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Code Correlations: Delay Reason Codes – Medi-Cal

files.medi-cal.ca.gov

Inpatient and Outpatient (UB-92) Paper Claims. ❖ Version 4 Flat File, CMC … The
following correlation is in Medi-Cal Current Code value order. … Billing Media:
Inpatient and Outpatient Version 4 Flat File, CMC Proprietary (CMC 02, 03, 04,.

ODM Hospital Billing Guidelines – Ohio Department of Medicaid

medicaid.ohio.gov

Oct 1, 2015 … value code 02 (hospital has no semi-private rooms) must be present …. claim (bill
types 131 and 135 on the UB-04 and 837i) that is billed to …

UB-04 – CMS

www.cms.gov

25/50/Uniform Bill (UB) – Form CMS-1450 for Billing (UB-92). R …. maximum
number of the UB-04 codes (value … Form Locators (FL) FL02 (Pay-to
Information),.

UB-92 Desk Reference

www.dhs.pa.gov

837 Institutional/UB-92 Claim Form. UB-92 Desk Reference … 02 Condition is
Employment Related … agreement or law to accept payment by primary payer as.

UB-04 Desk Reference

www.dhs.pa.gov

These values are valid for paper claim submission on the UB-04 Claim Form only
. Type of Bill Codes. (Form Locator 4) … 02 Condition is Employment Related.

ub-04 claim form instructions – eohhs – RI.gov

www.eohhs.ri.gov

Sep 16, 2016 … Enter the four digit code that identifies the specific type of bill and … 2:00 a.m. – 02
. 3:00 a.m. – … Enter up to three value codes to identify special.

List of UB-04 Data Elements – CDC

www.cdc.gov

List of UB-04 Data Elements. FL … Telephone, Fax, Country. Code]. FL02. [Billing
Provider's. Designated Pay-to. Name]. FL02 … Occurrence Code/Date. FL31.

UB-04 Required Fields IP OP Renal Rev 06-09.doc – Illinois.gov

www.illinois.gov

Required. 31-34. Occurrence Codes and Dates – Refer to the UB-04 Data … 02 –
TPL Adjudicated – patient not covered: TPL Status Code 02 is to be entered …

Chapter 6: Billing on the UB-04 Claim Form – ahcccs

www.azahcccs.gov

Sep 15, 2015 … The UB-04 claim form is used to bill for all hospital inpatient, outpatient, and
emergency room services. Dialysis … 02/20/14. Or. 02/15/2014 02/20/2014 …
Enter the appropriate condition codes that apply to this bill. See UB-04.

njddcs data dictionary – State of New Jersey

www.nj.gov

Occurrence Span Codes and Dates . ….. Transfer In Code (UB Referral Source
Code). + …. 2300 Loop, HI01-02 to HI12-02, Code Qualifier BG. Valid Codes:.

Bill Finerfrock – HRSA

www.hrsa.gov

Feb 2, 2012 … 02-02-12/1:00 pm CT ….. Field locator 31 through 34 which are occurance codes
and dates – …… less attention was paid to the UB-04 side.

Wisconsin Medicaid Personal Care Handbook, Billing Section

www.forwardhealth.wi.gov

Items 68 – 75 … UB-92 Claim Form Example – Personal Care Services Series Billing . ….
Regulation: Wisconsin Administrative Code, Rules of Health and Family ….. 02.
Condition is employment related: Patient alleges that medical condition is …

Mississippi Inpatient Outpatient Data System User's Manual

msdh.ms.gov

Authority-Mississippi Code Annotated § 41-63-4 requires certain licensed health
… establish a registry program concerning the condition and treatment of … is
based on the Health Care Finance Administration (HCFA) UB-04 or the most
recent version …… DMG02. Loop 2000B, SBR02 not = 18. Loop 2010CA, NM101
= QC.

Hospice Care Billing Manual – Colorado.gov

www.colorado.gov

Jul 21, 2016 … Providers should refer to the Code of Colorado Regulations, Program Rules (10
….. All code values listed in the NUBC UB-04 Reference Manual for each form …
02/15/08). …. If a value code is entered, a dollar amount or.

NewMMIS Billing Tips – Mass.Gov

www.mass.gov

includes the CMS-1500 claim form, 837P transaction, UB-04 claim form, and the
… All institutional claims have to be billed with value code 24, which implies …

General Billing – Idaho Department of Health and Welfare

healthandwelfare.idaho.gov

To submit claims on paper, use original red UB-04 claim forms … Idaho Medicaid
allows twenty-four (24) condition codes on an electronic …. 02/01-02/15/04. 30.

Hospital Discharge Data System User Manual – State of Tennessee

www.tn.gov

In 2007, a nationwide change from the UB-92 form for hospital claims billing to
the UB-04 form occurred. … commonly used health claim data items into the UB-
04 coding structure for those health care … If any Condition Code has a …… Valid
time format: 00-23, 99, or blank. Code. Time – AM. Code. Time – PM. 00. 01. 02.
03.

PT01 with Medicare v7.1 – Finance and Administration Cabinet

finance.ky.gov

Aug 8, 2014 … 02/16/2006 Carolyn Stearman Updated with revisions requested by … Inserted
new UB-04 claim form and descriptors. 1.7 …. Replace occurrences of SHPS with
Carewise … Added Revenue code 430 to outpatient services.

table of contents – SCDHHS.gov

www.scdhhs.gov

Dec 1, 2016 … National Drug Code (NDC) Billing Requirements for Outpatient ….. SCDHHS will
not supply the UB-04 to providers. …. Field 31 – Occurrence Codes and Dates:
Enter ….. prefaced by a claim line number (“L01,” “L02,” etc.).