How To Pay And Indian Health Services Bill

Indian Health Service (IHS)

• Indian Health Service (IHS)
  • IHS Provider
  • Urban Indian Organization (UIO)
  • Early and Periodic Screening, Diagnostic, and Handling (EPSDT)
• Billing Information
• Indian Health Service (IHS) Benefits
  • Coding
• UB-04 Paper Claim Reference Table
  • UB-04 Outpatient Claim Example
  • UB-04 Inpatient Merits Instance
  • UB-04 Behavioral Health Claim Instance
  • CMS 1500 Professional Claim Example
• Sterilizations, Hysterectomies, and Abortions
• Timely Filing
• IHS Revisions Log

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Indian Wellness Service (IHS)

Providers must exist enrolled equally a Health Showtime Colorado (Colorado's Medicaid Program) provider in club to:

• Treat a Health Outset Colorado member
• Submit claims for payment to Health First Colorado

Providers should refer to the Code of Colorado Regulations, Program Rules (10 C.C.R. 2505-ten 8.700), for specific information when providing FQHC and RHC services.

NOTE: Wellness Offset Colorado should be billed only in the result that an eligible American Indian Alaska Native (AIAN) fellow member is enrolled in Wellness Starting time Colorado. If the eligible member also possesses a third-party insurance plan, the individual plan must exist billed first. Any services not covered by the private insurance programme that are covered by Health First Colorado may then be billed. In the event an eligible AIAN fellow member is dually eligible for Medicare and Health Start Colorado, Medicare must be billed get-go. Whatsoever services not covered by Medicare that are covered by Health First Colorado may then exist billed.

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IHS Provider

In guild to bill as an IHS provider with Health Starting time Colorado, the treatment facility must reside on land owned and operated by a federally recognized tribe as defined under Title 4 of the Indian Health Care Improvement Act.

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Urban Indian Organization (UIO)

Urban Indian Organizations (UIO) are currently ineligible to receive IHS designation under federal law. Even so, UIOs may apply to become a federally qualified wellness center (FQHC) with Health First Colorado, as long as they receive funds under Title V of the Indian Health Care Improvement Deed.

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Early on and Periodic Screening, Diagnostic, and Treatment (EPSDT)

8.280.iv.E Other EPSDT Benefits

Other wellness care services may include other EPSDT benefits if the need for such services is identified. The services are a benefit when they meet the following requirements:

1. All goods and services described in Department 1905(a) of the Social Security Human activity are a covered benefit under EPSDT when medically necessary every bit defined at 10 C.C.R. 2505-10, Department viii.076.1.eight, regardless of whether such goods and services are covered nether the Colorado Medicaid State Plan.
2. For the purposes of EPSDT, medical necessity includes a proficient or service that volition, or is reasonably expected to, help the client to attain or maintain maximum functional capacity in performing one or more Activities of Daily Living; and meets the criteria set forth at Department 8.076.1.8.b - g.
3. The service provides a condom environment or situation for the child.
4. The service is not for the convenience of the caregiver.
5. The service is medically necessary.
6. The service is not experimental or investigational and is generally accepted by the medical customs for the purpose stated.
7. The service is the least plush.

Billing Information

Refer to the General Provider Information manual for general billing data.

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Indian Wellness Service (IHS) Benefits

Outpatient Services

Payment for outpatient services rendered shall be paid per visit/encounter. Rates are determined by the U.South. Department of Wellness and Human being Services and are published each year in the Federal Register. Wellness Offset Colorado covers the followingoutpatient services:

• Medical services
• Behavioral wellness services
• Hospital outpatient services
• Podiatry services
• Optometry services
• Radiology services
• Laboratory services

Health Offset Colorado shall reimburse multiple visit/encounter claims for a member on the same date of service by the same facility based on the following conditions:

1. If the services provided are for different diagnoses and the claims each accept a unlike diagnosis ICD-10 code, or
2. If the services are in the categories of either medical, clinical laboratory, or radiology, based on the process lawmaking detail of the merits. If all iii types of services are rendered then these iii split up claims may be billed:
   1. Clinical Laboratory procedure codes.
   2. Radiology procedure codes.
   3. Medical services would be any other medical procedure code not in the Clinical Laboratory or Radiology category.

