UB04 Type of Bill Code 0322: Home Health - Interim - First Claim

Overview

The UB-04 Type of Bill code 0322 is a four-digit alphanumeric code used for billing purposes in the healthcare industry. According to Noridian Healthcare Solutions, the Type of Bill code structure consists of a leading zero (which is ignored by CMS), followed by three digits that provide specific information: the type of facility, type of care, and frequency/sequence of the claim ^[1].

In code 0322, the second digit "3" indicates the type of facility is Home Health. The third digit "2" indicates the type of care is Inpatient Part B (except Clinics) or Renal Dialysis (Clinics) or Hospice hospital (Special). The fourth digit "2" indicates the frequency is Interim - First Claim ^[1].

This code is specifically used for home health services when a provider submits the first interim claim for a patient's episode of care. The MassHealth UB-04 Billing Guide provides general instructions for completing the UB-04 form, including code sets, but does not specifically define individual Type of Bill codes ^[2]. The code is part of the standardized UB-04 claim form used by various providers, including acute inpatient hospitals and acute outpatient hospitals, as noted in the MassHealth guide ^[2].

When to Use

Code 0322 should be used when a home health agency is submitting the first interim claim for a patient's episode of care. This typically occurs when the patient's treatment spans multiple billing periods and the provider needs to receive partial payment before the episode is complete. According to Noridian, the frequency digit "2" specifically means "Interim - First Claim," which is distinct from other interim codes such as "3" (Interim - Continuing Claims) or "4" (Interim - Last Claim) ^[1].

This code is appropriate when:

• The patient is receiving home health services under Medicare Part B (as indicated by the third digit "2")
• The provider needs to submit an initial claim for partial payment before the full episode ends
• The claim represents the first in a series of interim claims for a single episode of care
• The provider is not submitting a final claim (which would use frequency digit "4") or a continuing claim (frequency digit "3")

The MassHealth UB-04 guide notes that providers must use the UB-04 claim form when submitting paper claims, including acute inpatient hospitals and acute outpatient hospitals ^[2]. However, the guide does not provide specific instructions for home health billing codes.

Step-by-Step Claim Example

Scenario: A home health agency provides services to a Medicare beneficiary for a 60-day episode of care. The agency submits the first interim claim after 30 days to receive partial payment.

Step 1: Identify the Type of Bill Code

• Facility type: Home Health (3)
• Type of care: Inpatient Part B (2)
• Frequency: Interim - First Claim (2)
• Result: 0322

Step 2: Complete the UB-04 Form

• Field 4 (Type of Bill): Enter 0322
• Field 1 (Provider Name, Address, and Telephone Number): Enter the home health agency's information
• Field 2 (Pay-to Name and Address): Enter billing address
• Field 3 (Patient Control Number): Assign a unique number for this claim
• Field 5 (Federal Tax Number): Enter the agency's tax ID
• Field 6 (Statement Covers Period): Enter dates from day 1 to day 30 of the episode
• Field 8 (Patient Name): Enter the beneficiary's name
• Field 9 (Patient Address): Enter the patient's home address
• Field 10 (Patient Birthdate): Enter date of birth
• Field 11 (Patient Sex): Enter M or F
• Field 12 (Admission Date): Enter the start date of home health services
• Field 13 (Admission Hour): Enter the time of admission (if applicable)
• Field 14 (Type of Admission/Visit): Enter code for home health visit
• Field 15 (Source of Admission): Enter appropriate code
• Field 16 (Discharge Hour): Leave blank for interim claim
• Field 17 (Patient Discharge Status): Enter code indicating patient is still under care
• Field 18-28 (Condition Codes): Enter any applicable codes
• Field 31-34 (Occurrence Codes and Dates): Enter relevant dates
• Field 39-41 (Value Codes and Amounts): Enter charges and payments
• Field 42 (Revenue Codes): Enter appropriate revenue codes for home health services
• Field 43 (Revenue Description): Describe services provided
• Field 44 (HCPCS/Rates): Enter procedure codes
• Field 45 (Service Date): Enter date of service
• Field 46 (Service Units): Enter number of units
• Field 47 (Total Charges): Enter total charges for this interim period
• Field 48 (Non-Covered Charges): Enter any non-covered amounts
• Field 50 (Payer Identification): Enter Medicare as primary payer
• Field 51 (Provider Number): Enter the agency's Medicare provider number
• Field 52 (Release of Information): Sign appropriately
• Field 53 (Assignment of Benefits): Sign appropriately
• Field 54 (Prior Payments): Enter any prior payments received
• Field 55 (Estimated Amount Due): Calculate and enter estimated payment
• Field 56 (National Provider Identifier): Enter NPI
• Field 57 (Other Provider ID): Enter any secondary IDs
• Field 58-60 (Insured's Name, Payer, Employer): Enter patient and payer details
• Field 61 (Insured's Group Name): Enter group name if applicable
• Field 62 (Insured's Group Number): Enter group number
• Field 63 (Treatment Authorization Code): Enter prior authorization number if required
• Field 64 (Document Control Number): Enter reference number
• Field 65 (Employer Name): Enter patient's employer if applicable
• Field 66 (Diagnosis and Procedure Codes): Enter ICD-10 codes
• Field 67 (Diagnosis Code Pointer): Link diagnoses to revenue lines
• Field 68 (Occurrence Span Codes and Dates): Enter any span codes
• Field 69 (Occurrence Codes and Dates): Enter additional occurrence codes
• Field 70 (Value Codes and Amounts): Enter additional value codes
• Field 71 (Revenue Code): Continue revenue codes from field 42
• Field 72 (Payer A, B, C): Enter payer information
• Field 73 (Health Plan ID): Enter plan identifier
• Field 74 (Employer Name): Enter employer name if applicable
• Field 75 (Insured's Group Name): Enter group name
• Field 76 (Insured's Group Number): Enter group number
• Field 77 (Insured's Date of Birth): Enter patient's DOB
• Field 78 (Insured's Sex): Enter patient's sex
• Field 79 (Insured's Relationship to Patient): Enter relationship code
• Field 80 (Insured's Employer Name): Enter employer name
• Field 81 (Insured's Employer Address): Enter employer address

