The UB2 segment contains data necessary to complete UB92 bills specific to the United States. Realms outside the US are referred to chapter 16. Only Uniform Billing fields that do not exist in other HL7 defined segments appear in this segment. For example, Patient Name and Date of Birth are required; they are included in the PID segment and therefore do not appear here. Uniform Billing field locators are provided in parentheses ( ). The UB codes listed as examples are not an exhaustive or current list; refer to a UB specification for additional information.
| Seq# | Data Element Name | DataType | Usage | Vocabulary | Cardinality | Item # | Length | C.LEN | Flags |
|---|---|---|---|---|---|---|---|---|---|
UB2
|
|||||||||
1
|
Set ID - UB2 | SI | O | [0..1] | 00553 | [1..4] | |||
|
2
|
Co-Insurance Days | ST | O | [0..1] | 00554 | [1..3] | |||
|
3
|
Condition Code | CWE | O | [0..7] | 00555 | ||||
|
4
|
Covered Days | ST | O | [0..1] | 00556 | [1..3] | |||
|
5
|
Non-Covered Days | ST | O | [0..1] | 00557 | [1..4] | |||
|
6
|
Value Amount & Code | UVC | O | [0..12] | 00558 | ||||
|
7
|
Occurrence Code & Date | OCD | O | [0..8] | 00559 | ||||
|
8
|
Occurrence Span Code/Dates | OSP | O | [0..2] | 00560 | ||||
|
9
|
Uniform Billing Locator 2 | ST | O | [0..2] | 00561 | [1..29] | |||
|
10
|
Uniform Billing Locator 11 | ST | O | [0..2] | 00562 | [1..12] | |||
|
11
|
Uniform Billing Locator 31 | ST | O | [0..1] | 00563 | [1..5] | |||
|
12
|
Document Control Number | ST | O | [0..3] | 00564 | [1..23] | |||
|
13
|
Uniform Billing Locator 49 | ST | O | [0..23] | 00565 | [1..4] | |||
|
14
|
Uniform Billing Locator 56 | ST | O | [0..5] | 00566 | [1..14] | |||
|
15
|
Uniform Billing Locator 57 | ST | O | [0..1] | 00567 | [1..27] | |||
|
16
|
Uniform Billing Locator 78 | ST | O | [0..2] | 00568 | [1..2] | |||
17
|
Special Visit Count | NM | O | [0..1] | 00815 | [1..3] | |||
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 the number of inpatient days exceeding defined benefit coverage. In the US, this corresponds to Uniform Billing form locator 9. This field is defined by CMS or other regulatory agencies.
Definition: This field contains a code reporting conditions that may affect payer processing; for example, the condition is related to employment (Patient covered by insurance not reflected here, treatment of non-terminal condition for hospice patient). The code in this field can repeat up to seven times to correspond to Uniform Billing form locators 24-30. Refer to User-defined Table 0043 - Condition Code in Chapter 2C, Code Tables, for suggested values. Refer to a UB specification for additional information. This field is defined by CMS or other regulatory agencies.
Definition: This field contains Uniform Billing field 7. This field is defined by CMS or other regulatory agencies.
Definition: This field contains Uniform Billing field 8. This field is defined by CMS or other regulatory agencies.
Definition: This field contains a monetary amount and an associated billing code. The pair in this field can repeat up to twelve times to represent/contain UB92 form locators 39a, 39b, 39c, 39d, 40a, 40b, 40c, 40d, 41a, 41b, 41c, and 41d. This field is defined by CMS or other regulatory agencies.
Definition: The set of values in this field can repeat up to eight times. Uniform Billing fields 32a, 32b, 33a, 33b, 34a, 34b, 35a, and 35b. This field is defined by CMS or other regulatory agencies.
Definition: This field contains an occurrence span code and an associated date. This field can repeat up to two times to represent/contain Uniform Billing form locators 36a and 36b. This field is defined by CMS or other regulatory agencies.
Definition: The value in this field may repeat up to two times.
Definition: The value in this field may repeat up to two times.
Definition: Defined by CMS 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. Refer Uniform Billing field 37.
Definition: This field is defined by CMS or other regulatory agencies. This field may repeat up to twenty-three times.
Definition: This field may repeat up to five times.
Definition: Defined by Uniform Billing CMS specification.
Definition: This field may repeat up to two times.
Definition: This field contains the total number of special therapy visits.
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