Required Fields on Paper UB-04
{"Image DocumentName": "Required Fields on Paper UB-04", "Image ImageDescription": "FIELD 17: STATUS. Indicates the discharge status as of ending service date. Required for inpatient and LTC. Codes 05, 08, 63, and 70 changed 9/30/09. Codes were changed to give more accurate information on transfer status. IHCP Provider Manual, Chapter 8, Section 2 has complete list. Examples: 01 Discharged to home or self-care, routine discharge. 03 Discharged or transferred to skilled nursing facility (SNF) 20 Expired. 30 Still a patient. 51 Discharged to hospice \u2013 medical facility.", "Image XResolution": "37", "Image YResolution": "37", "Image ResolutionUnit": "Pixels/Centimeter", "Image Software": "SlidePlayer", "Image YCbCrPositioning": "Centered"}