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Nachricht MEDRUC: D

NameMEDRUC
VersionD
Release18B
BeschreibungMedical resource usage and cost message

Elemente

SegmentEbeneBeschreibungOpt/Mand.
UNH0A service segment starting and uniquely identifying a message. The message type code for the Medical resource usage and cost message is MEDRUC. Note: Medical resource usage and cost messages conforming to this document must contain the following data in segment UNH, composite S009: Data element 0065 MEDRUC D B UNMandatory
BGM0A segment for unique identification of the message and specification of its function.Mandatory
DTM0A segment identifying the date/time of message generation and/or other date/times concerning the whole message.Optional
RFF0A segment specifying references to other related message(s) or batch(es), e.g. a previous message.Optional
FTX0A segment giving free text information, in coded or clear form, for specifying information about the whole message.Optional
CUX0A segment specifying the currency in which all the monetary amounts are expressed in the message.Optional
CNT0A segment specifying aggregate information concerning the whole message, e.g. number of claims, number of parties, number of patients, etc.Optional
SG10SG1Optional
MOA1A segment specifying total amounts for the whole reimbursement message.Mandatory
TAX1A segment specifying the tax type if relevant.Optional
SG20SG2Optional
PNA1A segment specifying the identity number and name of a party.Mandatory
SEQ1A segment allocating a sequence number to the individual party allowing each party to be referenced from within the message.Optional
ADR1A segment specifying address(es) of the party.Optional
CTA1A segment identifying a person or department to whom contacts should be directed and their function.Optional
COM1A segment giving communication type and number of the party.Optional
RFF1A segment specifying alternative identification numbers of the party. This segment also facilitates reference to another party if the current party is related to another party such as a department in a hospital, a physician in a department, etc.Optional
REL1A segment specifying the relationship with another party.Optional
NAT1A segment specifying the nationalities of the party.Optional
LAN1A segment specifying the language used by the party.Optional
SPR1A segment specifying the type and (medical) speciality of an organisation.Optional
EMP1A segment specifying the type and (medical) speciality of a person as well as his/her position within an organisation.Optional
QUA1A segment specifying the professional (medical) qualifications of the party.Optional
DTM1A segment specifying validity dates or any other date related to the party.Optional
STS1A segment specifying the status of involvement for the party (former, previous, current, next).Optional
RCS1A segment specifying administrative conditions of a party, such as the type of location from which a healthcare professional operates, (e.g. town, countryside, mountain area), identifier for agreement on reimbursement mode and tariff, or other statutory information.Optional
PDI1A segment specifying demographic information such as sex, marital status, and other demographic information.Optional
FII1A segment identifying an account number and a financial institution related to the party.Optional
SG30SG3Optional
AGR1A segment identifying the type of the insurance contract.Mandatory
SEQ1A segment allocating a sequence number to the individual contract allowing each contract to be referenced from within the message.Optional
RFF1A segment specifying certificate numbers and other references related to the contract. This segment is also used to hold a reference to administrative parties in the Parties Segment Group where the related insurance organisation or institution is identified.Optional
DTM1A segment specifying dates, times and periods related to the contract such as period of validity and period of specific coverage.Optional
SG41SG4Optional
ICD2A segment identifying the insurance scheme or product covering the patient.Mandatory
FTX2A segment with free text information, in coded or clear form, illustrating or justifying a particular term of the insurance scheme or product, specified in the ICD segment.Optional
SG50SG5Optional
DOC1A segment specifying the type and the name of a document.Mandatory
DTM1A segment specifying dates related to the document. (e.g. issuing date, validity date, etc.).Optional
SG61SG6Optional
PNA2A segment identifying the party.Mandatory
ADR2A segment specifying the address of the party.Optional
STS2A segment specifying the involvement status of the party (former, previous, current, next).Optional
RCS2A segment specifying administrative conditions of a party such as the social sector it belongs to.Optional
SG70SG7Optional
FCA1A segment specifying whether reimbursement is due to the patient, to the healthcare service provider, or to a combination of both.Mandatory
GEI1A segment specifying the service type of the actual reimbursement claim, i.e. whether this is a new reimbursement claim, modification of a previous reimbursement claim, cancellation of a previous reimbursement claim or a complete replacement of a previous reimbursement claim.Optional
RFF1A segment specifying certificate numbers and other references related to the reimbursement claim. This segment may also be used to hold the reference to administrative, financial, and medical parties of the Parties Segment Group, insurance contracts of the Contract Segment Group and transport activities of the Transports Segment Group.Optional
DTM1A segment specifying dates, times and periods related to the reimbursement claim.Optional
FTX1A segment with free text information, in coded or clear form, for specifying information about the reimbursement claim.Optional
AGR1A segment identifying the type of the insurance contract related to the reimbursement claim.Optional
DOC1A segment specifying documents the reimbursement claim is referring to. This segment may also be used to hold a document reference of the external documents Segment Group.Optional
SG81SG8Optional
MOA2A segment specifying total amounts such as total amount to pay.Mandatory
TAX2A segment specifying relevant tax information.Optional
