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Which form is also known as the UB-04 form?

The Office of Management and Budget and the National Uniform Billing Committee have approved the UB-04 claim form, also known as the CMS-1450 form. The UB-04 claim form accommodates the National Provider Identifier (NPI) and has incorporated other important changes.

How many data fields does UB-04 have?

Fields of the UB-04. There are 81 fields or lines on a UB-04. They're referred to as form locators or "FL." Each form locator has a unique purpose: Form locator 1: Billing provider name, street address, city, state, zip, telephone, fax, and country code.

What is the difference between UB-04 and CMS-1500?

The UB-04 (CMS-1450) form is the claim form for institutional facilities such as hospitals or outpatient facilities. This would include things like surgery, radiology, laboratory, or other facility services. The HCFA-1500 form (CMS-1500) is used to submit charges covered under Medicare Part B.

Who submits a UB04 form?

All institutional providers may use the UB-04 form to bill claims, such as hospitals, specialists, mental health centers, hospices, rehabs, organ procurement organizations and therapy services.

How many fields are there is a UB-04 claim form?

Structure of UB-04 and CMS-1500 Forms The CMS-1450 consists of 81 fields or form locators called FL that are used to fill specific information.

ub 04 claim form pdf

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What setting uses UB-04 form?

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.

What is a UB04 form used for?

UB-04 (also known as the CMS-1450): The UB-04 is the claim form for institutional facilities, and includes the following: Hospitals. Rehab facilities, e.g. physical therapy, occupational therapy and speech therapy. General health centers, federal health centers and rural clinics.

What type of services are reported on a UB-04 form?

The UB-04 claim form is used to submit claims for outpatient services by institutional facilities (for example, outpatient departments, Rural Health Clinics and chronic dialysis centers).

How do I print a UB-04 form?

Printing UB-04 Claims Select the UB-04 claims. ... Correct any errors in the UB-04 claims. ... Add additional information to the UB-04 forms. ... Right-click on an insurance claim or insurance carrier and select Print UB04 to print the UB-04 form and send it to your insurance carrier in the mail.

What is the UB04 form?

The UB04 claim form is used to submit claims for inpatient and outpatient services by institutional facilities (for example, outpatient departments, Rural Health Clinics, chronic dialysis and Adult Day Health Care).

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Which form is also known as the UB-04 form?

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