library/edihistory/codes/edih_271_code_class.php

   1 <?php
   2 /*
   3  * test_271_codes.php
   4  *
   5  * Copyright 2016 Kevin McCormick <kevin@kt61p>
   6  *
   7  * This program is free software; you can redistribute it and/or modify
   8  * it under the terms of the GNU General Public License as published by
   9  * the Free Software Foundation; either version 2 of the License, or
  10  * (at your option) any later version.
  11  *
  12  * This program is distributed in the hope that it will be useful,
  13  * but WITHOUT ANY WARRANTY; without even the implied warranty of
  14  * MERCHANTABILITY or FITNESS FOR A PARTICULAR PURPOSE.  See the
  15  * GNU General Public License for more details.
  16  *
  17  * You should have received a copy of the GNU General Public License
  18  * along with this program; if not, write to the Free Software
  19  * Foundation, Inc., 51 Franklin Street, Fifth Floor, Boston,
  20  * MA 02110-1301, USA.
  21  *
  22  *
  23  */
  24
  25 class edih_271_codes {
  26 //
  27 //public $code271 = array();
  28 private $code271 = array();
  29 private $ds = '';
  30 private $dr = '';
  31 // the key_match array is a concept of matching code lists to
  32 // segment elements when diferent segments are looking for the same
  33 // code or reference lists
  34 //  -- a very tedious project and immediately put on hold
  35 //public $key_match = array('HCR04'=>array('CRC02');
  36 //
  37 function __construct($component_separator, $repetition_separator) {
  38 //
  39 // echo "class edih_271_codes ds=$component_separator dr=$repetition_separator".PHP_EOL;
  40 //
  41 $this->ds = $component_separator;
  42 $this->dr = $repetition_separator;
  43 //
  44 $this->code271['BHT02'] = array(
  45 '13'=>'Request',
  46 '08'=>'Status',
  47 '06'=>'Confirmation',
  48 '11'=>'Response',
  49 '00'=>'Original',
  50 '18'=>'Reissue',
  51 '01'=>'Cancellation',
  52 '36'=>'Auth (Reply)'
  53 );
  54
  55 // transaction type code
  56 $this->code271['BHT06'] = array(
  57 '18'=>'Response - no further updates',
  58 '19'=>'Response - further updates to follow',
  59 '31'=>'Subrogation Demand',
  60 'AT'=>'Administrative Action',
  61 'CH'=>'Chargeable',
  62 'DG'=>'Response',
  63 'RP'=>'Reporting',
  64 'RT'=>'Spend Down',
  65 'RU'=>'Medical Services Reservation',
  66 'TH'=>'Receipt Acknowledgment'
  67 );
  68
  69 // AAA reject reason code
  70 $this->code271['AAA03'] = array(
  71 '04'=>'Authorized quantity exceeded',
  72 '15'=>'Required application data missing',
  73 '33'=>'Input Errors',
  74 '35'=>'Out of Network',
  75 '41'=>'Authorization/Access restrictions',
  76 '42'=>'Unable to respond at current time.',
  77 '43'=>'Invalid/Missing provider information',
  78 '44'=>'Invalid/Missing provider name',
  79 '45'=>'Invalid/Missing provider speciality',
  80 '46'=>'Invalid/Missing provider phone number',
  81 '47'=>'Invalid/Missing provider state',
  82 '48'=>'Invalid/Missing referring provider identification number',
  83 '49'=>'Provider is not primary care physician',
  84 '50'=>'Provider ineligible for inquiries',
  85 '51'=>'Provider not on file',
  86 '52'=>'Service dates not within provider plan enrollment',
  87 '53'=>'Inquired benefit inconsistent with provider type',
  88 '56'=>'Inappropriate date',
  89 '57'=>'Invalid/Missing dates of service',
  90 '58'=>'Invalid/Missing date of birth',
  91 '60'=>'Date of birth follows date of service',
  92 '61'=>'Date of death preceeds dates of service',
  93 '62'=>'Date of service not within allowable inquiry period',
  94 '63'=>'Date of service in future',
  95 '64'=>'Invalid/Missing patient ID',
  96 '65'=>'Invalid/Missing patient name',
  97 '66'=>'Invalid/Missing patient gender code',
  98 '67'=>'Patient not found',
  99 '69'=>'Inconsistent with patient age.',
 100 '70'=>'Inconsistent with patient gender.',
 101 '71'=>'Patient birth date does not match that for the patient in the database',
 102 '72'=>'Invalid/Missing subscriber/insured ID',
 103 '73'=>'Invalid/Missing subscriber/insured name',
 104 '74'=>'Invalid/Missing subscriber/insured gender code',
 105 '75'=>'Subscriber/Insured not found',
 106 '76'=>'Duplicate Subscriber/Insured ID number',
 107 '77'=>'Subscriber found, patient not found',
 108 '78'=>'Subscriber/Insured not in Group/Plan identified',
 109 '79'=>'Invalid participant identification',
 110 '97'=>'invalid or missing provider address',
 111 'T4'=>'Payer name or identifier missing',
 112 'T5'=>'Certification Information Missing',
 113 '80'=>'No response received by clearinghouse',
 114 '98'=>'Expiremental service or procedure.',
 115 'AA'=>'Authorization number not found.',
 116 'AE'=>'Requires primary care physician authorization.',
 117 'AF'=>'Invalid/Missing diagnosis codes.',
 118 'AG'=>'Invalid/Missing procedure codes.',
 119 'AO'=>'Additional patient condition information required.',
 120 'CI'=>'Certification information does not match patient.',
 121 'E8'=>'Requires medical review.',
 122 'IA'=>'Invalid authorization number format.',
 123 'MA'=>'Missing authorization number.'
 124 );
 125
 126
 127
 128 // follow-up action code
 129 $this->code271['AAA04'] = array(
 130 'C'=>'Please correct and resubmit',
 131 'N'=>'Resubmission not allowed',
 132 'P'=>'Please resubmit original transaction',
 133 'R'=>'Resubmission allowed',
 134 'S'=>'Do not resubmit; Inquiry initiated to a third party',
 135 'W'=>'Please wait 30 days and resubmit',
 136 'X'=>'Please wait 10 days and resubmit',  // 'Y'=>'Do not resubmit; We will hold your request and respond again shortly'
 137 'Y'=>'Do not resubmit; We will respond again shortly'
 138 );
 139
 140 // provider PRV codes
 141 $this->code271['PRV'] = array(
 142 'AD'=>'Admitting',
 143 'AT'=>'Attending',
 144 'BI'=>'Billing',
 145 'CO'=>'Consulting',
 146 'CV'=>'Covering',
 147 'H'=>'Hospital',
 148 'HH'=>'Home Health Care',
 149 'LA'=>'Laboratory',
 150 'OT'=>'Other Physician',
 151 'P1'=>'Pharmacy',
 152 'PC'=>'Primary Care Physician',
 153 'PE'=>'Performing',
 154 'R'=>'Rural Health Clinic',
 155 'RF'=>'Referring',
 156 'SB'=>'Sunmitting',
 157 'SK'=>'Skilled Nursing Facility',
 158 'SU'=>'Supervising'
 159 );
 160
 161
 162 // REF codes
 163 $this->code271['REF'] = array(
 164 "18" => "Plan Number",
 165 "1A" => "Blue Cross Provider Number",
 166 "1B" => "Blue Shield Provider Number",
 167 "1C" => "Medicare Provider Number",
 168 "1D" => "Medicaid Provider Number",
 169 "1G" => "Provider UPIN Number",
 170 "1H" => "CHAMPUS Identification Number",
 171 "1J" => "Facility ID Number",
 172 "1K" => "Payer Control Number",
 173 "1L" => "Group or Policy Number",
 174 "1W" => "Member ID Number",
 175 "1S" => "Ambulatory Patient Group (APG) Number",
 176 "2U" => "Payer Identification Number",
 177 "3H" => "Case Number",
 178 "49" => "Family Unit Number",
 179 "6P" => "Group Number",
 180 "6R" => "Provider Control Number",
 181 "9A" => "Repriced Claim Reference Number",
 182 "9C" => "Adjusted Repriced Claim Reference Number",
 183 "BB" => "Authorization Number",
 184 "BLT" => "Billing Type",
 185 "CE" => "Class of Contract code",
 186 "CT" => "Provider Contract Number",
 187 "D9" => "Clearinghouse ID Number",
 188 "D3" => "Natl Assn Bds of Pharm Number",
 189 "E9" => "Attachment Code",
 190 "EA" => "Medical Record ID Number",
 191 "EI" => "Employer's ID Number",
 192 "EJ" => "Patient Account Number",
 193 "EO" => "Submitter Identification Number",
 194 "EV" => "Receiver Identificaton Number",
 195 "F2" => "Version Identification Qualifier",
 196 "F6" => "Health Ins Claim (HIC) Number",
 197 "F8" => "Original Reference Number",
 198 "FJ" => "Service Item Information",
 199 "G1" => "Prior Authorization Number",
 200 "G2" => "Provider Commercial Number",
 201 "G3" => "Predetermination of Benefits ID Number",
 202 "G5" => "Provider Site Number",
 203 "GH" => "ID Card Serial Number",
 204 "HI" => "Health Industry Number (HIN)",
 205 "HJ" => "Identity Card Number",
 206 "HPI" => "CMMS Natl Provider ID",
 207 "IF" => "Issue Number",
 208 "IG" => "Ins Policy Number",
 209 "LU" => "Location Number",
 210 "N5" => "Provider Plan Network ID Number",
 211 "N6" => "Plan Network ID Number",
 212 "N7" => "Facility Network IID Number",
 213 "NF" => "Natl Assn of Ins Commissn (NAIC) Code",
 214 "NQ" => "Medicaid Recipient ID Number",
 215 "NT" => "Administrator's Reference Number",
 216 "0B" => "State License Number",
 217 "Q4" => "Prior Identifier Number",
 218 "RB" => "Rate Code Number",
 219 "SY" => "Social Security Number",
 220 "TJ" => "Fed Tax ID Number",
 221 "VV" => "Voucher Number",
 222 "XZ" => "Prescription Number",
 223 "Y4" => "Agency Claim Number",
 224 "ZH" => "Carrier Assigned Reference Number"
 225 );
 226
 227
 228 // DTP date qualifiers
 229 $this->code271['DTP'] = array(
 230 'ABC'=>'Estimated Date of Birth',
 231 'AAH'=>'Event',
 232 '007'=>'Effective',
 233 '036'=>'Expiration',
 234 '050'=>'Received',
 235 '096'=>'Discharge',
 236 '102'=>'Issue',
 237 '150'=>'Service period start',
 238 '151'=>'Service period end',
 239 '152'=>'Effective date of change',
 240 '232'=>'Claim stmt period start',
 241 '233'=>'Claim stmt period end',
 242 '291'=>'Plan',
 243 '303'=>'Maintenance effective',
 244 '307'=>'Eligibility',
 245 '318'=>'Added',
 246 '340'=>'COBRA begin',
 247 '341'=>'COBRA end',
 248 '342'=>'Premium paid to date begin',
 249 '343'=>'Premium paid to date end',
 250 '346'=>'Plan begin',
 251 '347'=>'Plan end',
 252 '348'=>'Benefit date',
 253 '349'=>'Benefit end',
 254 '356'=>'Eligibility begin',
 255 '357'=>'Eligibility end',
 256 '382'=>'Enrollment',
 257 '405'=>'Production',
 258 '435'=>'Admission',
 259 '431'=>'Onset of Current Symptoms or Illness',
 260 '439'=>'Accident',
 261 '442'=>'Date of death',
 262 '458'=>'Certification',
 263 '472'=>'Service',
 264 '484'=>'Last Menstrual Period',
 265 '539'=>'Policy effective',
 266 '540'=>'Policy expiration',
 267 '598'=>'Rejected',
 268 '636'=>'Date of last update',
 269 '771'=>'Status',
 270 );
 271
 272
 273 // entity identifier code  --code source 237
 274 // NM101 STC01-3 N101
 275 $this->code271['NM101'] = array(
 276 '03'=>'Dependent',
 277 '13'=>'Contracted Service Provider',
 278 '17'=>'Consultant\'s Office',
 279 '1E'=>'Health Maintenance Organization (HMO)',
 280 '1G'=>'Oncology Center',
 281 '1H'=>'Kidney Dialysis Unit',
 282 '1I'=>'Preferred Provider Organization (PPO)',
 283 '1O'=>'Acute Care Hospital',
 284 '1P'=>'Provider',
 285 '1Q'=>'Military facility',
 286 '1R'=>'University, College, or School',
 287 '1S'=>'Outpatient Surgicenter',
 288 '1T'=>'Physician, Clinic or Group Practice',
 289 '1U'=>'Long Term Care Facility',
 290 '1V'=>'Extended Care Facility',
 291 '1W'=>'Psychiatric Health Facility',
 292 '1X'=>'Laboratory',
 293 '1Y'=>'Retail Pharmacy',
 294 '2A'=>'Federal, State, County or City Facility',
 295 '2B'=>'Third-Party Administrator',
 296 '2I'=>'Church Operated Facility',
 297 '2P'=>'Public Health Service Facility',
 298 '2Q'=>'Veterans Administration Facility',
 299 '4M'=>'Adult Day Care Program Facility',
 300 '4R'=>'Geriatric Clinics',
 301 '5C'=>'Blood Bank',
 302 '5T'=>'X-Ray Radiation Therapy Unit',
 303 '5U'=>'CT Scanner Unit',
 304 '5V'=>'Diagnostic Radioisotope Facility',
 305 '5W'=>'Magnetic Resonance Imaging (MRI) Facility',
 306 '5X'=>'Ultrasound Unit',
 307 '5Y'=>'Rehabilitation Inpatient Unit',
 308 '5Z'=>'Rehabilitation Outpatient Services',
 309 '36'=>'Employer',
 310 '40'=>'Receiver',
 311 '41'=>'Submitter',
 312 '45'=>'Drop-off Location',
 313 '61'=>'Performed At',
 314 '6A'=>'Reproductive Health Services',
 315 '6G'=>'Sports Medicine Clinic/Services',
 316 '6O'=>'Physical Therapy Services',
 317 '6S'=>'Women\'s Health Center/Services',
 318 '6Y'=>'Case Manager',
 319 '70'=>'Prior Incorrect Insured',
 320 '71'=>'Attending Physician',
 321 '72'=>'Operating Physician',
 322 '73'=>'Other Physician',
 323 '74'=>'Corrected Insured',
 324 '75'=>'Participant',
 325 '77'=>'Service Location',
 326 '82'=>'Rendering Provider',
 327 '85'=>'Billing Provider',
 328 '87'=>'Pay-to Provider',
 329 'AAG'=>'Ground Ambulance Services',
 330 'AAJ'=>'Admitting Services',
 331 'AAK'=>'Primary Surgeon',
