Hospitals may interim bill for inpatient claims if the member has been an inpatient at the hospital for more than 60 days.
To receive final payment for the claim, submit an adjustment to the original claim.
If additional interim payments are necessary, submit a corrected claim for the subsequent requests. At least 30 additional days are required to elapse since the "through" date on any previous claim or adjustment. Write "interim payment for long length of stay" as the adjustment reason. Attach an updated UB-04 Claim Form to the request. On the updated UB-04 Claim Form include:
For more information about the requirements and to complete the state forms, sign in to the ForwardHealth Portal.