Inpatient claim form ub04
Commonwealth of Massachusetts
Billing Instructions for the UB-04 Paper Claim Form . Appendix A: Third Party Liability (TPL) Supplemental Instructions for Submitting Claims on the UB-04 for Members with Other Health Insurance (cont.) * Requires the entry of the number of units in Field 46. March 2010Page 41.
[DOC File]UB-04 Submission and Timeliness Instructions (ub sub)
https://info.5y1.org/inpatient-claim-form-ub04_1_e2c757.html
Inpatient providers must use claim frequency code 5 when adding a new ancillary code to indicate a hospital stay that was billed when the original claim was submitted. 15 * ‡ Natural disaster. Attach a letter on provider letterhead describing the circumstances and date of occurrence.
[DOC File]UB04 Billing Instructions Guide - Maine
https://info.5y1.org/inpatient-claim-form-ub04_1_ccb700.html
Feb 25, 2021 · Inpatient and Outpatient Hospital claims may overlap months. All other providers must bill no more than one calendar month on a claim form. FROM. Enter the date that services on this claim began. THROUGH. Enter the date that services on this claim ended, including the discharge date, if applicable. FL 7: RESERVED FOR ASSIGNMENT BY THE NUBC. Not ...
[DOC File]Form Locator Number
https://info.5y1.org/inpatient-claim-form-ub04_1_f0b475.html
1 = Inpatient. 3 = Outpatient. 4 = Other. Digit 4: Frequency . 1 = Admit through Discharge claim. 2 = Interim-First Claim. 3 = Interim-Continuing Claim. 4 = Interim-Last Claim. 5 = Late Charge **For further explanation on Type of Bill, please refer to the NUBC UB04 Official Data Specifications Manual
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