Form Locator 4: Type of Bill (TOB). This is a four-digit code beginning with zero, according to the National Uniform Billing Committee guidelines. Form Locator 5: Federal tax number for your facility. Form Locator 6: Statement from and through dates for the service covered on the claim, in MMDDYY format.

[i] An inpatient event can be identified by various data points like an inpatient Evaluation and Management (E&M) Current Procedure Terminology (CPT) code; an inpatient Uniform Billing (UB) revenue code; or an inpatient bill type.

The primary difference between the UB and the HCFA-1500 forms is that the UB form is required for facility billing purposes. ... The HCFA-1500 is the standard paper claim form used by medical suppliers and professionals to bill Medicare providers and Durable Medical Equipment Medicare Administrative Contractors.

The UB-04 (CMS 1450) is a claim form used by hospitals, nursing facilities, in-patient, and other facility providers. ... On the other hand, the HCFA-1500 (CMS 1500) is a medical claim form employed by individual doctors & practices, nurses, and professionals, including therapists, chiropractors, and out-patient clinics.

For example, if a surgeon performs a procedure in a facility such as a hospital or ASC, a CMS-1500 will be submitted for the surgeon's services only, while a separate UB-04 form will be submitted for the use of the facility. Both forms will be needed to fully bill out for a procedure.

Form UB 92 is also known as a Uniform or Universal Billing form. It is used in the healthcare industry to submit insurance claims to Medicare or other health insurance companies. ... The healthcare facility should also maintain a copy for their records.

Admit Through Discharge - Use for a bill encompassing an entire inpatient confinement or course of outpatient treatment for which it expects payment from payer or which will update deductible for inpatient or Part B claims when Medicare is secondary to an Employer Group Health Plan (EGHP)

The UB-04 uniform billing form is the standard claim form that any institutional provider can use for the billing of medical and mental health claims. It's printed with red ink on white standard paper.

The UB-92 will no longer be acceptable, even as an adjustment claim, after May 22, 2007. The UB-04 is the basic form that CMS prescribes for the Medicare program. ... The UB-04 (Form CMS-1450) is a uniform institutional provider bill suitable for billing multiple third party payers.