UB-92 Problematic Fields for DOL claims

Box 1 –Billing Address Billing Address
Box 4 –Type of billT ype of bill
Box 5 –Provider tax ID number Provider tax ID number
Box 6 –Statement covers period Statement covers period
Box 17 to 20 –Admission Admission (date/hour/type/source)(date/hour/type/source)
Box 21 & 22 Box 21 & 22 –Discharge hour and Discharge hour and Discharge status Discharge status
Box 42 to 47 –Detail line items (Provide Detail line items (Provide HCPCS for required HCPCS for required RCCRCC’’s)
Box 51 –Provider number and Medicare Provider number and Medicare
number number
Box 60 –Claimant Claimant’’s case numbers case number
Box 67 to 75 –ICD-9 Diagnosis codes 9 Diagnosis codes
Box 80 to 81 –Appropriate procedure codes Appropriate procedure codes