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minor bug fix
[openemr.git] / library / edihistory / ibr_status_code_arrays.php
blob31d95e468cf996aecf7e9efcd4468da6592ba6b7
1 <?php
2 /*
3 * ibr_status_code_arrays.php
4 *
5 * Copyright 2012 Kevin McCormick Longview, Texas
6 *
7 *
8 * This program is distributed in the hope that it will be useful,
9 * but WITHOUT ANY WARRANTY; without even the implied warranty of
10 * MERCHANTABILITY or FITNESS FOR A PARTICULAR PURPOSE. See the
11 * GNU General Public License for more details.
12 *
13 * This program is free software; you can redistribute it and/or modify
14 * it under the terms of the GNU General Public License as published by
15 * the Free Software Foundation; version 3 or later. You should have
16 * received a copy of the GNU General Public License along with this program;
17 * if not, write to the Free Software Foundation, Inc.,
18 * 51 Franklin Street, Fifth Floor, Boston, MA 02110-1301, USA.
19 * <http://opensource.org/licenses/gpl-license.php>
20 *
21 *
22 * @link http://www.wpc-edi.com
23 * @author Kevin McCormick
24 * @link: http://www.open-emr.org
25 * @package OpenEMR
26 * @subpackage ediHistory
27 */
28
29 /**
30 * retrieve descriptions of claim status codes
31 *
32 * there are a multitude of codes and many will never be used in healthcare claim
33 * status responses, but which ones are superfluous?
34 *
35 * There are get_ methods only
36 */
37 class status_code_arrays {
38
39 private $STC_Category_Code;
40 private $STC_HCSDR_Code;
41 private $STC_Status_Code;
42 private $STC_Entity_Code;
43 private $STC_IDType_Code;
44
45 /**
46 * ID Type codes
47 *
48 * @param string code
49 * @return array 0=>code, [1]=>description, [2]=>empty, [3]=>empty [4]=>empty
50 */
51 public function get_STC_IDType_Code( $code ) {
52 // 0 => code, [1] => description, [2] => dates, [3] => notes (empty, none available)
53 // contains "Unknown" for codes for which I did not find definitions
54 if ( is_array( $this->STC_IDType_Code )) {
55 if (array_key_exists($code, $this->STC_IDType_Code)){
56 return $this->STC_IDType_Code[$code];
57 } else {
58 return array($code, "Not found in STC Category codes table", "", "", "");
59 }
60 } else {
61 $this->STC_IDType_Code = array (
62 'PI'=> array('PI', 'Payor Identification', '', '', ''),
63 'XV'=> array('XV', 'Centers for Medicare and Medicaid Services PlanID', '', '', ''),
64 '46'=> array('46', 'Electronic Transmitter Identification Number', '', '', ''),
65 '24'=> array('24', 'Employers Identification Number', '', '', ''),
66 'II'=> array('II', 'Standard Unique Health Identifier', '', '', ''),
67 'MI'=> array('MI', 'Member Identification Number', '', '', ''),
68 'FI'=> array('FI', 'Federal Taxpayers Identification Number', '', '', ''),
69 'SV'=> array('SV', 'Service Provider Number', '', '', ''),
70 'XX'=> array('XX', 'Centers for Medicare and Medicaid Services NationalProvider Identifier', '', '', '')
71 );
72 if (array_key_exists($code, $this->STC_IDType_Code)){
73 return $this->STC_IDType_Code[$code];
74 } else {
75 return array($code, "Not found in STC ID Type codes table", "", "", "");
76 }
77 }
78 } // end get_STC_IDType_Code
79
80 /**
81 * entity identifier code --code source 237
82 *
83 * Entity Codes from http://ushik.ahrq.gov/ and CMS 276/277 Side-by-Side
84 *
85 * @param string code
86 * @return array 0=>code, [1]=>description, [2]=>empty, [3]=>empty [4]=>empty
87 */
88 public function get_STC_Entity_Code( $code ) {
89 // 0 => code, [1] => description, [2] => '', [3] => '', [4] => ''
90 if ( is_array( $this->STC_Entity_Code )) {
91 if (array_key_exists($code, $this->STC_Entity_Code)){
92 return $this->STC_Entity_Code[$code];
93 } else {
94 return array($code, "Not found in STC Category codes table", "", "", "");
95 }
96 } else {
97 $this->STC_Entity_Code = array(
98 '03' => array('03', 'Dependent', '', '', ''),
99 '13' => array('13', 'Contracted Service Provider', '', '', ''),
100 '17' => array('17', 'Consultant´s Office', '', '', ''),
101 '1E' => array('1E', 'Health Maintenance Organization (HMO)', '', '', ''),
102 '1G' => array('1G', 'Oncology Center', '', '', ''),
103 '1H' => array('1H', 'Kidney Dialysis Unit', '', '', ''),
104 '1I' => array('1I', 'Preferred Provider Organization (PPO)', '', '', ''),
105 '1O' => array('1O', 'Acute Care Hospital', '', '', ''),
106 '1P' => array('1P', 'Provider', '', '', ''),
107 '1Q' => array('1Q', 'Military Facility', '', '', ''),
108 '1R' => array('1R', 'University, College or School', '', '', ''),
109 '1S' => array('1S', 'Outpatient Surgicenter', '', '', ''),
110 '1T' => array('1T', 'Physician, Clinic or Group Practice', '', '', ''),
111 '1U' => array('1U', 'Long Term Care Facility', '', '', ''),
112 '1V' => array('1V', 'Extended Care Facility', '', '', ''),
113 '1W' => array('1W', 'Psychiatric Health Facility', '', '', ''),
114 '1X' => array('1X', 'Laboratory', '', '', ''),
115 '1Y' => array('1Y', 'Retail Pharmacy', '', '', ''),
116 '1Z' => array('1Z', 'Home Health Care', '', '', ''),
117 '28' => array('28', 'Subcontractor', '', '', ''),
118 '2A' => array('2A', 'Federal, State, County or City Facility', '', '', ''),
119 '2B' => array('2B', 'Third-Party Administrator', '', '', ''),
120 '2D' => array('2D', 'Miscellaneous Health Care Facility', '', '', ''),
121 '2E' => array('2E', 'Non-Health Care Miscellaneous Facility', '', '', ''),
122 '2I' => array('2I', 'Church Operated Facility', '', '', ''),
123 '2K' => array('2K', 'Partnership', '', '', ''),
124 '2P' => array('2P', 'Public Health Service Facility', '', '', ''),
125 '2Q' => array('2Q', 'Veterans Administration Facility', '', '', ''),
126 '2S' => array('2S', 'Public Health Service Indian Service Facility', '', '', ''),
127 '2Z' => array('2Z', 'Hospital Unit of an Institution (prison hospital, college infirmary, etc.)', '', '', ''),
128 '30' => array('30', 'Service Supplier', '', '', ''),
129 '36' => array('36', 'Employer', '', '', ''),
130 '3A' => array('3A', 'Hospital Unit Within an Institution for the Mentally Retarded', '', '', ''),
131 '3C' => array('3C', 'Tuberculosis and Other Respiratory Diseases Facility', '', '', ''),
132 '3D' => array('3D', 'Obstetrics and Gynecology Facility', '', '', ''),
133 '3E' => array('3E', 'Eye, Ear, Nose and Throat Facility', '', '', ''),
134 '3F' => array('3F', 'Rehabilitation Facility', '', '', ''),
135 '3G' => array('3G', 'Orthopedic Facility', '', '', ''),
136 '3H' => array('3H', 'Chronic Disease Facility', '', '', ''),
137 '3I' => array('3I', 'Other Specialty Facility', '', '', ''),
138 '3J' => array('3J', 'Children´s General Facility', '', '', ''),
139 '3K' => array('3K', 'Children´s Hospital Unit of an Institution', '', '', ''),
140 '3L' => array('3L', 'Children´s Psychiatric Facility', '', '', ''),
141 '3M' => array('3M', 'Children´s Tuberculosis and Other Respiratory Diseases Facility', '', '', ''),
142 '3N' => array('3N', 'Children´s Eye, Ear, Nose and Throat Facility', '', '', ''),
143 '3O' => array('3O', 'Children´s Rehabilitiaion Facility', '', '', ''),
144 '3P' => array('3P', 'Children´s Orthopedic Facility', '', '', ''),
145 '3Q' => array('3Q', 'Children´s Chronic Disease Facility', '', '', ''),
146 '3R' => array('3R', 'Children´s Other Specialty Facility', '', '', ''),
147 '3S' => array('3S', 'Institution for Mental Retardation', '', '', ''),
148 '3T' => array('3T', 'Alcoholism and Other Chemical Dependency Facility', '', '', ''),
149 '3U' => array('3U', 'General Inpatient Care for AIDS/ARC Facility', '', '', ''),
150 '3V' => array('3V', 'AIDS/ARC Unit', '', '', ''),
151 '3W' => array('3W', 'Specialized Outpatient Program for AIDS/ARC', '', '', ''),
152 '3X' => array('3X', 'Alcohol/Drug Abuse or Dependency Inpatient Unit', '', '', ''),
153 '3Y' => array('3Y', 'Alcohol/Drug Abuse or Dependency Outpatient Services', '', '', ''),
154 '3Z' => array('3Z', 'Arthritis Treatment Center', '', '', ''),
155 '36' => array('36', 'Employer', '', '', ''),
156 '40' => array('40', 'Receiver', '', '', ''),
157 '43' => array('43', 'Claimant Authorized Representative', '', '', ''),
158 '44' => array('44', 'Data Processing Service Bureau', '', '', ''),
159 '4A' => array('4A', 'Birthing Room/LDRP Room', '', '', ''),
160 '4B' => array('4B', 'Burn Care Unit', '', '', ''),
161 '4C' => array('4C', 'Cardiac Catherization Laboratory', '', '', ''),
162 '4D' => array('4D', 'Open-Heart Surgery Facility', '', '', ''),
163 '4E' => array('4E', 'Cardiac Intensive Care Unit', '', '', ''),
164 '4F' => array('4F', 'Angioplasty Facility', '', '', ''),
165 '4G' => array('4G', 'Chronic Obstructive Pulmonary Disease Service Facility', '', '', ''),
166 '4H' => array('4H', 'Emergency Department', '', '', ''),
167 '4I' => array('4I', 'Trauma Center (Certified)', '', '', ''),
168 '4J' => array('4J', 'Extracorporeal Shock-Wave Lithotripter (ESWL) Unit', '', '', ''),
169 '4L' => array('4L', 'Genetic Counseling/Screening Services', '', '', ''),
170 '4M' => array('4M', 'Adult Day Care Program Facility', '', '', ''),
171 '4N' => array('4N', 'Alzheimer´s Diagnostic/Assessment Services', '', '', ''),
172 '4O' => array('4O', 'Comprehensive Geriatric Assessment Facility', '', '', ''),
173 '4P' => array('4P', 'Emergency Response (Geriatric) Unit', '', '', ''),
174 '4Q' => array('4Q', 'Geriatric Acute Care Unit', '', '', ''),
175 '4R' => array('4R', 'Geriatric Clinics', '', '', ''),
176 '4S' => array('4S', 'Respite Care Facility', '', '', ''),
177 '4U' => array('4U', 'Patient Education Unit', '', '', ''),
178 '4V' => array('4V', 'Community Health Promotion Facility', '', '', ''),
179 '4W' => array('4W', 'Worksite Health Promotion Facility', '', '', ''),
180 '4X' => array('4X', 'Hemodialysis Facility', '', '', ''),
181 '4Y' => array('4Y', 'Home Health Services', '', '', ''),
182 '4Z' => array('4Z', 'Hospice', '', '', ''),
183 '41' => array('41', 'Submitter', '', '', ''),
184 '5A' => array('5A', 'Medical Surgical or Other Intensive Care Unit', '', '', ''),
185 '5B' => array('5B', 'Hisopathology Laboratory', '', '', ''),
186 '5C' => array('5C', 'Blood Bank', '', '', ''),
187 '5D' => array('5D', 'Neonatal Intensive Care Unit', '', '', ''),
188 '5E' => array('5E', 'Obstetrics Unit', '', '', ''),
189 '5F' => array('5F', 'Occupational Health Services', '', '', ''),
190 '5G' => array('5G', 'Organized Outpatient Services', '', '', ''),
191 '5H' => array('5H', 'Pediatric Acute Inpatient Unit', '', '', ''),
192 '5I' => array('5I', 'Psychiatric Child/Adolescent Services', '', '', ''),
