RaeToll
Networker
Hello, I would really truly appreciate any assistance in this scenario.
This is a facility claim for an inpatient L&D where the mother went into preterm labor. Private room charges were billed. In Box 39 of the UB04 there is a value code 01 with the amount that is typically charged for semi-private rooms.
My question is, if the carrier denies a portion of the claim stating "room charges are limited to semi-private room rates", does that imply the claim should have been paid at the rate listed in Box 39?
Also, if L&D does not have semi-private rooms in the unit, can we report value code 02 (Hospital has no semi-private rooms)?
Thank you so much for any help you can provide.
This is a facility claim for an inpatient L&D where the mother went into preterm labor. Private room charges were billed. In Box 39 of the UB04 there is a value code 01 with the amount that is typically charged for semi-private rooms.
My question is, if the carrier denies a portion of the claim stating "room charges are limited to semi-private room rates", does that imply the claim should have been paid at the rate listed in Box 39?
Also, if L&D does not have semi-private rooms in the unit, can we report value code 02 (Hospital has no semi-private rooms)?
Thank you so much for any help you can provide.