Get the free Health First Colorado UB-04 Federally Qualified ... - Colorado.gov

HEALTH FIRST COLORADOFQHC/RHC BILLING MANUALFederally Qualified Health Centers (FCS) and Rural Health Clinics (RCS) Federally Qualified Health Centers (FCS) and Rural Health Clinics (RCS) ..............................

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 patient's name, address, and other demographic information in the designated fields.
3. Provide the health insurance or coverage information, including policy number and group identification number.
4. Specify the patient's admission and discharge dates in the appropriate fields.
5. Document the principal diagnosis or reason for the hospital stay in the primary diagnosis field.
6. List any secondary diagnoses, if applicable.
7. Indicate the type of facility where the services were rendered (e.g., hospital, nursing facility, outpatient clinic).
8. Enter the appropriate medical procedure codes and units of service for each line item.
9. Include any additional information or remarks in the designated section.
10. Finally, make sure to sign and date the form before submitting it.

Who needs health first colorado ub-04?

1. Health First Colorado UB-04 form is needed by medical providers and facilities that participate in the Health First Colorado (Colorado's Medicaid Program). They must use this form to submit claims for reimbursement of services provided to Health First Colorado members.

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What is health first colorado ub-04?

Health First Colorado UB-04 is a standardized claim form used by healthcare providers to bill for services rendered to Medicaid recipients in Colorado.

Who is required to file health first colorado ub-04?

Healthcare providers, institutions, and facilities that provide services to Health First Colorado members are required to file the UB-04 form.

How to fill out health first colorado ub-04?

To fill out the Health First Colorado UB-04, providers must enter accurate patient information, service details, diagnosis codes, and provider information according to the guidelines provided by Colorado Medicaid.

What is the purpose of health first colorado ub-04?

The purpose of the Health First Colorado UB-04 is to facilitate the billing and payment process for Medicaid services provided to eligible individuals.

What information must be reported on health first colorado ub-04?

The information that must be reported includes patient demographics, service dates, diagnosis codes, procedure codes, revenue codes, and the provider's NPI number.