Get the free Managed Care UB-04 Billing Guidelines - emedny

This document provides guidelines for managed care organizations participating in the New York State Medicaid program regarding claim submission, billing instructions, and remittance advice.

How to fill out managed care ub-04 billing

How to fill out Managed Care UB-04 Billing Guidelines

1. Start with accurate patient information including demographics.
2. Ensure correct insurance details are entered at the top of the form.
3. Fill out the provider information completely, including NPI and tax ID.
4. Input the type of bill in Form locators 4-8.
5. Complete the patient coverage section with policy numbers and group details.
6. Detail the services provided using appropriate CPT/HCPCS codes.
7. Include the dates of service for each entry in the service section.
8. Specify any applicable modifiers related to the services provided.
9. Check for accuracy in the total billed amount before submission.
10. Review the submission requirements of the Managed Care payer for electronic or paper claims.

Who needs Managed Care UB-04 Billing Guidelines?

1. Healthcare providers submitting claims for services rendered to patients under managed care contracts.
2. Billing professionals responsible for processing and submitting insurance claims.
3. Accounting departments within healthcare institutions needing to ensure compliance with payer requirements.

People Also Ask about

How many diagnosis codes can be on a UB04 claim?

The UB-04 paper claim form, specifically locator 67, is designed for the listing of diagnosis codes related to hospital inpatient claims. In total, it can include up to 25 diagnosis codes.

What can be billed on UB-04?

The UB-04 claim form is used to submit claims for outpatient services by institutional facilities (for example, outpatient departments, Rural Health Clinics and chronic dialysis centers).

What services are billed on UB-04?

The UB-04 claim form is used to submit claims for outpatient services by institutional facilities (for example, outpatient departments, Rural Health Clinics and chronic dialysis centers).

Does NY Medicaid accept paper claims?

Paper submission of claims and requests to New York Medicaid must be presented on original forms.

How many diagnoses can be reported electronically?

Up to twelve diagnoses can be reported in the header on the Form CMS-1500 paper claim and up to eight diagnoses can be reported in the header on the electronic claim.

How to read an UB04 form?

Understanding Each Field on the UB-04 Form FL 1: Billing provider information including name, address, and phone number. FL 2: Pay-to provider's name and address, if different. FL 3: Patient control and medical record numbers. FL 4: Type of bill (TOB). FL 5: Federal tax number for your facility.

For pdfFiller’s FAQs

What is Managed Care UB-04 Billing Guidelines?

The Managed Care UB-04 Billing Guidelines provide specific instructions for healthcare providers on how to properly complete the UB-04 claim form used for billing services provided to patients enrolled in managed care plans.

Who is required to file Managed Care UB-04 Billing Guidelines?

Healthcare providers, including hospitals, clinics, and skilled nursing facilities, that render services to patients covered under managed care plans are required to file using the Managed Care UB-04 Billing Guidelines.

How to fill out Managed Care UB-04 Billing Guidelines?

To fill out the Managed Care UB-04 claim form, providers need to ensure that they accurately enter patient demographic information, services provided, diagnosis codes, procedure codes, and any relevant financial details, following the specific instructions outlined in the guidelines.

What is the purpose of Managed Care UB-04 Billing Guidelines?

The purpose of the Managed Care UB-04 Billing Guidelines is to standardize the billing process for managed care services, ensuring that claims are submitted accurately and uniformly, which facilitates proper reimbursement and reduces errors.

What information must be reported on Managed Care UB-04 Billing Guidelines?

The information that must be reported includes patient identification details, provider's information, service dates, revenue codes, diagnosis codes, procedure codes, the total charges for services, and any applicable adjustments or discounts.