Get the free CMS-1450 / UB 04 - Montana Medicaid Provider Information
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1 4 3a PAT. CNT # b. MED. REC. # 2 6 5 FED. TAX NO. 8 PATIENT NAME 9 PATIENT ADDRESS a 10 BIRTHDATE 11 SEX 31 OCCURRENCE CODED ATE 12 DATE a c 32 OCCURRENCE CODE DATE ADMISSION 13 HR 14 TYPE 15 SRC
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What is cms-1450 ub 04?
CMS-1450 UB-04 is a standard claim form used by institutional providers to bill Medicare for services provided.
Who is required to file cms-1450 ub 04?
Institutional providers such as hospitals, nursing homes, hospices, and home health agencies are required to file CMS-1450 UB-04.
How to fill out cms-1450 ub 04?
CMS-1450 UB-04 is filled out with specific information about the patient, services provided, and charges incurred. Providers must follow the instructions provided by Medicare for accurate completion.
What is the purpose of cms-1450 ub 04?
The purpose of CMS-1450 UB-04 is to submit claims for payment to Medicare for services provided by institutional providers.
What information must be reported on cms-1450 ub 04?
Information such as patient demographics, dates of service, diagnosis codes, procedure codes, charges, and provider information must be reported on CMS-1450 UB-04.
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