CMS 1450 (UB-04) Instructions

The document provides instructions for completing a UB-04 claim form. It lists each field (locators 1-70) on the form and provides details on what information should be entered in each field. In general, it calls for entering information identifying billing providers, patients, services rendered, diagnoses, dates of admission/discharge, revenue codes, procedure codes, payment sources and amounts. The level of detail is intended to ensure claims are accurately completed to facilitate proper processing and payment.