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  1. DrChrono Customer Success
  2. Medical Billing
  3. Claims
  4. Institutional Claims
  5. Adding elements on the UB04 form

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?
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