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Guarantor/Program Billing Defaults - Electronic UB-92 Section - PM

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Set the default values for the Electronic UB-92 billing file.

Note:  The UB-92 is no longer a valid billing format. It has been replaced by the UB-04. For electronic submissions, use the 837 Institutional.

  1. In the Submitter EIN# (UB '01') field, enter the value for the submitter EIN# column of the UB 92 billing file, 01 record.
  2. In the Receiver ID# (UB '01') field, enter the value for the receiver ID# column of the UB 92 billing file, 01 record.
  3. In the Receiver Sub ID# (UB '01') field, enter the value for the receiver sub ID# column of the UB 92 billing file, 01 record.
  4. In the Test/Production Indicator (UB '01') field, select a value from the list. This value is included in the Test/Production Indicator column of the UB-92 billing file.
  5. In the Contact Name (UB '01') field, enter the value for the contact name column of the UB 92 billing file, 01 record.
  6. In the Filler Over-Ride (UB '01' field 21) field, type the value to include in field 21 of the UB 92 billing file, 01 record.
  7. In the Provider Number (UB '10' and '30') field, type the value to include in the provider number column of the UB 92 billing file, 10 and 30 records.
  8. In the Exclude Record 21 From Submission field, select Yes to exclude record 21 from the electronic filing; select No to include record 21.
  9. In the UB-92 Form Locator 4 (First Two Digits) field, select a value from the list. This value is included in the bill type column of the UB-92 billing file.
  10. In the Display Revenue Code '0001' (UB-92 '60' and '61') field, select Display Zeros to automatically place zeros in this column; select Display Total Charge to display the total charge of the service in this column.
  11. In the File Creation - Add Carriage Return at the End of Each Record field, select Yes to automatically place a carriage return at the end of each record.
  12. In the File Creation - Add Line Feed at the End of Each Record field, select Yes to automatically create a new row at the end of each record; select No to continue the next record on the same row.
  13. In the Include Claim Number In Patient Control Number Within 10-90 Records field, select Yes to automatically include the claim number in the patient control number for 10-90 records; select No to exclude the claim number.
  14. In the Display Logic For Covered Days (UB-92 '30'- Outpatient Only) field, select Blank to leave this column blank; select Total Units to include the total units of service in this column.
  15. In the Display HCPCS For The Following Revenue Codes (UB-92 '60 And 61' - Ancillaries Only) field, select the ancillary revenue codes for inclusion of HCPCS information.
  16. In the Display Dates Of Service For The Following Revenue Codes (UB-92 '60' - Inpatient Ancillaries Only) field, select the ancillary revenue codes for inclusion in dates of service information.
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