Hospital Coverage Guidelines Please note that coverage guidelines and procedures are subject to change. Refer to the monthly Provider Update for more information. Hospital Coverage Guidelines Provider Participation Recertification Claim Billing Guidelines Reimbursement Guidelines Out of State Providers Federally Regulated Services Medicare/Medicaid Crossovers Inpatient Services Introduction Reimbursement Guidelines Co-Payment Other Institutions Covered Services 24 Hours Minimum Inpatient Stay Day of Admission Administratively Necessary Days (AND) Non-covered Services Limitations/ Special Requirements Review Services General Information Pre-Admission Review Length of Stay (LOS) Extension Review Concurrent Reviews Retrospective Review Claims Billing Guidelines Outpatient Services Introduction Reimbursement Guidelines Laboratory Services Surgical Services Dialysis Professional Services Multiple Surgical Procedures Emergency Room Co-Payment Covered Services Non-covered Services Limitations/ Special Requirements Claims Billing Guidelines Other Institutions Revenue Codes Claim Preparation Instructions UB-04 Form Filing Instructions Inpatient/Outpatient - UB-04 Claim Form CMS 1500 Form Filing Instructions Outpatient Hospital Services - CMS 1500 Claim Form Error Status Codes ESC Code List (English) Explanation of Benefits (EOB) Codes EOB Codes and Messages List (English) EOB Codes and Messages List (Spanish) Appendix - Third Party Liability Carrier and Coverage Codes Third Party Liability Carrier and Coverage Codes For specific questions you may contact the Customer Service Help Desk at (401) 784-8100 for In-state and long distance callers, or 1-800-964-6211 for In-state toll callers and border communities.