Claim Form Codes Type of Bill Facility Codes - FL 4 Type of Bill Frequency Codes - FL 4 Admission/Discharge Hour - FL 13/16 Point of Origin Admission/Visit - FL 15 Patient Discharge Status - FL 17 Condition Codes - FLs 18-28 Occurrence Codes - FLs 31-34 Occurrence Span Codes - FLs...
(From & Through Dates) dates of the period covered by this bill. Required. Enter the beginning and ending service dates.Note: Do not show days before the patient’s entitlement began.Note: A claim may not span more than one month of service at a time.7 Unlabeled Leave blank.1 ...
The following is a list of the valid Type of Bill entries. The third digit may be any digit you choose from the UB-92 manual, EXCEPT 7 or 8. The third digit of 7 or 8 is used only to Adjust (7) or Void (8) a claim. Group B Providers: Nursing Home: 21 through 28 Hospices:...
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