Behavioral wellness servicesare a covered benefit. Behavioral health services must be billed using Revenue Lawmaking 900. Claims must be billed direct to Health Starting time Colorado. These services are reimbursed the IHS outpatient encounter charge per unit.

Inpatient Services

Health First Colorado coversinpatient servicesat IHS facilities. Payment for services rendered shall exist per date of inpatient stay and is set in the Federal Register past the U.Southward. Department of Health and Human Services. Health Kickoff Colorado shall brandonly one payment per date of service per member.

Professional Services

Professional servicesrendered by IHS providers at an inpatient hospital or ambulatory surgical middle are billed on the professional person claim type (837p/CMS1500) and are reimbursed at the Fee Schedule charge per unit. Providers should refer to the billing manual for medical and surgical services found on the Billing Manuals web page under the CMSS 1500 driblet-downwards menu. Covered services include anesthesia services, obstetric services, medical services, vaccine/immunization services, psychiatric services, and surgical services equally detailed in the medical and surgical services billing transmission (run across link above).

Pharmacy services rendered by an IHS pharmacy are covered past Health Starting time Colorado, instructions can be found in the pharmacy billing manual.

Dental servicesare covered by Health First Colorado, only must be billed to DentaQuest. For more than information, see locator 42 on folio xi of this manual.

Urban Indian Organizations (UIO)who are designated as federally qualified health centers (FQHC) with Health Get-go Colorado who use cost reports in lieu of the federal encounter rate should refer to the billing transmission for FQHCs institute on the Billing Manuals web page under the UB-04 drop-down menu.

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Coding

IHS facilities are required to employ revenue codes to neb Health First Colorado. The valid revenue codes for reimbursement are:

Revenue Lawmaking	Type of Service
529	Concrete Health (Outpatient)
900	Behavioral Health (Outpatient)
110	Inpatient Services (Physical and Behavioral Wellness)

IHS services are priced at an encounter rate. All routine services are included in the come across rate. Encounter rates for Tribal-FQHCs and IHS facilities are adamant by the federal Department of Wellness and Human being Services and are published in the Federal Annals for each calendar year.

In order to provide the Health Offset Colorado programme with basic clinical information for utilise in evaluating services requested and received past Health Outset Colorado members, IHS and Tribal-FQHCs are required to include all procedure codes (CPT and HCPCS codes) for services provided during a visit on claims. To be reimbursed, a Tribal-FQHC or IHS facility that submits a UB-04 or 837 Institutional (837I) electronic transaction must have at to the lowest degree ane (1) claim line that identifies revenue lawmaking 0529. All other lines on the merits should have the revenue lawmaking most appropriate for the service. The line item with revenue code 0529 or 0521 can appear at any line on the claim and with whatsoever procedure lawmaking.

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UB-04 Newspaper Claim Reference Table

The data in the following table provides instructions for completing form locators (FL) as they appear on the paper UB-04 claim form. Instructions for completing the UB-04 claim form are based on the electric current National Uniform Billing Committee (NUBC) UB-04 Reference Manual. Unless otherwise noted, all data form locators on the UB-04 have the same attributes (specifications) for Wellness First Colorado as those indicated in the NUBCUB-04 Reference Manual.

All code values listed in the NUBC UB-04 Reference Transmission for each form locatormay notexist used for submitting paper claims to Health Get-go Colorado. The advisable lawmaking values listed in this manual must exist used when billing Health First Colorado.

The UB-04 Certification document (located subsequently the Sterilizations, Hysterectomies, and Abortions instructions and in the Provider Services Forms section) must be completed and attached to all claims submitted on the paper UB-04. Completed UB-04 newspaper Health Commencement Colorado claims, including hardcopy Medicare claims, should be mailed to the correct fiscal agent address listed in Appendix A, under the Appendices drop-downwards section on the Billing Manuals web page.

