What does 86 mean in UM03?

86 (Emergency Services): Emergency services. Prior authorization cannot be required for emergency care under the prudent layperson standard; 278 usage here is about notification and downstream concurrent review of resulting admissions, not pre-service approval.

UM03 — Service Type Code (X12 element 1365)

86 — Emergency Services

Draft — pending verification

This reference entry has not yet been verified against its authoritative source (X12 element 1365 external code list — verify against licensed copy). Do not rely on it for production configuration until this notice is removed.

How 86 is used

Appears in notification-style flows (e.g., ER-to-inpatient admission notices) rather than true prior-auth requests.

Example

UM03 = 86 on an admission notification following an emergency department visit.

Where it lives in the transaction

86 is a value of UM03 — Service Type Code (X12 element 1365), carried in the UM (Health Care Services Review Information); same element is used in EQ01 of the 270/271 of the 278 Health Care Services Review (005010X217). For the payer-side view of how PA Bridge normalizes these codes across X12 and FHIR intake, see the articles section.