UB-04 (健康保険請求フォーム) - ドキュメントの種類

概要

UB-04 (健康保険請求フォーム) または CMS-1450 (健康保険請求フォーム) は、医療提供者が実施した医療サービスの費用を Medicare、Medicaid、および民間保険会社に請求するために使用する、標準化された請求フォームです。患者、提供された医療サービス、および発生した費用に関する重要な詳細が含まれており、医療施設の償還プロセスを合理化します。

This Document Understanding^TM skill is extracting 26 regular fields and 6 column fields containing key data points of the UB04.

詳細

このスキルは、以下のようなデータを自動的に検出するようトレーニングされています。

• Billing Name (請求先宛名)、Billing Address (請求先住所)、Billing Tax ID Number (請求先の納税者番号)
• Patient Name (患者名)、Patient Address (患者の住所)、Patient DoB (患者の生年月日)
• Admission Date (入院日)、Admission Hour (入院時間)、Type of Visit (入院の種類)
• Value Code (金額コード)、Value Amount (金額)

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 UB04

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
Federal Tax Number	billing-tax-id-number	regular	string
Patient Name	patient-name	regular	string
Patient Address	patient-address	regular	string
Birthdate	patient-birthdate	regular	Date
Patient Gender	patient-gender	regular	string
Type of Bill	bill-notype	regular	string
Total Amount	total-amount	regular	Number
Other Procedure Codes	other-procedure-code	regular	string
Other Procedure Dates	other-procedure-date	regular	Date
Statement Covers Period From	statement-period-from	regular	Date
Statement Covers Period Through	statement-period-to	regular	Date
Admission Date	admission-date	regular	Date
Admission Hour	admission-hour	regular	Number
Admission Type	type-of-visit	regular	Number
Discharge Hour	discharge-hour	regular	Number
Principal Procedure Date	principal-procedure-date	regular	Date
Condition Codes	condition-code	regular	id-no
作成日	creation-date	regular	Date
プロバイダー名	provider-name	regular	string
Provider Address	provider-address	regular	string
Payment Name	payment-name	regular	string
Payment Address	payment-address	regular	string
Patient Control Number	patient-control-number	regular	string
Medical Record Number	medical-record-number	regular	string
Patient Identifier	patient-identifier	regular	string
Source Of Referral	source-of-referral	regular	string
Patient Status	patient-status	regular	string
Accident State	accident-state	regular	string
Billing Name	billing-name	regular	string
Billing Address	billing-address	regular	string
Page Number	page-number	regular	string
Number Of Pages	number-of-pages	regular	string
Total Amount Non-Covered Charges	total-non-covered-amount	regular	string
National Provider Identifier	npi	regular	string
Primary Provider ID	primary-provider-id	regular	string
Other Provider ID	other-provider-id	regular	string
Provider ID	tertiary-provider-id	regular	string
ICD Version Idicator	icd-version-indicator	regular	string
Principal Diagnosis Code	principal-diagnosis-code	regular	string
Other Diagnosis Codes	67-other-diagnosis-codes	regular	string
Admitting Diagnosis	69-admitting-diagnosis	regular	string
Patient Reason For Visit	patient-reason-for-visit	regular	string
PPS Code	pps-code	regular	string
ECI Code	eci-code	regular	string
Principal Procedure Code	principal-procedure-code	regular	string
備考	remarks	regular	string
Authorization and Employer Information - Treatment Authorization Codes	treatment-codes	items	string
Authorization and Employer Information - Document Control Number	document-control-number	items	string
Authorization and Employer Information - Employer Name	employer-name	items	string
Code-Code - Qualifier Codes	qualifier-codes	items	string
Code-Code - ID 1	id-1	items	string
Code-Code - ID 2	id-2	items	string
Insured Informations - Insured's Name	insured-name	items	string
Insured Informations - Patient's Relationship	patient-relationship	items	string
Insured Informations - Insured's Unique ID	insured-unique-id	items	string
Insured Informations - Group Name	group-name	items	string
Insured Informations - Insurance Group Number	insurance-group-number	items	string
Medical Service Details - Revenue Codes	revenue-codes	items	string
Medical Service Details - Description	説明	items	string
Medical Service Details - HCPCS/Rate/Hipps Code	hcpcs-rate-hipps-code	items	string
Medical Service Details - Service Date	service-date	items	string
Medical Service Details - Service Units	service-units	items	string
Medical Service Details - Total Charges	total-charges	items	string
Medical Service Details - Non-Covered Charges	non-covered-charges	items	string
Occurrence - Occurrence Code	occurence-code	items	string
Occurrence - Occurrence Date	occurrence-date	items	Date
Occurrence Span - Occurrence Span Code	occurrence-span-code	items	string
Occurrence Span - Occurrence Span From	occurrence-span-from	items	string
Occurrence Span - Occurrence Span Through	occurrence-span-through	items	string
Payer Informations - Payer Name	payer-name	items	string
Payer Informations - Health Plan ID	health-plan-id	items	string
Payer Informations - Release Of Information	release-of-information	items	string
Payer Informations - Assignment Of Benefits	assignment-of-benefits	items	string
Payer Informations - Prior Payments	prior-payments	items	string
Payer Informations - Estimated Amount Due	estimated-amount-due	items	string
Physician Information - Physician NPI	physician-npi	items	string
Physician Information - Physician Qualifier	physician-qualifier	items	string
Physician Information - Physician ID	physician-id	items	string
Physician Information - Physician Name	physician-name	items	string
Value Codes and Amounts - Value Codes	value-codes	items	string
Value Codes and Amounts - Value Codes Amount	value-codes-amount	items	string

サンプル

You can download a sample filled-in form from here.

また、入力済みのフォームのサンプルのプレビューは以下のとおりです。