Setup for Institutional Claims (UB04)
System Setting for Institutional claims (UB04)
- From Admin, select System Settings.
- Select Charges in the Category Menu.
- Scroll to UB04_USED - USE UB04 CHARGES.
- Select Yes.
Insurance Library Setup for Institutional Claims (UB04)
In the Insurance Library:
- If your office sends both Professional and Institutional Claims, choose Electronic for Primary & Secondary Form Type. You will then have the option to choose Professional or Institutional when adding or modifying the Charge.
- If your office only sends Institutional Claims, choose Electronic/Institutional for Primary & Secondary Form Type.
Procedure Code Library Revenue Code
From Libraries. choose Procedure Codes.
Select the Revenue Code for the Procedure.
Select Save [F2].
Institutional (UB04) Claims for a Specific Payer
If this payer only sends UB claims and no professional claims, on the Modify Charge screen for Primary & Secondary Form Types, choose Electronic/Institutional, and for Tertiary Form Type, choose UB04.
If this payer sends both Professional and UB claims, choose Electronic for the Primary and Secondary Form Types. You will use the dropdown on the Modify Charge screen to choose Institutional or Professional. Otherwise, you would need to set up 2 insurances: one for professional and one for institutional.
- CMS requirements https://www.cms.gov/Regulations-and-Guidance/Regulations-and-Guidance (External link).
- Helpful information regarding Types of Billing Codes https://www.verywellhealth.com/types-of-billing-codes-2317067 (External link).
Post Charge Claim Type
- On the Modify Charge screen, select Institutional for Claim Type.
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