(a)

1. (1) In general, the submittal is identical to the current UB-04 1450 version 7 format used.
2. (2) The differences are minor but nevertheless important.
3. (3) The most notable difference is the requirement for one (1) discharge record for one (1) patient, as opposed to the possibility of multiple claim records for one (1) patient.
4. (4) For discharges with multiple claim records, they should be consolidated into a single discharge, accumulating amounts where necessary (e.g., amounts by payer).

(b)

1. (1) Only one type 10 is required per hospital per submittal.

2. (2)

   1. (A) Only the first type 10 record and type 95 record will be processed.
   2. (B) All others will be ignored.
3. (3) A record type 10 will be processed as a header record and a record type 95 will be processed as a trailer record.

(f)

1. (1) Record type 27 is not a record type used in the UB-04 claim.

2. (2) It contains data that:

   1. (A) May come from other record types, such as Type of Bill;
   2. (B) May be computable, such as Total Charges; or
   3. (C) Should be found in your current databases, Patient Social Security Number for example.