Get Ub02 Form

The Ub02 form, also known as the UB-04, is a critical document used by healthcare providers for billing purposes. This guide provides a step-by-step approach to navigating the form online, ensuring a clear and efficient submission process.

Follow the steps to complete the Ub02 Form online.

1. Click 'Get Form' button to obtain the Ub02 form and open it in the editor.
2. Fill out the provider name, address, and telephone number in Field 1. Ensure the information is current and accurate.
3. In Field 4, enter the type of bill. Select the appropriate code based on your service type, such as inpatient or outpatient.
4. Complete Fields 8b through 12 with patient information, including their name, address, date of birth, and sex.
5. Provide the admission date in Field 14 and the hour of admission in Field 13. Ensure that these fields are filled correctly for inpatient services.
6. Fill in the patient's status in Field 17 to indicate their condition during the billing period.
7. Document the revenue codes and descriptions for services provided in Fields 42 and 43, ensuring the codes match the corresponding services.
8. Once all required fields are completed, review for accuracy and clarity, then save your changes.
9. Download, print, or share the completed form as needed for submission.

Complete your Ub02 form online today for efficient billing submission.