HI

Value Information

Pos: 231	Max: 2
Detail - Optional
Loop: 2300	Elements: 12

Ref

Id

Element Name

Req

Type

Min/Max

Usage

HI01

C022

Health Care Code Information
Description: To send health care codes and their associated dates, amounts and quantities

M

Comp

Required

1270

Code List Qualifier Code
Description: Code identifying a specific industry code list

M

ID

1/3

Required

Code

Name

BE

Value

CODE SOURCE:

132: National Uniform Billing Committee (NUBC) Codes

1271

Industry Code
Description: Code indicating a code from a specific industry code list
Industry: Value Code
UB-92 Ref. [UB-Name]: 39 (a-d) [Value Codes and Amounts]
40 (a-d) [Value Codes and Amounts]
41 (a-d) [Value Codes and Amounts]
EMC v.6.0 Reference: Record Type 41 Field No. 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 35, 37, 38, 39

M

AN

1/30

Required

ExternalCodeList

Name: 132

Description: National Uniform Billing Committee (NUBC) Codes

782

Monetary Amount
Description: Monetary amount
Industry: Value Code Associated Amount
This data element must contain the Value Code Amount when HIxx-1 value equals BE (Value Code).

O

R

1/18

Required

HI02

C022

Health Care Code Information
Description: To send health care codes and their associated dates, amounts and quantities
Used when necessary to report multiple additional co-existing conditions.

O

Comp

Situational

1270

Code List Qualifier Code
Description: Code identifying a specific industry code list

M

ID

1/3

Required

Code

Name

BE

Value

CODE SOURCE:

132: National Uniform Billing Committee (NUBC) Codes

1271

Industry Code
Description: Code indicating a code from a specific industry code list
Industry: Value Code
UB-92 Ref. [UB-Name]: 39 (a-d) [Value Codes and Amounts]
40 (a-d)0 [Value Codes and Amounts]
41 (a-d) [Value Codes and Amounts]
EMC v.6.0 Reference: Record Type 41 Field No. 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 35, 37, 38, 39

M

AN

1/30

Required

ExternalCodeList

Name: 132

Description: National Uniform Billing Committee (NUBC) Codes

782

Monetary Amount
Description: Monetary amount
Industry: Value Code Associated Amount
This data element must contain the Value Code Amount when HIxx-1 value equals BE (Value Code).

O

R

1/18

Required

HI03

C022

Health Care Code Information
Description: To send health care codes and their associated dates, amounts and quantities
Used when necessary to report multiple additional co-existing conditions.

O

Comp

Situational

1270

Code List Qualifier Code
Description: Code identifying a specific industry code list

M

ID

1/3

Required

Code

Name

BE

Value

CODE SOURCE:

132: National Uniform Billing Committee (NUBC) Codes

1271

Industry Code
Description: Code indicating a code from a specific industry code list
Industry: Value Code
UB-92 Ref. [UB-Name]: 39 (a-d) [Value Codes and Amounts]
40 (a-d)0 [Value Codes and Amounts]
41 (a-d) [Value Codes and Amounts]
EMC v.6.0 Reference: Record Type 41 Field No. 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 35, 37, 38, 39

M

AN

1/30

Required

ExternalCodeList

Name: 132

Description: National Uniform Billing Committee (NUBC) Codes

782

Monetary Amount
Description: Monetary amount
Industry: Value Code Associated Amount
This data element must contain the Value Code Amount when HIxx-1 value equals BE (Value Code).

O

R

1/18

Required

HI04

C022

Health Care Code Information
Description: To send health care codes and their associated dates, amounts and quantities
Used when necessary to report multiple additional co-existing conditions.

O

Comp

Situational

1270

Code List Qualifier Code
Description: Code identifying a specific industry code list

M

ID

1/3

Required

Code

Name

BE

Value

CODE SOURCE:

132: National Uniform Billing Committee (NUBC) Codes

1271

Industry Code
Description: Code indicating a code from a specific industry code list
Industry: Value Code
UB-92 Ref. [UB-Name]: 39 (a-d) [Value Codes and Amounts]
40 (a-d)0 [Value Codes and Amounts]
41 (a-d) [Value Codes and Amounts]
EMC v.6.0 Reference: Record Type 41 Field No. 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 35, 37, 38, 39

M

AN

1/30

Required

ExternalCodeList

Name: 132

Description: National Uniform Billing Committee (NUBC) Codes

782

Monetary Amount
Description: Monetary amount
Industry: Value Code Associated Amount
This data element must contain the Value Code Amount when HIxx-1 value equals BE (Value Code).

