By Alice Scott and
Michele Redmond
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
