Monday, September 27, 2010

Filing UB 04 claim

UB Form Introduction

The UB-04 Billing Instructions handbook is designed to help those who bill the Department’s Division of Medical Assistance Programs (DMAP) for Medicaid services complete the billing form correctly the first time. This will give you step-by-step instructions so that DMAP can pay you, the provider, more quickly. Use this handbook with the General Rules and your provider guidelines (administrative rules and supplemental information), which contain information on policy and covered services specific to your provider type.
This handbook lists the requirements for completion prior to sending your claim to DMAP for payment processing, as well as helpful hints on how to avoid common billing errors.

The UB-04 Billing Instructions are designed to assist institutional providers who bill DMAP for Medicaid services:*

 Freestanding kidney dialysis centers
 Home health agencies
 Hospice services
 Hospitals
 Nursing facilities: For Intermediate Care Facility (ICF), Skilled Nursing Facility (SNF), Swing-Beds (Swing), and Post-Hospital Extended Care (PHEC) services.

For more details and claim samples that show how nursing facilities must complete the UB-04 claim form, refer to the Nursing Facility UB-04 Paper Billing Guide at

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