Ifomu yokuTyala eFanayo yeeNkokeli zamaziko
Ifom ye-UB-04 ifom yefom ye-uniform iyinki ebomvu kumfaki omhlophe wefom yefom yesicelo esetyenziswe ngababoneleli bamaziko ekubhatalwa kwebango. Nangona yaveliswa ngamaziko e-Medicare kunye neMedicaid (i-CMS), uye waba ifom eqhelekileyo esetyenziswa ngabo bonke abathwali bomshuwalense.
IKomiti yeSizwe yokuThengwa kweeNkundla eziManyeneyo kunye noMbutho we-American Hospital Association ukuyila nokuguqula iinkcukacha ze-Official Official UB-04.
Bashicilela i-UB-04 Manual.
Ngubani na onokuyenza amabango eBill usebenzisa i-UB-04?
Nawuphi na umboneleli weziko angasebenzisa i-UB-04 kwiibango zonyango lokuhlawula .
- Iziko lempilo yengqondo yengingqi
- Isibonelelo sokuvuselela izigulane
- Isibhedlele sokufikelela esibalulekileyo
- Indawo yokugcina isifo se-renal
- Iziko lempilo elifanelekileyo lempilo
- I-laboratory laboratory
- Inkonzo yezempilo yasekhaya
- Hospice
- Isibhedlele
- Indawo yeeNkonzo zeMpilo yaseNdiya
- Inhlangano yokuthengwa kwempahla
- Iinkonzo zonyango zonyango
- Iinkonzo zonyango
- Iinkonzo zengqondo yokuthetha
- Iziko lonakekelo lwempilo loncedo elingenakunyango
- Iiklinikhi zempilo zasemaphandleni
- Iziko lononophelo
Iingcebiso zokulungiselela UB-04
Ukuze uzalise ifom ngokuchanekileyo ngokupheleleyo, khangela oku:
- Hlola ngomhlawuli ngamnye we-inshorensi ukufumana ukuba yeyiphi idatha efunekayo.
- Qinisekisa ukuba yonke idatha ingeniswe ngokuchanekileyo kunye ngokuchanekileyo kwiindawo ezifanelekileyo.
- Imigaqo emininzi yeenkonzo ezingenasiphene kunye neziphene zifana. Jonga isiKhokelo sokuBala okuYilungeleleneyo malunga neenkcukacha ezithile.
- Faka ulwazi lomshuwalense kubandakanya negama lomguli njengoko libonakala kwikhadi le-inshurensi.
- Sebenzisa izixhobo ezichanekileyo zokuxilonga (ICD-9 okanye i-ICD -10 ) kunye neenkqubo zenkqubo (CPT / HCPCS) usebenzisa i-modifiers xa zifunwa.
- Sebenzisa kuphela idilesi yangokwenkonzo yendawo yendawo yesevisi.
- Ungalibali ukufaka ulwazi lwe-NPI apho kuboniswe khona.
Imiyalelo engakumbi ifumaneka kwi-www.cms.gov okanye ku-www.nubc.org
Iimimandla ze-UB-04
Kukho imihlaba engama-81 okanye imigca kwi-UB-04 ebizwa ngokuba yi-locator loc "okanye" FL ". Ifom yefom nganye inenjongo ekhethekileyo.
- Ifom yefomu 1 Igama lomniki-ntlawulo, idilesi yesitalato, isixeko, isizwe, i-zip, ifoni, ifeksi kunye nekhodi yelizwe
- Ifom yefowuni 2 Umrhumo wentlawulo-mboleko kwigama, idilesi, isixeko, i-state, i-zip, kunye ne-ID ukuba iyahluke kwintsimi 1
- Ifom yefomu 3 Inombolo yokulawula isigulane kunye nombolo yerekhodi yezokwelapha kwisibonelelo sakho
- Ifom yefom ye-4 Uhlobo lwebhilikhi (TOB) Le khowudi yeefayili ezine eqala ngo-zero, ngokulandela izikhokelo zeKomiti yeeNkcazo zeSizwe.
