What is Box 70 on UB04?
What is Box 70 on UB04?
But that should not be set as a default. Box 69 is the diagnosis used to indicate the reason for the admission, while 70 is used to indicate, for an unscheduled outpatient visit, what the patient indicated as their reason for visit to the provider.
How many boxes does UB-04 have?
81 fields
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: Form locator 1: Billing provider name, street address, city, state, zip, telephone, fax, and country code.
What are UB04 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.
Where does the frequency code go on a UB04?
UB-04 should be submitted with the appropriate resubmission code in the third digit of the bill type (for corrected claim this will be 7), the original claim number in Box 64 of the paper claim and a copy of the original EOP.
What box is the DRG on a UB04?
Box 67
In addition, for claims that will be reimbursed under the DRG payment methodology: The primary reason for admission should be placed in the primary diagnosis field (Box 67) of the UB-04 claim form.
What is Box 81 on a UB04?
Billing Tip: Enter code “81” when billing for emergency services, or the claim may be reduced or denied. An Emergency Certification Statement must be attached to the claim or entered in the Remarks field (Box 80). Note: Providers may include codes accepted by other payers.
What goes in box 38 on a UB04?
38 Responsible Party Name and Address Required This field is for reporting the name and address of the person responsible for the bill. 39 – 41 Value Codes and Amounts Conditional These fields contain the codes and related dollar amounts to identify the monetary data for processing claims.
What is type of bill in UB04?
Type of bill codes are four-digit alphanumeric codes that specify different pieces of information on claim form UB-04 or form CMS-1450 and is reported in box 4 on line 1.
What does condition code 51 mean?
attestation of unrelated outpatient non-diagnostic services
If the nondiagnostic outpatient services are not related to the inpatient admission, the hospital must report condition code 51 (attestation of unrelated outpatient non-diagnostic services) on the outpatient claim.
What does condition code 42 mean?
Note: Condition Code 42 may be used to indicate that the care provided by the Home Care Agency is not related to the Hospital Care and therefore, will result in payment based on the MS-DRG and not a per diem payment.
What is Box 81 on UB04?
How do I get a UB-04?
UB-04 instructions and forms can be downloaded free of charge from the Web site for the Centers for Medicare and Medicaid Services (CMS) at http://www.cms.hhs.gov/transmittals/downloads/R1104CP.pdf. UB-04 manuals may be ordered from the National Uniform Billing Committee Web site at http://www.nubc.org/.
How to complete the UB-04 claim form for facility?
Medica claims. Inside is a blank UB-04 claim form for reference, and information on Medica’s requirements for successful completion of the UB-04 claim form. These instructions include specifications for each form locator (field) on the UB-04 claim form and whether or not Medica requires the field be completed.
What does form locator 4 for UB-04 mean?
Form locator 4: Type of bill (TOB). This is a four-digit code beginning with zero, according to the National Uniform Billing Committee guidelines. Form locator 6: Statement from and through dates for the service covered on the claim, in MMDDYY (month, date, year) format. Form locator 9: Patient street address, city, state, zip, and country code
How to complete ub04 for facility institutional providers?
Completing the UB-04 Claim Form Guidelines for Facility/Institutional Providers Medica follows national and state uniform billing guidelines for the submission of UB-04 claim forms, although some fields required by Medicare or other payers may not be necessary for Medica claims.
Do you need a Revenue Code for UB-04?
Accommodation codes require a rate in Form Locator 44. Revenue Codes 300-319 and 490 for outpatient require a CPT/HCPCS procedure code in Form Locator 44. Specific revenue codes should be selected if at all possible (i.e. 258 = IV Solutions, 305 = Lab / Revenue Codes 89x (other donor bank) are now unassigned.
