Dokar Bayar da Sharuɗɗa don Ƙungiyoyi
Takardar lissafin kuɗin UB-04 shi ne ja tawada a kan takardun da'awar takarda na takarda mai tsabta wanda masu amfani da ma'aikata ke amfani da su don biyan kuɗi. Kodayake Cibiyar Kula da Medicare da Medicaid (CMS) sun ci gaba da shi, ya zama misali mai amfani da dukan masu haɗin haya.
Kwamitin Gudanar da Ƙirƙirar Ƙungiya na Ƙasa da Ƙungiyar Asibiti ta Amurka da ke tsarawa da gyaran bayanin da aka sanya na Kamfanin UB-04.
Suna wallafa littafin UB-04.
Wane ne ke iya Sharuɗɗa Sharuɗɗa Amfani da UB-04?
Duk wani mai bada sabis na iya amfani da UB-04 don biyan kuɗi na lissafin kuɗi.
- Cibiyar kiwon lafiya ta al'umma
- Gidajen aikin gyaran ƙwaƙwalwar fitar da kayan aiki
- Hanyar isa ga asibiti
- Ƙarshen ƙaddamar da ginin ƙwayar cuta
- Cibiyar kiwon lafiya mai kula da lafiya
- Dandalin tarihin tarihi
- Hukumar lafiya ta gida
- Hospice
- Asibitin
- Gidan Kula da Lafiya ta Indiya
- Ƙungiyar sayarwa
- Ayyukan farfadowa na asibitoci
- Ayyukan farfadowa na sana'a
- Bayanan maganganun maganganu
- Addini marasa kula da kiwon lafiya
- Ƙungiyar kiwon lafiya na yanki
- Gidajen kula da aikin jinya
Tips don Shiryawa UB-04
Don cika fom din daidai da gaba ɗaya, duba wadannan abubuwa:
- Duba tare da kowane mai biya biya don sanin abin da ake buƙatar bayanin.
- Tabbatar cewa an shigar da dukkan bayanai daidai kuma daidai a cikin matakan da suka dace.
- Yawancin umarnin don sabis na asibiti da kuma fitar da kayan aiki ɗaya ne. Dubi Jagoran Bayar Gudanar da Ƙungiya ta Musamman don cikakkun bayanai.
- Shigar da bayanin inshora ciki har da sunan mai haƙuri kamar yadda ya bayyana a katin inshora.
- Yi amfani da lambobin ganewar asali (ICD-9 ko ICD -10 ) da ka'idojin tafiyar (CPT / HCPCS) ta amfani da masu amfani idan an buƙata.
- Yi amfani kawai da adireshin jiki don filin filin wurin sabis.
- Kada ka manta ka hada bayanin NPI inda aka nuna.
Za a iya samun cikakken bayani a www.cms.gov ko www.nubc.org
Fields na UB-04
Akwai filayen 81 ko Lines a kan UB-04 da ake magana da ita a matsayin 'yan kasuwa ko "FL". Kowace mai samfurin yana da manufa na musamman.
- Kirar mai samfurin 1 Sunan mai ba da izinin bita , adireshin titi, gari, jihar, zip, tarho, fax, da lambar ƙasar
- Kayan mai samfuri 2 Biyan bashin mai ba da bashi - sunan, adireshin, gari, jihar, zip, da kuma ID idan ya bambanta da filin 1
- Kirar mai samfurin 3 Lambar kulawa na haƙuri da lambar rikodin likita don ginin ku
- Former locator 4 Nau'in lissafi (TOB) Wannan lambar lambobi huɗu ne da suka fara da sifili, bisa ga ka'idodi na Ƙungiyoyi na Ƙasa na Ƙasa.
- Kayan mai samfuri 5 Lambar haraji na Tarayya don makaman ku
- Mai samarda takarda 6 Sanarwa daga kuma ta hanyar kwanakin don hidimar da aka rufe akan da'awar, a cikin tsarin MMDDYY.
- Farin mai samfurin 7 Ba a amfani ba
- Farin mai samfurin 8 Sunan haƙuri a Ƙarshe, Na farko, Tsarin MI
- Kirar mai amfani 9 Adireshin titi na gari, birni, jihar, zip, da lambar ƙasa
- Mai samin takarda 10 Ranar haihuwar haƙuri a cikin tsarin MMDDCCYY
- Firayi mai kama da shi 11 Jima'i mai haƙuri - M, F, ko U
- Kayan mai samfurin 12 Yarda shiga a cikin tsarin MMDDCCYY
- Kayan mai samfurin 13 Sautin shigarwa ta amfani da lambar lambobi biyu daga 00 domin tsakar dare zuwa 23 ga karfe 11 na yamma
- Mai samarda takarda 14 Hanyoyin ziyarar: 1 don gaggawa, 2 don gaggawa, 3 don zaɓin zabe, 4 ga jariri, 5 don cuta, 9 don ba'a samu bayanai ba.
- Mai samowa 15 Mai asalin (tushen shigarwa)
- Mai samfurin fannoni 16 Sauke sa'a a cikin wannan tsari kamar layi 13.
- Mai samfurin mai amfani 17 Yanayin ƙwaƙwalwa ta amfani da lambobin lambobi biyu daga manual NUBC.
