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Sub-Field: 356.2215

Package: Integrated Billing

HCS REVIEW TRANSMISSION(#356.22)-->356.2215

Sub-Field: 356.2215


Information

Parent File Name Number Package
HCS REVIEW TRANSMISSION(#356.22) OTHER UMO 356.2215 Integrated Billing

Details

Field # Name Loc Type Details
.01 UMO TYPE 0;1 SET
  • '00' FOR Alternate insurer (commercial);
  • 'CA' FOR Carrier (Medicare Part B);
  • 'GG' FOR Intermediary (Medicare Part A);

  • LAST EDITED:  JAN 02, 2015
  • HELP-PROMPT:  Enter a valid UMO Qualifier.
  • DESCRIPTION:  
    The Utilizaton Managment Organization Qualifier.
  • CROSS-REFERENCE:  356.2215^B
    1)= S ^IBT(356.22,DA(1),15,"B",$E(X,1,30),DA)=""
    2)= K ^IBT(356.22,DA(1),15,"B",$E(X,1,30),DA)
.02 UMO NAME 0;2 POINTER TO INSURANCE COMPANY FILE (#36) INSURANCE COMPANY(#36)

  • LAST EDITED:  JAN 02, 2015
  • HELP-PROMPT:  Enter a valid UMO Name.
  • DESCRIPTION:  
    The name of the payer who previously denied this request. This is a REQUIRED field if the request has been denied by another UMO.
.03 UMO DENIAL REASON #1 0;3 POINTER TO X12 278 HCS DECISION REASON CODES FILE (#356.021) X12 278 HCS DECISION REASON CODES(#356.021)

  • INPUT TRANSFORM:  S DIC("S")="I $$UDREASN^IBTRH5I(.03)" D ^DIC K DIC S DIC=$G(DIE),X=+Y K:Y<0 X
  • OUTPUT TRANSFORM:  UMO DENIAL REASON #1:DESCRIPTION
  • LAST EDITED:  DEC 31, 2014
  • HELP-PROMPT:  Enter a valid UMO Denial Reason. The entered code must not already be present in Denial Reasons #2, #3 or #4.
  • DESCRIPTION:  
    The Denial Reason for which the request was previously denied. Up to 4 Denial Reasons are allowed.
  • SCREEN:  S DIC("S")="I $$UDREASN^IBTRH5I(.03)"
  • EXPLANATION:  Select a valid UMO Denial Reason
.04 UMO DENIAL REASON #2 0;4 POINTER TO X12 278 HCS DECISION REASON CODES FILE (#356.021) X12 278 HCS DECISION REASON CODES(#356.021)

  • INPUT TRANSFORM:  S DIC("S")="I $$UDREASN^IBTRH5I(.04)" D ^DIC K DIC S DIC=$G(DIE),X=+Y K:Y<0 X
  • OUTPUT TRANSFORM:  UMO DENIAL REASON #2:DESCRIPTION
  • LAST EDITED:  DEC 31, 2014
  • HELP-PROMPT:  Enter a valid UMO Denial Reason. The entered code must not already be present in Denial Reasons #1, #3 or #4.
  • DESCRIPTION:  
    The Denial Reason for which the request was previously denied. Up to 4 Denial Reasons are allowed.
  • SCREEN:  S DIC("S")="I $$UDREASN^IBTRH5I(.04)"
  • EXPLANATION:  Select a valid UMO Denial Reason
.05 UMO DENIAL REASON #3 0;5 POINTER TO X12 278 HCS DECISION REASON CODES FILE (#356.021) X12 278 HCS DECISION REASON CODES(#356.021)

  • INPUT TRANSFORM:  S DIC("S")="I $$UDREASN^IBTRH5I(.05)" D ^DIC K DIC S DIC=$G(DIE),X=+Y K:Y<0 X
  • OUTPUT TRANSFORM:  UMO DENIAL REASON #3:DESCRIPTION
  • LAST EDITED:  DEC 31, 2014
  • HELP-PROMPT:  Enter a valid UMO Denial Reason. The entered code must not already be present in Denial Reasons #1, #2, or #4.
  • DESCRIPTION:  
    The Denial Reason for which the request was previously denied. Up to 4 Denial Reasons are allowed.
  • SCREEN:  S DIC("S")="I $$UDREASN^IBTRH5I(.05)"
  • EXPLANATION:  Select a valid UMO Denial Reason
.06 UMO DENIAL REASON #4 0;6 POINTER TO X12 278 HCS DECISION REASON CODES FILE (#356.021) X12 278 HCS DECISION REASON CODES(#356.021)

  • INPUT TRANSFORM:  S DIC("S")="I $$UDREASN^IBTRH5I(.06)" D ^DIC K DIC S DIC=$G(DIE),X=+Y K:Y<0 X
  • OUTPUT TRANSFORM:  UMO DENIAL REASON #4:DESCRIPTION
  • LAST EDITED:  DEC 31, 2014
  • HELP-PROMPT:  Enter a valid UMO Denial Reason. The entered code must not already be present in Denial Reasons #1, #2 or #3.
  • DESCRIPTION:  
    The Denial Reason for which the request was previously denied. Up to 4 Denial Reasons are allowed.
  • SCREEN:  S DIC("S")="I $$UDREASN^IBTRH5I(.06)"
  • EXPLANATION:  Select a valid UMO Denial Reason
.07 UMO DENIAL DATE 0;7 DATE

  • INPUT TRANSFORM:  S %DT="EX" D ^%DT S X=Y K:X<1 X
  • LAST EDITED:  DEC 31, 2014
  • HELP-PROMPT:  Enter a valid date.
  • DESCRIPTION:  
    The Date on which this request was previously denied.
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