Iowa Medicaid Enterprise UB-04 Claim Form Health Insurance ...
Iowa Medicaid Enterprise UB-04 Claim Form Health Insurance ...
Iowa Medicaid Enterprise UB-04 Claim Form Health Insurance ...
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05 Discharged/transferred to another type ofinstitution for inpatient care or outpatientservices06 Discharged/transferred to home with careoforganized home health services07 Left care against medical advice orotherwisediscontinued own care08 Discharged/transferred to home with careofhome IV provider10 Discharged/transferred to mental healthcare11 Discharged/transferred to <strong>Medicaid</strong>certifiedrehabilitation unit12 Discharged/transferred to <strong>Medicaid</strong>certifiedsubstance abuse unit13 Discharged/transferred to <strong>Medicaid</strong>certifiedpsychiatric unit20 Expired30 Remains a patient or is expected to returnforoutpatient services (valid only for non-DRGclaims)40 Hospice patient died at home41 Hospice Patient died at hosp42 Hospice patient died unknown43 Discharge/transferred to Fed <strong>Health</strong>50 Hospice Home51 Hospice Medical Facility61 Transferred to Swingbed62 Transferred to Rehab Facility64 Transferred to Nursing Facility65 Disc Tran Psychiatric Hosp71 Trans for another Outpat Fac
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