193 '5J' => array('5J', 'Psychiatric Consultation-Liaison Services', '', '', ''),
194 '5K' => array('5K', 'Psychiatric Education Services', '', '', ''),
195 '5L' => array('5L', 'Psychiatric Emergency Services', '', '', ''),
196 '5M' => array('5M', 'Psychiatric Geriatric Services', '', '', ''),
197 '5N' => array('5N', 'Psychiatric Inpatient Unit', '', '', ''),
198 '5O' => array('5O', 'Psychiatric Outpatient Services', '', '', ''),
199 '5P' => array('5P', 'Psychiatric Partial Hospitalization Program', '', '', ''),
200 '5Q' => array('5Q', 'Megavoltage Radiation Therapy Unit', '', '', ''),
201 '5R' => array('5R', 'Radioactive Implants Unit', '', '', ''),
202 '5S' => array('5S', 'Theraputic Radioisotope Facility', '', '', ''),
203 '5T' => array('5T', 'X-Ray Radiation Therapy Unit', '', '', ''),
204 '5U' => array('5U', 'CT Scanner Unit', '', '', ''),
205 '5V' => array('5V', 'Diagnostic Radioisotope Facility', '', '', ''),
206 '5W' => array('5W', 'Magnetic Resonance Imaging (MRI) Facility', '', '', ''),
207 '5X' => array('5X', 'Ultrasound Unit', '', '', ''),
208 '5Y' => array('5Y', 'Rehabilitation Inpatient Unit', '', '', ''),
209 '5Z' => array('5Z', 'Rehabilitation Outpatient Services', '', '', ''),
210 '61' => array('61', 'Performed At', '', '', ''),
211 '6A' => array('6A', 'Reproductive Health Services', '', '', ''),
212 '6B' => array('6B', 'Skilled Nursing or Other Long-Term Care Unit', '', '', ''),
213 '6C' => array('6C', 'Single Photon Emission Computerized Tomography (SPECT) Unit', '', '', ''),
214 '6D' => array('6D', 'Organized Social Work Service Facility', '', '', ''),
215 '6E' => array('6E', 'Outpatient Social Work Services', '', '', ''),
216 '6F' => array('6F', 'Emergency Department Social Work Services', '', '', ''),
217 '6G' => array('6G', 'Sports Medicine Clinic/Services', '', '', ''),
218 '6H' => array('6H', 'Hospital Auxiliary Unit', '', '', ''),
219 '6I' => array('6I', 'Patient Representative Services', '', '', ''),
220 '6J' => array('6J', 'Volunteer Services Department', '', '', ''),
221 '6K' => array('6K', 'Outpatient Surgery Services', '', '', ''),
222 '6L' => array('6L', 'Organ/Tissue Transplant Unit', '', '', ''),
223 '6M' => array('6M', 'Orthopedic Surgery Facility', '', '', ''),
224 '6N' => array('6N', 'Occupational Therapy Services', '', '', ''),
225 '6O' => array('6O', 'Physical Therapy Services', '', '', ''),
226 '6P' => array('6P', 'Recreational Therapy Services', '', '', ''),
227 '6Q' => array('6Q', 'Respiratory Therapy Services', '', '', ''),
228 '6R' => array('6R', 'Speech Therapy Services', '', '', ''),
229 '6S' => array('6S', 'Women´s Health Center/Services', '', '', ''),
230 '6U' => array('6U', 'Cardiac Rehabilitation Program Facility', '', '', ''),
231 '6V' => array('6V', 'Non-Invasive Cardiac Assessment Services', '', '', ''),
232 '6W' => array('6W', 'Emergency Medical Technician', '', '', ''),
233 '6X' => array('6X', 'Disciplinary Contact', '', '', ''),
234 '6Y' => array('6Y', 'Case Manager', '', '', ''),
235 '70' => array('70', 'Prior Incorrect Insured', '', '', ''),
236 '71' => array('71', 'Attending Physician', '', '', ''),
237 '72' => array('72', 'Operating Physician', '', '', ''),
238 '73' => array('73', 'Other Physician', '', '', ''),
239 '74' => array('74', 'Corrected Insured', '', '', ''),
240 '75' => array('75', 'Participant', '', '', ''),
241 '77' => array('77', 'Service Location', '', '', ''),
242 '7C' => array('7C', 'Place of Occurrence', '', '', ''),
243 '80' => array('80', 'Hospital', '', '', ''),
244 '82' => array('82', 'Rendering Provider', '', '', ''),
245 '84' => array('84', 'Subscriber´s Employer', '', '', ''),
246 '85' => array('85', 'Billing Provider', '', '', ''),
247 '87' => array('87', 'Pay-to Provider', '', '', ''),
248 '95' => array('95', 'Research Institute', '', '', ''),
249 'AY' => array('AY', 'Clearinghouse','', '', ''),
250 'CK' => array('CK', 'Pharmacist', '', '', ''),
251 'CZ' => array('CZ', 'Admitting Surgeon', '', '', ''),
252 'D2' => array('D2', 'Commercial Insurer', '', '', ''),
253 'DD' => array('DD', 'Assistant Surgeon', '', '', ''),
254 'DJ' => array('DJ', 'Consulting Physician', '', '', ''),
255 'DK' => array('DK', 'Ordering Physician', '', '', ''),
256 'DN' => array('DN', 'Referring Provider', '', '', ''),
257 'DO' => array('DO', 'Dependent Name', '', '', ''),
258 'DQ' => array('DQ', 'Supervising Physician', '', '', ''),
259 'E1' => array('E1', 'Person or Other Entity Legally Responsible for a Child', '', '', ''),
260 'E2' => array('E2', 'Person or Other Entity With Whom a Child Resides', '', '', ''),
261 'E7' => array('E7', 'Previous Employer', '', '', ''),
262 'E9' => array('E9', 'Participating Laboratory', '', '', ''),
263 'FA' => array('FA', 'Facility', '', '', ''),
264 'FD' => array('FD', 'Physical Address', '', '', ''),
265 'FE' => array('FE', 'Mail Address', '', '', ''),
266 'G0' => array('G0', 'Dependent Insured', '', '', ''),
267 'G3' => array('G3', 'Clinic', '', '', ''),
268 'GB' => array('GB', 'Other Insured', '', '', ''),
269 'GD' => array('GD', 'Guardian', '', '', ''),
270 'GI' => array('GI', 'Paramedic', '', '', ''),
271 'GJ' => array('GJ', 'Paramedical Company', '', '', ''),
272 'GK' => array('GK', 'Previous Insured', '', '', ''),
273 'GM' => array('GM', 'Spouse Insured', '', '', ''),
274 'GP' => array('GP', 'Gateway Provider', '', '', ''),
275 'GW' => array('GW', 'Group', '', '', ''),
276 'GY' => array('GY', 'Treatment Facility', '', '', ''),
277 'HF' => array('HF', 'Healthcare Professional Shortage Area (HPSA) Facility', '', '', ''),
278 'HH' => array('HH', 'Home Health Agency', '', '', ''),
279 'I3' => array('I3', 'Independent Physicians Association (IPA)', '', '', ''),
280 'IJ' => array('IJ', 'Injection Point', '', '', ''),
281 'IL' => array('IL', 'Insured or Subscriber', '', '', ''),
282 'IN' => array('IN', 'Insurer', '', '', ''),
283 'LI' => array('LI', 'Independent Lab', '', '', ''),
284 'LR' => array('LR', 'Legal Representative', '', '', ''),
285 'MR' => array('MR', 'Medical Insurance Carrier', '', '', ''),
286 'NZ' => array('NZ', 'Primary Physician', '', '', ''),
287 'OB' => array('OB', 'Ordered By', '', '', ''),
288 'OC' => array('OC', 'Origin Carrier', '', '', ''),
289 'OD' => array('OD', 'Doctor of Optometry', '', '', ''),
290 'OX' => array('OX', 'Oxygen Therapy Facility', '', '', ''),
291 'P0' => array('P0', 'Patient Facility', '', '', ''),
292 'P2' => array('P2', 'Primary Insured or Subscriber', '', '', ''),
293 'P3' => array('P3', 'Primary Care Provider', '', '', ''),
294 'P4' => array('P4', 'Prior Insurance Carrier', '', '', ''),
295 'P5' => array('P5', 'Plan Sponsor', '', '', ''),
296 'P6' => array('P6', 'Third Party Reviewing Preferred Provider Organization (PPO)', '', '', ''),
297 'P7' => array('P7', 'Third Party Repricing Preferred Provider Organization (PPO)', '', '', ''),
298 'PR' => array('PR', 'Payer', '', '', ''),
299 'PT' => array('PT', 'Party to Receive Test Report', '', '', ''),
300 'PV' => array('PV', 'Party performing certification', '', '', ''),
301 'PW' => array('PW', 'Pick Up Address', '', '', ''),
302 'QA' => array('QA', 'Pharmacy', '', '', ''),
303 'QB' => array('QB', 'Purchase Service Provider', '', '', ''),
304 'QC' => array('QC', 'Patient', '', '', ''),
305 'QD' => array('QD', 'Responsible Party', '', '', ''),
306 'QE' => array('QE', 'Policyholder', '', '', ''),
307 'QH' => array('QH', 'Physician', '', '', ''),
308 'QK' => array('QK', 'Managed Care', '', '', ''),
309 'QL' => array('QL', 'Chiropractor', '', '', ''),
310 'QN' => array('QN', 'Dentist', '', '', ''),
311 'QO' => array('QO', 'Doctor of Osteopathy', '', '', ''),
312 'QS' => array('QS', 'Podiatrist', '', '', ''),
313 'QV' => array('QV', 'Group Practice', '', '', ''),
314 'QY' => array('QY', 'Medical Doctor', '', '', ''),
315 'RC' => array('RC', 'Receiving Location', '', '', ''),
316 'RW' => array('RW', 'Rural Health Clinic', '', '', ''),
317 'S4' => array('S4', 'Skilled Nursing Facility', '', '', ''),
318 'SJ' => array('SJ', 'Service Provider', '', '', ''),
319 'SU' => array('SU', 'Supplier/Manufacturer', '', '', ''),
320 'T4' => array('T4', 'Transfer Point', '', '', ''),
321 'TQ' => array('TQ', 'Third Party Reviewing Organization (TPO)', '', '', ''),
322 'TT' => array('TT', 'Transfer To', '', '', ''),
323 'TU' => array('TU', 'Third Party Repricing Organization (TPO)', '', '', ''),
324 'UH' => array('UH', 'Nursing Home', '', '', ''),
325 'VN' => array('VN', 'Vendor', '', '', ''),
326 'X3' => array('X3', 'Utilization Management Organization', '', '', ''),
327 'X4' => array('X4', 'Spouse', '', '', ''),
328 'X5' => array('X5', 'Durable Medical Equipment Supplier', '', '', ''),
329 'Y2' => array('Y2', 'Managed Care Organization', '', '', ''),
330 'ZZ' => array('ZZ', 'Mutually Defined', '', '', ''),
331 'MSC' => array('MSC', 'Mammography Screening Center', '', '', ''),
332 'PRP' => array('PRP', 'Primary Payer', '', '', ''),
333 'SEP' => array('SEP', 'Secondary Payer', '', '', ''),
334 'TL' => array('TL', 'Testing Laboratory', '', '', ''),
335 'TTP' => array('TTP', 'Tertiary Payer', '', '', ''),
336 'EXS' => array('EXS', 'Ex-spouse', '', '', ''),
337 'NZ' => array('NZ', 'Primary Physician', '', '', ''),
338 'AAG' => array('AAG', 'Ground Ambulance Services', '', '', ''),
339 'AAK' => array('AAK', 'Primary Surgeon', '', '', ''),
340 'AAL' => array('AAL', 'Medical Nurse', '', '', ''),
341 'AAM' => array('AAM', 'Cardiac Rehabilitation Services', '', '', ''),
342 'AAN' => array('AAN', 'Skilled Nursing Services', '', '', ''),
343 'AAO' => array('AAO', 'Observation Room Services', '', '', ''),
344 'AAQ' => array('AAQ', 'Anesthesiology Services', '', '', ''),
345 'NCT' => array('NCT', 'Name Changed To', '', '', ''),
346 'ORI' => array('ORI', 'Original Name', '', '', ''),
347 'VER' => array('VER', 'Party Performing Verification', '', '', ''),
348 );
349 if (array_key_exists($code, $this->STC_Entity_Code)){
350 return $this->STC_Entity_Code[$code];
351 } else {
352 return array($code, "Not found in STC Entity codes table", "", "", "");
353 }
354 }
355 } // end get_STC_Entity_Code
356
357 //
358 /**
359 * entity identifier code --code source 237
360 *
361 * Codes from http://www.wpc-edi.com
362 * Claim Status Category Codes LAST UPDATED 7/1/2012
363 *
364 * @param string code
365 * @return array 0=>code, [1]=>description, [2]=>empty, [3]=>empty [4]=>empty
366 */
367 public function get_STC_Category_Code( $code ) {