O

R

1/18

Required

HI05

C022

Health Care Code Information
Description: To send health care codes and their associated dates, amounts and quantities
Used when necessary to report multiple additional co-existing conditions.

O

Comp

Situational

1270

Code List Qualifier Code
Description: Code identifying a specific industry code list

M

ID

1/3

Required

Code

Name

BE

Value

CODE SOURCE:

132: National Uniform Billing Committee (NUBC) Codes

1271

Industry Code
Description: Code indicating a code from a specific industry code list
Industry: Value Code
UB-92 Ref. [UB-Name]: 39 (a-d) [Value Codes and Amounts]
40 (a-d)0 [Value Codes and Amounts]
41 (a-d) [Value Codes and Amounts]
EMC v.6.0 Reference: Record Type 41 Field No. 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 35, 37, 38, 39

M

AN

1/30

Required

ExternalCodeList

Name: 132

Description: National Uniform Billing Committee (NUBC) Codes

782

Monetary Amount
Description: Monetary amount
Industry: Value Code Associated Amount
This data element must contain the Value Code Amount when HIxx-1 value equals BE (Value Code).

O

R

1/18

Required

HI06

C022

Health Care Code Information
Description: To send health care codes and their associated dates, amounts and quantities
Used when necessary to report multiple additional co-existing conditions.

O

Comp

Situational

1270

Code List Qualifier Code
Description: Code identifying a specific industry code list

M

ID

1/3

Required

Code

Name

BE

Value

CODE SOURCE:

132: National Uniform Billing Committee (NUBC) Codes

1271

Industry Code
Description: Code indicating a code from a specific industry code list
Industry: Value Code
UB-92 Ref. [UB-Name]: 39 (a-d) [Value Codes and Amounts]
40 (a-d)0 [Value Codes and Amounts]
41 (a-d) [Value Codes and Amounts]
EMC v.6.0 Reference: Record Type 41 Field No. 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 35, 37, 38, 39

M

AN

1/30

Required

ExternalCodeList

Name: 132

Description: National Uniform Billing Committee (NUBC) Codes

782

Monetary Amount
Description: Monetary amount
Industry: Value Code Associated Amount
This data element must contain the Value Code Amount when HIxx-1 value equals BE (Value Code).

O

R

1/18

Required

HI07

C022

Health Care Code Information
Description: To send health care codes and their associated dates, amounts and quantities
Used when necessary to report multiple additional co-existing conditions.

O

Comp

Situational

1270

Code List Qualifier Code
Description: Code identifying a specific industry code list

M

ID

1/3

Required

Code

Name

BE

Value

CODE SOURCE:

132: National Uniform Billing Committee (NUBC) Codes

1271

Industry Code
Description: Code indicating a code from a specific industry code list
Industry: Value Code
UB-92 Ref. [UB-Name]: 39 (a-d) [Value Codes and Amounts]
40 (a-d)0 [Value Codes and Amounts]
41 (a-d) [Value Codes and Amounts]
EMC v.6.0 Reference: Record Type 41 Field No. 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 35, 37, 38, 39

M

AN

1/30

Required

ExternalCodeList

Name: 132

Description: National Uniform Billing Committee (NUBC) Codes

782

Monetary Amount
Description: Monetary amount
Industry: Value Code Associated Amount
This data element must contain the Value Code Amount when HIxx-1 value equals BE (Value Code).

O

R

1/18

Required

HI08

C022

Health Care Code Information
Description: To send health care codes and their associated dates, amounts and quantities
Used when necessary to report multiple additional co-existing conditions.

O

Comp

Situational

1270

Code List Qualifier Code
Description: Code identifying a specific industry code list

M

ID

1/3

Required

Code

Name

BE

Value

CODE SOURCE:

132: National Uniform Billing Committee (NUBC) Codes

1271

Industry Code
Description: Code indicating a code from a specific industry code list
Industry: Value Code
UB-92 Ref. [UB-Name]: 39 (a-d) [Value Codes and Amounts]
40 (a-d)0 [Value Codes and Amounts]
41 (a-d) [Value Codes and Amounts]
EMC v.6.0 Reference: Record Type 41 Field No. 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 35, 37, 38, 39

M

AN

1/30

Required

ExternalCodeList

Name: 132

Description: National Uniform Billing Committee (NUBC) Codes

782

Monetary Amount
Description: Monetary amount
Industry: Value Code Associated Amount
This data element must contain the Value Code Amount when HIxx-1 value equals BE (Value Code).

