Chidule cha Fomu ya UB-04

Fomu Yokongoletsera Imodzi Yomwe Akuperekera Maphunziro

Fomu ya kubwezera yunifolomu ya UB-04 ndi inki yofiira pa fomu yoyera yapepala yoyenera yomwe imagwiritsidwa ntchito ndi omwe amapereka chithandizo pamalopo. Ngakhale kuti inayambitsidwa ndi Centers for Medicare ndi Medicaid (CMS), yakhala mawonekedwe omwe amagwiritsidwa ntchito ndi ogulitsa inshuwalansi onse.

Komiti ya National Uniform Billing Association ndi American Hospital Association amapanga ndi kusintha ndondomeko ya Malamulo Ovomerezeka a UB-04 Electronic Data Set.

Amafalitsa Buku la UB-04.

Ndani Angayesere Ma Bill Kugwiritsa Ntchito UB-04?

Wothandizira bungwe lililonse angagwiritse ntchito UB-04 kuti adziwe zachipatala .

• Chigawo cha thanzi la anthu
• Malo osungirako zovuta kuchipatala
• Chipatala chovuta kuchipatala
• Malo otsiriza a matenda a renal matenda
• Bungwe la thanzi labwino la federal
• Zomangamanga zake labotale
• Bungwe la thanzi labwino
• Hospice
• Chipatala
• Malo Othandizira Zaumoyo ku India
• Gulu la kugula katundu
• Mankhwala opatsirana opatsirana
• Ntchito zachipatala
• Mauthenga ogwira ntchito
• Pulogalamu yachipatala yopanda chithandizo
• Kachipatala chakumidzi
• Unamwino wodziwa bwino

Malangizo Okonzekera UB-04

Kuti mudzaze fomuyo molondola, onani zinthu izi:

• Onetsetsani munthu aliyense wa inshuwalansi kuti mudziwe kuti ndi chiwerengero chotani chomwe chikufunika.
• Onetsetsani kuti deta yonse imalowa molondola komanso molondola m'minda yoyenera.
• Malangizo ambiri othandizira anthu odwala matenda opatsirana komanso odwala matendawa ndi ofanana. Onani Mndandanda Wosungira Momwe Mungagwiritsire ntchito zachinsinsi.

• Lowani uthenga wa inshuwalansi kuphatikizapo dzina la wodwalayo momwe ziwonekera pa khadi la inshuwalansi.
• Gwiritsani ntchito zizindikiro zolondola za matenda opatsirana (ICD-9 kapena ICD -10 ) ndi ndondomeko zoyendetsera ntchito (CPT / HCPCS) pogwiritsa ntchito kusintha komwe kumafunika.
• Gwiritsani ntchito adiresi yokhayoyi pa munda wa malo ogwira ntchito.
• Musaiwale kuti muphatikize mfundo za NPI zomwe zasonyezedwa.

Maumboni ochuluka angapezeke pa www.cms.gov kapena www.nubc.org

Munda wa UB-04

Pali minda 81 kapena mizere pa UB-04 yomwe imatchedwa "malo" kapena "FL". Fomu iliyonse ili ndi cholinga chapadera.

