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ADI - |
Health care claim adjudication information
UN/CEFACT Revision 1999B Segment List |
| Function: | To provide adjudication information for all services in a health care claim. |
| This segment also occurs in the following versions of this standard:
D99B, D00A, D00B, D01A, D01B, D01C, D02A, D02B, D03A, D03B, D04A, D04B |
| Pos |
Segment |
M/C |
Repeat |
Repr. |
Notes |
| 010 |
|
E206 |
OBJECT IDENTIFICATION |
M |
3 |
|
|
|
|
7402 |
Object identifier |
M |
|
an..35 |
|
|
|
7405 |
Object identification code qualifier |
C |
|
an..3 |
|
|
|
4405 |
Status description code |
C |
|
an..3 |
|
| 020 |
|
E021 |
SERVICE |
C |
3 |
|
|
|
|
7135 |
Product identifier |
M |
|
an..35 |
|
|
|
1131 |
Code list identification code |
C |
|
an..3 |
|
|
|
9629 |
Procedure modification code |
C |
|
an..3 |
|
|
|
9629 |
Procedure modification code |
C |
|
an..3 |
|
|
|
9629 |
Procedure modification code |
C |
|
an..3 |
|
|
|
9629 |
Procedure modification code |
C |
|
an..3 |
|
| 030 |
|
1229 |
Action request/notification description code |
C |
1 |
an..3 |
|
| 040 |
|
E017 |
MONETARY AMOUNT |
C |
15 |
|
|
|
|
5025 |
Monetary amount type code qualifier |
C |
|
an..3 |
|
|
|
5004 |
Monetary amount value |
C |
|
n..35 |
|
|
|
6345 |
Currency identification code |
C |
|
an..3 |
|
|
|
6343 |
Currency qualifier |
C |
|
an..3 |
|
|
|
4405 |
Status description code |
C |
|
an..3 |
|
| 050 |
|
6060 |
Quantity |
C |
3 |
an..35 |
|
| 060 |
|
E030 |
ADJUSTMENT INFORMATION |
C |
15 |
|
|
|
|
9619 |
Adjustment category code |
M |
|
an..3 |
|
|
|
4465 |
Adjustment reason description code |
M |
|
an..3 |
|
|
|
5004 |
Monetary amount value |
C |
|
n..35 |
|
| 070 |
|
9620 |
Policy limitation identifier |
C |
4 |
an..10 |
|
| 080 |
|
5389 |
Product group name code |
C |
1 |
an..25 |
|
| 090 |
|
E507 |
DATE/TIME/PERIOD |
C |
1 |
|
|
|
|
2005 |
Date/time/period function code qualifier |
M |
|
an..3 |
|
|
|
2380 |
Date/time/period value |
C |
|
an..35 |
|
|
|
2379 |
Date/time/period format code |
C |
|
an..3 |
|
| 100 |
|
9639 |
Diagnosis category code |
C |
1 |
an..3 |
|
| 110 |
|
5482 |
Percentage |
C |
1 |
n..10 |
|
| Pos | Position |
|---|
| M/C | Mandatory or Conditional |
|---|
| Repr. | Representation (Data or Content Type) |
|---|
| Segment ADI is used in the following messages: |
|---|
| IHCLME |
| Change indicators |
|
plus sign |
|
An addition. |
|
asterisk |
|
Addition/substraction/change to a code entry for a particular data element. |
|
hash or pound sign |
|
Changes to names. |
|
vertical bar |
|
Changes to text for descriptions, notes and functions. |
|
minus sign |
|
A deletion. |
|
letter X |
|
Marked for deletion. |
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|