What Form Is Used for Filing Paper Claims in an Inpatient Setting?
Understand the specific documentation needed for submitting inpatient facility claims manually. Master the process for accurate paper billing.
A paper claim in healthcare billing refers to a physical document submitted to an insurance company for reimbursement of services. While electronic claim submissions are common, paper claims remain in use for various reasons, including specific payer requirements, system limitations, or for providers with lower claim volumes. These claims ensure that healthcare providers can still seek payment for services rendered when electronic methods are not feasible or preferred.
Identifying the Inpatient Claim Form
The standard form used for submitting paper claims in an inpatient setting is the CMS-1450, widely known as the UB-04. This form serves as the universal billing document for institutional providers, encompassing services provided by hospitals, skilled nursing facilities, and other healthcare organizations. It specifically handles facility-based services, distinct from professional services which typically use a different claim form.
The UB-04 form is specifically designed to capture the comprehensive details of inpatient and outpatient facility services, including room and board, pharmacy, and laboratory charges. Its primary purpose is to allow hospitals and other institutions to bill for the resources and services they provide during a patient’s stay or visit.
Essential Information for the Claim Form
Accurately completing the CMS-1450 (UB-04) form requires specific data elements for proper processing. Patient demographics, such as the patient’s full name, address, date of birth, and insurance identification number, are fundamental to identifying the individual receiving care. Information about the healthcare provider, including the facility’s name, address, and National Provider Identifier (NPI), is also necessary for claim identification.
The form mandates the inclusion of diagnosis codes, typically from the ICD-10-CM classification system, which describe the patient’s medical conditions. Procedure codes, often CPT or HCPCS codes, are included when applicable for facility services to detail interventions performed. Service dates clearly indicate when the care was provided, while revenue codes categorize the specific types of services or departments that generated charges. The total charges for the services rendered and comprehensive payer information, including the insurance company’s name and address, complete the financial picture. These official forms can be obtained from the Centers for Medicare & Medicaid Services (CMS) website or through medical supply vendors.
Submitting Paper Claims
After the CMS-1450 (UB-04) form has been thoroughly completed with all necessary information, the next step involves its physical submission. Typically, the completed claim form is mailed directly to the payer’s designated claims processing address, which can often be found on the patient’s insurance card or the payer’s website. Some providers may opt to send claims through a clearinghouse, which acts as an intermediary to electronically transmit paper claims.
It is advisable to send important claims via certified mail, which provides proof of mailing and delivery, offering a record of submission. After mailing, providers can generally expect a processing timeline ranging from 30 to 45 days for paper claims, though this can vary by payer. Payers may issue confirmation receipts or reach out with requests for additional documentation if information is missing or unclear, necessitating prompt responses to avoid delays in reimbursement.