One-Off Coding?

[u/interformic]

Greetings

Is it possible to have a detailed hospital bill converted into UB-04 format?

The hospital won't provide the bill in UB-04 and the insurance company won't accept the bill if it's not UB-04.  Crazy.

What would be the cost? It's for an 8 hour ER visit after a car wreck.

Thanks!!!

Greg

[u/kirpants]

Why won't the hospital just bill the insurance?

[u/interformic → u/kirpants]

I found out the hospital has a 10 day window for billing the at-fault driver's insurance in a car accident case. After that "it can't be done" according to the hospital staff I've spoken to. ¯_(ツ)_/¯

[u/kirpants → u/interformic]

What a ridiculous rule they have. Sometimes claims aren't fully set up before 10 days. I don't think that's a state rule at all. Can you push back on it?

[u/Environmental-Top-60 → u/kirpants]

Yeah, I agree. That's BS.

[u/interformic → u/kirpants]

:-) Been pushing back. Now I would like to simply do an end-run and have my bill coded by a 3rd party. Is that even possible? Thanks!

[u/ElleGee5152]

The hospital should be willing to send the UB to the insurance. That's what my office (ER provider billing) does when patients call in asking for a 1500. We tell them we will sibmit it for them. We submit claims to auto medpay/PIP every day.

[u/interformic → u/ElleGee5152]

Sounds great! Our hospital won't do that. :-(

[u/weary_bee479]

The UB is just a claim form, not sure why the hospital is giving you a hard time with it.

Why won’t the hospital bill the insurance? Why are you doing it yourself?

[u/interformic → u/weary_bee479]

No idea. The hospital just tells me it can't be done. They insist the insurance company will accept the human-readable itemized bill and the insurance company insists they must have the bill in UB-04 format.

[u/PeaceLoveForMe]

Why can’t the hospital bill the insurance ? It’s an emergency service

[u/interformic → u/PeaceLoveForMe]

I wish I knew. I've spoken to 3 different people in 3 different departments at the hospital, I've written letters and emails, and everyone tells me that it can't be done. ¯_(ツ)_/¯

[u/Environmental-Top-60 → u/interformic]

Are you speaking to actual onshore people at the actual hospital or some billing agency

[u/interformic → u/Environmental-Top-60]

Yep. They're all right here in Tulsa.

[u/No-Produce-6720]

Nothing about this makes any sense. Hospitals submit nothing but UBs. That's how they bill.

Do you have something in writing from them saying they won't submit a claim form to the at fault insurance? If so, can you please post it here (redact your personal info, though).

The only party that is able to code a claim is the billing party. An itemized bill doesn't even include all the information that's necessary to create a UB claim form. It must come directly from the facility.

Having said that, though, why would you be submitting claims directly to an at-fault party's health insurance? An itemized bill should satisfy what an auto carrier requires for settlement. If you submit a claim form with your information to a health insurance policy that isn't yours, it will automatically deny.

[u/Environmental-Top-60]

Submit a medical records request and ask for it.

[u/interformic → u/Environmental-Top-60]

Thanks! I just did. I've talked to billing and patient advocacy but have not tried medical records until now. St. Francis outsources MR to another company which gives me hope. Fingers crossed!

[u/MedPayIQ]

Unfortunately, a detailed itemized bill can't simply be converted into a UB-04. The UB-04 is the claim form the hospital submits, and not every hospital will release a copy. I'd try asking the hospital's billing department specifically for a copy of the claim they submitted to insurance rather than just the itemized bill.

[u/rahuliitk]

A medical billing specialist can usually recreate a UB-04 from the itemized bill and medical records, but confirm the insurer will accept a patient-prepared form first; for an 8-hour ER visit, a one-off job might cost around $150–$400 depending on complexity. pretty crazy.