Get the free Medi-Cal Subsection III.B. UB04 Billing Form - partnershiphp

PARTNERSHIP HEALTHILY OF CALIFORNIA MEDICAL PROVIDER MANUAL CLAIMS DEPARTMENT III. B. UB-04 Billing Form The information listed below are the UB-04 fields that must be completed accurately and completely

How to fill out medi-cal subsection iiib ub04

How to fill out medi-cal subsection iiib ub04:

1. Start by obtaining the ub04 form from the official Medi-Cal website or your healthcare provider. Make sure to use the most up-to-date version of the form.
2. Fill out the patient information section accurately, including the patient's name, date of birth, and Medi-Cal identification number. Ensure that this information matches the patient's Medi-Cal eligibility details.
3. Proceed to the subsection iiib, which is specifically for Medi-Cal billing. This section requires you to provide detailed information about the services provided.
4. Begin by entering the date when the service was performed. Make sure it corresponds to the date of service for the claim.
5. Next, specify the place of service by selecting the appropriate code from the list provided. This code should reflect the location where the service was rendered, such as a hospital, clinic, or nursing home.
6. Identify the type of bill code (TOB) by referring to the Medi-Cal guidelines or contacting your healthcare provider. This code determines the type of service being billed.
7. Enter the revenue code(s) that correspond to the specific services provided. These codes help to identify the different types of procedures, tests, or treatments given to the patient.
8. Provide the HCPCS procedure code(s) that represent the specific healthcare services rendered. This code set helps to standardize the billing process and ensure accurate reimbursement.
9. Specify the units of service for each procedure code entered. This indicates the quantity or duration of the services provided. For example, if multiple X-rays were taken, record the number of X-rays in this section.
10. Lastly, include any applicable charges or payments made for each service provided. This should include the charges that are billable to Medi-Cal and any payments received from other sources, such as insurance or the patient.

Who needs medi-cal subsection iiib ub04:

1. Medi-Cal subsection iiib of the UB04 form is specifically designed for healthcare providers who offer services to Medi-Cal beneficiaries. It is used to accurately bill and claim reimbursement from the Medi-Cal program.
2. Healthcare providers, including hospitals, clinics, skilled nursing facilities, or any other facility that accepts Medi-Cal patients, may need to fill out this subsection. It ensures that the services provided are properly documented and eligible for reimbursement.
3. It is important to note that only healthcare providers participating in the Medi-Cal program need to fill out this specific section. Medicare or private insurance providers may have their own billing forms and requirements.

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