CurrentNeighborhood Health Plan of Rhode IslandPolicy N/A

Outpatient UB-92 billing itemization requirements

Governs how outpatient services crossing calendar days must be billed to Neighborhood Health Plan of Rhode Island; applies to claims submitted on UB-92 forms and affects providers submitting outpatient claims.

Policy Summary

PayerNeighborhood Health Plan of Rhode Island

PolicyOutpatient UB-92 billing itemization requirements

Policy CodePolicy N/A

Change TypeNo material change

Effective DateSep 1, 2011

Next Review Date

Key ActionClaims for outpatient services crossing calendar days must be itemized by individual date rendered and units per day; claims submitted with only a date range and total units will be rejected and returned for corrected, itemized billing.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

1required itemization by individual date rendered

UB-92claim form this policy applies to

error + rejectioncondensed/date-range claims will receive

cross-dayscope of outpatient service coverage

Outpatient Itemization Requirements

Policy Summary

PayerNeighborhood Health Plan of Rhode Island

PolicyOutpatient UB-92 billing itemization requirements

Policy CodePolicy N/A

Change TypeNo material change

Effective DateSep 1, 2011

Next Review Date

SourceLink

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Outpatient UB-92 itemization criteria

Billing acceptance criteria for outpatient services that cross calendar days:

Claims must be submitted on a UB-92 form when applicable (institutional outpatient billing).

The policy applies to any outpatient service that crosses a calendar day (i.e., services rendered across two or more calendar dates).

All services must be itemized by individual date rendered and list the corresponding units for each date (individual date and units per day required).

Claims submitted with a condensed date range and a total unit count only will be rejected.

Such claims will receive an error message and be returned requesting a corrected, itemized bill for processing.

Required Billing Actions and Risks

Billing Rule

Itemize outpatient services by date and units (UB-92)

Claims for outpatient services that cross a calendar day must list each service by the individual date rendered and show the units for that specific date. Claims submitted with only a condensed date range and a total unit count will receive an error and be rejected; the provider must submit a corrected, itemized UB-92 claim for processing.

Applies to charges billed on a UB-92.
Each service line must include the date of service and units for that date.
Condensed date-range claims with total units will receive an error message and claim rejection and must be resubmitted itemized.

Form and Itemization Definitions

UB-92 claim form

Applicable formThis policy applies to charges billed on a UB-92 claim form.

Billing settingApplies to institutional billing for outpatient services that cross a calendar day.

Effective datePublication Date 09/01/2011.

Itemized billing

Itemized listingList each service by individual date rendered with the corresponding units per day.

Noncompliant submissionCondensed submissions with a date range and total units are not acceptable and will be rejected.

ScopeRequirement applies to any outpatient service that crosses a calendar day.

OpenPayer

Outpatient UB-92 billing itemization requirements

Outpatient Itemization Requirements

Claim Form and Itemization Details

Required Billing Actions and Risks

Form and Itemization Definitions