Practice tab on UB Tab

• Select a practice location.
• For multiple location practices, the Location field must be populated before any of the fields on the UB tab are enabled.
• For single location practices, the Location field does not display and all fields on the UB tab are automatically enabled.

The Field Locator 1 Name field is a free-form text entry field. The default for this field is blank.

• If the field is left blank, the name that defaults to Field Locator 1 on the UB claim depends on how the provider for this claim is set up for billing.
  • If the provider is set up in a group, then the group name on the Group Information window opens on the UB claim form.
  • If the provider is not set up in a group, then the provider name on the Modify Provider Information window opens on the UB claim form.
• If the payer requires a name on the UB claim form that is different from what defaults from the Group Information window or the Modify Provider Information window, then use this field to enter the name that must display on the UB claim form.
• The address information that displays on the UB claim form cannot be changed. This information automatically defaults from the Group Information window or the Modify Provider Information window to the UB claim based on how the provider is set up for billing.

The Default Hold Date check box is disabled by default.

If this check box is enabled, the hold date will default to the Hold Date field located on the Encounter Maintenance window on the UB tab.

The default hold date is generated by the system and is based on the last day of the month of the encounter date, plus any grace days that were set in the Grace Days field on the Service Location Information window. For example, if the last day of the month of the encounter date is June 30th and the Grace Days field is set to 3, then the hold date would be July 3rd.

The Include CPT4 Modifiers in Field Locator 44 check box is disabled by default. If left disabled, Field Locator 44 on the UB claim form only populates with the CPT4 code.

If this check box is enabled, Field Locator 44 populates with the CPT4 code, Modifier 1, and Modifier 2.

• Field Locator 17, Field Locator 18, and Field Locator 21 on the UB92 claim form are affected.
• Field Locator 17 on the UB claim form populates with the Admit Date from the Create Encounter Maintenance window. Field Locator 18 and Field Locator 21 on the UB claim form populate with the value 99, which cannot be changed.
• The check box is disabled by default. If left disabled, Field Locator 17 on the UB claim form is blank.

• The <none> option and the default for this field, which is a blank field, populates Field Locator 6 on the claim form with the Svc Dates (from and to) of the first line item charge from the Charge Posting window. Field Locator 7 on the claim form will be blank.
• The Total Days in billing cycle option will populate the From section of Field Locator 6 on the claim form with the first (from) Svc Dates of the first line item charge on the Charge Posting window. The Through section of Field Locator 6 on the claim form populates with the second (through) Svc Dates of the last line item charge listed on the Charge Posting window. Field Locator 7 on the claim form populates with the total number of service days, which is calculated from the two dates in Field Locator 6 on the claim form.
• The Total Units in billing cycle option will populate the From and Through sections of Field Locator 6 on the claim form with the Svc Dates (from and through) of the first line item charge on the Charge Posting window. Field Locator 7 on the claim form populates with a value based on the sum of all the units listed in the Field Locator 46 column of the UB claim form.

Once this field is set up on the Payer Information window, that setup automatically defaults to the Type of Admission field on the UB tab of the Encounter Information window. You can change the type of admission code on a per encounter basis by changing the default admission code type on the UB tab of the Encounter Information window.

The following list outlines the standard UB Type of Admission codes:

• Elective - 3
• Emergency - 1
• Information Not Available - 9
• Newborn - 4
• Urgent - 2

• The <none> option and the default for this field, which is a blank field, populates Field Locator 43 on the UB claim with the CPT4 Description.
• The CPT4 Description option prints the CPT4 or alternate CPT4 description on the UB claim.
• The Revenue Code Description option prints the revenue code description on the UB claim.

• This is a free-form text entry field.
• This is a required field for Enhanced UB users. You must use this field to enter the number provided to you by the payer when creating a UB claim.
• The default for this field is blank. If you are an Enhanced UB user and you leave this field blank and generate a UB claim, an edit will occur during the claims process that reads: Loc 51 Provider Number is missing.

• The <none> option, and the default for this field, which is a blank field, prints nothing in the Field Locator 61 box on the UB claim form.
• The Group Name option prints the group name from the Group Name field on the patient’s Insurance Maintenance window in the Field Locator 61 box on the UB claim form.
• The Payer Name option prints the payer’s name in the Field Locator 61 box on the UB claim form.

• The <none> option and the default for this field, which is a blank field, populates Field Locator 79 on the UB claim with the value 4. This value corresponds to the CPT4 coding method.
• The CPT4 Coding Method option displays the value 4 on the UB claim.
• The ICD-9 Coding Method option displays the value 9 on the UB claim.

