What is the difference between HCFA-1500 (CMS 1500) and UB-04 (CMS 1450)? (2024)

FAQs

What is the difference between HCFA-1500 (CMS 1500) and UB-04 (CMS 1450)? ›

The UB-04 (CMS-1450) form is the claim form for institutional facilities such as hospitals or outpatient facilities. This would include things like surgery, radiology, laboratory, or other facility services. The HCFA-1500 form (CMS-1500) is used to submit charges covered under Medicare Part B.

In general, the UB-04 form is used by institutional healthcare providers, such as hospitals, nursing homes, and rehabilitation centers, while the CMS 1500 form is used by individual healthcare providers, such as physicians, therapists, and dietitians.

The Form CMS-1450, also known as the UB-04, is the standard claim form to bill Medicare Administrative Contractors (MACs) when a paper claim is allowed. In addition to billing Medicare, the 837I and Form CMS-1450 may be suitable for billing various government and some private insurers.

The UB-04 uniform medical billing form is the standard claim form that institutional providers use, such as hospitals and community mental health care centers. It is used to bill Medicare, Medicaid, and other health insurance companies for inpatient or outpatient services.

What is HCFA-1500 in Medical Billing and why is it so important? HCFA stands for Health Care Financing Administration (now the Centers for Medicare and Medicaid Services) and is used for reimbursem*nt from various government insurance plans including Medicare, Medicaid and Tricare.

The term CMS 1500 refers to the Centers for Medicare & Medicaid Services Form 1500, while HCFA 1500 is an older term that stands for Health Care Financing Administration Form 1500. The HCFA was renamed CMS in the year 2001, but the term HCFA 1500 is still widely accepted and used in the industry.

Both the CMS-1500 and UB-04 forms contain many of the same boxes that need to be filled out including patient demographics, provider identification information, procedures and charges and insurance plan identification information. The more information you can provide to the patient's insurance company, the better.

The UB-04 (CMS-1450) form is the claim form for institutional facilities such as hospitals or outpatient facilities. This would include things like surgery, radiology, laboratory, or other facility services. The HCFA-1500 form (CMS-1500) is used to submit charges covered under Medicare Part B.

The CMS-1450 form is printed with “red ink” on a standard white paper. The UB-04 is the electronic version of CMS-1450 only.

What is the difference between UB-04 and HCFA? While individual, noninstitutional practitioners file HCFA forms, institutional practitioners submit Form UB-04. This distinction means that hospitals, inpatient facilities, nursing facilities and other medical facilities use Form UB-04.

What is a HCFA? ›

Subscribe. The Health Care Financing Administration (HCFA) was created in 1977 to combine under one administration the oversight of the Medicare program, the Federal portion of the Medicaid program, and related quality assurance activities.

The UB-04 form is used for institutional billing. The 837-I is used for electronic claims in institutional billing. The letter “I” represents the institutional configuration.

The Uniform Billing Form, known either as the UB-04 or CMS 1450, is a key player in the healthcare billing process. This form, which contains more than 80 lines of vital patient information, is the standard for billing all major insurance providers, including Medicare.

HCFA became responsible for the coordination of Medicare and Medicaid. The responsibility for enrolling beneficiaries into Medicare and processing premium payments remained with SSA. HCFA was renamed the Centers for Medicare and Medicaid Services on July 1, 2001.

The Health Care Financing Administration (HCFA) has changed its name to the Centers for Medicare and Medicaid Services (CMS).

What is the difference between UB-04 and HCFA? While individual, noninstitutional practitioners file HCFA forms, institutional practitioners submit Form UB-04. This distinction means that hospitals, inpatient facilities, nursing facilities and other medical facilities use Form UB-04.

The Office of Management and Budget and the National Uniform Billing Committee have approved the UB-04 claim form, also known as the CMS-1450 form.

If you wonder what HCFA stands for, it's the "Health Care Financing Administration," a federal agency responsible for administering the Medicare and Medicaid programs in the United States.

The CMS-1450 form (aka UB-04 at present) can be used by an institutional provider to bill a Medicare fiscal intermediary (FI) when a provider qualifies for a waiver from the Administrative Simplification Compliance Act (ASCA) requirement for electronic submission of claims.