Get the free UB-04 Form Locator - dhhs nh

State of New Hampshire Department of Health and Human Services Division of Public Health Services Health Statistics and Data Management New Hampshire Uniform Health Facility Discharge Data Set 5010

How to fill out ub-04 form locator

How to fill out UB-04 form locator:

1. Start by gathering all the necessary information, such as patient demographics, insurance policy details, and medical treatment records.
2. Begin filling out the UB-04 form by providing the patient's name, address, and contact information in the designated fields.
3. Specify the patient's insurance information, including the policy number and any relevant identification numbers, in the appropriate sections.
4. Next, indicate the dates of service for the medical treatment being reported on the form.
5. Provide details about the healthcare provider or facility by entering their name, address, and contact information.
6. Select the appropriate type of bill code that corresponds to the purpose of the form submission.
7. Include the necessary diagnosis and procedure codes for the medical treatment provided. These codes should accurately reflect the services rendered.
8. If there are multiple providers or facilities involved in the treatment, indicate the relevant information for each one.
9. Finally, review the completed form for accuracy and ensure that all required fields have been filled out correctly.

Who needs UB-04 form locator?

1. Hospitals and healthcare facilities: UB-04 form locators are commonly used by hospitals, inpatient rehabilitation facilities, skilled nursing facilities, and other healthcare providers to submit claims for reimbursement from insurance companies or government programs like Medicare or Medicaid.
2. Health insurance companies: Insurance companies use the UB-04 form locators to process and adjudicate claims submitted by healthcare providers, ensuring that the services provided are covered under the policy and reimbursing the providers accordingly.
3. Government agencies: UB-04 form locators are also used by government agencies like Medicare or Medicaid to review and process claims for reimbursement to hospitals and healthcare providers for services rendered to eligible beneficiaries.

In summary, filling out the UB-04 form locator involves gathering necessary information, accurately entering patient and provider details, submitting the relevant codes, and ensuring the form is completed correctly. This form is used by hospitals, healthcare providers, insurance companies, and government agencies involved in the reimbursement process for medical services.

For pdfFiller’s FAQs

What is ub-04 form locator?

UB-04 form locator is a specific section on the UB-04 form where certain information related to healthcare services provided is reported.

Who is required to file ub-04 form locator?

Healthcare providers, hospitals, and other facilities that bill for services provided to patients are required to file the UB-04 form locator.

How to fill out ub-04 form locator?

The UB-04 form locator is filled out by entering the relevant information in the designated fields according to the guidelines provided by the National Uniform Billing Committee.

What is the purpose of ub-04 form locator?

The purpose of the UB-04 form locator is to standardize the billing process for healthcare services and ensure that the necessary information is accurately reported for reimbursement purposes.

What information must be reported on ub-04 form locator?

Information such as patient demographics, dates of service, procedures performed, and charges incurred must be reported on the UB-04 form locator.

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