US Legal Forms
Washington UB04 HCFA 1450

Washington UB04 HCFA 1450

Name: Washington UB04 HCFA 1450
Brand: US Legal Forms
Price: 59.00 USD
Rating: 4.59 (333 reviews)

Category:

Washington Workers Compensation - Official

State:

Washington

Control #:

WA-SKU-4031

Format:

Instant download

This website is not affiliated with any governmental entity

Public form

Description

UB04 HCFA 1450 Washington UB04 CFA 1450 is a standardized form used by hospitals and other medical providers in Washington State for submitting claims information to insurance companies. It is also known as the Uniform Billing (UP) 04 and is part of the Health Care Financing Administration (CFA) series of forms. It is used to submit claims for inpatient, outpatient, and professional services. The form is divided into sections for submitting patient information, diagnosis codes, procedure codes, and other related data. There are three versions of the Washington UB04 CFA 1450: the CMS-1450, CMS-1450A, and CMS-1450B. The CMS-1450 is the most commonly used form for submitting claims. The CMS-1450A is used for inpatient services, while the CMS-1450B is used for outpatient services.

Washington UB04 CFA 1450 is a standardized form used by hospitals and other medical providers in Washington State for submitting claims information to insurance companies. It is also known as the Uniform Billing (UP) 04 and is part of the Health Care Financing Administration (CFA) series of forms. It is used to submit claims for inpatient, outpatient, and professional services. The form is divided into sections for submitting patient information, diagnosis codes, procedure codes, and other related data. There are three versions of the Washington UB04 CFA 1450: the CMS-1450, CMS-1450A, and CMS-1450B. The CMS-1450 is the most commonly used form for submitting claims. The CMS-1450A is used for inpatient services, while the CMS-1450B is used for outpatient services.

View Letter from Tenant to Landlord about Illegal entry by landlord

View this form

View Letter from Landlord to Tenant about time of intent to enter premises

View this form

View Letter from Tenant to Landlord containing Notice to Cease Unjustified Nonacceptance of Rent

View this form

View Letter from Tenant to Landlord about Sexual Harassment

View this form

View Letter from Tenant to Landlord containing Notice of termination for landlord's noncompliance with possibility to cure

View this form

How to fill out Washington UB04 HCFA 1450?

Coping with official documentation requires attention, precision, and using properly-drafted templates. US Legal Forms has been helping people across the country do just that for 25 years, so when you pick your Washington UB04 HCFA 1450 template from our service, you can be sure it meets federal and state laws.

Dealing with our service is straightforward and quick. To get the required paperwork, all you’ll need is an account with a valid subscription. Here’s a quick guide for you to find your Washington UB04 HCFA 1450 within minutes:

Remember to attentively look through the form content and its correspondence with general and legal requirements by previewing it or reading its description.
Search for another official template if the previously opened one doesn’t suit your situation or state regulations (the tab for that is on the top page corner).
Log in to your account and download the Washington UB04 HCFA 1450 in the format you prefer. If it’s your first experience with our service, click Buy now to proceed.
Register for an account, select your subscription plan, and pay with your credit card or PayPal account.
Choose in what format you want to obtain your form and click Download. Print the blank or add it to a professional PDF editor to prepare it paper-free.

All documents are drafted for multi-usage, like the Washington UB04 HCFA 1450 you see on this page. If you need them in the future, you can fill them out without re-payment - just open the My Forms tab in your profile and complete your document whenever you need it. Try US Legal Forms and accomplish your business and personal paperwork rapidly and in total legal compliance!

Form Rating

4.59

Satisfied(333)

Form popularity

FAQ

The electronic counterpart to the UB-04 is the 837I.

Both the CMS-1500 and UB-04 forms contain many of the same boxes that need to be filled out including patient demographics, provider identification information, procedures and charges and insurance plan identification information. The more information you can provide to the patient's insurance company, the better.

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.

WHAT ARE THE 837I AND THE FORM CMS-1450? The 837I (Institutional) is the standard format used by institutional providers to transmit health care claims electronically. The Form CMS-1450, also known as the UB-04, is the standard claim form to bill Medicare Administrative Contractors (MACs) when a paper claim is allowed.

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 (CMS-1450) form is the claim form for institutional facilities such as hospitals or outpatient facilities. This would include things like surgery, radiology, laboratory, or other facility services. The HCFA-1500 form (CMS-1500) is used to submit charges covered under Medicare Part B.

The UB-04 is the electronic version of CMS-1450 only.

More info

To assure your claim is not rejected or denied, we provide the tips below for accurately completing the UB04 (CMS-1450) claim form. Field. An original UB-04 claim form must be completed.• No photocopied or fax claims are accepted. These instructions are for the completion of the UB-04 claim for BadgerCare Plus. Completion of the CMS1450 (UB04) claim form. Overview. All paper claims you submit must be on the appropriate CMS claim form. UB-04 CMS-1450 Paper Claim Filing Instructions. Inpatient billing is suggested to list a single claim line for the revenue code and. HCPCS combination with the total units on one claim line. Claim form, also known as the CMS-1450 form.

Washington UB04 HCFA 1450

Description

Related forms

How to fill out Washington UB04 HCFA 1450?

Show more info

Form Rating

Form popularity

FAQ

Which electronic transaction standard replaces the paper UB-04 CMS-1450 quizlet?

How are UB-04 and CMS 1500 similar?

Which electronic form replaced the paper CMS 1500 billing form?

Which electronic transaction standard replaces the paper UB-04 CMS-1450?

Is CMS-1450 the same as UB-04?

What is UB-04 or CMS-1450?

What is the electronic version of UB04?

Is a UB-04 the same as a HCFA 1500?

More info

Trusted and secure by over 3 million people of the world’s leading companies