BILLING FORM. The PHP shall use the UB-92 billing form (or subsequent editions). PHPs shall identify PHP care on the billing form in the remarks block by stating “PHP care”.
Appears in 5 contracts
Samples: Participation Agreement for Partial Hospitalization Program Services, Participation Agreement for Partial Hospitalization Program Services, Participation Agreement for Partial Hospitalization Program Services
BILLING FORM. The PHP shall use the UB-92 CMS 1450 UB-04 billing form (or subsequent editions). PHPs shall identify PHP care on the billing form in the remarks block by stating “PHP care”.
Appears in 4 contracts
Samples: Participation Agreement for Freestanding Psychiatric Partial Hospitalization Program Services, Participation Agreement for Hospital Based Psychiatric Partial Hospitalization Program Services, Participation Agreement for Freestanding Psychiatric Partial Hospitalization Program Services
