What are the four sections of the UB-04?

Section 1:

Table of Contents

Credentialing. Section 2:
Contracting. Section 3:
Hospital Inpatient Notifications. Section 4:
Transfer of Patients to/from Facilities. Section 5:
Hospital Bill Audits. Section 6:
UB-04 (CMS 1450) Guidelines. Section 7:
Interim Bills and Late Charges. Section 8:
Sample UB-04 (CMS 1450) Claim Form. Section 9:

What are UB-04 value codes?

Value Codes

Code	Description
04	Inpatient Professional Component Charges Which Are Combined Billed – (Used only by some all- inclusive rate hospitals)
05	Professional component included in charges and billed separately to carrier – (Applies to Part B bills only)

What is another name for UB-04?

CMS-1450 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.

Is DRG on UB04?

In addition, for claims that will be reimbursed under the DRG payment methodology: The primary reason for admission should be placed in the primary diagnosis field (Box 67) of the UB-04 claim form.

What is value code A0?

For claims with dates of service on or after January 1, 2001, providers must report on every Part B ambulance claim value code A0 (zero) and the related ZIP Code of the geographic location from which the beneficiary was placed on board the ambulance in the Value Code field.

What does condition code C5 mean?

Any medical review
C5 Any medical review will be completed after the claim is paid. UB04 Condition Code. C6 The QIO authorized this admission/procedure but has not reviewed the services provided.

What is an occurrence code 32?

Occurrence code 32 on a claim signifies that an ABN, Form CMS-R-131, was given to a beneficiary on a specific date. This code must be employed if this specific ABN form is given, and condition code 20 will not be used on the subsequent claim (i.e., no charges will be submitted as non-covered).

What does UB-04 stand for?

The UB-04 uniform billing form is the standard claim form that any institutional provider can use for the billing of medical and mental health claims. It’s printed with red ink on white standard paper. Although developed by the Centers for Medicare and Medicaid

What are the fields on a UB-04 form?

More detailed instructions can be found at www.cms.gov or www.nubc.org . 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

Who can use the UB-04 form for billing medical claims?

Any institutional provider can use the UB-04 for billing medical claims. This includes: To fill out the form accurately and completely, be sure to do the following: Check with each insurance payer to determine what data is required. Ensure that all data is entered correctly and accurately in the correct fields.

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

The UB-04 form is used by institutional providers, such as nursing homes and hospitals, while the CMS-1500 form is the standard claim form used by a non-institutional provider or supplier, such as a physician or a provider of durable medical equipment.