UB-04 Completion: Outpatient Services (ub comp op)

This field is mandatory for radiologists. If the physician is not a Medi-Cal provider, enter the state license number. Do not use a group provider number. The referring or prescribing physician’s first and last names are not required by Medi-Cal. Note: Providers billing lab service for residents in a Skilled Nursing Facility (NF) Level A or B are required to enter the NF-A or NF-B as the ... ................
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