368 // 0 => code, [1] => description, [2] => dates, [3] => notes (empty, none available)
369 // contains "Unknown" for codes for which I did not find definitions
370 if ( is_array( $this->STC_Category_Code )) {
371 if (array_key_exists($code, $this->STC_Category_Code)){
372 return $this->STC_Category_Code[$code];
373 } else {
374 return array($code, "Not found in STC Category codes table", "", "", "");
375 }
376 } else {
377 $this->STC_Category_Code = array(
378 'A0' => array('A0', 'Acknowledgement/Forwarded-The claim/encounter has been forwarded to another entity.', '', '', ''),
379 'A1' => array('A1', 'Acknowledgement/Receipt-The claim/encounter has been received.', '', '', ''),
380 'A2' => array('A2', 'Acknowledgement/Acceptance into adjudication system-The claim/encounter has been accepted into the adjudication system.', '', '', ''),
381 'A3' => array('A3', 'Acknowledgement/Returned as unprocessable claim-The claim/encounter has been rejected and has not been entered into the adjudication system.', '', '', ''),
382 'A4' => array('A4', 'Acknowledgement/Not Found-The claim/encounter can not be found in the adjudication system.', '', '', ''),
383 'A5' => array('A5', 'Acknowledgement/Split Claim-The claim/encounter has been split upon acceptance into the adjudication system.', '', '', ''),
384 'A6' => array('A6', 'Acknowledgement/Rejected for Missing Information - The claim/encounter is missing the information specified in the Status details and has been rejected.', '', '', ''),
385 'A7' => array('A7', 'Acknowledgement/Rejected for Invalid Information - The claim/encounter has invalid information as specified in the Status details and has been rejected.', '', '', ''),
386 'A8' => array('A8', 'Acknowledgement/Rejected for relational field in error.', '', '', ''),
387 // Pending
388 'P0' => array('P0', 'Pending: Adjudication/Details-This is a generic message about a pended claim.', '', '', ''),
389 'P1' => array('P1', 'Pending/In Process-The claim or encounter is in the adjudication system.', '', '', ''),
390 'P2' => array('P2', 'Pending/Payer Review-The claim/encounter is suspended and is pending review ', '', '', ''),
391 'P3' => array('P3', 'Pending/Provider Requested Information - The claim or encounter is waiting for information that has already been requested from the provider.', '', '', ''),
392 'P4' => array('P4', 'Pending/Patient Requested Information - The claim or encounter is waiting for information that has already been requested from the patient.', '', '', ''),
393 'P5' => array('P5', 'Pending/Payer Administrative/System hold', '', '', ''),
394 // Finalized
395 'F0' => array('F0', 'Finalized-The claim/encounter has completed the adjudication cycle and no more action will be taken.', '', '', ''),
396 'F1' => array('F1', 'Finalized/Payment-The claim/line has been paid.', '', '', ''),
397 'F2' => array('F2', 'Finalized/Denial-The claim/line has been denied.', '', '', ''),
398 'F3' => array('F3', 'Finalized/Revised - Adjudication information has been changed', '', '', ''),
399 'F3F' => array('F3F', 'Finalized/Forwarded-The claim/encounter processing has been completed.', '', '', ''),
400 'F3N' => array('F3N', 'Finalized/Not Forwarded-The claim/encounter processing has been completed.', '', '', ''),
401 'F4' => array('F4', 'Finalized/Adjudication Complete - No payment forthcoming-The claim/encounter has been adjudicated and no further payment is forthcoming.', '', '', ''),
402 // Requests for additional information
403 'R0' => array('R0', 'Requests for additional Information/General Requests-Requests that don\'t fall into other R-type categories.', '', '', ''),
404 'R1' => array('R1', 'Requests for additional Information/Entity Requests-Requests for information about specific entities ', '', '', ''),
405 'R3' => array('R3', 'Requests for additional Information/Claim/Line-Requests for information that could normally be submitted on a claim.', '', '', ''),
406 'R4' => array('R4', 'Requests for additional Information/Documentation-Requests for additional supporting documentation.', '', '', ''),
407 'R5' => array('R5', 'Request for additional information/more specific detail-Additional information as a follow up to a previous request is needed.', '', '', ''),
408 'R6' => array('R6', 'Requests for additional information – Regulatory requirements', '', '', ''),
409 'R7' => array('R7', 'Requests for additional information – Confirm care is consistent with Health Plan policy coverage', '', '', ''),
410 'R8' => array('R8', 'Requests for additional information – Confirm care is consistent with health plan coverage exceptions', '', '', ''),
411 'R9' => array('R9', 'Requests for additional information – Determination of medical necessity', '', '', ''),
412 'R10' => array('R10', 'Requests for additional information – Support a filed grievance or appeal', '', '', ''),
413 'R11' => array('R11', 'Requests for additional information – Pre-payment review of claims', '', '', ''),
414 'R12' => array('R12', 'Requests for additional information – Clarification or justification of use for specified procedure code', '', '', ''),
415 'R13' => array('R13', 'Requests for additional information – Original documents submitted are not readable.', '', '', ''),
416 'R14' => array('R14', 'Requests for additional information – Original documents received are not what was requested.', '', '', ''),
417 'R15' => array('R15', 'Requests for additional information – Workers Compensation coverage determination.', '', '', ''),
418 'R16' => array('R16', 'Requests for additional information – Eligibility determination', '', '', ''),
419 // General
420 // Error
421 'E0' => array('E0', 'Response not possible - error on submitted request data', '', '', ''),
422 'E1' => array('E1', 'Response not possible - System Status', '', '', ''),
423 'E2' => array('E2', 'Information Holder is not responding; resubmit at a later time.', '', '', ''),
424 'E3' => array('E3', 'Correction required - relational fields in error.', '', '', ''),
425 'E4' => array('E4', 'Trading partner agreement specific requirement not met: Data correction required.', '', '', ''),
426 'Searches' => array('Searches', '', '', '', ''),
427 'D0' => array('D0', 'Data Search Unsuccessful - The payer is unable to return status on the requested claim(s) based on the submitted search criteria.', '', '', ''),
428 );
429 if (array_key_exists($code, $this->STC_Category_Code)){
430 return $this->STC_Category_Code[$code];
431 } else {
432 return array($code, "Not found in STC Category codes table", "", "", "");
433 }
434 }
435 } // end get_STC_Category_Code
436
437 /**
438 * Health Care Services Decision Reason Codes LAST UPDATED 7/1/2012
439 *
440 * @param string code
441 * @return array 0=>code, [1]=>description, [2]=>empty, [3]=>empty [4]=>empty
442 */
443 public function get_STC_HCSDR_Code( $code ) {
444 // 0 => code, [1] => description, [2] => dates, [3] => notes (empty, none available)
445 // contains "Unknown" for codes for which I did not find definitions
446 if ( is_array( $this->STC_HCSDR_Code )) {
447 if (array_key_exists($code, $this->STC_HCSDR_Code)){
448 return $this->STC_HCSDR_Code[$code];
449 } else {
450 return array($code, "Not found in STC_HCSDR_Code codes table", "", "", "");
451 }
452 } else {
453 $this->STC_HCSDR_Code = array(
454 '1' => array('1', 'Price Authorization Expired', '', '', ''),
455 '2' => array('2', 'Price authorization no longer required', '', '', ''),
456 '3' => array('3', 'Product not on the price authorization', '', '', ''),
457 '4' => array('4', 'Authorized Quantity Exceeded', '', '', ''),
458 '5' => array('5', 'Special Cost Incorrect', '', '', ''),
459 '6' => array('6', 'No Credit Allowed', '', '', ''),
460 '7' => array('7', 'Administrative Cancellation', '', '', ''),
461 '8' => array('8', 'Unit resale higher than authorized', '', '', ''),
462 '9' => array('9', 'Out of Network', '', '', ''),
463 '0A' => array('0A', 'Testing not Included', '', '', ''),
464 '0B' => array('0B', 'Request Forwarded To and Decision Response Forthcoming From an External Review Organization', '', '', ''),
465 '0C' => array('0C', 'Authorization/Access Restrictions', '', '', ''),
466 '0D' => array('0D', 'Requires PCP authorization', '', '', ''),
467 '0E' => array('0E', 'Provider is Not Primary Care Physician', '', '', ''),
468 '0F' => array('0F', 'Not Medically Necessary', '', '', ''),
469 '0G' => array('0G', 'Level of Care Not Appropriate', '', '', ''),
470 '0H' => array('0H', 'Certification Not Required for this Service', '', '', ''),
471 '0J' => array('0J', 'Certification Responsibility of External Review Organization', '', '', ''),
472 '0K' => array('0K', 'Primary Care Service', '', '', ''),
473 '0L' => array('0L', 'Exceeds Plan Maximums', '', '', ''),
474 '0M' => array('0M', 'Non-covered Service', '', '', ''),
475 '0N' => array('0N', 'No Prior Approval', '', '', ''),
476 '0P' => array('0P', 'Requested Information Not Received', '', '', ''),
477 '0Q' => array('0Q', 'Duplicate Request', '', '', ''),
478 '0R' => array('0R', 'Service Inconsistent with Diagnosis', '', '', ''),
479 '0S' => array('0S', 'Pre-existing Condition', '', '', ''),
480 '0T' => array('0T', 'Experimental Service or Procedure', '', '', ''),
481 '0U' => array('0U', 'Additional Patient Information required', '', '', ''),
482 '0V' => array('0V', 'Requires Medical Review', '', '', ''),
483 '0W' => array('0W', 'Disposition pending review', '', '', ''),
484 '0X' => array('0X', 'Service Inconsistent with Provider Type', '', '', ''),
485 '0Y' => array('0Y', 'Service inconsistent with Patient\'s Age', '', '', ''),
486 '0Z' => array('0Z', 'Service inconsistent with Patient\'s Gender', '', '', ''),
487 '10' => array('10', 'Product/service/procedure delivery pattern ', '', '', ''),
488 '11' => array('11', 'Pricing', '', '', ''),
489 '12' => array('12', 'Patient is restricted to specific provider', '', '', ''),
490 '13' => array('13', 'Service authorized for another provider', '', '', ''),
491 '14' => array('14', 'Plan/contractual guidelines not followed', '', '', ''),
492 '15' => array('15', 'Plan/contractual geographic restriction', '', '', ''),
493 '16' => array('16', 'Inappropriate facility type', '', '', ''),
494 '17' => array('17', 'Time limits not met', '', '', ''),
495 '18' => array('18', 'Notification received', '', '', ''),
496 '19' => array('19', 'Cosmetic', '', '', ''),
497 '20' => array('20', 'Once in a lifetime restriction applies', '', '', ''),
