UB04 Form: What is a UB04 form, where can I get one, and how do I fill it out?
Do you need to complete a UB04 form for an insurance company? What is a UB04 form? Where do you find one? and how do you fill it? We run into these questions often in the world of medical billing. Most health insurance claims are filed on CMS 1500 forms (sometimes called HCFA forms). These are more common for most people. Many billers don’t know when to use CMS forms and when to use UB 04 forms.
The UB04 claim form is used by facilities instead of physicians for their health insurance billing. Hospitals, rehabilitation centers, ambulatory surgery centers, clinics, etc. they must bill their services on the UB04 form to receive payment. Physician billing is done on CMS 1500 claim forms.
From time to time we get a call from a person who is trying to pay an insurance claim and the insurance company tells them they need to file the claim on a UB04 claim form. These people have no idea what this form is or how to fill it out. They may have had to admit a loved one to a drug and alcohol rehab center only to find out that the center does not participate in their insurance plan. These facilities often do not file UB04 forms and cannot help the family obtain reimbursement from the insurance company.
Many times the family has paid in advance for the center’s services and is now trying to get the insurance company to reimburse them. The insurance policy may pay out of network, but the claim must be properly filed on a UB04 form. Often people try to collect many thousands of dollars on the claim. Required fields on the UBO4 form include revision codes, value codes, and invoice type. What do you put in these fields? These forms can be very confusing. Where do you get the correct information to fill out the forms? And what fields are required in the form? If the facility does not have a UB04 form to fill out, where can you get one?
Unfortunately the answers are not easy. Rev codes represent procedure codes. The bill type is a three-digit number that represents the type of facility, bill classification, and bill frequency. Value codes are required fields only in certain situations. It is very difficult to correctly complete these forms without prior experience or proper training. Another drawback is that the forms were changed in May 2007 to allow the use of the NPI number. You must fully understand NPI numbers to determine where you should enter an individual NPI number or a group NPI number. And when you try to find UB04 forms for sale, you find that they are available in boxes of 2,500.
If you need to file a claim on a UB04 form and you don’t know what you’re doing, be sure to fully investigate it. Claims are often denied over and over again because the information is incomplete or incorrect. If your claim is for a large amount of money, you may not want to wait months for payment.
Copyright November 2008 – Alice Scott
