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UB-04 Completion Guide Hospital Services 3a 1 2 3b 5 4 6 # FIELD NAME 1 Provider Name, Address, and Telephone Enter the provider s name and mailing address and telephone number. Number 2 Pay-to Name,

How to fill out ub-04 completion guide hospital

How to fill out UB-04 completion guide hospital:

1. Gather all necessary information: Before filling out the UB-04 form, make sure you have all the required information handy. This includes the patient's personal details, insurance information, dates of service, procedure codes, and any other relevant documentation.
2. Complete the patient information section: Start by entering the patient's full name, date of birth, gender, and Social Security number or Medicaid ID. Also, include the patient's address and phone number, as well as the admission and discharge dates.
3. Provide insurance details: In the insurance section, input the primary and secondary payer information. Include the insurance company name, policy or group number, and the type of plan (e.g., Medicaid, Medicare, commercial insurance). If there is more than one insurance, indicate the order of priority.
4. Fill out the claim details: Next, provide the necessary details about the services rendered. This includes the dates of service, procedure codes, revenue codes, and number of units or days. Indicate the diagnosis code(s) related to the services provided for accurate billing.
5. Include additional information, if required: Certain situations may require additional information, such as accidents, worker's compensation, or other special circumstances. Consult the UB-04 completion guide for specific instructions on how to include this information accurately.
6. Review and double-check: Before submitting the form, carefully review all the information entered to ensure accuracy. Mistakes or missing information can lead to claim denials or delays in reimbursement.

Who needs UB-04 completion guide hospital?

1. Hospitals and healthcare facilities: The UB-04 form is primarily used by hospitals and other healthcare facilities to bill for services rendered to patients. It provides a standardized format for submitting claims to insurance companies.
2. Billing and coding staff: The UB-04 completion guide is essential for billing and coding staff who are responsible for accurately filling out the form. It provides instructions and explanations for each section, ensuring compliance with billing regulations and maximizing reimbursement.
3. Insurance companies: Insurance companies also benefit from the UB-04 completion guide as it helps them understand the format and structure of the form. This enables efficient processing and review of claims submitted by hospitals and healthcare facilities.

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