VOID

Effective April 21, 2017, institutional ambulance claims will be denied when an invalid ZIP code is submitted. The first five positions of the ambulance pick-up ZIP code must be numeric but should not be all zeros, nines, or alpha-numeric.

The following denial message will be applied to the claim if an invalid ZIP code is submitted:

E6183 ?Value Code A0 And Value Amount Equal To The Zip Code Must Not Be All Zeros Or Alpha Numeric Or Nines For Ambulance Services. Please Resubmit The Claim With The Valid Zip Code."

Billing guidelines

Please use the following guidelines based on how you submit claims for institutional ambulance services:

• Paper claims (UB-04 claim form). Use Form Locators 39-41: Value Codes and Amounts. Enter the Value Code "A0" and the five-digit ZIP code of the point of pick-up.
  
  Note: The Form Locator must be populated with the approved code and value specified by the National Uniform Billing Committee (NUBC) in the UB-04 Data Specifications Manual. Visit the NUBC website for more information.
• Electronic claims (837I). Use Loop 2300 and complete the following: HI01-1 = BE, HI01-2 = A0, HI01-5 = Pick-up ZIP code.

Please contact your Network Coordinator if you have any questions about these guidelines.