The Paper Merits Reference Table below lists the required, optional, or provisional form locators for submitting the newspaper UB-04 claim form to Wellness Outset Colorado for FQHC and RHC services.

Form Locator and Labels	Completion Format	Instructions
1. Billing Provider Name, Address, Phone Number	Text	Abbreviate the state using standard postal service office abbreviations. Enter the telephone number. Street City State Zippo Code Abbreviate the state using standard post office abbreviations. Enter the phone number.
2. Pay-to Name, Accost, Metropolis, State	Text	Required simply if different from FL 1. Enter the provider or agency name and complete mailing address of the provider who will receive payment for the services: Street/Postal service Office box Metropolis Land Zip Lawmaking Abridge the state using standard post function abbreviations. Enter the phone number.
3a. Patient Control Number	Upward to 20 characters: Letters, numbers or hyphens	Optional Enter data that identifies the member or claim in the provider's billing system. Submitted information appears on the Remittance Communication (RA).
3b. Medical Record Number	17 digits	Optional Enter the number assigned to the member to assist in retrieval of medical records.
4. Type of Bill	3 digits	Required IHS: Apply type of Bill 71X or 77X for outpatient, 111 for inpatient. Digit 1 Frequency 0 Not-Payment/Zero Merits 1 Admit through belch claim two Acting - First merits 3 Interim - Continuous claim four Interim - Last claim 7 Replacement of prior claim 8 Void of prior claim
five. Federal Tax Number	None	Submitted information is not entered into the claim processing arrangement.
half dozen. Statement covers period From/Through	From:6 digits MMDDYY Through: 6 digits MMDDYY	Required Each date of service must be billed on a dissever line. Split an entire calendar month into ii claims. This FL must reverberate the showtime and ending dates of service listed on the detail dates of service lines.
8a. Patient Identifier		Submitted information is non entered into the claim processing system.
8b. Patient Name	Up to 25 characters, letters & spaces	Required Enter the member's last name, first proper name and middle initial.
9a. Patient Accost - Street	Characters Letters & numbers	Required Enter the member's street/post office box as determined at the time of access.
9b. Patient Address - City	Text	Required Enter the fellow member'south city as determined at the time of admission
9c. Patient Accost - State	Text	Required Enter the fellow member'due south state as determined at the time of admission.
9d. Patient Address - ZIP	Digits	Required Enter the fellow member's nada lawmaking equally determined at the fourth dimension of admission.
9e. Patient Address - Country Lawmaking	Digits	Optional
x. Birthdate	8 digits (MMDDYYYY)	Required Enter the member'south birthdate using two digits for the calendar month, 2 digits for the date, and four digits for the year (MMDDYYYY format). Example: 01012010 for January 1, 2010.
11. Patient Sex	1 letter of the alphabet	Required Enter an M (male) or F (female) to point the member's sex.
12. Access Appointment	6 digits	Non Required
13. Admission Hour	6 digits	Not Required
14. Admission Type	ane digit	Provisional Consummate for emergency visits. one - Emergency Fellow member requires immediate intervention every bit a result of astringent, life-threatening or potentially disabling atmospheric condition. Exempts outpatient hospital claims from co-payment and PCP referral but if Acquirement Lawmaking 0450 or 0459 is nowadays. This is the merely do good service for an undocumented alien. If bridge billing, emergency services cannot be included in the span bill and must be billed separately from other outpatient services.
fifteen. Source of Access	ane digit	Not Required
sixteen. Belch Hour	2 digits	Not Required
17. Patient Discharge Status	2 digits	Not Required
18-28. Weather condition Codes	ii digits	Conditional Complete with every bit many codes necessary to identify conditions related to this pecker that may touch payer processing. Status Codes 01 Military service related 02 Employment related 04 Information simply bill 05 Lien has been filed 06 ESRD member - First 30 months entitlement 07 Treatment of non-terminal status/hospice fellow member 17 Member is homeless 25 Member is a non-US resident 39 Individual room medically necessary 60 -DRG (24-hour interval outlier) Renal dialysis settings 71 Full care unit 72 Self care unit of measurement 73 Cocky-care training 74 Home care 75 Domicile care - 100 percent reimbursement 76 Redundancy facility Special Plan Indicator Codes A1 EPSDT/CHAP A2 Physically Handicapped Children's Program A4 Family Planning A6 PPV/Medicare A9 Second Opinion Surgery B3 Pregnancy Indicator PRO Approving Codes C1 Approved as billed C2 Automatic approval as billed - Based on focused review C3 Partial approval C4 Access/Services denied C5 Post payment review applicable C6 Admission preauthorization C7 Extended authorisation
