UB04 - 文档类型

概述

UB-04 或 CMS-1450 是医疗保健提供者使用的标准化索赔表，用于向医疗保险、医疗补助和私人保险机构服务收取费用。其中包含有关患者、所提供服务和产生成本的基本详细信息，从而简化了医疗机构的报销流程。

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

特殊性

该技能经过训练，可以自动检测以下数据：

• 账单名称、账单地址、账单税号；
• 患者姓名、患者地址、患者出生日期；
• 入院日期、入院时间、就诊类型；
• 值代码，值金额。

Extracted fields

备注：

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

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

示例

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

您还可以预览已填写表单的示例：