Outpatient UB04 claim dates and reporting
Governs submission and reimbursement of outpatient facility claims billed on UB04/837i forms, requiring valid per-line dates of service within the claim's From and To statement period; applies to UnitedHealthcare Commercial and Individual Exchange products and all network and non‑network facilities.
No material clinical or coverage changes in this revision.
Reimbursement Requirements for Outpatient UB04 Claims
inv-01: Reimbursement criteria for outpatient UB04 claims
Requirements for outpatient UB04 claims to be reimbursable:
ALL of the following
- Each outpatient claim line must report a single valid date of service (MMDDYY) representing when the service was provided.
- There must be a single line-item date of service reported for every revenue code, procedure code, or drug code on all outpatient claims.
- Each service date (MMDDYY) must fall within the From and To date of service on the outpatient facility claim (UB-04 Line 6 Statement Covers Period).
- If the date of service submitted for a procedure is outside the From and To date calendar range, the claim will be denied; providers should correct and resubmit the claim with an appropriate date of service.
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