29. Accident Country	2 digits	Not required
31 - 34. Occurrence Code/Date	2 digits & six digits	Conditional Complete both the code and date of occurrence. Enter the appropriate code and the date on which it occurred. Enter the date using MMDDYY format. Occurrence Codes: 1 Accident/Medical Coverage ii Auto Accident - No Mistake Insurance Involved 3 Accident/Tort Liability 4 Blow/Employment Related 5 Other Blow/No Medical Coverage or Liability Coverage 6 Criminal offence Victim 20 Engagement Guarantee of Payment Began 24* Date Insurance Denied 25* Date Benefits Terminated by Primary Payer 26 Engagement Skilled Nursing Facility Bed Available 27 Date of Hospice Certification or Re-certification twoscore Scheduled Date of Admission (RTD) l Medicare Pay Date 51 Medicare Deprival Date 55 Date of Death A3 Benefits Exhausted - Bespeak the final appointment of service that benefits are bachelor and after which payment can be fabricated by payer indicated in FL l, Line A B3 Benefits Exhausted - Indicate the concluding date of service that benefits are bachelor and afterward which payment tin be fabricated past payer indicated in FL 50, Line B C3 Benefits Exhausted - Signal the last date of service that benefits are available and after which payment can be made by payer indicated in FL 50, Line C *Other Payer occurrence codes 24 and 25 must be used when applicable. The merits must be submitted with the 3rd-political party data
35-36. Occurrence Span Code From/ Through	ii & half-dozen digits	Not required
38. Responsible Party Name/Address	None	Leave blank
39 - 41. Value Codes and Amounts	2 characters and up to ix digits	Provisional Enter advisable codes and related dollar amounts to identify monetary data or number of days using whole numbers, necessary for the processing of this merits. Never enter negative amounts. Codes must be in ascending gild. If a value code is entered, a dollar amount or numeric value related to the code must ever exist entered. 01 Virtually common semiprivate rate (Accommodation Rate) 06 Medicare claret deductible 14 No fault including auto/other 15 Worker's Compensation 30 Preadmission testing 31 Fellow member Liability Amount 32 Multiple Member Ambulance Transport 37 Pints of Blood Furnished 38 Blood Deductible Pints xl New Coverage Non Implemented by HMO 45 Blow Hr Enter the hour when the blow occurred that necessitated medical treatment. Employ the same coding used in FL 18 (Admission 60 minutes). 49 Hematocrit Reading - EPO Related 58 Arterial Claret Gas (PO2/PA2) 68 EPO-Drug 80 Covered Days 81 Non-Covered Days Enter the deductible corporeality applied past indicated payer: Deductible Payer A B1 Deductible Payer B C1 Deductible Payer C Enter the corporeality practical to member's co-insurance by indicated payer: A2 Coinsurance Payer A B2 Coinsurance Payer B C2 Coinsurance Payer C Enter the corporeality paid past indicated payer: A3 Estimated Responsibility Payer A B3 Estimated Responsibleness Payer B C3 Estimated Responsibility Payer C
42. Revenue Code	3 digits	Required IHS Outpatient Medical Claims Use revenue code 0529 on each line of the claim regardless of the type of service identified in locator 44. All other lines should use the acquirement code advisable for the service. IHS Inpatient Medical Claims Use any of the following revenue codes: 110, 111, 112, 117, 120-25, 127-31, 140, 145, 150, 159, 160, and 169. IHS Behavioral Health Claims Use revenue code 0900 on each line of the claim regardless of the type of service identified in locator 44. All other lines should use the revenue code appropriate for the service. IHS Dental Claims For claims with dates of service prior to March 1, 2018, employ revenue lawmaking 529 on each line of the claim regardless of the type of services identified in locator 44. For claims with dates of service afterward March 1, 2018, refer to the Office Reference Manual (ORM) under 'DentaQuest Resource' located on the Dentist page of DentaQuest's website.
43. Revenue code Description	Text	Required Enter the revenue code description or abbreviated description. When reporting an NDC: Enter the NDC qualifier of "N4" in the beginning two positions on the left side of the field, immediately followed past the 11-digit NDC numeric code Enter 1 space for separation. Enter the NDC unit of measurement of measure qualifier (examples include): F2 - International Unit of measurement GR - Gram ML - Milliliter UN - Units Enter the NDC unit of measurement of measure out quantity Example: 42 REV.CD. 43 Description 0636 N467066000501 ME.016
