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Newsletter Vol. 5, No. 30
Act
immediately
Effective date
May 1, 1995
Identified
Jun 20, 2026
Summary
New billing procedures established for outpatient partial hospitalization services for Medicare/Medicaid dual-eligible patients. Hospitals must follow specific crossover claim processes and can submit balance billing claims using UB-92 forms with specific codes and documentation requirements.
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What to do
immediately · 2 steps
01Hospital billing teams must implement new partial hospitalization billing workflow: 1) Follow Medicare crossover procedures first, 2) Wait 45 days for Medicaid crossover claims to appear on RA, 3) Submit UB-92 hard copy claims with EOMB if crossover doesn't process, 4) For balance billing use Bill Type 131, Condition Codes 41 and 85, Revenue Code 912, and Clinic Code 28, 5) Attach all required EOB/EOMB documentation.
02Contact Unisys Provider Services at 1-800-776-6334 for billing questions.
Codes mentioned
418528
Original notice
Newsletter Vol. 5, No. 30
njmmis.com · Always check the source before changing claims.
Related changes
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