CMS 1500 (米国の医療保険請求フォーム) - ドキュメントの種類

概要

CMS-1500 は医療保険請求の標準フォームであり、施設外の医療従事者や医療提供者がメディケア対応保険会社や DMERCS (Durable Medical Equipment Regional Carriers) に請求する場合に使用します。また、一部のメディケイド州当局の請求にも使用されます。

この ML パッケージは、キー情報を自動的に検出して、この種類のフォームから関連データを抽出するようトレーニングされています。80 以上のフィールドがあり、このフォームに含まれる可能性があるあらゆる種類の情報をカバーします。

詳細

このモデルは、以下のようなデータを自動的に検出します。

• Payer Name and Address (支払者の名前と住所)。
• Patient Address (患者の住所)、Telephone (電話番号)、DoB (生年月日)。
• Insurer Name and Address (保険会社の名前と住所)。
• Date of Illness (症状が現れた日)、Claim Information (請求情報)、Hospitalization Date (入院日)。
• Nature of Illness (症状)、Diagnosis Nature (診断)、Date of Service (受診日)、Place of Service (受診地)。

Extracted fields

注:

If you are using using public endpoints, such as https://du.uipath.com/ie/invoices, all fields are available. However, if you are using custom-trained extractors, the availability of extracted fields is dependant on the version you are currently using. You can also check the list of fields and types on any endpoint in the /info/model object. To access this, simply add /info/model to any endpoint, like so: https://du.uipath.com/ie/invoices/info/model. For an enhanced reading experience of the fields list, it's recommended to install a JSON viewer extension in your browser.

Table 1. List of extracted fields for CMS 1500

表示名	フィールド名	フィールドの種類	コンテンツの種類
Payment Name	payment-name	regular	string
Payment Address	payment-address	regular	string
Health Insurance Coverage Type	health-insurance-coverage-type	regular	string
Insured's I.D Number	insured-s-i-d-number	regular	string
Patient's Name	patient-name	regular	string
Patient's Address	patient-address	regular	string
Patient's Birthdate	patient-birthdate	regular	Date
Patient Relationship To Insured	patient-relationship-to-insured	regular	string
Insured's Name	insured-name	regular	string
Insured Address	insured-address	regular	string
Other Insured's Name	other-insured-name	regular	string
Other Insured's I.D.	other-insured-id	regular	string
Patient's Condition Related To Employment	condition-employment	regular	string
Patient's Condition Related To Auto Accident	condition-auto-accident	regular	string
Auto Accident State	auto-accident-state	regular	string
Insured Policy Group Or Feca Number	insured-policy-feca-id	regular	string
Insured's Birth Date	insured-birth-date	regular	Date
Insured's Gender	insured-sex	regular	string
Other Claim ID	other-claim-id	regular	string
Insurance Plan Name	insurance-plan-name	regular	string
Another Health Benefit Plan	another-health-plan	regular	string
Claim Codes	claim-codes	regular	string
Other Insurance Plan Name	other-insurance-plan	regular	string
Patient's Signature	patient-signature	regular	string
Patient's Signature Date	patient-signature-date	regular	Date
Insured's Signature	insured-signature	regular	string
Current Health Condition Date	health-condition-date	regular	Date
Current Health Qualifier	current-health-qualifier	regular	string
Other Health Condition Date	other-health-condition-date	regular	Date
Other Health Condition Qualifier	other-health-condition-qualifier	regular	string
Patient Unable To Work Date From	unable-to-work-date-from	regular	Date
Unable To Work To	unable-to-work-to	regular	Date
Name Of Referring Provider	name-of-referring-provider	regular	string
Referring Provider ID	referring-provider-id	regular	string
Referring Provider NPI	referring-provider-npi	regular	string
Hospitalization Dates From	hospitalization-dates-from	regular	Date
Hospitalization Dates To	hospitalization-dates-to	regular	Date
Additional Claim Information	additional-claim-information	regular	string
Services Outside Lab	services-outside-lab	regular	string
Charges	outside-lab-charges	regular	string
Diagnosis Codes	diagnosis-codes	regular	string
ICD Indicator	icd-indicator	regular	string
Resubmission Code	resubmission-code	regular	string
Original Reference Code	original-reference-code	regular	string
Prior Authorization Number	prior-authorization-number	regular	string
Patient's Account Number	patient-account-number	regular	string
Total Charge	total-charge	regular	string
Amount Paid	amount-paid	regular	string
Signature Of Physician Or Supplier	signature-of-physician-or-supplier	regular	string
Physician Or Supplier Signature Date	physician-supplier-signature-date	regular	Date
Service Facility Location NPI	service-location-npi	regular	string
Service Facility Location ID Number	service-location-id	regular	string
Billing Name	billing-name	regular	string
Billing Address	billing-address	regular	string
Billing Phone Number	billing-phone-number	regular	string
Billing NPI	billing-npi	regular	string
Billing ID	billing-id	regular	string
Patient's Phone Number	patient-phone-number	regular	string
Insured Phone Number	insured-phone-number	regular	string
Patient's Condition Related To Other Accident	condition-other-accident	regular	string
Reported ID Number	reported-id-number	regular	string
Assignment Acceptance	assignment-acceptance	regular	string
Patient Gender	patient-gender	regular	string
Federal Tax ID Number	federal-tax-id-number	regular	string
Service Facility Name	service-facility-name	regular	string
Service Facility Address	service-facility-address	regular	string
Medical Service Details - Date Of Service From	date-of-service-from	items	Date
Medical Service Details - Date Of Service To	date-of-service-to	items	Date
Medical Service Details - Place Of Service	place-of-service	items	string
Medical Service Details - CPT/HCPCS	cpt-hcpcs-number	items	string
Medical Service Details - Modifier	modifier	items	string
Medical Service Details - Diagnosis Pointer	diagnosis-pointer	items	string
Medical Service Details - Charges Amount	charges	items	string
Medical Service Details - Days Or Units	days-or-units	items	string
Medical Service Details - EPSDT Codes	epsdt-codes	items	string
Medical Service Details - EPSDT Family Planning	epsdt-family-planning	items	string
Medical Service Details - ID Qualifier	id-qualifier	items	string
Medical Service Details - Rendering Provider NPI	rendering-provider-npi	items	string
Medical Service Details - Rendering Provider Other ID	rendering-provider-other-id	items	string
Medical Service Details - Supplemental Information	supplemental-information	items	string
Medical Service Details - Emergency Indicator	emergency-indicator	items	string

サンプル

以下に入力済みのフォームの例を示します。