 332 'AAL'=>'Medical Nurse',
 333 'AAM'=>'Cardiac Rehabilitation Services',
 334 'AAN'=>'Skilled Nursing Services',
 335 'AAO'=>'Observation Room Services',
 336 'AAQ'=>'Anesthesiology Services',
 337 'CA'=>'Carrier',
 338 'DD'=>'Assistant Surgeon',
 339 'DK'=>'Ordering Physician',
 340 'DN'=>'Referring Provider',
 341 'EXS'=>'Ex-spouse',
 342 'FA'=>'Facility',
 343 'FS'=>'Final Scheduled Destination',
 344 'G3'=>'Clinic',
 345 'GB'=>'Other Insured',
 346 'GD'=>'Guardian',
 347 'GG'=>'Intermediary',
 348 'GM'=>'Spouse Insured',
 349 'GP'=>'Gateway Provider',
 350 'GW'=>'Group',
 351 'HF'=>'HPSA Facility',
 352 'HH'=>'Home Health Agency',
 353 'I3'=>'Independent Physicians Association (IPA)',
 354 'IL'=>'Insured or Subscriber',
 355 'IR'=>'Self Insured',
 356 'LR'=>'Legal Representative',
 357 'MSC'=>'Mammography Screening Center',
 358 'NCT'=>'Name Changed To',
 359 'ND'=>'Next Destination',
 360 'NZ'=>'Primary Physician',
 361 'OC'=>'Origin Carrier',
 362 'OO'=>'Alternate Insurer',
 363 'ORI'=>'Original Name',
 364 'P2'=>'Primary Insured or Subscriber',
 365 'P3'=>'Primary Care Provider',
 366 'P4'=>'Prior Insurance Carrier',
 367 'P5'=>'Plan Sponsor',
 368 'PE'=>'Payee',
 369 'PR'=>'Payer',
 370 'PRP'=>'Primary Payer',
 371 'PW'=>'Pickup Address',
 372 'QB'=>'Purchase Service Provider',
 373 'QC'=>'Patient',
 374 'QV'=>'Group Practice',
 375 'R3'=>'Next Scheduled Destination',
 376 'SEP'=>'Secondary Payer',
 377 'SJ'=>'Service Provider',
 378 'TT'=>'Transfer To',
 379 'TTP'=>'Tertiary Payer',
 380 'VER'=>'Party Performing Verification',
 381 'VN'=>'Vendor',
 382 'VY'=>'Organization Completing Configuration Change',
 383 'X3'=>'Utilization Management Organization',
 384 'X4'=>'Spouse',
 385 'Y2'=>'Managed Care Organization'
 386 );
 387
 388
 389 // entity ID type code
 390 // NM108  N101
 391 $this->code271['NM108'] = array(
 392 "AD"=>"BCBS Assoc Plan Code",
 393 "NI"=>"NAIC ID",
 394 "24"=>"Employer ID Number (EIN)",
 395 "34"=>"Social Security No",
 396 "46"=>"Electronic Transmiter ID (ETIN)",
 397 "BD"=>"Blue Cross Provider No",
 398 "BS"=>"Blue Shield Provider No",
 399 "C"=>"Insured's Changed Unique ID",
 400 "PC"=>"Provider Commercial No",
 401 "FI"=>"Federal Taxpayer ID",
 402 "II"=>"Standard Unique Health ID",
 403 "HN"=>"Health Ins Claim No",
 404 "MC"=>"Medicaid Provider No",
 405 "MI"=>"Member ID",
 406 "MR"=>"Medicaid Recipient ID No",
 407 "NI"=>"NAIC Identification",
 408 "PI"=>"Payer ID",
 409 "PP"=>"Pharmacy Processor No",
 410 "UP"=>"UPIN",
 411 "SV"=>"Service Provider Number",
 412 "XV"=>"CMS Plan ID",
 413 "XX"=>"CMS National ID"
 414 );
 415
 416 // entity relationship code
 417 $this->code271['NM110'] = array(
 418 '01'=>'Parent',
 419 '02'=>'Child',
 420 '27'=>'Domestic Partner',
 421 '41'=>'Spouse',
 422 '48'=>'Employee',
 423 '65'=>'Other',
 424 '72'=>'Unknown'
 425 );
 426
 427 //      contact number identifier
 428 $this->code271['PER03'] = array(
 429 'ED'=>'EDI Access Number',
 430 'EM'=>'Electronic Mail',
 431 'EX'=>'Telephone Extension',
 432 'FX'=>'Facsimile',
 433 'TE'=>'Telephone',
 434 'UR'=>'URL'
 435 );
 436
 437 //      contact type identifier
 438 $this->code271['PER01'] = array(
 439 'CX'=>'Cliams Office',
 440 'BL'=>'Technical Dept',
 441 'IC'=>'Information Contact',
 442 );
 443
 444 // MPI  qualifiers Military Service
 445 // the MPI03 Service affiliation qualifiers have 'SB' prepended
 446 $this->code271['MPI'] = array(
 447 'A'=>'Partial',
 448 'C'=>'Current',
 449 'L'=>'Latest',
 450 'O'=>'Oldest',
 451 'P'=>'Prior',
 452 'S'=>'Second most current',
 453 'T'=>'Third most current',
 454 'AE'=>'Active reserve',
 455 'AO'=>'Active military-overseas',
 456 'AS'=>'Academy student',
 457 'AT'=>'Presidential appointee',
 458 'CC'=>'Contractor',
 459 'DD'=>'Dishonorably discharges',
 460 'HD'=>'Honorably discharges',
 461 'IR'=>'Inactive reserve',
 462 'LX'=>'Leave of absence: military',
 463 'PE'=>'Plan to enlist',
 464 'RE'=>'REcommissioned',
 465 'RM'=>'Retired military-overseas',
 466 'RR'=>'Retired without recall',
 467 'RU'=>'REtired military-USA',
 468 'SBA'=>'Air Force',
 469 'SBB'=>'Air Force Reserves',
 470 'SBC'=>'Army',
 471 'SBD'=>'Army Reserves',
 472 'SBE'=>'Coast Guard',
 473 'SBF'=>'Marine Corps',
 474 'SBG'=>'Marine Corps Reserves',
 475 'SBH'=>'National Guard',
 476 'SBI'=>'Navy',
 477 'SBJ'=>'Navy Reserves',
 478 'SBK'=>'Other',
 479 'SBL'=>'Peace Corp',
 480 'SBM'=>'Regular Armed Forces',
 481 'SBN'=>'Reserves',
 482 'SBO'=>'U.S. Public Health Service',
 483 'SBQ'=>'Foreign Military',
 484 'SBR'=>'American Red Cross',
 485 'SBS'=>'Department of Defvense',
 486 'SBU'=>'Unites Services Organization',
 487 'SBW'=>'Military Sealift Command',
 488 'A1'=>'Admiral',
 489 'A2'=>'Airman',
 490 'A3'=>'Airman First Class',
 491 'B1'=>'Basic Airman',
 492 'B2'=>'Brigadier General',
 493 'C1'=>'Captain',
 494 'C2'=>'Chief Master Sergeant',
 495 'C3'=>'Chief Petty Officer',
 496 'C4'=>'Chief Warrant',
 497 'C5'=>'Colonel',
 498 'C6'=>'Commander',
 499 'C7'=>'Commodore',
 500 'C8'=>'Corporal',
 501 'C9'=>'Corporal Specialist 4',
 502 'E1'=>'Ensign',
 503 'F1'=>'First Lieutenant',
 504 'F2'=>'First Sergeant',
 505 'F3'=>'First Sergeant-Master Sergeant',
 506 'F4'=>'Fleet Admiral',
 507 'G1'=>'General',
 508 'G4'=>'Gunnery Sergeant',
 509 'L1'=>'Lance Corporal',
 510 'L2'=>'Lieutenant',
 511 'L3'=>'Lieutenant Colonel',
 512 'L4'=>'Lieutenant Commander',
 513 'L5'=>'Lieutenant General',
 514 'L6'=>'Lieutenant Junior Grade',
 515 'M1'=>'Major',
 516 'M2'=>'Major General',
 517 'M3'=>'Master Chief Petty Officer',
 518 'M4'=>'Master Gunnery Sergeant Major',
 519 'M5'=>'Master Sergeant',
 520 'M6'=>'Master Sergeant Specialist 8',
 521 'P1'=>'Petty Officer First Class',
 522 'P2'=>'Petty Officer Second Class',
 523 'P3'=>'Petty Officer Third Class',
 524 'P4'=>'Private',
 525 'P5'=>'Private First Class',
 526 'R1'=>'Rear Admiral',
 527 'R2'=>'Recruit',
 528 'S1'=>'Seaman',
 529 'S2'=>'Seaman Apprentice',
 530 'S3'=>'Seaman Recruit',
 531 'S4'=>'Second Lieutenant',
 532 'S5'=>'Senior Chief Petty Officer',
 533 'S6'=>'Senior Master Sergeant',
 534 'S7'=>'Sergeant',
 535 'S8'=>'Sergeant First Class Specialist 7',
 536 'S9'=>'Sergeant Major Specialist 9',
 537 'SA'=>'Sergeant Specialist 5',
 538 'SB'=>'Staff Sergeant',
 539 'SC'=>'Staff Sergeant Specialist 6',
 540 'T1'=>'Technical Sergeant',
 541 'V1'=>'Vice Admiral',
 542 'W1'=>'Warrant Officer'
 543 );
 544
 545 // eligibility or benifit information code
 546 $this->code271['EB01'] = array(
 547 '1'=>'Active Coverage',
 548 '2'=>'Active-Full Risk Capitation',
 549 '3'=>'Active-Services Capitated',                       //      '4'=>'Active - Services Capitated to Primary Care Physician',
 550 '4'=>'Active-Capitated to PCP',
 551 '5'=>'Active-Pending Investigation',
 552 '6'=>'Inactive',                                                        //      '7'=>'Inactive - Pending Eligibility Update',
 553 '7'=>'Inactive-Pending Elig Update',
 554 '8'=>'Inactive-Pending Investigation',
 555 'A'=>'Co-Insurance',
 556 'B'=>'Co-Payment',
 557 'C'=>'Deductible',
 558 'D'=>'Benefit Description',
 559 'E'=>'Exclusions',
 560 'F'=>'Limitations',
 561 'G'=>'Out of Pocket (Stop Loss)',
 562 'H'=>'Unlimited',
 563 'I'=>'Non-Covered',
 564 'J'=>'Cost Containment',
 565 'K'=>'Reserve',
 566 'L'=>'Primary Care Provider',
 567 'M'=>'Pre-existing Condition',
 568 'N'=>'Services Restricted to Following Provider',
 569 'O'=>'Not Deemed a Medical Necessity',
 570 'P'=>'Benefit Disclaimer',
 571 'Q'=>'Second Surgical Opinion Required',
 572 'R'=>'Other or Additional Payer',
 573 'S'=>'Prior Year(s) History',
 574 'T'=>'Card(s) Reported Lost/Stolen',            //      'U'=>'Contact Following Entity for Eligibility or Benefit Information',
 575 'U'=>'Contact Entity for Information',
 576 'V'=>'Cannot Process',
 577 'W'=>'Other Source of Data',
 578 'X'=>'Health Care Facility',
 579 'Y'=>'Spend Down',
 580 'CB'=>'Coverage Basis',
 581 'MC'=>'Managed Care Coordinator'
 582 );
 583
 584 // coverage level code
 585 $this->code271['EB02'] = array(
 586 'CHD'=>'Children Only',
 587 'DEP'=>'Dependents Only',
 588 'E1D'=>'Employee and One Dependent',
 589 'E2D'=>'Employee and Two Dependents',
 590 'E3D'=>'Employee and Three Dependents',
 591 'E5D'=>'Employee and One or More Dependents',
 592 'E6D'=>'Employee and Two or More Dependents',
 593 'E7D'=>'Employee and Three or More Dependents',
 594 'E8D'=>'Employee and Four or More Dependents',
 595 'E9D'=>'Employee and Five or More Dependents',
 596 'ECH'=>'Employee and Children',
 597 'EMP'=>'Employee Only',
 598 'ESP'=>'Employee and Spouse',
 599 'FAM'=>'Family',
 600 'IND'=>'Individual',
 601 'SPC'=>'Spouse and Children',
 602 'SPO'=>'Spouse Only',
 603 'TWO'=>'Two Party'
 604 );
 605
 606 // Health Care Services Type Codes
 607 // ASC X12 External Code Source 958  LAST UPDATED 3/1/2016
 608 $this->code271['EB03'] = array(
 609 "1" => "Medical Care",
 610 "2" => "Surgical",
 611 "3" => "Consultation",
 612 "4" => "Diagnostic X-Ray",
 613 "5" => "Diagnostic Lab",
 614 "6" => "Radiation Therapy",
 615 "7" => "Anesthesia",
 616 "8" => "Surgical Assistance",
 617 "10" => "Blood",
 618 "11" => "Durable Medical Equipment Used",
 619 "12" => "Durable Medical Equipment Purchased",
 620 "14" => "Renal Supplies",
 621 "17" => "Pre-Admission Testing",
 622 "18" => "Durable Medical Equipment Rental",
 623 "19" => "Pneumonia Vaccine",
 624 "20" => "Second Surgical Opinion",
 625 "21" => "Third Surgical Opinion",
 626 "22" => "Social Work",
 627 "23" => "Diagnostic Dental",
 628 "24" => "Periodontics",
 629 "25" => "Restorative",
 630 "26" => "Endodontics",
 631 "27" => "Maxillofacial Prosthetics",
 632 "28" => "Adjunctive Dental Services",
 633 "30" => "Health Benefit Plan Coverage",
 634 "32" => "Plan Waiting Period",
 635 "33" => "Chiropractic",
 636 "34" => "Chiropractic Modality",
 637 "35" => "Dental Care",
 638 "36" => "Dental Crowns",
 639 "37" => "Dental Accident",
 640 "38" => "Orthodontics",
 641 "39" => "Prosthodontics",
 642 "40" => "Oral Surgery",
 643 "41" => "Preventive Dental",
 644 "42" => "Home Health Care",
 645 "43" => "Home Health Prescriptions",
 646 "45" => "Hospice",
 647 "46" => "Respite Care",
 648 "47" => "Hospitalization",
 649 "49" => "Hospital - Room and Board",
 650 "54" => "Long Term Care",
 651 "55" => "Major Medical",
 652 "56" => "Medically Related Transportation",
 653 "60" => "General Benefits",
 654 "61" => "In-vitro Fertilization",
 655 "62" => "MRI Scan",
 656 "63" => "Donor Procedures",
 657 "64" => "Acupuncture",
 658 "65" => "Newborn Care",
 659 "66" => "Pathology",
 660 "67" => "Smoking Cessation",
 661 "68" => "Well Baby Care",
 662 "69" => "Maternity",
 663 "70" => "Transplants",
 664 "71" => "Audiology",
 665 "72" => "Inhalation Therapy",
 666 "73" => "Diagnostic Medical",
 667 "74" => "Private Duty Nursing",
 668 "75" => "Prosthetic Device",
 669 "76" => "Dialysis",
 670 "77" => "Otology",
 671 "78" => "Chemotherapy",
 672 "79" => "Allergy Testing",
 673 "80" => "Immunizations",
 674 "81" => "Routine Physical",
 675 "82" => "Family Planning",
 676 "83" => "Infertility",
 677 "84" => "Abortion",
 678 "85" => "HIV - AIDS Treatment",
 679 "86" => "Emergency Services",
 680 "87" => "Cancer Treatment",
 681 "88" => "Pharmacy",
 682 "89" => "Free Standing Prescription Drug",
 683 "90" => "Mail Order Prescription Drug",
 684 "91" => "Brand Name Prescription Drug",
 685 "92" => "Generic Prescription Drug",
 686 "93" => "Podiatry",
 687 "A4" => "Psychiatric",
 688 "A6" => "Psychotherapy",
 689 "A7" => "Psychiatric - Inpatient",
 690 "A8" => "Psychiatric - Outpatient",
 691 "A9" => "Rehabilitation",
 692 "AB" => "Rehabilitation - Inpatient",
 693 "AC" => "Rehabilitation - Outpatient",
 694 "AD" => "Occupational Therapy",
 695 "AE" => "Physical Medicine",
 696 "AF" => "Speech Therapy",
 697 "AG" => "Skilled Nursing Care",
 698 "AI" => "Substance Abuse",
 699 "AJ" => "Alcoholism Treatment",
 700 "AK" => "Drug Addiction",
 701 "AL" => "Optometry",
 702 "AM" => "Frames",
 703 "AO" => "Lenses",
 704 "AP" => "Routine Eye Exam",
