Adding elements on the UB04 form

DrChrono will pull data from a patient’s chart to populate the UB04/HCFA 1450 form. The following is a guide identifying which fields the data will be pulled from. Box 1 - Billing Provider Name, Street Address, City, State, Zip, T...

If you want to add an alternative pay-to-address or lockbox (P.O. Box) address in box 2 on the UB04 Form, follow the steps outlined below: Hover your cursor on the Account tab and select Offices . Press the Edit button cor...

Within box 3A of the UB04 form, DrChrono will print a patient control number that will follow the patient throughout their history with your practice. It is similar to the chart ID number (example: AABB000001) in that once assigned to a patient, ...

On an institutional claim, a 4-digit code in box 4 identifies the type of facility and type of care, and the frequency code is generated based on parameters set under the office settings and attached to a patient's claim. Facility Level ...

When billing institutional care, the start/end dates of care included on that billing statement must appear in box 6 of the UB04 claim form. In DrChrono, it is easy to enter/update this information from within the patient claim in the Live Claim...

DrChrono makes it easy to add an admission date and hour to your patient's claim. It can be done right within the patient's encounter. Navigate to Billing > Live Claims Feed > Inside the patient's appointment > Right column > Info tab ...

Box 14 of the UB04 institutional claim form requires a description of the patient's type of admission. You can quickly add this information via the patient's encounter under your Live Claims Feed. Navigate to Billing > Live Claims Feed ...

A point of origin code discloses to the payer the source or method of the patient's referral for admission. The point of origin code is similar to a "place of service" code on a professional claim/HCFA-1500 form. To add it to an institutiona...

DrChrono makes it easy to add the discharge hour to your patient's claim. It can be done right within the patient's encounter. Navigate to Billing > Live Claims Feed > Inside the patient's appointment > Right column > Info tab ...

DrChrono makes it simple to add the patient's discharge status to their institutional claim which will be printed in box 17 on the UB04 institutional claim form and transmitted on the EDI file. Navigate to Billing > Live Claims Feed > Insi...

Condition codes are 2-digit numerical or alphanumeric representations of aspects of a patient, services provided, the type of service venue, and/or billing situations that can impact a payer's processing of an institutional claim. These codes ar...

Each patient appointment within DrChrono will be assigned a unique claim ID number automatically. This number will be transmitted to the payer with each submitted claim. On the HCFA-1500 form , it will print in box 26 under the label "Pati...

Occurrence codes and their respective dates disclose the payer-specific event(s) related to the billing period on the UB04. They are located in boxes 31-36 on the UB04. To view and enter them into your patient's...

Value codes are required on an institutional claim to identify data elements such as: Medicare lifetime reserve days, no-fault payments, and the number of days not covered by the primary payer. They can be easily added to the U...

As you build your institutional claim for services rendered, you will need to add revenue codes to each charge line. This will combine charges by category. Revenue codes can be added first to your fee schedule, and then to each patient enc...

On your institutional claim, you will need to note that you either have (Y) a signed statement on file from the patient permitting a data release or (I) have informed consent to release medical information. DrChrono makes it easy to note both ...

On your institutional claim, you will need to notate that you either have (Y) a signed assignment of benefits from the patient permitting direct payment from the payer to the provider, (N) if there is no signed assignment of benefits on file whi...

On both professional and institutional claims, the billing provider must disclose whether ICD-9 or ICD-10 codes are being utilized. Since October 1, 2015 claims have been required to use ICD-10 coding. DrChrono will automatically print procedu...

There are a few ways in DrChrono to add diagnosis codes to a patient's claim. Which one is best depends on where you are in the system and what fits better in your workflow. Adding directly to the appointment Navigate to Billing > Live ...

The patient's admitting diagnosis must be printed in box 69 on the UB04 institutional claim form. DrChrono makes it easy to add to your patient's claim. Navigate to Billing > Live Claims Feed > inside patient's appointment > Line items transa...

Patient reason for visit codes is required on institutional claims when the Type of Bill is 013X (hospital outpatient) and 085X (Critical Access Hospital) when the type of visit codes are 1, 2, or 5 and revenue codes 045X, 0516, or 0762 are billed. ...

For inpatient claims where a procedure was performed, the claim must include the procedure code(s) and dates on which they were performed. This field is not currently required on outpatient claims. Be sure to check t he Medicare Claims Processing ...

Providers involved in a patient's institutional care can quickly, and easily be added to the claim. Adding these providers to your contacts will make the process of adding them to any claim that much faster. Navigate to Billing > Live Claim...

Yes! You can add any information that the payer may need when adjudicating the claim can be added to appear in box 80 on the UB04 form. Navigate to Billing > Live Claims Feed > Inside patient's appointment > Info tab If you need additio...