This chapter provides instructions for filling in patient information on the UB-04. Patient information is contained in form locators 8-17. The form includes basic identifying information—the patient's name, address, date of birth, and sex. It also includes the details of the patient's admission and discharge—the date, hour, type, and point of origin for the admission, as well as the hour of discharge and the patient's condition at the time of discharge.

Medicare and other payers use patient information for a variety of purposes in processing UB-04 claims. It may be used to make sure the right patient receives the right benefits or to verify a beneficiary's eligibility for Medicare benefits. Patient information is also used for statistical purposes such as for Medicare's Quality Improvement Organization (QIO) reviews, for obtaining basic patient demographic information, and to help determine final Prospective Payment System (PPS) payments for inpatient services.

Accurate patient information is also important from the point of view of coding compliance. A common edit in claim processing is to check that a patient's sex and age are coordinated correctly with an age- or sex-related diagnosis or surgical procedure. For example, for a pediatric diagnosis, the patient's age must be between zero and seventeen to pass the corresponding edit. If the surgical procedure listed on the claim is a maternity procedure, the patient's sex must be female to pass the edit.

Learning Objectives