 705 "AQ" => "Nonmedically Necessary Physical (e.g., insurance app, pilot license, employment or school)",
 706 "AR" => "Experimental Drug Therapy",
 707 "B1" => "Burn Care",
 708 "B2" => "Brand Name Prescription Drug - Formulary",
 709 "B3" => "Brand Name Prescription Drug - Non-Formulary",
 710 "BA" => "Independent Medical Evaluation",
 711 "BB" => "Psychiatric Treatment Partial Hospitalization",
 712 "BC" => "Day Care (Psychiatric)",
 713 "BD" => "Cognitive Therapy",
 714 "BE" => "Massage Therapy",
 715 "BF" => "Pulmonary Rehabilitation",
 716 "BG" => "Cardiac Rehabilitation",
 717 "BH" => "Pediatric",
 718 "BI" => "Nursery Room and Board",
 719 "BK" => "Orthopedic",
 720 "BL" => "Cardiac",
 721 "BM" => "Lymphatic",
 722 "BN" => "Gastrointestinal",
 723 "BP" => "Endocrine",
 724 "BQ" => "Neurology",
 725 "BT" => "Gynecological",
 726 "BU" => "Obstetrical",
 727 "BV" => "Obstetrical/Gynecological",
 728 "BW" => "Mail Order Prescription Drug: Brand Name",
 729 "BX" => "Mail Order Prescription Drug: Generic",
 730 "BY" => "Physician Visit - Sick",
 731 "BZ" => "Physician Visit - Well",
 732 "C1" => "Coronary Care",
 733 "CK" => "Screening X-ray",
 734 "CL" => "Screening laboratory",
 735 "CM" => "Mammogram, High Risk Patient",
 736 "CN" => "Mammogram, Low Risk Patient",
 737 "CO" => "Flu Vaccination",
 738 "CP" => "Eyewear Accessories",
 739 "CQ" => "Case Management",
 740 "DG" => "Dermatology",
 741 "DM" => "Durable Medical Equipment",
 742 "DS" => "Diabetic Supplies",
 743 "E0" => "Allied Behavioral Analysis Therapy",
 744 "E1" => "Non-Medical Equipment (non DME)",
 745 "E2" => "Psychiatric Emergency",
 746 "E3" => "Step Down Unit",
 747 "E4" => "Skilled Nursing Facility Head Level of Care",
 748 "E5" => "Skilled Nursing Facility Ventilator Level of Care",
 749 "E6" => "Level of Care 1",
 750 "E7" => "Level of Care 2",
 751 "E8" => "Level of Care 3",
 752 "E9" => "Level of Care 4",
 753 "E10" => "Radiographs",
 754 "E11" => "Diagnostic Imaging",
 755 "E12" => "Basic Restorative - Dental",
 756 "E13" => "Major Restorative - Dental",
 757 "E14" => "Fixed Prosthodontics",
 758 "E15" => "Removable Prosthodontics",
 759 "E16" => "Intraoral Images - Complete Series",
 760 "E17" => "Oral Evaluation",
 761 "E18" => "Dental Prophylaxis",
 762 "E19" => "Panoramic Images",
 763 "E20" => "Sealants",
 764 "E21" => "Flouride Treatments",
 765 "E22" => "Dental Implants",
 766 "E23" => "Temporomandibular Joint Dysfunction",
 767 "E24" => "Retail Pharmacy Prescription Drug",
 768 "E25" => "Long Term Care Pharmacy",
 769 "E26" => "Comprehensive Medication Therapy Management Review",
 770 "E27" => "Targeted Medication Therapy Management Review",
 771 "E28" => "Dietary/Nutritional Services",
 772 "E29" => "Technical Cardiac Rehabilitation Services Component",
 773 "E30" => "Professional Cardiac Rehabilitation Services Component",
 774 "E31" => "Professional Intensive Cardiac Rehabilitation Services Component",
 775 "E32" => "Intensive Cardiac Rehabilitation - Technical Component",
 776 "E33" => "Intensive Cardiac Rehabilitation",
 777 "E34" => "Pulmonary Rehabilitation - Technical Component",
 778 "E35" => "Pulmonary Rehabilitation - Professional Component",
 779 "E36" => "Convenience Care",
 780 "E37" => "Telemedicine",
 781 "E38" => "Pharmacist Services",
 782 "E39" => "Diabetic Education",
 783 "EA" => "Preventive Services",
 784 "EB" => "Specialty Pharmacy",
 785 "EC" => "Durable Medical Equipment New",
 786 "ED" => "CAT Scan",
 787 "EE" => "Ophthalmology",
 788 "EF" => "Contact Lenses",
 789 "F1" => "Medical Coverage",
 790 "F2" => "Social Work Coverage",
 791 "F3" => "Dental Coverage",
 792 "F4" => "Hearing Coverage",
 793 "F5" => "Prescription Drug Coverage",
 794 "F6" => "Vision Coverage",
 795 "F7" => "Orthodontia Coverage",
 796 "F8" => "Mental Health Coverage",
 797 "GF" => "Generic Prescription Drug - Formulary",
 798 "GN" => "Generic Prescription Drug - Non-Formulary",
 799 "GY" => "Allergy",
 800 "IC" => "Intensive Care",
 801 "MH" => "Mental Health",
 802 "NI" => "Neonatal Intensive Care",
 803 "ON" => "Oncology",
 804 "PE" => "Positron Emission Tomography (PET) Scan",
 805 "PT" => "Physical Therapy",
 806 "PU" => "Pulmonary",
 807 "RN" => "Renal",
 808 "RT" => "Residential Psychiatric Treatment",
 809 "SMH" => "Serious Mental Health",
 810 "TC" => "Transitional Care",
 811 "TN" => "Transitional Nursery Care",
 812 "UC" => "Urgent Care"
 813 );
 814
 815 // insurance type codes
 816 $this->code271['EB04'] = array(
 817 'D'=>'Disability',
 818 //'12'=>'Medicare Secondary Working Aged Beneficiary or Spouse with Employer Group Health Plan',
 819 //'13'=>'Medicare Secondary End-Stage Renal Disease Beneficiary in the 12 month coordination period with an employer\'s group health plan',
 820 //'14'=>'Medicare Secondary, No-fault Insurance including Auto is Primary',
 821 //'15'=>'Medicare Secondary Worker\'s Compensation',
 822 //'16'=>'Medicare Secondary Public Health Service (PHS)or Other Federal Agency',
 823 //'41'=>'Medicare Secondary Black Lung',
 824 //'42'=>'Medicare Secondary Veteran\'s Administration',
 825 //'43'=>'Medicare Secondary Disabled Beneficiary Under Age 65 with Large Group Health Plan (LGHP)',
 826 //'47'=>'Medicare Secondary, Other Liability Insurance is Primary',
 827 '12'=>'Medicare Secondary',
 828 '13'=>'Medicare Secondary (ESRD)',
 829 '14'=>'Medicare Secondary (No-fault Primary)',
 830 '15'=>'Medicare Secondary (WC)',
 831 '16'=>'Medicare Secondary (PHS)',
 832 '41'=>'Medicare Secondary (Black Lung)',
 833 '42'=>'Medicare Secondary (VA)',
 834 '43'=>'Medicare Secondary (LGHP)',
 835 '47'=>'Medicare Secondary, Liability Ins Primary',
 836 'AP'=>'Auto Insurance Policy',
 837 'C1'=>'Commercial',                             // 'CO'=>'Consolidated Omnibus Budget Reconciliation Act (COBRA)',
 838 'CO'=>'(COBRA)',
 839 'CP'=>'Medicare Conditionally Primary',
 840 'DB'=>'Disability Benefits',
 841 'EP'=>'Exclusive Provider Organization',
 842 'FF'=>'Family or Friends',
 843 'GP'=>'Group Policy',                   //'HM'=>'Health Maintenance Organization (HMO)',
 844 'HM'=>'(HMO)',                                  //'HN'=>'Health Maintenance Organization (HMO) - Medicare Risk',
 845 'HN'=>'(HMO)-Medicare Risk',    //'HS'=>'Special Low Income Medicare Beneficiary',
 846 'HS'=>'Special Low Income Medicare',
 847 'IN'=>'Indemnity',
 848 'IP'=>'Individual Policy',
 849 'LC'=>'Long Term Care',
 850 'LD'=>'Long Term Policy',
 851 'LI'=>'Life Insurance',
 852 'LT'=>'Litigation',
 853 'MA'=>'Medicare Part A',
 854 'MB'=>'Medicare Part B',
 855 'MC'=>'Medicaid',
 856 'MH'=>'Medigap Part A',
 857 'MI'=>'Medigap Part B',
 858 'MP'=>'Medicare Primary',
 859 'OT'=>'Other',                                  //'PE'=>'Property Insurance - Personal',
 860 'PE'=>'Property Ins-Personal',
 861 'PL'=>'Personal',                               //'PP'=>'Personal Payment (Cash - No Insurance)',
 862 'PP'=>'Cash (No Ins)',                  //'PR'=>'Preferred Provider Organization (PPO)',
 863 'PR'=>'(PPO)',
 864 'PS'=>'Point of Service (POS)',
 865 'QM'=>'Qualified Medicare Beneficiary',
 866 'RP'=>'Property Insurance-Real',
 867 'SP'=>'Supplemental Policy',    //'TF'=>'Tax Equity Fiscal Responsibility Act (TEFRA)',
 868 'TF'=>'(TEFRA)',
 869 'WC'=>'Workers Compensation',
 870 'WU'=>'Wrap Up Policy'
 871 );
 872
 873 // time period qualifier
 874 $this->code271['EB06'] = array(
 875 '1'=>'Month',
 876 '2'=>'Year',
 877 '6'=>'Hour',
 878 '7'=>'Day',
 879 '21'=>'Years',
 880 '22'=>'Service Year',
 881 '23'=>'Calendar Year',
 882 '24'=>'Year to Date',
 883 '25'=>'Contract',
 884 '26'=>'Episode',
 885 '27'=>'Visit',
 886 '28'=>'Outlier',
 887 '29'=>'Remaining',
 888 '30'=>'Exceeded',
 889 '31'=>'Not Exceeded',
 890 '33'=>'Lifetime Remaining',
 891 '34'=>'Month',
 892 '35'=>'Week',
 893 '36'=>'Admission',                      //'A'=>'Hourly Appurtenance Units (Hours of Enhancement/Addition to Equipment)',
 894 'A'=>'Hourly Appurtenance Units',
 895 'D'=>'Daily Time Units',
 896 'H'=>'Hourly Time Units',
 897 'O'=>'Other Time Units'
 898 );
 899
 900 // quantity type qualifier
 901 $this->code271['EB09'] = array(
 902 '8H'=>'Minimum',
 903 '99'=>'Quantity Used',
 904 'CA'=>'Covered-Actual',
 905 'CE'=>'Covered-Estimated',
 906 'D3'=>'Number of Co-insurance Days',
 907 'DB'=>'Deductible Blood Units',
 908 'DY'=>'Days',
 909 'HS'=>'Hours',
 910 'LA'=>'Life-time Reserve-Actual',
 911 'LE'=>'Life-time Reserve-Estimated',
 912 'M2'=>'Maximum',
 913 'MN'=>'Month',
 914 'P6'=>'Number of Services or Procedures',
 915 'QA'=>'Quantity Approved',
 916 'S7'=>'Age, High Value',
 917 'S8'=>'Age, Low Value',
 918 'VS'=>'Visits',
 919 'YY'=>'Years'
 920 );
 921
 922 // authorization required code
 923 $this->code271['EB11'] = array(
 924 'N'=>'Pre-Auth: No',
 925 'U'=>'Pre-Auth: Unknown',
 926 'Y'=>'Pre-Auth: Yes'
 927 );
 928
 929 // in-network status
 930 $this->code271['EB12'] = array(
 931 'N'=>'In Network: No',
 932 'U'=>'In Network: Unknown',
 933 'W'=>'In Network: N/A',
 934 'Y'=>'In Network: Yes'
 935 );
 936
 937 // product/service id qualifier
 938 $this->code271['EB13'] = array(
 939 'AD'=>'Am Dental Assoc Codes',
 940 'ER'=>'Jurisdiction Specific',
 941 'CJ'=>'CPT Codes',
 942 'HC'=>'HCPCS Codes',
 943 'HP'=>'HIPPS SNF Rate Code',
 944 'ID'=>'ICD-9-CM-Procedure',
 945 'IV'=>'(HIEC) Product/Service Code',
 946 'N4'=>'Natl Drug Code 5-4-2 Fmt',
 947 'N6'=>'Natl Health Related Item Code in 4-6 Fmt',
 948 'NU'=>'Natl Uniform Billing Committee (NUBC) UB92',
 949 'UI'=>'U.P.C. Consumer Pkg Code (1-5-5)',
 950 'WK'=>'Advanced Billing Concepts (ABC) Codes',
 951 'ZZ'=>'Mutually Defined'
 952 );
 953
 954 // quantity qualifier - unit or basis copde
 955 $this->code271['HSD01'] = array(
 956 'DY'=>'Days',
 957 'FL'=>'Units',
 958 'HS'=>'Hours',
 959 'MN'=>'Month',
 960 'VS'=>'Visit',
 961 'DA'=>'Days',
 962 'MO'=>'Months',
 963 'WK'=>'Week',
 964 'YR'=>'Years'
 965 );
 966
 967 // delivery frequency code
 968 $this->code271['HSD07'] = array(
 969 '1'=>'1st Week of Month',
 970 '2'=>'2nd Week of Month',
 971 '3'=>'3rd Week of Month',
 972 '4'=>'4th Week of Month',
 973 '5'=>'5th Week of Month',
 974 '6'=>'1st & 3rd Weeks of Month',
 975 '7'=>'2nd & 4th Weeks of Month',
 976 '8'=>'1st Working Day of Period',
 977 '9'=>'Last Working Day of Period',
 978 'A'=>'Mon through Fri',
 979 'B'=>'Mon through Sat',
 980 'C'=>'Mon through Sun',
 981 'D'=>'Monday',
 982 'E'=>'Tuesday',
 983 'F'=>'Wednesday',
 984 'G'=>'Thursday',
 985 'H'=>'Friday',
 986 'J'=>'Saturday',
 987 'K'=>'Sunday',
 988 'L'=>'Mon through Thur',
 989 'M'=>'Immediately',
 990 'N'=>'As Directed',
 991 'O'=>'Daily Mon. through Fri.',
 992 'P'=>'1/2 Mon & 1/2 Thurs',
 993 'Q'=>'1/2 Tue & 1/2 Thur',
 994 'R'=>'1/2 Wed & 1/2 Fri',
 995 'S'=>'Once Anytime Mon through Fri',
 996 'T'=>'1/2 Tue & 1/2 Fri',
 997 'U'=>'1/2 Mon. & 1/2 Wed',
 998 'V'=>'1/3 Mon, 1/3 Wed, 1/3 Fri',
 999 'W'=>'When Necessary',
1000 'X'=>'1/2 By Wed, Bal. By Fri',
1001 'Y'=>'None/Cancel/Override',
1002 'Z'=>'Mutually Defined',
1003 'SA'=>'Sun, Mon, Thur, Fri, Sat',
1004 'SB'=>'Tue through Sat',
1005 'SC'=>'Sun, Wed, Thur, Fri, Sat',
1006 'SD'=>'Mon, Wed, Thur, Fri, Sat',
1007 'SG'=>'Tue through Fri',
1008 'SL'=>'Mon, Tue and Thur',
1009 'SP'=>'Mon, Tue and Fri',
1010 'SX'=>'Wed and Thur',
1011 'SY'=>'Mon, Wed and Thur',
1012 'SZ'=>'Tue, Thur and Fri',
1013 );
1014
1015 // Ship/Delivery Pattern Time Code
1016 $this->code271['HSD08'] = array(
1017 'A'=>'1st Shift (9-5)',
1018 'B'=>'2nd Shift',
1019 'C'=>'3rd Shift',
1020 'D'=>'A.M.',
1021 'E'=>'P.M.',
1022 'F'=>'As Directed',
1023 'G'=>'Any Shift',
1024 'Y'=>'None/Cancel/Override',
1025 'Z'=>'Mutually Defined'
1026 );
1027
1028 // Nature of Injury Codes
1029 $this->code271['IIIGR'] = array(
1030 '1'=>' No Physical Injury',
1031 '01'=>' No Physical Injury',
1032 '2'=>' Amputation',
1033 '02'=>' Amputation',
1034 '3'=>' Angina Pectoris',
1035 '03'=>' Angina Pectoris',
1036 '4'=>' Burn',
1037 '04'=>' Burn',
1038 '7'=>' Concussion',
1039 '07'=>' Concussion',
1040 '10'=>' Contusion',
1041 '13'=>' Crushing',
1042 '16'=>' Dislocation',
1043 '19'=>' Electric Shock',
1044 '22'=>' Enucleation',
1045 '25'=>' Foreign Body',
