1500
UB-04
1500
1500 and UB-04 Grouped by HMS Field
Most HMS data comes from either the 1500 or the UB-04.
The three HMS fields that get data from both forms are in italics in the HMS Services Fields in the left column.
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HMS gets data from the 1500 and UB-04 forms.
On this page, the color of the HMS text matches the color of the 1500 and/or UB-04 field where the data comes from.
HMS Services Fields:
- 8 PAT-STATUS-CODE
- 35 TPL-ACCIDENT-INDICATOR
- 54 ADMIT-DATE-CCYYMMDD
- 55 ADMIT-HOUR
- 84 ADMIT-TYPE
- 88 SOURCE-OF-ADMISSION
- 16 DISCHARGE-HOUR
- 36 PRIMARY-DIAG
- 37 ADMITTING-DIAGNOSIS
- 38 SECONDARY-DIAG
- 45 DX-3
- 46 DX-4
- 47 CLAIM-FROM-DOS-CCYYMMDD
- 47 CLAIM-THRU-DOS-CCYYMMDD
- 49 PLACE-OF-SERVICE
- 50 CLAIM-EMERGENCY-INDICATOR
- 51 CLAIM-UNIT-VISTS-DAYS
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131 LINE-ITEM-UNITS