Get Ub04 Preprinted Fillable Forms

The Ub04 Preprinted Fillable Forms are essential for submitting outpatient claims effectively. This guide provides detailed instructions on how to fill out the essential components of the form accurately and confidently.

Follow the steps to complete the Ub04 Preprinted Fillable Forms with ease.

1. Press the ‘Get Form’ button to retrieve the Ub04 Preprinted Fillable Forms and open it in your preferred editor.
2. Identify the section for revenue codes on the form. You will need to enter the correct revenue code as per the outpatient services provided. Refer to the recognized facility codes listed, such as 0510 for outpatient clinical non-surgical services or 0821 for hemodialysis.
3. Ensure that you do not enter both a facility code and a CPT/HCPCS code on the same line. Select only one type for your entry.
4. If billing for observation room services, ensure to use the procedure code G0378 along with revenue code 0762. Additionally, enter the total number of hours the participant was in observation status in the Units field.
5. Remember that only one observation code per stay may be billed. If the stay goes beyond midnight, bill only once for the date the participant was placed in observation.
6. For services provided in hospital-based dialysis clinics, include the appropriate revenue codes (e.g., 0831 for peritoneal dialysis).
7. Once all necessary fields are completed, you can save the changes to the form, download it, print it, or share it as needed.

Fill out your Ub04 Preprinted Fillable Forms online today for efficient claims processing.