the current National Uniform Billing Committee (NUBC) UB04 Reference Manual. Unless otherwise noted, all data form locators on the UB04 have the same attributes (specifications) for Health First Colorado as those indicated in the NUBCUB04 Reference Manual.
Form# CMS 1450 Form Title UB04 Uniform Bill Revision Date O. M. B. # O. M. B. Expiration Date CMS Manual NA Special Instructions PR0041 V1. 5. UB04 CLAIM FORM INSTRUCTIONS. FIELD NUMBER FIELD NAME INSTRUCTIONS 1.
Billing Provider Name& Address Enter the name and address of the hospitalfacility UB04 (CMS 1450) FORM COMPLETION INSTRUCTIONS. INTRODUCTION. The UB04 claim form is used to bill for all hospital inpatient, outpatient, and emergency room services. between the AHCCCS Claim Reference Number (CRN) and the facilitys accounting or tracking system.
See UB92 Manual Premera Reference Manual Premera Blue Cross ( ) UB04 Billing Chapter 12 Page 1 12 UB04 Billing. Description. This chapter contains participation, claims and billing information for providers who bill on a (Form 1 Discharge PA PROMISe Provider Handbook 837 InstitutionalUB04 Claim Form UB04 Desk Reference for Hospitals UB04 Claim Form Instructions Rev.
completion of the UB04 claim form. It is to be used as a companion to, and not a replacement for, the UB04 Data Specifications Manual, available from the National Uniform Billing Committee at Ub 04 reference manual the applicable coding reference to determine correct service unit measurements (days, hours UB04 (CMS 1450) billing guidelines The Centers for Medicare and Medicaid Services (CMS) form 1450, referred to as the UB04, is the standard claim form used to bill facility services to us and our affiliates.
Official UB04 Data Specifications Manual. This manual, copyrighted by the American Hospital Association, is the only official source of UB Data. This manual, copyrighted by the American Hospital Association, is the only official source of UB Data.
CMS Manual System Department of Health& Human Services (DHHS) Pub Medicare Claims Processing Centers for Medicare& SUBJECT: Uniform Billing (UB04) Implementation. I. SUMMARY OF CHANGES: The CMS needs to be ready to receive the new UB04 by March 1, 2007. information, all providers should have a copy of the UB04 Data Specifications Manual for reference. To become a UB04 Subscriber, refer to the following Web site: Skilled Nursing Facility. Quick Reference. Billing Manual. 1 Table of Contents.
Disclaimer: All information contained in this manual has been complied in good faith from internal& external materials believed to be reliable. Topics Page Table of Contents 2 UB04 Form Locator Descriptions.