UB 04

Completion of UB 04 claim – Additional information Additional information needed for a complete UB-04 form • Date and hour

UB 04 – Claims Processing The federal government requires DMAP to process Medicaid claims through an automated claim processing system

Filing UB 04 claim UB Form Introduction The UB-04 Billing Instructions handbook is designed to help those who bill the

UB 04 billing – Valid Claim format Uniform Billing (UB) Claim form – Valid Claim format DMAP only accepts commercially

UB-92 Problematic Fields for DOL claims Box 1 –Billing Address Billing Address Box 4 –Type of billT ype of bill