6.6.5509    REQUIREMENTS FOR USE OF HCFA FORM 1450 (UB-92)

(1) Institutional care practitioners shall use the HCFA Form 1450 (UB-92) and instructions provided by HCFA for use of the HCFA Form 1450 (UB-92) when filing claims with issuers for health care services. Institutional care providers that bill patients directly shall provide a properly completed HCFA Form 1450 in addition to any other explanation information used to bill the patient when requested by the patient.

(2) Issuers may only require institutional care practitioners to use the following coding system for the initial filing of claims for health care services:

(a) ICD-9-CM codes;

(b) revenue codes;

(c) HCPCS codes; and

(d) the information outlined in ARM 6.6.5507, if the charges include direct service furnished by a health care practitioner, and the direct service is not covered by the instructions for the HCFA Form 1450 (UB-92) .

(3) Hospitals may use the HCFA Form 1500 to supplement a HCFA Form 1450 (UB-92) if necessary in billing patients or their representatives or filing claims with issuers for outpatient services.

History: Sec. 50-4-501, MCA; IMP, 50-4-305 and 50-4-501, MCA; NEW, 1995 MAR p. 923, Eff. 5/26/95.