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EDIFACT message guide · Healthcare and social

MEDRUC Medical resource usage and cost

The UN/EDIFACT message healthcare providers send to funding institutions to report medical activity and justify reimbursement.

Sent by
Healthcare provider
Received by
Funding institution, such as a health insurer
Standard
UN/EDIFACT · Batch message
X12 equivalent
837 Health Care Claim

What is the EDIFACT MEDRUC message?

MEDRUC is the UN/EDIFACT medical resource usage and cost message. The directory defines it as a message sent from a party providing medical and related administrative services to a funding institution, allowing evaluation of the medical activity and justification for reimbursement. It can also be sent to other parties for statistical or management purposes.

It plays the role of a healthcare claim, reporting the services, resources used and costs for patients treated, so the funder can assess and pay them.

How the EDIFACT MEDRUC message worksDiagram of the UN/EDIFACT MEDRUC Medical resource usage and cost message. Healthcare provider sends it to funding institution, such as a health insurer. It usually starts the exchange. Inside the UNB and UNH envelopes, the directory D.21A requires, in the start of message: BGM (Beginning of message). 7 conditional segment groups are listed by their trigger segment.How the EDIFACT MEDRUC message worksMedical resource usage and cost: who sends it, where it fits and what the directory marks mandatory1 WHERE IT FITSUSUALLY FOLLOWSStarts the exchangeMEDRUCSENDERHealthcare providerRECEIVERFunding institution,such as a healthinsurerCONTRL syntax report back, if agreedUSUALLY FOLLOWED BYNo business reply expected2 WHAT DIRECTORY D.21A REQUIRESInterchange: sender and recipient IDsUNB … UNZMessage MEDRUCUNH … UNTSTART OF MESSAGEBGMBeginning of messageBODY AND SEGMENT GROUPS+ 7 conditional groups, starting with:MOAPNAAGRDOCFCATMDAUTBlue box: mandatory segment group. Conditional groups are listed by the trigger segment that starts them; a group is sent only when its data applies.Conditional segments outside groups are not drawn.Structure: mandatory segments and groups in the UN/EDIFACT directory D.21A listing for MEDRUC. Your trading partner's implementation guide adds itsown requirements.
How the EDIFACT MEDRUC message worksDiagram of the UN/EDIFACT MEDRUC Medical resource usage and cost message. Healthcare provider sends it to funding institution, such as a health insurer. It usually starts the exchange. Inside the UNB and UNH envelopes, the directory D.21A requires, in the start of message: BGM (Beginning of message). 7 conditional segment groups are listed by their trigger segment.How the EDIFACT MEDRUCmessage worksMedical resource usage and cost: who sends it,where it fits and what the directory marksmandatory1 WHERE IT FITSUSUALLY FOLLOWSStarts the exchangeMEDRUCSENDERHealthcareproviderRECEIVERFundinginstitution, suchas a healthinsurerCONTRL syntax report back, if agreedUSUALLY FOLLOWED BYNo business reply expected2 WHAT DIRECTORY D.21A REQUIRESInterchange: sender and recipient IDs(UNB … UNZ)Message MEDRUC (UNH … UNT)START OF MESSAGEBGMBeginning of messageBODY AND SEGMENT GROUPS+ 7 conditional groups, starting with:MOAPNAAGRDOCFCATMDAUTBlue box: mandatory segment group. Conditionalgroups are listed by the trigger segment thatstarts them; a group is sent only when its dataapplies. Conditional segments outside groups arenot drawn.Structure: mandatory segments and groups in theUN/EDIFACT directory D.21A listing for MEDRUC.Your trading partner's implementation guide adds itsown requirements.

How to read this diagram: the top row shows who sends MEDRUC, to whom, and which messages usually come before and after it. The lower part shows what the directory D.21A itself requires: the envelopes around MEDRUC and the segments and segment groups it marks mandatory. Conditional groups are listed by their trigger segment rather than drawn in full. This is the directory's minimum, not a trading partner's requirement: a message implementation guide, such as an industry subset or a partner’s own guide, usually makes some conditional groups mandatory, restricts the codes and may use an older directory.

Expand diagram Download SVG

When it is used

  • Claiming reimbursement for treatment
  • Reporting hospital activity to funders
  • Supplying activity data for statistics

Where it fits in the message flow

This message MEDRUC Medical resource usage and cost

No other message routinely comes directly before or after MEDRUC; it is exchanged when the business event occurs. If the partners agree, the receiver confirms each interchange with a CONTRL syntax and service report.

Structure

Mandatory segments in MEDRUC (directory D.21A)

In UN/EDIFACT directory D.21A, the MEDRUC message has 127 segment positions arranged in 26 segment groups. These are the segments and segment groups marked mandatory at message level, in order; a mandatory group is shown with the segment that starts it. Segments inside conditional groups are needed only when the group is used. This is the directory’s requirement, not your trading partner’s: each partner’s message implementation guide names the directory it uses, often an older one such as D.96A or D.01B where the structure can differ, makes some conditional segments mandatory and restricts the codes.

  • UNH
  • BGM
  • UNT

Practical example

MEDRUC in practice

A hospital sends a health insurer MEDRUC messages for patients discharged during the week, with the diagnoses, procedures, length of stay and costs. The insurer evaluates each case against its reimbursement rules and pays the hospital.

Implementation

Implementation considerations for MEDRUC

  • Comply with health data protection laws.
  • Use the diagnosis and procedure coding the funder requires.
  • Reconcile reimbursements with submitted claims.
  • Follow the national specification in force.

How ECOM helps

Automate MEDRUC with ECOM

Industry

Healthcare

Secure B2B integration and file transfer for providers, suppliers, distributors and healthcare partners.

Solution

Financial Document Automation

Automate invoices, remittances, payment files and bank statements from capture to posting.

Solution

EDI Integration

Exchange X12 and EDIFACT documents with partners and integrate them directly with your ERP.

Compare X12 and EDIFACT, or see answers to general questions in the EDI FAQ.

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