Posts tagged: ub04

where to find value codes on ub04

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By , January 27, 2018 6:36 am


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where to find value codes on ub04

PDF download:

Uniform Billing (UB-04) – CMS.gov

www.cms.gov

maximum number of the UB-04 codes (value codes, condition codes, occurrence
codes occurrence span codes, etc) that may be reported for the UB-92 and not …

Medicare Claims Processing Manual Crosswalk – CMS.gov

www.cms.gov

This form, also known as the UB-04, is a uniform institutional provider bill suitable
for use in billing multiple …. FL39 Value Code Amount a N. 9. 1. FL39 Value …

UB04 Billing Guide – Inpatient Hospitals 01-30-2017 – Pennsylvania …

www.dhs.pa.gov

Jan 30, 2017 … paper UB04 using the applicable LARC procedure code-modifier combinations
identified in ….. this Form Locator using Value Code 66. When a.

UB-04 Claim Form – Medi-Cal

files.medi-cal.ca.gov

Jan 3, 2016 … Identify the provider manual sections regarding UB-04 claim form completion. •
Outline ….. Example: If billing for two value codes “30” (accepted.

UB-04 Claim Form Instructions – Nevada Medicaid

www.medicaid.nv.gov

May 30, 2017 … Under the shaded UB-04 field requirements section, corrected ….. On claims with
Medicare TPL, enter up to 3 value codes and amounts on.

UB04 Billing Instructions Guide – Health PAS Online – Maine.gov

mainecare.maine.gov

Aug 30, 2016 … UB 04 Billing Instructions Guide ….. FL 31 – 34: OCCURRENCE CODES AND
DATES. … FL 39 – 41: VALUE CODES: CODES, AMOUNTS.

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

www.eohhs.ri.gov

Sep 16, 2016 … UB-04 CLAIM FORM INSTRUCTIONS … Enter the hour (using a two-digit code
below) that … Enter up to three value codes to identify special.

UB04 Billing Instructions for Hospice Services – Maryland Medicaid

mmcp.dhmh.maryland.gov

Jul 30, 2007 … Sample UB04 – Hospice Services Claim (81X Type of Bill). 6. Sample UB04 –
Hospice … 15. FL 39-41. Value Codes and Amounts. 15. FL 42.

UB04 Hospital Billing Instructions – Maryland Medicaid – Maryland.gov

mmcp.dhmh.maryland.gov

Responsible party name and address. 38. FL 39-41. Value Codes and Amounts.
38. FL 42. Revenue Codes. 42. FL 43. National Drug Code (NDC) Reporting.

Hospital UB-04 Claim filing instructions, Section 2 Billing Book

dss.mo.gov

an electronic version of the UB-04 claim form for inpatient services are slightly …
code(s). The values applicable to MO. HealthNet are: C1-Approved as billed.

471-000-71 appendix – Nebraska Department of Health and Human …

dhhs.ne.gov

These instructions can be used in combination with the CMS-1450 (UB-04) claim
form instructions in the … Use Bill Type code 66X for assisted living Waiver
services. •. Use Bill Type code 18X for … Not Used. 39-41. Value Codes and
Amounts.

ihs/638 provider manual – ahcccs

www.azahcccs.gov

Jun 3, 2016 … NOTE: This chapter applies to paper CMS 1500, UB-04, and ADA claims
submitted to AHCCCS. … AHCCCS does not accept DSM-4 diagnosis codes.
Behavioral health ….. 39-41 Value Codes and Amounts. Required if …

Residential Care Home Billing Guide for the UB-04 – Mass.Gov

www.mass.gov

Residential Care Home Billing Guide for the UB-04. December 2011. Page i.
Table of ….. Enter value code 80 for covered days and the number of covered
days.

UB-04 Billing Guide – Mass.Gov

www.mass.gov

Many types of providers use the UB-04 claim form to bill MassHealth for services.
… The type of bill codes and UB-04 claim frequency type code values for.

