To access the option to create UB claims, you must choose Yes for Institutional Claims in System Settings. See Setup for UB04/Institutional Claims.
On the Post Charge screen > Claim Type> choose Institutional (If you do not see the Institutional Option, ask your administrator to do the setup.)
When the screen is Saved, the Add/Modify UB04 screen will display.
To Modify the Institutional Claim after the UB04 screen is saved:
The last digit of the 'Type of Bill' needs to be 7.
The best way to change the last digit to a 7 is to use the 'Claim' dropdown at the bottom of the Modify Encounter screen and select Replacement for claim.
Institutional Claims
Revenue Code
UB04: Box 43
ANSI (837i): Loop 2220D SVC04
Attending Provider: Loop 2310A
By Default, the Billing Provider is populated in UB Box 76, and on the ANSI, the Attending is populated in Loop 2310A.
For Institutional Paper Claims, there is an Internal setting for the Attending to print in Box 76.
Ask Support or your Implementation manager to add the setting.
For UB ANSI, select the Attending on the Modify Charge screen, which is a mandatory field for UBs.
If the Attending field is blank, the Attending will pull from the Referring Provider field.
If the Attending and Referring Provider fields are blank, the Attending will pull from the Rendering Provider field.
Referring Provider:
Loop 2310A
Loop 2420D: Is only required if the Provider is different than the Provider in 2310A.
Loop 2310F: There is an Internal Setting for Referring to display in 2310F on ANSI UB and in Box 78 on the UB Paper Claim.
2310 F is only required on an outpatient Claim/Encounter when the Referring Provider is different than the Attending Provider.
Ask Support or your Implementation manager to add the setting.
Institutional and Professional
Billing Provider: Loop 2010AA
Rendering Provider: Loop 2310B
This loop is used to populate the Rendering Provider at the Claim level and the Provider's NPI.
This loop is only populated if the Rendering information is different from the information in the Billing Provider Loop 2010AA.
Supervising Provider
Loop 2310D on both UB and Professional
UB04 Box 76: Labeled Attending
HCFA Box 17
Loop 2320: Prior Payers Claim level adjustments
Professional Claims
Loop 2430:
Professional Claims: Loop 2430 is present for each Procedure line which contains the Primary Payer's Payment, Adjustment, and Patient responsible information.
Institutional Claims: Do not have the 2430 Loop.
All Primary Payer's Payment, Adjustment, and Patient Responsible information is sent at the Claim level in Loop 2320
Loop 2310A: Referring Provider