UB04 Billing Instructions Guide - Health PAS-OnLine

Jun 08, 2020 · Enter the patient’s sex as M, F, or U. M=Male. F=Female. U=Unknown. FL 12 – 15: ADMISSION . Figure 3 11: FL12 - 15 Admission. FL 12: ADMISSION DATE. Situational (Required if noted below). Enter the date the member was admitted to the facility if the provider type and Type of Bill (TOB) is: Alternative Residential Facility – TOB 086x ................
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