1046 '28'=>' Fracture',
1047 '30'=>' Freezing',
1048 '31'=>' Hearing Loss or Impairment',
1049 '32'=>' Heat Prostration',
1050 '34'=>' Hernia',
1051 '36'=>' Infection',
1052 '37'=>' Inflammation',
1053 '40'=>' Laceration',
1054 '41'=>' Myocardial Infarction',
1055 '42'=>' Poisoning-General',
1056 '43'=>' Puncture',
1057 '46'=>' Rupture',
1058 '47'=>' Severance',
1059 '49'=>' Sprain or Tear',
1060 '52'=>' Strain or Tear',
1061 '53'=>' Syncope',
1062 '54'=>' Asphyxiation',
1063 '55'=>' Vascular',
1064 '58'=>' Vision Loss',
1065 '59'=>' All Other Specific Injuries, NOC',
1066 '60'=>' Dust Disease, NOC',
1067 '61'=>' Asbestosis',
1068 '62'=>' Black Lung',
1069 '63'=>' Byssinosis',
1070 '64'=>' Silicosis',
1071 '65'=>' Respiratory Disorders',
1072 '66'=>' Poisoning-Chemical, (Other Than Metals)',
1073 '67'=>' Poisoning-Metal',
1074 '68'=>' Dermatitis',
1075 '69'=>' Mental Disorder',
1076 '70'=>' Radiation',
1077 '71'=>' All Other Occupational Disease Injury, NOC',
1078 '72'=>' Loss of Hearing',
1079 '73'=>' Contagious Disease',
1080 '74'=>' Cancer',
1081 '75'=>' AIDS',
1082 '76'=>' VDT-Related Diseases',
1083 '77'=>' Mental Stress',
1084 '78'=>' Carpal Tunnel Syndrome',
1085 '79'=>' Hepatitis C',
1086 '80'=>' All Other Cumulative Injury, NOC',
1087 '90'=>' Multiple Physical Injuries Only',
1088 '91'=>' Multiple Injuries Including Both Physical & Psychological'
1089 );
1090
1091
1092 // place of service  --code source 237
1093 $this->code271['POS'] = array(
1094 '01'=>'Pharmacy',
1095 '02'=>'Unassigned',
1096 '03'=>'School',
1097 '04'=>'Homeless Shelter',
1098 '05'=>'Indian Health Service Free-standing Facility',
1099 '06'=>'Indian Health Service Provider-based Facility',
1100 '07'=>'Tribal 638 Free-standing Facility',
1101 '08'=>'Tribal 638 Provider-based Facility',
1102 '09'=>'Prison/Correctional Facility',
1103 '11'=>'Office',
1104 '12'=>'Home ',
1105 '13'=>'Assisted Living Facility',
1106 '14'=>'Group Home',
1107 '15'=>'Mobile Unit',
1108 '16'=>'Temporary Lodging',
1109 '17'=>'Walk-in Retail Health Clinic',
1110 '20'=>'Urgent Care Facility',
1111 '21'=>'Inpatient Hospital',
1112 '22'=>'Outpatient Hospital',
1113 '23'=>'Emergency Room-Hospital',
1114 '24'=>'Ambulatory Surgical Center',
1115 '25'=>'Birthing Center',
1116 '26'=>'Military Treatment Facility',
1117 '31'=>'Skilled Nursing Facility',
1118 '32'=>'Nursing Facility',
1119 '33'=>'Custodial Care Facility',
1120 '34'=>'Hospice',
1121 '41'=>'Ambulance-Land',
1122 '42'=>'Ambulance-Air or Water',
1123 '49'=>'Independent Clinic',
1124 '50'=>'Federally Qualified Health Center',
1125 '51'=>'Inpatient Psychiatric Facility',
1126 '52'=>'Psychiatric Facility-Partial Hospitalization',
1127 '53'=>'Community Mental Health Center',
1128 '54'=>'Intermediate Care Facility/Mentally Retarded',
1129 '55'=>'Residential Substance Abuse Treatment Facility',
1130 '56'=>'Psychiatric Residential Treatment Center',
1131 '57'=>'Non-residential Substance Abuse Treatment Facility',
1132 '60'=>'Mass Immunization Center',
1133 '61'=>'Comprehensive Inpatient Rehabilitation Facility',
1134 '62'=>'Comprehensive Outpatient Rehabilitation Facility',
1135 '71'=>'Public Health Clinic',
1136 '72'=>'Rural Health Clinic',
1137 '81'=>'Independent Laboratory',
1138 '99'=>'Other Place of Service'
1139 );
1140
1141 // insurance relationship code
1142 $this->code271['INS02'] = array(
1143 '18'=>'self',
1144 '01'=>'spouse',
1145 '19'=>'child',
1146 '20'=>'employee',
1147 '21'=>'unknown',
1148 '39'=>'Organ Donor',
1149 '40'=>'Cadaver Donor',
1150 '53'=>'Life Partner',
1151 'G8'=>'Other Relationship'
1152 );
1153
1154 // 278 authorization Health Care Services Review
1155 $this->code271['UM01'] = array(
1156 'AR'=>'Admission review',
1157 'HS'=>'Health Services Review',
1158 'IN'=>'Individual',
1159 'SC'=>'Specialty Care review'
1160 );
1161
1162 $this->code271['UM02'] = array(
1163 '1'=>'Appeal--Immediate',
1164 '2'=>'Appeal--Standard',
1165 '3'=>'Cancel',
1166 '4'=>'Extension',
1167 'I'=>'Initial',
1168 'N'=>'Reconsideration',
1169 'R'=>'Renewal',
1170 'S'=>'Revised'
1171 );
1172
1173 // related causes code
1174 $this->code271['UM05'] = array(
1175 'AA'=>'Auto Accident',
1176 'AP'=>'Another Party responsible',
1177 'EM'=>'Employment'
1178 );
1179
1180 // level of service code
1181 $this->code271['UM06'] = array(
1182 '03'=>'Emergency',
1183 'E'=>'Elective',
1184 'U'=>'Urgent'
1185 );
1186
1187 // current patient condition code
1188 $this->code271['UM07'] = array(
1189 '1'=>'Acute',
1190 '2'=>'Stable',
1191 '3'=>'Chronic',
1192 '4'=>'Systemic',
1193 '5'=>'Localized',
1194 '6'=>'Mild Disease',
1195 '7'=>'Normal, Healthy',
1196 '8'=>'Severe Systemic Disease',
1197 '9'=>'Severe Systemic Disease Constant Threat to Life',
1198 'E'=>'Excellent',
1199 'F'=>'Fair',
1200 'G'=>'Good',
1201 'P'=>'Poor'
1202 );
1203
1204 // prognosis code
1205 $this->code271['UM08'] = array(
1206 '1'=>'Poor',
1207 '2'=>'Guarded',
1208 '3'=>'Fair',
1209 '4'=>'Good',
1210 '5'=>'Very Good',
1211 '6'=>'Excellent',
1212 '7'=>'Less than 6 Months to Live',
1213 '8'=>'Terminal'
1214 );
1215
1216 // delay reason code
1217 $this->code271['UM10'] = array(
1218 '1'=>'Proof of Eligibility Unknown',
1219 '2'=>'Litigation',
1220 '3'=>'Authorization Delays',
1221 '4'=>'Delay in Certifying Provider',
1222 '7'=>'Third Party Processing Delay',
1223 '8'=>'Delay in Eligibility Determination',
1224 '10'=>'Administration Delay in Prior Approval Process',
1225 '11'=>'Other',
1226 '15'=>'Natural Disaster',
1227 '16'=>'Lack of Information',
1228 '17'=>'No Response to Initial Request'
1229 );
1230
1231 // certification action code
1232 $this->code271['HCR01'] = array(
1233 'A1'=>'Certified in total',
1234 'A2'=>'Certified - partial',
1235 'A3'=>'Not Certified',
1236 'A4'=>'Pended',
1237 'A6'=>'Modified',
1238 'C'=>'Cancelled',
1239 'CT'=>'Contact Payer',
1240 'NA'=>'No Action Required'
1241 );
1242
1243 // health care decision reason code
1244 $this->code271['HCR03'] = array(
1245 '1'=>'Price Authorization Expired',
1246 '2'=>'Price authorization no longer required',
1247 '3'=>'Product not on the price authorization',
1248 '4'=>'Authorized Quantity Exceeded',
1249 '5'=>'Special Cost Incorrect',
1250 '6'=>'No Credit Allowed',
1251 '7'=>'Administrative Cancellation',
1252 '8'=>'Unit resale higher than authorized',
1253 '9'=>'Out of Network',
1254 '0A'=>'Testing not Included',
1255 '0B'=>'Request Forwarded To and Decision Response Forthcoming From an External Review Organization',
1256 '0C'=>'Authorization/Access Restrictions',
1257 '0D'=>'Requires PCP authorization',
1258 '0E'=>'Provider is Not Primary Care Physician',
1259 '0F'=>'Not Medically Necessary',
1260 '0G'=>'Level of Care Not Appropriate',
1261 '0H'=>'Certification Not Required for this Service',
1262 '0J'=>'Certification Responsibility of External Review Organization',
1263 '0K'=>'Primary Care Service',
1264 '0L'=>'Exceeds Plan Maximums',
1265 '0M'=>'Non-covered Service',
1266 '0N'=>'No Prior Approval',
1267 '0P'=>'Requested Information Not Received',
1268 '0Q'=>'Duplicate Request',
1269 '0R'=>'Service Inconsistent with Diagnosis',
1270 '0S'=>'Pre-existing Condition',
1271 '0T'=>'Experimental Service or Procedure',
1272 '0U'=>'Additional Patient Information required',
1273 '0V'=>'Requires Medical Review',
1274 '0W'=>'Disposition pending review',
1275 '0X'=>'Service Inconsistent with Provider Type',
1276 '0Y'=>'Service inconsistent with Patient\'s Age',
1277 '0Z'=>'Service inconsistent with Patient\'s Gender',
1278 '10'=>'Product/service/procedure delivery pattern (e.g., units, days, visits, weeks, hours, months)',
1279 '11'=>'Pricing',
1280 '12'=>'Patient is restricted to specific provider',
1281 '13'=>'Service authorized for another provider',
1282 '14'=>'Plan/contractual guidelines not followed',
1283 '15'=>'Plan/contractual geographic restriction',
1284 '16'=>'Inappropriate facility type',
1285 '17'=>'Time limits not met',
1286 '18'=>'Notification received',
1287 '19'=>'Cosmetic',
1288 '20'=>'Once in a lifetime restriction applies',
1289 '21'=>'Transport Request Denied',
1290 '22'=>'Ambulance Certification Segment information doesn\'t correspond to Transport Address Segment',
1291 '23'=>'Mileage cannot be computed based on data submitted',
1292 '24'=>'Computed mileage is inconsistent with transport information or service units submitted',
1293 '25'=>'Services were not considered due to other errors in the request.',
1294 '26'=>'Missing Provider Role',
1295 '27'=>'Patient in Health Insurance Exchange premium payment grace period -- first month.',
1296 '28'=>'Patient in Health Insurance Exchange premium payment grace period -- second month.',
1297 '29'=>'Patient in Health Insurance Exchange premium payment grace period -- third month.',
1298 );
1299
1300 // yes/no condition code
1301 $this->code271['HCR04'] = array(
1302 'N'=>'No',
1303 'U'=>'Unknown',
1304 'W'=>'Not Applicable',
1305 'Y'=>'Yes'
1306 );
1307
1308
1309 // code source identifier code
1310 $this->code271['HI01'] = array(
1311 'ABF'=>'ICD-10-CM Diagnosis',
1312 'ABJ'=>'ICD-10-CM Admitting Diagnosis',
1313 'ABK'=>'ICD-10-CM Principal Diagnosis',
1314 'APR'=>'ICD-10-CM Patient Reason for Visit',
1315 'BF'=>'ICD-9-CM Diagnosis',
1316 'BJ'=>'ICD-9-CM Admitting Diagnosis',
1317 'BK'=>'ICD-9-CM Principal Diagnosis',
1318 'DR'=>'Diagnosis Related Group (DRG)',
1319 'PR'=>'ICD-9-CM Patient Reason for Visit',
1320 'LOI'=>'LOINC codes'
1321 );
1322
1323 // code source identifier
1324 $this->code271['SV101'] = array(
1325 'HP'=>'Health Ins Prospective Pmt System',
1326 'N6'=>'National Health Related Item Code in 4-6 Format',
1327 'UI'=>'U.P.C. Consumer Package Code (1-5-5)',
1328 'AD'=>'Am Dental Assoc Codes.',
1329 'CJ'=>'CPT Codes',
1330 'DX'=>'(ICD-9-CM) Diagnosis',
1331 'EN'=>'EAN/UCC--13',
1332 'EO'=>'EAN/UCC--8',
1333 'ER'=>'Jurisdiction Specific Codes',
1334 'HC'=>'(HCPCS) Codes',
1335 'HI'=>'HIBC (HC Bar Code)', // Supplier Labeling Standard Primary Data Message',
1336 'HP'=>'(HIPPS) SNF Rate Code', //Health Insurance Prospective Payment System
1337 'ID'=>'(ICD-9-CM) - Procedure',
1338 'IV'=>'Home Infusion (HIEC) Code',
1339 'N4'=>'National Drug Code in 5-4-2 Format',
1340 'N6'=>'National Health Related Item Code in 4-6 Format',
1341 'NU'=>'National Uniform Billing Committee (NUBC) UB92 Codes',
1342 'ON'=>'Customer Order Number',
1343 'UI'=>'U.P.C. Consumer Package Code (1-5-5)',
1344 'UK'=>'GTIN 14-digit Data Structure',
1345 'UP'=>'UCC--12',
1346 'WK'=>'Advanced Billing Concepts (ABC) Codes',
1347 'ZZ'=>'Mutually Defined'
1348 );
1349
1350
1351 // code source identifier
1352 $this->code271['SV103'] = array(
1353 'DA'=>'Days',
1354 'F2'=>'International Unit',
1355 'MJ'=>'Minutes',
1356 'UN'=>'Unit'
1357 );
1358
1359 // nursing home level of care
1360 $this->code271['SV120'] = array(
1361 '1'=>'Skilled Nursing Facility (SNF)',
1362 '2'=>'Intermediate Care Facility (ICF)',
1363 '3'=>'Intermediate Care Facility - Mentally Retarded (ICF-MR)',
1364 '4'=>'Chronic Disease Hospital (CD)',
1365 '5'=>'ntermediate Care Facility (ICF) Level II I',
1366 '6'=>'Special Skilled Nursing Facility (SNF)',
1367 '7'=>'Nursing Facility (NF)',
1368 '8'=>'Hospice'
1369 );
1370
1371
1372 // admission type code
1373 $this->code271['CL101'] = array(
1374 '1'=>'Emergency',
1375 '2'=>'Urgent',
1376 '3'=>'Elective',
1377 '4'=>'Newborn',
1378 '5'=>'Trauma',
1379 '9'=>'Information not available'
1380 );
1381
1382 // admission source type code
1383 $this->code271['CL102'] = array(
1384 '1'=>'Physician Referral',
1385 '2'=>'Clinic Referral',
1386 '3'=>'HMO Referral',
1387 '4'=>'Transfer from a Hospital',
1388 '5'=>'Transfer from a Skilled Nursing Facility (SNF)',
1389 '6'=>'Transfer from Another Health Facility',
1390 '7'=>'Emergency Room',
1391 '8'=>'Court/Law Enforcement',
1392 '9'=>'Information Not Available',
1393 '10'=>'Transfer from Psych Substance Abuse or Rehab Hospital',
1394 '11'=>'Transfer from a Critical Access Hospital',
1395 'E'=>'Transfer from Ambulatory Surgical Center',
1396 'F'=>'Transfer from Hospice and is Under a Hospice Plan of Care or Enrolled in Hospice Program'
1397 );
1398
1399 // release of information indicator code
1400 // -- which segment?
