As a medical billing company for various doctors and facilities, we understand that knowing which form to use is the first step to filing a successful claim. UB-40 and CMS-1500 are the two most common claim forms for submitting to insurance companies. These acronyms may not appear to say much about which is appropriate to use – both forms are printed in red “drop out” ink and contain numerous fields. However, this is where most of the similarities end. Here are some facts to help demystify these forms.
What is a UB-04 Form?
According to CMS.gov, the National Uniform Billing Committee (NUCC) replaced the UB-92 with the current UB-04 in 2005. Since then, the UB-04 has been the standardized form used by hospitals, ambulatory surgery centers, nursing facilities, and other medical and mental health institutions. These claims forms can be submitted both electronically and on paper.
However, each insurance company stipulates which filing method they will accept. As a medical billing company we know that the required form will change from state to state – especially for Medicaid and California BCBS plans.
One exception to this rule is when a facility is billing to Medicare. All Medicare claims must be submitted on a CMS-1500.
What is a CMS-1500?
Also referred to as the HCFA or the 1500, this form was developed by NUCC as the standard form for individual doctors, nurses, practices and other professionals. This form can also list prior payer information when being sent to secondary, though this is not always utilized.
The two form types do not always stand alone. For example, if a surgeon performs a procedure in a facility such as a hospital or ASC, a CMS-1500 will be submitted for the surgeon’s services only, while a separate UB-04 form will be submitted for the use of the facility. Both forms will be needed to fully bill out for a procedure.
Things to Consider When Filing Claim Forms
The UB-04 form includes 81 fields, or form locators, while the 1500 includes 33. The extent to which these will need to be completed is determined by each carrier. Nevertheless, all insurance companies will require that the information be legible and correctly aligned within each box
Once submitted, the forms will be scanned by a digital process called Optical Character Recognition, or OCR. This process will drop away anything printed in red, leaving only what has been filled out by the billing company. For this reason, it is highly recommended that claims that are not submitted electronically should be typed in black. Claim forms should never be written by hand.
As well as being aware of the differences, it is important that a medical billing company complete these forms carefully. Keeping track of the specific requirements for each insurance company will avoid needless denials and ultimately speed up reimbursement.
For more information on the UB-04 and the CMS-1500, please visit www.nucc.org and www.cms.gov .
Disclaimer: The materials contained on this website are provided for informational purposes only and do not constitute legal or other professional advice on any subject matter. Advanced Medical Practice Management does not accept any responsibility for any loss which may arise from reliance on information contained on this site.
