The last section of the UB-04, FLs 76-81, contains three types of information that bring the billing process to a conclusion (see Figure 15.1). The first type of information is a set of four fields for reporting physician information (FLs 76-79). Physician information is required by all payers. The UB-04 contains separate fields for reporting the attending physician and an operating physician, and two fields for reporting other provider types who may have been involved in the patient's care.

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The other two fields in this section—the field for text remarks (FL 80) and the Code-Code field (FL 81)—serve as locations for information that does not fit in other fields. The Remarks field is used to enter remarks needed to process the claim that are not shown elsewhere on the bill—for example, information needed to coordinate a claim that involves more than one payer. The Code-Code field captures information through the use of special qualifiers and code sets. It is used to report overflow codes from other form locators or codes external to the UB-04 data set. The Remarks and Code-Code fields, while not used on all claims, provide a format for reporting miscellaneous information that payers may require on a particular claim. With this closing information, the claim is complete.

Learning Objectives