498 '21' => array('21', 'Transport Request Denied', '', '', ''),
499 '22' => array('22', 'Ambulance Certification Segment information doesn\'t correspond to Transport Address Segment', '', '', ''),
500 '23' => array('23', 'Mileage cannot be computed based on data submitted', '', '', ''),
501 '24' => array('24', 'Computed mileage is inconsistent with transport information or service units submitted', '', '', ''),
502 '25' => array('25', 'Services were not considered due to other errors in the request.', '', '', ''),
503 '26' => array('26', 'Missing Provider Role', '', '', ''),
504 );
505 if (array_key_exists($code, $this->STC_HCSDR_Code)){
506 return $this->STC_HCSDR_Code[$code];
507 } else {
508 return array($code, "Not found in Health Care Service Decision Rules codes table", "", "", "");
509 }
510 }
511 } // end get_STC_HCSDR_Code
512
513
514 /**
515 * Health Care Claim Status Codes LAST UPDATED 7/1/2012
516 * http://www.wpc-edi.com/reference/codelists/healthcare/claim-status-codes/
517 *
518 * @param string code
519 * @return array 0=>code, [1]=>description, [2]=>empty, [3]=>empty [4]=>empty
520 */
521 public function get_STC_Status_Code( $code ) {
522 // 0 => code, [1] => description, [2] => dates, [3] => notes (empty, none available)
523 // contains "Unknown" for codes for which I did not find definitions
524 if ( is_array( $this->STC_Status_Code )) {
525 if (array_key_exists($code, $this->STC_Status_Code)){
526 return $this->STC_Status_Code[$code];
527 } else {
528 return array($code, "Not found in STC Status codes table", "", "", "");
529 }
530 } else {
531 $this->STC_Status_Code = array(
532 '0' => array('0', 'Cannot provide further status electronically.', '', '', ''),
533 '1' => array('1', 'For more detailed information, see remittance advice.', '', '', ''),
534 '2' => array('2', 'More detailed information in letter.', '', '', ''),
535 '3' => array('3', 'Claim has been adjudicated and is awaiting payment cycle.', '', '', ''),
536 '6' => array('6', 'Balance due from the subscriber.', '', '', ''),
537 '12' => array('12', 'One or more originally submitted procedure codes have been combined.', '', '', ''),
538 '15' => array('15', 'One or more originally submitted procedure code have been modified.', '', '', ''),
539 '16' => array('16', 'Claim/encounter has been forwarded to entity.', '', '', ''),
540 '17' => array('17', 'Claim/encounter has been forwarded by third party entity to entity.', '', '', ''),
541 '18' => array('18', 'Entity received claim/encounter, but returned invalid status.', '', '', ''),
542 '19' => array('19', 'Entity acknowledges receipt of claim/encounter.', '', '', ''),
543 '20' => array('20', 'Accepted for processing.', '', '', ''),
544 '21' => array('21', 'Missing or invalid information.', '', '', ''),
545 '23' => array('23', 'Returned to Entity.', '', '', ''),
546 '24' => array('24', 'Entity not approved as an electronic submitter.', '', '', ''),
547 '25' => array('25', 'Entity not approved.', '', '', ''),
548 '26' => array('26', 'Entity not found.', '', '', ''),
549 '27' => array('27', 'Policy canceled.', '', '', ''),
550 '29' => array('29', 'Subscriber and policy number/contract number mismatched.', '', '', ''),
551 '30' => array('30', 'Subscriber and subscriber id mismatched.', '', '', ''),
552 '31' => array('31', 'Subscriber and policyholder name mismatched.', '', '', ''),
553 '32' => array('32', 'Subscriber and policy number/contract number not found.', '', '', ''),
554 '33' => array('33', 'Subscriber and subscriber id not found.', '', '', ''),
555 '34' => array('34', 'Subscriber and policyholder name not found.', '', '', ''),
556 '35' => array('35', 'Claim/encounter not found.', '', '', ''),
557 '37' => array('37', 'Predetermination is on file, awaiting completion of services.', '', '', ''),
558 '38' => array('38', 'Awaiting next periodic adjudication cycle.', '', '', ''),
559 '39' => array('39', 'Charges for pregnancy deferred until delivery.', '', '', ''),
560 '40' => array('40', 'Waiting for final approval.', '', '', ''),
561 '41' => array('41', 'Special handling required at payer site.', '', '', ''),
562 '42' => array('42', 'Awaiting related charges.', '', '', ''),
563 '44' => array('44', 'Charges pending provider audit.', '', '', ''),
564 '45' => array('45', 'Awaiting benefit determination.', '', '', ''),
565 '46' => array('46', 'Internal review/audit.', '', '', ''),
566 '47' => array('47', 'Internal review/audit - partial payment made.', '', '', ''),
567 '49' => array('49', 'Pending provider accreditation review.', '', '', ''),
568 '50' => array('50', 'Claim waiting for internal provider verification.', '', '', ''),
569 '51' => array('51', 'Investigating occupational illness/accident.', '', '', ''),
570 '52' => array('52', 'Investigating existence of other insurance coverage.', '', '', ''),
571 '53' => array('53', 'Claim being researched for Insured ID/Group Policy Number error.', '', '', ''),
572 '54' => array('54', 'Duplicate of a previously processed claim/line.', '', '', ''),
573 '55' => array('55', 'Claim assigned to an approver/analyst.', '', '', ''),
574 '56' => array('56', 'Awaiting eligibility determination.', '', '', ''),
575 '57' => array('57', 'Pending COBRA information requested.', '', '', ''),
576 '59' => array('59', 'Information was requested by a non-electronic method.', '', '', ''),
577 '60' => array('60', 'Information was requested by an electronic method.', '', '', ''),
578 '61' => array('61', 'Eligibility for extended benefits.', '', '', ''),
579 '64' => array('64', 'Re-pricing information.', '', '', ''),
580 '65' => array('65', 'Claim/line has been paid.', '', '', ''),
581 '66' => array('66', 'Payment reflects usual and customary charges.', '', '', ''),
582 '72' => array('72', 'Claim contains split payment.', '', '', ''),
583 '73' => array('73', 'Payment made to entity, assignment of benefits not on file.', '', '', ''),
584 '78' => array('78', 'Duplicate of an existing claim/line, awaiting processing.', '', '', ''),
585 '81' => array('81', 'Contract/plan does not cover pre-existing conditions.', '', '', ''),
586 '83' => array('83', 'No coverage for newborns.', '', '', ''),
587 '84' => array('84', 'Service not authorized.', '', '', ''),
588 '85' => array('85', 'Entity not primary.', '', '', ''),
589 '86' => array('86', 'Diagnosis and patient gender mismatch.', '', '', ''),
590 '88' => array('88', 'Entity not eligible for benefits for submitted dates of service.', '', '', ''),
591 '89' => array('89', 'Entity not eligible for dental benefits for submitted dates of service.', '', '', ''),
592 '90' => array('90', 'Entity not eligible for medical benefits for submitted dates of service.', '', '', ''),
593 '91' => array('91', 'Entity not eligible/not approved for dates of service.', '', '', ''),
594 '92' => array('92', 'Entity does not meet dependent or student qualification.', '', '', ''),
595 '93' => array('93', 'Entity is not selected primary care provider.', '', '', ''),
596 '94' => array('94', 'Entity not referred by selected primary care provider.', '', '', ''),
597 '95' => array('95', 'Requested additional information not received.', '', '', ''),
598 '96' => array('96', 'No agreement with entity.', '', '', ''),
599 '97' => array('97', 'Patient eligibility not found with entity.', '', '', ''),
600 '98' => array('98', 'Charges applied to deductible.', '', '', ''),
601 '99' => array('99', 'Pre-treatment review.', '', '', ''),
602 '100' => array('100', 'Pre-certification penalty taken.', '', '', ''),
603 '101' => array('101', 'Claim was processed as adjustment to previous claim.', '', '', ''),
604 '102' => array('102', 'Newborn\'s charges processed on mother\'s claim.', '', '', ''),
605 '103' => array('103', 'Claim combined with other claim(s).', '', '', ''),
606 '104' => array('104', 'Processed according to plan provisions ', '', '', ''),
607 '105' => array('105', 'Claim/line is capitated.', '', '', ''),
608 '106' => array('106', 'This amount is not entity\'s responsibility.', '', '', ''),
609 '107' => array('107', 'Processed according to contract provisions ', '', '', ''),
610 '109' => array('109', 'Entity not eligible.', '', '', ''),
611 '110' => array('110', 'Claim requires pricing information.', '', '', ''),
612 '111' => array('111', 'At the policyholder\'s request these claims cannot be submitted electronically.', '', '', ''),
613 '114' => array('114', 'Claim/service should be processed by entity.', '', '', ''),
614 '116' => array('116', 'Claim submitted to incorrect payer.', '', '', ''),
615 '117' => array('117', 'Claim requires signature-on-file indicator.', '', '', ''),
616 '121' => array('121', 'Service line number greater than maximum allowable for payer.', '', '', ''),
617 '123' => array('123', 'Additional information requested from entity.', '', '', ''),
618 '124' => array('124', 'Entity\'s name, address, phone and id number.', '', '', ''),
619 '125' => array('125', 'Entity\'s name.', '', '', ''),
620 '126' => array('126', 'Entity\'s address.', '', '', ''),
621 '127' => array('127', 'Entity\'s Communication Number.', '', '', ''),
622 '128' => array('128', 'Entity\'s tax id.', '', '', ''),
623 '129' => array('129', 'Entity\'s Blue Cross provider id.', '', '', ''),
624 '130' => array('130', 'Entity\'s Blue Shield provider id.', '', '', ''),
625 '131' => array('131', 'Entity\'s Medicare provider id.', '', '', ''),
626 '132' => array('132', 'Entity\'s Medicaid provider id.', '', '', ''),
627 '133' => array('133', 'Entity\'s UPIN.', '', '', ''),
628 '134' => array('134', 'Entity\'s CHAMPUS provider id.', '', '', ''),
629 '135' => array('135', 'Entity\'s commercial provider id.', '', '', ''),
630 '136' => array('136', 'Entity\'s health industry id number.', '', '', ''),
631 '137' => array('137', 'Entity\'s plan network id.', '', '', ''),
632 '138' => array('138', 'Entity\'s site id .', '', '', ''),
633 '139' => array('139', 'Entity\'s health maintenance provider id ', '', '', ''),
634 '140' => array('140', 'Entity\'s preferred provider organization id ', '', '', ''),
635 '141' => array('141', 'Entity\'s administrative services organization id ', '', '', ''),
636 '142' => array('142', 'Entity\'s license/certification number.', '', '', ''),
637 '143' => array('143', 'Entity\'s state license number.', '', '', ''),
638 '144' => array('144', 'Entity\'s specialty license number.', '', '', ''),
639 '145' => array('145', 'Entity\'s specialty/taxonomy code.', '', '', ''),
