LTC Claim Form and Code Conversion

DHCS will retire the use of the Long Term Care (LTC) local service codes and the Payment Request for Long Term Care (25-1) local form. These local procedures will be replaced by National Uniform Billing Committee (NUBC) data elements and the UB-04 claim form or an electronic 837I claim transaction.

Articles

• LTC Providers Will Transition to the UB-04 Claim Form


• LTC Code and Claim Form Conversion: Crosswalks and FAQ Are Available


• LTC Code and Claim Form Conversion: CalAIM LTC Carve-In Transition

Crosswalks

• LTC Code and Claim Form Conversion: LTC 25-1 to UB-04 Claim Form Crosswalk


• LTC Code and Claim Form Conversion: LTC Accommodation Code to Revenue Code, Value Code and Value Code Amount Crosswalk


• LTC Code and Claim Form Conversion: LTC Patient Status Code to Patient Discharge Status Code Crosswalk

Flyers

• LTC Facility Claim Form and Code Conversion

Web pages

• LTC Code and Claim Form Conversion: Frequently Asked Questions