What goes in box 51 on UB04?

What goes in box 51 on UB04?

Box 50a-c: (Required) Primary Payer Name (Secondary/Tertiary information can be entered on the lines below. Box 51a-c: (Not required) Health Plan ID should be entered into this box to identify the Health Plan Box 52a-c: (Not required) Each payer line will have a separate Assignment of Benefits Marker Box. Box 53a-c: ( …

What is Box 57 on a UB04?

57. Other Provider ID. Enter the correct 7-digit provider number as assigned by Medica. for the type of services provided. RA.

What is an ICD version indicator?

A –The ICD indicator is used to indicate to the Payer if the codes entered are ICD-9 or ICD-10 codes. The selected indicator must match the codes that were entered on the claim.

What is Box 38 on a UB04?

38 Responsible Party Name and Address Required This field is for reporting the name and address of the person responsible for the bill. 39 – 41 Value Codes and Amounts Conditional These fields contain the codes and related dollar amounts to identify the monetary data for processing claims.

Where does taxonomy code go on UB04?

box 81
For paper UB-04 institutional claims, the taxonomy code should be placed in box 81 and submitted with the “B3” qualifier. For paper CMS-1500 claims, the taxonomy code should be identified with the qualifier “ZZ” in the shaded portion of box 24i.

Where is POA indicator on UB04?

On the UB-04, the POA indicator is the eighth digit of Field Locator (FL) 67, Principal Diagnosis, and the eighth digit of each of the Secondary Diagnosis fields, FL 67 A–Q. Report the applicable POA indicator (Y, N, U, or W) for the principal diagnosis and any secondary diagnoses as the eighth digit.

What are value codes?

Values coding is a method of coding that delves into the subjective nature of the human experience. In particular, values coding deals with labeling the values, attitudes and belief systems that are expressed by participants.

What does ICD indicator 0 mean?

Entering a “0” will indicate the provider intends to submit ICD-10 codes. Below is a guide for provider claim staff. Date of Discharge or Date of Service.

What are condition codes on UB04?

CMS1450/UB04 Fields: 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, and 28 are places for Condition Codes. The provider enters the corresponding code (in numerical order) to describe any conditions or events that apply to the billing period.

What is a UB 04 form used for?

UB-04 Claim Form Description The UB-04 claim form is used to request reimbursement for services rendered by the following institutions: Inpatient hospital facilities, such as medical/surgical intensive care, burn care, coronary care and ancillary charges (such as labor and delivery, anesthesiology and central services and supplies)

How do I fill out the uubub-04 form?

UB-04 Claim Form Instructions FORM LOCATOR NAME INSTRUCTIONS 1. Billing Provider Name & Address Enter the name and address of the hospital/facility submitting the claim. 2. Pay to Address Pay to address if different than field 1. 3a. Patient Control Number Enter your facility’s unique account number

What is the ECI code for external cause of injury?

FL72: ECI – External cause of injury code. Contains up to 3 full ICD-10-CM diagnosis codes, including the fourth and fifth digits when appropriate, pertaining to the external cause of injury, poisoning, or adverse effect

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