Get Ub 04 Form - Humana Veterans

Filling out the UB 04 Form for Humana Veterans can be a crucial task for healthcare providers and facilities. This guide provides step-by-step instructions to help users complete the form accurately and efficiently in an online format.

Follow the steps to effectively complete the UB 04 Form.

1. To begin, click the ‘Get Form’ button to access the UB 04 Form. Open it in an online editor to facilitate your filling process.
2. Start with the top section of the form. Enter the patient identification information in fields 1 to 4, including the patient control number, medical record number, federal tax number, and the patient's name and address.
3. In fields 10 and 11, provide the birthdate and sex of the patient. Ensure that this information is accurate, as it is essential for processing claims.
4. For the admission details (fields 12 to 17), record the admission date, type, source, and the discharge hour, which are pivotal for billing claims.
5. Fill in occurrence codes in fields 31, 32, 34, and 37, indicating any significant events regarding the patient's treatment. Include corresponding dates for each occurrence to clarify the circumstances.
6. Move on to enter the type of bill in field 18, and specify the statement covers period in fields 6 and 7. These fields help delineate the billing timeframe.
7. Complete condition codes in fields 21 to 24. This section is essential for identifying any special conditions affecting the billing process.
8. In the 'Services' section, fill out fields 41 through 47 detailing the service provided, including procedure codes, dates of service, units of service, and total charges.
9. Complete the 'Payer' information in fields 50 to 54, capturing the name of the payer, health plan ID, and any estimated amounts due or prior payments.
10. In the last section, provide any additional information in fields 75 to 80, including remarks and other necessary credentials.
11. Once all fields are completed, review the entire form for accuracy. After making necessary edits, you can save changes, download, print, or share the form as needed.

Start completing the UB 04 Form online to facilitate efficient billing and ensure timely claims processing.