44. HCPCS/Rates/ HIPPS Rate Codes	v digits	Required Medical Claims - There may be multiple lines, each identified by revenue code 529 in locator 42. For each line enter a valid CPT lawmaking or HCPCS code that reflects the services rendered during the run into. This includes any medical, laboratory, radiology, physical therapy, occupational therapy, pharmacy, supply or other service rendered during the see. When a line identifies revenue code in the range of 0631-0636, the HCPCS will be required and an NDC. CPT and HCPCS codes cannot be repeated for the same date of service. Combine the units in FL 46 (Units) to report multiple services. On dental claims the D-code must exist put in locator 44 on each line for dates of services prior to July 1, 2014. For dates of services afterwards July 1, 2014, refer to the Office Reference Manual (ORM) nether 'DentaQuest Resources' located on the Dentist page of DentaQuest's website. Behavioral Health Claims - There may be multiple lines, each identified by acquirement code 900 in locator 42. For each line enter a curt-term behavioral health service code that reflects the service rendered during the encounter. HCPCS codes cannot be repeated for the same appointment of service. Combine the units in FL 46 (Units) to report multiple services.
45. Service Date	6 digits	Required Enter the date of service using MMDDYY format for each detail line completed. Each date of service must autumn within the engagement span entered in the "Statement Covers Period" (FL vi). Not required for single date of service claims.
46. Service Units	Up to three digits	Required Enter a unit value on each line completed. Use whole numbers merely. Do not enter fractions or decimals and exercise not show a decimal bespeak followed by a 0 to designate whole numbers (e.grand., Practice not enter 1.0 to signify ane unit)
47. Total Charges	Upward to nine digits	Required Enter the full accuse for each line particular. Calculate the full charge as the number of units multiplied past the unit accuse. Exercise not subtract Medicare or third-party payments from line charge entries. Do non enter negative amounts. A yard total in line 23 is required for all charges.
48. Not-covered Charges	Up to ix digits	Required Enter incurred charges that are non payable by Wellness Starting time Colorado. Non-covered charges must be entered in both FL 47 (Full Charges) and FL 48 (Non-Covered Charges). Each cavalcade requires a chiliad total. Non-covered charges cannot exist billed for outpatient hospital laboratory or hospital-based transportation services.
l. Payer Name	ane letter and text	Enter the payment source code followed past name of each payer system from which the provider might expect payment. At least one line must indicate Health First Colorado. Source Payment Codes B Workmen's Compensation C Medicare D Health Outset Colorado E Other Federal Plan F Insurance Visitor G Bluish Cross, including Federal Employee Program H Other - Inpatient (Function B Merely) I Other Line A Primary Payer Line B Secondary Payer Line C Tertiary Payer
51. Health Plan ID	8 digits	Required Enter the provider'southward Wellness Plan ID for each payer proper noun. Enter the viii-digit Health First Colorado Program provider number assigned to the billing provider. Payment is made to the enrolled provider or agency that is assigned this number.
52. Release of Data	None
53. Assignment of Benefits	None
54. Prior Payments	Upwardly to 9 digits	Conditional Complete when there are Medicare or third-party payments. Enter 3rd party and/or Medicare payments.
55. Estimated Amount Due	Up to nine digits	Conditional Consummate when there are Medicare or third-political party payments. Enter the net amount due from Health Get-go Colorado after provider has received other third party, Medicare or fellow member liability amount. Medicare Crossovers Enter the sum of the Medicare coinsurance plus Medicare deductible less 3rd-political party payments and member payments.
56. National Provider Identifier (NPI)	x digits	Required Enter the billing provider's 10-digit National Provider Identifier(NPI).
57. Other Provider ID		Submitted data is not entered into the merits processing system.
58. Insured's Name	Up to 30 characters	Required Enter the fellow member'due south name on the Health First Colorado line. Other Insurance/Medicare Consummate boosted lines when there is third party coverage. Enter the policyholder'south final name, first proper noun, and eye initial.
sixty. Insured'south Unique ID	Up to 20 characters	Required Enter the insured's unique identification number assigned past the payer arrangement exactly as it appears on the health insurance card. Include letter prefixes or suffixes shown on the carte.
61. Insurance Group Name	fourteen letters	Conditional Complete when in that location is third party coverage. Enter the proper name of the group or programme providing the insurance to the insured exactly as it appears on the health insurance bill of fare.
62. Insurance Group Number	17 digits	Conditional Consummate when at that place is third political party coverage. Enter the identification number, control number, or lawmaking assigned by the carrier or fund administrator identifying the group under which the private is carried.
63. Handling Authorization Code	Up to 18 characters	Conditional Complete when the service requires a PAR. Enter the authorization number in this FL if a PAR is required and has been approved for services.
64. Document Control Number		Provisional
