Monetary amountMandatoryMax 1
To specify a monetary amount.
- 0100Duty/tax/fee detailsConditionalMax 1
To specify relevant duty/tax/fee information.
- 0090Monetary amountMandatoryMax 1
- Segment group 2Repeat 999
- 0120Party identificationMandatoryMax 1
To specify information necessary to establish the identity of a party.
- 0130Sequence detailsConditionalMax 1
To provide details relating to the sequence.
- 0140AddressConditionalMax 9
To specify an address.
- 0150Contact informationConditionalMax 9
To identify a person or a department to whom communication should be directed.
- 0160Communication contactConditionalMax 9
To identify a communication number of a department or a person to whom communication should be directed.
- 0170ReferenceConditionalMax 99
To specify a reference.
- 0180RelationshipConditionalMax 9
To identify relationships between objects.
- 0190NationalityConditionalMax 9
To specify a nationality.
- 0200LanguageConditionalMax 9
To specify a language.
- 0210Organisation classification detailsConditionalMax 1
To provide classification details relating to the activities of an organisation.
- 0220Employment detailsConditionalMax 9
To specify employment details.
- 0230QualificationConditionalMax 9
To specify the qualification of a person.
- 0240Date/time/periodConditionalMax 99
To specify date, and/or time, or period.
- 0250StatusConditionalMax 1
To specify the status of an object or service, including its category and the reason(s) for the status.
- 0260Requirements and conditionsConditionalMax 99
To specify sector/subject requirements and conditions.
- 0270Person demographic informationConditionalMax 1
To specify items of person demographic information.
- 0280Financial institution informationConditionalMax 9
To identify an account and a related financial institution.
- 0120Party identificationMandatoryMax 1
- Segment group 3Repeat 999
- 0300Agreement identificationMandatoryMax 1
To specify the agreement details.
- 0310Sequence detailsConditionalMax 1
To provide details relating to the sequence.
- 0320ReferenceConditionalMax 99
To specify a reference.
- 0330Date/time/periodConditionalMax 99
To specify date, and/or time, or period.
- Segment group 4Repeat 99
- 0350Insurance cover descriptionMandatoryMax 1
To describe the insurance cover.
- 0360Free textConditionalMax 9
To provide free form or coded text information.
- 0350Insurance cover descriptionMandatoryMax 1
- 0300Agreement identificationMandatoryMax 1
- Segment group 5Repeat 99
- 0380Document/message detailsMandatoryMax 1
To identify documents and details directly related to it.
- 0390Date/time/periodConditionalMax 9
To specify date, and/or time, or period.
- Segment group 6Repeat 9
- 0410Party identificationMandatoryMax 1
To specify information necessary to establish the identity of a party.
- 0420AddressConditionalMax 9
To specify an address.
- 0430StatusConditionalMax 1
To specify the status of an object or service, including its category and the reason(s) for the status.
- 0440Requirements and conditionsConditionalMax 9
To specify sector/subject requirements and conditions.
- 0410Party identificationMandatoryMax 1
- 0380Document/message detailsMandatoryMax 1
- Segment group 7Repeat 999
- 0460Financial charges allocationMandatoryMax 1
Description of allocation of charges.
- 0470Processing informationConditionalMax 9
To identify processing information.
- 0480ReferenceConditionalMax 99
To specify a reference.
- 0490Date/time/periodConditionalMax 99
To specify date, and/or time, or period.
- 0500Free textConditionalMax 99
To provide free form or coded text information.
- 0510Agreement identificationConditionalMax 99
To specify the agreement details.
- 0520Document/message detailsConditionalMax 9
To identify documents and details directly related to it.
- Segment group 8Repeat 99
- 0540Monetary amountMandatoryMax 1
To specify a monetary amount.
- 0550Duty/tax/fee detailsConditionalMax 1
To specify relevant duty/tax/fee information.
- 0540Monetary amountMandatoryMax 1
- Segment group 9Repeat 99
- 0570Requirements and conditionsMandatoryMax 1
To specify sector/subject requirements and conditions.