• Fomu yowonjezera 1 Dzina loperekera ngongole, adiresi ya msewu, mzinda, dziko, zip, telefoni, fax, ndi chikho cha dziko
• Fomu yokhalapo 2 Wopereka msonkho wothandizira olemba ngongole, adilesi, mzinda, dziko, zip, ndi chidziwitso ngati ziri zosiyana ndi gawo 1
• Fomu loconjera 3 Manambala oletsa odwala ndi nambala ya mbiri yachipatala ya malo anu
• Fomu locwiritsa ntchito 4 Mtundu wa bili (TOB) Iyi ndi code ya manambala anayi oyambira ndi zero, malinga ndi ndondomeko ya National Uniform Billing Committee.
• Fomu locwiritsa ntchito Fomu ya msonkho ya Federal pa malo anu
• Wokonza fomu 6 Chidziwitso kuyambira ndi nthawi ya utumiki womwe wagwiritsidwa ntchito, pamutu wa MMDDYY.
• Fomu locwiritsa ntchito 7 Osagwiritsidwa ntchito
• Fomu loconjera 8 Dzina lachirombo mu Last, First, MI format
• Fomu locwiritsa ntchito 9 Adilesi ya mumsewu wodwala, mzinda, dziko, zip, ndi code ya dziko
• Fomu loconjera 10 Odwala odwala mu MMDDCCYY
• Wokonza fomu 11 Kugonana kwa odwala - M, F, kapena U
• Fomu locwiritsa ntchito 12 Tsiku lovomerezeka mu MMDDCCYY
• Fomu locwiritsa ntchito 13 Ola lolowetsamo pogwiritsa ntchito madiii awiri kuchokera pa 00 pakati pa usiku mpaka 23 koloko masana 11 koloko
• Wowunikira maulendo 14 Ulendo wa ulendo: 1 pazidzidzidzi, 2 mwachangu, 3 kusankhidwa, 4 kwa mwana wakhanda, 5 chifukwa cha zoopsa, 9 kuti mudziwe zambiri.

• Wolemba malo Fomu yochokera (gwero la kuvomereza)
• Fomu locwiritsa ntchito 16 Ola lotulutsa nthawi yofanana ndi mzere 13.
• Fomu locwiritsa ntchito 17 Kutaya koyeretsa pogwiritsira ntchito zizindikiro ziwiri kuchokera ku buku la NUBC.
• Wokonza fomu 18-28 Chikhalidwe chimagwiritsa ntchito zizindikiro ziwirizo kuchokera ku bukhu la NUBC kwa maulendo 11.
• Wowonjezera fomu 29 Chikhalidwe cha ngozi (ngati chikuyenera) chikhalidwe cha chigawo cha ma chididi
• Wopezera malo 30 Osagwiritsidwa ntchito
• Wopezeramo fomu 31-34 Zizindikiro zochitika ndi nthawi pogwiritsa ntchito bukhu la NUBC la ma code
• Wowonjezera maofesi 35-36 Madipatimenti amatsenga opezeka ndi nthawi mu MMDDYY
• Fomu locwiritsa ntchito 37 Osagwiritsidwa ntchito
• Fomu loconjera 38 Dzina la phwando loyang'anira ndi adiresi

