Key points
- UB-04 billing uses concepts such as type of bill, statement dates, revenue codes, condition, occurrence and value codes, payer information, service-line data, diagnoses, and facility/provider information.
- Hospitals, skilled nursing facilities, home health agencies, hospices, and other institutional providers may use UB-04 concepts.
- The institutional form is not simply a different visual layout.
Institutional claim structure
UB-04 billing uses concepts such as type of bill, statement dates, revenue codes, condition, occurrence and value codes, payer information, service-line data, diagnoses, and facility/provider information.
Who encounters the form
Hospitals, skilled nursing facilities, home health agencies, hospices, and other institutional providers may use UB-04 concepts. Whether a paper claim is accepted depends on the payer and applicable electronic-transaction requirements.
Do not treat it as a larger CMS-1500
The institutional form is not simply a different visual layout. Its coding structure, service lines, and form locators require an institutional billing workflow.
Institutional-claim review
- Review the institutional claim as a connected record rather than a collection of independent form locators.
- Verify copied values against the current encounter, facility, and payer records.
- Use current CMS/NUBC and payer instructions for the claim type.
Sources and verification
Use the CMS institutional-claim sources below for current CMS-1450/UB-04 guidance, then apply the payer’s rules for the facility claim.
- CMS institutional paper claim form (CMS-1450/UB-04)
- CMS Medicare Claims Processing Manual, Chapter 25
Related guides
Try UB-04 software
For offices that prepare institutional paper claims, MedClaimSoftware’s dedicated UB-04 / CMS-1450 program can save and retrieve claims, support printing and alignment, and keep facility claim preparation in a focused Windows workflow. The software is $99/year for up to 2 computers, with a free downloadable trial. View UB-04 software.