Aetna Ub4 Claim Form
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People also ask
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What is a UB-04 claim form?
The UB-04 claim form is used to submit claims for outpatient services by institutional facilities (for example, outpatient departments, Rural Health Clinics and chronic dialysis centers).
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What is box 17 on UB claim form?
Box Definition Box 17 on the UB-04 contains the patient's discharge status. Use this field to report the status of the patient upon discharge which is required for institutional claims.
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What is the UB04 form for Aetna?
The UB-04, also known as the Form CMS-1450, is the uniform institutional provider claim form suitable for use in billing multiple third-party payers. The 837 Institutional electronic claim format is the electronic version of the form and is in use by providers who submit claims electronically.
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What is the Aetna provider corrected claim form?
The purpose of the Aetna corrected claim form is to submit necessary corrections to a previously submitted claim for healthcare services. This form allows healthcare providers to update any errors or missing information on the original claim, such as incorrect procedure codes, billing codes, or patient data.
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Who fills out UB-04 form?
Institutional healthcare providers, such as hospitals, nursing homes, rehabilitation centers, and other healthcare facilities, use the UB-04 form to submit claims to insurance companies for reimbursement.
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Which form is also identified as the UB-04 form?
CMS-1450 is another name for the UB-04 and the Medicare-required Part A claim form.
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What is an UB-04 claim form?
Institutional paper claim form (CMS-1450) The CMS-1450 form (aka UB-04 at present) can be used by an institutional provider to bill a Medicare fiscal intermediary (FI) when a provider qualifies for a waiver from the Administrative Simplification Compliance Act (ASCA) requirement for electronic submission of claims.
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Can you submit claims electronically to Aetna?
You can submit claims online or resubmissions through ConnectCenter.
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