File HCS_REVIEW_TRANSMISSION(356.22) Data List

DATE ENTERED	PATIENT	INSURANCE POLICY	INPATIENT / OUTPATIENT	WARD	CLINIC	EVENT DATE	STATUS	MARKED 'IN PROGRESS' BY	DATE MARKED 'IN PROGRESS'	REQUESTED BY	MESSAGE CONTROL ID	INQUIRY	RESPONSE	TRANSMISSION DATE/TIME	SOURCE	TICKLER	FROM RESPONSE	215 TRIGGERED	TRANSACTION TYPE	RESPONSE STATUS	DELETED RESPONSE	DATE MANUALLY REMOVED	MANUALLY REMOVED BY	DELETE REASON	MANUAL 215	REQ FROM RESP	COMMENTS	HOME HEALTH START DATE	HOME HEALTH CERT. START	HOME HEALTH CERT. END	COVERED BY MEDICARE?	SURGERY DATE	SURGICAL PROCEDURE CODE TYPE	SURGICAL PROCEDURE CODE	PHYSICIAN ORDER DATE	LAST VISIT DATE	PHYSICIAN CONTACT DATE	LAST ADMISSION START DATE	LAST ADMISSION END DATE	PATIENT LOCATION	AAA SEGMENTS	CERTIFICATION ACTION CODE	REVIEW IDENTIFICATION NUMBER	REVIEW DECISION REASON CODE	SECOND SURGICAL OPINION FLAG	TRN SEGMENTS	HI SEGMENTS	ATTACHMENTS	MESSAGE TEXT	PATIENT EVENT PROVIDER	PATIENT EVENT TRANSPORT	OTHER UMO	SERVICE LINE	PREV. AUTHORIZATION #	PREV. ADMIN. REFERENCE #	WEIGHT UNITS	PATIENT WEIGHT	AMBULANCE TRANSPORT CODE	AMBULANCE TRANSPORT REASON	DISTANCE UNITS	TRANSPORT DISTANCE	ROUND TRIP PURPOSE DESCRIPTION	STRETCHER PURPOSE DESCRIPTION	UMO CONTACT NAME	COMMUNICATION NO. QUALIFIER-1	COMMUNICATION NO. QUALIFIER-2	COMMUNICATION NO. QUALIFIER-3	REQUEST CATEGORY	CERTIFICATION TYPE CODE	SERVICE TYPE CODE	FACILITY TYPE QUALIFIER	FACILITY TYPE	LOCATION OF CARE	BILL CLASSIFICATION	RELATED CAUSES #1	RELATED CAUSES #2	RELATED CAUSES #3	STATE	COUNTRY	LEVEL OF SERVICE	CURRENT HEALTH CONDITION	PROGNOSIS CODE	RELEASE OF INFORMATION CODE	DELAY REASON	ACCIDENT DATE	LAST MENSTRUAL PERIOD DATE	ESTIMATED DOB	ILLNESS DATE	DISCHARGE DATE	CERTIFICATION ISSUE DATE	CERTIFICATION EXPIRATION DATE	CERTIFICATION EFFECTIVE DATE	CERT EFFECTIVE THRU DATE	CONTACT COMMUNICATION NUMBER-1	CONTACT COMMUNICATION NUMBER-2	CONTACT COMMUNICATION NUMBER-3	DELETE REASON NOTE	PATIENT DIAGNOSIS	HCSD QUANTITY QUALIFIER	HCSD SERVICE UNIT COUNT	HCSD UNITS OF MEASUREMENT	HCSD SAMPLE SELECTION MODULUS	HCSD TIME PERIOD QUALIFIER	HCSD PERIOD COUNT	HCSD DELIVERY FREQUENCY	HCSD DELIVERY TIME PATTERN	AMBULANCE CERT. CONDITION	AMBULANCE CONDITION #1	AMBULANCE CONDITION #2	AMBULANCE CONDITION #3	AMBULANCE CONDITION #4	AMBULANCE CONDITION #5	CHIROPRACTIC CERT. CONDITION	CHIROPRACTIC CONDITION #1	CHIROPRACTIC CONDITION #2	CHIROPRACTIC CONDITION #3	CHIROPRACTIC CONDITION #4	CHIROPRACTIC CONDITION #5	DME CERT. CONDITION	DME CONDITION #1	DME CONDITION #2	DME CONDITION #3	DME CONDITION #4	DME CONDITION #5	OXYGEN CERT. CONDITION	OXYGEN CONDITION #1	OXYGEN CONDITION #2	OXYGEN CONDITION #3	OXYGEN CONDITION #4	OXYGEN CONDITION #5	FUNCT. LIMIT CERT. CONDITION	FUNCT. LIMIT CONDITION #1	FUNCT. LIMIT CONDITION #2	FUNCT. LIMIT CONDITION #3	FUNCT. LIMIT CONDITION #4	FUNCT. LIMIT CONDITION #5	ACTIVITIES CERT. CONDITION	ACTIVITIES CONDITION #1	ACTIVITIES CONDITION #2	ACTIVITIES CONDITION #3	ACTIVITIES CONDITION #4	ACTIVITIES CONDITION #5	MENTAL STATUS CERT. CONDITION	MENTAL STATUS CONDITION #1	MENTAL STATUS CONDITION #2	MENTAL STATUS CONDITION #3	MENTAL STATUS CONDITION #4	MENTAL STATUS CONDITION #5	ADMISSION TYPE	ADMISSION SOURCE	PATIENT STATUS	NURSING HOME STATUS	TREATMENT SERIES NUMBER	TREATMENT COUNT	SUBLUXATION LEVEL CODE #1	SUBLUXATION LEVEL CODE #2	PATIENT CONDITION CODE	COMPLICATION INDICATOR	PAT. COND. DESCRIPTION LINE 1	PAT. COND. DESCRIPTION LINE 2	X-RAY AVAILABLE?	OXYGEN EQUIPMENT TYPE #1	OXYGEN EQUIPMENT TYPE #2	OXYGEN EQUIPMENT TYPE #3	OXYGEN EQUIPMENT REASON	OXYGEN FLOW RATE	DAILY OXYGEN USE COUNT	OXYGEN USE PERIOD HOUR COUNT	RESPIRATORY THERAPIST ORDER	ARTERIAL BLOOD GAS QUANTITY	OXYGEN SATURATION QUANTITY	OXYGEN TEST CONDITION	OXYGEN TEST FINDINGS #1	OXYGEN TEST FINDINGS #2	OXYGEN TEST FINDINGS #3	PORTABLE OXYGEN SYSTEM FLOW	OXYGEN DELIVERY SYSTEM