What is a UB-04?

A healthcare provider uses a UB-04 claim form to submit insurance claims for services provided to patients. The form is named after the National Uniform Billing Committee (NUBC), the organization that developed and standardized it. It is also known as the CMS-1450 form and was previously called the UB-92 form.

This form is used to bill government insurance payers such as Medicare and Medicaid, as well as other insurance payers. It allows healthcare providers and payers to standardize billing practices, simplifying the billing process regardless of the organization submitting the form.

The UB-04 claim form includes the following:

• Patient details: This typically includes the patient's name, address, date of birth, and insurance details.

• Provider details: This can include the name and address of the hospital or healthcare facility providing services, as well as the name and contact details of the actual provider.

• Diagnosis and procedure codes: These are codes that indicate the reason for the patient's medical treatment and the procedures performed.

• Description of services: This is a detailed summary of the services, treatments, and procedures provided to the patient.

• Charges: This includes the billed costs of the provided services and procedures.

• Payer information: This includes the name, address, and contact information of the insurance company or payer responsible for covering the costs.

• Patient's signature: This is the patient's authorization that the details on the form are true. Alternatively, it can be the signature of an authorized healthcare proxy.

Insurance companies, including Medicare and Medicaid payers, use the information on the UB-04 form to process and adjudicate claims, determine payment amounts, and verify the medical necessity of the services provided.

It is crucial for healthcare providers to accurately complete the UB-04 form in a timely manner to ensure proper reimbursement for their services. Managing billing on their own can be time-consuming for practices. TempDev's NextGen EPM consulting can assist with billing and collections, helping with payment posting, accounts receivable, and denials management for efficient revenue cycles and claims management.