The UB2 segment contains data necessary to complete UB92 bills. Only UB92 fields that do not exist in other HL7 defined segments appear in this segment. Just as with the UB82 billing, Patient Name and Date of Birth are required; they are included in the PID segment and therefore do not appear here. When the field locators are different on the UB92, as compared to the UB82, the element is listed with its new location in parentheses ( ).
Figure 6-11. UB2 attributes
SEQ |
LEN |
DT |
OPT |
RP/# |
TBL# |
ITEM# |
ELEMENT NAME |
1 |
4 |
SI |
O |
00553 |
Set ID - UB2 |
||
2 |
3 |
ST |
O |
00554 |
Co-Insurance Days (9) |
||
3 |
2 |
IS |
O |
Y/7 |
0043 |
00555 |
Condition Code (24-30) |
4 |
3 |
ST |
O |
00556 |
Covered Days (7) |
||
5 |
4 |
ST |
O |
00557 |
Non-Covered Days (8) |
||
6 |
11 |
CM |
O |
Y/12 |
0153 |
00558 |
Value Amount & Code |
7 |
11 |
CM |
O |
Y/8 |
00559 |
Occurrence Code & Date (32-35) |
|
8 |
28 |
CM |
O |
Y/2 |
00560 |
Occurrence Span Code/Dates (36) |
|
9 |
29 |
ST |
O |
Y/2 |
00561 |
UB92 Locator 2 (State) |
|
10 |
12 |
ST |
O |
Y/2 |
00562 |
UB92 Locator 11 (State) |
|
11 |
5 |
ST |
O |
00563 |
UB92 Locator 31 (National) |
||
12 |
23 |
ST |
O |
Y/3 |
00564 |
Document Control Number |
|
13 |
4 |
ST |
O |
Y/23 |
00565 |
UB92 Locator 49 (National) |
|
14 |
14 |
ST |
O |
Y/5 |
00566 |
UB92 Locator 56 (State) |
|
15 |
27 |
ST |
O |
00567 |
UB92 Locator 57 (National) |
||
16 |
2 |
ST |
O |
Y/2 |
00568 |
UB92 Locator 78 (State) |
|
17 |
3 |
NM |
O |
00815 |
Special Visit Count |
6.4.11.0 UB2 field definitions
Definition: This field contains the number that identifies this transaction. For the first occurrence of the segment the sequence number shall be 1, for the second occurrence it shall be 2, etc.
Definition: This field contains UB92 field 9. This field is defined by HCFA or other regulatory agencies.
Definition: The code in this field can repeat up to seven times. UB92 fields 24-30. Refer to user-defined table 0043 - Condition code for suggested values. This field is defined by HCFA or other regulatory agencies.
Definition: This field contains UB92 field 7. This field is defined by HCFA or other regulatory agencies.
Definition: This field contains UB92 field 8. This field is defined by HCFA or other regulatory agencies.
Components: <value code (IS)> ^ <value amount (NM)>
Definition: The pair in this field can repeat up to twelve times. UB92 fields 39a, 39b, 39c, 39d, 40a, 40b, 40c, 40d, 41a, 41b, 41c, and 41d. Refer to user-defined table 0153 - Value code for suggested values. This field is defined by HCFA or other regulatory agencies.
Components: <identifier (ST) & text (ST) & name of coding system (ST) & alternate identifier (ST) & alternate text (ST) & name of alternate coding system (ST)> ^ <occurrence date (DT)>
Definition: The set of values in this field can repeat up to eight times. UB92 fields 32a, 32b, 33a, 33b, 34a, 34b, 35a, and 35b. This field is defined by HCFA or other regulatory agencies.
Components: <identifier (ST) & text (ST) & name of coding system (ST) & alternate identifier (ST) & alternate text (ST) & name of alternate coding system (ST)> ^ <occurrence span start date (DT)> ^ <occurrence span stop date (DT)>
Definition: This field can repeat up to two times. UB92 field 36a, 36b. This field is defined by HCFA or other regulatory agencies.
Definition: The value in this field may repeat up to two times. This field is defined by HCFA or other regulatory agencies.
Definition: The value in this field may repeat up to two times.
Definition: Defined by HCFA or other regulatory agencies.
Definition: This field contains the number assigned by payor that is used for rebilling/adjustment purposes. It may repeat up to three times. UB92 field 37
Definition: This field may repeat up to twenty-three times. This field is defined by HCFA or other regulatory agencies.
Definition: This field may repeat up to five times.
Definition: Defined by UB-92 HCFA specification.
Definition: This field may repeat up to two times.
Definition: This field contains the total number of special therapy visits.