Do you have to have a form UB04 completed for an insurance company? What is a UB04 form? Where can you find one? And how do you fill it in? We often encounter these questions in the world of medical billing. Most medical health insurance claims are filed on CMS 1500 forms (also known as HCFA forms). These are more common in most people. Many billers do not know when to use the CMS forms and when to use the UB 04 forms.
The UB04 claim form is used by facilities rather than physicians for their health insurance billing. Hospitals, Rehabilitation Centers, Outpatient Surgical Centers, Clinics, etc. must invoice their services on the UB04 form to get paid. Physician billing is done on the CMS 1500 claim forms.
Once in a while we get a call from a person trying to get an insurance claim paid out and they are told by the insurance company to file the claim on a UB04 claim form. These people have no idea what this form is or how to fill it out. They may have had to admit a loved one to a drug and alcohol rehab center and now discover that the facility is not part of their insurance plan. These facilities often do not file UB04 forms and cannot help the family get reimbursed by the insurance company.
Often, the family has prepaid for the facility’s services and is now trying to get the insurance company to pay them back. The insurance policy can pay out of the network, but the claim must be properly submitted on a UB04 form. Often people with the claim try to collect many thousands of dollars. Mandatory fields on the UBO4 form include rev codes, value codes and invoice type. What do you put in these fields? These forms can be very confusing. Where do you get the correct information to fill in the forms? And which fields are required on the form? If the facility does not have a UB04 form to fill out, where do you get one?
Unfortunately, the answers are not simple. The Rev codes represent the procedure codes. The invoice type is a three-digit number that indicates the facility type, invoice classification, and frequency of the invoice. The value codes are mandatory fields only in certain situations. It is very difficult to fill out these forms correctly without previous experience or proper training. Another catch is that the forms were changed in May 2007 to allow the use of the NPI number. You must fully understand NPI numbers to determine where to enter an individual NPI number or a group NPI number. And when you try to find UB04 forms for sale, you will find that they are available in boxes of 2500.
If you find yourself needing to make a claim on a UB04 form and don’t know what you’re doing, make sure you research it fully. Claims are often rejected time and time again because information is incomplete or incorrect. If your claim involves a lot of money, you may not want to wait months for payment.
Copyright November 2008 – Alice Scott
UB04 form – What is a UB04 form, where do I get one and how do I complete it?
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