UB-04 continuous  form s are designed for hospitals to document a claim  with the patient’s insurance corporation.  UB-04 laser-cut  forms are designed for medical offices to file a  claim  with the patient’s insurance corporation.  UB-04  corrected claims should be sent over electronically, whenever possible.

The UB-04 form (formerly recognized as the UB-92 and CMS-1450 claim forms) captures esential information factors for providers of solutions in institutional/inpatient/facility settings.  

UB-04 Claim Form – also referred to as  CMS 1450 was made by the National Uniform Billing Committee (NUBC) in 1975; in participation with the American Hospital Association (AHA), major insurance corporations and providers to standardize institutional claims so that the UB-04 could be used countrywide.  The UB-04 claim form will support the National Provider Identifier (NPI) and has incorporated other critical changes.  
The UB-04 claim form was required May 23, 2007.   

The UB-04 claim form is utilized by inpatient and outpatient hospitals, extended term care and assisted living facilities, hospice, and home health providers.  Since May 23, 2007, the UB-04 claim form is applied to invoice for allevery hospital inpatient, outpatient, and emergency room services.   Eleven form placeslocators on the UB-04 are not specified Seven  fields (FLs 7, 30, 37, 49, 68, 73, and 75) are set aside for usage by the NUBC and are not meant for provider use.

 
Medicare reliant Hospital UB-04 payment is based on Medicare PPS methodology.  Ambulance is chargeable on the UB-04 form only in conjunction with inpatient admissions.

Facility suppliers making use of the UB-04 form:   The facility supplier ID must be shown in position 56 and the attending provider ID should be indicated in position 76, 77, 78 or 79 of the UB-04 form.  For data of actual directions using the UB-04, visit the National Uniform Billing Committee internet site at nubc.org  .  
The demands for submitting an digital model of the UB-04 claim form for inpatient services are slightly different.  The requirements for filing an electronic version of the UB-04 claim form for outpatient services are slightly unique.  The National Uniform Billing Committee (NUBC) revised the UB-04 paper claim form to accommodate the use of the National Provider Identifier (NPI).  
Although the specialist fees may be reportable on the UB-04, all professional services coding and billing requirements apply.  Suppliers who employ paper claims are expected to put to use the UB-04 (CMS-1450) (charge~claim} form  when submitting a claim for an outpatient administered  drug.  There are 81 form places available for completion on the UB-04 claim formdepending on the form of health program and contractual agreement with the supplier.

by Marty

www.drsforms-systems.com