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| Value Information Group Definition | ||||
| Format-Length: | Required For: See Below | |||
| Effective Date: 1/1/94 | Revision Date: September 2003 | |||
| NOTE: | This is a composite data element. Up to 12 Value Codes and Amounts can be reported. For mapping guidelines refer to the Inpatient and Outpatient 837 Addenda. |
| National Standard Mapping: | |||||||
Electronic - 837I |
X12 Loop |
Ref. Des. |
Data Element |
Code |
Description |
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| Version 4050R | 2300 | HI01-1 | 1270 | BE | Value Code Qualifier | ||
| HI01-2 | 1271 | Value Code | |||||
| HI01-5 | 782 | Value Code Associated Amount |
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| Paper Form | Locator | Code Qualifier | |||||
| Institutional - UB-04 | 39-41 | N/A | |||||
Definition:
A code structure to relate amounts or values to identified data elements necessary to process this claim as qualified by the payer organization. The elements listed below are collected by SPARCS as Value Codes.
- Ambulatory Surgery Only:
- Accident Hour
- Emergency Department Only:
- Accident Hour
- Inpatient Only:
- Workers' Compensation/No-Fault Indicator
- Surplus, Catastrophic, or Recurring Monthly Income Code and Amount
- Blood Furnished Code and Amount
- Neonate Birth Weight
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