UB-04 Claim – Mississippi Division of Medicaid

medicaid.ms.gov

May 3, 2017 … The following provider types should bill using the UB-04 claim form …. example,
to report 5 covered days on a claim, enter Value Code 80 and.

2016-31 – ForwardHealth Portal

www.forwardhealth.wi.gov

Jul 29, 2016 … recorded on the newborn's claim using Value Code 54. … UB-04 claim form …
include Value Code 54 with an invalid birth weight will be denied …

Hospice Care Billing Manual – Colorado.gov

www.colorado.gov

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 …

UB-04 – OK.gov

www.ok.gov

Value must be 01-99. 18-28. Condition Codes O. Inpatient and Outpatient:
Required when applicable. Refer to the UB-04 Manual for requirements and for
the …

(CMS-1450) (UB-04) – CT.gov

www.ct.gov

VALUE CODES … FIRST c. d. e. OTHER PROCEDURE. NPI. CODE. DATE.
DATE. FIRST. NPI b. LAST. FIRST c. NPI d. LAST. FIRST. UB-04 CMS-1450. 7.

General Billing – Idaho Department of Health and Welfare

healthandwelfare.idaho.gov

To submit claims on paper, use original red UB-04 claim forms available from
local form … Value, Occurrence, and Occurrence Span Codes. Idaho Medicaid …

ub04 box 59 value code

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By , January 23, 2018 10:45 pm


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Medicare replacement (PDF download)

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AARP life insurance (PDF download)

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medicare part b (PDF download)


ub04 box 59 value code

PDF download:

Uniform Billing (UB-04) – CMS.gov

www.cms.gov

25/75/General Instructions for Completion of Form CMS-1450 (UB-04). R … 25/
75.4/Form Locator 42. R … maximum number of the UB-04 codes (value ….. FL59.
Patient's Relationship – Tertiary. C. AN. 2. 1. FL60. Insured's Unique ID – Primary.

UB-04 Claim Form – Medi-Cal

files.medi-cal.ca.gov

Jan 3, 2016 … Identify the provider manual sections regarding UB-04 claim form completion. •
Outline …. the left border of the Revenue Code field (Box 42) to the right border of
Box 49. Enter …. the Patient's Relationship to Insured field (Box 59). … value. For
example, if billing for three condition codes, “A1” (services.

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 …. codes. In the
Amount box, enter the number, amount, or. UCR value … 59. Patient's
Relationship to Insured Enter the code for the patient's relationship to the.

UB04 Billing Guide – Inpatient Hospitals 01-30-2017 – Pennsylvania …

www.dhs.pa.gov

Jan 30, 2017 … UB-04 Billing Guide for PROMISe™ Inpatient Hospitals … Form Locator Code –
Lists one of four codes that denote how the Form Locator …. Midnight – 12:59
a.m. = 00 … Occurrence Codes, please refer to the UB-04 Desk.

UB-04 Claim Form Instructions – Nevada Medicaid

www.medicaid.nv.gov

May 30, 2017 … Under the shaded UB-04 field requirements section, corrected …. follow the
Billing Instructions in fields 31-34 (Occurrence codes and dates). • Field 50A-C
….. 59A-C. Not required. Patient's Relationship to Insured (P. REL).

UB-04 Claim filing instructions, Outpatient Hospital, Hospital Billing …

dss.mo.gov

an electronic version of the UB-04 claim form for outpatient services are … box
number or RFD, city, state, and zip code. 10. … the visit, enter this condition code.
… the participant's name. 59. Patient's Relationship. Leave blank. to the Insured.

Hospital UB-04 Claim filing instructions, Section 2 Billing Book

dss.mo.gov

The required three digits in this code identify … an electronic version of the UB-04
claim form for inpatient services are slightly different. If filing … field. The allowed
values are: 4-Transfer from a hospital. 5-Transfer from a skilled nursing facility ….
2.9. FIELD NUMBER AND NAME. INSTRUCTIONS FOR COMPLETION. 59.

