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Hospital bill format pdf for Operations

hey my name is Ariana and in this video I will be showing you how to fill on ub-04 claim with or software I will help you learn how to submit an Institutional or uv04 claim for Adult Day Care so you can move forward and build without any problem using our software on time we make it simple and easy for you to create a claim so with that being said let's go to the practice now that we're in on time let's go to villain and we're going to click where it says monoclean uv04 this is going to show you the claim format one thing that you need to know is that there are two type of claims there is the claim ub-04 or institutional claim and there is another claim which is a claim 1500 or professional claim the one that you're going to use it will depend on the one that the mltc or the insurance company works with okay normally they tell you this information in the contract so once that we are in the monoclaim uv04 we're going to start filling the claim okay as you see it has multiple segments and they are uh specified or they are they have a number on the first segment we will put the address of the company or your address this is not going to be your home address it will be the company's address okay then on the segment too it go blank we don't have to put any information in there then we have the patient control number and this is going to be the patient account number okay so each patient will have an account number and this can this can be for you to have a record of all your patients or software creates an unique patient control number for each one of our patients okay then we have the type of field the type of Bill is very important because it depends on the type of Provider that you are so for Adult Day Care the type of Bill is 892 if it is an original claim and eight nine seven if it is a corrected claim if you are a home health agency your type of bill is going to be completely different okay it's going to be three two one to identify a regional claim and three to seven if you are identifying and corrected claim then we have the federal tax ID this is the tax ID of your company then we have the statement covers period and this will be the period of the claim so it is if it is from Sunday to Friday you're going to select the period of the claim then we will go to the patient's information this will be the ID of the patient the address the name again the address the date of birth and the gender then we will have the admission codes and this is also very important because the admission codes are related to the type of Provider that you are so again like the type of Bill if you are an adult day care center your admission codes are going to be different than if you are a home health agency so for Adult Day Care the admission date is going to be when the patient has started receiving Services the admission hour will be nine and this means information not available then from the segment 18 healed the segment 37 we don't have to put any information in there and then we have the segment 38 which is also the information of the patient the name and the address then we have the segment 42 and here we are going to list the services that were render or the services that the agency or the center provided if you are an adult day care center your services are going to be either social daycare Transportation meals and Telehealth okay if you select the type of service in or software is going to automatically add the procedure call and the Revenue code okay this information is going to appear in your contract as well okay they are going to list the procedure code the name of that service the Revenue code and the rate for that service then we're going to select the date when the services were provided then we're going to add the units and since we're talking about Adult Day Care Centers normally it's going to be only one unit because if it is a social daycare visit is only one unit if it is transportation it's going to be only one unit if it is Telehealth it's going to be only one unit and normally if you are providing meals you are allowed to provide up to two meals uh per day so meals can be two units once you add the units we go to the total charges and this is also something that appears in your contract and it will be the rate that is assigned to that type of service okay here in our software you can add or you can delete as many lines as you want and you can select from the list the type of service that you need to build okay as you see if you select the type of service it's going to automatically add the procedure code and the Revenue code okay then we select the date when the service was provided and then we add the units and the weight then we go to the payers information here it will be the name and the address of the payer in this case the payer is going to be the insurance company or the motc then we have the health plan ID and this is going to be the payer ID each motc has its unique payer ID and this is also given on your contract it's very important that you put the correct pay ID because as you know there are millions of insurance companies uh in the market and if you don't put the correct pay ID you're clearing house or the Clearinghouse won't be able to match your claim with any payer electronically okay then we have the release of information this yes the assignment of benefits is yes we don't have any prior payments and then we have again the total amount of the claim then on the segment 56 we have the MPI and this is going to be your agency's MPI and then again we have the patient's information okay then on the segment 59 this refers to Patient relationship and it's going to be 18. this is a code okay then we have the patient's ID and then from the segment 61 till the 65 we don't have to put any information in there then we have the segment 66 and this is going to be the diagnosis code and this is all this is the diagnosis code of the patient okay and this is on the authorization once you complete that claim you're gonna click where it says process and it's going to create a file a text file and this is the file that you're going to submit through the Clearinghouse okay if you are using our software you don't need to add all this information because if you go to the list where it says patient name you will have all the patients here you just need to find the patient that you need to build for the system will automatically add this information for you like the admission codes the address of your agency the patient's information uh the type of Bill and the payers information okay because we set up the system for that the only thing you will need to add is the services that were render the rest of the data is configured for your type of provider the biggest problem with billing is that the providers or agencies don't know where to find all the data and where to add it on the claim that's why most of them get rejected or deny it and you don't know how to fix it but for that reason you have us so if you have any problems with your billing or any doubts or if you need help you can contact me at financial support ontimeitn.com and we will help you with your situation I hope you enjoyed this video and if you have any comments you can leave them down below and remember to subscribe to our Channel we also have a video talking about Mana claim 15 000 or professional claim so if you want to check it go to the channel foreign [Music]