UB(92) Options

Field	UB(92) Options Description Common Rules Tab
[FL23] Medical Record Number	Select one of the following options: Blank Medical Record Number Patient Control Number
[FL 31] Delay Reason Code	Select one of the following options: Blank Delay Reason code
[FL42] Four-digit Claim Total Rev Code	Select this option to use a four-digit claim total rev code.
[FL46] Align Service Units	Select one of the following options to insert space before or after the value: <none> 1 Space - Left 1 Space - Right 2 Spaces - Left 2 Spaces - Right
[FL47] Align Total Charges	Select one of the following options to insert space before or after the value: <none> 1 Space - Left 1 Space - Right 2 Spaces - Left 2 Spaces - Right
[FL47] Suppress Commas in amount	Select this option to suppress commas in claims printed for form type UB (FL47).
[FL 48] Align Non-Covered Charges	Select one of the following options to insert space before or after the value: <none> 1 Space - Left 1 Space - Right 2 Spaces - Left 2 Spaces - Right
[FL50] Payer Name	Select one of the following options: Blank Payer Alias Payer Alias - Upper Case Payer Name Payer Name - Upper Case
[FL51] Provider Nbr	Select one of the following options: Blank FL51 Value
[FL52] Release of Information	Select one of the following options: Blank HIPAA electronic claims code Yes/No Yes/No/Restricted
[FL59] Patient's Relationship to Insured - Code Set	Select one of the following options: Blank HIPAA electronic claims code set (from Relationship code table) NSF paper claims code set
[FL59] Patient's Relationship to Insured - Exception Codes	Select one of the following options: Blank 01 = NSF paper claims value for Self 99 = NextGen® Enterprise PM value for Self G8 = HIPAA electronic claims 'Other' value for Self 18 for Self 18 for Self or 01 for Spouse
[FL60] Use Policy Override if entered	Select this option to use Policy Override, if it is entered.
[FL63] Treatment Authorization Codes	Select one of the following options: Blank Authorization Number Authorization Number - Upper Case Referral Number
[FL76] Populate admitting diag code	Select this option to populate the admitting diagnosis for UB92 institutional claims. The value is set to that of the principal diagnosis, which is the first diagnosis on the claim.
[FL82] Attending Phys ID	Select one of the following options: <Payer Mstr Attending Setting> Blank Configurable - When you select this field, a list of conditional functions display to the left of this field that control what appears in the Attending Phys ID field. The conditions are based on the following criteria: If contents of FL51 match, then enter the text that must be matched Then enter in FL82 (enter text to appear if condition is met) You can enter up to five sets of conditions in the manner described above. You can also set an option in case no match is found. Select one of the following options: - <Payer Mstr Attending Setting> - Blank - UPIN & <Payer Mstr Attending Setting> License Number & <Payer Mstr Attending Setting> Provider ID & <Payer Mstr Attending Setting> UPIN & <Payer Mstr Attending Setting>
[FL83] Other Phys ID	Select one of the following options: <Payer Mstr FL83 Setting> <Use Legacy Standards> Blank Rendering - License Number & <Payer Mstr FL83 Setting> Rendering - Provider ID & <Payer Mstr FL83 Setting> Rendering - UPIN & <Payer Mstr FL83 Setting>
[FL84] Display payer address or narrative	Select one of the following options: Narrative Payer Address The payer’s address prints in Field Locator 84. If Narrative is selected, then the narrative from the Charge Posting window prints in Field Locator 84.
[FL85-86] Rendering name and/or date	Select one of the following options: 'Signature on File' 'Signature on File' and Date <Payer Mstr Setting> <Payer Mstr Setting> and Date Blank Current Date

[FL23] Medical Record Number

Select one of the following options:

Blank
Medical Record Number
Patient Control Number

[FL 31] Delay Reason Code

Select one of the following options:

Blank
Delay Reason code

[FL42] Four-digit Claim Total Rev Code

Select this option to use a four-digit claim total rev code.

