Health Information Management

Tip of the Week: Watch for problematic fields on UB-04

APCs Insider, July 13, 2007

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According to Claudia Birkenshaw, MSA, CEO of Modern Management Muse, LLC, in Flint, MI, some potentially problematic fields on the new UB-04 claim form include the following:

FL 8A and 8B

FLs 8A and 8B (patient name) seem the least error-prone, but nevertheless, the way that the UB-04 is set up can be confusing. On the UB-04 form, there is a box marked "a" just to the right of "patient name" and a box marked "b" just below it. So, which should you use to record the patient's name? "It actually goes in 8b-it's a little confusing when you look at the form," Birkenshaw says.

Use field 8a only if the patient's identification number is different than the insured's number in FL 60 (insured's unique ID). Some national health plans have unique ID numbers for their patients that differ from the subscriber's number, she notes.

FL 51

FL 51 on the UB-92 is completely different than FL 51 on the UB-04. The new FL 51 is a health plan identifier. In many instances, hospitals will leave a blank in FL 51 on the UB-04, "but eventually the goal is for all the health plans in the country to have their own unique identifier number to use, just like we providers have a unique identifier through the NPI," Birkenshaw says. "I encourage hospitals to contact their claims scrubber vendor and payers to confirm if information is needed at this time."

Don't report your provider identifier (e.g., hospital legacy number) in this field as you used to do on the UB-92, Birkenshaw adds. You must report this number in FL 57 (other payer identification) using box a, b, or c, depending on whether you're billing payer a, b, or c.

It's critical to put your hospital legacy number in FL 57, as payers will use it to provide payment during the 12-month NPI contingency period.

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