UB-92 Billing Instructions Guide for Providers

To submit the UB-92 form, compile all necessary information and ensure the form is accurately completed. You can submit the form via email, fax, online submission forms, or physical mail depending on the requirements of the payer. For email submission, send the completed form to the relevant email address provided by the payer. For fax submission, fax the form to the designated fax number. For online submission, log in to the payer's portal and upload the form. For physical mail submission, print the completed form and mail it to the payer's address. Ensure you keep a copy of the submitted form for your records. My advice is to double-check all information for accuracy before submission to avoid delays or denials.

The purpose of the UB-92 form is to facilitate accurate billing and reimbursement for healthcare services. This form captures essential information about the healthcare provider, patient, and services rendered, ensuring that claims are processed correctly. By following the detailed instructions provided, healthcare providers can avoid errors and delays in payment, ultimately improving their revenue cycle management.

• 1. Provider Name: Enter the name of the provider or facility submitting the claim.
• 2. Address: Provide the address of the provider or facility.
• 3. Telephone #: Enter the telephone number of the provider or facility.
• 4. Patient Control No.: Enter the patient control number, which may consist of letters and/or numbers and be a maximum of 16 characters.
• 5. Type of Bill: Enter the 3-digit code indicating the facility type, bill classification, and frequency.
• 6. Statement Covers Period: Enter the dates of the period covered by the bill (From and Through Dates).
• 7. Covered Days: For inpatient services, enter the number of days approved by the Utilization Review Committee as medically necessary.
• 8. Non-Covered Days: For inpatient services, enter the number of days not approved by the Utilization Review Committee as medically necessary.
• 9. Co-Insurance Days: Enter the number of co-insurance days if required for Medicare Crossover.
• 10. Lifetime Reserve Days: Enter the number of lifetime reserve days if required for Medicare Crossover.
• 11. Patient's Phone No.: Enter the patient's phone number.
• 12. Patient's Name: Enter the patient's name exactly as shown on their Medicaid eligibility card: Last name, first name, middle initial.
• 13. Patient's Address (City, State, Zip): Enter the patient's permanent address.
• 14. Patient's Birthdate: Enter the patient's date of birth using 8 digits (MMDDYYYY).
• 15. Patient's Sex: Enter the patient's sex as M (Male), F (Female), or U (Unknown).
• 16. Patient's Marital Status: Enter the patient's marital status if required.
• 17. Admission Date: Enter the date of admission for inpatient services using 6 digits (MMDDYY).
• 18. Admission Hour: Enter the hour of admission for inpatient care as a 2-digit code.
• 19. Type Admission: Enter the appropriate code indicating the priority of the admission for inpatient services.
• 20. Source of Admission: Enter the appropriate code indicating the source of the admission for inpatient services.

If you fail to submit the UB-92 form, your claims may not be processed, leading to delays or denial of reimbursement. Ensuring accurate and timely submission is critical for receiving payments.

• Delayed Reimbursement: Failure to submit the form can result in postponed payments for services rendered.
• Denied Claims: Incomplete or missing forms can lead to claims being denied by insurance providers.
• Revenue Cycle Disruption: Errors or delays in form submission can disrupt the healthcare provider's revenue cycle management.

• 1. Billing for Inpatient Services: Use the form to bill for services provided to inpatients, including admission and discharge information.
• 2. Billing for Outpatient Services: Use the form to bill for services provided to outpatients or in an ambulatory surgical center.
• 3. Medicare and Medicaid Billing: Use the form to bill for services covered by Medicare and Medicaid programs.
• 4. Claim Replacement: Use the form to replace a previously submitted claim if corrections are needed.
• 5. Claim Void: Use the form to void a previously submitted claim if it was submitted in error.