Get Ub 04

The UB-04 is a claim form that is utilized for Hospital Services and select residential services. Please note that these instructions are specifically written to correlate with Partners Behavioral Health Management's Claim Management System – Alpha MCS.

A number of things were added to the UB92 form when it underwent the revision to become UB04. The main change is the addition of the field in which to input a National Provider Identifier (NPI). Additional fields were also added like more diagnosis code fields.

The CMS-1450 form (aka UB-04 at present) can be used by an institutional provider to bill a Medicare fiscal intermediary (FI) when a provider qualifies for a waiver from the Administrative Simplification Compliance Act (ASCA) requirement for electronic submission of claims.

The UB-04 claim form is used to submit claims for outpatient services by institutional facilities (for example, outpatient departments, Rural Health Clinics and chronic dialysis centers).

The UB-04 is the claim form for institutional facilities and includes the following: The form would be used for surgery, radiology, laboratory, or other facility services.

Use of the Uniform Bill (UB)-04 for NHCS Data Collection The UB-04 is a data specification that is used by hospitals to transmit patient encounter information to the Centers for Medicare and Medicaid Services (CMS) and to insurance payers for payment.

All institutional providers may use the UB-04 form to bill claims, such as hospitals, specialists, mental health centers, hospices, rehabs, organ procurement organizations and therapy services.

The UB04 claim form is used to submit claims for inpatient and outpatient services by institutional facilities (for example, outpatient departments, Rural Health Clinics, chronic dialysis and Adult Day Health Care).