Get the free Health First Colorado UB-04 Inpatient-Outpatient Billing Manual

HEALTH FIRST COLORADOINPATIENT/OUTPATIENT BILLING MANUALInpatient/Outpatient Hospital General Billing Information ..................................................................................................................1

How to fill out health first colorado ub-04

How to fill out health first colorado ub-04

1. To fill out the Health First Colorado UB-04 form, follow these steps:
2. Begin by entering the facility's name and address in the designated fields.
3. Fill in the patient's full name, date of birth, and Social Security number.
4. Provide the patient's insurance information, including Health First Colorado ID number.
5. Indicate the dates of service and fill in the corresponding charges for each day.
6. Include any additional charges for services, supplies, or medications provided.
7. If applicable, enter the referring physician's name and National Provider Identifier (NPI).
8. Provide any relevant diagnosis codes and procedure codes for the services rendered.
9. Finally, review the completed UB-04 form for accuracy and completeness before submitting it.

Who needs health first colorado ub-04?

1. Health First Colorado UB-04 is required by healthcare facilities, hospitals, clinics, and healthcare providers who offer services to patients covered by Health First Colorado (Colorado's Medicaid program). It helps in billing and submitting claims for reimbursement of services provided to eligible individuals.

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