640 '146' => array('146', 'Entity\'s anesthesia license number.', '', '', ''),
641 '147' => array('147', 'Entity\'s qualification degree/designation ', '', '', ''),
642 '148' => array('148', 'Entity\'s social security number.', '', '', ''),
643 '149' => array('149', 'Entity\'s employer id.', '', '', ''),
644 '150' => array('150', 'Entity\'s drug enforcement agency ', '', '', ''),
645 '152' => array('152', 'Pharmacy processor number.', '', '', ''),
646 '153' => array('153', 'Entity\'s id number.', '', '', ''),
647 '154' => array('154', 'Relationship of surgeon & assistant surgeon.', '', '', ''),
648 '155' => array('155', 'Entity\'s relationship to patient.', '', '', ''),
649 '156' => array('156', 'Patient relationship to subscriber', '', '', ''),
650 '157' => array('157', 'Entity\'s Gender.', '', '', ''),
651 '158' => array('158', 'Entity\'s date of birth.', '', '', ''),
652 '159' => array('159', 'Entity\'s date of death.', '', '', ''),
653 '160' => array('160', 'Entity\'s marital status.', '', '', ''),
654 '161' => array('161', 'Entity\'s employment status.', '', '', ''),
655 '162' => array('162', 'Entity\'s health insurance claim number ', '', '', ''),
656 '163' => array('163', 'Entity\'s policy number.', '', '', ''),
657 '164' => array('164', 'Entity\'s contract/member number.', '', '', ''),
658 '165' => array('165', 'Entity\'s employer name, address and phone.', '', '', ''),
659 '166' => array('166', 'Entity\'s employer name.', '', '', ''),
660 '167' => array('167', 'Entity\'s employer address.', '', '', ''),
661 '168' => array('168', 'Entity\'s employer phone number.', '', '', ''),
662 '170' => array('170', 'Entity\'s employee id.', '', '', ''),
663 '171' => array('171', 'Other insurance coverage information ', '', '', ''),
664 '172' => array('172', 'Other employer name, address and telephone number.', '', '', ''),
665 '173' => array('173', 'Entity\'s name, address, phone, gender, DOB, marital status, employment status and relation to subscriber.', '', '', ''),
666 '174' => array('174', 'Entity\'s student status.', '', '', ''),
667 '175' => array('175', 'Entity\'s school name.', '', '', ''),
668 '176' => array('176', 'Entity\'s school address.', '', '', ''),
669 '177' => array('177', 'Transplant recipient\'s name, date of birth, gender, relationship to insured.', '', '', ''),
670 '178' => array('178', 'Submitted charges.', '', '', ''),
671 '179' => array('179', 'Outside lab charges.', '', '', ''),
672 '180' => array('180', 'Hospital s semi-private room rate.', '', '', ''),
673 '181' => array('181', 'Hospital s room rate.', '', '', ''),
674 '182' => array('182', 'Allowable/paid from other entities coverage NOTE: This code requires the use of an entity code.', '', '', ''),
675 '183' => array('183', 'Amount entity has paid.', '', '', ''),
676 '184' => array('184', 'Purchase price for the rented durable medical equipment.', '', '', ''),
677 '185' => array('185', 'Rental price for durable medical equipment.', '', '', ''),
678 '186' => array('186', 'Purchase and rental price of durable medical equipment.', '', '', ''),
679 '187' => array('187', 'Date(s) of service.', '', '', ''),
680 '188' => array('188', 'Statement from-through dates.', '', '', ''),
681 '189' => array('189', 'Facility admission date', '', '', ''),
682 '190' => array('190', 'Facility discharge date', '', '', ''),
683 '191' => array('191', 'Date of Last Menstrual Period ', '', '', ''),
684 '192' => array('192', 'Date of first service for current series/symptom/illness.', '', '', ''),
685 '193' => array('193', 'First consultation/evaluation date.', '', '', ''),
686 '194' => array('194', 'Confinement dates.', '', '', ''),
687 '195' => array('195', 'Unable to work dates/Disability Dates.', '', '', ''),
688 '196' => array('196', 'Return to work dates.', '', '', ''),
689 '197' => array('197', 'Effective coverage date(s).', '', '', ''),
690 '198' => array('198', 'Medicare effective date.', '', '', ''),
691 '199' => array('199', 'Date of conception and expected date of delivery.', '', '', ''),
692 '200' => array('200', 'Date of equipment return.', '', '', ''),
693 '201' => array('201', 'Date of dental appliance prior placement.', '', '', ''),
694 '202' => array('202', 'Date of dental prior replacement/reason for replacement.', '', '', ''),
695 '203' => array('203', 'Date of dental appliance placed.', '', '', ''),
696 '204' => array('204', 'Date dental canal(s) opened and date service completed.', '', '', ''),
697 '205' => array('205', 'Date(s) dental root canal therapy previously performed.', '', '', ''),
698 '206' => array('206', 'Most recent date of curettage, root planing, or periodontal surgery.', '', '', ''),
699 '207' => array('207', 'Dental impression and seating date.', '', '', ''),
700 '208' => array('208', 'Most recent date pacemaker was implanted.', '', '', ''),
701 '209' => array('209', 'Most recent pacemaker battery change date.', '', '', ''),
702 '210' => array('210', 'Date of the last x-ray.', '', '', ''),
703 '211' => array('211', 'Date(s) of dialysis training provided to patient.', '', '', ''),
704 '212' => array('212', 'Date of last routine dialysis.', '', '', ''),
705 '213' => array('213', 'Date of first routine dialysis.', '', '', ''),
706 '214' => array('214', 'Original date of prescription/orders/referral.', '', '', ''),
707 '215' => array('215', 'Date of tooth extraction/evolution.', '', '', ''),
708 '216' => array('216', 'Drug information.', '', '', ''),
709 '217' => array('217', 'Drug name, strength and dosage form.', '', '', ''),
710 '218' => array('218', 'NDC number.', '', '', ''),
711 '219' => array('219', 'Prescription number.', '', '', ''),
712 '222' => array('222', 'Drug dispensing units and average wholesale price ', '', '', ''),
713 '223' => array('223', 'Route of drug/myelogram administration.', '', '', ''),
714 '224' => array('224', 'Anatomical location for joint injection.', '', '', ''),
715 '225' => array('225', 'Anatomical location.', '', '', ''),
716 '226' => array('226', 'Joint injection site.', '', '', ''),
717 '227' => array('227', 'Hospital information.', '', '', ''),
718 '228' => array('228', 'Type of bill for UB claim', '', '', ''),
719 '229' => array('229', 'Hospital admission source.', '', '', ''),
720 '230' => array('230', 'Hospital admission hour.', '', '', ''),
721 '231' => array('231', 'Hospital admission type.', '', '', ''),
722 '232' => array('232', 'Admitting diagnosis.', '', '', ''),
723 '233' => array('233', 'Hospital discharge hour.', '', '', ''),
724 '234' => array('234', 'Patient discharge status.', '', '', ''),
725 '235' => array('235', 'Units of blood furnished.', '', '', ''),
726 '236' => array('236', 'Units of blood replaced.', '', '', ''),
727 '237' => array('237', 'Units of deductible blood.', '', '', ''),
728 '238' => array('238', 'Separate claim for mother/baby charges.', '', '', ''),
729 '239' => array('239', 'Dental information.', '', '', ''),
730 '240' => array('240', 'Tooth surface(s) involved.', '', '', ''),
731 '241' => array('241', 'List of all missing teeth ', '', '', ''),
732 '242' => array('242', 'Tooth numbers, surfaces, and/or quadrants involved.', '', '', ''),
733 '243' => array('243', 'Months of dental treatment remaining.', '', '', ''),
734 '244' => array('244', 'Tooth number or letter.', '', '', ''),
735 '245' => array('245', 'Dental quadrant/arch.', '', '', ''),
736 '246' => array('246', 'Total orthodontic service fee, initial appliance fee, monthly fee, length of service.', '', '', ''),
737 '247' => array('247', 'Line information.', '', '', ''),
738 '249' => array('249', 'Place of service.', '', '', ''),
739 '250' => array('250', 'Type of service.', '', '', ''),
740 '251' => array('251', 'Total anesthesia minutes.', '', '', ''),
741 '252' => array('252', 'Entity\'s authorization/certification number.', '', '', ''),
742 '254' => array('254', 'Principal diagnosis code.', '', '', ''),
743 '255' => array('255', 'Diagnosis code.', '', '', ''),
744 '256' => array('256', 'DRG code(s).', '', '', ''),
745 '257' => array('257', 'ADSM-III-R code for services rendered.', '', '', ''),
746 '258' => array('258', 'Days/units for procedure/revenue code.', '', '', ''),
747 '259' => array('259', 'Frequency of service.', '', '', ''),
748 '260' => array('260', 'Length of medical necessity, including begin date.', '', '', ''),
749 '261' => array('261', 'Obesity measurements.', '', '', ''),
750 '262' => array('262', 'Type of surgery/service for which anesthesia was administered.', '', '', ''),
751 '263' => array('263', 'Length of time for services rendered.', '', '', ''),
752 '264' => array('264', 'Number of liters/minute & total hours/day for respiratory support.', '', '', ''),
753 '265' => array('265', 'Number of lesions excised.', '', '', ''),
754 '266' => array('266', 'Facility point of origin and destination - ambulance.', '', '', ''),
755 '267' => array('267', 'Number of miles patient was transported.', '', '', ''),
756 '268' => array('268', 'Location of durable medical equipment use.', '', '', ''),
757 '269' => array('269', 'Length/size of laceration/tumor.', '', '', ''),
758 '270' => array('270', 'Subluxation location.', '', '', ''),
759 '271' => array('271', 'Number of spine segments.', '', '', ''),
760 '272' => array('272', 'Oxygen contents for oxygen system rental.', '', '', ''),
761 '273' => array('273', 'Weight.', '', '', ''),
762 '274' => array('274', 'Height.', '', '', ''),
763 '275' => array('275', 'Claim.', '', '', ''),
764 '276' => array('276', 'UB04/HCFA-1450/1500 claim form', '', '', ''),
765 '277' => array('277', 'Paper claim.', '', '', ''),
766 '279' => array('279', 'Claim/service must be itemized', '', '', ''),
767 '281' => array('281', 'Related confinement claim.', '', '', ''),
768 '282' => array('282', 'Copy of prescription.', '', '', ''),
769 '283' => array('283', 'Medicare entitlement information is required to determine primary coverage', '', '', ''),
770 '284' => array('284', 'Copy of Medicare ID card.', '', '', ''),
771 '286' => array('286', 'Other payer\'s Explanation of Benefits/payment information.', '', '', ''),
772 '287' => array('287', 'Medical necessity for service.', '', '', ''),
773 '288' => array('288', 'Hospital late charges', '', '', ''),
774 '290' => array('290', 'Pre-existing information.', '', '', ''),
775 '291' => array('291', 'Reason for termination of pregnancy.', '', '', ''),
776 '292' => array('292', 'Purpose of family conference/therapy.', '', '', ''),
777 '293' => array('293', 'Reason for physical therapy.', '', '', ''),
