UB04 Forms Vs. The CMS 1500 Forms – When to Use Each

Many people are unsure whether to file their medical insurance claims on CMS 1500 or UB04 forms. Most medical providers should be using the CMS 1500 form.

UB04 forms are used for facility billing – such as hospitals, outpatient clinics, drug rehabilitation, and ambulatory surgical centers. Even though UB04s are used for these providers, some insurance companies accept claims billed on CMS forms. The best way to know for sure if you are in doubt is to call the individual insurance carriers and ask. Explain what type of facility you are and ask if they prefer that you bill your claims on the UB04 or the CMS form.

Sending Insurance Adjustment forms

Here’s a time saver for you.

Insurance adjustment forms are sometimes required to resubmit an insurance claim to an insurance company. Each company may have a preprinted form that they wish you to complete. The adjustment form is then completed and attached to the front of the claim form.

It is necessary to use an adjustment form when you wish to correct information on the claim such as dx. code, cpt code, date of service, referral number and for lots of other reasons. Many times if an incorrect claim is corrected and resubmitted to an insurance company without an adjustment form, the claim will be denied as a duplicate.

We also made up our own generic form for any company that doesn’t require an adjustment form. We do this because it gives the claims processor all the necessary information right there with the claim to reprocess the claim and reduces the chances of the claim being denied for being a duplicate

To save time in filing out these adjustment forms, fill in all the information you can, excluding any patient or claim information. For example, complete the portions relating to your office including, NPI number, tax id or legacy number, provider’s name, phone number, contact person, etc. Photocopy this partially completed form and use it for your template for completing adjustment forms. You will now need to add only the patient and claim information. It will save you a lot of time in the future.
Copyright 2007 – Solutions Medical Billing Inc.