Billing > Facility Billing

Must facilities have a state license to send claim information on a UB04?


Hi Alice, as always, thanks for your help. A representative from a major insurance company told me today that its the law that facilities must have a state license in order to send claim information on a UB04 (UB92) Please advise if you find this information to be accurate. In New York, do facilities require its own license to file on a UB04. I called the Dept of Health a few months ago, and was told that our facility does not need its own license since the doctor has a medical license. A few weeks ago, one of the insurance company reps told me that. Thanks for your help.
Nancy O

Hi Nancy,
Your facility may not require a state license in order to treat patients since you have a doctor with a medical license. However, if the insurance company is reimbursing you as a facility and at the facility rate, they may require you to have a license as a facility. Otherwise they will only treat you as a physician and an office setting.


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