UM Health Care Services Review Information

To specify health care services review information

Position: UM-01 · Element: 1525 · Name: Request Category Code · Type: Identifier (ID) · Requirement: Mandatory · Min: 1 · Max: 2 · Repeat: -

Code indicating a type of request

Position: UM-02 · Element: 1322 · Name: Certification Type Code · Type: Identifier (ID) · Requirement: Optional · Min: 1 · Max: 1 · Repeat: -

Code indicating the type of certification

Position: UM-03 · Element: 1365 · Name: Service Type Code · Type: Identifier (ID) · Requirement: Optional · Min: 1 · Max: 2 · Repeat: -

Code identifying the classification of service

Position: UM-04 · Element: 1384 · Name: Patient Location Code · Type: Identifier (ID) · Requirement: Optional · Min: 1 · Max: 1 · Repeat: -

Code identifying the location where patient is receiving medical treatment

UM-05 C024 Related Causes Information Composite (composite) Optional

Position: 01 · Element: 1362 · Name: Related-Causes Code · Type: Identifier (ID) · Requirement: Mandatory · Min: 2 · Max: 3 · Repeat: -

Code identifying an accompanying cause of an illness, injury or an accident

Position: 02 · Element: 1362 · Name: Related-Causes Code · Type: Identifier (ID) · Requirement: Optional · Min: 2 · Max: 3 · Repeat: -

Code identifying an accompanying cause of an illness, injury or an accident

Position: 03 · Element: 1362 · Name: Related-Causes Code · Type: Identifier (ID) · Requirement: Optional · Min: 2 · Max: 3 · Repeat: -

Code identifying an accompanying cause of an illness, injury or an accident

Position: 04 · Element: 156 · Name: State or Province Code · Type: Identifier (ID) · Requirement: Optional · Min: 2 · Max: 2 · Repeat: -

Code (Standard State/Province) as defined by appropriate government agency.

C024-04 and C024-05 apply only to auto accidents when C024-01, C024-02, or C024-03 is equal to AA.

Position: 05 · Element: 26 · Name: Country Code · Type: Identifier (ID) · Requirement: Optional · Min: 2 · Max: 3 · Repeat: -

Code identifying the country.

Position: UM-06 · Element: 1338 · Name: Level of Service Code · Type: Identifier (ID) · Requirement: Optional · Min: 1 · Max: 3 · Repeat: -

Code specifying the level of service rendered

Position: UM-07 · Element: 1213 · Name: Current Health Condition Code · Type: Identifier (ID) · Requirement: Optional · Min: 1 · Max: 1 · Repeat: -

Code indicating current health condition of the individual.

Position: UM-08 · Element: 923 · Name: Prognosis Code · Type: Identifier (ID) · Requirement: Optional · Min: 1 · Max: 1 · Repeat: -

Code indicating physician's prognosis for the patient

Position: UM-09 · Element: 1363 · Name: Release of Information Code · Type: Identifier (ID) · Requirement: Optional · Min: 1 · Max: 1 · Repeat: -

Code indicating whether the provider has on file a signed statement by the patient authorizing the release of medical data to other organizations

Position: UM-10 · Element: 1514 · Name: Delay Reason Code · Type: Identifier (ID) · Requirement: Optional · Min: 1 · Max: 2 · Repeat: -

Code indicating the reason why a request was delayed