Get the free OK UB-04 letterOklahomarev.doc

This document informs healthcare providers about the transition from the UB-92 to the UB-04 billing form by Blue Cross and Blue Shield of Oklahoma, including key dates and requirements for provider

How to fill out ok ub-04 letteroklahomarevdoc

How to fill out the UB-04 letter (Oklahoma version):

1. Start by obtaining the UB-04 form. The form can be found on the Oklahoma Health Care Authority's website or may be provided by your healthcare facility.
2. Begin completing the form by entering the patient information in the designated fields. This includes the patient's name, address, and contact information.
3. Next, provide the patient's insurance information. This includes the name of the insurance company, policy number, and group number, if applicable.
4. Proceed to indicate the type of bill by checking the appropriate box. The UB-04 form allows for different types of bills, such as inpatient, outpatient, or institutional claims.
5. In the "Admission Date" field, specify the date the patient was admitted to the healthcare facility. Similarly, in the "Discharge Date" field, enter the date the patient was discharged or is expected to be discharged.
6. Specify the principal diagnosis or reason for the patient's visit in the designated field. This should be a concise description of the primary medical condition or injury.
7. If applicable, list any additional diagnoses or conditions in the appropriate fields. These may include secondary medical conditions or complications that have arisen during the patient's stay.
8. Provide information about any procedures or services rendered to the patient during their visit. This includes the date of each procedure, a brief description, and the corresponding medical code.
9. Indicate the number of days covered by the claim in the "Covered Days" field. This refers to the total number of days the patient received care at the facility.
10. If necessary, include any additional remarks or comments in the designated section of the form. This can be used to provide additional details or explanations related to the claim.

Who needs the UB-04 letter (Oklahoma version)?

1. Healthcare facilities: Hospitals, clinics, and other healthcare providers use the UB-04 form to submit claims for reimbursement from insurance companies or government healthcare programs.
2. Billing departments: Staff involved in the billing and coding process at healthcare facilities need the UB-04 form to accurately document and submit claims for services provided.
3. Insurance companies: The UB-04 form is used by insurance companies to process and review claims submitted by healthcare providers.
4. Patients: While patients do not directly fill out the UB-04 form, understanding its purpose and contents can help them navigate the billing process and communicate with their healthcare providers and insurance companies.
5. Government agencies: Government healthcare programs, such as Medicaid or Medicare, may require the UB-04 form for reimbursement purposes and to ensure compliance with program guidelines.

For pdfFiller’s FAQs

How do I make changes in ok ub-04 letteroklahomarevdoc?

With pdfFiller, you may not only alter the content but also rearrange the pages. Upload your ok ub-04 letteroklahomarevdoc and modify it with a few clicks. The editor lets you add photos, sticky notes, text boxes, and more to PDFs.

Can I sign the ok ub-04 letteroklahomarevdoc electronically in Chrome?

You can. With pdfFiller, you get a strong e-signature solution built right into your Chrome browser. Using our addon, you may produce a legally enforceable eSignature by typing, sketching, or photographing it. Choose your preferred method and eSign in minutes.

How do I complete ok ub-04 letteroklahomarevdoc on an iOS device?

Download and install the pdfFiller iOS app. Then, launch the app and log in or create an account to have access to all of the editing tools of the solution. Upload your ok ub-04 letteroklahomarevdoc from your device or cloud storage to open it, or input the document URL. After filling out all of the essential areas in the document and eSigning it (if necessary), you may save it or share it with others.