Effective May 26, 2009 For all acute inpatient hospital claims processed on or after May 26, 2009, providers will be required to use HIPAA-compliant value code 24 (Medicaid Rate ID) in Field 39 of the UB-04. For direct data entry (DDE) submissions, the Value Code field is found under the Extended Services tab. For EDI submissions, the Value Code is found in the 2300 HI loop, specifically HI01-1(Qualifier) and HI01-2 (Value Code). MassHealth will use specific data submitted on the claim to determine the appropriate inpatient rate at which to pay the claim. Following are specific instructions for unique billing situations. 1) When billing for administrative days (ADs), providers should enter 31 (Inpatient Care No Longer Required) in Field 31 of the UB-04, followed by the admission date on the claim. For DDE submissions, providers can find the List of Occurrences under the Extended Services tab. Providers should click on “New”, enter 31 in the Occurrence Code field. The type should be BH-Regular Occurrence and the From (Date) should be the admission date. For EDI submissions, the 837I has Occurrence Code in the 2300 HI loop. Providers should enter a qualifier of BH in HI01-1, and Occurrence Code 31 in the HI01-2. Providers should enter a date qualifier in HI01-3 and the date of admission in HI01-4. 2) Providers who are contracted to provide psychiatric services in a distinct psychiatric unit and have enumerated a unique NPI for this unit should use this unique NPI when billing for psychiatric services. Providers who do not have a distinct NPI for these discrete psychiatric units should enter Taxonomy Code 273R00000X in Field 81 of the UB-04 in order to be paid at the correct rate. For DDE submissions, the taxonomy field is found under the Billing and Service tab. For EDI submissions, the 837I has Billing Provider Taxonomy in the 2000A PRV loop – specifically the PRV03 field of that loop. 3) Providers who are contracted to provide rehabilitation services in a distinct rehabilitation unit and have enumerated a unique NPI for this unit should use this unique NPI when billing for rehabilitation services. Providers who do not have a distinct NPI for these discrete rehabilitation units should enter Taxonomy Code 273Y00000X in Field 81 of the UB-04 in order to be paid at the correct rate. For DDE submissions, the taxonomy field is found under the Billing and Service tab. For EDI submissions, the 837I has Billing Provider Taxonomy in the 2000A PRV loop – specifically the PRV03 field of that loop. 4) Providers billing for informational reasons only (zero-pay claim) should enter 22 (Active Care Ended) in Field 31 of the UB-04, followed by the admission date on the claim. For DDE submissions, providers can find the list of occurrences under the Extended Services Tab. Providers should click on “New” and enter 22 in the Occurrence Code field of the resulting Occurrence Code Detail panel. (See sample Occurrence Code Detail panel below.) Type should be BH- Regular Occurrence and the From (Date) should be the admission date. For EDI submissions, the 837I has Occurrence Code in the 2300 HI loop. Providers should enter a qualifier of BH in HI01-1, and Occurrence Code 22 in the HI01-2. Providers should enter a date qualifier in HI01-3 and the date of admission in HI01-4. Sample Occurrence Code Detail panel The following chart indicates the data elements that will be used to determine the payment rate. Provider Type Type of Bill Patient Status # of Days Occurrence Code Member Age Out of State Taxonomy Member Medicare Rate ID Description 70 111 01 1 through 20 Any age 25 Adult SPAD 70 111 02 1 through 20 Any age 61 Adult Transfer 70 111 03 1 through 20 Any age 25 Adult SPAD 70 111 04 1 through 20 Any age 25 Adult SPAD 70 111 05 1 through 20 Any age 25 Adult SPAD 70 111 06 1 through 20 Any age 25 Adult SPAD 70 111 07 1 through 20 Any age 25 Adult SPAD 70 111 20 1 through 20 Any age 25 Adult SPAD 70 111 30 1 through 20 Any age 25 Adult SPAD 70 111 40 1 through 20 Any age 25 Adult SPAD 70 111 41 1 through 20 Any age 25 Adult SPAD 70 111 62 1 through 20 Any age 25 Adult SPAD 70 112 30 1 through 20 Any age 25 Adult SPAD 70 113 30 1 through 999 Any age 28 Adult Outlier 70 114 01 1 through 999 Any age 28 Adult Outlier 70 114 02 1 through 999 Any age 61 Adult Transfer 70 114 03 1 through 999 Any age 28 Adult Outlier 70 114 04 1 through 999 Any age 28 Adult Outlier 70 114 05 1 through 999 Any age 28 Adult Outlier 70 114 06 1 through 999 Any age 28 Adult Outlier 70 114 07 1 through 999 Any age 28 Adult Outlier 70 114 20 1 through 999 Any age 28 Adult Outlier 70 114 40 1 through 999 Any age 28 Adult Outlier 70 114 41 1 through 999 Any age 28 Adult Outlier 70 114 62 1 through 999 Any age 28 Adult Outlier 70 111 01 1 through 20 Less than 21 27 Pediatric SPAD 70 111 02 1 through 20 Less than 21 63 Pediatric Transfer 70 111 03 1 through 20 Less than 21 27 Pediatric SPAD 70 111 04 1 through 20 Less than 21 27 Pediatric SPAD 70 111 05 1 through 20 Less than 21 27 Pediatric SPAD 70 111 06 1 through 20 Less than 21 27 Pediatric SPAD 70 111 07 1 through 20 Less than 21 27 Pediatric SPAD 70 111 20 1 through 20 Less than 21 27 Pediatric SPAD 70 111 30 1 through 20 Less than 21 27 Pediatric SPAD 70 111 40 1 through 20 Less than 21 27 Pediatric SPAD 70 111 41 1 through 20 Less than 21 27 Pediatric SPAD 70 111 62 1 through 20 Less than 21 27 Pediatric SPAD 70 112 30 1 through 20 Less than 21 27 Pediatric SPAD 70 113 30 1 through 999 Less than 21 29 Pediatric Outlier 70 114 01 1 through 999 Less than 21 29 Pediatric Outlier 70 114 02 1 through 999 Less than 21 63 Pediatric Transfer 70 114 03 1 through 999 Less than 21 29 Pediatric Outlier 70 114 04 1 through 999 Less than 21 29 Pediatric Outlier 70 114 05 1 through 999 Less than 21 29 Pediatric Outlier 70 114 06 1 through 999 Less than 21 29 Pediatric Outlier 70 114 07 1 through 999 Less than 21 29 Pediatric Outlier 70 114 20 1 through 999 Less than 21 29 Pediatric Outlier 70 114 40 1 through 999 Less than 21 29 Pediatric Outlier 70 114 41 1 through 999 Less than 21 29 Pediatric Outlier 70 114 62 1 through 999 Less than 21 29 Pediatric Outlier 70 115 1 through 999 Any age 72 Zero Pay Claim 70 115 1 through 999 Any age Yes 80 Percentage of Charge 70 Any type of bill 1 through 999 22 Any age 72 Zero Pay Claim 70 Any type of bill 1 through 999 31 Any age Yes 84 AND with Medicare 70 Any type of bill 1 through 999 31 Any age No 85 AND w/o Medicare 70 Any type of bill 1 through 999 Any age Yes 80 Percentage of Charge 70 Any type of bill 1 through 999 Any age 273R00000X 90 Psych Per Diem 70 Any type of bill 1 through 999 Any age 273Y00000X 71 Acute Rehab IMPORTANT VALUE CODE INFORMATION for Acute Inpatient Hospitals (Provider Type 70) 1 of 6