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condition code 51 on ub04

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MM7142 – CMS

www.cms.gov

denoted by revenue code 054X on the claim line) and maintenance renal dialysis
… Providers may submit outpatient claims with condition code 51 starting April …

CMS Manual System

www.cms.gov

25/75/General Instructions for Completion of Form CMS-1450 (UB-04). R ….
codes, condition codes, occurrence codes occurrence ….. FL51 Provider Number.
A.

Medicare Claims Processing Manual Crosswalk – CMS

www.cms.gov

This form, also known as the UB-04, is a uniform institutional provider bill suitable
for use in billing …. FL51 Health Plan Identification Number. A AN. 15 …..
Required when there is a condition code that applies to this claim. GUIDELINES
FOR …

MM7677 – CMS

www.cms.gov

Feb 6, 2012 … New Hospice Condition Code for Out of Service Area Discharges. Note: This …
You are instructed to use occurrence code 42 only to indicate a discharge due to
a patient revocation, in …. Patient Status Code 50 or 51; no other.

OWCP-04 – United States Department of Labor

www.dol.gov

UB-04 CMS-1450 … CODE. QUAL. LAST. LAST. National Uniform. Billing
Committee. NUBC™ … OWCP uses a condition-specific fee schedule based on
the Prospective …. Block 50 Type or print program payer: U.S. DOL-OWCP-FECA,
-BLBA or -EEOICPA, as appropriate, and Medicare number (51B) for inpatient
services.

ub-04 claim form instructions – RI.gov

www.eohhs.ri.gov

Sep 16, 2016 … UB-04 CLAIM FORM INSTRUCTIONS. FIELD … Type of Bill. Enter the four digit
code that identifies the specific type … Condition Codes. Enter two digit … 51.
Health Plan ID. The number used by the health plan to identify itself.

UB04 Hospital Billing Instructions – Maryland Medicaid – Maryland.gov

mmcp.dhmh.maryland.gov

Other Diagnosis Codes. 51. FL 68. Reserved for Assignment by NUBC. 52 …
UB04 HOSPITAL ADDENDUM INSTRUCTIONS – ADMINISTRATIVE DAY
BILLING …… Condition Codes required to process your Maryland Medicaid claim
first; then …

Iowa Medicaid Enterprise UB-04 Claim Form Health Insurance …

dhs.iowa.gov

… Insurance Claim Form. The following Iowa Medicaid provider types bill for
services on the UB-04 claim form: …. 51 Hospice Medical Facility … Condition
Codes.

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 ….
Enter the appropriate condition codes that apply to this bill. …. than AHCCCS,
AHCCCS will be the only entry. 50. PAYER. 51. PROVIDER NO. 52.

Health Care Data System Manual – Mississippi State Department of …

msdh.ms.gov

Please refer to the ub04 data crosswalk document for more detail information …
information is used in connection with the Medicare provider number (FL 51) to
verify … FLs 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, and 28 – Condition Codes …

Data Element Specifications Guide – West Virginia Health Care …

www.hca.wv.gov

Admit from Emergency Room Condition Code . ….. Format & Valid Codes Digits 1
-2. All WV provider numbers begin with '51'. Digit 3 … Format & Valid Codes
Submit valid codes per NUBC Official UB-04 Data Specifications. Edit Check.

Inpatient/Outpatient Hospital Billing Manual – Colorado.gov

www.colorado.gov

Refer to the Colorado Medical Assistance Program UB-04 Revenue Code Table
… management of, the prior stay's medical condition, the hospital must bill these …

Chapter 4 – Billing Instructions – Ohio Bureau of Workers …

www.bwc.ohio.gov

Jun 1, 2014 … Code 4123-3-23 set forth billing and adjustment request timelines and are … of
mailing of the final order of allowance of the claim or the condition being treated,
….. Line-by-line instructions for hospital providers completing the UB-04 Billing ….
51. Provider number: Enter the 11-digit BWC provider number.

UB-04 Claim Form Instructions November 18, 2014 – Nevada Medicaid

www.medicaid.nv.gov

Nov 18, 2014 … Under the shaded UB-04 field requirements section, corrected …. Condition
codes: If applicable, indicate conditions or events relating …. 51A-C. Lines A, B &
C recommended. Health plan ID: As applicable, enter the carrier …

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] … Condition Code. FL19. Condition Code
… Health Plan ID. FL51. Health Plan ID. FL52. Release of Information -. Primary.

April 1, 2016 – Washington State Health Care Authority

www.hca.wa.gov

Apr 1, 2016 … Replaced table of ICD-9 codes under the MID ….. Use appropriate condition
codes when billing for qualified trauma cases ……………………51.

Institutional Billing Manual – South Dakota Department of Social …

dss.sd.gov

required to use the official UB-04 (CMS-1450) claim form printed in red OCR ink
…. It is provided in response to a life-threatening condition; to treat pain, injury, …

TABLE OF CONTENTS – SCDHHS.gov

www.scdhhs.gov

Dec 1, 2016 … National Drug Code (NDC) Billing Requirements for Outpatient Hospital. Setting .
….. 51. REIMBURSEMENT TYPE N – SAME DAY DISCHARGE WITH COST.
OUTLIER . ….. Medicaid claims must be filed on the UB-04 claim form. Alternative
….. SCDHHS has implemented the use of Condition Code B4.

ND Health Enterprise MMIS UB-04 Claim Form Instructions

www.nd.gov

Sep 1, 2016 … UB-04 Claim Form Instructions …. Condition Codes: Enter conditions or events
relating to this claim. 29. Situational … 51A-C Not Required.

3.1 Claim 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 … Idaho Medicaid allows twenty-four (24) condition codes on an electronic.




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