Form locators 50-65 of the UB-04 contain detailed information about the payer and the insured, including the insured's employment. This information must be reported accurately to make a proper determination of benefits and to coordinate benefits when there is more than one payer. To ensure proper and timely reimbursement, each payer must be identified accurately in this section of the UB-04. The details of the patient's insurance, especially the insured's identification number, must also be accurate and complete. If the insurance identification number is reported incorrectly, for example, or if there is more than one payer on a claim and the payers are listed in the wrong order, the reimbursement process will be held up. If Medicare is possibly a secondary payer based on the patient's responses to Medicare Secondary Payer (MSP) program development during the admission process, the insured's employer information must be double-checked for accuracy.

With the exception of FL 56 for reporting the hospital's NPI, which contains one line only, each field in this section of the claim form contains three lines that run the full width of the form. These lines are labeled A, B, and C in the left margin of the claim form (see Figure 13.1). They are used to represent three levels of payers: line A is used to report information connected with the primary payer, line B the secondary payer if applicable, and line C the tertiary payer if applicable.

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Explain how to correctly identify and bill the primary payer as well as a secondary and a tertiary payer, if applicable, in FL 50, lines A, B, and C, of the UB-04 form.

Discuss how lines A, B, and C in adjacent fields FL 51 through FL 55 contain information related to the payers reported in lines A, B, and C of FL 50.

Understand the importance of reporting the billing provider's National Provider Identifier (NPI) in FL 56, as well as previous legacy identifiers as required in FL 57, lines A, B, and C.

Describe the types of information about the insured that must be reported in FL 58 through FL 62, lines A, B, and C, on the UB-04.

Describe the purpose of FL 63, Treatment Authorization Codes, in reporting a course of treatment that requires prior authorization, and FL 64, Document Control Number (DCN), when filing a replacement or cancellation to a previously processed claim.

Discuss the use of FL 65 for reporting the name of the insured's employer when applicable.