If your clinic or office is established as a facility by the insurance company, you are required to file your medical insurance claims on UB04 forms rather than CMS 1500 claim forms. Many providers’ claims are denied because they are filed on CMS forms. These offices don’t know what to do as they not familiar with the UB04s.
UB04 forms (formerly UB92 forms) are quite a bit different than CMS or HCFA forms and require different information. They can be very confusing, but it is important to complete the UB04 correctly if you expect payment from the insurance companies.
Rev codes, type of bill, and value codes are required on the UB form. These are all new to those of us who have only completed CMS 1500 forms. You must be able to figure out what to put in these fields to complete the claim properly.
Many of the insurance carriers have different requirements for what information goes in each box on the UB04 form. For example, one company may require a certain rev code for the service you are billing for, while another company may require a totally different rev code for the same service.
We bill for an outpatient drug and alcohol rehab facility. BCBS requires rev code 945 but UBH requires we bill it with rev code 0513. It is exactly the same service but if we want the claim to be paid, that’s what we have to do. It is important to know the different requirements for each of the insurance carriers that you bill to.
If one required box is not completed, the claim will be denied by the insurance carrier. If CPT codes are entered instead of Rev codes, the claim will be denied. It is not difficult to get UB04 claims paid, it is just necessary to understand what the required information is.
Make sure you know how to complete these forms correctly so you will receive maximum reimbursement for your insurance claims when you are required to use the UB04 form.
Copyright 2008 – Alice Scott