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Back  RFI # 2183: Value Code Requirement

Formal vs. Informal Help Informal Formal


Kaelyn Cleary


Is it valid to require Value Code 81 (Loop 2300 Segment HI01-2) to account for the time span between the Statement From (Loop 2300 Segment DTP*434) and Admission Date (Loop 2300 Segment DTP*435), when the dates do not match?

Per the UB Manual, Value Code 81 is defined as Noncovered Days ; The number of days of care not covered by the primary payer


The 837 Health Care Claim: Institutional TR3 requires a value code when one applies to the claim. A value code may not be required when one does not apply to a claim.
There is no TR3 requirement for value codes based upon Statement Dates or Admission Date.
There is no requirement that the Statement From Date be the same as the Admission Date.


Consult the NUBC UB-04 Data Specifications Manual (current version is 2017), for more clarification on Statement Dates and Admission Date (Form Locator 6) or Value Codes (Form Locators 39-41).
Submission 12/7/2016
Status Date 1/30/2017
Status F - Final
Primary References
Document 005010X223