United States Health Information Knowledgebase

 

Data Elements Related to Universal Claim Form

Name: Universal Claim Form
Definition: For Telecommunication 5.1, D.0, and Workers' Compensation/Property and Casualty manual claims processing.
Results 1-10 of 77

sort Name
sort Definition
Basis Of Cost DeterminationCode indicating the method by which 'Ingredient Cost Submitted' (Field 409-D9) was calculated.
BIN NumberCard Issuer ID or Bank ID Number used for network routing.
Cardholder First NameIndividual first name.
Cardholder IDInsurance ID assigned to the cardholder or identification number used by the plan.
Cardholder Last NameIndividual last name.
Compound Dispensing Unit Form IndicatorNCPDP standard product billing codes.
Compound Dosage Form Description CodeDosage form of the complete compound mixture.
Compound Ingredient Basis of Cost DeterminationCode indicating the method by which the drug cost of an ingredient used in a compound was calculated.
Compound Ingredient Component CountCount of compound product IDs (both active and inactive) in the compound mixture submitted.
Compound Ingredient Drug CostIngredient cost for the metric decimal quantity of the product included in the compound mixture indicated in 'Compound Ingredient Quantity' (Field 448-ED).
Scroll To Top