Ifomu lokukhokha elifanayo lokuhlinzeka ngezikhungo
Ifomu le-UB-04 yokukhokhisa ifomu lokubomvu i-inkino ebomvu ephepheni elimhlophe lefomu lokufaka isicelo elimhlophe elisetshenziswe ngabahlinzeki bezikhungo ekukhokheni imali. Nakuba lakhiwa yiCenter for Medicare and Medicaid (CMS), seliye ifomu elijwayelekile elisetshenziselwa bonke abathwali bomshuwalense.
Ikomidi lokuThengisa iNational Uniform kanye ne-American Hospital Association lwakla futhi lishintshe imininingwane ye-Official Data UB-04 Electronic Data Set.
Bashicilela umqulu we-UB-04.
Ubani Ongayenza Izimangalo ZeBill usebenzisa i-UB-04?
Noma ubani umhlinzeki wesikhungo angasebenzisa i-UB-04 izimangalo zezokwelapha zokukhokha .
- Isikhungo sempilo yengqondo yomphakathi
- Isikhungo sokuvuselela iziguli eziphuthumayo
- Isibhedlela sokufinyelela esibucayi
- Indawo yokugcina isifo se-renal
- Isikhungo sempilo esifanelekayo seFederal
- I-laboratory ye-Histocompatibility
- I-ejensi yezempilo yasekhaya
- Izibhedlela
- Isibhedlela
- Isikhungo sezeMpilo eNdiya
- Inhlangano yokuthenga impahla
- Izinsizakalo zokwelashwa ezingaphili kahle
- Izinsizakalo zokwelapha emsebenzini
- Izinsizakalo zezinkulumo zokukhuluma
- Isikhungo sokunakekelwa kwezempilo esingasemthethweni
- Umtholampilo wezempilo yasemakhaya
- Isikhungo sokunakekela abanekhono
Amathiphu Wokulungiselela UB-04
Ukuze ugcwalise ifomu ngokunembile futhi ngokuphelele, hlola lezi zinto:
- Hlola nomkhokhi womshuwalense ngamunye ukuthola ukuthi iyiphi idatha edingekayo.
- Qinisekisa ukuthi yonke idatha ifakiwe ngendlela efanele futhi ngokunembile emasimini afanele.
- Imilayezo eminingi yezinsizakalo ezingelapheki kanye neziphululi eziphuthumayo ziyafana. Bheka Umhlahlandlela Wokukhokha Okungafani wemininingwane ethile.
- Faka ulwazi lomshuwalense kufaka phakathi negama lesiguli ngendlela ebonakala ngayo ekhadini lomshuwalense.
- Sebenzisa amakhodi okuxilongwa okulungile (i-ICD-9 noma i-ICD -10 ) namakhodi wenqubo (CPT / HCPCS) usebenzisa ama-modifiers uma kudingeka.
- Sebenzisa kuphela ikheli lendawo yendawo yendawo yesevisi.
- Ungakhohlwa ukufaka ulwazi lwe-NPI lapho kubonisiwe khona.
Imiyalo eningiliziwe ingatholakala ku-www.cms.gov noma ku-www.nubc.org
Izinsimu ze-UB-04
Kukhona amasimu angu-81 noma imigqa ku-UB-04 ebizwa ngokuthi i-locators noma i-"FL". I-locator ngayinye inenhloso ehlukile.
- Ifomu locator 1 Igama lomhlinzeki wokukhokha, ikheli lomgwaqo, idolobha, izwe, i-zip, ucingo, ifeksi, nekhodi yezwe
- Ifomu locator 2 Inkokhelo yomhlinzeki wezinkokhelo, igama, ikheli, idolobha, i-zip, ne-ID uma ihluke ensimini 1
- Ifomu locator 3 Inombolo yokulawula isiguli kanye nombolo yerekhodi yezokwelapha kwesikhungo sakho
- Ifomu locator 4 Uhlobo lwe-bill (TOB) Leli khodi ledijithi ezine eqala ngo-zero, ngokusho kwemihlahlandlela yeKomidi likaZwelonke lokuThengiswa kweMigomo ye-Bill Uniform.
- Ifomu yendawo ye-Fomu yenombolo yentela yesifundazwe yesistimu yakho
- Ifomu locator 6 Isitatimende kusukela nangosuku lwenkonzo ehlanganiswe nesimangalo, kwifomethi ye-MMDDYY.
- Ifomu locator 7 Ayisetshenziswa
- Ifomu locator 8 Igama lesineke ku-Last, First, MI format
- Ifomu locator 9 Ikheli lesiguli lesiguli, idolobha, izwe, i-zip, nekhodi yezwe
- Ifomu locator 10 Isikhathi sokubeletha ngesineke esimisweni se-MMDDCCYY
- Ifomu locator 11 Ubulili besineke - M, F, noma u-U
- Ifomu locator 12 Usuku lokungeniswa kufomethi ye-MMDDCCYY
- Ifomu locator 13 Ihora lokungena usebenzisa ikhodi emidijithi emibili ukusuka ku-00 phakathi kwamabili kuya ku-23 ngo-11 ntambama
- Ifomu locator 14 Uhlobo lokuvakashelwa: 1 oluphuthumayo, 2 oluphuthumayo, olu-3 lokukhethwa, 4 olusanda kuzalwa, olungu-5 lokulimala, 9 ngolwazi olutholakali.
- Ifomu locator 15 Indawo yokuvela (umthombo wokungena)
- Ifomu locator 16 Ihora lokukhipha inomumo ofanayo nolayini 13.
- Ifomu locator 17 Isimo sokukhishwa usebenzisa amakhodi amabili amadijithi kusuka kumbhalo we-NUBC.
