What documents do I have to submit to bill the program?

What documents do I have to submit to bill the program?

What documents do I have to submit to bill the program?

What documents do I have to submit to bill the program? 150 150 Emergency Medical Services Agency
  • A completedOriginalUB-04 form   
  • A completedOriginalTSCE form (Attachment U-1)  

or  

  • 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.