April 25, 2014

MS-14-3
 
 
 

BC-14-3
 
 
 

To:

All Blue Cross Contracting Providers

From:

Connie Winkley – Education/Communication Coordinator
Institutional Provider Relations
Blue Cross and Blue Shield of Kansas, Inc.
An Independent Licensee of the Blue Cross and Blue Shield Association

Subject:

Value Code Required for Private Room Only Facilities

Value Codes and amounts (Field Locator 39-41 on the UB-04 claim form)  are defined as a code structure to relate amounts or values to identify data elements necessary to process the claim as qualified by the payer organization.  The value code is required on a UB-04 claim form when there is a value code that applies to the claim.  Effective April 13, 2014, contracting facilities with only private rooms are required to submit claims with a value code of 02 (hospital has no semi-private rooms) and a room rate amount of 0.00 in Field Locator (FL) 39-41.  The electronic equivalent for paper claims FL 39-41 is 2300 HI.

39
CODE
VALUE CODES
AMOUNT
40
CODE
VALUE CODES
AMOUNT
41
CODE
VALUE CODES
AMOUNT
           
           
           
           

VALUE CODES AND AMOUNTS
Enter the appropriate two-digit value code and value if there is a value code and value appropriate for this claim.  For more information on Value Codes and Amounts, refer to the National Uniform Billing Committee's official UB-04 Data Specifications Manual at www.nubc.org.

The submission of Value code 02 will assist in the processing of BlueCard claims for services provided to an out-of-state Blue Plan member. When a facility only has private rooms, the average semi-private (AVSP) room rate is not applicable.

If you have questions regarding this newsletter, please contact your Institutional Provider Representative.  Denny Hartman can be reached at 1-316-269-1602 and Cindy Garrison at 1-785-291-8862.

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