| # | Name | Location | Type | Details | Index | Description |
|---|---|---|---|---|---|---|
| .001 | number | 11 | This is the sequential number of the entry. Use of this number facilitates reference to the line item charges and revenue codes it is associated with. | |||
| .01 | revenue code(+) | 0;1 | POINTER | 399.2 | B | Enter the Revenue Code to assign the charge for the care being billed. |
| .02 | charges(+) | 0;2 | NUMERIC | This is the unit charge for this revenue code. It will be multiplied times the number of units to determine the total cost for this revenue code. | ||
| .03 | units of service(+) | 0;3 | NUMERIC | This is the number of day of inpatient care or the number of outpatient visits for this revenue code. It will be multiplied by the CHARGES field to determine the TOTAL charges for this revenue code. | ||
| .04 | total(+) | 0;4 | NUMERIC | This is the total charges for this revenue code. It is computed by the system. | ||
| .05 | bedsection(+) | 0;5 | POINTER | 399.1 | If this is an inpatient bill then this is the Specialty associated with authorized rates for the type of care provided for this revenue code. | |
| .06 | procedure | 0;6 | POINTER | 81 | This field may be used to associate the revenue code with a procedure. This will be needed primarily to accomodate the CMS-1500 which allows charges by procedure not revenue code. The charge associated with the revenue code will be printed on the CMS-1500 claim form in the same line item as the procedure. This field is also used for revenue codes that are for Billable Ambulatory Surgeries (BASC). It identifies the CPT code of the surgery which is being billed for. | |
| .07 | division | 0;7 | POINTER | 40.8 | This identifes the division where the treatement being billed was performed. It is only required if the charges are based on CPT and region and the division is different than the bills Default Division. | |
| .08 | auto | 0;8 | BOOLEAN | 1:YES | True if the revenue code and charge were added by the automatic charge calculation routine, blank if added manually by the user. | |
| .09 | non-covered charge | 0;9 | NUMERIC | This is the amount of the charges that are not covered for this revenue code line item. Use to record things such as pass days that need to be reported but are not chargeable. | ||
| .1 | type | 0;10 | SET OF CODES | 1:INPT BS 2:OPT VST DT 3:RX 4:CPT 5:PROS 6:DRG 9:UNASSOCIATED | The type of item the charge is for. This places the charges into categories and should correspond to the billable event. | |
| .11 | item | 0;11 | NUMERIC | This is a soft pointer to the item being charged for. The TYPE field defines the file reference this is pointing to. Automatically set when charges are set by the auto calculator. | ||
| .12 | component | 0;12 | SET OF CODES | 1:INSTITUTIONAL 2:PROFESSIONAL | The total charges for some events are broken into Institutional and Professional charges. If this charge is for only one of these components enter it here. | |
| .13 | *ub92 form locator 49 | 0;13 | FREE TEXT | This is the data that should print for a revenue code line in the form locator 49. This field is marked for deletion and can be deleted 11/23/2008. | ||
| .15 | rx procedure | 0;15 | FREE TEXT | ACP | This is a soft pointer to the CP multiple entry for prescriptions billed on a CMS-1500 billing form. | |
| .16 | manually edited | 0;16 | BOOLEAN | 0:NO 1:YES | This field indicates whether the user manually changed the CHARGES (#.02) field. |
Error: Invalid Global File Type: 399.042