65. Employer Proper noun	Text	Conditional Complete when there is third party coverage. Enter the proper noun of the employer that provides health intendance coverage for the private identified in FL 58 (Insured Name).
66. Diagnosis Version Qualifier		Submitted information is not entered into the merits processing system. Enter applicative ICD indicator to identify which version of ICD codes is beingness reported. 0ICD-10-CM (DOS 10/1/15 and later on) 9ICD-ten-CM (DOS 9/30/xv and before)
67. Master Diagnosis Code	Up to 6 digits	Required Enter the exact diagnosis code describing the principal diagnosis that exists at the time of admission or develops subsequently and affects the length of stay. Do not add extra zeros to the diagnosis code. Utilize diagnosis lawmaking Z00.00-10 Z00.110-Z00.111 Z00.121-Z00.129 Z00.6-Z00.8 Z02.0-Z02.6 Z02.81-Z02.89 Z76.2 for EPSDT screenings.
67A. - 67Q. - Other Diagnosis	six digits	Optional Enter the exact diagnosis lawmaking respective to additional conditions that co-exist at the time of access or develop afterwards and which result the treatment received or the length of stay. Do non add extra zeros to the diagnosis code.
69. Admitting Diagnosis Code	6 digits	Not required
70. Patient Reason Diagnosis		Submitted information is not entered into the claim processing system.
71. PPS Code		Submitted information is not entered into the merits processing arrangement.
72. External Cause of Injury code (E-Lawmaking)	6 digits	Required if known Enter the diagnosis code for the external cause of an injury, poisoning, or adverse effect. This lawmaking must begin with an "Eastward".
74. Chief Procedure Code/Appointment	7 characters and half dozen digits	Conditional Enter the procedure code for the principal process performed during this billing menstruum and the date on which procedure was performed. Enter the engagement using MMDDYY format. Apply the following criteria to determine the principle procedure: The principal procedure is not performed for diagnostic or exploratory purposes. This code is related to definitive treatment. The principal procedure is nearly related to the principal diagnosis.
74A. Other Process Code/Date	seven characters and 6 digits	Conditional Complete when there are additional significant procedure codes. Enter the procedure codes identifying all meaning procedures other than the main procedure and the dates on which the procedures were performed. Report those that are most important for the episode of care and specifically any therapeutic procedures closely related to the principal diagnosis. Enter the engagement using MMDDYY format.
76. Attending NPI - Required Attending Concluding/Offset Name	NPI - 10 digits Text	Health Beginning Colorado ID Required NPI - Enter the 10-digit NPI number assigned to the physician having primary responsibleness for the member'south medical care and treatment. This number is obtained from the md and cannot be a clinic or group number. (If the attending physician is not enrolled in Health First Colorado or if the member leaves the ER before existence seen by a physician, the hospital may enter their private numbers.) Hospitals and FQHCs may enter the member's regular md's 10- digit NPI in the Attending Physician ID form locator if the locum tenens dr. is not enrolled in Wellness Get-go Colorado. QUAL - Enter "1D" for Medicaid Enter the attending doctor's concluding and kickoff proper name. This course locator must exist completed for all services.
77. Operating NPI		Submitted information is not entered into the claim processing organization.
78 - 79. Other ID NPI - Provisional	NPI - x digits	Conditional Consummate when attending physician is not the PCP or to identify additional physicians. NPI - Enter up to two 10-digit NPI numbers, when applicable. This form locator identifies physicians other than the attending physician. If the attention doctor is non the PCP or if a clinic is a PCP agent, enter the PCP NPI number equally the referring doctor. The name of the Wellness First Colorado member's PCP appears on the eligibility verification. Review either for eligibility and PCP. Health Get-go Colorado does non require that the PCP number appear more than once on each claim submitted. The attending md'southward last and first name are optional.
80. Remarks	Text	Enter specific additional data necessary to process the merits or fulfill reporting requirements.
81. Lawmaking - QUAL/CODE/VALUE (a-d)	Qualifier: 2 digits Taxonomy Code: 10 digits	Optional Complete both the qualifier and the taxonomy code for the billing provider in field 81CC-a. Field 81CC-a must be billed with qualifier B3 for the taxonomy code to be captured in the claims processing system. If B3 is missing, no taxonomy lawmaking will be captured in the claims processing system. Only one taxonomy code can exist captured from field 81CC. If more than than one taxonomy lawmaking is provided, only the first instance of B3 and taxonomy code volition be captured in the claims processing arrangement.

