UB-04 Questions


Vancouver, WA
Best answers

I have some questions regarding the UB-04 claim form. Insight from someone who is currently working in a hospital inpatient setting would be very much appreciated. Thanks! Sincerely, Jacob

1. Do U.S. Hospitals typically use the electronic UB-04? Or is the paper UB-04 still frequently used? I do notice some differences between the paper UB-04 and the electronic UB-04.

2. If the Pay-To-Group (box 2) is identical to the Billing Provider (box 1), can we put "SAME" in box 2, leave blank, or do we fill in with the same information? (except for line 4 in box 2 that I read we do not use.. i.e. no phone number for box 2).

3. Is box 37 "Reason for Delay" applicable to electronic UB-04s? I've read we do not use this box on paper UB-04s, but noticed we do have this capability to fill out on the electronic version.

4. On box 38, is the Patient information always put there? For paper UB-04s, I read that box 38 is: Responsible Party Name and Address (Claim Addressee). Definition: The name and address of the party to whom the bill is being submitted. I wonder if the Primary payer insurance could also go there on UB-04s or perhaps only paper UB-04s?

5. Is box 43 "Description" required for electronic claim forms? I read that the description is required only for paper UB-04s.

6. What is the SVC Qual in-between section 43 and 44? I think it means Service Qualification or perhaps Service Quality. I noticed it is not on the paper UB-04... We are given the following options:
HC =
HP =
ZZ =
OK to leave blank?

7. Do we fill out section 49 for electronic UB-04 claim forms? I read we do not use this section on paper UB-04s.

8. For box 57, do we only fill in the Other Provider ID if the payer specifically requires this? It seems the NPI in box 56 would be sufficient...

P.S.----I found this resource very helpful when filling out the UB-04, for anyone who's interested (it describes each part of the UB-04 in detail): https://www.bcnepa.com/Providers/providerrelations/Manuals/UB04_20LOCATORS.pdf
Last edited: