Wiki UB04 box 76 OP facility claim

[NoelleL]

We are an outpatient facility billing for IOP on UB04 claims. The counselors there do not have NPI's so we've always billed with our medical directors name and billing NPI. Is this accurate? Should we bill with the LADC provider name and facility NPI or is either correct? I was taught to bill the way we have been with the directors name and claims do get processed/paid, just always questioned if this was the best or most accurate way to bill. Thanks in advance for any advice.

 

[thomas7331]

When you bill on a UB-04 form, you are billing for the facility and not for the professional services of the providers so the credentials in box 76 are informational only and usually do not affect payment, which is being made to the facility and tax ID identified in boxes 1 and 5. The information in box 76 should just reflect the name and NPI of the provider who is responsible for admitting the patient or overseeing the care. For outpatient claims, the facilities I've worked with have identified the providers primarily involved in the patient's care (e.g. the surgeon performing a procedure or provider who admitted the patient to an observation stay) or in the case of encounters for ancillary services such as labs, x-ray or medication administration, the provider or providers who ordered the service.