UM02 Certification Type Codes
UM02 — Certification Type Code (X12 element 1322)
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 |
|---|---|---|
| I | Initial | The first request for certification of this admission, service, or referral. |
| R | Renewal | A request to renew an existing certification for a further period or additional units — the prior certification is expiring or exhausted and the requester is asking for a new certification of the same service.. |
| S | Revised | A request to revise an existing certification — the service, dates, provider, or quantities originally certified have changed and the certification needs to be modified to match what will actually occur.. |
| 1 | Appeal — Immediate | An immediate (expedited) appeal of an adverse determination. |
| 2 | Appeal — Standard | A standard (non-expedited) appeal of an adverse determination, processed on the plan's normal appeal timeline. |
| 3 | Cancel | A request to cancel an existing certification — the certified admission, service, or referral will not occur, and the requester is notifying the UM organization so the certification can be voided.. |
| 4 | Extension | A request to extend an existing certification — same service, same terms, but more time (or a continued stay) beyond what was originally certified. |