Iowa Medicaid Enterprise UB-04 Claim Form Health Insurance …

dhs.iowa.gov

The following Iowa Medicaid provider types bill for services on the UB-04 claim
form: • Hospital … reported using value codes in fields 39a-41d. … 04 4:00 – 4:59.

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 … (If the
revenue center code (RCC) in Form Locator 42 indicates room … Insured's Name
. IP, OP. 59. Patient's Relationship to Insured. IP, OP. 60 … claim (bill types 131
and 135 on the UB-04 and 837i) that is billed to ODM regardless of …

UB04 Billing Instructions Guide – Health PAS Online – Maine.gov

mainecare.maine.gov

Aug 30, 2016 … UB 04 Billing Instructions Guide ….. FL 31 – 34: OCCURRENCE CODES AND
DATES. ….. Figure 3-28: FL59 Patient Relationship .

APG Provider Manual – New York State Department of Health

www.health.ny.gov

Aug 1, 2012 … 4.22 Specialty Rate Codes Not Subject to APGs… ….. A single claim can be
assigned one or more APG values, each of which carries its own “weight,” …..
CPT Modifier 59 (Separate Procedures or Distinct Procedural Service): CPT
Modifier 59 ….. field indicates the CPT/APG to which payment has been …

njddcs data dictionary – State of New Jersey

www.nj.gov

Occurrence Span Codes and Dates . ….. External Code Source: National Uniform
Billing Committee's UB04 ….. (Field # 59 in NJDDCS V2 Extract File Layout).

General Billing – Idaho Department of Health and Welfare

healthandwelfare.idaho.gov

To submit claims on paper, use original red UB-04 claim forms available … Idaho
Medicaid allows twenty-four (24) condition codes on an electronic. HIPAA 837 …
field is required and refer to the 'Description' column for additional information. …..
59. P. REL. Desired. Patient's Relationship to Insured: See the UB-04 Manual.

Inpatient/Outpatient Hospital – Colorado.gov

www.colorado.gov

UB-04 Revenue Codes . … Providers billing on the UB-04 claim form . ….
Providers should refer to the Code of Colorado Regulations, Program Rules (10
… Requests may be sent to Hewlett Packard Enterprise (HPE), P.O. Box ….. Non
covered Days; must be reported using Value code 81 … on page 59 of this billing
manual.

2015 Hospital Based Outpatient Surgery Data XML … – OK.gov

www.ok.gov

Sep 18, 2015 … Value Codes were added as a new data element, please see page 49. 9. …..
specified for the field entry in the UB -04 manual. Facilities using …

NH Medicaid Final Hospital Provider Billing Manual – New …

nhmmis.nh.gov

Covered Hospital Based Rural Health Clinic Revenue Codes . …. which are
reasonable and necessary to evaluate an outpatient's condition or ….. inpatient
admission, with a calendar day beginning at 12:00 AM and ending at 11:59 PM,
will be … bills, the UB 04 must indicate a patient status code 02 in form locator 17.

ForwardHealth Provider Portal Institutional Claims User Guide

www.dhs.wisconsin.gov

Nov 11, 2016 … refer to the UB-04 Claim Form completion instructions in the applicable service
area of …. coding structure in the Admission Diagnosis Code field or search for a
code using the Search …. The Condition Code search panel will be displayed. …..
Figure 59 Adjustment Code and Description Added to the Panel.

SOUTH CAROLINA HEALTHY CONNECTIONS – SCDHHS.gov

www.scdhhs.gov

Apr 1, 2005 … BILLING CODES REQUIRING PRIOR AUTHORIZATION . ….. field 67 o
Remittance Advice Items – field M o UB-04 Data Fields ….. 53, 57, 59. 73.

