Claims : Submission

Dates on Inpatient Claims

Providers are required to indicate correct dates on inpatient claims as outlined by NUBC guidelines. Claims submitted with incorrect or inaccurate information are subject to audit by the Wisconsin DHS and may result in recoupment. When determining the dates to indicate on inpatient claims, providers should refer to the following definitions, which are based on NUBC guidelines:

• The "from" DOS is the date on which the member initially receives care (e.g., care received in the ER prior to admission to the hospital).
• The "admission" date is the date on which the member is admitted to the hospital as an inpatient and is subsequently first counted in the midnight census.
• The "to" DOS is the date on which the member is discharged from the hospital.

Based on the above definitions, if a member enters the ER on January 1 and receives care, is admitted to the hospital on January 2, and is discharged from the hospital on January 3, providers would be required to indicate the following on the inpatient claim that they submit to ForwardHealth:

• January 1 as the "from" DOS
• January 2 as the "admission" date
• January 3 as the "to" DOS

Providers should not indicate the same "from" DOS and "admission" date unless the member received their initial care on the same day that they were admitted to the hospital.