2013 ub 04 manual 2015

The emedny system allows new york medicaid providers to submit claims and receive payments for medicaidcovered services provided to eligible members. You can access the ub04 billing information adopted by the nubc by subscribing. This manual, ed by the american hospital association, is the only. Ambulatoryoutpatient claims ub04 pdf format effective 2015. This manual is designed to assist facilities with their phc4 inpatient data submission. R3435cp 12312015 clarification on patients reason for visit. This manual, ed by the american hospital association, is the only official source of ub data. Legibility and completion standards section of this manual. A ub04 with field descriptions and instructions is included in the link below. New type of bill frequency code for reopenings july 31 august 1, 20 meeting minutes, august 20, 2014 conference call minutes, march 34, 2015. These instructions are to be supplemented with the information and codes in the uniform billing manual for the ub 04. Residential health care version 20 01 211 20 page 2 of 15. Because it serves many payers, a particular payer may not need some data elements.

For additional claim preparation information, refer to the forms. Official ub 04 data specifications manual 2015 national uniform 04 manual andor codes and descriptions. For general policy information, refer to the home health agencies hha section in this manual. The following instructions explain how to complete the ub 04 claim form and whether a field is required, required if applicable, or not required. These forms can be bought at office supply centers and from other sources including. This form, also known as the ub04, is a uniform institutional provider bill suitable for use in billing multiple. Instructions for completing the ub04 claim form san francisco. Outpatient services section of this manual for instruc. You can access the ub 04 billing information adopted by the nubc by subscribing to the official ub 04 data specifications manual. The national uniform billing committee nubc maintains lists of approved coding for the form. Detail record quick reference includes ub04 form locator. Examples in this section are to assist providers in billing home health agency hha services on the ub 04 claim form.

Providers are responsible for obtaining their own ub04 forms. No other publication governmental or privatecommercial can be considered authoritative. In many form locators fl, go to the ub04 manual for specific codes or other information. Pennsylvania promise provider handbook 837 institutionalub. Inpatient claims ub04 pennsylvania health care cost.

Ub04 billing instructions guide health pasonline maine. Inpatient services section of this manual for instructions to complete claim fields. Ub04 change implementation calendar effective date form. This form, also known as the ub04, is a uniform institutional provider bill suitable for use in billing multiple third party payers.