1401 //$this->code271['CL102'] = array(
1402 //'Y'=>'Yes',
1403 //'R'=>'Restricted or Modified Release',
1404 //'N'=>'No Release'
1405 //};
1406
1407
1408
1409 // patient status code
1410 $this->code271['CL103'] = array(
1411 '1'=>'Discharged to Home or Self-Care (Routine Discharge)',
1412 '2'=>'Discharged/Transferred to Another Short-Term General Hospital',
1413 '3'=>'Discharged/Transferred to an SNF',
1414 '4'=>'Discharged/Transferred to an Intermediate Care Facility (ICF)',
1415 '5'=>'Discharged/Transferred to Another Type of Institution (Including Distinct Parts) or Referred for',
1416 '6'=>'Outpatient Services to Another Institution',
1417 '7'=>'Discharged/Transferred to Home Under Care of Organized Home Health Service Organization',
1418 '8'=>'Left Against Medical Advise or Discontinued Care',
1419 '9'=>'Discharged/Transferred to Home Under Care of Home IV Therapy Provider',
1420 '20'=>'Admitted as an Inpatient to this Hospital',
1421 '30'=>'Expired (or Did Not Recover-Christian Science Patient)',
1422 '40'=>'Expired at Home (for Hospice Care Only)',
1423 '41'=>'Expired in a Medical Facility such as a Hospital, SNF, ICF or Freestanding Hospice (for Hospice Care Only)',
1424 '42'=>'Expired, Place Unknown (for Hospice Care Only)',
1425 '50'=>'Discharged to Hospice-Home',
1426 '51'=>'Discharged to Hospice-Medical Facility',
1427 '61'=>'Discharged/transferred within this institution to a hospital based Medicare approved swing bed.',
1428 '62'=>'Discharged/transferred to an inpatient rehabilitation facility including distinct part units of a hospital',
1429 '63'=>'Discharged/transferred to a long term care hospital',
1430 '64'=>'Discharged/transferred to a nursing facility certified under Medicaid but not certified under Medicare.',
1431 '65'=>'Discharged/transferred to a psychiatric hospital or psychiatric distinct part unit of a hospital',
1432 '66'=>'Discharged/transferred to a Critical Access Hospital (CAH)',
1433 '69'=>'Discharged/transferred to a designated disaster alternative care site',
1434 '81'=>'Discharged to home or self-care with a planned acute care hospital inpatient readmission',
1435 '82'=>'Discharged/transferred to a short term general hospital for inpatient care with a planned acute care hospital inpatient readmission',
1436 '83'=>'Discharged/transferred to a skilled nursing facility (SNF) with Medicare certification with a planned acute care hospital inpatient readmission',
1437 '84'=>'Discharged/transferred to a facility that provides custodial or supportive care with a planned acute care hospital inpatient readmission',
1438 '85'=>'Discharged/transferred to a designated cancer center or children\'s hospital with a planned acute care hospital inpatient readmission',
1439 '86'=>'Discharged/transferred to home under care of organized home health service organization with a planned acute care hospital inpatient readmission',
1440 '87'=>'Discharged/transferred to court/law enforcement with a planned acute care hospital inpatient readmission',
1441 '88'=>'Discharged/transferred to a federal health care facility with a planned acute care hospital inpatient readmission',
1442 '89'=>'Discharged/transferred to a hospital-based Medicare approved swing bed with a planned acute care hospital inpatient readmission',
1443 '90'=>'Discharged/transferred to an inpatient rehabilitation facility (IRF) including rehabilitation distinct part units of a hospital with a planned acute care hospital inpatient readmission',
1444 '91'=>'Discharged/transferred to a Medicare certified long term care hospital (LTCH) with a planned acute care hospital inpatient readmission',
1445 '92'=>'Discharged/transferred to a nursing facility certified under Medicaid but not certified under Medicare with a planned acute care hospital inpatient readmission',
1446 '93'=>'Discharged/transferred to a psychiatric distinct part unit of a hospital with a planned acute care hospital inpatient readmission',
1447 '94'=>'Discharged/transferred to a critical access hospital (CAH) with a planned acute care hospital inpatient readmission',
1448 '95'=>'Discharged/transferred to another type of health care institution not defined elsewhere in this code list with a planned acute care hospital inpatient readmission'
1449 );
1450
1451 // ambulance transport code
1452 $this->code271['CR103'] = array(
1453 'I'=>'Initial Trip',
1454 'R'=>'Return Trip',
1455 'T'=>'Transfer Trip',
1456 'X'=>'Round Trip'
1457 );
1458
1459
1460 // spinal subluxation level code
1461 $this->code271['CR203'] = array(
1462 'C1'=>'Cervical 1',
1463 'C2'=>'Cervical 2',
1464 'C3'=>'Cervical 3',
1465 'C4'=>'Cervical 4',
1466 'C5'=>'Cervical 5',
1467 'C6'=>'Cervical 6',
1468 'C7'=>'Cervical 7',
1469 'CO'=>'Coccyx',
1470 'IL'=>'Ilium',
1471 'L1'=>'Lumbar 1',
1472 'L2'=>'Lumbar 2',
1473 'L3'=>'Lumbar 3',
1474 'L4'=>'Lumbar 4',
1475 'L5'=>'Lumbar 5',
1476 'OC'=>'Occiput',
1477 'SA'=>'Sacrum',
1478 'T1'=>'Thoracic 1',
1479 'T2'=>'Thoracic 2',
1480 'T3'=>'Thoracic 3',
1481 'T4'=>'Thoracic 4',
1482 'T5'=>'Thoracic 5',
1483 'T6'=>'Thoracic 6',
1484 'T7'=>'Thoracic 7',
1485 'T8'=>'Thoracic 8',
1486 'T9'=>'Thoracic 9',
1487 'T10'=>'Thoracic 10',
1488 'T11'=>'Thoracic 11',
1489 'T12'=>'Thoracic 12'
1490 );
1491
1492 // oxygen type code
1493 $this->code271['CR503'] = array(
1494 'A'=>'Concentrator',
1495 'B'=>'Liquid Stationary',
1496 'C'=>'Gaseous Stationary',
1497 'D'=>'Liquid Portable',
1498 'E'=>'Gaseous Portable',
1499 'O'=>'Other'
1500 );
1501
1502
1503 // oxygen delivery type code
1504 $this->code271['CR517'] = array(
1505 'A'=>'Nasal Cannula',
1506 'B'=>'Oxygen Conserving Device',
1507 'C'=>'Oxygen Conserving Device with Oxygen Pulse System',
1508 'D'=>'Oxygen Conserving Device with Reservoir System',
1509 'E'=>'Transtracheal Catheter'
1510 );
1511
1512
1513 // certification type code
1514 $this->code271['CR608'] = array(
1515 '1'=>'Appeal-Immediate',
1516 '2'=>'Appeal-Standard',
1517 '3'=>'Cancel',
1518 '4'=>'Extension',
1519 '5'=>'Notification',
1520 '6'=>'Verification',
1521 'I'=>'Initial',
1522 'R'=>'Renewal',
1523 'S'=>'Revised'
1524 );
1525
1526
1527
1528 // paperwork type code
1529 $this->code271['PWK01'] = array(
1530 '3'=>' Report Justifying Treatment Beyond Utilization Guidelines',
1531 '4'=>' Drugs Administered',
1532 '5'=>' Treatment Diagnosis',
1533 '6'=>' Initial Assessment',
1534 '7'=>' Functional Goals',
1535 '8'=>' Plan of Treatment',
1536 '9'=>' Progress Report',
1537 '10'=>'Continued Treatment',
1538 '11'=>'Chemical Analysis',
1539 '13'=>'Certified Test Report',
1540 '15'=>'Justification for Admission',
1541 '21'=>'Recovery Plan',
1542 '48'=>'Social Security Benefit Letter',
1543 '55'=>'Rental Agreement',
1544 '59'=>'Benefit Letter',
1545 '77'=>'Support Data for Verification',
1546 'A3'=>'Allergies/Sensitivities Document',
1547 'A4'=>'Autopsy Report',
1548 'AM'=>'Ambulance Certification',
1549 'AS'=>'Admission Summary',
1550 'AT'=>'Purchase Order Attachment',
1551 'B2'=>'Prescription',
1552 'B3'=>'Physician Order',
1553 'BR'=>'Benchmark Testing Results',
1554 'BS'=>'Baseline',
1555 'BT'=>'Blanket Test Results',
1556 'CB'=>'Chiropractic Justification',
1557 'CK'=>'Consent Form(s)',
1558 'D2'=>'Drug Profile Document',
1559 'DA'=>'Dental Models',
1560 'DB'=>'Durable Medical Equipment Prescription',
1561 'DG'=>'Diagnostic Report',
1562 'DJ'=>'Discharge Monitoring Report',
1563 'DS'=>'Discharge Summary',
1564 'FM'=>'Family Medical History Document',
1565 'HC'=>'Health Certificate',
1566 'HR'=>'Health Clinic Records',
1567 'I5'=>'Immunization Record',
1568 'IR'=>'State School Immunization Records',
1569 'LA'=>'Laboratory Results',
1570 'M1'=>'Medical Record Attachment',
1571 'NN'=>'Nursing Notes',
1572 'OB'=>'Operative Note',
1573 'OC'=>'Oxygen Content Averaging Report',
1574 'OD'=>'Orders and Treatments Document',
1575 'OE'=>'Objective Physical Examination (including vital signs) Document',
1576 'OX'=>'Oxygen Therapy Certification',
1577 'P4'=>'Pathology Report',
1578 'P5'=>'Patient Medical History Document',
1579 'P6'=>'Periodontal Charts',
1580 'P7'=>'Periodontal Reports',
1581 'PE'=>'Parenteral or Enteral Certification',
1582 'PN'=>'Physical Therapy Notes',
1583 'PO'=>'Prosthetics or Orthotic Certification',
1584 'PQ'=>'Paramedical Results',
1585 'PY'=>'Physician Report',
1586 'PZ'=>'Physical Therapy Certification',
1587 'QC'=>'Cause and Corrective Action Report',
1588 'QR'=>'Quality Report',
1589 'RB'=>'Radiology Films',
1590 'RR'=>'Radiology Reports',
1591 'RT'=>'Report of Tests and Analysis Report',
1592 'RX'=>'Renewable Oxygen Content Averaging Report',
1593 'SG'=>'Symptoms Document',
1594 'V5'=>'Death Notification',
1595 'XP'=>'Photographs'
1596 );
1597
1598 // paperwork delivery code
1599 $this->code271['PWK02'] = array(
1600 'BM'=>'By Mail',
1601 'EL'=>'Electronically Only',
1602 'EM'=>'E-Mail',
1603 'FX'=>'By Fax',
1604 'VO'=>'Voice'
1605 );
1606
1607
1608 // certification type code
1609 $this->code271['CRC01'] = array(
1610 '07'=>'Ambulance Certification',
1611 '08'=>'Chiropractic Certification',
1612 '09'=>'Durable Medical Equipment Certification'
1613 );
1614
1615 //
1616 $this->code271['CRC03'] = array(
1617 '1'=>'Patient was admitted to a hospital',
1618 '2'=>'Patient was bed confined before the ambulance service',
1619 '3'=>'Patient was bed confined after the ambulance service',
1620 '4'=>'Patient was moved by stretcher',
1621 '5'=>'Patient was unconscious or in shock',
1622 '6'=>'Patient was transported in an emergency situation',
1623 '7'=>'Patient had to be physically restrained',
1624 '8'=>'Patient had visible hemorrhaging',
1625 '9'=>'Ambulance service was medically necessary',
1626 '10'=>'Patient is ambulatory',
1627 '11'=>'Ambulation is Impaired and Walking Aid is Used for Therapy or Mobility',
1628 '12'=>'Patient is confined to a bed or chair',
1629 '13'=>'Patient is Confined to a Room or an Area Without Bathroom Facilities',
1630 '14'=>'Ambulation is Impaired and Walking Aid is Used for Mobility',
1631 '15'=>'Patient Condition Requires Positioning of the Body or Attachments Which Would Not be Feasible With the Use of an Ordinary Bed',
1632 '16'=>'Patient needs a trapeze bar to sit up due to respiratory condition or change body positions for other medical reasons',
1633 '17'=>'Patient\'s Ability to Breathe is Severely Impaired',
1634 '18'=>'Patient condition requires frequent and/or immediate changes in body positions',
1635 '19'=>'Patient can operate controls',
1636 '20'=>'Siderails Are to be Attached to a Hospital Bed Owned by the Beneficiary',
1637 '21'=>'Patient owns equipment',
1638 '22'=>'Mattress or Siderails are Being Used with Prescribed Medically Necessary Hospital Bed Owned by the Beneficiary',
1639 '23'=>'Patient Needs Lift to Get In or Out of Bed or to Assist in Transfer from Bed to Wheelchair',
1640 '24'=>'Patient has an orthopedic impairment requiring traction equipment which prevents ambulation during period of use',
1641 '25'=>'Item has been prescribed as part of a planned regimen of treatment in patient home',
1642 '26'=>'Patient is highly susceptible to decubitus ulcers',
1643 '27'=>'Patient or a care-giver has been instructed in use of equipment',
1644 '29'=>'A 6-7 hour nocturnal study documents 30 episodes of apnea each lasting more than 10 seconds',
1645 '30'=>'Without the equipment, the patient would require surgery',
1646 '31'=>'Patient has had a total knee replacement',
1647 '32'=>'Patient has intractable lymphedema of the extremities',
1648 '33'=>'Patient is in a nursing home',
1649 '35'=>'This Feeding is the Only Form of Nutritional Intake for This Patient',
1650 '37'=>'Oxygen delivery equipment is stationary',
1651 '38'=>'Certification signed by the physician is on file at the supplier\'s office',
1652 '40'=>'Patient or Caregiver is Capable of Using the Equipment Without Technical or Professional Supervision',
1653 '41'=>'Patient or Caregiver is Unable to Propel or Lift a Standard Weight Wheelchair',
1654 '42'=>'Patient Requires Leg Elevation for Edema or Body Alignment',
1655 '43'=>'Patient Weight or Usage Needs Necessitate a Heavy Duty Wheelchair',
1656 '44'=>'Patient Requires Reclining Function of a Wheelchair',
1657 '45'=>'Patient is Unable to Operate a Wheelchair Manually',
1658 '46'=>'Patient or Caregiver Requires Side Transfer into Wheelchair, Commode or Other',
1659 '58'=>'Durable Medical Equipment (DME) Purchased New',
1660 '59'=>'Durable Medical Equipment (DME) Is Under Warranty',
1661 '60'=>'Transportation Was To the Nearest Facility',
1662 '9D'=>'Lack of Appropriate Facility within Reasonable Distance to Treat Patient in the Event of Complications',
1663 '9H'=>'Patient Requires Intensive IV Therapy',
1664 '9J'=>'Patient Requires Protective Isolation',
1665 '9K'=>'Patient Requires Frequent Monitoring',
1666 'IH'=>'Independent at Home',
1667 'LB'=>'Legally Blind',
1668 'SL'=>'Speech Limitations'
1669 );
1670
1671 // Claim Status Category Codes
1672 // ASC X12 External Code Source 507  LAST UPDATED 7/1/2015
1673 $this->code271['HCCSCC'] = array(
1674 'A0' => 'Acknowledgement/Forwarded-The claim/encounter has been forwarded to another entity.',
1675 'A1' => 'Acknowledgement/Receipt-The claim/encounter has been received.',
1676 'A2' => 'Acknowledgement/Acceptance into adjudication system-The claim/encounter has been accepted into the adjudication system.',
1677 'A3' => 'Acknowledgement/Returned as unprocessable claim-The claim/encounter has been rejected and has not been entered into the adjudication system.',
1678 'A4' => 'Acknowledgement/Not Found-The claim/encounter can not be found in the adjudication system.',
1679 'A5' => 'Acknowledgement/Split Claim-The claim/encounter has been split upon acceptance into the adjudication system.',
1680 'A6' => 'Acknowledgement/Rejected for Missing Information - The claim/encounter is missing the information specified in the Status details and has been rejected.',
1681 'A7' => 'Acknowledgement/Rejected for Invalid Information - The claim/encounter has invalid information as specified in the Status details and has been rejected.',
