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PAP405

Bill Types


Provider Administrative Policy

Section
Hospital
Policy Date
November 2007
Status/Date
Revised/March 2012
Provider Type(s)
Hospitals  

Disclaimer

Our provider administrative policies contain information regarding claims submission, reimbursement, and other information in order to achieve an efficient relationship with our providers. These policies are not an authorization or explanation of benefits. Blue Cross of Idaho retains the right to add to, delete from and otherwise modify this policy in accordance with our provider contracts.

Policy

Bill Types

Blue Cross of Idaho requires facility inpatient and outpatient claims submitted on the UB-04 form to include a bill type code that indicates the specific type of bill submitted (inpatient, outpatient, adjustment, void, etc.).

You must code all positions properly for us to process your claims. The following list contains recognized codes for each digit:

 

1st and 2nd Digits Type of Facility

01

Hospital

02

Skilled Nursing

03

Home Health

04

Religious Nonmedical Health Care Institution (hospital)

06

Intermediate Care

 07*

Clinic

 08**

Special Facility or ASC surgery

* When Code 07 is used, the third digit (bill classification) must come from the “Clinics Only” codes.
** When Code 08 is used, the third digit (bill classification) must come from the “Special Facilities” codes.

You must submit Critical Access Hospital (CAH) claims on a UB-04 form with a bill type of 0851. The CAH designation and procedures only apply to claims where Medicare is primary.

 

3rd Digit: Type of Facility

1

Inpatient (including Medicare Part A)

2

Inpatient (Medicare Part B only)

3

Outpatient

4

Laboratory services provided to non-patients or home health not under plan of treatment

5

Intermediate Care – Level I

6

Intermediate Care – Level II

8

Swing Beds
3rd Digit: Bill Classification (Clinics Only)

1

Rural Health

2

Hospital Based or Independent Renal Dialysis Center

3

Freestanding

4

Outpatient Rehabilitation Facility (ORF)

5

Comprehensive Outpatient Rehabilitation Facility (CORF)

6

Community Mental Health Center (CMHC)

7

Federally Qualified Health Center (FQHC)

8

Licensed Freestanding Emergency Medical Facility (eff 07/01/12)

9

Other
3rd Digit: Bill Classification (Special Facilities Only)

1

Hospice (non-hospital based)

2

Hospice (hospital based)

3

Ambulatory Surgery Center

4

Freestanding Birthing Center

5

Critical Access Hospital

6

Residential Facility (not used for Medicare)

9

Other (not used for Medicare)
4th Digit: Frequency

0

Nonpayment/Zero Claim

1

Admit through Discharge Claim

2

Interim – First Claim

3

Interim – Continuing Claim

4

Interim – Last Claim

5

Late Charge(s) Only Claim

7

Replacement of Prior Claim

8

Void/Cancel Prior Claim

9

Final claim for home health in the prospective payment system (PPS) episode
4th Digit: Frequency – Hospice

A

Admission/election notice

B

Hospice/Medicare Coordinated Care Demonstration/Religious Nonmedical Health Care Institution/Centers of Excellence Demonstration/Provider Partnerships Demonstration-Termination/Revocation Notice

C

Hospice Change of Provider Notice

D

Hospice/Medicare Coordinated Care Demonstration/Religious Nonmedical Health Care Institution/Centers of Excellence Demonstration/Provider Partnerships Demonstration-Void/Cancel

E

Hospice Change of Ownership

F

Beneficiary Initiated Adjustment Claim

G

CWF Initiated Adjustment Claim

H

CMS Initiated Adjustment Claim

I

Intermediary Adjustment Claim (Other than PRO or Provider)

J

Initiated Adjustment Claim – Other

K

OIG Initiated Adjustment Claim

M

MSP Initiated Adjustment Claim

N

QIO Adjustment Claim

O

Nonpayment/Zero Claims

P

Reserved for Assignment by the NUBC

Q

Claim Submitted for Reconsideration Outside of Timely Limits

X

Void/Cancel a Prior Abbreviated Encounter Submission

Y

Replacement of a Prior Abbreviated Encounter Submission

 Z

New Abbreviated Encounter Submission 


Policy History

Date Action Reason
March 2012 Revised Additions and deletions to bill types
November 2008 Revised Additions to bill types
August 2008 Revised UB-04 revisions

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