EDI Dictionary

Transaction Sets Segments

EDI-Dictionary

4010

CR5

CR5 Oxygen Therapy Certification

Batch

To supply information regarding certification of medical necessity for home oxygen therapy

Elements

Position	Element	Name		Type	Min/Max	Repeat

1	1322	Certification Type Code	Opt	ID	1/1	1
2	380	Quantity	Opt	Decimal	1/15	1
3	1348	Oxygen Equipment Type Code	Opt	ID	1/1	1
4	1348	Oxygen Equipment Type Code	Opt	ID	1/1	1
5	352	Description	Opt	Alphanumeric	1/80	1
6	380	Quantity	Opt	Decimal	1/15	1
7	380	Quantity	Opt	Decimal	1/15	1
8	380	Quantity	Opt	Decimal	1/15	1
9	352	Description	Opt	Alphanumeric	1/80	1
10	380	Quantity	Opt	Decimal	1/15	1
11	380	Quantity	Opt	Decimal	1/15	1
12	1349	Oxygen Test Condition Code	Opt	ID	1/1	1
13	1350	Oxygen Test Findings Code	Opt	ID	1/1	1
14	1350	Oxygen Test Findings Code	Opt	ID	1/1	1
15	1350	Oxygen Test Findings Code	Opt	ID	1/1	1
16	380	Quantity	Opt	Decimal	1/15	1
17	1382	Oxygen Delivery System Code	Opt	ID	1/1	1
18	1348	Oxygen Equipment Type Code	Opt	ID	1/1	1

Element Details

ID1322

NameCertification Type Code

LengthMin 1 / Max 1

Position1

RequirementOpt

Codes

<>ACertification of Current Cost and Pricing Data
<>1Appeal - Immediate
<>DFinal
<>4Extension
<>BCertification of Overhead
<>2Appeal - Standard
<>RRenewal
<>ERecertification
<>5Notification
<>CCertification Not Required
<>3Cancel
<>SRevised
<>6Verification
<>IInitial