1682 'A8' => 'Acknowledgement/Rejected for relational field in error.',
1683 // Pending
1684 'P0' => 'Pending: Adjudication/Details-This is a generic message about a pended claim.',
1685 'P1' => 'Pending/In Process-The claim or encounter is in the adjudication system.',
1686 'P2' => 'Pending/Payer Review-The claim/encounter is suspended and is pending review ',
1687 'P3' => 'Pending/Provider Requested Information - The claim or encounter is waiting for information that has already been requested from the provider.',
1688 'P4' => 'Pending/Patient Requested Information - The claim or encounter is waiting for information that has already been requested from the patient.',
1689 'P5' => 'Pending/Payer Administrative/System hold',
1690 // Finalized
1691 'F0' => 'Finalized-The claim/encounter has completed the adjudication cycle and no more action will be taken.',
1692 'F1' => 'Finalized/Payment-The claim/line has been paid.',
1693 'F2' => 'Finalized/Denial-The claim/line has been denied.',
1694 'F3' => 'Finalized/Revised - Adjudication information has been changed',
1695 'F3F' => 'Finalized/Forwarded-The claim/encounter processing has been completed.',
1696 'F3N' => 'Finalized/Not Forwarded-The claim/encounter processing has been completed.',
1697 'F4' => 'Finalized/Adjudication Complete - No payment forthcoming-The claim/encounter has been adjudicated and no further payment is forthcoming.',
1698 // Requests for additional information
1699 'R0' => 'Requests for additional Information/General Requests-Requests that don\'t fall into other R-type categories.',
1700 'R1' => 'Requests for additional Information/Entity Requests-Requests for information about specific entities ',
1701 'R3' => 'Requests for additional Information/Claim/Line-Requests for information that could normally be submitted on a claim.',
1702 'R4' => 'Requests for additional Information/Documentation-Requests for additional supporting documentation.',
1703 'R5' => 'Request for additional information/more specific detail-Additional information as a follow up to a previous request is needed.',
1704 'R6' => 'Requests for additional information – Regulatory requirements',
1705 'R7' => 'Requests for additional information – Confirm care is consistent with Health Plan policy coverage',
1706 'R8' => 'Requests for additional information – Confirm care is consistent with health plan coverage exceptions',
1707 'R9' => 'Requests for additional information – Determination of medical necessity',
1708 'R10' => 'Requests for additional information – Support a filed grievance or appeal',
1709 'R11' => 'Requests for additional information – Pre-payment review of claims',
1710 'R12' => 'Requests for additional information – Clarification or justification of use for specified procedure code',
1711 'R13' => 'Requests for additional information – Original documents submitted are not readable.',
1712 'R14' => 'Requests for additional information – Original documents received are not what was requested.',
1713 'R15' => 'Requests for additional information – Workers Compensation coverage determination.',
1714 'R16' => 'Requests for additional information – Eligibility determination',
1715 // General
1716 // Error
1717 'E0' => 'Response not possible - error on submitted request data',
1718 'E1' => 'Response not possible - System Status',
1719 'E2' => 'Information Holder is not responding; resubmit at a later time.',
1720 'E3' => 'Correction required - relational fields in error.',
1721 'E4' => 'Trading partner agreement specific requirement not met: Data correction required.',
1722 // Searches
1723 'D0' => 'Data Search Unsuccessful - The payer is unable to return status on the requested claim(s) based on the submitted search criteria.',
1724 );
1725
1726
1727 // Health Care Claim Status Codes
1728 // ASC X12 External Code Source 508  LAST UPDATED 3/1/2016
1729 $this->code271['HCCSC'] = array(
1730 "0" => "Cannot provide further status electronically.",
1731 "1" => "For more detailed information, see remittance advice.",
1732 "2" => "More detailed information in letter.",
1733 "3" => "Claim has been adjudicated and is awaiting payment cycle.",
1734 "6" => "Balance due from the subscriber.",
1735 "12" => "One or more originally submitted procedure codes have been combined.",
1736 "15" => "One or more originally submitted procedure code have been modified.",
1737 "16" => "Claim/encounter has been forwarded to entity.",
1738 "17" => "Claim/encounter has been forwarded by third party entity to entity.",
1739 "18" => "Entity received claim/encounter, but returned invalid status.",
1740 "19" => "Entity acknowledges receipt of claim/encounter.",
1741 "20" => "Accepted for processing.",
1742 "21" => "Missing or invalid information.",
1743 "23" => "Returned to Entity.",
1744 "24" => "Entity not approved as an electronic submitter.",
1745 "25" => "Entity not approved.",
1746 "26" => "Entity not found.",
1747 "27" => "Policy canceled.",
1748 "29" => "Subscriber and policy number/contract number mismatched.",
1749 "30" => "Subscriber and subscriber id mismatched.",
1750 "31" => "Subscriber and policyholder name mismatched.",
1751 "32" => "Subscriber and policy number/contract number not found.",
1752 "33" => "Subscriber and subscriber id not found.",
1753 "34" => "Subscriber and policyholder name not found.",
1754 "35" => "Claim/encounter not found.",
1755 "37" => "Predetermination is on file, awaiting completion of services.",
1756 "38" => "Awaiting next periodic adjudication cycle.",
1757 "39" => "Charges for pregnancy deferred until delivery.",
1758 "40" => "Waiting for final approval.",
1759 "41" => "Special handling required at payer site.",
1760 "42" => "Awaiting related charges.",
1761 "44" => "Charges pending provider audit.",
1762 "45" => "Awaiting benefit determination.",
1763 "46" => "Internal review/audit.",
1764 "47" => "Internal review/audit - partial payment made.",
1765 "49" => "Pending provider accreditation review.",
1766 "50" => "Claim waiting for internal provider verification.",
1767 "51" => "Investigating occupational illness/accident.",
1768 "52" => "Investigating existence of other insurance coverage.",
1769 "53" => "Claim being researched for Insured ID/Group Policy Number error.",
1770 "54" => "Duplicate of a previously processed claim/line.",
1771 "55" => "Claim assigned to an approver/analyst.",
1772 "56" => "Awaiting eligibility determination.",
1773 "57" => "Pending COBRA information requested.",
1774 "59" => "Information was requested by a non-electronic method.",
1775 "60" => "Information was requested by an electronic method.",
1776 "61" => "Eligibility for extended benefits.",
1777 "64" => "Re-pricing information.",
1778 "65" => "Claim/line has been paid.",
1779 "66" => "Payment reflects usual and customary charges.",
1780 "72" => "Claim contains split payment.",
1781 "73" => "Payment made to entity, assignment of benefits not on file.",
1782 "78" => "Duplicate of an existing claim/line, awaiting processing.",
1783 "81" => "Contract/plan does not cover pre-existing conditions.",
1784 "83" => "No coverage for newborns.",
1785 "84" => "Service not authorized.",
1786 "85" => "Entity not primary.",
1787 "86" => "Diagnosis and patient gender mismatch.",
1788 "88" => "Entity not eligible for benefits for submitted dates of service.",
1789 "89" => "Entity not eligible for dental benefits for submitted dates of service.",
1790 "90" => "Entity not eligible for medical benefits for submitted dates of service.",
1791 "91" => "Entity not eligible/not approved for dates of service.",
1792 "92" => "Entity does not meet dependent or student qualification.",
1793 "93" => "Entity is not selected primary care provider.",
1794 "94" => "Entity not referred by selected primary care provider.",
1795 "95" => "Requested additional information not received.",
1796 "96" => "No agreement with entity.",
1797 "97" => "Patient eligibility not found with entity.",
1798 "98" => "Charges applied to deductible.",
1799 "99" => "Pre-treatment review.",
1800 "100" => "Pre-certification penalty taken.",
1801 "101" => "Claim was processed as adjustment to previous claim.",
1802 "102" => "Newborn's charges processed on mother's claim.",
1803 "103" => "Claim combined with other claim(s).",
1804 "104" => "Processed according to plan provisions (Plan refers to provisions that exist between the Health Plan and the Consumer or Patient)",
1805 "105" => "Claim/line is capitated.",
1806 "106" => "This amount is not entity's responsibility.",
1807 "107" => "Processed according to contract provisions (Contract refers to provisions that exist between the Health Plan and a Provider of Health Care Services)",
1808 "109" => "Entity not eligible.",
1809 "110" => "Claim requires pricing information.",
1810 "111" => "At the policyholder's request these claims cannot be submitted electronically.",
1811 "114" => "Claim/service should be processed by entity.",
1812 "116" => "Claim submitted to incorrect payer.",
1813 "117" => "Claim requires signature-on-file indicator.",
1814 "121" => "Service line number greater than maximum allowable for payer.",
1815 "123" => "Additional information requested from entity.",
1816 "124" => "Entity's name, address, phone and id number.",
1817 "125" => "Entity's name.",
1818 "126" => "Entity's address.",
1819 "127" => "Entity's Communication Number.",
1820 "128" => "Entity's tax id.",
1821 "129" => "Entity's Blue Cross provider id.",
1822 "130" => "Entity's Blue Shield provider id.",
1823 "131" => "Entity's Medicare provider id.",
1824 "132" => "Entity's Medicaid provider id.",
1825 "133" => "Entity's UPIN.",
1826 "134" => "Entity's CHAMPUS provider id.",
1827 "135" => "Entity's commercial provider id.",
1828 "136" => "Entity's health industry id number.",
1829 "137" => "Entity's plan network id.",
1830 "138" => "Entity's site id .",
1831 "139" => "Entity's health maintenance provider id (HMO).",
1832 "140" => "Entity's preferred provider organization id (PPO).",
1833 "141" => "Entity's administrative services organization id (ASO).",
1834 "142" => "Entity's license/certification number.",
1835 "143" => "Entity's state license number.",
1836 "144" => "Entity's specialty license number.",
1837 "145" => "Entity's specialty/taxonomy code.",
1838 "146" => "Entity's anesthesia license number.",
1839 "147" => "Entity's qualification degree/designation (e.g. RN,PhD,MD).",
1840 "148" => "Entity's social security number.",
1841 "149" => "Entity's employer id.",
1842 "150" => "Entity's drug enforcement agency (DEA) number.",
1843 "152" => "Pharmacy processor number.",
1844 "153" => "Entity's id number.",
1845 "154" => "Relationship of surgeon & assistant surgeon.",
1846 "155" => "Entity's relationship to patient.",
1847 "156" => "Patient relationship to subscriber",
1848 "157" => "Entity's Gender.",
1849 "158" => "Entity's date of birth.",
1850 "159" => "Entity's date of death.",
1851 "160" => "Entity's marital status.",
1852 "161" => "Entity's employment status.",
1853 "162" => "Entity's health insurance claim number (HICN).",
1854 "163" => "Entity's policy number.",
1855 "164" => "Entity's contract/member number.",
1856 "165" => "Entity's employer name, address and phone.",
1857 "166" => "Entity's employer name.",
1858 "167" => "Entity's employer address.",
1859 "168" => "Entity's employer phone number.",
1860 "170" => "Entity's employee id.",
1861 "171" => "Other insurance coverage information (health, liability, auto, etc.).",
1862 "172" => "Other employer name, address and telephone number.",
1863 "173" => "Entity's name, address, phone, gender, DOB, marital status, employment status and relation to subscriber.",
1864 "174" => "Entity's student status.",
1865 "175" => "Entity's school name.",
1866 "176" => "Entity's school address.",
1867 "177" => "Transplant recipient's name, date of birth, gender, relationship to insured.",
1868 "178" => "Submitted charges.",
1869 "179" => "Outside lab charges.",
1870 "180" => "Hospital s semi-private room rate.",
1871 "181" => "Hospital s room rate.",
1872 "182" => "Allowable/paid from other entities coverage NOTE: This code requires the use of an entity code.",
1873 "183" => "Amount entity has paid.",
1874 "184" => "Purchase price for the rented durable medical equipment.",
1875 "185" => "Rental price for durable medical equipment.",
1876 "186" => "Purchase and rental price of durable medical equipment.",
1877 "187" => "Date(s) of service.",
1878 "188" => "Statement from-through dates.",
1879 "189" => "Facility admission date",
1880 "190" => "Facility discharge date",
1881 "191" => "Date of Last Menstrual Period (LMP)",
1882 "192" => "Date of first service for current series/symptom/illness.",
1883 "193" => "First consultation/evaluation date.",
1884 "194" => "Confinement dates.",
1885 "195" => "Unable to work dates/Disability Dates.",
1886 "196" => "Return to work dates.",
1887 "197" => "Effective coverage date(s).",
1888 "198" => "Medicare effective date.",
1889 "199" => "Date of conception and expected date of delivery.",
1890 "200" => "Date of equipment return.",
1891 "201" => "Date of dental appliance prior placement.",
1892 "202" => "Date of dental prior replacement/reason for replacement.",
1893 "203" => "Date of dental appliance placed.",
1894 "204" => "Date dental canal(s) opened and date service completed.",
1895 "205" => "Date(s) dental root canal therapy previously performed.",
1896 "206" => "Most recent date of curettage, root planing, or periodontal surgery.",
1897 "207" => "Dental impression and seating date.",
1898 "208" => "Most recent date pacemaker was implanted.",
1899 "209" => "Most recent pacemaker battery change date.",
1900 "210" => "Date of the last x-ray.",
1901 "211" => "Date(s) of dialysis training provided to patient.",
1902 "212" => "Date of last routine dialysis.",
1903 "213" => "Date of first routine dialysis.",
1904 "214" => "Original date of prescription/orders/referral.",
