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Elizabeth M. Whitehorn, Director

Provider Notice issued 07/16/03

Change to Inpatient Co-payment Assessment Policy and New UB-92 Condition Code

 

​To: ​Enrolled Hospitals
​Date: ​July 16, 2003
​Re: ​Change to Inpatient Co-payment Assessment Policy and New UB-92 Condition Code

The purpose of this notice is to inform hospitals of a policy change and a billing change related to the assessment of co-payments for participants under the Department's Medical Programs.

  • An inpatient co-payment amount is assessed on certain inpatient claims submitted to the Department. Effective with admissions on or after January 1, 2003, children under the age of 19 are exempt from inpatient co-payment. This supersedes the co-payment policy stated in Topic H-202.3 of the Handbook for Hospitals. The exemption does not apply to children covered under the KidCare Share and KidCare Premium programs. The co-payment policies for inpatient admissions under these programs still apply.
  • The National Uniform Billing Committee (NUBC) has approved a new HIPAA-compliant UB-92 condition code AJ, which will replace local code 94 to denote by-pass of inpatient co-payment for pregnant women and postpartum women up to six weeks after giving birth. New condition code AJ is effective for admissions on or after April 1, 2003; however, the Department will also continue to accept local code 94 for admission dates occurring through October 15, 2003. Only condition code AJ will be valid for admissions occurring on or after October 16, 2003.

 

Any questions regarding this notice should be directed to the Bureau of Comprehensive Health Services at 217-782-5565.

Anne Marie Murphy, Ph.D.
Administrator
Division of Medical Programs