UB04 Setup User Checklist

Use the following checklists as a helpful reminder tool for staff members in your practice to help you successfully set up OfficeMate to process UB04 insurance claims.

For more detailed information on how to set up OfficeMate to process UB04 insurance claims, see the topics under the Setting Up section, view the Billing recorded video tutorials, and schedule additional training in the New-11 course with OMU.

Location Maintenance

Completed

Task

Type the appropriate tax ID for the UB04 claim in the Tax ID text box in the Sales Tax box.

Type the appropriate NPI number for the UB04 claim in the NPI Num (33a) text box in the Claims information box.

Resource Setup

Completed

Task

Record all of the provider’s information.

Type the EMC submitter ID in the EMC Submitter Id text box. If you are using TriZetto, this ID is the same as your site ID for UB04 claims.

Type your SSN, EIN, or NPI number - whichever number is appropriate for UB04 claims - in the appropriate text box.

Insurance Carrier Setup

Completed

Task

Select the insurance type from the Box 1 Insurance Type drop-down menu on the Claim Form tab.

Select the tax ID from the Box 25 Tax ID drop-down menu on the Claim Form tab.

Select the Yes radio button next to Box 27 Accept Assignment on the Claim Form tab.

Select the No radio button next to UB04 not applicable. Use CMS 1500 only on the Claim Form tab.

Select the policy type from the Policy Type drop-down menu on the Claim Form tab.

Select CMS 1500 Form from the Output Format drop-down menu on the Claim Form tab.

If you are using TriZetto, select GatewayEDI - ANSI 837 from the E-Claim Processor drop-down menu on the Claim Form tab.

Record the necessary and appropriate information in the Preferences, Modifiers/Combos, and Notes tabs.

Insurance Plan Setup

Completed

Task

Select the Yes radio button next to Create Claim on the Claim Form tab.

Record the necessary and appropriate information in the Preferences, Dispensing Fees, and Notes tabs.

Third Party Setup

Completed

Task

Add any necessary new procedure codes in the Procedure Codes tab.

Select procedure codes for UB04 billing and then select the UB-04 Billing Code check box.

Products

Completed

Task

Create services that you will bill on UB04 claims.

Select the correct place of service for each service from the Place of Service drop-down menu in the HCFA - 1500 Additional Information box.

Click the Product Details tab and select the correct CPT code for each service from the CPT drop-down menu.

Click the Product Details tab and record the correct price for each service.

Fee Slip

Completed

Task

Select the provider who is set up to process UB04 claims from the Provider drop-down menu at the top of the window.

Select the CPT codes that you previously set up for UB04 billing in the Product Name/Code column. Note that these CPT codes may have already been selected by the provider in ExamWRITER.

Record the fee slip.

Third Party Processing - UB04 Claims

Completed

Task

Click the Claims icon and then right-click on it and select Select Claims.

Correct any errors in the claims and then refresh them.

Click the Claims icon and then right-click on it and select Create Claims.

If you are using TriZetto, go to their website and upload the UB04 claims. The claims will be located in the OfficeMate\DATA\EMC\UB04 Files or OMATE32\DATA\EMC\UB04 Files folder on your network and they will be named GWUB04Claim.cnx.