SG91SG9Optional
RCS2A segment specifying requirements and conditions concerning the reimbursement claim.Mandatory
FTX2A segment with free text information, in coded or clear form, illustrating or justifying a particular condition specified in the RCS segment.Optional
SG101SG10Optional
PNA2A segment identifying the patient, related person, or party identity number and name.Mandatory
RFF2A segment specifying the identification numbers of the person or other identification references such as card number. This segment may also be used to keep the reference to administrative, financial, and medical parties of the Parties Segment Group, and insurance contracts of the Contracts Segment Group.Optional
ADR2A segment specifying the details of the patient and related person(s) place of residence, or any other address or location related to the person, such as place of birth.Optional
COM2A segment providing a telecommunication number for the person.Optional
DTM2A segment specifying relevant dates/times for the person such as date of birth, date of death or date identification card was issued.Optional
PDI2A segment specifying demographic information such as sex, marital status, and other demographic information.Optional
RSL2A segment specifying the result of a clinical examination, such as the height or weight of the patient.Optional
NAT2A segment specifying the nationality of a person.Optional
LAN2A segment specifying the language used by the person.Optional
HAN2A segment specifying confidentiality constraints on person data.Optional
REL2A segment specifying the relationship between a related person and the patient. This relation can be an organ donor- receiver relationship, a mother-child relationship or any other family relationship.Optional
SG111SG11Optional
PRC2A segment specifying the type of medical activity provided such as hospitalisation or outpatient treatment.Mandatory
GEI2A segment specifying the service type for the medical activity: new activity, modification of a previous activity, cancellation of a previous activity or replacement of a previous activity.Optional
STS2A segment specifying the activity status regarding its achievement (e.g. started, in progress, terminated) and/or payment (e.g. received, granted, paid).Optional
IMD2A segment identifying the actual medical activity, and allowing several alternative coding schemes depending on separately agreed criteria.Optional
CIN2A segment justifying the medical activity provided in terms of diagnosis or clinical observation.Optional
PNA2A segment specifying the identity number and name of any medical or administrative party related to the current activity, such as treatment provider or prescriber, diagnosis originator, etc.Optional
DTM2A segment specifying dates, times and periods related to the current medical activity such as date performed, date of prescription, date of sickness and date of medical authorisation.Optional
RFF2To specify a reference related to a treatment such as identification number of prescription or medical authorisation number. This segment may also be used to hold the reference to administrative, financial, and medical parties of the Parties Segment Group, insurance contracts of the Contracts Segment Group and transports of the Transports Segment Group.Optional
FTX2A segment with free text information, in coded or clear form, specifying information about the current medical activity.Optional
QTY2A segment providing quantities related to the medical activity such as number of units of service as identified in the IMD segment. If the service type of this medical activity is a modification then variations from the original quantities are given here.Optional
PCD2A segment specifying percentage used to calculate a share of a reimbursement. This information is useful when a party has already paid a certain amount, or more generally when several recipients are identified in the business scenario (e.g. 75% of a visit will be paid to the general practitioner and 25% to the patient).Optional
SG122SG12Optional
PAS3A segment specifying patient administrative information such as administrative status concerning current hospital stay or outpatient visit or ward stay related to the patient.Mandatory
LOC3A segment specifying the physical location of patient care in terms of ward, room, bed, etc.Optional
DTM3A segment specifying admission and/or discharge date and time or start and/or end date and time of a ward stay.Optional
RFF3This segment holds the reference of a healthcare party for specifying healthcare administrative information such as hospital, department, etc. where patient is admitted, located, etc.Optional
SG132SG13Optional
MOA3A segment specifying total amounts such as amount of fees.Mandatory
TAX3A segment specifying relevant tax information.Optional
SG142SG14Optional
RCS3A segment specifying requirements and conditions about the current medical activity.Mandatory
FTX3A segment with free text information, in coded or clear form, illustrating or justifying a particular condition specified in the RCS segment.Optional
SG152SG15Optional
CLI3A segment specifying a clinical intervention.Mandatory
GEI3A segment specifying the service type of the current detailed medical activity, i.e. whether this is a new detailed medical activity, modification of a previous detailed medical activity, cancellation of a previous detailed medical activity or a complete replacement of a previous detailed medical activity.Optional
IMD3A segment identifying the current detailed medical activity and allowing several alternative coding schemes depending on separately agreed criteria.Optional
CIN3A segment specifying the reason for applying the current detailed medical activity in terms of diagnosis or clinical observation.Optional
PNA3A segment specifying the identity number and name of any medical or administrative party related to the current activity, such as activity provider or prescriber, diagnosis originator, etc.Optional
DTM3A segment specifying dates, times and periods related to the current medical activity such as date performed, date of prescription, date of sickness and date of medical authorisation.Optional