• The <none> option and the default for this field, which is a blank field, populates Field Locator 82 on the UB claim with the Rendering Physician and UPIN that is attached to the first line item charge on the Charge Posting window.
• The 1st Consult, 2nd Consult, Admitting, Referring, Rendering, and Supervisor options default from the corresponding fields on the Create Encounter Maintenance window. Field Locator 82 on the UB claim populates with the doctor’s name and UPIN that is entered in that field. If on the Create Encounter Maintenance window, the field that corresponds to the option you selected is blank or the provider is not set up as a provider with the payer, an edit will occur during the claims process, which reads: Provider for Loc82 was not found on NSF.

• If you select a provider in the Operating Provider field, the Operating Provider's information is used to create the 2310B loop.
• If you select a provider in the Operating Provider field and the Claim Print library option is enabled, the appropriate information prints in FL77 on the UB04 form.
• If you do not select a provider in the Operating Provider field, the 2310B Operating loop does not automatically create. Creation of the loop then falls to the Submitter Profile option.
• The submitter profile option Populate Operating Physician information if applicable only creates the 2310B loop if a provider is selected in the Other Provider field on the UB tab of the Payer master file.

• The <none> option is the default for this field, which is a blank field. This option leaves Field Locator 83 on the UB claim blank.
• The 1st Consult, 2nd Consult, Admitting, Referring, Rendering, and Supervisor options default from the corresponding fields on the Create Encounter Maintenance window. Field Locator 83 on the UB claim populates with the doctor’s name and UPIN that is entered in that field. If, on the Create Encounter Maintenance window, the field that corresponds to the option you selected is blank or the provider is not set up as a provider with the payer, an edit will occur during the claims process, which reads: Provider for Loc83 was not found on NSF.

• The <none> option and the default for this field, which is a blank field, populates Field Locator 85 on the UB92 claim with the rendering physician, but no UPIN, that is attached to the first line item of the charges on the Charge Posting window.
• The 1st Consult, 2nd Consult, Admitting, Referring, Rendering, and Supervisor options default from the corresponding fields on the Create Encounter Maintenance window. Field Locator 85 on the UB92 claim populates with the doctor’s name, but no UPIN, that is entered in that field. If, on the Create Encounter Maintenance window, the field that corresponds to the option you selected is blank or the provider is not set up as a provider with the payer, an edit will occur during the claims process, which reads: Provider for Loc85 was not found on NSF.

• The default for this field displays the entry from the Bill Classification field on the Claims Practice Preferences. If nothing is entered in this field at the Practice Preferences level, the field on the UB tab automatically fills in with a value based on other criteria.
• To override the default value and description, select another value from the list. If you override the default that displays in this field, the override only affects encounters attached to this payer for Enhanced UB users.
• The value that displays in this field automatically populates the second digit on Field Locator 4 on the UB claim form.
• This field must be populated with the value 4 (Outpatient Rehab Facility), if you want to use the recurring UB claims process.

• The default for this field displays what was entered in the Type of Facility field in the Claims Practice Preferences.
• To override the default value and description, select another value from the list. If you override the default that displays in this field, the override only affects encounters attached to this payer for Enhanced UB users.
• The value that displays in this field automatically populates the first digit in Field Locator 4 on the UB claim form.
• This field must be populated with the value 7 (Clinic) if you want to use the recurring UB claims process.

• Enable the check box next to each provider name set as a UB rendering provider for this payer. The selected doctors always have a UB claim generated when charges are billed to this payer.
• If the Field Locator 51 field is populated, any doctor that is selected in this field always has a UB claim generated, regardless of the Service Item Form setting, when they have charges that are being billed to this payer.

• The default for this field is the value entered in the Frequency of Bill field on the Claims Practice Preferences. If the Frequency of Bill field is left blank, this field is also blank.
• To override the default, select another value from the list. If you override the default that displays in this field, the override only affects encounters attached to this payer for Enhanced UB users.
• The value that displays in this field automatically populates the third digit in Field Locator 4 on the UB claim form.
• This field must be left blank if you want to use the recurring UB claims process.

The CPT4 Field Locator 51 is a required field.

• Select the Open Menu button to the left of the field box to open the Field Loc 51 for a CPT4 Range window. Then, select the beginning CPT4 code for the range. The question mark button to the right of the range boxes enables you to search for specific codes. Repeat this for the Thru CPT4 ending range box.
  

• The CPT4 range boxes are required entries.
• You must enter a provider number in the Field Locator 51 field. This is required. If no provider number is entered, there is no CPT4 codes associated with a provider rendering billing impossible.

Select the appropriate referring provider from the list:

• <none>
• 1st Consult
• 2nd Consult
• Admitting
• Referring
• Rendering
• Supervisor

The provider information from your selection is used to populate the 2310F Referring Provider loop in the 5010 format.