UB04 (837i) Setup and Claim Submission
UB04 billing (also known as 837i) requires steps to set up in both the patient chart and in the Settings & Directories. This document will outline the setup and submission of UB04 claims. Please be aware that to follow this workflow, your practice does need to have UB04 billing functionality enabled. Please reach out to us for additional details on how to have UB04 billing enabled. Training is required before UB04 billing can be enabled for your practice.
Setting & Directories Set Up
1. From the Chart Room, click the 'Settings & Directories' drawer.
2. Click the Group Level Settings & Directories tab and then 'Service/Mod Codes' tab to add your Revenue Codes.
Revenue Codes can be added to the areas outlined in green below.
3. Room & Board is at the top middle of the Service/Mod Codes Tab. This is an independent Revenue Code.
4. Set up Revenue Codes. Revenue Codes are only used with UB04 billing. Revenue codes must be added for your practice to use, similar to service codes.
5. To relate a Revenue Code to a Service Code (HCPCS), add the Revenue Code in the column titled Revenue Code under the Service Code Short List.
6. Click on the 'Insur Payers' tab.
a. A Payer ID will need to be present in the Institutional Payer ID field. this may differ from the Payer ID used for HCFA/Professional claims.
b. The Institutional tab allows for changes to the UB04 claim to include or exclude content. These options are set for each payer individually as they may vary from payer to payer.
Patient Set Up
1. Access your patient's Demographics. These steps will need to be taken for each patient you will be billing UB04 with.
2. Click on the 'Episode Of Care' tab. Click on the 'From' field to add an admission. Only the most recent episode of care will show on the demographics, but you can click in the field and see all of the episodes of care.
3. Add an Admission. This will include several data points listed below.
- Click the '+Add' button to create an EOC. You must click this button to populate b-e
- Click the calendar to select the admission date.
- Enter the time of admission.
- Click the calendar to select the discharge date.
- Enter the time of discharge.
- Click the 'Save' button.
You may want to add the Legal Status of your patient. The options are shown and described below.
- PEC = Physician's Emergency Certificate
- CEC = Coroner Emergency Certificate
- JC = Judicial Commitment (JC)
- IVC = Involuntary Commitment
- NC = Nonagreed Commitment
- FVA = Formal Voluntary Admission
4. UB04 billing requires a role for assigned providers in demographics. The attending provider (Att) must be set. Click in the field next to the provider's name to populate a list to select from.
5. Add the Where Seen location.
6. Release of Info needs to be entered using the dropdown menu. Click on the field to populate the menu options.
7. In the Insurance Info tab, address who the responsible party will be.
If self, check the 'Patient is Responsible Party' box.
If other than self, go to 'Other Contacts' tab and fill out the guarantor information on the 'Responsible/Guarantor Info' tab.
8. Under the 'Insurance Information' tab, select the 'Benefits' tab to complete the 'Assignment of Benefits' box.
- Click in the 'Assign. of Benefits' field.
- Select from the options that populate.
9. Click on the 'Other Contacts' tab and fill out the Referring Provider Name and NPI (if applicable).
Creating a UB04 for 837i
1. From the Chart Room, click the EOC/UB04 link on the Patient Accounts drawer.
2. The Episode of Care tab is split into 4 columns as outlined below.
- Episodes of Care area (purple box): This is where you can locate your patient's episode of care.
- Encounters for selected episode (red box): If the patient has any notes during this time period, the reports will be listed in this column.
- Patient Account Charges for Episode (green box): This is where the service charges for this episode are listed and can be edited.
- Current UB04s for (orange box): This is where all of the UB04s that were created are shown.
3. To find your patient, click the 'Search' button.
4. Enter the search criteria in the Search / Filter Episode of Care popup window.
5. Click the 'Search' button.
6. Click on the episode of care that you wish to create or edit a UB04 for.
7. The UB04's will show in the right column. To create a new UB04, click the 'Create/Update UB04 from Selected Episode of Care' button.
8. To edit your UB04, click the pencil icon shown in the image above. This will open the UB04 work area. Much of the information will be filled out automatically from the information provided in Demographics and the note for the service (if one has been generated). The required fields to submit will be blue until they are filled as shown below. Fields 15, 15 and 17 are required, but are no longer blue since they have been filled in.
9. Some fields will appear to have a shadow. These fields have a drop down menu associated, to provide information without having to manually enter it. In the image below, a small calendar will populate when you click into the indicated field.
10. The 'TYPE OF BILL' field indicates the claim type and is a three-digit number, with a leading zero. This is a required field.
- First number is for the type of facility.
- Second number is for billing classification.
- Third number is for frequency of claim.
For assistance on finding the correct entry, feel free to use this website.
11. Click the 'Services' tab to add or edit services. The image below has a charge added from the note. You can add charges if there is not a note that already populated charges, or there are others to be added.
12. Click the 'Add Service' button above field 42 to create a service charge. Revenue Code, Service Date, and Total Charges are required fields. Choose the correct Date of Service for the charge. Once completed, click the 'Done' button to return to the UB04 work area.
13. Click on the 'Coverage' tab. The information for the required fields (50, 51, 52, 53, 56, 58 and 59) should populate from the patient demographics.
14. Click on the 'Other Codes' tab. Fields 66 and 67 (diagnostic codes) are required and should populate from the chart if present.
15. Click the 'Back' button in the upper right of the window to return to the Episodes of Care & UB04 Batch Submission window.
Submitting 837i Claims
1. Click the Batch UB04 tab.
2. If information is missing, a red triangle icon will show under errors. Clicking the red triangle icon will show the missing or incorrect information. Click the 'Edit' option to return to the UB04 form and update4 the missing information to allow for submission of the claim.
2. Clicking the 'ANSI' button will show what the ANSI looks like.
4. When the claims have all of the needed information and you are ready to submit, click the box under Select for as many claims as are present/that you want to send and then click the 'Submit Selected' button.
Join Joy as she shows the new UB04 template feature.
Video link: https://youtu.be/_yBpgn7OK6A
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