• Wopezeramo fomu 39-41 Zizindikiro zamtengo wapatali ndi ndalama pa zochitika zapadera kuchokera ku bukhu la NUBC
• Fomu locwiritsa ntchito Mapepala 42 a Mapepala ochokera ku Buku la NUBC
• Ndemanga ya mphotho 43 Mndandanda wa ndondomeko ya mapepala, chiwerengero cha kufufuza chipangizo (IDE), kapena ndondomeko ya mankhwala ya Medicaid NDC (kachidindo ka mankhwala)
• Wowonjezeramo fomu 44 HCPCS (Healthcare Common Procedure Coding System System), malo ogona, HIPPS (inshuwalansi yapamwamba yowonetsera ndalama)
• Fomu loculukira 45 Dongosolo la utumiki
• Fomu locwiritsa ntchito 46 Zigawo za utumiki
• Fomu locwiritsa ntchito 47 Milandu yonse
• Fomu locwiritsa ntchito 48 Zopanda malipiro
• Fomu loculukirapo 49 Page_of_ ndi tsiku la Chilengedwe
• Fomu lopezeketsa Chidziwitso cha Malipiro 50 (a) Choyambirira, (b) Sekondale, ndi (c) Mapamwamba
• Wokonza malo Fomu 51 Zothandizira Zaumoyo (a) Pansi, (b) Sekondale, ndi (c) Zapamwamba
• Fomu locwiritsa ntchito 52 Kutulutsidwa kwa chidziwitso (a) Choyambirira, (b) Sekondale, ndi (c) Mapamwamba
• Wopatsa Fomu 53 Ntchito Yopindulitsa (a) Pansi, (b) Sekondale, ndi (c) Zaka zapakati
• Fomu locwiritsa ntchito 54 Zopereka zisanayambe (a) Zopambana, (b) Sekondale, ndi (c) Zapamwamba
• Fomu yowonetsera Fomu 55 Kuchuluka kwa ndalama zofunikira (a) Zophunzira, (b) Sekondale, ndi (c) Zapamwamba
• Fomu locwiritsa ntchito fomu 56 Wopereka ndalama wothandizira dziko lonse chizindikiro chodziwika (NPI)
• Fomu locwiritsa ntchito 57 Wopereka Wopereka Wina (a) Wapamwamba, (b) Sekondale, ndi (c) Mapamwamba
• Dzina lopezeketsa dzina la a Inshuwalansi (a) Pachiyambi, (b) Sekondale, ndi (c) Mapamwamba
• Maulendo apakati 59 Ubale wa wodwala (a) Wapamwamba, (b) Sekondale, ndi (c) Mapamwamba
• Fomu yowonjezera 60 Chidziwitso chapadera cha Inshuwalansi (a) Choyambirira, (b) Sekondale, ndi (c) Mapamwamba
• Fomu loculukira 61 Dzina la kagulu ka inshuwalansi (a) Mwapamwamba, (b) Sekondale, ndi (c) Maphunziro apamwamba
• Fomu yowunikira 62 Dipatimenti ya inshuwalansi (a) Mapiri, (b) Sekondale, ndi (c) Maphunziro apamwamba
• Fomu yowonjezera 63 Chilolezo cha chithandizo cha mankhwala (a) Choyambirira, (b) Sekondale, ndi (c) Zapamwamba
• Fomu yowonjezera 64 Nambala yoyendetsera ndondomekoyi imatchedwanso kuti "Control Control Number" (Primary), (b) Sekondale, ndi (c) Zapamwamba
• Wopezera maofesi 65 Dzina la abwana a inshuwalansi (a) Pachiyambi, (b) Sekondale, ndi (c) Mapamwamba
• Fomu locwiritsa ntchito zizindikiro 66 Zogwiritsira ntchito matenda (ICD)
• Wowunikira Fomu 67 Mfundo yaikulu yodzitetezera, zizindikiro zina ndizopezeka pa zizindikiro zovomerezeka (POA)
• Fomu loculukira 68 Osagwiritsidwa ntchito
• Wokonza fomu 69 Kuvomereza zizindikiro za matenda
• Fomu loconjera 70 Odwala chifukwa cha maulendo obwereza
• Chombo chokonzekera Fomu 71 Yopindulitsa kachitidwe ka malipiro (PPS)
• Wowonjezera Fomu 72 Chifukwa chakunja cha code yovulaza ndi POA chizindikiro
• Fomu loculukira 73 Osagwiritsidwa ntchito
• Fomu loculukira 74 Mchitidwe wina wa ndondomeko ndi tsiku
• Wowonjezera fomu 75 Osagwiritsidwa ntchito
• Wowunikira Fomu 76 Akupita kumalo operekera NPI, ID, qualifiers, ndi otsiriza ndi dzina loyamba
• Wopezera maofesi 77 Dokotala wogwira ntchito NPI, ID, qualifiers, ndi wotsiriza ndi dzina loyamba
• Fomu loculukira 78 Ena amapereka NPI, ID, qualifiers, ndi otsiriza ndi dzina loyamba
• Wopanga Fomu 79 Wina amapereka NPI, ID, qualifiers, ndi otsiriza ndi dzina loyamba
• Fomu lopezeketsa 80 Mawu
• Fomu locwiritsa ntchito Taxonomy code ndi qualifier