Do you need to get a UB04 form completed for an insurance company? What is a UB04 form? Where do you find one? And how do you fill it out? We run across these questions often in the world of medical billing. Most medical health insurance claims are filed on CMS 1500 forms (sometimes called HCFA forms). These are more common to most people. Many billers don’t know when to use the CMS forms and when to use the UB 04 forms.
The UB04 claim form is used by facilities rather than physicians for their health insurance billing. Hospitals, rehabilitation centers, ambulatory surgery centers, clinics, etc need to bill their services on the UB04 form in order to get paid. Physician billing is done on the CMS 1500 claim forms.
Every once in awhile we get a call from a person who is trying to get an insurance claim paid and they are told by the insurance company that they must file the claim on a UB04 claim form. These people don’t have a clue what this form is or how to complete it. They may have had to admit a loved one into a drug and alcohol rehab facility and now find that the facility doesn’t participate with their insurance plan. These facilities often don’t file UB04 forms and can not help the family get reimbursed by the insurance company.
Many times the family has paid up front for the services of the facility and are now trying to get the insurance company to reimburse them. The insurance policy may pay out of network but the claim must be filed correctly on a UB04 form. Often times people are trying to collect many thousands of dollars on the claim. Required fields on the UBO4 form include rev codes, value codes and type of bill. What do you put in these fields? These forms can be very confusing. Where do you get the correct information to complete the forms? And which fields are required on the form? If the facility does not have a UB04 form to fill out, where do you get one?
Unfortunately the answers are not easy. The Rev codes represent the procedure codes. The type of bill is a three digit number that represents the type of facility, the bill classification and the frequency of the bill. The value codes are required fields only in certain situations. It is very difficult to complete these forms correctly without previous experience or proper training. Another catch is that the forms were changed in May 2007 to allow for use of the NPI number. You must understand NPI numbers completely to determine where you should be entering an individual NPI number or a group NPI number. And when you try to find UB04 forms for sale, you find they are available in boxes of 2500.
If you find yourself needing to file a claim on a UB04 form and don’t know what you are doing, make sure you look into it fully. Claims are often denied time after time for information being incomplete or incorrect. If your claim is for a lot of money, you may not want to wait months for payment.
Copyright November 2008 – Alice Scott