778 '294' => array('294', 'Supporting documentation.', '', '', ''),
779 '295' => array('295', 'Attending physician report.', '', '', ''),
780 '296' => array('296', 'Nurse\'s notes.', '', '', ''),
781 '297' => array('297', 'Medical notes/report.', '', '', ''),
782 '298' => array('298', 'Operative report.', '', '', ''),
783 '299' => array('299', 'Emergency room notes/report.', '', '', ''),
784 '300' => array('300', 'Lab/test report/notes/results.', '', '', ''),
785 '301' => array('301', 'MRI report.', '', '', ''),
786 '305' => array('305', 'Radiology/x-ray reports and/or interpretation', '', '', ''),
787 '306' => array('306', 'Detailed description of service.', '', '', ''),
788 '307' => array('307', 'Narrative with pocket depth chart.', '', '', ''),
789 '308' => array('308', 'Discharge summary.', '', '', ''),
790 '310' => array('310', 'Progress notes for the six months prior to statement date.', '', '', ''),
791 '311' => array('311', 'Pathology notes/report.', '', '', ''),
792 '312' => array('312', 'Dental charting.', '', '', ''),
793 '313' => array('313', 'Bridgework information.', '', '', ''),
794 '314' => array('314', 'Dental records for this service.', '', '', ''),
795 '315' => array('315', 'Past perio treatment history.', '', '', ''),
796 '316' => array('316', 'Complete medical history.', '', '', ''),
797 '318' => array('318', 'X-rays/radiology films', '', '', ''),
798 '319' => array('319', 'Pre/post-operative x-rays/photographs.', '', '', ''),
799 '320' => array('320', 'Study models.', '', '', ''),
800 '322' => array('322', 'Recent Full Mouth X-rays', '', '', ''),
801 '323' => array('323', 'Study models, x-rays, and/or narrative.', '', '', ''),
802 '324' => array('324', 'Recent x-ray of treatment area and/or narrative.', '', '', ''),
803 '325' => array('325', 'Recent fm x-rays and/or narrative.', '', '', ''),
804 '326' => array('326', 'Copy of transplant acquisition invoice.', '', '', ''),
805 '327' => array('327', 'Periodontal case type diagnosis and recent pocket depth chart with narrative.', '', '', ''),
806 '329' => array('329', 'Exercise notes.', '', '', ''),
807 '330' => array('330', 'Occupational notes.', '', '', ''),
808 '331' => array('331', 'History and physical.', '', '', ''),
809 '333' => array('333', 'Patient release of information authorization.', '', '', ''),
810 '334' => array('334', 'Oxygen certification.', '', '', ''),
811 '335' => array('335', 'Durable medical equipment certification.', '', '', ''),
812 '336' => array('336', 'Chiropractic certification.', '', '', ''),
813 '337' => array('337', 'Ambulance certification/documentation.', '', '', ''),
814 '339' => array('339', 'Enteral/parenteral certification.', '', '', ''),
815 '340' => array('340', 'Pacemaker certification.', '', '', ''),
816 '341' => array('341', 'Private duty nursing certification.', '', '', ''),
817 '342' => array('342', 'Podiatric certification.', '', '', ''),
818 '343' => array('343', 'Documentation that facility is state licensed and Medicare approved as a surgical facility.', '', '', ''),
819 '344' => array('344', 'Documentation that provider of physical therapy is Medicare Part B approved.', '', '', ''),
820 '345' => array('345', 'Treatment plan for service/diagnosis', '', '', ''),
821 '346' => array('346', 'Proposed treatment plan for next 6 months.', '', '', ''),
822 '352' => array('352', 'Duration of treatment plan.', '', '', ''),
823 '353' => array('353', 'Orthodontics treatment plan.', '', '', ''),
824 '354' => array('354', 'Treatment plan for replacement of remaining missing teeth.', '', '', ''),
825 '360' => array('360', 'Benefits Assignment Certification Indicator', '', '', ''),
826 '363' => array('363', 'Possible Workers Compensation', '', '', ''),
827 '364' => array('364', 'Is accident/illness/condition employment related?', '', '', ''),
828 '365' => array('365', 'Is service the result of an accident?', '', '', ''),
829 '366' => array('366', 'Is injury due to auto accident?', '', '', ''),
830 '374' => array('374', 'Is prescribed lenses a result of cataract surgery?', '', '', ''),
831 '375' => array('375', 'Was refraction performed?', '', '', ''),
832 '380' => array('380', 'CRNA supervision/medical direction.', '', '', ''),
833 '382' => array('382', 'Did provider authorize generic or brand name dispensing?', '', '', ''),
834 '383' => array('383', 'Nerve block use ', '', '', ''),
835 '384' => array('384', 'Is prosthesis/crown/inlay placement an initial placement or a replacement?', '', '', ''),
836 '385' => array('385', 'Is appliance upper or lower arch & is appliance fixed or removable?', '', '', ''),
837 '386' => array('386', 'Orthodontic Treatment/Purpose Indicator', '', '', ''),
838 '387' => array('387', 'Date patient last examined by entity.', '', '', ''),
839 '388' => array('388', 'Date post-operative care assumed', '', '', ''),
840 '389' => array('389', 'Date post-operative care relinquished', '', '', ''),
841 '390' => array('390', 'Date of most recent medical event necessitating service(s)', '', '', ''),
842 '391' => array('391', 'Date(s) dialysis conducted', '', '', ''),
843 '394' => array('394', 'Date(s) of most recent hospitalization related to service', '', '', ''),
844 '395' => array('395', 'Date entity signed certification/recertification Note: This code requires use of an Entity Code.', '', '', ''),
845 '396' => array('396', 'Date home dialysis began', '', '', ''),
846 '397' => array('397', 'Date of onset/exacerbation of illness/condition', '', '', ''),
847 '398' => array('398', 'Visual field test results', '', '', ''),
848 '400' => array('400', 'Claim is out of balance', '', '', ''),
849 '401' => array('401', 'Source of payment is not valid', '', '', ''),
850 '402' => array('402', 'Amount must be greater than zero.', '', '', ''),
851 '403' => array('403', 'Entity referral notes/orders/prescription', '', '', ''),
852 '406' => array('406', 'Brief medical history as related to service(s)', '', '', ''),
853 '407' => array('407', 'Complications/mitigating circumstances', '', '', ''),
854 '408' => array('408', 'Initial certification', '', '', ''),
855 '409' => array('409', 'Medication logs/records ', '', '', ''),
856 '414' => array('414', 'Necessity for concurrent care ', '', '', ''),
857 '417' => array('417', 'Prior testing, including result(s) and date(s) as related to service(s)', '', '', ''),
858 '419' => array('419', 'Individual test(s) comprising the panel and the charges for each test', '', '', ''),
859 '420' => array('420', 'Name, dosage and medical justification of contrast material used for radiology procedure', '', '', ''),
860 '428' => array('428', 'Reason for transport by ambulance', '', '', ''),
861 '430' => array('430', 'Nearest appropriate facility', '', '', ''),
862 '431' => array('431', 'Patient\'s condition/functional status at time of service.', '', '', ''),
863 '432' => array('432', 'Date benefits exhausted', '', '', ''),
864 '433' => array('433', 'Copy of patient revocation of hospice benefits', '', '', ''),
865 '434' => array('434', 'Reasons for more than one transfer per entitlement period', '', '', ''),
866 '435' => array('435', 'Notice of Admission', '', '', ''),
867 '441' => array('441', 'Entity professional qualification for service(s)', '', '', ''),
868 '442' => array('442', 'Modalities of service', '', '', ''),
869 '443' => array('443', 'Initial evaluation report', '', '', ''),
870 '449' => array('449', 'Projected date to discontinue service(s)', '', '', ''),
871 '450' => array('450', 'Awaiting spend down determination', '', '', ''),
872 '451' => array('451', 'Preoperative and post-operative diagnosis', '', '', ''),
873 '452' => array('452', 'Total visits in total number of hours/day and total number of hours/week', '', '', ''),
874 '453' => array('453', 'Procedure Code Modifier(s) for Service(s) Rendered', '', '', ''),
875 '454' => array('454', 'Procedure code for services rendered.', '', '', ''),
876 '455' => array('455', 'Revenue code for services rendered.', '', '', ''),
877 '456' => array('456', 'Covered Day(s)', '', '', ''),
878 '457' => array('457', 'Non-Covered Day(s)', '', '', ''),
879 '458' => array('458', 'Coinsurance Day(s)', '', '', ''),
880 '459' => array('459', 'Lifetime Reserve Day(s)', '', '', ''),
881 '460' => array('460', 'NUBC Condition Code(s)', '', '', ''),
882 '464' => array('464', 'Payer Assigned Claim Control Number', '', '', ''),
883 '465' => array('465', 'Principal Procedure Code for Service(s) Rendered', '', '', ''),
884 '466' => array('466', 'Entity\'s Original Signature.', '', '', ''),
885 '467' => array('467', 'Entity Signature Date.', '', '', ''),
886 '468' => array('468', 'Patient Signature Source', '', '', ''),
887 '469' => array('469', 'Purchase Service Charge', '', '', ''),
888 '470' => array('470', 'Was service purchased from another entity? Note: This code requires use of an Entity Code.', '', '', ''),
889 '471' => array('471', 'Were services related to an emergency?', '', '', ''),
890 '472' => array('472', 'Ambulance Run Sheet', '', '', ''),
891 '473' => array('473', 'Missing or invalid lab indicator', '', '', ''),
892 '474' => array('474', 'Procedure code and patient gender mismatch', '', '', ''),
893 '475' => array('475', 'Procedure code not valid for patient age', '', '', ''),
894 '476' => array('476', 'Missing or invalid units of service', '', '', ''),
895 '477' => array('477', 'Diagnosis code pointer is missing or invalid', '', '', ''),
896 '478' => array('478', 'Claim submitter\'s identifier', '', '', ''),
897 '479' => array('479', 'Other Carrier payer ID is missing or invalid', '', '', ''),
898 '480' => array('480', 'Entity\'s claim filing indicator.', '', '', ''),
899 '481' => array('481', 'Claim/submission format is invalid.', '', '', ''),
900 '483' => array('483', 'Maximum coverage amount met or exceeded for benefit period.', '', '', ''),
901 '484' => array('484', 'Business Application Currently Not Available', '', '', ''),
902 '485' => array('485', 'More information available than can be returned in real time mode.', '', '', ''),
903 '486' => array('486', 'Principal Procedure Date', '', '', ''),
904 '487' => array('487', 'Claim not found, claim should have been submitted to/through entityName.', '', '', ''),
905 '488' => array('488', 'Diagnosis code(s) for the services rendered.', '', '', ''),
906 '489' => array('489', 'Attachment Control Number', '', '', ''),
907 '490' => array('490', 'Other Procedure Code for Service(s) Rendered', '', '', ''),