- 0580Free textConditionalMax 9
To provide free form or coded text information.
- 0570Requirements and conditionsMandatoryMax 1
- Segment group 10Repeat 999
- 0600Party identificationMandatoryMax 1
To specify information necessary to establish the identity of a party.
- 0610ReferenceConditionalMax 99
To specify a reference.
- 0620AddressConditionalMax 9
To specify an address.
- 0630Communication contactConditionalMax 9
To identify a communication number of a department or a person to whom communication should be directed.
- 0640Date/time/periodConditionalMax 99
To specify date, and/or time, or period.
- 0650Person demographic informationConditionalMax 1
To specify items of person demographic information.
- 0660ResultConditionalMax 9
To specify a discrete or non-discrete result as a value or value range.
- 0670NationalityConditionalMax 9
To specify a nationality.
- 0680LanguageConditionalMax 9
To specify a language.
- 0690Handling instructionsConditionalMax 9
To specify handling and where necessary, notify hazards.
- 0700RelationshipConditionalMax 1
To identify relationships between objects.
- 0600Party identificationMandatoryMax 1
- Segment group 11Repeat 999
- 0720Process identificationMandatoryMax 1
To identify a process.
- 0730Processing informationConditionalMax 1
To identify processing information.
- 0740StatusConditionalMax 9
To specify the status of an object or service, including its category and the reason(s) for the status.
- 0750Item descriptionConditionalMax 9
To describe an item in either an industry or free format.
- 0760Clinical informationConditionalMax 99
To describe an item of clinical information.
- 0770Party identificationConditionalMax 99
To specify information necessary to establish the identity of a party.
- 0780Date/time/periodConditionalMax 99
To specify date, and/or time, or period.
- 0790ReferenceConditionalMax 99
To specify a reference.
- 0800Free textConditionalMax 99
To provide free form or coded text information.
- 0810QuantityConditionalMax 99
To specify a pertinent quantity.
- 0820Percentage detailsConditionalMax 99
To specify percentage information.
- Segment group 12Repeat 99
- 0840AttendanceMandatoryMax 1
To specify attendance information relating to an individual.
- 0850Place/location identificationConditionalMax 9
To identify a place or a location and/or related locations.
- 0860Date/time/periodConditionalMax 9
To specify date, and/or time, or period.
- 0870ReferenceConditionalMax 9
To specify a reference.
- 0840AttendanceMandatoryMax 1
- Segment group 13Repeat 99
- 0890Monetary amountMandatoryMax 1
To specify a monetary amount.
- 0900Duty/tax/fee detailsConditionalMax 1
To specify relevant duty/tax/fee information.
- 0890Monetary amountMandatoryMax 1
- Segment group 14Repeat 99
- 0920Requirements and conditionsMandatoryMax 1
To specify sector/subject requirements and conditions.
- 0930Free textConditionalMax 9
To provide free form or coded text information.
- 0920Requirements and conditionsMandatoryMax 1
- Segment group 15Repeat 999
- 0950Clinical interventionMandatoryMax 1
To specify a clinical intervention such as treatments and investigations.
- 0960Processing informationConditionalMax 1
To identify processing information.
- 0970Item descriptionConditionalMax 9
To describe an item in either an industry or free format.
- 0980Clinical informationConditionalMax 99
To describe an item of clinical information.
- 0990Party identificationConditionalMax 99
To specify information necessary to establish the identity of a party.
- 1000Date/time/periodConditionalMax 99
To specify date, and/or time, or period.
- 1010ReferenceConditionalMax 99
To specify a reference.
- 1020Free textConditionalMax 99
To provide free form or coded text information.
- 1030QuantityConditionalMax 99
To specify a pertinent quantity.
- 1040Percentage detailsConditionalMax 99
To specify percentage information.
- 1050PackageConditionalMax 9
To describe the number and type of packages/physical units.
- Segment group 16Repeat 99
- 1070Monetary amountMandatoryMax 1
To specify a monetary amount.
