NUMBER PRESS SOFTWARE USER MANUAL CODE
Revenue code 0001 must be the final entry on all bills.Įnter the narrative description of the related room and board and/or ancillary categories shown in field 42. If required by Medica contract, enter value code 01 and the semiprivate room rate for the facility.Įnter the appropriate numeric code to identify specific accommodations and/or ancillary service in ascending numeric order, by date of service if applicable. Left-justify and enter up to 5 lines of information. Used to identify conditions or events relating to this bill that may affect processing.Įnter the 2-digit state abbreviation indicating where the accident occurred.Įnter the code and associated date noting a significant event relating to the claim that may affect payer processing.Ī code and the related dates that identify an event relating to the payment of the claim.Įnter the name and address of the party responsible for the bill. Note: Completion of this field is not required on rural health clinic (RHC) and federally qualified health center (FQHC) claims. Source of referral for admission or visitĮnter the 1-digit code indicating the source of referral for this admission or visit.Įnter the hour of discharge from inpatient care in military time using 2 numeric characters.Įnter the code indicating the disposition or discharge status of the patient on the ending service date of the period covered on this bill, as reported in FL6. Enter in MMDDYY format.Įnter the hour of admission or start of care in military time using 2 numeric characters.Įnter the 1-digit code indicating the priority of this admission/visit.
NUMBER PRESS SOFTWARE USER MANUAL ZIP
box or RFD city state ZIP code.Įnter patient’s date of birth in MMDDYYYY format.Įnter the date of admission for inpatient services for other services enter the date the episode of care began. Report if number is different from the subscriber/insured’s ID.Įnter patient’s last name, first name, and middle initial.Įnter patient’s complete mailing address including street number and name or P.O. The patient identifier as assigned by the payer. For services provided on a single day, enter the date of service as both the “from” and “through” date. Left-justify up to 10 characters (include hyphen).Įnter the beginning and ending service dates of the entire period covered in the claim in MMDDYY format. Type of bill must be consistent with services rendered.Įnter the number assigned to the provider by the federal government for tax reporting purposes. The first digit is a leading zero, The next 2 digits indicate the type of bill, The fourth digit indicates the frequency of the bill. Refer to UB-04 manual)Įnter the 4-digit code to indicate the specific type of bill (e.g., hospital inpatient, outpatient, replacements, voids, etc.). Left-justify up to 24 characters.Įnter the number assigned to the patient’s medical/health record by the provider. Reserved for Assignment by the NUBCĮnter patient’s unique (alphanumeric) number assigned by provider to retrieve individual accounts. Line 3: City, State, and 5-digit Zip Code
Line 2: Street Address or Post Office Box (Use standard state abbreviation andĮnter the address that the provider submitting the bill intends payment to be sent if different than FL 01. The name and service location of the provider submitting the bill. R = Required | RA = Required if applicable | NR = Not Required | O = Optional Field IDīilling provider name, address and telephone number (phone # and fax # desirable)
0 kommentar(er)