TABLE OF CONTENTS – SCDHHS.gov

www.scdhhs.gov

Dec 1, 2016 … National Drug Code (NDC) Billing Requirements for Outpatient Hospital. Setting .
….. Medicaid claims must be filed on the UB-04 claim form. Alternative forms …..
admissions. SCDHHS has implemented the use of Condition Code B4 … of
Admission code 4 (Transfer from a Hospital) in field 15 on the claim …

Anthem Blue Cross and Blue Shield Provider and Facility Manual

www.akleg.gov

Dec 15, 2014 … to entities contracted with Anthem that bill on a UB 04, such as Acute General
Hospitals … This Manual includes CPT codes selected by Anthem. No fee
schedules, basic unit values, relative value guides, maximum allowances,
conversion factors or scales are …… Field 59: Relationship of patient to insured.

ub04 span codes

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By , January 23, 2018 12:00 pm


AARP health insurance plans (PDF download)

Medicare replacement (PDF download)

AARP MedicareRx Plans United Healthcare (PDF download)

AARP life insurance (PDF download)

medicare benefits (PDF download)

medicare part b (PDF download)


ub04 span codes

PDF download:

Uniform Billing (UB-04) – CMS.gov

www.cms.gov

maximum number of the UB-04 codes (value codes, condition codes, occurrence
codes occurrence span codes, etc) that may be reported for the UB-92 and not …

Medicare Claims Processing Manual Crosswalk – CMS.gov

www.cms.gov

This form, also known as the UB-04, is a uniform institutional provider bill suitable
for use in billing …. FL35 Occurrence Span Code/From/Through a AN/N/N 2/6/ …

UB-04 Claim Form Instructions – Nevada Medicaid

www.medicaid.nv.gov

May 30, 2017 … Under the shaded UB-04 field requirements section, corrected ….. Occurrence
span codes and dates: If applicable, enter an occurrence.

UB04 Billing Guide – Inpatient Hospitals 01-30-2017 – Pennsylvania …

www.dhs.pa.gov

Jan 30, 2017 … UB-04 Billing Guide for PROMISe™ Inpatient Hospitals. Purpose of the …..
description of. Occurrence Span Codes, please refer to the UB-04.

UB04 Billing Instructions Guide – Health PAS Online – Maine.gov

mainecare.maine.gov

Aug 30, 2016 … MaineCare. Medicaid Management Information Systems. Maine Integrated
Health Management Solution. UB 04 Billing Instructions Guide.

UB04 Hospital Billing Instructions – Maryland Medicaid – Maryland.gov

mmcp.dhmh.maryland.gov

Accident State. 32. FL 30. Reserved for Assignment by NUBC. 32. FL 31-34.
Occurrence Codes and Dates. 32. FL 35-36. Occurrence Span Codes and Dates.
36.

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 frequency of ….
Enter the span of occurrence dates as indicated in. 31 – 35 in …

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

www.azahcccs.gov

Sep 15, 2015 … Occurrence Span codes and dates. Required if applicable. 38. … See UB-04
Manual for revenue codes and abbreviations. Revenue codes.

Long Term Care Service Billing Requirements and … – Illinois.gov

www.illinois.gov

May 18, 2016 … Paper UB-04 claims submitted for LTC services will not be accepted. … non-
covered occurrence span code 74 with the appropriate LOA dates …

Hospital UB-04 Claim filing instructions, Section 2 Billing Book

dss.mo.gov

an electronic version of the UB-04 claim form for inpatient services are slightly
different. … Enter the 2-digit patient status code that best … Occurrence Span.

General Billing – Idaho Department of Health and Welfare

healthandwelfare.idaho.gov

To submit claims on paper, use original red UB-04 claim forms available from
local … and twenty-four (24) occurrence span codes on the electronic HIPAA 837.

UB-04 Claim – Mississippi Division of Medicaid

medicaid.ms.gov

May 3, 2017 … The following provider types should bill using the UB-04 claim form. • Dialysis
Centers …. Occurrence Span Codes and Dates. 37. Not Required.

