Quick Answer: What Is A HCFA 1500 Claim Form?

What does UB 04 stand for?

Uniform Billing FormVice President, Innovations, Streamline Health.

The Uniform Billing Form – known either as the UB-04 or CMS 1450 – is the standard for billing all major insurance providers as well as Medicare.

The form contains more than 80 lines for important patient information..

What is a HCFA in medical billing?

The Health Care Finance Administration (HCFA) form is a claim form used in settlement of government insurance programs such as Medicare and Medicaid to medical providers. Developed by The Center of Medicaid and Medicare (CMS) but was adopted as a standard form by all Insurance plans.

What goes in box 33b on a CMS 1500?

Box 33b is used to indicate a payer-assigned identifier of the Billing Provider. Some payers require the provider’s taxonomy code be listed in Box 33b.

What goes in box 24j on HCFA 1500?

What is it? Box 24j Shaded is used to identify the non-NPI if indicated by a qualifier in 24i. Box 24j displays the NPI of the Rendering Provider.

What is a CMS 1500 claim form used for?

The CMS-1500 form is the standard claim form used by a non-institutional provider or supplier to bill Medicare carriers and durable medical equipment regional carriers (DMERCs) when a provider qualifies for a waiver from the Administrative Simplification Compliance Act (ASCA) requirement for electronic submission of …

What is Medicare Part A B C D?

There are four parts of Medicare: Part A, Part B, Part C, and Part D. Part A provides inpatient/hospital coverage. Part B provides outpatient/medical coverage. Part C offers an alternate way to receive your Medicare benefits (see below for more information). Part D provides prescription drug coverage.

Is Medicare a secondary payer?

In 1980, Congress passed legislation that made Medicare the secondary payer to certain primary plans in an effort to shift costs from Medicare to the appropriate private sources of payment. … Medicare remains the primary payer for beneficiaries who are not covered by other types of health insurance or coverage.

What is Box 57 on ub04?

Box 57 – Other Physician ID This field is for old legacy id that the facility is currently submitting in box 51 on the UB92. Box 51 on the UB04 has been changed to the Health Plan ID, which is a national number that has not been rolled out.

How do you read a UB 04 form?

Form Locator 4: Type of Bill (TOB). This is a four-digit code beginning with zero, according to the National Uniform Billing Committee guidelines. Form Locator 5: Federal tax number for your facility. Form Locator 6: Statement from and through dates for the service covered on the claim, in MMDDYY format.

What goes in box 19 on a CMS 1500?

What is it? Box 19 is used to identify additional information about the patient’s condition or the claim. See the NUCC 1500 Health Insurance Claim Form Reference Instruction Manual for additional details.

How do I fill out a HCFA 1500 claim form?

Enter the patient’s mailing address and telephone number. On the first line enter the street address; the second line, the city and state; the third line, the ZIP code and Page 2 Instructions on how to fill out the CMS 1500 Form telephone number. If Medicare is primary, leave blank.

What goes in box 38 on a ub04?

38 Responsible Party Name and Address Required This field is for reporting the name and address of the person responsible for the bill. 39 – 41 Value Codes and Amounts Conditional These fields contain the codes and related dollar amounts to identify the monetary data for processing claims.

What is the difference between HCFA 1500 and CMS 1500?

The UB-04 (CMS 1450) is a claim form used by hospitals, nursing facilities, in-patient, and other facility providers. … On the other hand, the HCFA-1500 (CMS 1500) is a medical claim form employed by individual doctors & practices, nurses, and professionals, including therapists, chiropractors, and out-patient clinics.

What does a ub04 look like?

The UB-04 uniform billing form is the standard claim form that any institutional provider can use for the billing of medical and mental health claims. It’s printed with red ink on white standard paper.

Does ub04 have place of service?

Enter the four digit code that identifies the specific type of bill and frequency of submission.

What is the difference between UB 04 and UB 92?

The UB-92 will no longer be acceptable, even as an adjustment claim, after May 22, 2007. The UB-04 is the basic form that CMS prescribes for the Medicare program. … The UB-04 (Form CMS-1450) is a uniform institutional provider bill suitable for billing multiple third party payers.

What is a HCFA Claim Form?

A HCFA 1500 form is used by the Health Care Financing Administration. It is used for health care claims. It is used to submit a bill or charge for health insurance coverage. This could be through Medicare, Champus, group health care, or other forms of insurance.

What does HCFA mean?

From Wikipedia, the free encyclopedia. HCFA may refer to: American Health Care Act of 2017, also known as the Health Care Freedom Act. Centers for Medicare and Medicaid Services, formerly known as the Health Care Financing Administration.