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When billing with place of service code 22, outpatient hospital, it is important to remember that you must complete all required fields in their entirety, including the proper ZIP code, to receive payment.

Required fields

For claims submitted electronically:

• Loop 2310C NM1 (Service Facility Location Name)
• N3 (Service Facility Location Address)
• N4 (Service Facility Location City, State, ZIP Code)
• REF (Service Facility)

For claims submitted on paper:

• Box 32 (see image, below)

Completing all required fields ensures the accurate application of your contractual business arrangement with Independence.

For complete information on submitting claims electronically, refer to the Independence Blue Cross HIPPA Transaction Standard Companion Guide. For complete information on submitting paper claims, please read the Claims Submission Toolkit for Proper Electronic and Paper Claims Submission.

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