
UB 04 Paper Claim Guidelines XLS Form


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People also ask
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What should be entered in box fl04 on the UB-04 claim form?
FL4: Type of Bill - The first digit of the three-digit number identifies the type of facility, the second digit classifies the type of care being billed, and the third digit indicates the sequence of the bill for a specific episode of care.
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What is an UB04 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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What is box 51 on a UB04?
51 = Hospice – Medical Facility. 52- 60 Reserved. 61 = Discharge to Hospital Based Swing Bed. 62 = Discharged to Inpatient Rehab. 63 = Discharged to Long Term Care Hospital.
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What is the difference between CMS 1500 and UB-04 claim forms?
In general, the UB-04 form is used by institutional healthcare providers, such as hospitals, nursing homes, and rehabilitation centers, while the CMS 1500 form is used by individual healthcare providers, such as physicians, therapists, and dietitians.
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