Get Ub 04cms 1450 Reference Material Form

Filling out the Ub 04cms 1450 Reference Material Form online can streamline your documentation process. This guide provides a clear and supportive walkthrough so that you can complete the form with confidence.

Follow the steps to fill out the Ub 04cms 1450 Reference Material Form online

1. Click the ‘Get Form’ button to access the Ub 04cms 1450 Reference Material Form and open it in your preferred document editor.
2. Begin by filling out Field 4, Type of Bill Codes. Choose the appropriate three-digit code that corresponds to the type of facility, classification, and frequency of the claim.
3. Navigate to Field 15 for Sex Codes. Select the code that best represents the patient’s gender: M for male, F for female, or U for unknown.
4. Proceed to Field 16 for Marital Status Codes. Indicate the marital status of the patient by selecting the appropriate letter code: S for single, M for married, and so forth.
5. Next, fill out Field 19, Type of Admission Codes. Select the code that applies to the admission type, such as 1 for emergency or 2 for urgent.
6. For Field 20, Source of Admission Codes, identify the source of the patient admission. Choose the relevant code based on the referral type or transfer noted.
7. Complete Field 22, Patient Status Codes. This field requires you to denote the current status of the patient with the appropriate code.
8. Finally, in Field 52, Release of Information Indicator Codes, select 'Y' for yes, 'R' for restricted or modified release, or 'N' for no release, depending on the patient's consent.
9. After ensuring all sections are accurately filled out, save your changes. You can then download, print, or share the completed form as needed.

Complete your Ub 04cms 1450 Reference Material Form online today for efficient documentation!