908 '491' => array('491', 'Entity not eligible for encounter submission.', '', '', ''),
909 '492' => array('492', 'Other Procedure Date', '', '', ''),
910 '493' => array('493', 'Version/Release/Industry ID code not currently supported by information holder', '', '', ''),
911 '494' => array('494', 'Real-Time requests not supported by the information holder, resubmit as batch request', '', '', ''),
912 '495' => array('495', 'Requests for re-adjudication must reference the newly assigned payer claim control number for this previously adjusted claim.', '', '', ''),
913 '496' => array('496', 'Submitter not approved for electronic claim submissions on behalf of this entity.', '', '', ''),
914 '497' => array('497', 'Sales tax not paid', '', '', ''),
915 '498' => array('498', 'Maximum leave days exhausted', '', '', ''),
916 '499' => array('499', 'No rate on file with the payer for this service for this entity Note: This code requires use of an Entity Code.', '', '', ''),
917 '500' => array('500', 'Entity\'s Postal/Zip Code.', '', '', ''),
918 '501' => array('501', 'Entity\'s State/Province.', '', '', ''),
919 '502' => array('502', 'Entity\'s City.', '', '', ''),
920 '503' => array('503', 'Entity\'s Street Address.', '', '', ''),
921 '504' => array('504', 'Entity\'s Last Name.', '', '', ''),
922 '505' => array('505', 'Entity\'s First Name.', '', '', ''),
923 '506' => array('506', 'Entity is changing processor/clearinghouse.', '', '', ''),
924 '507' => array('507', 'HCPCS', '', '', ''),
925 '508' => array('508', 'ICD9 NOTE: At least one other status code is required to identify the related procedure code or diagnosis code.', '', '', ''),
926 '509' => array('509', 'External Cause of Injury Code ', '', '', ''),
927 '510' => array('510', 'Future date.', '', '', ''),
928 '511' => array('511', 'Invalid character.', '', '', ''),
929 '512' => array('512', 'Length invalid for receiver\'s application system.', '', '', ''),
930 '513' => array('513', 'HIPPS Rate Code for services Rendered', '', '', ''),
931 '514' => array('514', 'Entity\'s Middle Name Note: This code requires use of an Entity Code.', '', '', ''),
932 '515' => array('515', 'Managed Care review', '', '', ''),
933 '516' => array('516', 'Other Entity\'s Adjudication or Payment/Remittance Date.', '', '', ''),
934 '517' => array('517', 'Adjusted Repriced Claim Reference Number', '', '', ''),
935 '518' => array('518', 'Adjusted Repriced Line item Reference Number', '', '', ''),
936 '519' => array('519', 'Adjustment Amount', '', '', ''),
937 '520' => array('520', 'Adjustment Quantity', '', '', ''),
938 '521' => array('521', 'Adjustment Reason Code', '', '', ''),
939 '522' => array('522', 'Anesthesia Modifying Units', '', '', ''),
940 '523' => array('523', 'Anesthesia Unit Count', '', '', ''),
941 '524' => array('524', 'Arterial Blood Gas Quantity', '', '', ''),
942 '525' => array('525', 'Begin Therapy Date', '', '', ''),
943 '526' => array('526', 'Bundled or Unbundled Line Number', '', '', ''),
944 '527' => array('527', 'Certification Condition Indicator', '', '', ''),
945 '528' => array('528', 'Certification Period Projected Visit Count', '', '', ''),
946 '529' => array('529', 'Certification Revision Date', '', '', ''),
947 '530' => array('530', 'Claim Adjustment Indicator', '', '', ''),
948 '531' => array('531', 'Claim Disproportinate Share Amount', '', '', ''),
949 '532' => array('532', 'Claim DRG Amount', '', '', ''),
950 '533' => array('533', 'Claim DRG Outlier Amount', '', '', ''),
951 '534' => array('534', 'Claim ESRD Payment Amount', '', '', ''),
952 '535' => array('535', 'Claim Frequency Code', '', '', ''),
953 '536' => array('536', 'Claim Indirect Teaching Amount', '', '', ''),
954 '537' => array('537', 'Claim MSP Pass-through Amount', '', '', ''),
955 '538' => array('538', 'Claim or Encounter Identifier', '', '', ''),
956 '539' => array('539', 'Claim PPS Capital Amount', '', '', ''),
957 '540' => array('540', 'Claim PPS Capital Outlier Amount', '', '', ''),
958 '541' => array('541', 'Claim Submission Reason Code', '', '', ''),
959 '542' => array('542', 'Claim Total Denied Charge Amount', '', '', ''),
960 '543' => array('543', 'Clearinghouse or Value Added Network Trace', '', '', ''),
961 '544' => array('544', 'Clinical Laboratory Improvement Amendment', '', '', ''),
962 '545' => array('545', 'Contract Amount', '', '', ''),
963 '546' => array('546', 'Contract Code', '', '', ''),
964 '547' => array('547', 'Contract Percentage', '', '', ''),
965 '548' => array('548', 'Contract Type Code', '', '', ''),
966 '549' => array('549', 'Contract Version Identifier', '', '', ''),
967 '550' => array('550', 'Coordination of Benefits Code', '', '', ''),
968 '551' => array('551', 'Coordination of Benefits Total Submitted Charge', '', '', ''),
969 '552' => array('552', 'Cost Report Day Count', '', '', ''),
970 '553' => array('553', 'Covered Amount', '', '', ''),
971 '554' => array('554', 'Date Claim Paid', '', '', ''),
972 '555' => array('555', 'Delay Reason Code', '', '', ''),
973 '556' => array('556', 'Demonstration Project Identifier', '', '', ''),
974 '557' => array('557', 'Diagnosis Date', '', '', ''),
975 '558' => array('558', 'Discount Amount', '', '', ''),
976 '559' => array('559', 'Document Control Identifier', '', '', ''),
977 '560' => array('560', 'Entity\'s Additional/Secondary Identifier.', '', '', ''),
978 '561' => array('561', 'Entity\'s Contact Name.', '', '', ''),
979 '562' => array('562', 'Entity\'s National Provider Identifier ', '', '', ''),
980 '563' => array('563', 'Entity\'s Tax Amount.', '', '', ''),
981 '564' => array('564', 'EPSDT Indicator', '', '', ''),
982 '565' => array('565', 'Estimated Claim Due Amount', '', '', ''),
983 '566' => array('566', 'Exception Code', '', '', ''),
984 '567' => array('567', 'Facility Code Qualifier', '', '', ''),
985 '568' => array('568', 'Family Planning Indicator', '', '', ''),
986 '569' => array('569', 'Fixed Format Information', '', '', ''),
987 '570' => array('570', 'Free Form Message Text', '', '', ''),
988 '571' => array('571', 'Frequency Count', '', '', ''),
989 '572' => array('572', 'Frequency Period', '', '', ''),
990 '573' => array('573', 'Functional Limitation Code', '', '', ''),
991 '574' => array('574', 'HCPCS Payable Amount Home Health', '', '', ''),
992 '575' => array('575', 'Homebound Indicator', '', '', ''),
993 '576' => array('576', 'Immunization Batch Number', '', '', ''),
994 '577' => array('577', 'Industry Code', '', '', ''),
995 '578' => array('578', 'Insurance Type Code', '', '', ''),
996 '579' => array('579', 'Investigational Device Exemption Identifier', '', '', ''),
997 '580' => array('580', 'Last Certification Date', '', '', ''),
998 '581' => array('581', 'Last Worked Date', '', '', ''),
999 '582' => array('582', 'Lifetime Psychiatric Days Count', '', '', ''),
1000 '583' => array('583', 'Line Item Charge Amount', '', '', ''),
1001 '584' => array('584', 'Line Item Control Number', '', '', ''),
1002 '585' => array('585', 'Denied Charge or Non-covered Charge', '', '', ''),
1003 '586' => array('586', 'Line Note Text', '', '', ''),
1004 '587' => array('587', 'Measurement Reference Identification Code', '', '', ''),
1005 '588' => array('588', 'Medical Record Number', '', '', ''),
1006 '589' => array('589', 'Provider Accept Assignment Code', '', '', ''),
1007 '590' => array('590', 'Medicare Coverage Indicator', '', '', ''),
1008 '591' => array('591', 'Medicare Paid at 100% Amount', '', '', ''),
1009 '592' => array('592', 'Medicare Paid at 80% Amount', '', '', ''),
1010 '593' => array('593', 'Medicare Section 4081 Indicator', '', '', ''),
1011 '594' => array('594', 'Mental Status Code', '', '', ''),
1012 '595' => array('595', 'Monthly Treatment Count', '', '', ''),
1013 '596' => array('596', 'Non-covered Charge Amount', '', '', ''),
1014 '597' => array('597', 'Non-payable Professional Component Amount', '', '', ''),
1015 '598' => array('598', 'Non-payable Professional Component Billed Amount', '', '', ''),
1016 '599' => array('599', 'Note Reference Code', '', '', ''),
1017 '600' => array('600', 'Oxygen Saturation Qty', '', '', ''),
1018 '601' => array('601', 'Oxygen Test Condition Code', '', '', ''),
1019 '602' => array('602', 'Oxygen Test Date', '', '', ''),
1020 '603' => array('603', 'Old Capital Amount', '', '', ''),
1021 '604' => array('604', 'Originator Application Transaction Identifier', '', '', ''),
1022 '605' => array('605', 'Orthodontic Treatment Months Count', '', '', ''),
1023 '606' => array('606', 'Paid From Part A Medicare Trust Fund Amount', '', '', ''),
1024 '607' => array('607', 'Paid From Part B Medicare Trust Fund Amount', '', '', ''),
1025 '608' => array('608', 'Paid Service Unit Count', '', '', ''),
1026 '609' => array('609', 'Participation Agreement', '', '', ''),
1027 '610' => array('610', 'Patient Discharge Facility Type Code', '', '', ''),
1028 '611' => array('611', 'Peer Review Authorization Number', '', '', ''),
1029 '612' => array('612', 'Per Day Limit Amount', '', '', ''),
1030 '613' => array('613', 'Physician Contact Date', '', '', ''),
1031 '614' => array('614', 'Physician Order Date', '', '', ''),
1032 '615' => array('615', 'Policy Compliance Code', '', '', ''),
1033 '616' => array('616', 'Policy Name', '', '', ''),
1034 '617' => array('617', 'Postage Claimed Amount', '', '', ''),
1035 '618' => array('618', 'PPS-Capital DSH DRG Amount', '', '', ''),
1036 '619' => array('619', 'PPS-Capital Exception Amount', '', '', ''),
1037 '620' => array('620', 'PPS-Capital FSP DRG Amount', '', '', ''),
1038 '621' => array('621', 'PPS-Capital HSP DRG Amount', '', '', ''),
1039 '622' => array('622', 'PPS-Capital IME Amount', '', '', ''),
1040 '623' => array('623', 'PPS-Operating Federal Specific DRG Amount', '', '', ''),
1041 '624' => array('624', 'PPS-Operating Hospital Specific DRG Amount', '', '', ''),
1042 '625' => array('625', 'Predetermination of Benefits Identifier', '', '', ''),
1043 '626' => array('626', 'Pregnancy Indicator', '', '', ''),
1044 '627' => array('627', 'Pre-Tax Claim Amount', '', '', ''),
1045 '628' => array('628', 'Pricing Methodology', '', '', ''),
1046 '629' => array('629', 'Property Casualty Claim Number', '', '', ''),
1047 '630' => array('630', 'Referring CLIA Number', '', '', ''),
1048 '631' => array('631', 'Reimbursement Rate', '', '', ''),
1049 '632' => array('632', 'Reject Reason Code', '', '', ''),
1050 '633' => array('633', 'Related Causes Code ', '', '', ''),
