UB-04 (CMS-1450) Claim Form

1. NUBC and the data specification

   NUBC ownership of the UB-04 data specification and form locators.

2. Form locators

   Form locators 1 to 81 for provider, patient, dates, codes, charges and payer data.

3. Type of bill

   Type of bill digits: facility type, bill classification and frequency.

4. Revenue codes

   Revenue code lines with HCPCS, units and charges in outpatient billing.

5. Inpatient billing

   Inpatient hospital billing rules including covered days, admit and discharge dates.

6. Mapping to 837I

   Mapping UB-04 form locators to 837I loops.

Each section links to the official page. Titles and summaries by Extra Credit; the docs belong to their authors.