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Occurrence Code 22 (date active care ended) ? include the date active care ended; this should match the statement covers through date on the claim. Cover Days and Charges ? Submit all covered days and charges as if the beneficiary had days available up until the date active care ended.

A code to describe to describe specific event(s) relating to this billing period covered by the claim.

1 VALUE CODES FL 39-41 Enter the value codes ?12? to indicate Working Aged insurance, or ?43? to indicate Disability insurance and the amount you were paid by the primary insurance.

If filing for a Conditional Payment, report with Occurrence Code 24. Date Insurance denied - Date of receipt of a denial of coverage by a higher priority payer. This could be date of primary payer's Explanation of Benefit (EOB) statement, letter or other documentation.

Answer 2: Submit condition code 08 when the patient would not furnish information concerning the other insurance coverage. The Common Working File (CWF) monitors these claims and alerts the MSP Contractor. The MSP Contractor will then contact the patient if necessary.

The date the outpatient physical therapy (OPT) plan was established or last reviewed (occurrence code 29) is required on all outpatient claims on which physical therapy (revenue code 42x) is billed.

Value code 44 Medicare uses the amount the provider is obligated to accept as payment in full in its payment calculation. In such cases, the provider reports in value code 44 the amount it is obligated to accept as payment in full. Medicare considers this amount to be the provider's charges.