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.

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Header

Position
Segment
Name
Max use

  1. To head, identify and specify a message.

  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 provide control total.

  7. Segment group 1
    Repeat 9

    1. To specify a monetary amount.

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

  8. 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 specify a language.

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

    9. To specify employment details.

    10. To specify the qualification of a person.

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

    12. To specify sector/subject requirements and conditions.

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

  9. 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.

  10. Segment group 5
    Repeat 999

    1. Description of allocation of charges.

    2. To transmit a processing indicator.

      Segment marked for deletion in the D.02B directory.

    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. Segment group 6
      Repeat 99

      1. To specify sector/subject requirements and conditions.

      2. To provide free form or coded text information.

    8. Segment group 7
      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 nationality.

      8. To specify a language.

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

      10. To identify relationships between objects.

    9. Segment group 8
      Repeat 999

      1. To identify a process.

      2. To transmit a processing indicator.

        Segment marked for deletion in the D.02B directory.

      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. Segment group 9
        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.

      12. Segment group 10
        Repeat 99

        1. To specify a monetary amount.

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

      13. Segment group 11
        Repeat 99

        1. To specify sector/subject requirements and conditions.

        2. To provide free form or coded text information.

      14. Segment group 12
        Repeat 999

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

        2. To transmit a processing indicator.

          Segment marked for deletion in the D.02B directory.

        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 13
          Repeat 99

          1. To specify a monetary amount.

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

        13. Segment group 14
          Repeat 99

          1. To specify sector/subject requirements and conditions.

          2. To provide free form or coded text information.

        14. Segment group 15
          Repeat 99

          1. To identify a unit of equipment.

          2. To provide details relating to the sequence.

  11. Segment group 16
    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 transmit a processing indicator.

      Segment marked for deletion in the D.02B directory.

    4. To provide free form or coded text information.

    5. Segment group 17
      Repeat 999

      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.

      2. To transmit a processing indicator.

        Segment marked for deletion in the D.02B directory.

      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 18
        Repeat 99

        1. To specify an address.

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

      10. Segment group 19
        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 20
        Repeat 999

        1. To specify charges.

        2. To transmit a processing indicator.

          Segment marked for deletion in the D.02B directory.

        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 21
          Repeat 99

          1. To specify a monetary amount.

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

        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.

  12. Segment group 23
    Repeat 9

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

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

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

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