- 1080Duty/tax/fee detailsConditionalMax 1
To specify relevant duty/tax/fee information.
- 1070Monetary amountMandatoryMax 1
- Segment group 17Repeat 99
- 1100Requirements and conditionsMandatoryMax 1
To specify sector/subject requirements and conditions.
- 1110Free textConditionalMax 9
To provide free form or coded text information.
- 1100Requirements and conditionsMandatoryMax 1
- Segment group 18Repeat 99
- 1130Equipment detailsMandatoryMax 1
To identify a unit of equipment.
- 1140Sequence detailsConditionalMax 1
To provide details relating to the sequence.
- 1130Equipment detailsMandatoryMax 1
- 0950Clinical interventionMandatoryMax 1
- 0720Process identificationMandatoryMax 1
- 0460Financial charges allocationMandatoryMax 1
- Segment group 19Repeat 999
- 1160Transport movement detailsMandatoryMax 1
To specify operational transport movement details for a goods item or equipment (which may differ from the contractual conditions).
- 1170Sequence detailsConditionalMax 1
To provide details relating to the sequence.
- 1180Processing informationConditionalMax 1
To identify processing information.
- 1190Free textConditionalMax 99
To provide free form or coded text information.
- Segment group 20Repeat 999
- 1210Transport informationMandatoryMax 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 - 1220Processing informationConditionalMax 1
To identify processing information.
- 1230Item descriptionConditionalMax 9
To describe an item in either an industry or free format.
- 1240Party identificationConditionalMax 99
To specify information necessary to establish the identity of a party.
- 1250ReferenceConditionalMax 99
To specify a reference.
- 1260Free textConditionalMax 99
To provide free form or coded text information.
- 1270Clinical informationConditionalMax 99
To describe an item of clinical information.
- 1280QuantityConditionalMax 99
To specify a pertinent quantity.
- Segment group 21Repeat 99
- 1300AddressMandatoryMax 1
To specify an address.
- 1310Date/time/periodConditionalMax 9
To specify date, and/or time, or period.
- 1300AddressMandatoryMax 1
- Segment group 22Repeat 99
- 1330Transport service requirementsMandatoryMax 1
To specify the contract and carriage conditions and service and priority requirements for the transport.
- 1340Free textConditionalMax 9
To provide free form or coded text information.
- 1330Transport service requirementsMandatoryMax 1
- Segment group 23Repeat 999
- 1360Charge/rate calculationsMandatoryMax 1
To specify charges.
- 1370Processing informationConditionalMax 1
To identify processing information.
- 1380Item descriptionConditionalMax 9
To describe an item in either an industry or free format.
- 1390Date/time/periodConditionalMax 99
To specify date, and/or time, or period.
- 1400ReferenceConditionalMax 99
To specify a reference.
- 1410Free textConditionalMax 99
To provide free form or coded text information.
- 1420QuantityConditionalMax 99
To specify a pertinent quantity.
- 1430Percentage detailsConditionalMax 99
To specify percentage information.
- Segment group 24Repeat 99
- 1450Monetary amountMandatoryMax 1
To specify a monetary amount.
- 1460Duty/tax/fee detailsConditionalMax 1
To specify relevant duty/tax/fee information.
- 1450Monetary amountMandatoryMax 1
- Segment group 25Repeat 99
- 1480Transport service requirementsMandatoryMax 1
To specify the contract and carriage conditions and service and priority requirements for the transport.
- 1490Free textConditionalMax 9
To provide free form or coded text information.
- 1480Transport service requirementsMandatoryMax 1
- 1360Charge/rate calculationsMandatoryMax 1
- 1210Transport informationMandatoryMax 1
- 1160Transport movement detailsMandatoryMax 1
- Segment group 26Repeat 9
- 1510Authentication resultMandatoryMax 1
To specify results of the application of an authentication procedure.
- 1520Date/time/periodConditionalMax 9
To specify date, and/or time, or period.
- 1510Authentication resultMandatoryMax 1
- 1530Message 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.