1905 "215" => "Date of tooth extraction/evolution.",
1906 "216" => "Drug information.",
1907 "217" => "Drug name, strength and dosage form.",
1908 "218" => "NDC number.",
1909 "219" => "Prescription number.",
1910 "222" => "Drug dispensing units and average wholesale price (AWP).",
1911 "223" => "Route of drug/myelogram administration.",
1912 "224" => "Anatomical location for joint injection.",
1913 "225" => "Anatomical location.",
1914 "226" => "Joint injection site.",
1915 "227" => "Hospital information.",
1916 "228" => "Type of bill for UB claim",
1917 "229" => "Hospital admission source.",
1918 "230" => "Hospital admission hour.",
1919 "231" => "Hospital admission type.",
1920 "232" => "Admitting diagnosis.",
1921 "233" => "Hospital discharge hour.",
1922 "234" => "Patient discharge status.",
1923 "235" => "Units of blood furnished.",
1924 "236" => "Units of blood replaced.",
1925 "237" => "Units of deductible blood.",
1926 "238" => "Separate claim for mother/baby charges.",
1927 "239" => "Dental information.",
1928 "240" => "Tooth surface(s) involved.",
1929 "241" => "List of all missing teeth (upper and lower).",
1930 "242" => "Tooth numbers, surfaces, and/or quadrants involved.",
1931 "243" => "Months of dental treatment remaining.",
1932 "244" => "Tooth number or letter.",
1933 "245" => "Dental quadrant/arch.",
1934 "246" => "Total orthodontic service fee, initial appliance fee, monthly fee, length of service.",
1935 "247" => "Line information.",
1936 "249" => "Place of service.",
1937 "250" => "Type of service.",
1938 "251" => "Total anesthesia minutes.",
1939 "252" => "Entity's authorization/certification number.",
1940 "254" => "Principal diagnosis code.",
1941 "255" => "Diagnosis code.",
1942 "256" => "DRG code(s).",
1943 "257" => "ADSM-III-R code for services rendered.",
1944 "258" => "Days/units for procedure/revenue code.",
1945 "259" => "Frequency of service.",
1946 "260" => "Length of medical necessity, including begin date.",
1947 "261" => "Obesity measurements.",
1948 "262" => "Type of surgery/service for which anesthesia was administered.",
1949 "263" => "Length of time for services rendered.",
1950 "264" => "Number of liters/minute & total hours/day for respiratory support.",
1951 "265" => "Number of lesions excised.",
1952 "266" => "Facility point of origin and destination - ambulance.",
1953 "267" => "Number of miles patient was transported.",
1954 "268" => "Location of durable medical equipment use.",
1955 "269" => "Length/size of laceration/tumor.",
1956 "270" => "Subluxation location.",
1957 "271" => "Number of spine segments.",
1958 "272" => "Oxygen contents for oxygen system rental.",
1959 "273" => "Weight.",
1960 "274" => "Height.",
1961 "275" => "Claim.",
1962 "276" => "UB04/HCFA-1450/1500 claim form",
1963 "277" => "Paper claim.",
1964 "279" => "Claim/service must be itemized",
1965 "281" => "Related confinement claim.",
1966 "282" => "Copy of prescription.",
1967 "283" => "Medicare entitlement information is required to determine primary coverage",
1968 "284" => "Copy of Medicare ID card.",
1969 "286" => "Other payer's Explanation of Benefits/payment information.",
1970 "287" => "Medical necessity for service.",
1971 "288" => "Hospital late charges",
1972 "290" => "Pre-existing information.",
1973 "291" => "Reason for termination of pregnancy.",
1974 "292" => "Purpose of family conference/therapy.",
1975 "293" => "Reason for physical therapy.",
1976 "294" => "Supporting documentation.",
1977 "295" => "Attending physician report.",
1978 "296" => "Nurse's notes.",
1979 "297" => "Medical notes/report.",
1980 "298" => "Operative report.",
1981 "299" => "Emergency room notes/report.",
1982 "300" => "Lab/test report/notes/results.",
1983 "301" => "MRI report.",
1984 "305" => "Radiology/x-ray reports and/or interpretation",
1985 "306" => "Detailed description of service.",
1986 "307" => "Narrative with pocket depth chart.",
1987 "308" => "Discharge summary.",
1988 "310" => "Progress notes for the six months prior to statement date.",
1989 "311" => "Pathology notes/report.",
1990 "312" => "Dental charting.",
1991 "313" => "Bridgework information.",
1992 "314" => "Dental records for this service.",
1993 "315" => "Past perio treatment history.",
1994 "316" => "Complete medical history.",
1995 "318" => "X-rays/radiology films",
1996 "319" => "Pre/post-operative x-rays/photographs.",
1997 "320" => "Study models.",
1998 "322" => "Recent Full Mouth X-rays",
1999 "323" => "Study models, x-rays, and/or narrative.",
2000 "324" => "Recent x-ray of treatment area and/or narrative.",
2001 "325" => "Recent fm x-rays and/or narrative.",
2002 "326" => "Copy of transplant acquisition invoice.",
2003 "327" => "Periodontal case type diagnosis and recent pocket depth chart with narrative.",
2004 "329" => "Exercise notes.",
2005 "330" => "Occupational notes.",
2006 "331" => "History and physical.",
2007 "333" => "Patient release of information authorization.",
2008 "334" => "Oxygen certification.",
2009 "335" => "Durable medical equipment certification.",
2010 "336" => "Chiropractic certification.",
2011 "337" => "Ambulance certification/documentation.",
2012 "339" => "Enteral/parenteral certification.",
2013 "340" => "Pacemaker certification.",
2014 "341" => "Private duty nursing certification.",
2015 "342" => "Podiatric certification.",
2016 "343" => "Documentation that facility is state licensed and Medicare approved as a surgical facility.",
2017 "344" => "Documentation that provider of physical therapy is Medicare Part B approved.",
2018 "345" => "Treatment plan for service/diagnosis",
2019 "346" => "Proposed treatment plan for next 6 months.",
2020 "352" => "Duration of treatment plan.",
2021 "353" => "Orthodontics treatment plan.",
2022 "354" => "Treatment plan for replacement of remaining missing teeth.",
2023 "360" => "Benefits Assignment Certification Indicator",
2024 "363" => "Possible Workers' Compensation",
2025 "364" => "Is accident/illness/condition employment related?",
2026 "365" => "Is service the result of an accident?",
2027 "366" => "Is injury due to auto accident?",
2028 "374" => "Is prescribed lenses a result of cataract surgery?",
2029 "375" => "Was refraction performed?",
2030 "380" => "CRNA supervision/medical direction.",
2031 "382" => "Did provider authorize generic or brand name dispensing?",
2032 "383" => "Nerve block use (surgery vs. pain management)",
2033 "384" => "Is prosthesis/crown/inlay placement an initial placement or a replacement?",
2034 "385" => "Is appliance upper or lower arch & is appliance fixed or removable?",
2035 "386" => "Orthodontic Treatment/Purpose Indicator",
2036 "387" => "Date patient last examined by entity.",
2037 "388" => "Date post-operative care assumed",
2038 "389" => "Date post-operative care relinquished",
2039 "390" => "Date of most recent medical event necessitating service(s)",
2040 "391" => "Date(s) dialysis conducted",
2041 "394" => "Date(s) of most recent hospitalization related to service",
2042 "395" => "Date entity signed certification/recertification",
2043 "396" => "Date home dialysis began",
2044 "397" => "Date of onset/exacerbation of illness/condition",
2045 "398" => "Visual field test results",
2046 "400" => "Claim is out of balance",
2047 "401" => "Source of payment is not valid",
2048 "402" => "Amount must be greater than zero.",
2049 "403" => "Entity referral notes/orders/prescription",
2050 "406" => "Brief medical history as related to service(s)",
2051 "407" => "Complications/mitigating circumstances",
2052 "408" => "Initial certification",
2053 "409" => "Medication logs/records (including medication therapy)",
2054 "414" => "Necessity for concurrent care (more than one physician treating the patient)",
2055 "417" => "Prior testing, including result(s) and date(s) as related to service(s)",
2056 "419" => "Individual test(s) comprising the panel and the charges for each test",
2057 "420" => "Name, dosage and medical justification of contrast material used for radiology procedure",
2058 "428" => "Reason for transport by ambulance",
2059 "430" => "Nearest appropriate facility",
2060 "431" => "Patient's condition/functional status at time of service.",
2061 "432" => "Date benefits exhausted",
2062 "433" => "Copy of patient revocation of hospice benefits",
2063 "434" => "Reasons for more than one transfer per entitlement period",
2064 "435" => "Notice of Admission",
2065 "441" => "Entity professional qualification for service(s)",
2066 "442" => "Modalities of service",
2067 "443" => "Initial evaluation report",
2068 "449" => "Projected date to discontinue service(s)",
2069 "450" => "Awaiting spend down determination",
2070 "451" => "Preoperative and post-operative diagnosis",
2071 "452" => "Total visits in total number of hours/day and total number of hours/week",
2072 "453" => "Procedure Code Modifier(s) for Service(s) Rendered",
2073 "454" => "Procedure code for services rendered.",
2074 "455" => "Revenue code for services rendered.",
2075 "456" => "Covered Day(s)",
2076 "457" => "Non-Covered Day(s)",
2077 "458" => "Coinsurance Day(s)",
2078 "459" => "Lifetime Reserve Day(s)",
2079 "460" => "NUBC Condition Code(s)",
2080 "464" => "Payer Assigned Claim Control Number",
2081 "465" => "Principal Procedure Code for Service(s) Rendered",
2082 "466" => "Entity's Original Signature.",
2083 "467" => "Entity Signature Date.",
2084 "468" => "Patient Signature Source",
2085 "469" => "Purchase Service Charge",
2086 "470" => "Was service purchased from another entity?",
2087 "471" => "Were services related to an emergency?",
2088 "472" => "Ambulance Run Sheet",
2089 "473" => "Missing or invalid lab indicator",
2090 "474" => "Procedure code and patient gender mismatch",
2091 "475" => "Procedure code not valid for patient age",
2092 "476" => "Missing or invalid units of service",
2093 "477" => "Diagnosis code pointer is missing or invalid",
2094 "478" => "Claim submitter's identifier",
2095 "479" => "Other Carrier payer ID is missing or invalid",
2096 "480" => "Entity's claim filing indicator.",
2097 "481" => "Claim/submission format is invalid.",
2098 "483" => "Maximum coverage amount met or exceeded for benefit period.",
2099 "484" => "Business Application Currently Not Available",
2100 "485" => "More information available than can be returned in real time mode. Narrow your current search criteria.",
2101 "486" => "Principal Procedure Date",
2102 "487" => "Claim not found, claim should have been submitted to/through 'entity'.",
2103 "488" => "Diagnosis code(s) for the services rendered.",
2104 "489" => "Attachment Control Number",
2105 "490" => "Other Procedure Code for Service(s) Rendered",
2106 "491" => "Entity not eligible for encounter submission.",
2107 "492" => "Other Procedure Date",
2108 "493" => "Version/Release/Industry ID code not currently supported by information holder",
2109 "494" => "Real-Time requests not supported by the information holder, resubmit as batch request",
2110 "495" => "Requests for re-adjudication must reference the newly assigned payer claim control number for this previously adjusted claim. Correct the payer claim control number and re-submit.",
2111 "496" => "Submitter not approved for electronic claim submissions on behalf of this entity.",
2112 "497" => "Sales tax not paid",
2113 "498" => "Maximum leave days exhausted",
2114 "499" => "No rate on file with the payer for this service for this entity",
2115 "500" => "Entity's Postal/Zip Code.",
2116 "501" => "Entity's State/Province.",
2117 "502" => "Entity's City.",
2118 "503" => "Entity's Street Address.",
2119 "504" => "Entity's Last Name.",
2120 "505" => "Entity's First Name.",
2121 "506" => "Entity is changing processor/clearinghouse. This claim must be submitted to the new processor/clearinghouse.",
2122 "507" => "HCPCS",
2123 "508" => "ICD9 NOTE: At least one other status code is required to identify the related procedure code or diagnosis code.",
2124 "509" => "External Cause of Injury Code.",
2125 "510" => "Future date.",
2126 "511" => "Invalid character.",
2127 "512" => "Length invalid for receiver's application system.",
2128 "513" => "HIPPS Rate Code for services Rendered",
2129 "514" => "Entity's Middle Name",
2130 "515" => "Managed Care review",
2131 "516" => "Other Entity's Adjudication or Payment/Remittance Date.",
2132 "517" => "Adjusted Repriced Claim Reference Number",
2133 "518" => "Adjusted Repriced Line item Reference Number",
2134 "519" => "Adjustment Amount",
2135 "520" => "Adjustment Quantity",
2136 "521" => "Adjustment Reason Code",
2137 "522" => "Anesthesia Modifying Units",
2138 "523" => "Anesthesia Unit Count",
2139 "524" => "Arterial Blood Gas Quantity",
2140 "525" => "Begin Therapy Date",
2141 "526" => "Bundled or Unbundled Line Number",
2142 "527" => "Certification Condition Indicator",
2143 "528" => "Certification Period Projected Visit Count",
2144 "529" => "Certification Revision Date",
2145 "530" => "Claim Adjustment Indicator",
2146 "531" => "Claim Disproportinate Share Amount",
2147 "532" => "Claim DRG Amount",
2148 "533" => "Claim DRG Outlier Amount",
2149 "534" => "Claim ESRD Payment Amount",
2150 "535" => "Claim Frequency Code",
2151 "536" => "Claim Indirect Teaching Amount",
2152 "537" => "Claim MSP Pass-through Amount",
2153 "538" => "Claim or Encounter Identifier",
2154 "539" => "Claim PPS Capital Amount",
2155 "540" => "Claim PPS Capital Outlier Amount",
2156 "541" => "Claim Submission Reason Code",
2157 "542" => "Claim Total Denied Charge Amount",
2158 "543" => "Clearinghouse or Value Added Network Trace",
2159 "544" => "Clinical Laboratory Improvement Amendment",
2160 "545" => "Contract Amount",
2161 "546" => "Contract Code",
2162 "547" => "Contract Percentage",
2163 "548" => "Contract Type Code",
2164 "549" => "Contract Version Identifier",
2165 "550" => "Coordination of Benefits Code",
2166 "551" => "Coordination of Benefits Total Submitted Charge",
2167 "552" => "Cost Report Day Count",
