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Across 1. Responsible for designing and printing of the UB-04. 4. True or False? If claim has a service date of October 1, 2008, the last day to file a timely claim to Medicare would be December 31, 2011. 6. Claim that is sent via provider's computer, modem, and/or telephone line. 8. Another name for the CMS Form 1500. 10. Effective May 23, 2007 this identifier is a required entry on the UB-04. 11. The payer can _____ the claim if critical information is missing from the UB-04.

Down 2. If a claim is filed too late, or _____, the payer can deny the claim with no appeal rights. 3. 4-digit code required on the UB-04 identifying type of facility and care. (3 words) 5. The standard uniform institutional provider bill suitable for billing multiple third party payers. 7. A code for the services provided and used by hospitals to allocate the revenue to the appropriate internal unit. 9. True or False? The correct Type of Bill (TOB) code for a patient admitted to the hospital for 3 days and the claim is billed from the admit date through the discharge date is 0118.