UB-92 Billing Instructions for Healthcare Providers
This file provides comprehensive guidance on completing the UB-92 billing form for healthcare services. It includes field descriptions, coding instructions, and necessary patient information. Utilize this document to ensure proper billing and reimbursement processes.
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How do I fill this out?
To fill out the UB-92 billing form, start by entering the provider and patient information. Ensure that you accurately input relevant codes and dates based on the service provided. Read through each field description to avoid errors.
How to fill out the UB-92 Billing Instructions for Healthcare Providers?
1
Enter provider name, address, and telephone number.
2
Input the patient's control number and date of birth.
3
Select the appropriate type of facility and classification codes.
4
Enter service dates and covered days.
5
Review and verify all information before submission.
Who needs the UB-92 Billing Instructions for Healthcare Providers?
1
Hospitals need this form to bill for inpatient services.
2
Clinics utilize this form for outpatient service billing.
3
Insurance companies require this form for reimbursement processing.
4
Healthcare providers use this form to document patient service details.
5
Billing departments need this form for accurate financial records.
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Save the edited form and download it for your records.
What are the instructions for submitting this form?
Submit the completed UB-92 form to the relevant payer or insurance provider via email, fax, or an online submission portal provided by the payer. For physical submissions, send the form to the designated address of the insurance company or government agency. Ensure all required fields are accurately filled out to avoid delays. Review submission guidelines from each payer to comply with their specific requirements.
What are the important dates for this form in 2024 and 2025?
Ensure all billing information is accurately submitted on a rolling basis to meet healthcare provider and insurance company deadlines.
What is the purpose of this form?
The purpose of the UB-92 form is to provide a standardized format for billing healthcare services. This form allows healthcare providers to itemize patient services and submit claims for reimbursement. Proper completion of the UB-92 form ensures that billing is accurate and meets the requirements set forth by insurance companies and government programs.
Tell me about this form and its components and fields line-by-line.
- 1. Provider Name: Enter the name of the provider or facility.
- 2. Patient Control No.: Input the patient control number, consisting of up to 16 characters.
- 3. Type of Bill: Enter the 3-digit code indicating the type of facility and bill classification.
- 4. Federal Tax No.: Include the provider's federal tax number.
- 5. Statement Covers Period: Enter the dates of the billing period.
- 6. Covered Days: Record the number of days approved by a utilization review committee.
- 7. Non-Covered Days: Indicate the number of non-covered days during the billing period.
- 8. Patient's Name: Enter the patient's name as shown on the Medicaid eligibility card.
- 9. Patient's Address: Provide the patient's permanent address.
- 10. Patient's Birthdate: Include the patient's date of birth using 8 digits (MMDDYYYY).
- 11. Patient's Sex: Enter the patient's sex using the appropriate code (M, F, U).
- 12. Admission Date: Enter the date of admission using 6 digits (MMDDYY).
- 13. Admission Hour: Record the hour of admission using a 2-digit code.
- 14. Type Admission: Enter a code indicating the priority of the admission.
- 15. Source of Admission: Provide the source of admission using the appropriate code.
What happens if I fail to submit this form?
Failure to submit the UB-92 form can lead to delayed or denied reimbursements for healthcare services.
- Delayed Reimbursement: Providers may experience delays in receiving payments.
- Denied Claims: Insurance companies may deny claims due to incomplete or missing information.
- Financial Loss: Providers may incur financial losses due to non-payment.
How do I know when to use this form?
- 1. Inpatient Services: Submit this form for inpatient services provided at hospitals.
- 2. Outpatient Services: Use this form for outpatient services at clinics or special facilities.
- 3. Surgical Procedures: Document ambulatory surgical procedures using this form.
- 4. Medicare and Medicaid: Bill services covered by Medicare or Medicaid with this form.
- 5. Replacement or Void Claims: Submit replacement or void claims using the appropriate codes.
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