2168 "553" => "Covered Amount",
2169 "554" => "Date Claim Paid",
2170 "555" => "Delay Reason Code",
2171 "556" => "Demonstration Project Identifier",
2172 "557" => "Diagnosis Date",
2173 "558" => "Discount Amount",
2174 "559" => "Document Control Identifier",
2175 "560" => "Entity's Additional/Secondary Identifier.",
2176 "561" => "Entity's Contact Name.",
2177 "562" => "Entity's National Provider Identifier (NPI).",
2178 "563" => "Entity's Tax Amount.",
2179 "564" => "EPSDT Indicator",
2180 "565" => "Estimated Claim Due Amount",
2181 "566" => "Exception Code",
2182 "567" => "Facility Code Qualifier",
2183 "568" => "Family Planning Indicator",
2184 "569" => "Fixed Format Information",
2185 "571" => "Frequency Count",
2186 "572" => "Frequency Period",
2187 "573" => "Functional Limitation Code",
2188 "574" => "HCPCS Payable Amount Home Health",
2189 "575" => "Homebound Indicator",
2190 "576" => "Immunization Batch Number",
2191 "577" => "Industry Code",
2192 "578" => "Insurance Type Code",
2193 "579" => "Investigational Device Exemption Identifier",
2194 "580" => "Last Certification Date",
2195 "581" => "Last Worked Date",
2196 "582" => "Lifetime Psychiatric Days Count",
2197 "583" => "Line Item Charge Amount",
2198 "584" => "Line Item Control Number",
2199 "585" => "Denied Charge or Non-covered Charge",
2200 "586" => "Line Note Text",
2201 "587" => "Measurement Reference Identification Code",
2202 "588" => "Medical Record Number",
2203 "589" => "Provider Accept Assignment Code",
2204 "590" => "Medicare Coverage Indicator",
2205 "591" => "Medicare Paid at 100% Amount",
2206 "592" => "Medicare Paid at 80% Amount",
2207 "593" => "Medicare Section 4081 Indicator",
2208 "594" => "Mental Status Code",
2209 "595" => "Monthly Treatment Count",
2210 "596" => "Non-covered Charge Amount",
2211 "597" => "Non-payable Professional Component Amount",
2212 "598" => "Non-payable Professional Component Billed Amount",
2213 "599" => "Note Reference Code",
2214 "600" => "Oxygen Saturation Qty",
2215 "601" => "Oxygen Test Condition Code",
2216 "602" => "Oxygen Test Date",
2217 "603" => "Old Capital Amount",
2218 "604" => "Originator Application Transaction Identifier",
2219 "605" => "Orthodontic Treatment Months Count",
2220 "606" => "Paid From Part A Medicare Trust Fund Amount",
2221 "607" => "Paid From Part B Medicare Trust Fund Amount",
2222 "608" => "Paid Service Unit Count",
2223 "609" => "Participation Agreement",
2224 "610" => "Patient Discharge Facility Type Code",
2225 "611" => "Peer Review Authorization Number",
2226 "612" => "Per Day Limit Amount",
2227 "613" => "Physician Contact Date",
2228 "614" => "Physician Order Date",
2229 "615" => "Policy Compliance Code",
2230 "616" => "Policy Name",
2231 "617" => "Postage Claimed Amount",
2232 "618" => "PPS-Capital DSH DRG Amount",
2233 "619" => "PPS-Capital Exception Amount",
2234 "620" => "PPS-Capital FSP DRG Amount",
2235 "621" => "PPS-Capital HSP DRG Amount",
2236 "622" => "PPS-Capital IME Amount",
2237 "623" => "PPS-Operating Federal Specific DRG Amount",
2238 "624" => "PPS-Operating Hospital Specific DRG Amount",
2239 "625" => "Predetermination of Benefits Identifier",
2240 "626" => "Pregnancy Indicator",
2241 "627" => "Pre-Tax Claim Amount",
2242 "628" => "Pricing Methodology",
2243 "629" => "Property Casualty Claim Number",
2244 "630" => "Referring CLIA Number",
2245 "631" => "Reimbursement Rate",
2246 "632" => "Reject Reason Code",
2247 "633" => "Related Causes Code (Accident, auto accident, employment)",
2248 "634" => "Remark Code",
2249 "635" => "Repriced Ambulatory Patient Group Code",
2250 "636" => "Repriced Line Item Reference Number",
2251 "637" => "Repriced Saving Amount",
2252 "638" => "Repricing Per Diem or Flat Rate Amount",
2253 "639" => "Responsibility Amount",
2254 "640" => "Sales Tax Amount",
2255 "642" => "Service Authorization Exception Code",
2256 "643" => "Service Line Paid Amount",
2257 "644" => "Service Line Rate",
2258 "645" => "Service Tax Amount",
2259 "646" => "Ship, Delivery or Calendar Pattern Code",
2260 "647" => "Shipped Date",
2261 "648" => "Similar Illness or Symptom Date",
2262 "649" => "Skilled Nursing Facility Indicator",
2263 "650" => "Special Program Indicator",
2264 "651" => "State Industrial Accident Provider Number",
2265 "652" => "Terms Discount Percentage",
2266 "653" => "Test Performed Date",
2267 "654" => "Total Denied Charge Amount",
2268 "655" => "Total Medicare Paid Amount",
2269 "656" => "Total Visits Projected This Certification Count",
2270 "657" => "Total Visits Rendered Count",
2271 "658" => "Treatment Code",
2272 "659" => "Unit or Basis for Measurement Code",
2273 "660" => "Universal Product Number",
2274 "661" => "Visits Prior to Recertification Date Count CR702",
2275 "662" => "X-ray Availability Indicator",
2276 "663" => "Entity's Group Name.",
2277 "664" => "Orthodontic Banding Date",
2278 "665" => "Surgery Date",
2279 "666" => "Surgical Procedure Code",
2280 "667" => "Real-Time requests not supported by the information holder, do not resubmit",
2281 "668" => "Missing Endodontics treatment history and prognosis",
2282 "669" => "Dental service narrative needed.",
2283 "670" => "Funds applied from a consumer spending account such as consumer directed/driven health plan (CDHP), Health savings account (H S A) and or other similar accounts",
2284 "671" => "Funds may be available from a consumer spending account such as consumer directed/driven health plan (CDHP), Health savings account (H S A) and or other similar accounts",
2285 "672" => "Other Payer's payment information is out of balance",
2286 "673" => "Patient Reason for Visit",
2287 "674" => "Authorization exceeded",
2288 "675" => "Facility admission through discharge dates",
2289 "676" => "Entity possibly compensated by facility.",
2290 "677" => "Entity not affiliated.",
2291 "678" => "Revenue code and patient gender mismatch",
2292 "679" => "Submit newborn services on mother's claim",
2293 "680" => "Entity's Country.",
2294 "681" => "Claim currency not supported",
2295 "682" => "Cosmetic procedure",
2296 "683" => "Awaiting Associated Hospital Claims",
2297 "684" => "Rejected. Syntax error noted for this claim/service/inquiry. See Functional or Implementation Acknowledgement for details. ",
2298 "685" => "Claim could not complete adjudication in real time. Claim will continue processing in a batch mode. Do not resubmit.",
2299 "686" => "The claim/ encounter has completed the adjudication cycle and the entire claim has been voided",
2300 "687" => "Claim estimation can not be completed in real time. Do not resubmit.",
2301 "688" => "Present on Admission Indicator for reported diagnosis code(s).",
2302 "689" => "Entity was unable to respond within the expected time frame.",
2303 "690" => "Multiple claims or estimate requests cannot be processed in real time.",
2304 "691" => "Multiple claim status requests cannot be processed in real time.",
2305 "692" => "Contracted funding agreement-Subscriber is employed by the provider of services",
2306 "693" => "Amount must be greater than or equal to zero.",
2307 "694" => "Amount must not be equal to zero.",
2308 "695" => "Entity's Country Subdivision Code.",
2309 "696" => "Claim Adjustment Group Code.",
2310 "697" => "Invalid Decimal Precision.",
2311 "698" => "Form Type Identification",
2312 "699" => "Question/Response from Supporting Documentation Form",
2313 "700" => "ICD10.",
2314 "701" => "Initial Treatment Date",
2315 "702" => "Repriced Claim Reference Number",
2316 "703" => "Advanced Billing Concepts (ABC) code",
2317 "704" => "Claim Note Text",
2318 "705" => "Repriced Allowed Amount",
2319 "706" => "Repriced Approved Amount",
2320 "707" => "Repriced Approved Ambulatory Patient Group Amount",
2321 "708" => "Repriced Approved Revenue Code",
2322 "709" => "Repriced Approved Service Unit Count",
2323 "710" => "Line Adjudication Information.",
2324 "711" => "Stretcher purpose",
2325 "712" => "Obstetric Additional Units",
2326 "713" => "Patient Condition Description",
2327 "714" => "Care Plan Oversight Number",
2328 "715" => "Acute Manifestation Date",
2329 "716" => "Repriced Approved DRG Code",
2330 "717" => "This claim has been split for processing.",
2331 "718" => "Claim/service not submitted within the required timeframe (timely filing).",
2332 "719" => "NUBC Occurrence Code(s)",
2333 "720" => "NUBC Occurrence Code Date(s)",
2334 "721" => "NUBC Occurrence Span Code(s)",
2335 "722" => "NUBC Occurrence Span Code Date(s)",
2336 "723" => "Drug days supply",
2337 "724" => "Drug dosage",
2338 "725" => "NUBC Value Code(s)",
2339 "726" => "NUBC Value Code Amount(s)",
2340 "727" => "Accident date",
2341 "728" => "Accident state",
2342 "729" => "Accident description",
2343 "730" => "Accident cause",
2344 "731" => "Measurement value/test result",
2345 "732" => "Information submitted inconsistent with billing guidelines.",
2346 "733" => "Prefix for entity's contract/member number.",
2347 "734" => "Verifying premium payment",
2348 "735" => "This service/claim is included in the allowance for another service or claim.",
2349 "736" => "A related or qualifying service/claim has not been received/adjudicated.",
2350 "737" => "Current Dental Terminology (CDT) Code",
2351 "738" => "Home Infusion EDI Coalition (HEIC) Product/Service Code",
2352 "739" => "Jurisdiction Specific Procedure or Supply Code",
2353 "740" => "Drop-Off Location",
2354 "741" => "Entity must be a person.",
2355 "742" => "Payer Responsibility Sequence Number Code",
2356 "743" => "Entity’s credential/enrollment information.",
2357 "744" => "Services/charges related to the treatment of a hospital-acquired condition or preventable medical error.",
2358 "745" => "Identifier Qualifier",
2359 "746" => "Duplicate Submission",
2360 "747" => "Hospice Employee Indicator",
2361 "748" => "Corrected Data",
2362 "749" => "Date of Injury/Illness",
2363 "750" => "Auto Accident State or Province Code",
2364 "751" => "Ambulance Pick-up State or Province Code",
2365 "752" => "Ambulance Drop-off State or Province Code",
2366 "753" => "Co-pay status code.",
2367 "754" => "Entity Name Suffix.",
2368 "755" => "Entity's primary identifier.",
2369 "756" => "Entity's Received Date.",
2370 "757" => "Last seen date.",
2371 "758" => "Repriced approved HCPCS code.",
2372 "759" => "Round trip purpose description.",
2373 "760" => "Tooth status code.",
2374 "761" => "Entity's referral number.",
2375 "762" => "Locum Tenens Provider Identifier. Code must be used with Entity Code 82 - Rendering Provider",
2376 "763" => "Ambulance Pickup ZipCode",
2377 "764" => "Professional charges are non covered.",
2378 "765" => "Institutional charges are non covered.",
2379 "766" => "Services were performed during a Health Insurance Exchange (HIX) premium payment grace period.",
2380 "767" => "Qualifications for emergent/urgent care",
2381 "768" => "Service date outside the accidental injury coverage period.",
2382 "769" => "DME Repair or Maintenance",
2383 "770" => "Duplicate of a claim processed or in process as a crossover/coordination of benefits claim.",
2384 "771" => "Claim submitted prematurely. Please resubmit after crossover/payer to payer COB allotted waiting period.",
2385 "772" => "The greatest level of diagnosis code specificity is required.",
2386 );
2387
2388
2389 //
2390 //
2391 }
2392 // end code271  array
2393 //
2394         // edih_271_codes
2395         public function classname() { return get_class($this); }
2396         //
2397         public function get_271_code($elem, $code) {
2398                 //
2399                 $e = (string)$elem;
2400                 $val = '';
2401                 if ( ($this->ds && strpos($code, $this->ds) !== false) || ($this->dr && strpos($code, $this->dr) !== false) ) {
2402                         if ($this->ds && strpos($code, $this->ds) !== false ) {
2403                                 $cdar = explode($this->ds, $code);
2404                                 foreach($cdar as $cd) {
2405                                         if ($this->dr && strpos($code, $this->dr) !== false) {
2406                                                 $cdar2 = explode($this->dr, $code);
2407                                                 foreach($cdar2 as $cd2) {
2408                                                         if (isset($this->code271[$e][$cd2]) ) {
2409                                                                 $val .= $this->code271[$e][$cd2] . '; ';
2410                                                         } else {
2411                                                                 $val .= "code $cd2 N/A ";
2412                                                         }
2413                                                 }
2414                                         } else {
2415                                                 $val .= (isset($this->code271[$e][$cd]) ) ? $this->code271[$e][$cd].' ' : "code $cd unknown";
2416                                         }
2417                                 }
2418                         } elseif ($this->dr && strpos($code, $this->dr) !== false) {
2419                                 $cdar = explode($this->dr, $code);
2420                                 foreach($cdar as $cd) {
2421                                         $val .= (isset($this->code271[$e][$cd]) ) ? $this->code271[$e][$cd].'; ' : "code $cd unknown";
2422                                 }
2423                         }
2424                 } elseif ( array_key_exists($e, $this->code271) ) {
2425                         $val = (isset($this->code271[$e][$code]) ) ? $this->code271[$e][$code] : "$elem code $code unknown";
2426                 } else {
2427                         $val = "$e codes not available ($code)";
2428                 }
2429                 //
2430                 return $val;
2431         }
2432         //
2433         public function get_keys() {
2434                 return array_keys($this->code271);
2435         }
2436 }