Box 39, 40, 41 - Value Code/Amount

Box(es) Definition 

Boxes 39, 40, and 41 contain the codes and related dollar amounts to identify the monetary data needed to process claims. 

In Kipu RCM

The RCM supports the 5 Value Codes listed below. Let's review how to include a Value Code in a claim! 

• 01 - Most Common Semi-Private Rate
• 24 - Medicaid Rate Code
• 80 - Covered Units
• 81 - Non-covered Units
• A3 - Estimated Responsibility - Payer A

• A Value Code can be added to a claim using a Claim Form Rule. Click here for more information. 
• Value Codes can be added to a claim before submitting them using our Claim Edits feature. To learn more about this feature, click here.

EDI Loop and Segment

Loop 2300, Segment HI, Qualifier BE. For additional information on loops and segments, click here.