Easily Remove Value Choice to the Accident Medical Claim Form

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How to Remove Value Choice to the Accident Medical Claim Form

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In this tutorial, the presenter demonstrates how to complete a HICFA 1500 claim form, which is utilized by non-institutional healthcare providers to submit claims. The majority of claims are submitted electronically, but secondary claims are filed on paper with the primary Explanation of Benefits (EOB). The example used involves a patient named Edna, with the insurance type indicated as 'other' for a commercial policy in Box 1, and the member ID filled out. Box 2 captures the patient's name, Box 3 includes the date of birth and gender, Box 5 contains the address and phone number, and Box 6 notes the patient relationship as 'self'. Information is entered accordingly, specifying that if there were a different policyholder, their details would be provided instead.

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What goes in box 57 on UB04?

57 Other Provider IdentifierBilling Provider Not Required The unique provider identifier assigned by the health plan is reported in this field.

What is field 14 on UB 04?

Box 14 of the UB04 claim form requires a description of the type of admission. You can quickly add this information via the patients encounter under your Live Claims Feed. Navigate to Billing Live Claims Feed Inside the patients encounter right side of the screen info tab.

What goes in 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 69 on UB04?

The admitting diagnosis must print in box 69 on the UB04 institutional claim form. DrChrono makes it easy to add to your patients claim. The admitting diagnosis code is added to the Adm box highlighted below. The diagnosis can be added by code or looked up using text.

What goes in box 17 on a UB04?

17 Patient Status Required. This code indicates the patients status as of the Through date of the billing period (Field 6). 18-28 Condition Codes Leave blank.

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 is box 59 on a UB04?

Insureds Name If other health insurance is involved, enter the insureds name. 59. Patients Relation to Insured Enter the code for the patients relationship to the insured.

What box are value codes on UB04?

They can be easily added to the UB04 by navigating to Billing Live Claims Feed Inside patients encounter right side of the screen value code tab. The codes entered here (up to 4 for each box) will appear on the UB04 in boxes 39-41.

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Remove Value Choice to the Accident Medical Claim Form