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National Uniform Billing Committee / Meter Point Administration Number / Healthcare Common Procedure Coding System


NEW MEXICO WORKERS’ COMPENSATION ADMINISTRATION
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Document Date: 2014-09-08 16:34:44

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City

Albuquerque / /

Company

Diagnosis Related Group / 67H C DRG Diagnosis Related Group / Medical Review Co. / Collection Instructions Page (8) UB04 Version New Mexico / Name Page (5) UB04 Version New Mexico / Microsoft / Page (7) UB04 Version New Mexico / Page (16-21) Page (9) UB04 Version New Mexico / /

Facility

hospital FEIN / Clinic Referral 3= HMO Referral / Hospital 5= Transfer / Hospital Facility / Skilled Nursing Facility / Hospital _FEIN Dt-Occurrence Date / /

IndustryTerm

electronic media / acute hospital inpatient services / inpatient services / hospital inpatient services / hospital services / dialysis services / /

Organization

Rate REV-CD Amt RC-XX Total Charges HOSP ID Hospital / Critical Access Hospital / Department of Health / Economic Research Bureau / =Trauma Center / Medicare / /

Person

Bill Bill / /

/

Position

claim administrator / injured worker / particular injured worker / Physician / worker / representative / /

ProgrammingLanguage

C / /

ProvinceOrState

New Mexico / /

Technology

ASCII / dialysis / /

SocialTag