[FL46] Align Service Units

Select one of the following options to insert space before or after the value:

<none>
1 Space - Left
1 Space - Right
2 Spaces - Left
2 Spaces - Right

[FL47] Align Total Charges

Select one of the following options to insert space before or after the value:

<none>
1 Space - Left
1 Space - Right
2 Spaces - Left
2 Spaces - Right

[FL47] Suppress Commas in amount

Select this option to suppress commas in claims printed for form type UB (FL47).

[FL 48] Align Non-Covered Charges

Select one of the following options to insert space before or after the value:

<none>
1 Space - Left
1 Space - Right
2 Spaces - Left
2 Spaces - Right

[FL50] Payer Name

Select one of the following options:

Blank
Payer Alias
Payer Alias - Upper Case
Payer Name
Payer Name - Upper Case

[FL51] Provider Nbr

Select one of the following options:

Blank
FL51 Value

[FL52] Release of Information

Select one of the following options:

Blank
HIPAA electronic claims code
Yes/No
Yes/No/Restricted

[FL59] Patient's Relationship to Insured - Code Set

Select one of the following options:

Blank
HIPAA electronic claims code set (from Relationship code table)
NSF paper claims code set

[FL59] Patient's Relationship to Insured - Exception Codes

Select one of the following options:

Blank
01 = NSF paper claims value for Self
99 = NextGen® Enterprise PM value for Self
G8 = HIPAA electronic claims 'Other' value for Self
18 for Self
18 for Self or 01 for Spouse

[FL60] Use Policy Override if entered

Select this option to use Policy Override, if it is entered.

[FL63] Treatment Authorization Codes

Select one of the following options:

Blank
Authorization Number
Authorization Number - Upper Case
Referral Number

[FL76] Populate admitting diag code

Select this option to populate the admitting diagnosis for UB92 institutional claims. The value is set to that of the principal diagnosis, which is the first diagnosis on the claim.

[FL82] Attending Phys ID

Select one of the following options:

<Payer Mstr Attending Setting>
Blank
Configurable - When you select this field, a list of conditional functions display to the left of this field that control what appears in the Attending Phys ID field. The conditions are based on the following criteria:
- If contents of FL51 match, then enter the text that must be matched
  Then enter in FL82 (enter text to appear if condition is met)
  
  You can enter up to five sets of conditions in the manner described above.
  You can also set an option in case no match is found. Select one of the following options:
  - - <Payer Mstr Attending Setting>
  - - Blank
  - - UPIN & <Payer Mstr Attending Setting>
License Number & <Payer Mstr Attending Setting>
Provider ID & <Payer Mstr Attending Setting>
UPIN & <Payer Mstr Attending Setting>

[FL83] Other Phys ID

Select one of the following options:

<Payer Mstr FL83 Setting>
<Use Legacy Standards>
Blank
Rendering - License Number & <Payer Mstr FL83 Setting>
Rendering - Provider ID & <Payer Mstr FL83 Setting>
Rendering - UPIN & <Payer Mstr FL83 Setting>

[FL84] Display payer address or narrative

Select one of the following options:

Narrative
Payer Address

The payer’s address prints in Field Locator 84. If Narrative is selected, then the narrative from the Charge Posting window prints in Field Locator 84.

[FL85-86] Rendering name and/or date

Select one of the following options:

'Signature on File'
'Signature on File' and Date
<Payer Mstr Setting>
<Payer Mstr Setting> and Date
Blank
Current Date

UB(92) Options

Recommendations

CMS 1500 (2005) Options

UB(92) Options

CMS 1500 (2005) Options

Claim Edit Descriptions

Claim Edit Descriptions

Location Information Field Descriptions

CMS 1500 (2005) Options

UB(92) Options

CMS 1500 (2005) Options

Claim Edit Descriptions

Claim Edit Descriptions

Location Information Field Descriptions