1. Industry
Send to a Friend via Email

Your suggestion is on its way!

An email with a link to:

http://medicaloffice.about.com/od/billingforms/tp/Type-Of-Bill-Codes.htm

was emailed to:

Thanks for sharing About.com with others!

You can opt-out at any time. Please refer to our privacy policy for contact information.

Discuss in my forum

Type of Bill Codes

By

Type of bill codes are three digit codes located on a claim form that describes the type of bill a provider is submitting to a payer. Each digit has a specific purpose and is required on all UB-04 claims in field locator 4.

First Digit

The first digit refers to the type of facility.

1 - Hospital
2 - Skilled Nursing
3 - Home Health
4 - Religious Nonmedical Health Care Facility (Hospital)
5 - Religious Nonmedical Health Care Facility (Extended Care)
7 - Clinic
8 - Specialty Facility, Hospital ASC Surgery

Second Digit

The second digit refers to the bill classification except for clinics and special facilities.

If the first digit is numbers 1 - 5, then the second digit is:
1 - Inpatient (Medicare Part A)
2 - Inpatient (Medicare Part B)
3 - Outpatient
4 - Other (Medicare Part B)
5 - Level I Intermediate Care
6 - Level II Intermediate Care
7 - Subacute Inpatient (for use with Revenue Code 019X)
8 - Swing Bed

The second digit refers to the bill classification for Clinics only.

If the first digit is 7, then the second digit is:
1 - Rural Health Clinic
2 - Hospital Based or Independent Renal Dialysis Facility
3 - Federally Qualified Health Center (FQHC), Free Standing Provider-Based
4 - Other Rehabilitation Facility (ORF)
5 - Comprehensive Outpatient Rehabilitation Facility (CORF)
6 - Community Mental Health Center (CMHC)

The second digit refers to the bill classification for Special Facilities Only.

If the first digit is 8, then the second digit is:
1 - Nonhospital Based Hospice
2 - Hospital Based Hospice
3 - Ambulatory Surgical Center Services to Hospital Patients
4 - Other Rehabilitation Facility (ORF)
5 - Comprehensive Outpatient Rehabilitation Facility (CORF)
6 - Community Mental Health Center (CMHC)

Third Digit

The third digit refers to the frequency.

0 - Nonpayment or Zero Claims
1 - Admit Through Discharge Claim
2 - Interim (First Claim)
3 - Interim (Continuing Claims)
4 - Interim (Last Claim)
5 - Late Charge Only
7 - Replacement of Prior Claim or Corrected Claim
8 - Void or Cancel of a Prior Claim
9 - Final Claim for a Home Health PPS Episoed

Examples of Bill Types

Type of Bill 111 represents a Hospital Inpatient Claim indicating that the claim period covers admit through the patients discharge.

Type of Bill 117 represents a Hospital Inpatient Replacement or Corrected claim to a previously submitted hospital inpatient claim that has paid in order for the payer to reprocess the claim.

Type of Bill 138 represents a Hospital Outpatient Void or Cancel of a Prior claim to a previously submitted hospital outpatient claim that has paid in order for the payer to recoup the payment made.

Type of Bill 831 represents a Hospital Outpatient Surgery performed in an Ambulatory Surgical Center. For an outpatient surgery performed in a Hospital, the type of bill would be 131 instead of 831.

Types of Facilities

Community Mental Health Center
Comprehensive Outpatient Rehabilitation Facility
Critical Access Hospital
End-Stage Renal Disease Facility
Federally Qualified Health Center
Histocompatibility Laboratory
Home Health Agency
Hospice
Hospital
Indian Health Services Facility
Organ Procurement Organization
Outpatient Physical Therapy Services
Occupational Therapy Services
Speech Pathology Services
Religious Non-Medical Health Care Institution
Rural Health Clinic
Skilled Nursing Facility

Corrected Claims

When making changes to previously paid claims, most corrected claims can be submitted electronically.

  1. Update the Claim Frequency Code with: 7 = Replacement of a prior claim 8 = Void/cancel of a prior claim
  2. Submit the claim using the DCN (document control number) or ICN (internal control number)from the payer's explanation of payment (EOP) or electronic remittance.
  3. If you must submit a corrected claim on paper, make sure the format is correct. Some payers accept the photocopied black-and-white versions of the medical claims but the best process is to submit the original red-and-white version. Depending on the payer, when the original claim form is not used, the claim may not scan into their system properly creating a delay or denial in payment.

    *Make sure the printer is lined properly to ensure that the information is printed in the correct field locations.

    *Do not highlight any information on the claim.

    *Do not handwrite comments on the form such as "Corrected Claim" or "EOB Attached".

    *Do not attach staples, stamps, tapes, sticky notes, paper clip or anything else to the claim forms.

©2014 About.com. All rights reserved.