Processing UB-04 Claims

The UB-04 claim form is used to submit claims for surgical procedures to insurance carriers. You can print UB-04 claims or export the claims to print image files to send electronically to insurance companies. OfficeMate automatically generates the UB-04 form for fee slips that meet the following criteria:

Contains a procedure code designated as a UB-04 billing code in the Customization window. For more information on designating UB-04 billing codes, see To add and modify procedure codes.

The insurance carrier recorded on the same line item as the UB-04 procedure code is set up to accept UB-04 claim forms. The “UB04 not applicable. Use CMS 1500 only” radio button on the Claim Form tab (Insurance Carrier tab) on the Insurance Billing Initial Setup window should not be selected for the insurance carrier. For more information on the “UB04 not applicable. Use CMS 1500 only” radio button, see To add and modify insurance carriers.

You must follow the steps below to properly process printed and electronic insurance claims:

1. Select insurance claims. For more information on selecting claims, see Selecting UB-04 Claims.
2. Correct errors in insurance claims. For more information on correcting errors, see Correcting Errors in UB-04 Claims.
3. Record additional information on CMS 1500 forms. For more information on recording additional information, see Recording Additional Information on the UB-04 Form.
4. Print or export electronic insurance claims. For more information on exporting insurance claims, see Exporting UB-04 Claims.
5. Preview and print insurance claims. For more information on previewing and printing insurance claims, see Printing UB-04 Claims.
6. View insurance claim billing histories. For more information on viewing billing histories, see Using the UB-04 Billing History.

   Before you begin processing insurance claims, set up the following information in OfficeMate:

   • Insurance information. For more information on setting up insurance carriers, see To modify or add appointment schedule resources. For more information on recording insurance information in a patient’s record, see Recording Patient Information.
   • Provider information. For more information on setting up provider information, see To modify or add provider information.
   • Procedure codes. For more information on setting up procedure codes, see To add and modify procedure codes.
   • Products and services. For more information on setting up products and services, see Recording Product Information.

   In addition to setting up the information above, you must also have recorded fee slips with insurance carriers.

This section contains information on the following topics:

• Opening the UB-04 Claims Window
• Selecting UB-04 Claims
• Correcting Errors in UB-04 Claims
• Recording Additional Information on the UB-04 Form
• Exporting UB-04 Claims
• Printing UB-04 Claims
• Using the UB-04 Billing History
• Reopening and Closing UB-04 Claims on Hold