What type of claim is UB04?

Asked by: Monty Walter  |  Last update: November 26, 2023
Score: 4.5/5 (46 votes)

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.

What type of bill is UB-04 claim form?

The UB-04 is a claim form that is utilized for Hospital Services and select residential services.

What are UB04 claims?

A UB-04 form—formerly known as the CMS-1450 form—is a standard claim form used by long-term care facilities to bill for all services provided to residents. This form is must be submitted to Medicare, Medicaid, and other third-party payors in order to process a claim.

What is another name for UB-04 claim forms?

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.

What does UB-04 mean in medical billing?

The Uniform Billing Form, known either as the UB-04 or CMS 1450, is a key player in the healthcare billing process. This form, which contains more than 80 lines of vital patient information, is the standard for billing all major insurance providers, including Medicare.

Lesson #1 UB 04 Form Field Locators

24 related questions found

Is a UB-04 an itemized bill?

The UB-04 is a standardized claim form your hospital uses to bill your insurance provider for the procedures you received. It's generally a single page containing 81 fields, including a line-item breakdown of your procedures, along with CPT, HCPCS, and revenue codes, descriptions, unit quantity and charges.

What is patient reason code UB-04?

Patient reason for visit codes is required on institutional claims when the Type of Bill is 013X (hospital outpatient) and 085X (Critical Access Hospital) when the type of visit codes are 1, 2, or 5 and revenue codes 045X, 0516, or 0762 are billed.

What is the UB-04 claim form also called quizlet?

CMS-1450 is another name for the UB-04 and the Medicare-required Part A claim form. True.

What type of bill is CMS 1500?

The CMS-1500 form is the standard claim form used by a non-institutional provider or supplier to bill Medicare carriers and durable medical equipment regional carriers (DMERCs) when a provider qualifies for a waiver from the Administrative Simplification Compliance Act (ASCA) requirement for electronic submission of ...

What is the difference between UB 92 claim form and UB-04?

Medicare and Medicaid no longer accept the UB92 form.

A number of things were added to the UB92 form when it underwent the revision to become UB04. The main change is the addition of the field in which to input a National Provider Identifier (NPI). Additional fields were also added like more diagnosis code fields.

What is UB-04 completion inpatient services?

The UB-04 claim form is used to submit claims for inpatient hospital accommodations (for example, medical/surgical intensive care, burn care and coronary care) and ancillary charges (for example, labor and delivery, anesthesiology and central services and supplies).

How do I void a UB-04 claim?

To complete a void or an adjustment, the claim reference number from your remittance advice will be needed. Each claim will have its own reference number. A void request will void the original claim. You cannot void a denied claim.

When was the UB-04 form created?

The UB04 form was introduced in 2007 as the successor to the UB92 form, which had been used since the 1980s. The UB92 form was initially created by the National Uniform Billing Committee (NUBC) to standardize billing for hospital services and to ensure that all necessary information was included in insurance claims.

What is a UB code in medical billing?

In medical billing, the term UB stands for Uniform Billing.

How they relate to the billing forms cms1500 and ub04?

For example, if a surgeon performs a procedure in a facility such as a hospital or ASC, a CMS-1500 will be submitted for the surgeon's services only, while a separate UB-04 form will be submitted for the use of the facility. Both forms will be needed to fully bill out for a procedure.

What is the UB-04 claim form also known as the 837I and the CMS 1450?

WHAT ARE THE 837I AND THE FORM CMS-1450? The 837I (Institutional) is the standard format used by institutional providers to transmit health care claims electronically. The Form CMS-1450, also known as the UB-04, is the standard claim form to bill Medicare Administrative Contractors (MACs) when a paper claim is allowed.

Is CMS 1500 a professional claim?

The 837P (Professional) is the standard format used by health care professionals and suppliers to transmit health care claims electronically. The Form CMS-1500 is the standard paper claim form to bill Medicare Fee-For-Service (FFS) Contractors when a paper claim is allowed.

What type of claims are submitted on a CMS 1500?

The CMS-1500 claim form is used to submit non-institutional claims for health care services to many private payers, Medicare, Medicaid and other government health insurance programs. (Most institution-based claims are submitted using a UB-04 form.)

What is the CMS 1500 claim form also known as?

Also known as the Healthcare Financing Administration (HCFA) form, the CMS-1500 form is used for claim reimbursement for several government insurance plans such as Medicaid, Tricare, and Medicare.

How many DX codes can be billed on UB 04 claim form?

67 Principal Diagnosis Code on Admission Enter the appropriate ICD diagnosis code that describes the nature of the illness or injury. 67A - Q Other Diagnosis Codes Enter up to 16 ICD codes for other diagnoses.

What is Box 14 on UB 04 claim form?

Box 14 of the UB04 claim form requires a description of the type of admission. You can quickly add this information via the patient's encounter under your Live Claims Feed.

What does modifier UB mean?

UB Used for surgical or general anesthesia-related supplies and drugs, including surgical trays and plaster casting supplies, provided in conjunction with a surgical procedure code.

What is denial code C 04?

CO-4: The procedure code is inconsistent with the modifier used or a required modifier is missing. Resubmit the claim using an appropriate modifier for the procedure.

What is an 04 condition code?

04. Bill is submitted for informational purposes only. 05. Lien has been filed. The provider has filed legal claim for recovery of funds potentially due to a patient as a result of legal action initiated by or on behalf of a patient.

Where is the principal diagnosis on a UB 04?

The patient's principal diagnosis should be recorded in form locator 67 of the UB-04 form. Other or secondary diagnoses, complications and comorbidities should be listed in form locators 67 A-Q. The admitting diagnosis (if different from the principal diagnosis) should be listed in form locator 69.