HCR Health Care Services Review

To specify the outcome of a health care services review

Position
Element
Name
Type
Requirement
Min
Max
Repeat
HCR01
Action Code
Identifier (ID)
Mandatory
1
2
-
Code indicating type of action
HCR02
Reference Identification
String (AN)
Optional
1
30
-
Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier
HCR02 is the number assigned by the information source to this review outcome.
HCR03
Reject Reason Code
Identifier (ID)
Optional
2
2
-
Code assigned by issuer to identify reason for rejection
HCR04
Yes/No Condition or Response Code
Identifier (ID)
Optional
1
1
-
Code indicating a Yes or No condition or response
HCR04 is the second surgical opinion indicator. A "Y" value indicates a second surgical opinion is required; an "N" value indicates a second surgical opinion is not required for this request.

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