Claims Processing Procedures

Claims Processing Procedures: UB-04 Security Health Plan

Claims processing procedures: UB-04 claim completion for inpatient and outpatient services billed by hospitals, skilled nursing facilities, home health agencies and other institutional providers (Continuation).

9. a – Patient address – Full mailing address of the patient. (Required)

10. Patient birth date – The patient’s birth date must be reported with all positions fully coded in the MM/DD/YY format. (Required)

11. Patient sex – The gender of the patient as recorded at the time of registration as an inpatient or outpatient or at the start of care. (Required)

12. Admission/start-of-care date – The date the patient was admitted to the provider for inpatient care, outpatient services or other start of care. (Required)

13. Admission hour – The hour during which the patient was admitted for inpatient or outpatient care. Hours are entered in military time using two numeric characters.

14. Type of admission/visit – A code that indicates the priority of admission/visit. (Required)

15. Source of admission – A code that indicates the source of admission or service: inpatient, outpatient, hospital, home health and inpatient SNF. (Required)

16. Discharge hour – The hour during which the patient was discharged from inpatient care (in military time).

17. Patient status – A code indicating the patient’s disposition as of the ending date of service for the period of care reported. (Required)

18. – 28. Condition codes – Codes identifying conditions that may affect payer processing of this bill. The codes help determine patient eligibility and benefits and are used to administer primary or secondary insurance coverage. (Required)

29. Accident state

30. Unlabeled

31. – 34. Occurrence codes and dates – These define a specific event relating to this bill that may affect payer processing. Codes are used to determine liability, coordinate benefits and administer subrogation clauses in benefit programs. (Required)

35. – 36. Occurrence span codes and dates – These identify an event that relates to payment of the claim. These codes identify occurrences that happened over a span of time. Report the code, the beginning (“from”) date and the ending (“through”) date associated with the reported occurrence span code. (Required).

Claims Processing Procedures: UB-04 (Part 1)

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