Insert Number Fields from the Claims Reporting Form

Aug 6th, 2022
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How to Insert Number Fields from the Claims Reporting Form

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[Music] welcome to module 7 the inpatient claims process ub4 form notice that i pronounced it ub4 this is a zero its ub04 we dont need to pronounce the zero so in medical billing we use a lot of acronyms we call this the ub 4 form and this is what the ub4 form looks like what i would like to do is to go over how the ub4 form was created and then i want to go over the most important field locators that requires a little bit more attention than the other fields what i mean by that is it requires a little bit more training even though this form is different than the cms 1500 form that you learned about you will notice it requires some of the same basic information like the facility name the patient name the date of birth so some of these things does not require training is self-explanatory what we will do first is i will point out the most important fields that require more training you will follow along with me and you will fill in some practice information on your blank ub4 form that

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A Place of Service (POS) is a field used when completing a CMS 1500 form to submit a claim to insurance. It indicates the location in which the health care service is actually provided.
What does the billing box 33 mean on the CMS 1500 form? Box 33 of the CMS 1500 form derives from the selected employeess Claims Settings area in the contact. Provide the billing providers name, address, NPI, EIN, and the phone number.
What is it? Box 32 is used to indicate the name and address of the facility where services were rendered. Enter the name, address, city, state, and ZIP code of the location.
If a Provider does not have a group NPI number, the national standard for EDI claims is that Box 32 is not necessary as it is already displayed in Box 33. Normally for claims standards, there are two sets of rules; one that applies to printed HCFA claims and a second set of standards that apply to EDI claims.
1500 Claim Form Required Fields 1500 Required Fields Number and NameExample1a. Insureds ID #1234567892. Patients NamePatient, Mary R.3. Patients DOB Patients SEX01012000 M or F4. Insureds NamePatient, Joe18 more rows
What does the Facility Box 32 mean on the CMS 1500 form? Box 32 of the CMS 1500 form derives from the selected employees Claims Settings area in the contact. Provide the name, address, NPI, and the phone number of the facility/location in which the service was provided.
Box 23 is used to show the payer assigned number authorizing the service(s).
Box 17a. The Other ID number of the referring, ordering, or supervising provider is reported in 17a in the shaded area. The qualifier indicating what the number represents is reported in the qualifier field to the immediate right of 17a.

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