Author Topic: APL codes- Medicaid  (Read 1911 times)


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APL codes- Medicaid
« on: May 05, 2019, 04:50:37 PM »
I work for a non profit hospital and i have some questions regarding the rules on billing a outpatient on a UB 04 claim for. Some of my MCO's are denying for No APL code. this is my second attempt to posting this question, because I'm in desperate need of understanding what is needed for a APL code to clean up some of these claims. upon my research i have found that an o/p on a UB needs to have one of three things: APL proc codes; An ED service code; or an OBS code. 

here's the question, if i choose to bill with no ED or OBS charge what is needed for the APL code.
Do i only need to bill the allowed revenue codes and procedure codes on the APL list (posted on HFS) ?
IF i include a rev / proc code that isn't on the APL list will the whole claim get rejected ?

PLEASE someone help the newbie!  :'(


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Re: APL codes- Medicaid
« Reply #1 on: May 08, 2019, 09:42:59 AM »
Basically it looks like they are saying that in order to file a claim on the UB04 it must be either an ED service, an observation, or an Ambulatory Procedure.  Are you billing for one of these three things?
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Re: APL codes- Medicaid
« Reply #1 on: May 08, 2019, 09:42:59 AM »