- A completedOriginalUB-04 form
- A completedOriginalTSCE form (Attachment U-1)
- AcompletedOriginal Inability to Cooperate form (Attachment U-2)
- A printout of the data in the Trauma and Emergency Information System(TEMIS)
Hospitals must ensure that all data elements from UB-04 match the data elements from TEMIS. Claims eligible for inclusion in the County’s payment methodology shall only include claims for which all required documentation matches TEMIS.