BILLING FORM. (a) The hospice program shall use the UB-92 billing form (or subsequent editions.) Hospice care shall be identified in item 4 of this form. (b) The UB-92 billing form (or subsequent editions) will also be used as an admission notice. This notice will be used to notify the contractor of the initiation, change or revocation of an election.
Appears in 4 contracts
Samples: Participation Agreement for Hospice Program, Participation Agreement, Participation Agreement for Hospice Program Services
