What is Box 66 on UB04?
Box 66 – Principal Diagnosis Code: (Required) Enter the Primary ICD-10 Diagnosis Code in this box marked with an asterisk. Box 76 – Attending NPI: (Required if applicable) (Clinician/Physician/Agency) that actually delivered the service.
What is Box 56 on UB04?
56. National Provider Identifier Billing Provider (NPI) Unique identifier assigned to the provider. Seven digit RI Medical Assistance Provider ID if not submitting NPI.
How many boxes does UB-04 have?
There are 81 fields (or lines) on a UB-04 form. These are referred to as form locators or “FL.” Each form locator has a unique purpose for the insurance carrier and provider so that they can communicate. It’s important that each of the UB-04 fields is filled out correctly to ensure a smooth process.
What is Box 38 on a ub04?
38 Responsible Party Name and Address Required This field is for reporting the name and address of the person responsible for the bill. 39 – 41 Value Codes and Amounts Conditional These fields contain the codes and related dollar amounts to identify the monetary data for processing claims.
What is Field 17 on a UB?
Policy: Field Locator 17 of the UB-04 and its electronic equivalence is a required field on all institutional claims. This code indicates the disposition or discharge status of the beneficiary on the submitted claims.
What is Field 15 on a UB?
Policy: Field Locator 15 of the UB-04 and its electronic equivalence is a required field on all institutional inpatient claims and outpatient registrations for diagnostic testing services. This code indicates the point of patient origin for the admission or visit of the claim being billed.
What goes in box 11b on a CMS-1500?
Box 11b displays the Claim Casualty number and qualifier (Y4) for Workers Compensation claims.
What is value code 61 on ub04?
The CBSA for the beneficiary’s residence, whether or not it is an inpatient setting, is reported on the claim using value code 61. This code is currently defined by the National Uniform Billing Committee (NUBC) as “Location Where Service is Furnished (HHA and Hospice).”
What does value code 76 mean?
76 Patient Liability Code indicates the From/Through dates for a period of noncovered care for which the hospital is permitted to charge the beneficiary.