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Last Modified: 9/9/2011
Location: FL, PR, USVI
Business: Part A
12206
The sum of covered days and non-covered days is not equal to the days as calculated between the statement covers 'from' date and the statement covers 'through' date.
1. Check screen 1 to verify covered and non-covered days
2. Check screen 1 to verify statement from and through dates
3. Verify patient status, if patient status is equal to '30' add one additional date to include the through date
4. Enter correct data and update the claim
Resources/tips to avoid or correct this return to provider claim
The covered and non-covered days are submitted electronically by using value codes for the UB-04 claim form. Review the Centers for Medicare & Medicaid Services (CMS), Internet-only manual, publication 100-04, chapter 25 -- completing and processing the form CMS-1450 data set 
for further instructions.
for further instructions.• Note: Do not use value codes on version 4010A1 837 electronic claims. Use Claim Quantity in Loop 2300, QTY01 instead. See the National Uniform Billing Committee (NUBC) Official UB-04 Manual for clarification. Click here 
to access the NUBC website.
to access the NUBC website.• If you submit your claims through direct data entry (DDE), code the covered and non-covered days appropriately, based on the DDE manual 
instructions.
instructions.Verify the dates of service in the 'from and thru' date fields and code the covered days and non-covered days appropriately.
• Correct the claim and resubmit
Descriptions of the value codes are listed below:
• Value code 80 -- Covered days
• The number of days covered by the primary payer as qualified by the payer
• Value code 81 -- Non-covered days
• Days of care not covered by the primary payer
• Value code 82 -- Co-insurance days
• The inpatient Medicare days occurring after the 60th day and before the 91st day or inpatient SNF/Swing bed days occurring after the 20th and before the 101st day in a single spell of illness
• Value code 83 -- Lifetime reserve days
• Under Medicare, each beneficiary has a lifetime reserve of 60 additional days of inpatient hospital services after using 90 days of inpatient hospital services during a spell of illness
Please use your browser's back button to return to the referring page.Source: FCSO Education Action Team
