Adding elements on the UB04 form
- UB04 / HCFA 1450 Boxes and Where Information is Pulled
- Box 2 - How Do I Use an Alternative Pay to Address on the UB04 form?
- Box 3A - Patient Control Number on UB04
- Box 4 - Type of Bill on a UB04 form
- Box 6 - Start/End Care Dates on a UB04
- Boxes 12-13 - Adding an admission date and hour to an institutional claim form
- Box 14 - How to add type of admission to an institutional claim
- Box 15 - What is a Point of Origin Code and how do I include it on an institutional claim?
- Box 16 - How to add a discharge hour to a UB04
- Box 17 - How to add a patient's discharge status to an institutional claim
- Boxes 18-28 - What is a condition code and how do I enter them on a UB04?
- Box 26 - Utilizing a claim ID from a HCFA-1500 or UB04 form
- Boxes 31-34 - What are occurrence codes and how do I add them to an institutional claim?
- Boxes 39 - 41 - What is a value code and why is it needed on my institutional claim?
- Box 42 - Adding revenue codes to an institutional claim/UB04
- Box 52 - Notating a signed release or informed consent on a UB04
- Box 53 - Noting an Assignment of Benefits on a UB04 form
- Box 66 - Procedure Code Qualifier
- Box 67 - How to add diagnosis codes to a patient's institutional claim
- Box 69 - Where do I add the admitting diagnosis on an institutional claim?
- Box 70 - When do I need to use a Patient Reason for Visit Code?
- Box 74 - Where do I add the Principal Procedure Code for an inpatient claim?
- Boxes 76 - 79 - Where do I add attending, operating, and consulting provider information on a UB04?
- Box 80 - Can I add free-text remarks on a UB04?