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UB-04 Claim: Type of Bill Codes Cheat Sheet by

UB-04 Claim: Type of Bill Codes
codes     healthcare     billing     ub-04

Introd­uction

Type of bill codes are three-­digit codes located on the UB-04 claim form that describe the type of bill a provider is submitting to a payer, such as Medicaid or an insurance company. This code is required on line 4 of the UB-04.

Each digit has a specific purpose and is required on all UB-04 claims in field locator 4.
The codes are published in the National Uniform Billing Committee (NUBC) guidel­ines.

First Digit of the Bill Type Code - Facility Type

1 - Hospital
2 - Skilled Nursing
3 - Home Health
4 - Religious Nonmedical Health Care Facility (Hospital)
5 - Religious Nonmedical Health Care Facility (Extended Care)
7 - Clinic
8 - Specialty Facility, Hospital ASC Surgery

Second Digit of the Bill Type Code

What the second digit signifies depends on the first digit is. It has a different set of meanings for clinics and special facili­ties. The second digit refers to the bill classi­fic­ation except for clinics and special facili­ties.
If the first digit is 1-5, then the second digit is:
1 - Inpatient (Medicare Part A)
2 - Inpatient (Medicare Part B)
3 - Outpatient
4 - Other (Medicare Part B)
5 - Level I Interm­ediate Care
6 - Level II Interm­ediate Care
7 - Subacute Inpatient (for use with Revenue Code 019X)
8 - Swing Bed

For Clinics only:
If the first digit is 7, then the second digit is:
1 - Rural Health Clinic
2 - Hospital Based or Indepe­ndent Renal Dialysis Facility
3 - Federally Qualified Health Center (FQHC), Free Standing Provid­er-­Based
4 - Other Rehabi­lit­ation Facility (ORF)
5 - Compre­hensive Outpatient Rehabi­lit­ation Facility (CORF)
6 - Community Mental Health Center (CMHC)
For Special Facilities Only:
If the first digit is 8, then the second digit is:
1 - Nonhos­pital Based Hospice
2 - Hospital Based Hospice
3 - Ambulatory Surgical Center Services to Hospital Patients
4 - Other Rehabi­lit­ation Facility (ORF)
5 - Compre­hensive Outpatient Rehabi­lit­ation Facility (CORF)
6 - Community Mental Health Center (CMHC)
 

Third Digit of the Bill Type Code - Frequency

0 - Non-pa­yme­nt/Zero Claim
A - Admiss­ion­/El­ection Notice for Hospice
1 - Admit Through Discharge
B - Hospic­e/M­edicare Coordi­nated Care Demons­tra­tio­n/R­eli­gious Nonmedical Health Care Instit­ution Termin­ation/ Revocation Notice
2 - Interim - First Claim
C - Hospice Change of Provider Notice
3 - Interi­m-C­ont­inuing Claims (Not valid for PPS Bills)
D - Hospic­e/M­edicare Coordi­nated Care Demons­tra­tio­n/R­eli­gious Nonmedical Health Care Instit­ution Void/C­ancel
4 - Interim - Last Claim (Not valid for PPS Bills)
E - Hospice Change of Ownership
5 - Late Charge Only (Outpa­tient claims only)
F - Benefi­ciary Initiated Adjustment Claim
7 - Replac­ement of Prior Claim (See adjustment third digit)
G - CWF Initiated Adjustment Claim
8 - Void/C­ancel of Prior Claim (See adjustment third digit)
G - CMS Initiated Adjustment Claim
9 - Final claim for a Home Health PPS Episode
I - FI Adjustment Claim (Other than QIO or Provider)
 
J - Initiated Adjustment Claim-­-Other K OIG Initiated Adjustment Claim
 
M - MSP Initiated Adjustment Claim
 
P - QIO Adjustment Claim
The third digit refers to the frequency.

Corrected Claims

When making changes to previously paid claims, most corrected claims can be submitted electr­oni­cally.
1. Update the Claim Frequency Code with: 7 = Replac­ement of a prior claim 8 = Void/c­ancel of a prior claim
2. Submit the claim using the DCN (document control number) or ICN (internal control number) from the payer's explan­ation of payment (EOP) or electronic remitt­ance.
3. If you must submit a corrected claim on paper, make sure the format is correct. Some payers accept the photoc­opied black-­and­-white versions of the medical claims but the best process is to submit the original red-an­d-white version. Depending on the payer, when the original claim form is not used, the claim may not scan into their system properly creating a delay or denial in payment.

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