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 HCFA 1450
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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.
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 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.
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.
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.
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.
The electronic counterpart to the UB-04 is the 837I.