Step 3: Submit the Claim

• Submit the completed UB-04 form to the Medicare Administrative Contractor (MAC) or appropriate payer
• For MassHealth, note that electronic submission is required unless a waiver has been approved ^[2]

Common Mistakes & Audit Red Flags

When using code 0322, providers should be aware of common errors that can lead to claim denials or audits:

1. Incorrect Frequency Code: Using code 0322 when the claim is actually a continuing claim (should be 0323) or a final claim (should be 0324) is a frequent error. According to Noridian, frequency digit "2" is specifically for "Interim - First Claim," while "3" is for "Interim - Continuing Claims" and "4" is for "Interim - Last Claim" ^[1].

2. Mismatched Service Dates: The statement covers period (Field 6) must align with the interim period. If the dates extend beyond the first interim period, the claim may be rejected.

3. Missing or Incorrect Revenue Codes: Home health services require specific revenue codes (e.g., 055x for home health services). Using incorrect revenue codes can trigger audits.

4. Duplicate Claims: Submitting code 0322 when a previous claim with the same service dates was already processed can result in duplicate claim denials.

5. Incorrect Patient Discharge Status: For interim claims, the discharge status should indicate the patient is still under care (e.g., status code 30 for still patient). Using a discharge code that suggests the patient was discharged can cause confusion.

6. Missing Prior Authorization: Some payers require prior authorization for home health services. Submitting code 0322 without proper authorization can lead to denials.

7. Incorrect Payer Information: For Medicare Part B claims, ensure the payer is correctly identified as Medicare Part B, not Part A.

8. Timely Filing Issues: Interim claims must be submitted within the payer's timely filing limits. Late submission can result in automatic denials.

9. Incomplete UB-04 Form: Missing required fields such as the National Provider Identifier (NPI), patient demographics, or diagnosis codes can cause processing delays.

10. Electronic Submission Requirements: MassHealth requires all claims to be submitted electronically unless a waiver is approved ^[2]. Submitting paper claims without a waiver will result in rejection.

Related Codes/Fields

Below is a table of related Type of Bill codes and fields relevant to home health billing:

Code/Field	Description	Source
0320	Home Health - Non-payment/Zero Claim	[1]
0321	Home Health - Admit Through Discharge	[1]
0322	Home Health - Interim - First Claim	[1]
0323	Home Health - Interim - Continuing Claims	[1]
0324	Home Health - Interim - Last Claim	[1]
0325	Home Health - Late Charge Only	[1]
0327	Home Health - Replacement of Prior Claim	[1]
0328	Home Health - Void/Cancel of Prior Claim	[1]
0329	Home Health - Final claim for Home Health PPS Period	[1]
Field 4	Type of Bill (UB-04)	[2]
Field 6	Statement Covers Period	[2]
Field 42	Revenue Codes (e.g., 055x for Home Health)	[2]
Field 56	National Provider Identifier (NPI)	[2]
Field 66	Diagnosis Codes (ICD-10)	[2]

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References

[1] Noridian Bill Types — https://med.noridianmedicare.com/web/jea/topics/claim-submission/bill-types

[2] MassHealth UB-04 Guide — https://www.mass.gov/doc/ub-04-billing-guide-0/download