Author Topic: Completing the UB02 Form  (Read 2836 times)

Leslie Bartley

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Completing the UB02 Form
« on: April 03, 2012, 11:52:14 AM »
I've been reading the book "How to Complete the UB02 Form line by line...".  I have a question about Box 2.  The authors of the book states:

"The address in this box is the provider’s physical address –
where the office is located. The pay to address goes in Box 2."

I understand what goes in Box 1, but Box 2 concerns me.  Do I put the same address that goes in Box 1, also in Box 2; as the funds are coming to the corporation?  Or do we put the address of our bank as our funds will be electronically deposited into our account in said bank?

Thank You,
Leslie E. Bartley, Ph.D.

Michele

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Re: Completing the UB02 Form
« Reply #1 on: April 04, 2012, 06:44:03 AM »

"The address in this box is the provider’s physical address –
where the office is located. The pay to address goes in Box 2."


I understand what goes in Box 1, but Box 2 concerns me.  Do I put the same address that goes in Box 1, also in Box 2; as the funds are coming to the corporation?  Or do we put the address of our bank as our funds will be electronically deposited into our account in said bank?

Thank You,
Leslie E. Bartley, Ph.D.


"The address in this box is the provider’s physical address –
where the office is located. The pay to address goes in Box 2."             -    This is for box 1.

Box 1 is the physical address and Box 2 is the pay to address.  For many these two would be the same.  They are only different if the provider/facility has their correspondence/checks sent to a different address than the physical location.  If that is the case the physical address would be in box 1 and the address for the checks would be in box 2. 

You would not put the address of the bank.  If you have EFT set up they will automatically deposit it into the bank account but you don't want to put the address of the bank on the claim. 

Hope that clarifies it!

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