Ambetter from Superior HealthPlan, a plan available on the Affordable Care Act (ACA) health insurance exchange, has changed the status of box 18 on the CMS-1500 claim form from a conditional/optional field to a required one, effective July 1.
If you submit a claim for an inpatient professional service with a location (box 24B) value of 06, 08, 21, 31, 32, 51, 54, 55, 56, or 61, box 18 (“Hospitalization Dates Related to Current Services”) must have the date of admission in the “from” portion of this field, using the eight-digit month-day-year format (mm-dd-yyyy).
If this field is blank, the claim may be rejected or denied. If you know the “to” date (the patient’s discharge date), you can add it to box 18, but this is not required.
If you have questions, call Ambetter at (877) 687-1196.
The Texas Medical Association’s payment specialists continuously review health care payment plans’ newsletters and updates for items important to Texas physicians. Texas Medicine Today periodically publishes key excerpts from those newsletters that you might have missed.
If you have questions about billing and coding or payer policies, contact the specialists at paymentadvocacy[at]texmed[dot]org for help, or call the TMA Knowledge Center at (800) 880-7955. TMA members can use the TMA Reimbursement Review and Resolution Service (formerly known as the TMA Hassle Factor Log program) to help resolve insurance-related problems. Visit www.texmed.org/GetPaid for more resources and information.
Last Updated On
September 23, 2020
Originally Published On
April 18, 2019