- Firayi mai samfuri 18-28 Yanayin ka'idoji ta amfani da lambobin lambobi biyu daga NUBC manual har zuwa 11 aukuwa.
- Mai kama da takaddama 29 Jihar mai hadarin (idan ya dace) lambar lambar jihar biyu
- Firar mai samo 30 Ba a amfani ba
- Mai samin takarda na 31-34 Lambobi da kwanakin da ke faruwa da yin amfani da NUBC manual don lambobin
- Lambar mai samfurin 35-36 Lambobin kwanan baya da kwanakin a cikin tsarin MMDDYY
- Kayan mai amfani 37 Ba a amfani ba
- Firayi mai samfurin 38 Sunan mahalarta da adireshi
- Mai samin takarda 39-41 Lambobin darajar da yawancin yanayi na NUBC
- Kayan mai samfurin 42 Lambobin kuɗi daga littafin NUBC
- Mai samo takarda 43 Lambar lambar haraji, lambar ƙwaƙwalwar na'urar bincike (IDE), ko magungunan likita na Medicaid NDC (lambar likitanci na ƙasa)
- Mai samfurin 44 HCPCS (Harkokin Kiwon Lafiyar Harkokin Kiwon Lafiya), yawan kuɗi, HIPPS (lambobin kuɗi na biyan kuɗi)
- Fayil mai samarda kwanakin sabis na 45
- Kayan mai amfani 46 Rahotan sabis
- Kwarar mai samfurin 47 Kariyoyin kuɗi
- Filalin mai samma 48 Hukuncin da ba a rufe ba
- Fayil mai samfurin 49 Page_of_ da Halitta kwanan wata
- Mai samarda takarda 50 Sanarwar haraji (a) Na farko, (b) Na biyu, da (c) Babban sakandare
- Kwararren takarda 51 Lambar ID na kiwon lafiya (a) Na farko, (b) Na biyu, da (c) Babban sakandare
- Mai samarda takarda 52 Sassa bayanai (a) Farfesa, (b) Makarantar sakandare, da (c) Babban sakandare
- Fassara mai samfurin 53 Alamar amfanin (a) na farko, (b) Makarantar sakandare, da (c) Tertiary
- Former locator 54 Kafin biya (a) Primary, (b) Secondary, da (c) Tertiary
- Mai samarda fannin 55 An kiyasta adadin (a) na farko, (b) Makarantar sakandare, da (c) Tertiary
- Kayan mai samfurin 56 Mai ba da bashi mai bada bayarwa mai bayarwa (NPI)
- Kayan mai amfani 57 Wani mai bada ID (a) Farfesa, (b) Na biyu, da (c) Babban sakandare
- Sunan yanki 58 Sunan hamsin (a) Na farko, (b) Na biyu, da (c) Tertiary
- Mai samo takarda 59 Abokin haƙuri (a) Na farko, (b) Na biyu, da (c) Babban sakandare
- Kayan samfurin sittin ID na musamman (a) Farfesa, (b) Makarantar sakandare, da (c) Babban sakandare
- Filali mai mahimmanci 61 Sunan rukuni na asusu (a) Farfesa, (b) Na biyu, da (c) Babban sakandare
- Kwararren takarda 62 Lambar ƙungiyar asusu (a) Farfesa, (b) Makarantar sakandare, da (c) Tertiary
- Mai samfurin tsari 63 Maganin izini na izini (a) Na farko, (b) Na biyu, da (c) Babban sakandare
- Mai samfurin ƙira 64 Lambar kula da takardun shaida kuma ake kira Cikin ikon sarrafawa (a) Primary, (b) Secondary, da (c) Babban sakandare
- Kwararren takarda 65 Nau'in aikin mai aiki (a) Farfesa, (b) Makarantar sakandare, da (c) Babban sakandare
- Lambar mai ganowa 66 Lambobin ganewa (ICD)
- Kwararren maƙalara 67 Maganar ganewar mahimmanci, wasu ƙididdigar da kuma gabatarwa akan alamun shiga (POA)
- Kirar mai kamawa 68 Ba a amfani ba
- Mai samfurin tsari 69 Shirye-shiryen ganewar asali
- Kayan mai samowa 70 Dalili na dalili don ziyarci lambobin
- Kayan mai samfurin 71 Lambar biya (PPS)
- Kayan mai samfurin 72 Lamba na lalacewa na waje da alamar POA
- Firar mai kama 73 Ba a amfani ba
- Kayan mai samfurin 74 Lambobi na sauran lokuta da kwanan wata
- Farin mai samarda 75 Ba a amfani ba
- Mai samfurin mai siyayi 76 Yin aiki na NPI, ID, matakai, da na karshe da na farko
- Kwararren magoya 77 Mai kula da aikin NPI, ID, matakai, da kuma na karshe da na farko
- Kayan mai samarda 78 Mai bada NPI, ID, matakai, da na karshe da na farko suna
- Kayan mai samfurin 79 Wani mai bada NPI, ID, matakai, da na karshe da na farko
- Samun mai samfurin 80 Magana
- Fayil mai samfurin 81 Taxonomy code da cancanta