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The UB-04 uniform medical billing form is the standard claim form that any institutional provider can use for the billing of inpatient or outpatient medical and mental health claims. It is a paper claim form printed with red ink on white standard paper.
How do I file an Aetna claim online?
Submit a claim online Log on to the secure Aetna member website. Click Contact Us at the top right of the page. Click Send a Message and select A claim from the dropdown menu. Input all requested information and attach a copy of your receipt. To check the status of a claim, visit the Manage Claims section.
What is a UB-04 form most likely 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.
How do I add a claim to Aetna?
After logging in to your secure member website, follow these steps: Click "Claims Center," then "Submit claims" Complete your claim online. Copy, scan and upload your supporting documents, including itemized bills, original receipts. Click "submit claim" to complete the process.
Claim Reconsideration Form which can be found on our Provider portal at www.carecentrixportal.com. A claim reconsideration form may not be submitted ...
Dec 1, 2021 — 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 ...
31 131 Section One: Section Title The Hospital Billing Process
Briefly discuss the purpose of a claim form and provide a brief outline of information ... (Modified from National Uniform Billing Committee: UB-04 Proofs, ...
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