How to Read the Monthly Referral Extract
Monthly Referral Extract includes Referral Authorization detail based on the following:
Report
Description

Records all status with activity in a calendar month (regardless of entry date).
Monthly Referral Extract is sorted in order by patient name, notification, record version, and procedure
line items.
Monthly Referral Extract is distributed to each RSG / Command via the UHC M&V A2D portal the first
week of each calendar month.
Report Information
Report Heading
Description
Output
Beneficiary Full Name
Full Name of Beneficiary
Last name, first name, middle name
Beneficiary DOB
Birthdate of the Beneficiary
Date of Birth
Sponsor SSN
Sponsor’s Social Security Number.
Sponsor’s SSN
Consult Tracking
Flag of referral requiring consult tracking process
Consult Y/N
Enrollment DMIS
Beneficiary identification number. Also called DOD #.
EDIPN Number
Enrolling MTF
Military Treatment Ffacility ID # where the beneficiary is
enrolled as primary facility
DMIS ID #
Enrolling MTF Name
Military Treatment Ffacility name where the beneficiary is
enrolled as primary facility Primary Diagnosis Standard
ICD9 code.
Faciity Name
Referring MTF ID
Military Treatment fFacility ID# referring enrollee
DMIS ID #
Referring MTF Name
Military Treatment fFacility name referring enrollee
Faciity Name
Unique Identification Number for Referral Authorization
Request.
(Similar to an “order number”.)
MTF order number or UIN
Format: XXXX-YYMMDD-ZZZZZ or
XXXXYYMMDDZZZZZ
XXXX - Referring DMIS ID
YYMMDDDate MTF initiated Referral
Authorization Request.
ZZZZZ- Sequential Number
UIN Number
Blank – 1) Referral Authorization Request
did not come directly from an MTF.
Unique system assigned number identifying Referral/
Authorization Request.
Referral Authorization Number
Format: Xnnnnnnnn
If Referral, X=7.
If Prior Auth-OP, X=4.
If Prior Auth-IN, X=1.
Authorization Number
Procedure begin date requested
Start date of procedure requested
Date
UHCMV1009_02272014 How To Read the Monthly Notification Extract
Page 1
Contains commercial information of UnitedHealth Military & Veterans Services, LLC and is protected under 5 U.S.C. 552(b)(4), and, as such, may not be used, disclosed or
reproduced, in whole or in part, outside the Government, without the express written permission of UnitedHealth Military & Veterans Services, LLC.
Procedure end date authorized
Date which procedure must be completed by
Date
Requesting provider name
Name of provider requesting procedure
Facility name
Servicing Provider Name
Facility name of treatment provider
Facility name
Diagnosis code
Five digit code referring to treatment / procedure
Diagnosis code
Diagnosis description
Description of procedure referred to in diagnosis code
Description of code referred too
Procedure quantity
Number of units authorized for each procedure
Number
Low procedure code
Lowest number within a code range for a type of
treatment
Five digit number
High procedure code
Highest number within a code range for a type of
treatment
Five digit number
Service Status Code
Status = Open, Closed, Complete, Cancelled –record
deleted,
Most recent status of each unique record
Service status reason
Short description correlating to Service service status
code
Description of service code
Low Procedure procedure
description
Description correlating to Low procedure code
Short description of procedure code
Notification update date and
time
Date time stamp of referral authorization or notification
Date/Time
Report Date
Date the report was generated
Report run date
Record version
Count of unique record versions
Tracking the number of times record has
been updated within the report period
Record source
Data tables from which data merge provides output
Source table name
UHCMV1009_02272014 How To Read the Monthly Notification Extract
Page 2
Contains commercial information of UnitedHealth Military & Veterans Services, LLC and is protected under 5 U.S.C. 552(b)(4), and, as such, may not be used, disclosed or
reproduced, in whole or in part, outside the Government, without the express written permission of UnitedHealth Military & Veterans Services, LLC.
Open Status Codes & Reasons
Status Codes
Status Reasons
Referral & Auth Requests Record Types
Open
In process
Referrals
Open
Pended for more information
Referrals
Open
Case open
Prior Auths-OP & Prior Auths-IP
Anticipated Admission
AN completed awaiting admission
Prior Auths-OP & Prior Auths-IP
Anticipated Admission
AN under ueview
Prior Auths-OP & Prior Auths-IP
Complete/Closed Status Codes & Reasons
Status Codes
Status Reasons
Referral & Auth Requests Record Types
Complete
Approved Referral
Referrals
Complete
Non-Covered Beneficiary
Referrals
Denied
Secondary referral denied
Referrals
Closed
Closed Case was managed & now complete
Prior Auths-OP & Prior Auths-IP
Closed
Ineligible
Prior Auths-OP & Prior Auths-IP
Closed
Notifications requirements met
Prior Auths-OP & Prior Auths-IP
Closed
Patient expired
Prior Auths-OP & Prior Auths-IP
Closed
Pre-determination decision given
Prior Auths-OP & Prior Auths-IP
Cancelled Status Codes & Reasons
Status Codes
Status Reasons
Referral & Auth Requests Record Types
Cancelled
Inter-region transfer
Referrals
Cancelled
Patient Deceased / Expired
Referrals
Cancelled
Member ineligible for benefits
Prior Auths-OP & Prior Auths-IP
Cancelled
Notification not required
Prior Auths-OP & Prior Auths-IP
Cancelled
Canceled Case opened on wrong member
All
Cancelled
Duplicate
All
Cancelled
Other payer
All
Cancelled
Redirected call
All
Cancelled
Service cancelled / delayed
All
UHCMV1009_02272014 How To Read the Monthly Notification Extract
Page 3
Contains commercial information of UnitedHealth Military & Veterans Services, LLC and is protected under 5 U.S.C. 552(b)(4), and, as such, may not be used, disclosed or
reproduced, in whole or in part, outside the Government, without the express written permission of UnitedHealth Military & Veterans Services, LLC.