- Ifom yefomu 5 Inombolo yentela yaseburhulumenteni yesibonelelo sakho
- Ifom ye-Locator 6 Inkcazo esuka kunye nangemihla yenkonzo efunyenwe kwibango, kwifomathi ye-MMDDY.
- Ifowuni yefomu 7 Ayikusetyenziswa
- Ifom yefomu 8 Igama elinesineke kuMgqibelo, Okokuqala, ifom ye-MI
- Ifom yefomu 9 Idilesi yesitalato yesineke, isixeko, isizwe, i-zip kunye nekhowudi yelizwe
- Ifom yefom ye-10 Indawo yokuzalwa yesineke kwifomathi ye-MMDDCYY
- Ifowuni yefomu 11 Ulwabelana ngesondo - M, F, okanye U
- Ifom yefomu 12 Ukwamkelwa komhla kwifomathi ye-MMDDCYY
- Ifom yefowuni 13 Ixesha lokungeniswa usebenzisa ikhowudi yamagama amabini ukusuka kwi-00 ukuya phakathi kwebusuku ukuya kwi-23 ukuya kwi-11 ntambama
- Ifom yefowuni 14 Uhlobo lokutyelela: 1 kwimeko engxamisekileyo, 2 ngokukhawuleza, 3 ukukhethwa, 4 ukuzalwa, 5 kwintlungu, 9 ngolwazi alufumanekanga.
- Ifom yefomu 15 Indawo yokuvela (umthombo wokungeniswa)
- Ifom yefowuni 16 Ixesha lokukhutshwa kwimizuzu efanayo kwifom ye-13.
- I-locator ye-17 Indawo yokukhutshwa kwetyala usebenzisa iikhowudi ezimbini zeenombolo ezivela kwikhokelo ye-NUBC.
- Ifom yefowuni 18-28 Isimo somnxeba usebenzisa iikhowudi ezimbini zeenombolo ezivela kwi-NUBC kwincwadi ye-11.
- Ifowuni yefomu 29 Iimeko zengozi (ukuba zikhona) ikhowudi yelizwe elinamanani amabini
- Ifowuni yefomu 30 Ayisetyenziswa
- Ifom yefowuni 31-34 Iikhowudi zokufumaneka kunye nemihla usebenzisa i-NUBC incwadana yekhowudi
- Ifom yefowuni 35-36 Ukufumaneka kweempawu zeempawu kunye nemihla kwifomathi ye-MMDDYY
- Ifom yefowuni 37 Ayisebenzisi
- Ifowuni yefomu 38 Igama leqela elijongene nalo nekheli
- Ifom yefomati 39-41 Iimpawu zexabiso kunye neemali kwiimeko ezizodwa kwi-manual ye-NUBC
- Ifom yefowuni 42 Iikhowudi zeRevenue ezivela kwikhokelo ye-NUBC
- Ifom yefomu 43 Inkcazo yekhowudi yentlawulo, inombolo yokupasa i-device (exemption) (IDE), okanye iNewicicaid rebate rebate NDC (ikhowudi yezilwanyana zesizwe)
- I-locator ye-44 HCPCS (inkqubo yeCoding System), ii-HIPPS (i-inshurensi yempilo yenkqubo yokuhlawula).
- Ifom yeefom 45 Imihla yenkonzo
- Ifom locator 46 IiNkonzo zeenkonzo
- Ifom yefomu 47 Iindleko ezipheleleyo
- Ifowuni yefomu 48 Iimali ezingabhalwanga
- Ifom yefomu 49 Page_of_ kunye nosuku lokudala
- I-Loc locator I- Identification Payer (a) Iiprayimari, (b) Sekondari, kunye (c) nemfundo ephakamileyo
- I-Locator yeFomu 51 I- ID yesicwangciso sezempilo (a) esiPrayimari, (b) Sekondari, kunye (c) nephakamileyo
- Ifom yefomu 52 Ukukhululwa kolwazi (a) Iiprayimari, (b) Sekondari, kunye (c) nephakamileyo
- I-locator yefomu 53 Ukwabiwa kweenzuzo (a) eziPrayimari, (b) Sekondari, kunye (c) nephakamileyo
- I-locator yefomu 54 Iintlawulo zangaphambili (a) eziPrayimari, (b) eziSondari, kunye (c) nephakamileyo
- Ifom yefom ye-55 Inani elilinganisiweyo elifunekayo (a) Iiprayimari, (b) Sekondari, kunye (c) nephakamileyo
- Ifowuni yefomu 56 Inkcazo yokubonelela ngenkonzo yomniki-kazwelonke (NPI)
- Ifowuni yefomu 57 Enye i-ID yomnikezeli (a) Iiprayimari, (b) Sekondari, kunye (c) nephakamileyo
- I-loc locator 58 Igama le-Insured (a) Iiprayimari, (b) Sekondari, kunye (c) nephakamileyo
- Ubume befomati Ulwalamano lomonde (a) Iiprayimari, (b) Sekondari, kunye (c) nemfundo ephakamileyo
- I-loc locator 60 I -ID ekhethekileyo ye-Inshurensi (a) Iiprayimari, (b) Sekondari, kunye (c) nephakamileyo
- Ifom yefomu 61 Igama leqela le-inshurensi (a) Iiprayimari, (b) Sekondari, kunye (c) nephakamileyo
- Ifom yefomu 62 Inombolo yeqela le-inshurensi (a) Iiprayimari, (b) Sekondari, kunye (c) nephakamileyo
- Ifowuni yefomu 63 Ikhowudi yokugunyazwa yonyango (a) Iiprayimari, (b) Sekondari, kunye (c) nephakamileyo
- Ifowuni yefomu 64 Inombolo yokulawula yomqulu iphinda ibhekiswe njengeNombolo yolawulo lwangaphakathi (a) Iiprayimari, (b) Sekondari, kunye (c) nemfundo ephakamileyo
- Ifom yefomu 65 Igama lomqeshi we-inshurensi (a) Iiprayimari, (b) Sekondari, kunye (c) nephakamileyo
- I-loc locator 66 Iikhowudi zokuxilonga (ICD)
- Ifowuni yefom 67 Ikhowudi yokuxilongwa, impawu yokuxilonga kunye nekhoyo kwiimpawu zokungeniswa (POA)
- Ifom yeefom 68 Ayisebenzisi
- Ifom yeefom 69 Ukuvuma iikhowudi zokuxilonga
- Ifom yefomu 70 Isizathu sesinezizathu zokutyelela iikhowudi
- Ifowuni yefomu 71 Inkqubo yokuhlawula iinjongo (PPS)
- Ifom yefowuni 72 Isizathu sangaphandle sendlela yokulimala kunye ne-POA
- Ifom yefowuni 73 Ayisebenzisi
- Ifom yefowuni 74 Enye ikhowudi yomgaqo kunye nomhla
- Ifom yefowuni 75 Ayisebenzisi
- Ifowuni yefomu 76 Ukuya kumboneleli we-NPI, i-ID, i-qualifiers, kunye neyokugqibela negama lokuqala
- I-loc locator 77 Ugqirha osebenzayo NPI, i-ID, i-qualifiers, kunye neyokugqibela negama lokuqala
- Ifom ye-Locator 78 Okunye umniki-NPI, i-ID, i-qualifiers, kunye neyokugqibela kunye negama lokuqala
- Ifom locator 79 Okunye umboneleli we-NPI, i-ID, i-qualifiers, kunye neyokugqibela negama lokuqala
- Ifom yeefom 80 Iingxelo
- Ifowuni yefomu 81 Ikhowudi ye-Taxonomy ne-qualifier