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

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

Note: The UB-92 is no longer a valid billing format. It has been replaced by the UB-04.

  1. In the Horizontal Offset (UB-92) field, type the positive or negative number value for shifting the printed form right or left. Example: A positive one (1) shifts the print to the right one character space. A negative one (-1) shifts the print to the left.
  2. In the Address Information To Print In Form Locator 1 field, select Provider Data From 'Facility Defaults' to retrieve provider address information from the Facility Defaults form; select Program Extended Dictionary to retrieve provider address information from the extended dictionary data elements associated with the Program data element. This information is from form locator 1 of the UB-92 paper bill. When a selection is not made, the information is retrieved from the Program Extended Dictionary.
  3. In the Display For Form Locator 2 field, choose whether form locator 2 should display the Claim Number or be left Blank.
  4. In the Display For Form Locator 3 field, select the display format for the client's account number.
  5. In the UB-92 Form Locator 4 (First Two Digits) field, select the value to be included in the bill type column of the UB-92 billing file.
  6. In the Override To Type Of Bill For Medicare Certified Bed Stay (Form Locator 4) field, select the type of bill to override to for Medicare certified bed stays in form locator 4.
  7. In the Display Logic For Form Locator 7 (Outpatient Only) field, select Blank to leave the form locator blank; select R&B Days to include number of Room and Board days in the form locator; select Total Units From Form Locator 46 to include total number of service units in the form locator.
  8. In the Information To Display For Form Locators 12, 13, 14, and 15 field, select the source for the information that will display in these form locators.
  9. In the Display For Form Locator 38 field, select Subscriber to include subscriber information in form locator 38; select Guarantor to display guarantor in form locator 38.
  10. In the Form Locator 42 - Number Of Digits For Revenue Code field, select the number of digits to allow for the revenue code.
  11. In the Form Locator 44 - Display HCPCS For The Following Revenue Code(s) field, select the ancillary revenue codes for inclusion of HCPCS information. This is a multiple selection data element.
  12. In the Form Locator 45 - Display Dates Of Service For The Following Revenue Code(s) field, select the ancillary revenue codes for inclusion of dates of service information. This is a multiple selection data element.
  13. In the Form Locator 47 - Charge Calculation field, select Use Service Fee Table to use the service charge from the Service Code Fee Table; select Use Client's Treatment Information to use the service charge from the Treatment History Table.
  14. In the Form Locator 51 (Provider No) field, enter the value for form locator 51 (Provider No).
  15. In the Leave Form Locator 83 (Other Phys. ID) Blank field, select Yes to leave the form locator blank; select No to include the practitioner in the bill.
  16. In the Display For Form Locator 84 field, select Blank to leave the form locator blank; select Guarantor Address Information to include this information in the form locator.
  17. In the Display For Form Locator 85 field, select Blank to leave the form locator blank; select Provider Representative to include this information in the form locator.
  18. In the Exclude Punctuation From Claim - Form Locator 67-77 and 80-81 (Diagnosis/E-Code/Procedure Codes) field, select Yes to exclude punctuation from the bill for the Guarantor/Program selections; select No to include punctuation in the bill.
  19. In the Print As An Outpatient Bill If There Are No Room And Board Charges field, select Yes to print the UB-92 as an outpatient bill when it is associated with an inpatient episode without room and board charges.
► Registry Settings
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  • Remove 'Guarantor/Program Billing Defaults' Sections No Longer Used
  • Use Claim First/Last Dates Of Service
  • Use Coverage Effective/Expiration Dates