ActReason
|
| Lvl |
Type, Domain name and/or Mnemonic code |
Concept ID |
Mnemonic |
Print Name |
Definition/Description |
| 1
|
A: ActAccommodationReason |
V17425 |
|
|
Identifies the reason the patient is assigned to this accommodation type
|
| 2
|
L: (ACCREQNA)
|
17429 |
ACCREQNA |
Accommodation Requested Not Available |
Accommodation requested is not available.
|
| 2
|
L: (FLRCNV)
|
17430 |
FLRCNV |
Floor Convenience |
Accommodation is assigned for floor convenience.
|
| 2
|
L: (MEDNEC)
|
17428 |
MEDNEC |
Medical Necessity |
Accommodation required for medical reason(s).
|
| 2
|
L: (PAT)
|
14880 |
PAT |
Patient request |
The Patient requested the action
|
| 1
|
A: ActIneligibilityReason |
V19355 |
|
|
Identifies the reason or rational for why a person is not eligibile for benefits under an insurance policy.
Examples are client deceased & adopted client has been given a new policy identifier.
|
| 2
|
L: (COVSUS)
|
19731 |
COVSUS |
coverage suspended |
When a client has no contact with the health system for an extended period, coverage is suspended. Client will be reinstated
to original start date upon proof of identification, residency etc.
|
| 2
|
L: (DECSD)
|
19729 |
DECSD |
deceased |
Client deceased.
|
| 2
|
L: (REGERR)
|
19730 |
REGERR |
registered in error |
Client was registered in error. Coverage and cancel dates will be the same date.
|
| 1
|
A: ActInvoiceCancelReason |
V19356 |
|
|
Domain specifies the codes used to describe reasons why a Provider is cancelling an Invoice or Invoice Grouping.
|
| 2
|
L: (INCCOVPTY)
|
19733 |
INCCOVPTY |
incorrect covered party as patient |
The covered party (patient) specified with the Invoice is not correct.
|
| 2
|
L: (INCINVOICE)
|
19735 |
INCINVOICE |
incorrect billing |
The billing information, specified in the Invoice Elements, is not correct. This could include incorrect costing for items
included in the Invoice.
|
| 2
|
L: (INCPOLICY)
|
19734 |
INCPOLICY |
incorrect policy |
The policy specified with the Invoice is not correct. For example, it may belong to another Adjudicator or Covered Party.
|
| 2
|
L: (INCPROV)
|
19736 |
INCPROV |
incorrect provider |
The provider specified with the Invoice is not correct.
|
| 1
|
A: ActPaymentReason |
V17432 |
|
|
Provides rationale for payment or adjustment.
|
| 2
|
A: ActPaymentAdjustmentReason |
V17433 |
|
|
Adjustments to payments (debit or credit) initiated by the payor such as retroactive adjustments and education fees.
|
| 3
|
L: (BONUS)
|
17436 |
BONUS |
Bonus |
Bonus payments based on performance, volume, etc. as agreed to by the payor.
|
| 3
|
L: (EDU)
|
17438 |
EDU |
Education Fees |
Fees deducted on behalf of a payee for tuition and continuing education.
|
| 3
|
L: (PROA)
|
17435 |
PROA |
Professional Association Deduction |
Professional association fee that is collected by the payor from the practitioner/provider on behalf of the association.
|
| 3
|
L: (RECOV)
|
17437 |
RECOV |
Recovery |
Deduction of monies owed to the payor due to previous overpayments to the payee.
|
| 3
|
L: (RETRO)
|
17434 |
RETRO |
Retro Adjustment |
Retroactive adjustment such as fee rate adjustment due to contract negotiations.
|
| 2
|
L: (INVOICE)
|
19726 |
INVOICE |
submitted invoice |
Payment is based on a payment intent for a previously submitted Invoice, based on formal adjudication results.
|
| 2
|
L: (TRAN)
|
19727 |
TRAN |
transaction fee |
Fees deducted on behalf of a payee for charges based on a per-transaction or time-period (e.g. monthly) fee.
|
| 1
|
A: SchedulingActReason |
V14879 |
|
|
Reasons for cancelling or rescheduling an Appointment
|
| 2
|
L: (BLK)
|
14885 |
BLK |
Unexpected Block (of Schedule) |
The time slots previously allocated are now blocked and no longer available for booking Appointments
|
| 2
|
L: (DEC)
|
14884 |
DEC |
Patient Deceased |
The Patient is deceased
|
| 2
|
L: (FIN)
|
14882 |
FIN |
No Financial Backing |
Patient unable to pay and not covered by insurance
|
| 2
|
L: (MED)
|
14883 |
MED |
Medical Status Altered |
The medical condition of the Patient has changed
|
| 2
|
L: (MTG)
|
14886 |
MTG |
In an outside meeting |
The Physician is in a meeting. For example, he/she may request administrative time to talk to family after appointment
|
| 2
|
L: (PAT)
|
14880 |
PAT |
Patient request |
The Patient requested the action
|
| 2
|
L: (PHY)
|
14881 |
PHY |
Physician request |
The Physician requested the action
|
| 1
|
A: TransferActReason |
V15983 |
|
|
The explanation for why a patient is moved from one location to another within the organization
|
| 2
|
L: (ER)
|
15984 |
ER |
Error |
Moved to an error in placing the patient in the original location.
|
| 2
|
L: (RQ)
|
15985 |
RQ |
Request |
Moved at the request of the patient.
|
| 1
|
L: (MEDNEC)
|
17428 |
MEDNEC |
Medical Necessity |
Accommodation required for medical reason(s).
|
| 1
|
L: (PAT)
|
14880 |
PAT |
Patient request |
The Patient requested the action
|