What is Medicare condition code 04?
Condition code 04 (information only bill) Condition code 69 (teaching hospitals only – code indicates a request for a supplemental payment for Indirect Medical Education/Graduate Medical Education/Nursing and Allied Health)
What is a UB-04 bill?
The UB-04 uniform medical billing form is the standard claim form that any institutional provider can use for the billing of inpatient or outpatient medical and mental health claims. It is a paper claim form printed with red ink on white standard paper.
What are billing condition codes?
Condition codes refer to specific form locators in the UB-04 form that demand to describe the conditions applicable to the billing period. It is important to note that condition codes are situational. These codes should be entered in an alphanumeric sequence.
What are payer codes?
The Payer ID or EDI is a unique ID assigned to each insurance company. It allows provider and payer systems to talk to one another to verify eligibility, benefits and submit claims. The payer ID is generally five (5) characters but it may be longer. It may also be alpha, numeric or a combination.
Where does condition code go on UB04?
Hospitals should report condition code G0 in Form Locators 24-30 on the UB-04 claim form, the electronic equivalent, when multiple medical visits occur on the same day in the same revenue center, but the visits were distinct and independent visits.
What are UB04 revenue codes?
What are UB04 Revenue Codes? This form, also known as the UB-04, is a uniform institutional provider bill suitable for use in billing multiple third party payers. Because it serves many payers, a particular payer may not need some data elements.
Who can bill claims using the UB-04?
Who Can Bill Claims Using the UB? All institutional providers may use the UB-04 form to bill claims, such as hospitals, specialists, mental health centers, hospices, rehabs, organ procurement organizations and therapy services.
What agency created the ub04?
The UB-04 is maintained by NUBC, which is a voluntary and multidisciplinary committee that develops data elements for claims and claim-related transactions and is responsible for the design and printing of the current UB-04 form.
What are occurrence codes used for on UB-04?
Occurrence Codes
| Code | Description |
|---|---|
| 04 | Accident/ Employment Related |
| 05 | Accident/No Medical or Liability Coverage |
| 06 | Crime Victim |
| 09 | Start of Infertility Treatment Cycle |
In which field of ub04 condition codes are entered?
What are the payer types?
There are three different types of healthcare payors:
- Commercial.
- Private.
- Government/public.
What are the two major payer types?
Private payers are insurance companies and public payers are federal or state governments.
What is Box 39 on ub04?
Box 39-41; a-d – Value codes and amounts: (Optional) Use these locators to indicate codes and amounts essential to the proper adjudication of the submitted claim. Each form locator contains a three digit field in which to key the indicator code, and a larger free text field in which to designate an applicable amount.
Are CPT codes on the ub04?
UB-04 Claims Outpatient hospital and ambulatory surgery centers must include CPT/HCPCS codes in Form Locator 44 to describe specific procedures, when and if appropriate codes are available.
What UB-04 claims are used for?
The UB-04 (CMS-1450) form is the claim form for institutional facilities such as hospitals or outpatient facilities. This would include things like surgery, radiology, laboratory, or other facility services.
Who uses the UB-04?
The UB-04 (CMS 1450) is a claim form used by hospitals, nursing facilities, in-patient, and other facility providers. A specific facility provider of service may also utilize this type of form.
How many fields are in ub04?
81 fields
There are 81 fields (or lines) on a UB-04 form. These are referred to as form locators or “FL.” Each form locator has a unique purpose for the insurance carrier and provider so that they can communicate.
What are the four main sections of the UB-04 claim form?
Section 1:
- Credentialing. Section 2:
- Contracting. Section 3:
- Hospital Inpatient Notifications. Section 4:
- Transfer of Patients to/from Facilities. Section 5:
- Hospital Bill Audits. Section 6:
- UB-04 (CMS 1450) Guidelines. Section 7:
- Interim Bills and Late Charges. Section 8:
- Sample UB-04 (CMS 1450) Claim Form. Section 9:
What is Box 14 on a ub04?
Box 14 – Admission Type (priority) of Visit: (Required) This field requires a one digit code that indicates the priority of the admission.