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Every payer—whether a government health plan such as Medicare or Medicaid or a commercial insurer such as Blue Cross and Blue Shield or CIGNA—has specific requirements for billing. Hospitals and other providers are responsible for gathering and recording the information about each patient's treatment that is required by the payer. A provider that fails to meet these requirements may be only partially paid, paid late, or not paid at all. The claim form used by institutional providers for gathering a patient's treatment information is known as the Uniform Bill (UB) and was developed by the National Uniform Billing Committee (NUBC). Learning ObjectivesDiscuss the history of the UB-04 claim form in the medical health billing environment.Discuss UB-04 claim creation and methods of transmittal to payers. Describe the importance of preparing clean claims. Describe the data elements and the general formats that are used for the form locators on the UB-04. Explain the purpose of the seven form locators designated as unlabeled fields on the UB-04. Explain the organization of the remaining chapters in Part 2 of this text. |