RFF3To specify the reference related to a detailed medical activity such as identification number of prescription and medical authorisation number. This segment may also be used to hold the reference to administrative, financial, and medical parties of the Parties Segment Group, insurance contracts of the Contracts Segment Group, and transports of the Transports Segment Group.Optional
FTX3A segment with free text information, in coded or clear form, specifying information about the current detailed medical activity.Optional
QTY3A segment specifying quantities related to the detailed medical activity such as number of units of service as identified in the IMD segment. If the service type of this detailed medical activity is a modification then variations from the original quantities are given here.Optional
PCD3A segment specifying percentage used to calculate a share of a reimbursement. This information is useful when a party has already paid a certain amount, or more generally when several recipients are identified in the business scenario (e.g. 75% of a visit will be paid to the general practitioner and 25% to the patient).Optional
PAC3A segment specifying package and number of physical units for drugs or any other materials.Optional
SG163SG16Optional
MOA4A segment specifying total amounts such as amount of fees.Mandatory
TAX4A segment specifying relevant tax information.Optional
SG173SG17Optional
RCS4A segment specifying requirements and conditions concerning the current detailed medical activity.Mandatory
FTX4A segment with free text information, in coded or clear form, illustrating or justifying a particular condition specified in the RCS segment.Optional
SG183SG18Optional
EQD4A segment identifying the equipment used.Mandatory
SEQ4A segment specifying the sequential number of the activity performed on the equipment.Optional
SG190SG19Optional
TMD1A segment specifying journey trip such as a journey from a hospital to a patient home.Mandatory
SEQ1A segment allocating a sequence number to the transport activity, allowing each transport activity to be referenced from within the message.Optional
GEI1A segment specifying the service type of the transport activity: new transport activity, modification of a previous transport activity, cancellation of a previous transport activity or replacement for a previous transport activity.Optional
FTX1A segment with free text information, in coded or clear form, specifying information about the whole transport activity.Optional
SG201SG20Optional
TDT2A segment identifying the transport service provider, the kind of transportation used, and the vehicle.Mandatory
GEI2A segment specifying the service type of the actual transport phase: new transport phase, modification of a previous reported transport phase, cancellation of a previous reported transport phase and replacement for a previous reported transport phase.Optional
IMD2A segment identifying the current transport activity and allowing several alternative coding schemes depending on separately agreed criteria.Optional
PNA2A segment identifying the party transported and the transport service provider, such as a driver.Optional
RFF2A segment specifying references concerning the actual transport phase such as authorisation number. This segment may also be used to hold the reference to administrative, financial, and medical parties of the Parties Segment Group, and insurance contracts of Contracts Segment Group.Optional
FTX2A segment with free text information, in coded or clear form, specifying information about the current transport phase.Optional
CIN2A segment specifying the reason for the current transport phase in terms of diagnosis or clinical observation.Optional
QTY2A segment specifying quantities related to the transport phase, such as number of people transported.Optional
SG212SG21Optional
ADR3A segment specifying the address details of the transport phase such as location of departure and arrival.Mandatory
DTM3A segment specifying relevant dates and times for the transport phase such as date/time of departure, arrival and elapsed time.Optional
SG222SG22Optional
TSR3A segment specifying special circumstances affecting the current transport phase.Mandatory
FTX3A segment with free text information, in coded or clear form, illustrating or justifying a particular circumstance specified in the TSR segment.Optional
SG232SG23Optional
TCC3A segment specifying charges for a transport component.Mandatory
GEI3A segment specifying the service type of the actual transport component, i.e. whether this is a new transport component, modification of a previous transport component, cancellation of a previous transport component or a complete replacement of a previous transport component.Optional
IMD3A segment identifying the current transport component such as night trip, day trip, toll gate and highway.Optional
DTM3A segment specifying dates and times concerning the current transport component.Optional
RFF3To specify references of a transport component.Optional
FTX3A segment with free text information, in coded or clear form, illustrating or justifying the current transport component.Optional
QTY3A segment specifying quantities related to the transport component such as number of km.Optional
PCD3A segment specifying percentage used to calculate a share of a reimbursement. This information is useful when a party has already paid a certain amount, or more generally when several recipients are identified in the business scenario (e.g. 75% of a transport will be paid to the transport service provider and 25% to the patient).Optional
SG243SG24Optional
MOA4A segment specifying total amounts such as amount of fees.Mandatory
TAX4A segment specifying relevant tax information.Optional
SG253SG25Optional
TSR4A segment specifying special circumstances affecting the current transport component.Mandatory
FTX4A segment with free text information, in coded or clear form, illustrating or justifying a particular circumstance specified in the TSR segment.Optional
SG260SG26Optional
AUT1A segment specifying the result of an authentication procedure.Mandatory
DTM1A segment specifying dates and times of an authentication result.Optional
UNT0A service segment ending a message, giving the total number of segments in the message (including the UNH & UNT) and the control reference number of the message.Mandatory