WebStep 1 Medicare A – Enter Medicare Part A and the recipient's applicable Medicare HMO. The first 'Other Insurance must be Medicare Part A, using Carrier Code 600 and Claim Filing Indicator MA. Web66 Patient Pay 73 Sequestration Adjustment Amount 80 Covered Days 81 Non-Covered Days 82 Co-insurance Days 83 Lifetime Reserve Days, Inpatient Only ... (Form Locator 59) 01 Spouse 4 Grandparent 5 Grandchild 07 Niece/Nephew 10 Foster Child 15 Ward of the Court 17 Step Child

Billing and Reimbursement Guide - omidriahcp.com

Web66 = Discharged to Critical Access Hospital 18-28. Condition Codes Enter two digit alpha numeric codes up to eleven occurrences to identify conditions that may affect processing … Webreported in Form Locator 7. Value Code 81 must be used to report non-covered days, which was formerly reported in Form Locator 8. Value Code 82 must be used to report co-insurance days, which was formerly reported in Form Locator 9. Value Code 83 must be used to report lifetime reserve days, which was formerly reported in Form Locator 10. asam halat

CMS Manual System

WebThe current version of the UB-04 paper claim form will continue to be used; however, Form Locator field 66 will be a required field as of January 6, 2014 (see Figure 1). The appropriate ICD indicator must be entered on paper claim forms: -Enter the number “9” to indicate ICD9. -Enter the number “0” to indicate ICD10. Page 1 of 3 WebUB-04 Form Locator code lookup. The UB-04 form locator tool is designed to help facilities understand the definitions of the codes needed for claim submission. Click on the form … WebIf you have any questions regarding the UB-04 claim form, please call your Network Coordinator or Customer Service at 1-800-ASK-BLUE. UB-04 data field requirements Field location UB-04 Description Inpatient Outpatient 1 Provider Name and Address Required Required 2 Pay-To Name and Address Situational Situational 3a Patient Control Number ... bani capy