- Ifomu locator 18-28 Isimo sekhodi esebenzisa amakhodi amabili amadijithi kusuka kumbhalo we-NUBC kuze kube yizinguquko ezingu-11.
- Ifomu locator 29 Isimo sengozi (uma kusebenza) ikhodi yesimo samadijithi amabili
- Ifomu locator 30 Ayisetshenziswa
- Ifomu locator 31-34 Ukutholakala amakhodi nezinsuku besebenzisa incwadi ye-NUBC yamakhodi
- Ifomu le-locator 35-36 Ukutholakala kwe-span amakhodi nezinsuku kufomethi ye-MMDDYY
- Ifomu locator 37 Ayisetshenziswa
- Ifomu locator 38 Igama leqembu elithintekayo nekheli
- Ifomu locator 39-41 Amanani amanani namanani ngezimo ezikhethekile ezivela kumbhalo we-NUBC
- Ifomu locator 42 Amakhodi amakhodi kusukela manual NUBC
- Ifomu locator 43 Incazelo yekhodi yeRevenue, inombolo yokuphenywa kwedivayisi (IDE), noma i-Medicaid rebate i-NDC (ikhodi yomuthi kazwelonke)
- Ifomu locator 44 HCPCS ( Systemcare Coding System Coding System), izindleko zokuhlala, i-HIPPS (umshuwalense wezempilo).
- Ifomu locator 45 Izinsuku zesevisi
- Ifomu locator 46 Amasevisi enkonzo
- Ifomu locator 47 Ingqikithi yenkokhelo
- Ifomu locator 48 Amacala angekho embozwe
- Ifomu locator 49 Page_of_ nosuku lokudala
- Ifomu locator Identification 50 Payer (a) Primary, (b) Secondary, futhi (c) ePhakeme
- Ifomu locator 51 I- ID yokuhlela impilo (a) Eyisisekelo, (b) Sekondari, kanye (c) nemfundo ephakeme
- Ifomu locator 52 Ukukhishwa kwemininingwane (a) Okuyinhloko, (b) Sekondari, kanye (c) nemfundo ephakeme
- Ifomu locator 53 Isabelo sezinzuzo (a) Eziyinhloko, (b) Sekondari, futhi (c) nemfundo ephakeme
- Ifomu le-locator 54 Izinkokhelo zangaphambili (a) Eziyinhloko, (b) Sekondari, kanye (c) Nezemfundo ePhakeme
- Ifomu locator 55 Inani elilinganiselwe ngenxa (a) Eyisisekelo, (b) Sekondari, kanye (c) nemfundo ephakeme
- Ifomu lendawo ye-Frapper 56 Umhlinzeki wokukhokhisa umhlinzeki wenkokhelo kazwelonke wokuhlinzekela (NPI
- Ifomu locator 57 Okunye I-ID yomhlinzeki (a) Eyisisekelo, (b) Sekondari, no (c) ephakeme
- Igama lendawo ye-Insured (a) Eyinhloko, (b) Secondary, futhi (c) Ephakeme
- Uhlobo lwendawo yokuxhumana Ubuhlobo bomguli (a) Okuyisisekelo, (b) Sekondari, futhi (c) nokufunda
- I-Form Locator 60 I -ID eyingqayizivele ye-Insured (a) Eyisisekelo, (b) Sekondari, no (c) ephakeme
- Ifomu locator 61 Igama leqembu lesishuwalense (a) Primary, (b) Secondary, futhi (c) ePhakeme
- Ifomu locator 62 Inombolo yesikhwama somshuwalense (a) Primary, (b) Sekondari, kanye (c) nemfundo ephakeme
- I-form locator Ikhodi yokugunyazwa kwezokwelapha (a) Eyisisekelo, (b) Sekondari, futhi (c) ephakeme
- Ifomu locator 64 Inombolo yokulawula idokhumenti iphinde ibhekiswe njengeNombolo yokulawula yangaphakathi (a) Eyinhloko, (b) Sekondari, no (c) Ephakeme
- Igama locator Igama lomqashi ka-Insured (a) Okuyinhloko, (b) Sekondari, no (c) Ephakeme
- Ifomu locator 66 Amakhodi wokuhlola (i-ICD)
- I-form locator 67 Ikhodi yokuthola i- Principal, enye i-diagnostic futhi ikhona ezinkomba zokungena (POA)
- Ifomu locator 68 Ayisetshenziswa
- Ifomu locator 69 Ukuvuma amakhodi okuxilongwa
- Ifomu locator 70 Isizathu sesineke sokuvakasha amakhodi
- I-Form Locator 71 Inqubo yokukhokha ebonakalayo (i-PPS)
- Ifomu locator 72 Isizathu sangaphandle sekhodi yokulimala kanye ne-POA inkomba
- Ifomu locator 73 Akusebenzi
- Ifomu locator 74 Okunye ikhodi yenqubo kanye nosuku
- Ifomu locator 75 Ayisetshenziswa
- Ifomu locator 76 Ukuhambela umhlinzeki we-NPI, ID, iziqu, negama lokugcina negama lokuqala
- Ifomu locator 77 Udokotela osebenzayo i-NPI, i-ID, i-qualifiers, neyokugcina negama lokuqala
- Ifomu locator 78 Okunye umhlinzeki we-NPI, ID, iziqu, kanye neyokugcina negama lokuqala
- Ifomu locator 79 Okunye umhlinzeki we-NPI, ID, iziqu, neyokugcina negama lokuqala
- Ifomu locator 80 Amazwana
- Ifomu locator 81 Ikhodi ye-Taxonomy ne-qualifier