EDI HIPAA UB-04 Claims Procedures (Security Health Plan)
EDI HIPAA UB-04 Claims processing procedures: EDI HIPAA UB-04 Claims completion for inpatient and outpatient services billed by hospitals, skilled nursing facilities, home health agencies and other institutional providers (Continuation).
76. Attending physician ID – The name and/NPI of the licensed physician who normally would be expected to certify and re-certify the medical necessity of the services rendered and/or who has primary responsibility for the patient’s medical care and treatment. (Required) Line 1 – Attending physician’s NPI (Type 1 for individuals) Line 2 – Attending physician’s name (last/first)
77. Operating physician – Include NPI on line 1 and name on line 2. (Required)
78. – 79. Other physician ID – Name and/or number of the licensed physician other than the attending physician, as defined by the payer organization. Include NPI on line 1 and name on line 2. (Required for Medicare billing.)
80. Remarks – This field is used to make notations relating to specific third-party payer needs. Provide any additional information that is necessary to adjudicate the claim or otherwise fulfill the payer’s reporting requirements.
81. a – d Additional codes – (Medicaid only -If the billing provider’s NPI was indicated in Form Locator 56, enter the qualifier “PXC” in the first field to the right of the form locator, followed by the 10-digit provider taxonomy code in the second field).
UB-04 Claims Processing Procedures (Part 1)
UB-04 Claims Processing Procedures (Part 2)
UB-04 Claims Processing Procedures (Part 3)