Which form is used for facility claims (hospitals, inpatient/outpatient departments, and other facilities)?

• A. HCFA-1500 form
• B. UB-99 form
• C. UB-04 form
• D. CMS-1500 form

Answer: (C)

Facility claims are filed on the UB-04 form because it is built specifically for institutional billing, capturing hospital and facility charges with fields for revenue codes, units, place of service, admission and discharge dates, and other facility-specific data. This format supports inpatient and outpatient billing and is the standard used by Medicare and most payers for facility services. In contrast, professional service claims—the bills for physicians and other non-facility providers—use the CMS-1500 (formerly HCFA-1500). UB-99 is a less common or legacy option and not the standard for facility claims. So, for hospitals and other facilities, the form used is UB-04.