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ODE DATE 33 OCCURRENCE DATE CODE 11 11 A3 12/24/2007 01/18/2008 19 20 34 OCCURRENCE CODE DATE 35 CODE 05/07/2008 74 2 38 CONDITION CODES 24 22 23 21 25 26 27 HI 28 d 96777 e 29 ACDT 30 STATE 20 7 31 OCCURRENCE CODE DATE b 777 Seventh St. c 18 7 STATEMENT COVERS PERIOD FROM THROUGH Anywhere ADMISSION 13 HR 14 TYPE 15 SRC 16 DHR 17 STAT DATE a TYPE OF BILL 211 6 5 FED. TAX NO. 8 PATIENT NAME b 14 000002 01/20/2008 3 36 CODE OCCURRENCE SPAN FROM THROUGH.

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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).

For paper UB-04 institutional claims, the taxonomy code should be placed in box 81 and submitted with the “B3” qualifier. For paper CMS-1500 claims, the taxonomy code should be identified with the qualifier “ZZ” in the shaded portion of box 24i.

An itemized medical bill lists in detail all the services that were provided during a visit or stay—such as a blood test or physical therapy—and may be sent to the patient directly. The UB-O4 form is used by institutions to bill Medicare or Medicaid and other insurance companies.

How do I change my Primary Taxonomy? Select Add Taxonomy. Once you have selected the desired Taxonomy code, it will allow you to input an associated license and state of issue, if applicable. Select Save to store the new information and return to a list of all Taxonomy and licenses currently on the record.

Taxonomy codes identify the provider's type, classification, and area of specialization. Each taxonomy code is a unique, 10-character alphanumeric code that enables providers (individuals and organizations) to identify their specialty at the claim/encounter level.

CMS designates the 1500 Health Insurance Claim Form as the CMS-1500 (08/05) and the form is referred to throughout this fact sheet as the CMS-1500. The American National Standards Institute (ANSI) Accredited Standards Committee (ASC) X12N 837P (Professional) Version 5010A1 is the current electronic claim version.

The HCFA 1500 claim form, also known as CMS-1500, enables medical physicians to submit health insurance claims for reimbursement from various government insurance plans including Medicare, Medicaid and Tricare.

Health Care Financing Administration, the agency that administers the Medicare, Medicaid, and Child Health Insurance programs.

The abbreviation “HCFA” stands for “Health Care Finance Administration.” As you might guess from this name, the HCFA 1500 has official origins. It's the work of the Centers for Medicare & Medicaid Services (CMS), which initially devised it to facilitate Medicare and Medicaid reimbursements.

PURPOSE OF HEALTH INSURANCE CLAIM FORM - HCFA-1500. The Form HCFA-1500 answers the needs of many health insurers. It is the basic form prescribed by HCFA for the Medicare program for claims from physicians and suppliers, except for ambulance services.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232