UM01 Request Category Codes
UM01 — Request Category Code (X12 element 1525)
UM (Health Care Services Review Information), 2000E/2000F loops · 278 Health Care Services Review (005010X217)
Draft — pending verification
This reference entry has not yet been verified against its authoritative source (X12 005010X217 TR3 — verify against licensed copy). Do not rely on it for production configuration until this notice is removed.
| Code | Name | Summary |
|---|---|---|
| AR | Admission Review | Identifies the 278 request as a review of a facility admission — the submitter is asking the utilization management organization to certify an inpatient admission (or review one already in progress). |
| HS | Health Services Review | The general-purpose request category for prior authorization of health services — outpatient procedures, imaging, therapies, DME, and most non-admission events. |
| SC | Specialty Care Review | Identifies the request as a specialty care review — commonly a referral from a primary care provider to a specialist that the plan requires to be reviewed or certified before the specialist visit occurs.. |