Active| Used by 0 transactions and 6 templates, Uses 7 templates | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Item | DT | Card | Conf | Description | Label |
|---|---|---|---|---|---|
| hl7v2:UB2.1 | SI | 0 … 1 | Set ID - UB2 Contains 2.16.840.1.113883.3.1937.777.10.15.88 SI - Sequence ID (DYNAMIC) | UB2_ ment | |
| @Item | 0 … 1 | F | 553 | ||
| @Type | 0 … 1 | F | SI | ||
| @LongName | 0 … 1 | F | Set ID - UB2 | ||
| hl7v2:UB2.2 | ST | 0 … 1 | Co-Insurance Days (9) Contains 2.16.840.1.113883.3.1937.777.10.15.89 ST - String (DYNAMIC) | UB2_ment | |
| @Item | 0 … 1 | F | 554 | ||
| @Type | 0 … 1 | F | ST | ||
| @LongName | 0 … 1 | F | Co-Insurance Days (9) | ||
| hl7v2:UB2.3 | IS | 0 … * | Condition Code (24-30) Contains 2.16.840.1.113883.3.1937.777.10.15.84 IS - Coded value for user-defined tables (DYNAMIC) | UB2_ment | |
| @Item | 0 … 1 | F | 555 | ||
| @Type | 0 … 1 | F | IS | ||
| @Table | 0 … 1 | F | HL70043 | ||
| @LongName | 0 … 1 | F | Condition Code (24-30) | ||
| hl7v2:UB2.4 | ST | 0 … 1 | Covered Days (7) Contains 2.16.840.1.113883.3.1937.777.10.15.89 ST - String (DYNAMIC) | UB2_ment | |
| @Item | 0 … 1 | F | 556 | ||
| @Type | 0 … 1 | F | ST | ||
| @LongName | 0 … 1 | F | Covered Days (7) | ||
| hl7v2:UB2.5 | ST | 0 … 1 | Non-Covered Days (8) Contains 2.16.840.1.113883.3.1937.777.10.15.89 ST - String (DYNAMIC) | UB2_ment | |
| @Item | 0 … 1 | F | 557 | ||
| @Type | 0 … 1 | F | ST | ||
| @LongName | 0 … 1 | F | Non-Covered Days (8) | ||
| hl7v2:UB2.6 | UVC | 0 … * | Value Amount & Code Contains 2.16.840.1.113883.3.1937.777.10.15.66 UVC - UB value code and amount (DYNAMIC) | UB2_ment | |
| @Item | 0 … 1 | F | 558 | ||
| @Type | 0 … 1 | F | UVC | ||
| @LongName | 0 … 1 | F | Value Amount & Code | ||
| hl7v2:UB2.7 | OCD | 0 … * | Occurrence Code & Date (32-35) Contains 2.16.840.1.113883.3.1937.777.10.15.40 OCD - Occurrence code and date (DYNAMIC) | UB2_ment | |
| @Item | 0 … 1 | F | 559 | ||
| @Type | 0 … 1 | F | OCD | ||
| @LongName | 0 … 1 | F | Occurrence Code & Date (32-35) | ||
| hl7v2:UB2.8 | OSP | 0 … * | Occurrence Span Code/Dates (36) Contains 2.16.840.1.113883.3.1937.777.10.15.42 OSP - Occurrence span code and date (DYNAMIC) | UB2_ment | |
| @Item | 0 … 1 | F | 560 | ||
| @Type | 0 … 1 | F | OSP | ||
| @LongName | 0 … 1 | F | Occurrence Span Code/Dates (36) | ||
| hl7v2:UB2.9 | ST | 0 … * | UB92 Locator 2 (State) Contains 2.16.840.1.113883.3.1937.777.10.15.89 ST - String (DYNAMIC) | UB2_ment | |
| @Item | 0 … 1 | F | 561 | ||
| @Type | 0 … 1 | F | ST | ||
| @LongName | 0 … 1 | F | UB92 Locator 2 (State) | ||
| hl7v2:UB2.10 | ST | 0 … * | UB92 Locator 11 (State) Contains 2.16.840.1.113883.3.1937.777.10.15.89 ST - String (DYNAMIC) | UB2_ment | |
| @Item | 0 … 1 | F | 562 | ||
| @Type | 0 … 1 | F | ST | ||
| @LongName | 0 … 1 | F | UB92 Locator 11 (State) | ||
| hl7v2:UB2.11 | ST | 0 … 1 | UB92 Locator 31 (National) Contains 2.16.840.1.113883.3.1937.777.10.15.89 ST - String (DYNAMIC) | UB2_ment | |
| @Item | 0 … 1 | F | 563 | ||
| @Type | 0 … 1 | F | ST | ||
| @LongName | 0 … 1 | F | UB92 Locator 31 (National) | ||
| hl7v2:UB2.12 | ST | 0 … * | Document Control Number Contains 2.16.840.1.113883.3.1937.777.10.15.89 ST - String (DYNAMIC) | UB2_ment | |
| @Item | 0 … 1 | F | 564 | ||
| @Type | 0 … 1 | F | ST | ||
| @LongName | 0 … 1 | F | Document Control Number | ||
| hl7v2:UB2.13 | ST | 0 … * | UB92 Locator 49 (National) Contains 2.16.840.1.113883.3.1937.777.10.15.89 ST - String (DYNAMIC) | UB2_ment | |
| @Item | 0 … 1 | F | 565 | ||
| @Type | 0 … 1 | F | ST | ||
| @LongName | 0 … 1 | F | UB92 Locator 49 (National) | ||
| hl7v2:UB2.14 | ST | 0 … * | UB92 Locator 56 (State) Contains 2.16.840.1.113883.3.1937.777.10.15.89 ST - String (DYNAMIC) | UB2_ment | |
| @Item | 0 … 1 | F | 566 | ||
| @Type | 0 … 1 | F | ST | ||
| @LongName | 0 … 1 | F | UB92 Locator 56 (State) | ||
| hl7v2:UB2.15 | ST | 0 … 1 | UB92 Locator 57 (National) Contains 2.16.840.1.113883.3.1937.777.10.15.89 ST - String (DYNAMIC) | UB2_ment | |
| @Item | 0 … 1 | F | 567 | ||
| @Type | 0 … 1 | F | ST | ||
| @LongName | 0 … 1 | F | UB92 Locator 57 (National) | ||
| hl7v2:UB2.16 | ST | 0 … * | UB92 Locator 78 (State) Contains 2.16.840.1.113883.3.1937.777.10.15.89 ST - String (DYNAMIC) | UB2_ment | |
| @Item | 0 … 1 | F | 568 | ||
| @Type | 0 … 1 | F | ST | ||
| @LongName | 0 … 1 | F | UB92 Locator 78 (State) | ||
| hl7v2:UB2.17 | NM | 0 … 1 | Special Visit Count Contains 2.16.840.1.113883.3.1937.777.10.15.86 NM - Numeric (DYNAMIC) | UB2_ment | |
| @Item | 0 … 1 | F | 815 | ||
| @Type | 0 … 1 | F | NM | ||
| @LongName | 0 … 1 | F | Special Visit Count | ||