Can FL 42 be spaced between information?
Response: Revenue Code lines on the UB-04 should be completed sequentially. DO NOT LEAVE BLANK LINES BETWEEN REVENUE CODES. Leaving blank lines between Revenue Codes will result in denial of the claim. 12. FL 15: What Admission Source Codes should we use for residents converting from private pay to Medical Assistance? (Note: They were not admitted in current month but they were just approved for Medical Assistance.) Response: Use the Admission Source Codes as it relates to their actual admission to the nursing facility. Refer to the UB-04 Desk Reference for Long Term Care Facilities (PDF download) for the appropriate Admission Source Codes.
