UM01 — Request Category Code (X12 element 1525)
SC — Specialty Care Review
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.
How SC is used
Sent in UM01 when the plan's UM program treats specialist referrals as a distinct review type. The referred-to provider appears in the appropriate provider loop, and the number of authorized visits may be returned in the response's HSD segment.
Example
A gatekeeper-model plan requires PCP referrals to dermatology to be certified: the PCP's office submits a 278 with UM01 = SC identifying the dermatologist as the service provider.
Where it lives in the transaction
SC is a value of UM01 — Request Category Code (X12 element 1525), carried in the UM (Health Care Services Review Information), 2000E/2000F loops 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.