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(Revised 04/14/2015). UP 04 MEDICARE ... Billing Provider Name: (must match the provider name, as it appears, in form LOC. 1 on your UB04 claim form).

How to fill out ub 04 medicare attachment

How to fill out UB 04 Medicare attachment:

1. Begin by obtaining the UB 04 Medicare attachment form. You can find this form on the official website of the Centers for Medicare and Medicaid Services (CMS).
2. Make sure you have all the necessary documents and information required to fill out the form. This may include the patient's Medicare number, admission and discharge dates, diagnosis codes, and any other relevant medical information.
3. Start filling out the form by entering the patient's personal information, such as their name, address, date of birth, and Social Security number.
4. Proceed to fill in the details regarding the facility, including its name, address, and Medicare provider number.
5. Next, provide information about the insurance coverage. This will include the patient's primary insurance carrier, policy number, and any secondary insurance information if applicable.
6. In the "Dates of Service" section, enter the date of admission and discharge for the specific medical treatment or services rendered.
7. Use the designated fields to provide the appropriate diagnosis codes corresponding to the patient's condition. These codes should be obtained from the International Classification of Diseases, Tenth Revision (ICD-10) coding manual.
8. If there were any procedures or services performed, indicate them in the designated section along with the corresponding revenue codes.
9. Include any relevant documentation, such as medical records or supporting documents, that may be required as attachments. These attachments should be referenced appropriately on the form.
10. Review the completed form for accuracy and completeness before submitting it to the appropriate Medicare administrative contractor for processing.

Who needs UB 04 Medicare attachment?

1. Healthcare facilities that provide services covered by Medicare may need to fill out the UB 04 Medicare attachment. This includes hospitals, rehabilitation centers, nursing homes, and other types of medical establishments.
2. The attachment may be required for Medicare patients who receive certain types of medical treatments or services that require additional documentation or supporting information.
3. The UB 04 Medicare attachment allows Medicare to process claims accurately and efficiently, ensuring that healthcare providers receive appropriate reimbursement for their services while also protecting the interests of the beneficiaries.

Please note that it is essential to consult the official guidelines and instructions provided by CMS or seek professional assistance when filling out the UB 04 Medicare attachment to ensure compliance with all regulations and requirements.

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What is ub 04 medicare attachment?

UB-04 Medicare attachment is a form used by healthcare providers to submit additional supporting documentation for Medicare claims.

Who is required to file ub 04 medicare attachment?

Healthcare providers who submit Medicare claims and are requested to provide additional documentation are required to file UB-04 Medicare attachment.

How to fill out ub 04 medicare attachment?

UB-04 Medicare attachment must be completed with the requested information and supporting documentation and submitted along with the corresponding Medicare claim.

What is the purpose of ub 04 medicare attachment?

The purpose of UB-04 Medicare attachment is to provide additional information and supporting documentation to Medicare claims to ensure accurate processing and reimbursement.

What information must be reported on ub 04 medicare attachment?

The information reported on UB-04 Medicare attachment will vary depending on the specific documentation requested for the Medicare claim.