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SOUTH CAROLINA MEDICAID WEB-BASED CLAIMS SUBMISSION TOOL User Guide Addendum UB-04 November 3, 2003, Updated June 03, 2013 UB-04 CLAIMS ENTRY This document describes the correspondence between the

How to fill out ub-04 addendum - healthy

How to Fill Out UB-04 Addendum - Healthy:

1. Gather all necessary information, including patient information, insurance details, and medical provider information.
2. Start by filling out the patient's personal information, including their name, date of birth, and social security number.
3. Next, provide the details of the patient's insurance coverage, such as the name of the insurance company, policy number, and group number.
4. Specify the reason for the medical visit or treatment by filling out the diagnosis code(s) in the designated field.
5. Provide the dates of service and indicate the type of service provided, whether it's an outpatient visit, inpatient stay, or any specific procedure.
6. Include the medical provider's information, such as their name, address, and National Provider Identifier (NPI) number.
7. Fill out the billing information, including the charges for the services rendered, any adjustments or discounts, and the total amount due.
8. Sign and date the UB-04 Addendum form to validate the information provided.
9. Keep a copy of the completed form for your records and submit the original to the relevant insurance company or healthcare facility.

Who Needs UB-04 Addendum - Healthy:

1. Healthcare providers who offer medical services to patients needing reimbursement from insurance companies or government health programs, such as Medicare or Medicaid, will require the UB-04 Addendum form.
2. Hospitals, clinics, rehabilitation centers, and other healthcare facilities that provide inpatient or outpatient services will also utilize the UB-04 Addendum for billing purposes.
3. Patients who have health insurance coverage that requires them to complete a claim form or those who utilize government healthcare programs will need to understand how to fill out the UB-04 Addendum when seeking reimbursement for medical services.

For pdfFiller’s FAQs

What is ub-04 addendum - healthy?

The UB-04 addendum - healthy is a supplemental form used to provide additional information related to a patient's health condition or treatment.

Who is required to file ub-04 addendum - healthy?

Healthcare providers or facilities responsible for submitting insurance claims using the UB-04 form may be required to file the addendum if additional details are needed.

How to fill out ub-04 addendum - healthy?

The UB-04 addendum - healthy should be filled out with accurate and detailed information about the patient's health condition or treatment in the designated sections of the form.

What is the purpose of ub-04 addendum - healthy?

The purpose of the UB-04 addendum - healthy is to ensure that all relevant information about a patient's health is included in insurance claims to facilitate accurate processing and reimbursement.

What information must be reported on ub-04 addendum - healthy?

Information such as specific diagnosis codes, treatment details, or any additional medical procedures related to the patient's health condition may be required to be reported on the UB-04 addendum - healthy.

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