What is a form locator?
They’re referred to as form locators or “FL.” Each form locator has a unique purpose: Form locator 1: Billing provider name, street address, city, state, zip, telephone, fax, and country code. Form locator 2: Billing provider’s pay-to name, address, city, state, zip, and ID if it’s different from field 1.
What is a UB 4?
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.
How do I get a UB-04 form?
UB-04 instructions and forms can be downloaded free of charge from the Web site for the Centers for Medicare and Medicaid Services (CMS) at http://www.cms.hhs.gov/transmittals/downloads/R1104CP.pdf. UB-04 manuals may be ordered from the National Uniform Billing Committee Web site at http://www.nubc.org/.
What is the difference between a CMS 1500 form and UB-04 form?
The UB-04 (CMS-1450) form is the claim form for institutional facilities such as hospitals or outpatient facilities. This would include things like surgery, radiology, laboratory, or other facility services. The HCFA-1500 form (CMS-1500) is used to submit charges covered under Medicare Part B.
What do you need to know about UB-04 form locator?
[Multiple email adresses must be separated by a semicolon.] The UB-04 form locator tool is designed to help facilities understand the definitions of the codes needed for claim submission.
How many fields are there on the UB-04 billing claim form?
There are 81 fields or lines on a UB-04. They’re referred to as form locators or “FL.” Each form locator has a unique purpose. Form locator 1: Billing provider name, street address, city, state, zip, telephone, fax, and country code
What does form locator 4 stand for in billing?
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 6: Statement from and through dates for the service covered on the claim, in MMDDYY (month, date, year) format.
What is the form locator for discharge hour?
Form locator 16: Discharge hour in the same format as line 13. Form locator 17: Discharge status using the two-digit codes from the NUBC manual. Form locator 18-28: Condition codes using the two-digit codes from the NUBC manual for up to 11 occurrences.
