Code | Display | Definition |
admissionperiod |
Admission Period |
Dates corresponding with the admission and discharge of the beneficiary to a facility |
pointoforigin |
Point Of Origin |
UB-04 Source of Admission (FL-15) identifies the place where the patient was identified as needing admission to a facility. |
admtype |
Admission Type |
UB-04 Priority of the admission (FL-14) indicates, for example, an admission type of elective indicates that the patient's condition permitted time for medical services to be scheduled. |
brandgenericindicator |
Brand Generic Indicator |
NCPDP code indicating whether the plan adjudicated the claim as a brand or generic drug. |
clmrecvddate |
Claim Received Date |
Date the claim was received by the payer. |
compoundcode |
Compound Code |
NCPDP code indicating whether or not the prescription is a compound. |
dawcode |
DAW (Dispense As Written) Code |
NCPDP code indicating the prescriber's instruction regarding substitution of generic equivalents or order to dispense the specific prescribed medication. |
dayssupply |
Days Supply |
NCPDP value indicating the Number of days supply of medication dispensed by the pharmacy. |
discharge-status |
Discharge Status |
UB-04 Discharge Status (FL-17) indicates the patient’s status as of the discharge date for a facility stay. |
drg |
DRG |
DRG (Diagnosis Related Group), including the code system, the DRG version and the code value |
refillnum |
Refill Number |
NCPDP value indicating the number fill of the current dispensed supply (0, 1, 2, etc.) |
refillsauthorized |
Refills Authorized |
NCPDP value indicating the number of refills authorized by the subscriber (0, 1, 2, etc.) |
rxorigincode |
Rx Origin Code |
NCPDP code indicating whether the prescription was transmitted as an electronic prescription, by phone, by fax, or as a written paper copy. |
servicefacility |
Service Facility |
The facility where the service occurred. Examples include hospitals, nursing homes, laboratories or homeless shelters. |
typeofbill |
Type of Bill |
UB-04 Type of Bill (FL-04) provides specific information for payer purposes. |
medicalrecordnumber |
Medical Record Number |
Patient Medical Record Number associated with the specific claim. |
patientaccountnumber |
Patient Account Number |
Patient Account Number associated with the specific claim. |
orthodontics |
Orthodontics |
Orthodontics treatment indicator. |
prosthesis |
Prosthesis |
Prosthesis replacement indicator. |
additionalbodysite |
Additional Body Site |
Additional tooth number or oral cavity. Additional body sites are specific to line item and have to be linked by ExplanationOfBenefit.item.informationSequence. |
missingtoothnumber |
Missing Tooth Number |
Missing tooth number. |
patientweight |
Patient Weight |
Patient weight (for transportation services) |
ambulancetransportreason |
Ambulance Transport Reason |
Reason ambulance transport was needed (for transportation services) |
transportationdistance |
Transportation Distance |
Distance traveled (for transportation services) |
roudtrippurpose |
Round Trip Purpose |
Reason for round trip (for transportation services) |
stretcherpurpose |
Stretcher Purpose |
Purpose of using a stretcher (for transportation services) |
pickuplocation |
Pick-up Location |
Patient pick-up Location (for transportation services) |
dropofflocation |
Drop-off Location |
Patient drop-off location (for transportation services) |