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Elizabeth M. Whitehorn, Director

Provider Notice issued 10/21/10

ASTC UB-04 Paper Billing Requirements

 

To:​ Participating Ambulatory Surgical Treatment Centers (ASTCs)​
Date:​ September 21, 2010​
Re:​ ASTC UB-04 Paper Billing Requirements​

The department has updated billing instructions for paper UB-04 outpatient ASTC claims, to assist providers in completing their institutional claim forms. Providers should take special note of the payee changes identified in Form Locator 2.  

Providers should use these billing guidelines in conjunction with the UB-04 Data Specifications Manual. To become a UB-04 Subscriber, refer to the National Uniform Billing Committee (NUBC) Web site.

The billing guidelines are posted, along with this notice, on the department's Ambulatory Surgical Treatment Centers Provider Notices Web site. Any questions regarding this notice should be directed to your facility’s medical assistance consultant in the Bureau of Comprehensive Health Services at 1-877-782-5565.

Theresa A. Eagleson, Administrator

Division of Medical Programs