OWCP-04 – United States Department of Labor

www.dol.gov

OCCURRENCE. OCCURRENCE SPAN … d. LAST. FIRST. UB-04 CMS-1450 ….
Block 35 Enter occurrence span code and occurrence span from date. Block 36 …

UB-04 Paper Claim Form Billing Instructions – North Dakota State …

www.nd.gov

Sep 1, 2016 … UB-04 Claim Form Instructions … Type of bill: Enter the appropriate type of bill
code. … occurrence span code and corresponding dates.

ICD-10 Information and Frequently Asked Questions – Virginia …

www.virginiamedicaid.dmas.virginia.gov

Q: What can I do if my system is not ready to submit ICD-10 codes to Virginia
Medicaid? … DMAS ICD-10 edits that enforce correct coding related to services
that span … UB-04 (Institutional) for inpatient surgical procedures, the answer is
yes.

Hospice Care Billing Manual – Colorado.gov

www.colorado.gov

Jul 21, 2016 … with a terminal illness (life expectancy of nine (9) months or less). ….. All code
values listed in the NUBC UB-04 Reference Manual for each form …

Dialysis Billing Manual – Colorado.gov

www.colorado.gov

All code values listed in the NUBC UB-04 Reference Manual for each form
locator may not be used for …. wishing to span bill following these guidelines,
must.

ICD-10 Frequently Asked Questions Send your … – Georgia Medicaid

www.mmis.georgia.gov

Oct 30, 2015 … describe an injury using an ICD-10 CM (diagnosis) code. 6. Will ICD-10-PCS
procedure codes be used for both inpatient and …. Version 30 grouper for UB-04
claims? …. may span both date spans with the ICD-10 transition.

UB-04 Form Locator – New Hampshire Department of Health and …

www.dhhs.nh.gov

May 20, 2015 … A11.29 N4 Patient City/State/Zip Code (2010CA) – Required if subscriber IS …
A11.42 HI Occurrence Span Information (2300) – Situational .

CMS-1450 Claim Form – FirstCarolinaCare Insurance Company

www.lni.wa.gov

OCCURRENCE SPAN … FIRST c. d. e. OTHER PROCEDURE. NPI. CODE.
DATE. DATE. FIRST. NPI b. LAST. FIRST c. NPI d. LAST. FIRST. UB-04 CMS-
1450.

ub04 value code list

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By , January 22, 2018 8:50 pm


AARP health insurance plans (PDF download)

Medicare replacement (PDF download)

AARP MedicareRx Plans United Healthcare (PDF download)

AARP life insurance (PDF download)

medicare benefits (PDF download)

medicare part b (PDF download)


ub04 value code list

PDF download:

Uniform Billing (UB-04) – CMS.gov

www.cms.gov

UB-04 only value codes: 80 – Covered days (the number of days covered by the
primary payer as qualified by the payer). 81 – Non-Covered Days (days of care …

Medicare Claims Processing Manual Crosswalk – CMS.gov

www.cms.gov

This form, also known as the UB-04, is a uniform institutional provider bill suitable
for use in billing multiple … (NUBC) maintains lists of approved coding for the
form. Medicare …. FL35 Occurrence Span Code/From/Through a AN/N/N 2/6/6.

CMS Manual System – CMS.gov

www.cms.gov

Apr 1, 2004 … Form Locator (FL)s 39-41 Value Codes and Amounts. R ….. The following table
lists “Type of Bill,” FL4, codes by Provider Number Range(s).

UB04 Billing Guide – Inpatient Hospitals 01-30-2017 – Pennsylvania …

www.dhs.pa.gov

Jan 30, 2017 … UB-04 Billing Guide for PROMISe™ Inpatient Hospitals. Purpose of the … Form
Locator Code – Lists one of four codes that denote how the Form Locator should
be treated. ….. NOTE: If you are using Value Code 14, 15, 16, or.

