There are 81 fields or lines on a UB-04. Patient street address, city, state, zip, and country code Form locator 10: Thanks for your feedback! All codes in this article are for example purposes only. Type of visit: It's printed with red ink on white standard paper. Patient sex M, F, or U Form locator 12: Please try again. Email Address Sign Up There was an error.
Billing provider's pay-to name, address, city, state, zip, and ID if it's different from field 1 Form locator 3: Was this page helpful? Assignment of benefits a Primary, b Secondary, and c Tertiary Form locator 54: Taxonomy code and qualifier.
The UB-04 form has humble beginnings in the early 1980s.
By David Fletcher 2017-06-13T18: Condition codes using the two-digit codes from the NUBC manual for up to 11 occurrences. This includes:. Any institutional provider can use the UB-04 for billing medical claims.
Ensure that all data is entered correctly and accurately in the correct fields. Form locator 17: Article Overview of Pharmacy Billing.
Continue Reading. Not in use Form locator 38: December 14th, 2017 0 Comments. Our intent is to enable accuracy improvements earlier in the mid revenue cycle instead of waiting until the patient is discharged. The form contains more than 80 lines for important patient information. Form locator 18-28: