UB1 - UB82 data segment (HL7 v2.3.1)
Versions: v2.3 v2.3.1 v2.4 v2.5.1 v2.6 v2.7.1
The UB1 segment (UB82 data segment) has 23 fields in HL7 v2.3.1. Fields are addressed as
UB1-n; composite fields break into components UB1-n.m. Paste a message into the
parser to see every field annotated with this table.
| # | Name | Type | Len | Opt | Repeats | Table |
|---|---|---|---|---|---|---|
| 1 | Set ID - UB1 | SI | 4 | Optional | No | |
| 2 | Blood Deductible | NM | 1 | Optional | No | |
| 3 | Blood Furnished-Pints Of | NM | 2 | Optional | No | |
| 4 | Blood Replaced-Pints | NM | 2 | Optional | No | |
| 5 | Blood Not Replaced-Pints | NM | 2 | Optional | No | |
| 6 | Co-Insurance Days | NM | 2 | Optional | No | |
| 7 | Condition Code | IS | 14 | Optional | Max 5 | 0043 |
| 8 | Covered Days - | NM | 3 | Optional | No | |
| 9 | Non Covered Days - | NM | 3 | Optional | No | |
| 10 | Value Amount & Code | UVC | 12 | Optional | Max 8 | |
| 11 | Number Of Grace Days | NM | 2 | Optional | No | |
| 12 | Special Program Indicator | CE | 60 | Optional | No | |
| 13 | PSRO/UR Approval Indicator | CE | 60 | Optional | No | |
| 14 | PSRO/UR Approved Stay-Fm | DT | 8 | Optional | No | |
| 15 | PSRO/UR Approved Stay-To | DT | 8 | Optional | No | |
| 16 | Occurrence | OCD | 20 | Optional | Max 5 | |
| 17 | Occurrence Span | CE | 60 | Optional | No | |
| 18 | Occur Span Start Date | DT | 8 | Optional | No | |
| 19 | Occur Span End Date | DT | 8 | Optional | No | |
| 20 | UB-82 Locator 2 | ST | 30 | Optional | No | |
| 21 | UB-82 Locator 9 | ST | 7 | Optional | No | |
| 22 | UB-82 Locator 27 | ST | 8 | Optional | No | |
| 23 | UB-82 Locator 45 | ST | 17 | Optional | No |