OfficeMate Home Office User's Guide - OfficeMate Software Solutions

Chapter 11 Processing Insurance Claims
Processing UB-04 Claims
Note,
cont.
• Box 43: Print on Fee Slip field on the Products & Services
window for the product billed on the fee slip.
• Box 44: CPT/HCPCS drop-down menu the Products &
Services window for the product billed on the fee slip.
• Box 45: Fee slip date. Box 46, Line 23 is the date the UB-04 was
created.
• Box 46: Qty field on the fee slip for the line item.
• Box 47: Fee field on the fee slip for the line item. Box 47, Line
23 is the total of Lines 1–22.
• Box 48: Blank, but you can edit this box.
• Box 49: Blank.
• Box 50 (A–C): Names of the primary, secondary, and tertiary
insurance companies assigned on the Patient Demographics
window. Lines B and C are blank if no insurance is assigned.
• Box 51(A–C): Destination ID field on the Insurance tab of the
Business Names window for the primary, secondary, and
tertiary insurances assigned to the patient.
• Box 52(A–C): Y or N based on the Release Information? check
box on the Insurance tab of the Patient Demographics window
for the primary, secondary, and tertiary insurances assigned to
the patient.
• Box 53(A– C): Y or N based on the Accept Assign radio button
on the Insurance tab of the Business Names window for
primary insurance assigned to the patient.
• Box 54(A–C): Blank, but you can edit these boxes.
• Box 55(A–C): Blank, but you can edit these boxes.
• Box 56: Home office NPI from the Location Maintenance
window when centralized third-party processing turned on.
Location NPI Number from the Location Maintenance
window when centralized third-party processing turned off.
• Box 57(A–C): Blank, but you can edit these boxes.
• Box 58(A–C): Patient name, guarantor name, or other name
from the Patient Demographics window
• Box 59(A–C): Relationship to Patient drop-down menu on the
Insurance tab of the Patient Demographics window.
• Box 60: Insured ID field on the Insurance tab of the Patient
Demographics window.
• Box 61: Plan Name drop-down on the Insurance tab of the
Patient Demographics window.
• Box 62: Policy Group No. field Insured ID field on the
Insurance tab of the Patient Demographics window.
OfficeMate Home Office User’s Guide 459