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UB-04 Paper Claim Form FAQs
1. Will CareFirst/CareFirst BlueChoice accept the UB-92 form after May 23, 2007?
Yes. Providers are encouraged to use the UB-92 version of the claim form until further notice. By doing so, you will submit paper claims with the legacy ID number, as you currently do.
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2. When will CareFirst/CareFirst BlueChoice accept the UB-04 paper claim form?
Providers are encouraged to use the UB-92 version of the claim form until further notice. However, we will accept the UB-04 as of May 23, 2007 when submitted with your legacy ID number. The NPI will be considered optional.
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3. What fields changed on the UB-04 form?
For information regarding the UB-04, visit the National Uniform Billing Committee Web site at www.nubc.org .
4. How do the UB-04 changes impact the way I submit paper claims to CareFirst/CareFirst BlueChoice?
Look for details in the May/June 2007 BlueLink. Here is a copy of the article for your reference:
What you Need to Know about the UB-04 Form
The National Uniform Billing Committee (NUBC) revised the UB-04 paper claim form to accommodate the use of the National Provider Identifier (NPI). Visit the NUBC Web site at www.nubc.org to find details for using and ordering the new form.
CareFirst and CareFirst BlueChoice will accept the UB-04 as of May 23, 2007 when submitted with your legacy provider ID number. NPI will be optional until further notice.
Below are some changes that impact the way you submit the UB-04 claim form to CareFirst/CareFirst BlueChoice:
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Field Locator
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Requested Information
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Required, Optional or Situational
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Additional Details
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51
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Health Plan ID
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Situational
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Do not report NPI in this field. Include the HIPAA national health plan identifier when it becomes mandatory.
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56
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Billing Provider NPI
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Optional
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You may include the NPI number of the billing provider, but it will not be used for claims processing at this time.
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57
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Billing Provider Legacy ID number
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Required
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Include the Legacy provider ID number of the billing provider in 57a. 57b and 57c are optional and are available for coordination of benefits information.
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76
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Attending Physician Information
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Situational
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Include the NPI number of the attending in the first block. Include ID Qualifier in the second block (G2 for Commercial #, 1G for UPIN). Enter the associated provider number in the third block. Please include last and first name where indicated.
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77
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Operating Physician Information
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Situational
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Include the NPI number of the operating physician in the first block. Include ID Qualifier in the second block (G2 for Commercial #, 1G for UPIN). Enter the associated provider number in the third block. Please include last and first name where indicated.
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78
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Other
Physician Information
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Situational
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Include the Provider type Qualifier (e.g., DN=Referring Provider; ZZ=Other Operating MD; 82=Rendering Provider) in the first block followed by the NPI number (if available). Then, include the ID Qualifier G2 for Provider Commerical # in the third block. Legacy ID number belongs in the last block. Please include last and first name where indicated.
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79
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Other
Physician Information
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Situational
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Include the Provider type Qualifier (e.g., DN=Referring Provider; ZZ=Other Operating MD; 82=Rendering Provider) in the first block followed by the NPI number (if available). Then, include the ID Qualifier G2 for Provider Commerical # s in the third block. Legacy ID number belongs in the last block. Please include last and first name where indicated.
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81 a-d
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Additional condition, occurrence and value codes
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Situational
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Used for entering additional codes :
In block 1 enter a value indicating what kind of code will be following: A1 = condition code; A2 = occurrence code; A3 = occurrence span; A4 = value code; B3 =provider taxonomy code. In block 2 enter the code associated with the value in box 1. In block 3 enter the date(s) or other values that correspond with the code.
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Please note that CareFirst/CareFirst BlueChoice encourage providers to use the UB-92 form until further notice.
If you have any questions about the requirements for the UB-04 paper claim form, please contact Provider Services.
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5. How can I obtain the UB-04 forms?
To order the UB-04 forms, please refer to the National Uniform Billing Committee Web site at www.nubc.org.
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