Tuesday, May 3, 2011

UB 04 - claim submission hints

UB-04:

*  Field 56 is for the NPI of the Billing Facility/Provider
*  Field 76 is for Type 1 NPIs (Attending Provider)
*  Fields 78 and 79 are for Type 1 NPIs (Other Referring Provider)

• Use the correct Tax ID or Social Security number. For participating providers, the Tax ID number
reported on the claim should match the Tax ID number (TIN) found within the provider agreement,
which is the provider/legal entity's payee TIN. Should your legal entity Tax ID change, please contact
your BCBSF Network Manager directly before claims are submitted containing this new information.

• If services are rendered in other than home or office, enter the complete name and address of
the facility where services were performed. Include the NPI of the facility, if available.
• Submit the correct billing provider information.

*  Individual Physicians/Providers: Enter the name, address, phone number, and NPI of the
individual physician, if services were rendered in a solo practice.
* Groups: Enter the name, address, phone number and NPI of the group practice.

• Avoid sending duplicate claims. For claims status, use Availity or call (800) 727-2227. If filing
electronically, be sure to also check your Availity file acknowledgement and EBR for claim level
failures. Allow 15 days for electronic claims and 30 days for paper claims before resubmitting.

• If you do not submit your corrected claims electronically, then indicate “Additional Services”
on claims when billing for additions to the original claim. This will clearly distinguish your claim
as being filed in addition to the original, but not replacing the original claim (i.e., a corrected claim).
The additional services must be submitted on a paper claim form.

1 comment:

  1. Dear sir/Madam, Iam Rafi from xplore Pioneer IT Solution in inda.we are BPO Service provider and we work on the Form Process Filling for Insurance (HCFA & UB92) and other industry too pls let me know do you have any project with you. get back to me ASAP.

    Thank you

    My mail id is rafi@xplorepioneerits.com

    Looking forward to hear from you

    ReplyDelete

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