Question: What Are UB 04 Codes?

How do you read a UB 04 form?

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..

What is d6 Code?

D6. Use when canceling a claim for reasons other than the Medicare ID or provider number. Use when canceling a claim to repay a payment. Condition code only applicable to a xx8 type of bill.

What are the DRG codes?

Diagnosis-related group (DRG) is a system which classifies hospital cases according to certain groups,also referred to as DRGs, which are expected to have similar hospital resource use (cost). They have been used in the United States since 1983.

Who uses a UB 04 claim form?

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.

What is a value code on a claim?

VALUE CODES All inpatient and Long Term Care (LTC) claims must report the covered and non-covered days and coinsurance days where applicable. Value codes vary and are comprised of two data elements; the value code and the amount. They are used to report the.

What is Condition Code F?

Condition: Material which involves only limited expense or effort to restore to serviceable condition and which is accomplished in the storage activity where the stock is located. F – Unserviceable reparable. Condition: Economically reparable material which requires repair, overhaul, or reconditioning.

What are condition codes?

Condition codes refer to specific form locators in the UB-04 form that demand to describe the conditions applicable to the billing period. It is important to note that condition codes are situational. These codes should be entered in an alphanumeric sequence.

What goes in box 38 on a ub04?

38 Responsible Party Name and Address Required This field is for reporting the name and address of the person responsible for the bill. 39 – 41 Value Codes and Amounts Conditional These fields contain the codes and related dollar amounts to identify the monetary data for processing claims.

What is the purpose of a UB 04 form?

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.

Why is the UB 04 printed in red?

Paper Format Providers are required to purchase UB-04 claim forms from a vendor. The claim forms ordered through vendors must include red “drop-out” ink to meet Centers for Medicare & Medicaid Services (CMS) standards.

What does NUBC stand for?

National Uniform Billing CommitteeThe National Uniform Billing Committee (NUBC) is the governing body for forms and codes use in medical claims billing in the United States for institutional providers like hospitals, nursing homes, hospice, home health agencies, and other providers.

What is Box 57 on ub04?

Box 57 – Other Physician ID This field is for old legacy id that the facility is currently submitting in box 51 on the UB92. Box 51 on the UB04 has been changed to the Health Plan ID, which is a national number that has not been rolled out.

What is type of bill in ub04?

Type of bill codes are four-digit alphanumeric codes that specify different pieces of information on claim form UB-04 or form CMS-1450 and is reported in box 4 on line 1. Type of Bill (TOB) is not required when a Physicians office reports claim on a CMS-1500.

What is Box 66 on ub04?

61 Group Name Enter the name of insured’s other group health coverage, if applicable. … 65 Employer Name Name of employer providing health coverage. 66 Diagnosis and Procedure Code Qualifier Enter 9 for ICD 9 coding or 0 for ICD-10 coding depending on date(s) of service.

What are condition codes on ub04?

CMS1450/UB04 Fields: 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, and 28 are places for Condition Codes. The provider enters the corresponding code (in numerical order) to describe any conditions or events that apply to the billing period.

What is a revenue code on a ub04?

Revenue codes are three-digit codes that affect reimbursement and represent the services provided by the ASC facility for a payer. Note that you can’t report revenue codes on a CMS-1500 form, but you can report them on a UB-04.

What is the difference between UB 04 and CMS 1500?

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.

What is an example of a Revenue Code?

Examples of Revenue Code An easy example to use here would be to match up CPT code 99282, which is for an emergency room visit of low to moderate severity, and revenue code 0450, which stands for the emergency room. … It could be done in a treatment room; that would be revenue code 0761.