What is an UB-04 Hospital Bill?

In our country, for almost every legal procedure we want to perform we must use the well-known “forms,” which are documents with a standard format issued by the institutions to facilitate the process of our requirements. When completing them, we must carefully comply with the instructions for doing so and thus, obtain a positive response to our claim. In the case of medical bills, the indicated form is the “UB-04 Hospital Bill”.

This form was mainly used for the Medicaid and Medicare centers, but due to its usefulness, it is now used for the bills of medical and mental health claims.

If you want to know more about this form, in this article, we have collected useful information for you.

What Is The UB-04 Form Used For?

The UB-04 hospital bill form is the form used by hospitals, nursing facilities, ambulatory centers, and any other medical attention provider to receive and process the billing of medical and mental health claims. It is also known as Form CMS-1450.

UB-04 blank hospital bill form

As we mentioned earlier, this form was originally used exclusively by the Medicaid and Medicare centers, but as of 2005, the National Uniform Billing Committee (NUCC) decreed this form as the standard form to address all claims related to medical and mental health billing, replacing form UB-92.

This does not mean that its use is mandatory; although it is the most widely used, each insurance company (in their contracts) establishes which documents must be used to attend to this type of claim regarding billing for medical and mental health matters.

Who Can Use UB-04 Hospital Bill?

Since this form has been used by almost all institutional providers since 2005, the vast majority of hospitals and other health centers in The U.S use it as a standard document to address the billing claims.

But, it is important to remember that although it is a standardized form due to the simplicity when completing it, its use is not mandatory. As we said previously, each insurance company and each institutional provider will establish which is the document indicated to present these claims, and if they determine that it is effectively the UB-04 Hospital Bill, then that is the one you should use.

Some of the various institutions that use this form are:

  • Hospitals.
  • Rural health clinics (RHCs).
  • Federal health centers (FQHCs).
  • Hospices.
  • Home health agencies.
  • Occupational therapy and outpatient physical therapy institutions,
  • End-stage renal disease services (ESRD).
  • Indian health services agencies (IHS).
  • Community mental health centers (CMHCs).
  • Organ procurement institutions.
  • Laboratories.
  • Speech pathology services.
  • Religious (non-medical) health care institutions (RNHCLs).

Filling UB-04 Hospital Form

This form is relatively simple to complete if, at the time of doing so, you are focused and have essential information at hands such as the name, diagnosis, and date of birth of the patient (as it appears on the insurance card), the name of the insurance company, addresses, patient control number and the patient’s medical record number from the health center.

This is general information that you will need to complete the form, however, we recommend that you check with your insurance company about other specific information that could be needed to fulfill your request.

Like any other form, the UB-04 hospital bill form has its own codes referring to diagnoses, procedures, occurrence, and value. It is for this reason that we invite you to visit the official website of the National Uniform Billing Committee and acquire the UB-04 Manual, which contains all the information you need to complete this form successfully, including the revenue codes and the indication that you must write in each of the 81 lines that make up the document.

On this page, you can verify the information contained in the manual and, if you click here, you will see the conditions and the procedure to follow to acquire the UB-04 Hospital Bill Manual. Prices vary depending on the number of users you want to buy the license for.

This manual will be valid until June 30th, 2021, after that date you must purchase a new manual following the same procedure.

Likewise, in this document, you can verify information related to this form in the state of Maryland (it dates from 2018 but it can serve as a guide and the best part is that its access is free). On page 12, you can find an example of this form.