Author Topic: Completing the UB04 form correctly  (Read 2653 times)

Alice Scott

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Completing the UB04 form correctly
« on: March 07, 2008, 08:50:44 AM »
I purchased your line by line UB04 helper and have a few questions first there are a few things that I have on my claims that are incorrect in line #4 we use 4 numbers and in the instructions it says to use 3.  I tried to use 3 in the beginning but the insurance companies wanted us to use 4.   line # 8a I put the patients account number, in line 17 stat I put just a “1”.  In line/box 54 I left blank.  Line 59 I have been using “01” for all of them which I just found out is wrong.  Box # 80 remarks I put the insurance’s address and from what I have found this is the only place to put the insurance company’s address. 

My question is should I change all of the problems above?  I normally don’t have any problems getting the claims paid but I do want the claims to be correct.??
DeeAnne W

Hi DeeAnne,

   We only use 3 digits in box 4.  I double checked with the UB92 editor also, and it indicates a 3 digit field.  If the insurance companies for your area want 4, and you are able to do it with 4 and get paid, then I would stick with the 4.  For box 8a, this can be the patient account number.  You were correct.  I interpreted it differently, but looking into it further, I see it can be an internal number.  (I’m going to clarify that in the book for future reference.)  Box 17 is suppose to be a 2 digit field.  If you are putting a 1, the insurance carriers are probably adding a ‘0’ to the front of it.  Box 54 is only required by some carriers if there is another insurance prime and payment was made.  Otherwise it should be left blank.  Box 59, 01 indicates spouse.  It probably hasn’t affected your payments, but you should use the appropriate relationship code.  Since box 80 is for remarks, it is ok to print the ins company address there.

I hope this helps clear things up.

Ok thank you so much!
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Completing the UB04 form correctly
« on: March 07, 2008, 08:50:44 AM »