Table of ContentsView AllTable of ContentsInstitutions Using the FormTips for Preparing the FormUB-04 Fields
Table of ContentsView All
View All
Table of Contents
Institutions Using the Form
Tips for Preparing the Form
UB-04 Fields
The UB-04 uniform medical billing form is the standard claim form that institutional providers use, such as hospitals and community mental health care centers. It is used to bill Medicare, Medicaid, and other health insurance companies for inpatient or outpatient services.
This article explains who can fill out the form and what the form’s various sections mean.
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Who Can Bill Claims Using the UB-04?
Any institutional provider can use the UB-04 for billingmedical claims. Non-institutional providers or suppliers, such as physicians or providers of durable medical equipment, use the CMS-1500 form.
Institutional providers that can use the UB-04 form include:
How Is the UB-04 Form Different Than an Itemized Bill?
Differences Between Physician and Hospital Billing
Tips for Preparing the UB-04
To fill out the form accurately and completely:
More detailed instructions can be found atwww.cms.govorwww.nubc.org.
Fields of the UB-04
There are 81 fields or lines on a UB-04. They’re referred to as form locators or “FL.” Each form locator has a unique purpose:
Summary
Institutions use the UB-04 form to bill insurance for inpatient or outpatient medical and mental health claims. Examples include hospitals, hospices, rural health clinics, and comprehensive outpatient rehabilitation facilities. When filling out the form, be sure to understand the meaning of each of the 81 fields and to make sure that the information is accurate.
4 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.National Uniform Billing Committee.National Uniform Billing Committee Official Data Specifications Manual.National Uniform Billing Committee.National Uniform Billing Committee Official Data Specifications Manual.Centers for Medicare and Medicaid Services.Professional paper claim form (CMS-1500).CMS.gov.Medicare Claims Processing Manual.
4 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.National Uniform Billing Committee.National Uniform Billing Committee Official Data Specifications Manual.National Uniform Billing Committee.National Uniform Billing Committee Official Data Specifications Manual.Centers for Medicare and Medicaid Services.Professional paper claim form (CMS-1500).CMS.gov.Medicare Claims Processing Manual.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
National Uniform Billing Committee.National Uniform Billing Committee Official Data Specifications Manual.National Uniform Billing Committee.National Uniform Billing Committee Official Data Specifications Manual.Centers for Medicare and Medicaid Services.Professional paper claim form (CMS-1500).CMS.gov.Medicare Claims Processing Manual.
National Uniform Billing Committee.National Uniform Billing Committee Official Data Specifications Manual.
Centers for Medicare and Medicaid Services.Professional paper claim form (CMS-1500).
CMS.gov.Medicare Claims Processing Manual.
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