In Form Locator 15 on the UB-04 Claim Form, the Codes

question 27

Multiple Choice

In form locator 15 on the UB-04 claim form, the codes for Physician Referral, HMO Referral, and Transfer from a skilled nursing facility (SNF) represent:

• A) admission source codes.
• B) discharge status codes.
• C) admission type codes.
• D) condition codes.