HCR Health Care Services Review

To specify the outcome of a health care services review

Position
Element
Name
Type
Requirement
Min
Max
Repeat
HCR-01
Action Code
Identifier (ID)
Mandatory
1
2
-
Code indicating type of action
HCR-02
Reference Identification
String (AN)
Optional
1
30
-
Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier
HCR02 is the number assigned by the information source to this review outcome.
HCR-03
Reject Reason Code
Identifier (ID)
Optional
2
2
-
Code assigned by issuer to identify reason for rejection
HCR-04
Yes/No Condition or Response Code
Identifier (ID)
Optional
1
1
-
Code indicating a Yes or No condition or response
HCR04 is the second surgical opinion indicator. A "Y" value indicates a second surgical opinion is required; an "N" value indicates a second surgical opinion is not required for this request.

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