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UB-04 Outpatient Merits Example

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UB-04 Inpatient Claim Example

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UB-04 Behavioral Health Claim Example

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CMS 1500 Professional person Claim Example

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Sterilizations, Hysterectomies, and Abortions

For information on this topic, please see the Sterilization, Hysterectomies, and Abortions section in the Obstetrical and Reproductive Wellness Billing Manual located on the Department's billing manual web folio, nether CMS 1500 > Obstetrical Care.

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Timely Filing

For more data on timely filing policy, including the resubmission rules for denied claims, delight see the General Provider Information manual located on the Department'southward billing manual web page.

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IHS Revisions Log

Revision Date	Changes	Made by
08/07/2018	Manual created	Section
04/22/2019	Updated inpatient acquirement code	Section
06/19/2019	Updated Appendices links and circumlocution	DXC
ten/02/2019	Updated Procedure Code/HCPCS	Department
12/02/2019	Converted to web page	Department
8/vii/2020	Updated detail 81 of the Paper Claim Reference Tabular array for taxonomy code billing	DXC
x/7/2020	Changes made to Process Code Requirements	Department
ii/1/2021	Updated the billing and coding portion to include multiple come across policy for medical, lab, and radiology services.	Department
7/seven/2021	Updating with the standard EPSDT policy language	HCPF

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Source: https://hcpf.colorado.gov/IHS-billing-manual

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