Demystifying the UB-04 Claim Form

Running a medical facility is a complex job. Amidst all of the other important work you do, one of the most critical jobs to execute correctly is the processing of patient medical claims to comply with insurance regulations. Without accurate records and an understanding of appropriate forms, administrative chaos can ensue, patients can become frustrated and your medical facility’s reputation can be compromised. One of the vital forms is the UB-04 claim form, previously known as the CMS-1450 claim form. In 2007, the UB-04 form replaced the UB-92 form. Here at Denials Management, we believe that as a healthcare provider, your time should be spent restoring your patient’s health. That is why we offer third-party medical billing, claims, and denial management services. One of the forms we use most often is the UB-04 and we are here to help you understand what is a UB-04, and how can your establishment use it.

Profile of the UB-04 Form

The CMS (Center for Medicare and Medicaid Services) developed the UB-04 claim form to establish a standard billing form that can be used by a provider of institutional medical or mental health services. To make the form stand out more clearly in the library of forms used in healthcare services, it is printed in red ink.

Users of the UB-04 Form

This claim form is designed to be useful to a wide range of medical facilities, such as:

  • General health centers, federal health centers, and rural clinics
  • Specialized health centers, e.g. mental health, renal care, and rehabilitation clinics
  • Therapist facilities, e.g. physical therapy, occupational therapy, and speech therapy
  • Hospitals
  • Hospices

A variety of medical claim forms exist for billing, but if your medical center matches one of these descriptions, then you ought to opt for the UB-04 claim form. Given how many types of medical centers exist in the United States, the confusion around the UB-04 claim form is understandable. Many medical centers are unsure if this is the correct form to use. Our expert staff at Denials Management can help you determine if the UB-04 form is appropriate for your establishment.

Coverage of the UB-04 Form

Some medical centers may be unsure as to whether this form can be used with regard to mental health claims. The UB-04 form was designed for medical as well as mental health claims, so you are able to use it for claims related to a wide range of patient conditions and treatments. It’s important to double check with a patient’s insurance company for further information about particular claims.

Importance of the UB-04 Form

The UB-04 claim form is important because it is used by many of the major insurance companies. The CMS officially put the form together with the intent that it be used for the billing of claims by medical institutions. Additionally, the AHA (American Hospital Association) and the NUBC (National Uniform Billing Committee) oversee and monitor the use of the UB-04 to ensure it is up-to-date and equally useful for patients, medical providers, and insurance companies.

Value of the UB-04 Form

The value of this form comes from its simplicity. Filling out the UB-04 can help free up time and energy within your facility to focus on other types of work. If your facility is small or understaffed, this freedom can be priceless. Previous forms and processes were complicated and niche in their focal points. The UB-04 claim form is a more universal and clear document, applicable to the majority of medical facilities in the United States. When you use Denials Management to assist with your claims management, we take care of the UB-04 claim form for you, allowing you more time to care for your patients.

How to Obtain a UB-04

The UB-04 claim form can be filled out on paper or electronically. If you have been wondering how to get a UB-04 form in paper format, then the majority of popular American office supply companies can assist with your purchase, often in bulk. If your billing department is going paperless and would prefer to fill out and submit the UB-04 electronically, then they have the option of choosing from numerous software programs loaded with the current version of the form and instructions for filing.  Take the time to perform internet research and speak with insurance companies to find the best option for your medical facility and your patients.

Top Tips for Filling Out the UB-04

The UB-04 claim form is intentionally designed to make medical claim processing easier for medical facilities as well as insurance companies. You will need to have some information prepared, but this form is less complex than previous iterations. It is a good idea to look up the requirements of particular insurance companies because there can be some differences between providers.

  1. Know the 10-digit NPI (National Provider Identifier) number and relevant Tax ID numbers.
  2. Learn the difference between the FLs (Form Locators), which are the 81 separate fields on the UB-04 form.
  3. Understand when to use certain procedure codes and diagnosis codes.
  4. Double check all information entered in the form.

It may seem overwhelming at first, but you can work towards a smoother future of medical claim billing processing by taking the time to read through and understand the different parts of the UB-04 claim form. With a thorough understanding of requirements, you and your billing department team can more efficiently and clearly manage these forms.

Difference Between the UB-04 and the CMS-1500

It can sometimes be confusing to know which form to use when handling a patient’s medical claims. Here is the primary difference between the UB-04 and the CMS-1500 (formerly the HCFA-1500):

  • Medical facilities fill out the UB-04 claim form.
  • Physicians fill out the CMS-1500 claim form.

If you work in a medical clinic, hospital, rehabilitation center or nursing home, then you would use the UB-04 claim form for billing purposes. If you are a physician or doctor, then you should fill out the CMS-1500 claim form to complete your billing.

The UB-04 claim form is intended to simplify the billing process, not complicate it. Once you can answer the question of what is a UB-04 form, research the meanings of the form locators and establish strong communication with insurance companies, then you and your billing department can successfully file claims for your patients. It is not difficult to learn how to get a UB-04 form and once you have a supplier, then you are ready to begin using the form. If you are looking to spend less time dealing with paperwork and more time treating patients, consider hiring a third party service that will assist with claims management. Denials Management takes care of all aspects of medical billing, including the UB-04. Contact us today to learn how we can simplify your process and give you more time to focus on other work.