The Differences Between The UB92 & UB04 Claim Forms

The UB92 form used to be the main medical insurance claim form for hospitals and other healthcare institutions to submit insurance claims to health insurance providers. The prevalence of the UB92 medical claim form has waned quite a bit since 2007, when the National Uniform Billing Committee (NUBC), the body that regulates all medical insurance claim forms in the United States, officially terminated the form’s use.

The UB92 was replaced with the UB04, a form that is in a constant state of evolution, which speaks to the NUBC’s commitment to making filing insurance claim forms easier and more consistently accurate. However, despite this discontinuation, many insurance companies and healthcare providers continue to use the UB92, and it is still available for purchase online, though finding it may be more difficult than it was five years ago. It should be noted that Medicare and Medicaid will no longer accept the older form. It is easy to contact the relevant insurance company and check if it prefers the UB92 or the UB04.

For those who continue to need to use the UB92 form, there are a number of tools available to make completing it correctly easier and faster. Though the form was phased out in 2007, some software had already been created that can automatically complete the first part of the form, relating to the patient’s personal data and the relevant information about the healthcare institution. Several companies have continued to update and improve this software so that along with printing the information onto the paper copies of the form, it is not possible to submit the UB92 medical claim for electronically, which leads to faster processing and payment.

However, for most hospitals and other healthcare institutions, the UB04 is probably the right form to submit to get reimbursed by an insurance company for services provided. It is important to understand how it is different from the HCFA1500. The UB04 is intended for submission only by health care institutions such as drug rehabilitation clinics, while the HCFA1500, also called the CMS 1500, is for private providers such as individual physicians. Because of the two forms’ different audiences, some of the fields are different, but they ultimately require the same types of information.

They both ask for information about the patient and the healthcare provider, about the specific time of patient admission and of the procedure or procedures, and various relevant payment data. Though the first part is fairly standard, the two forms use a different set of medical codes for the type of bill, admission status, and nature of procedure. However, because most healthcare providers fall uniformly into one category or the other, these code distinctions will probably never cause any confusion.

An important point that comes out of understanding the necessary fields on all these forms is that regardless of if an institution uses the UB92 form or the UB04, keeping very exact records of all the details of a patient’s visit is very important to have the necessary information to complete these forms. Because managing all this data, and repeatedly filling in the same information in the first half of these forms can be difficult, UB92 form and UB04 software is a very effective tool to help manage insurance claim submission.

This kind of software can interact with spread sheets and database software to import relevant data, decreasing clerical errors and cutting down on the time required to fill out repetitive data. It also facilitates electronic filing, the most efficient way to submit insurance claim forms. Nonetheless, unless there is a specific reason to use the UB92 form instead of the UB04, the wealth of support and its wider acceptance make the UB04 the better choice.

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