Massachusetts Release of Production Payment by Party Who Was Assigned or Reserved the Production Payment

State:
Multi-State
Control #:
US-OG-401
Format:
Word; 
Rich Text
Instant download

Description

This release is used when an Owner relinquishes, surrenders, and quit claims all of the Interest in the Lease to the party provided for in the Assignment to own the interests and that the production payment having been fully satisfied.

How to fill out Release Of Production Payment By Party Who Was Assigned Or Reserved The Production Payment?

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FAQ

Value Codes CodeDescription09Medicare Coinsurance Amount in the First Calendar Year in Billing Period10Medicare Lifetime Reserve Amount in the Second Calendar Year in Billing Period11Medicare Coinsurance Amount in the Second Calendar Year in Billing Period12Working Aged Beneficiary Spouse With an EGHP (Payer Code A)142 more rows

32 Required Service Facility Location Information - Enter the provider name. Enter the provider address, without a comma between the city and state, and a nine-digit zip code, without a hyphen. Enter the telephone number of the facility where services were rendered, if other than home or office.

D6 - Cancel only - duplicate payment, outpatient to inpatient overlap, OIG overpayment.

Collecting Unemployment While Receiving Severance Pay If you've signed a severance agreement with a release of claims, you can still collect unemployment benefits. Severance pay does not count against your eligibility.

A8 Weight of Patient - Code indicates the weight of the patient in kilograms. The weight of the patient should be measured after dialysis during the last dialysis session of the month. (Effective 3/3/05.) A9 Height of Patient - Code indicates the height of the patient in centimeters.

Code Title Definition 02Condition is Employment Related07Treatment of Non-terminal Condition for Hospice Patient08Beneficiary Would Not Provide Information Concerning Other Insurance Coverage09Neither Patient Nor Spouse is Employed10Patient and/or Spouse is Employed but no EGHP Coverage Exists4 more rows

Value codes are required on an institutional claim to identify data elements such as Medicare lifetime reserve days, no-fault payments, and the number of days not covered by the primary payer.

09. Medicare Coinsurance Amount in the First Calendar Year in Billing Period. The product of the number of coinsurance days used in the first calendar year of the billing period multiplied by the applicable coinsurance rate. These are days used in the year of admission. The provider may not use this code on Part B ...

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Massachusetts Release of Production Payment by Party Who Was Assigned or Reserved the Production Payment