O

R

1/18

Required

HI09

C022

Health Care Code Information
Description: To send health care codes and their associated dates, amounts and quantities
Used when necessary to report multiple additional co-existing conditions.

O

Comp

Situational

1270

Code List Qualifier Code
Description: Code identifying a specific industry code list

M

ID

1/3

Required

Code

Name

BE

Value

CODE SOURCE:

132: National Uniform Billing Committee (NUBC) Codes

1271

Industry Code
Description: Code indicating a code from a specific industry code list
Industry: Value Code
UB-92 Ref. [UB-Name]: 39 (a-d) [Value Codes and Amounts]
40 (a-d)0 [Value Codes and Amounts]
41 (a-d) [Value Codes and Amounts]
EMC v.6.0 Reference: Record Type 41 Field No. 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 35, 37, 38, 39

M

AN

1/30

Required

ExternalCodeList

Name: 132

Description: National Uniform Billing Committee (NUBC) Codes

782

Monetary Amount
Description: Monetary amount
Industry: Value Code Associated Amount
This data element must contain the Value Code Amount when HIxx-1 value equals BE (Value Code).

O

R

1/18

Required

HI10

C022

Health Care Code Information
Description: To send health care codes and their associated dates, amounts and quantities
Used when necessary to report multiple additional co-existing conditions.

O

Comp

Situational

1270

Code List Qualifier Code
Description: Code identifying a specific industry code list

M

ID

1/3

Required

Code

Name

BE

Value

CODE SOURCE:

132: National Uniform Billing Committee (NUBC) Codes

1271

Industry Code
Description: Code indicating a code from a specific industry code list
Industry: Value Code
UB-92 Ref. [UB-Name]: 39 (a-d) [Value Codes and Amounts]
40 (a-d)0 [Value Codes and Amounts]
41 (a-d) [Value Codes and Amounts]
EMC v.6.0 Reference: Record Type 41 Field No. 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 35, 37, 38, 39

M

AN

1/30

Required

ExternalCodeList

Name: 132

Description: National Uniform Billing Committee (NUBC) Codes

782

Monetary Amount
Description: Monetary amount
Industry: Value Code Associated Amount
This data element must contain the Value Code Amount when HIxx-1 value equals BE (Value Code).

O

R

1/18

Required

HI11

C022

Health Care Code Information
Description: To send health care codes and their associated dates, amounts and quantities
Used when necessary to report multiple additional co-existing conditions.

O

Comp

Situational

1270

Code List Qualifier Code
Description: Code identifying a specific industry code list

M

ID

1/3

Required

Code

Name

BE

Value

CODE SOURCE:

132: National Uniform Billing Committee (NUBC) Codes

1271

Industry Code
Description: Code indicating a code from a specific industry code list
Industry: Value Code
UB-92 Ref. [UB-Name]: 39 (a-d) [Value Codes and Amounts]
40 (a-d)0 [Value Codes and Amounts]
41 (a-d) [Value Codes and Amounts]
EMC v.6.0 Reference: Record Type 41 Field No. 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 35, 37, 38, 39

M

AN

1/30

Required

ExternalCodeList

Name: 132

Description: National Uniform Billing Committee (NUBC) Codes

782

Monetary Amount
Description: Monetary amount
Industry: Value Code Associated Amount
This data element must contain the Value Code Amount when HIxx-1 value equals BE (Value Code).

O

R

1/18

Required

HI12

C022

Health Care Code Information
Description: To send health care codes and their associated dates, amounts and quantities
Used when necessary to report multiple additional co-existing conditions.

O

Comp

Situational

1270

Code List Qualifier Code
Description: Code identifying a specific industry code list

M

ID

1/3

Required

Code

Name

BE

Value

CODE SOURCE:

132: National Uniform Billing Committee (NUBC) Codes

1271

Industry Code
Description: Code indicating a code from a specific industry code list
Industry: Value Code
UB-92 Ref. [UB-Name]: 39 (a-d) [Value Codes and Amounts]
40 (a-d)0 [Value Codes and Amounts]
41 (a-d) [Value Codes and Amounts]
EMC v.6.0 Reference: Record Type 41 Field No. 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 35, 37, 38, 39

M

AN

1/30

Required

ExternalCodeList

Name: 132

Description: National Uniform Billing Committee (NUBC) Codes

782

Monetary Amount
Description: Monetary amount
Industry: Value Code Associated Amount
This data element must contain the Value Code Amount when HIxx-1 value equals BE (Value Code).

O

R

1/18

Required

Notes:

1. Required when value information applies to the claim or encounter.

Example:

HI*BE:08:::1740~