HSD

Health Care Services Delivery

Pos: 135	Max: 9
Detail - Optional
Loop: 2110C	Elements: 8

Ref

Id

Element Name

Req

Type

Min/Max

Usage

HSD01

673

Quantity Qualifier
Description: Code specifying the type of quantity
Required if identifying type and quantity of benefits.
Required if HSD02 is used.

C

ID

2/2

Situational

Code

Name

DY

Days

FL

Units

HS

Hours

MN

Month

VS

Visits

HSD02

380

Quantity
Description: Numeric value of quantity
Industry: Benefit Quantity
Required if identifying type and quantity of benefits.
Required if HSD01 is used.

C

R

1/15

Situational

HSD03

355

Unit or Basis for Measurement Code
Description: Code specifying the units in which a value is being expressed, or manner in which a measurement has been taken
Used if needed to provide further information about the number and frequency of benefits.

O

ID

2/2

Situational

Code

Name

DA

Days

MO

Months

VS

Visit

WK

Week

YR

Years

HSD04

1167

Sample Selection Modulus
Description: To specify the sampling frequency in terms of a modulus of the Unit of Measure, e.g., every fifth bag, every 1.5 minutes
Used if needed to provide further information about the number and frequency of benefits.

O

R

1/6

Situational

HSD05

615

Time Period Qualifier
Description: Code defining periods
Used if needed to provide further information about the number and frequency of benefits.

C

ID

1/2

Situational

Code

Name

6

Hour

7

Day

21

Years

22

Service Year

23

Calendar Year

24

Year to Date

25

Contract

26

Episode

27

Visit

28

Outlier

29

Remaining

30

Exceeded

31

Not Exceeded

32

Lifetime

33

Lifetime Remaining

34

Month

35

Week

HSD06

616

Number of Periods
Description: Total number of periods
Industry: Period Count
Used if needed to provide further information about the number and frequency of benefits.

O

N0

1/3

Situational

HSD07

678

Ship/Delivery or Calendar Pattern Code
Description: Code which specifies the routine shipments, deliveries, or calendar pattern
Industry: Delivery Frequency Code
Used if needed to provide further information about the number and frequency of benefits.

O

ID

1/2

Situational

Code

Name

1

1st Week of the Month

2

2nd Week of the Month

3

3rd Week of the Month

4

4th Week of the Month

5

5th Week of the Month

6

1st & 3rd Weeks of the Month

7

2nd & 4th Weeks of the Month

8

1st Working Day of Period

9

Last Working Day of Period

A

Monday through Friday

B

Monday through Saturday

C

Monday through Sunday

D

Monday

E

Tuesday

F

Wednesday

G

Thursday

H

Friday

J

Saturday

K

Sunday

L

Monday through Thursday

M

Immediately

N

As Directed

O

Daily Mon. through Fri.

P

1/2 Mon. & 1/2 Thurs.

Q

1/2 Tues. & 1/2 Thurs.

R

1/2 Wed. & 1/2 Fri.

S

Once Anytime Mon. through Fri.

T

1/2 Tue. & 1/2 Fri.

U

1/2 Mon. & 1/2 Wed.

V

1/3 Mon., 1/3 Wed., 1/3 Fri.

W

Whenever Necessary

X

1/2 By Wed., Bal. By Fri.

Y

None (Also Used to Cancel or Override a Previous Pattern)

SG

Tuesday through Friday

SL

Monday, Tuesday and Thursday

SP

Monday, Tuesday and Friday

SX

Wednesday and Thursday

SY

Monday, Wednesday and Thursday

SZ

Tuesday, Thursday and Friday

HSD08

679

Ship/Delivery Pattern Time Code
Description: Code which specifies the time for routine shipments or deliveries
Industry: Delivery Pattern Time Code
Used if needed to provide further information about the number and frequency of benefits.

O

ID

1/1

Situational

Code

Name

A

1st Shift (Normal Working Hours)

B

2nd Shift

C

3rd Shift

D

A.M.

E

P.M.

F

As Directed

G

Any Shift

Y

None (Also Used to Cancel or Override a Previous Pattern)

1.

P0102 - If either HSD01,HSD02 is present, then all are required

2.

C0605 - If HSD06 is present, then all of HSD05 are required

Notes:

1. Use this segment only when benefits identified in either EB03 or EB13 have a specific delivery or usage pattern associated with the benefit.

Example:

HSD*VS*30***22~
Thirty visits per service year
HSD*VS*12*WK*3*34*1~
Twelve visits, three visits per week, for 1 month.