Type of Bill and Patient Status Codes

Blue Cross Blue Shield of North Dakota (BCBSND) has noticed several claims coming in with incorrect billing pertaining to the type of bill and patient status codes regarding our Medicaid Expansion plan.

Upon review, it appears many providers are utilizing a XX1 type of bill (TOB) with patient status codes that indicate a member is still inpatient, i.e. 30 (still a patient) and 09 (admitted as an inpatient to this hospital).

Through review, it appears TOB 131, 851, 891 for outpatient services are used frequently, with a patient status 30. Patient status 30 is primarily used for initial inpatient acute care hospital, inpatient rehab, inpatient psych, and a long-term care hospital interim claim type. Therefore, those types of services would not be used for outpatient services.

• As an example, ND Medicaid Expansion acceptable discharge status for outpatient TOB 131 claims would be 01, as the patient’s treatment for that date of service is complete and patient went home. This is true even if the patient will return on another day for more treatment.
• When a provider is billing multiple outpatient days on a single claim, 131 with discharge status 01 is still appropriate billing, because it indicates that each day of treatment, they finished that day’s services, “discharged” and the patient went home.

It is important to note that all UB-04 claims require a discharge status. For claims that are billed incorrectly, providers cannot remove the patient's status. If a claim needs to be corrected, depending on the scenario, the original claim may need to be voided, and then a new claim needs to be filed with a patient status that is compatible with the type of bill.

Questions?
If you have additional questions regarding this article, please contact the Medicaid Expansion Provider Service Center at 833-777-5779.