UM Health Care Services Review Information
To specify health care services review information
Position
Element
Name
Type
Requirement
Min
Max
Repeat
Code indicating a type of request
Code indicating the type of certification
Code indicating a code from a specific industry code list
UM03 is the Service Type (Code Source 958).
Code identifying where services were, or may be, performed; the National Uniform Billing Committee (NUBC) Facility Type Code for Institutional Services or the Place of Service Codes for Professional or Dental Services.
C023-01 does not contain the last position of the Uniform Bill Type Code (the Claim Frequency Code).
Code identifying the type of facility referenced
C023-02 qualifies C023-01.
Code specifying the Type of Bill Frequency Code. It is the last digit of Type of Bill in the UB manual, as defined by the National Uniform Billing Committee
Code identifying an accompanying cause of an illness, injury or an accident
Code identifying an accompanying cause of an illness, injury or an accident
Code identifying an accompanying cause of an illness, injury or an accident
Code specifying the 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".
Code identifying the country
Code specifying the level of service rendered
Code indicating current health condition of the individual
Code indicating physician's prognosis for the patient
Code indicating whether the provider has on file a signed statement by the patient authorizing the release of medical data to other organizations
Code indicating the reason why a request was delayed