What is the UB-04 manual?

This form, also known as the UB-04, is a uniform institutional provider bill suitable for use in billing multiple third party payers. Because it serves many payers, a particular payer may not need some data elements. The National Uniform Billing Committee (NUBC) maintains lists of approved coding for the form.

What is UB-04 claims?

The CMS-1450 form (aka UB-04 at present) can be used by an institutional provider to bill a Medicare fiscal intermediary (FI) when a provider qualifies for a waiver from the Administrative Simplification Compliance Act (ASCA) requirement for electronic submission of claims.

What is Box 39 on ub04?

Box 39-41; a-d – Value codes and amounts: (Optional) Use these locators to indicate codes and amounts essential to the proper adjudication of the submitted claim. Each form locator contains a three digit field in which to key the indicator code, and a larger free text field in which to designate an applicable amount.

What goes in box 17 on a ub04?

Patient Status
17. * Patient Status Enter the 2-digit patient status code that best describes the patient’s discharge status. 05-Discharged/transferred to another type of institution for inpatient care or referred for outpatient services to another institution.

What is the difference between a manual claim and an electronic claim submission?

When the physician practice is notified of a claim rejection electronically, it can quickly and easily correct and resubmit the claim electronically. Manual claim rejections, on the other hand, are received by the physician practice via mail and offer a paper copy of the payer’s explanation of benefits (EOB) form.

What setting is a UB-04 form used?

The UB-04 (CMS 1450) is a claim form used by hospitals, nursing facilities, in-patient, and other facility providers. A specific facility provider of service may also utilize this type of form.

Who will use UB 04 claim form for billing the medical services?

If you work in a medical clinic, hospital, rehabilitation center or nursing home, then you would use the UB-04 claim form for billing purposes. If you are a physician or doctor, then you should fill out the CMS-1500 claim form to complete your billing.

What is type of bill in UB04?

Type of bill codes are four-digit alphanumeric codes that specify different pieces of information on claim form UB-04 or form CMS-1450 and is reported in box 4 on line 1. Type of Bill (TOB) is not required when a Physicians office reports claim on a CMS-1500.

What is Box 81 on ub04?

Billing Tip: Enter code “81” when billing for emergency services, or the claim may be reduced or denied. An Emergency Certification Statement must be attached to the claim or entered in the Remarks field (Box 80).

What is Box 59 on a ub04?

59. Patient’s Relation to Insured Enter the code for the patient’s relationship to the insured. 60. Insured’s Unique Identifier Enter recipient’s nine-digit Medical Assistance ID.

What are the four main sections of the UB-04 claim form?

Section 1:

  • Credentialing. Section 2:
  • Contracting. Section 3:
  • Hospital Inpatient Notifications. Section 4:
  • Transfer of Patients to/from Facilities. Section 5:
  • Hospital Bill Audits. Section 6:
  • UB-04 (CMS 1450) Guidelines. Section 7:
  • Interim Bills and Late Charges. Section 8:
  • Sample UB-04 (CMS 1450) Claim Form. Section 9: