Claims Processing Procedures: UB-04 Security Health Plan

Claims Processing ProceduresClaims processing (UB-04 claim) completion for inpatient and outpatient services billed by hospitals, skilled nursing facilities, home health agencies and other institutional providers. The data elements are listed as fields on the claim form. Security Health Plan claims processing systems require that a complaint red form be used. If the form is not red, it will be returned with a request for a red form.

Claims processing required information must be filled in completely, accurately and legibly. If the information is inaccurate or incomplete, the claim cannot be processed, and it will be returned with a request for needed information.

1. Provider name, address and telephone number – Enter the name of the hospital submitting the claim and the hospital’s complete mailing address. The minimum requirement is the hospital’s name, city, state, and ZIP+4 digit code. The name in Form Locator 1 should correspond with the NPI in Form Locator 56.

2. Pay to or billing address – The name of the provider submitting the bill and the complete mailing address where the provider wishes payment sent.

3a. Patient control number – A unique number assigned by the provider to retrieve individual patient accounts and case records, and to post payments. (Required)

3b. Patient medical record number

4. Type of bill – Provides specific information about the bill for Medicare (or other payer) billing purposes. The first digit of the three-digit number identifies the type of facility, the second digit classifies the type of care being billed, and the third digit indicates the sequence of the bill for a specific episode of care. (Required)

5. Federal tax number – The federal tax number is the number assigned to the provider by the federal government for tax purposes. Should be reported as XX-XXXXXXX. (Required)

6. Statement covers period – This field is used for reporting the beginning and ending dates of service for the entire period reflected on the bill. (Required)

7. Unlabeled

8a. Patient ID

8b. Patient name – Not used for provider reporting, for State use only.

Continuation in the next posts

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