Emergency Department/Room Type of Bill Requirement
| Date: | May 15, 2024 |
| From: | Health Plan |
| To: | Health Plan of San Joaquin/Mountain Valley Health Plan (Health Plan) Hospital Outpatient Facilities |
| Type: | Regulatory |
| Subject: | Emergency Department/Room Type of Bill Requirement |
| Business: | Medi-Cal Managed Care |
Through the new Claims Editing System (CES), Health Plan has identified that an incorrect Type of Bill is being used when billing emergency department or emergency room services.
The Type of Bill code is a four-digit alphanumeric code which gives three specific pieces of information after a leading zero. The second digit identifies the type of facility. The third classifies the type of care. The fourth indicates the sequence of this bill in this episode of care. The type of bill code is in the field form locator 04 on the UB-04 claim form.
If CPT/HCPCS Code Z7502 or 99281 through 99285 is billed along with revenue code 0450, and Admission Type code “1”, the Type of Bill should be 014X.
Claims submitted with the incorrect Type of Bill/Admission Type code combination will be denied and a corrected claim submission will be required.
If you have any further questions, please contact your Provider Services Representative, or call our Customer Service Department at 1-888-936-PLAN (7526). You may also visit https://www.hpsj.com/alerts/ for online access to the documents shared. The most recent information about Health Plan and our services is always available on our website WWW.HPSJ-MVHP.ORG