1051 '634' => array('634', 'Remark Code', '', '', ''),
1052 '635' => array('635', 'Repriced Ambulatory Patient Group Code', '', '', ''),
1053 '636' => array('636', 'Repriced Line Item Reference Number', '', '', ''),
1054 '637' => array('637', 'Repriced Saving Amount', '', '', ''),
1055 '638' => array('638', 'Repricing Per Diem or Flat Rate Amount', '', '', ''),
1056 '639' => array('639', 'Responsibility Amount', '', '', ''),
1057 '640' => array('640', 'Sales Tax Amount', '', '', ''),
1058 '642' => array('642', 'Service Authorization Exception Code', '', '', ''),
1059 '643' => array('643', 'Service Line Paid Amount', '', '', ''),
1060 '644' => array('644', 'Service Line Rate', '', '', ''),
1061 '645' => array('645', 'Service Tax Amount', '', '', ''),
1062 '646' => array('646', 'Ship, Delivery or Calendar Pattern Code', '', '', ''),
1063 '647' => array('647', 'Shipped Date', '', '', ''),
1064 '648' => array('648', 'Similar Illness or Symptom Date', '', '', ''),
1065 '649' => array('649', 'Skilled Nursing Facility Indicator', '', '', ''),
1066 '650' => array('650', 'Special Program Indicator', '', '', ''),
1067 '651' => array('651', 'State Industrial Accident Provider Number', '', '', ''),
1068 '652' => array('652', 'Terms Discount Percentage', '', '', ''),
1069 '653' => array('653', 'Test Performed Date', '', '', ''),
1070 '654' => array('654', 'Total Denied Charge Amount', '', '', ''),
1071 '655' => array('655', 'Total Medicare Paid Amount', '', '', ''),
1072 '656' => array('656', 'Total Visits Projected This Certification Count', '', '', ''),
1073 '657' => array('657', 'Total Visits Rendered Count', '', '', ''),
1074 '658' => array('658', 'Treatment Code', '', '', ''),
1075 '659' => array('659', 'Unit or Basis for Measurement Code', '', '', ''),
1076 '660' => array('660', 'Universal Product Number', '', '', ''),
1077 '661' => array('661', 'Visits Prior to Recertification Date Count CR702', '', '', ''),
1078 '662' => array('662', 'X-ray Availability Indicator', '', '', ''),
1079 '663' => array('663', 'Entity\'s Group Name.', '', '', ''),
1080 '664' => array('664', 'Orthodontic Banding Date', '', '', ''),
1081 '665' => array('665', 'Surgery Date', '', '', ''),
1082 '666' => array('666', 'Surgical Procedure Code', '', '', ''),
1083 '667' => array('667', 'Real-Time requests not supported by the information holder, do not resubmit', '', '', ''),
1084 '668' => array('668', 'Missing Endodontics treatment history and prognosis', '', '', ''),
1085 '669' => array('669', 'Dental service narrative needed.', '', '', ''),
1086 '670' => array('670', 'Funds applied from a consumer spending account such as consumer directed/driven health plan ', '', '', ''),
1087 '671' => array('671', 'Funds may be available from a consumer spending account such as consumer directed/driven health plan ', '', '', ''),
1088 '672' => array('672', 'Other Payer\'s payment information is out of balance', '', '', ''),
1089 '673' => array('673', 'Patient Reason for Visit', '', '', ''),
1090 '674' => array('674', 'Authorization exceeded', '', '', ''),
1091 '675' => array('675', 'Facility admission through discharge dates', '', '', ''),
1092 '676' => array('676', 'Entity possibly compensated by facility.', '', '', ''),
1093 '677' => array('677', 'Entity not affiliated.', '', '', ''),
1094 '678' => array('678', 'Revenue code and patient gender mismatch', '', '', ''),
1095 '679' => array('679', 'Submit newborn services on mother\'s claim', '', '', ''),
1096 '680' => array('680', 'Entity\'s Country.', '', '', ''),
1097 '681' => array('681', 'Claim currency not supported', '', '', ''),
1098 '682' => array('682', 'Cosmetic procedure', '', '', ''),
1099 '683' => array('683', 'Awaiting Associated Hospital Claims', '', '', ''),
1100 '684' => array('684', 'Rejected.', '', '', ''),
1101 '685' => array('685', 'Claim could not complete adjudication in real time.', '', '', ''),
1102 '686' => array('686', 'The claim/ encounter has completed the adjudication cycle and the entire claim has been voided', '', '', ''),
1103 '687' => array('687', 'Claim estimation can not be completed in real time.', '', '', ''),
1104 '688' => array('688', 'Present on Admission Indicator for reported diagnosis code(s).', '', '', ''),
1105 '689' => array('689', 'Entity was unable to respond within the expected time frame.', '', '', ''),
1106 '690' => array('690', 'Multiple claims or estimate requests cannot be processed in real time.', '', '', ''),
1107 '691' => array('691', 'Multiple claim status requests cannot be processed in real time.', '', '', ''),
1108 '692' => array('692', 'Contracted funding agreement-Subscriber is employed by the provider of services', '', '', ''),
1109 '693' => array('693', 'Amount must be greater than or equal to zero.', '', '', ''),
1110 '694' => array('694', 'Amount must not be equal to zero.', '', '', ''),
1111 '695' => array('695', 'Entity\'s Country Subdivision Code.', '', '', ''),
1112 '696' => array('696', 'Claim Adjustment Group Code.', '', '', ''),
1113 '697' => array('697', 'Invalid Decimal Precision.', '', '', ''),
1114 '698' => array('698', 'Form Type Identification', '', '', ''),
1115 '699' => array('699', 'Question/Response from Supporting Documentation Form', '', '', ''),
1116 '700' => array('700', 'ICD10.', '', '', ''),
1117 '701' => array('701', 'Initial Treatment Date', '', '', ''),
1118 '702' => array('702', 'Repriced Claim Reference Number', '', '', ''),
1119 '703' => array('703', 'Advanced Billing Concepts ', '', '', ''),
1120 '704' => array('704', 'Claim Note Text', '', '', ''),
1121 '705' => array('705', 'Repriced Allowed Amount', '', '', ''),
1122 '706' => array('706', 'Repriced Approved Amount', '', '', ''),
1123 '707' => array('707', 'Repriced Approved Ambulatory Patient Group Amount', '', '', ''),
1124 '708' => array('708', 'Repriced Approved Revenue Code', '', '', ''),
1125 '709' => array('709', 'Repriced Approved Service Unit Count', '', '', ''),
1126 '710' => array('710', 'Line Adjudication Information.', '', '', ''),
1127 '711' => array('711', 'Stretcher purpose', '', '', ''),
1128 '712' => array('712', 'Obstetric Additional Units', '', '', ''),
1129 '713' => array('713', 'Patient Condition Description', '', '', ''),
1130 '714' => array('714', 'Care Plan Oversight Number', '', '', ''),
1131 '715' => array('715', 'Acute Manifestation Date', '', '', ''),
1132 '716' => array('716', 'Repriced Approved DRG Code', '', '', ''),
1133 '717' => array('717', 'This claim has been split for processing.', '', '', ''),
1134 '718' => array('718', 'Claim/service not submitted within the required timeframe ', '', '', ''),
1135 '719' => array('719', 'NUBC Occurrence Code(s)', '', '', ''),
1136 '720' => array('720', 'NUBC Occurrence Code Date(s)', '', '', ''),
1137 '721' => array('721', 'NUBC Occurrence Span Code(s)', '', '', ''),
1138 '722' => array('722', 'NUBC Occurrence Span Code Date(s)', '', '', ''),
1139 '723' => array('723', 'Drug days supply', '', '', ''),
1140 '724' => array('724', 'Drug dosage', '', '', ''),
1141 '725' => array('725', 'NUBC Value Code(s)', '', '', ''),
1142 '726' => array('726', 'NUBC Value Code Amount(s)', '', '', ''),
1143 '727' => array('727', 'Accident date', '', '', ''),
1144 '728' => array('728', 'Accident state', '', '', ''),
1145 '729' => array('729', 'Accident description', '', '', ''),
1146 '730' => array('730', 'Accident cause', '', '', ''),
1147 '731' => array('731', 'Measurement value/test result', '', '', ''),
1148 '732' => array('732', 'Information submitted inconsistent with billing guidelines.', '', '', ''),
1149 '733' => array('733', 'Prefix for entity\'s contract/member number.', '', '', ''),
1150 '734' => array('734', 'Verifying premium payment', '', '', ''),
1151 '735' => array('735', 'This service/claim is included in the allowance for another service or claim.', '', '', ''),
1152 '736' => array('736', 'A related or qualifying service/claim has not been received/adjudicated.', '', '', ''),
1153 '737' => array('737', 'Current Dental Terminology ', '', '', ''),
1154 '738' => array('738', 'Home Infusion EDI Coalition ', '', '', ''),
1155 '739' => array('739', 'Jurisdiction Specific Procedure or Supply Code', '', '', ''),
1156 '740' => array('740', 'Drop-Off Location', '', '', ''),
1157 '741' => array('741', 'Entity must be a person.', '', '', ''),
1158 '742' => array('742', 'Payer Responsibility Sequence Number Code', '', '', ''),
1159 '743' => array('743', 'Entity’s credential/enrollment information.', '', '', ''),
1160 '744' => array('744', 'Services/charges related to the treatment of a hospital-acquired condition or preventable medical error.', '', '', ''),
1161 '745' => array('745', 'Identifier Qualifier Note: At least one other status code is required to identify the specific identifier qualifier in error.', '', '', ''),
1162 '746' => array('746', 'Duplicate Submission Note: use only at the information receiver level in the Health Care Claim Acknowledgement transaction.', '', '', ''),
1163 '747' => array('747', 'Hospice Employee Indicator', '', '', ''),
1164 '748' => array('748', 'Corrected Data Note: Requires a second status code to identify the corrected data.', '', '', ''),
1165 '749' => array('749', 'Date of Injury/Illness', '', '', ''),
1166 '750' => array('750', 'Auto Accident State or Province Code', '', '', ''),
1167 '751' => array('751', 'Ambulance Pick-up State or Province Code', '', '', ''),
1168 '752' => array('752', 'Ambulance Drop-off State or Province Code', '', '', ''),
1169 '753' => array('753', 'Co-pay status code.', '', '', ''),
1170 '754' => array('754', 'Entity Name Suffix.', '', '', ''),
1171 '755' => array('755', 'Entity\'s primary identifier.', '', '', ''),
1172 '756' => array('756', 'Entity\'s Received Date.', '', '', ''),
1173 '757' => array('757', 'Last seen date.', '', '', ''),
1174 '758' => array('758', 'Repriced approved HCPCS code.', '', '', ''),
1175 '759' => array('759', 'Round trip purpose description.', '', '', ''),
1176 '760' => array('760', 'Tooth status code.', '', '', ''),
1177 '761' => array('761', 'Entity\'s referral number.', '', '', '')
1178 );
1179 if (array_key_exists($code, $this->STC_Status_Code)){
1180 return $this->STC_Status_Code[$code];
1181 } else {
1182 return array($code, "Not found in STC Status codes table", "", "", "");
1183 }
1184 }
1185 } // end get_STC_Status_Code
1186
1187 } // end class
1188
1189
1190 ?>
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