R 418.10921 Facility billing.

Rule 921. (1) Except for a freestanding surgical outpatient facility, a licensed facility as defined in these rules shall submit facility charges on a UB-04 claim form to the carrier. A copy of the UB-04 form shall be published separate from these rules in a manual provided on the agency’s website at www.michigan.gov/wca. The Official UB-04 Data Specifications Manual referenced in these rules contains instructions for facility billing. (2) A facility billing for a practitioner service shall bill charges on the CMS 1500 claim form.