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What is a field description for ub04?

Some common field descriptions include patient name, medical record number, admission date, discharge date, principal diagnosis, procedure codes, revenue codes, and the total charges for services provided.

What does the UB in UB04 represent?

You may be wondering, What does UB-04 mean? Simply put, this form can be used by any institutional provider for billing medical and mental health claims. This uniform billing form was created by The Centers for Medicare and Medicaid (CMS) to be used by institutional providers for claim billing.

What is the purpose of a UB-04 claim form?

The UB-04 form is a standardized medical claim form used by institutional healthcare providers to submit billing information for services provided to patients. Its essentially a receipt used specifically by healthcare institutions.

What goes in box 69 on ub04?

67A Q** Unlabeled Field Additional diagnosis codes, if applicable. 69** Admitting Diagnosis Inpatient: Enter diagnosis code identified at the time of hospitalization. 70** Patient Reason Diagnosis Outpatient Claims only enter the primary reason for visit diagnosis code.

What is the current UB-04 form?

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.

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