§2017.50. Requirements for Use of UB92/HCFA Form 1450

a)         Institutional health care providers shall use the UB92/HCFA Form 1450 when filing claims with health plans for health care services.

 

b)         Health plans shall accept the UB92/HCFA Form 1450 from institutional health care providers when completed in accordance with instructions provided by the National Uniform Billing Committee and the Illinois Uniform Billing Committee.

 

c)         Health plans shall not require institutional health care providers to use any coding system for the filing of claims for health care services other than the following:

 

1)         ICD-CM Codes;

 

2)         Revenue Codes;

 

3)         HCPCS Codes or CPT Codes.

 

            The ICD-CM Codes, Revenue Codes, HCPCS and CPT Codes must be used in accordance with the instructions provided by the National Uniform Billing Committee and the Illinois Uniform Billing Committee.

 

d)         Institutional providers may use the HCFA Form 1500 to supplement a UB92/HCFA Form 1450 if necessary.

 

(Source:  Amended at 20 Ill. Reg. 8497, effective June 5, 1996)