UB-04 Billing Guide for PROMISe™ Outpatient Hospitals

www.dhs.pa.gov

Jan 30, 2017 … Form Locator Code – Lists one of four codes that denote how the Form. Locator
should be …. Condition Codes, please refer to the UB-04 Desk.

UB-92 Desk Reference

www.dhs.pa.gov

PA PROMISe™. Provider Handbook. 837 Institutional/UB-04 Claim Form. UB-04
Desk Reference for Hospitals … Condition Codes. (Form Locators 18–28).

UB-04 Claim Form – Medi-Cal

files.medi-cal.ca.gov

Jan 3, 2016 … Identify the provider manual sections regarding UB-04 claim form completion. •
Outline … Inpatient Services manual for a listing of non-DRG hospitals. ….. The
Medi-Cal claims processing system recognizes condition codes.

Hospital UB-04 Claim filing instructions, Section 2 Billing Book

dss.mo.gov

The requirements for filing an electronic version of the UB-04 claim form for
inpatient services are slightly …. 18*-24*Condition Codes (continued) A1-Healthy
Children & Youth/EPSDT … List appropriate accommodation revenue codes first
in …

Chapter IV. Billing Iowa Medicaid – Iowa Department of Human …

dhs.iowa.gov

Jan 1, 2016 … A list of valid revenue codes can be found at the end of these UB-04 claim form
instructions. NOTE: Not all listed revenue codes are payable by …

OWCP-04 – United States Department of Labor

www.dol.gov

UB-04 CMS-1450. 7 … OWCP uses a condition-specific fee schedule based on
the Prospective. Payment … Revenue Center codes and Diagnosis-Related
Group (DRG) codes; therefore, use of correct codes and modifier(s) is required.

471-000-71 appendix – Nebraska Department of Health and Human …

dhhs.ne.gov

These instructions can be used in combination with the CMS-1450 (UB-04) claim
form … Use Occurrence Span Code 70 to report nursing facility Medicare Days.

Residential Care Home Billing Guide for the UB-04 – Mass.Gov

www.mass.gov

Dec 4, 2011 … Residential Care Home Billing Guide for the UB-04. December …. If applicable,
enter the occurrence span code from the list below, for any …

UB-04 Claim – Mississippi Division of Medicaid

medicaid.ms.gov

May 3, 2017 … The following provider types should bill using the UB-04 claim form. • Dialysis ….
example, to report 5 covered days on a claim, enter Value Code 80 and enter it
as 5 … For an all-inclusive list of revenue codes see the Uniform.

mississippi division of medicaid provider billing handbook

www.medicaid.ms.gov

3-1 Checklist of Required UB-04 Fields. 3-2 ….. To identify the assigned value for
each code, see the Mississippi Medicaid Global Surgical Period code list …

ODM Hospital Billing Guidelines – Ohio Department of Medicaid

medicaid.ohio.gov

Oct 1, 2015 … (See Appendix I for a listing of covered revenue codes. … 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 ODM regardless of mode …

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 frequency of ….
Enter up to three value codes to identify special circumstances …

NH UHFDDS User Guide – New Hampshire Department of Health …

www.dhhs.nh.gov

Value Codes and Amounts: . …. The current rule is based on the UB-04 form, and
the new system has been created in …. this Code List. 99. Unknown.

APG Provider Manual – New York State Department of Health

www.health.ny.gov

Aug 1, 2012 … 4.22 Specialty Rate Codes Not Subject to APGs… ….. In the APG classification
system, the patient is described by a list of APGs that …. should be used on an
E&M code only when the patient's condition requires a significant,.

SOUTH CAROLINA HEALTHY CONNECTIONS – SCDHHS.gov

www.scdhhs.gov

Apr 1, 2005 … … CODES. OUTPATIENT FEE SCHEDULE: REIMBURSEMENT TYPES………………
……………………………………………. 1 … BILLING CODES REQUIRING PRIOR
AUTHORIZATION . ….. o Completion of the UB-04 Claim Form – field 67.



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