UB-04 Integration

With the UB-04 Integration function, you can configure the information CGM webPRACTICE uses to generate Institutional (UB-04) claims for your database, including the Default Revenue Code, Institutional Billing Type, and the default values that populate Boxes 4, 14, 15, and 16 on the UB-04 claim form.

Action Required: It is mandatory that you complete this function for any database that submits Institutional claims. If the UB-04 Integration is not completed, Institutional claims will not generate for the database.



Data Field Information
Prompt Response Req Len
Default Revenue Code Type the default Revenue Code to use on Institutional claims when no Revenue Code is specified at the procedure level. Four-digit Revenue Codes are required on all Institutional claims; if you enter a Revenue Code that is less than four digits, an exception will be reported on the Print Exception Report.   4
Institutional Billing Type Select Outpatient Facility or FQHC/Rural Health to indicate the billing type for the database. If FQHC/Rural Health is selected, the UB Billing field on the Maintain Type of Service Codes function (Tables > Type of Service Table) must be selected for each Type of Service code that can bill UBs. 1
Medicare Part A Carrier Type the insurance carrier code  for the Medicare Part A carrier used for Institutional claims. The carrier name displays to the right of the field.   10
Type of Bill (Box 4) Type the default Type of Bill code that prints in Box 4 of the UB-04 claim form. 3
Admission Type (Box 14) Type the default Admission Type code that prints in Box 14 of the UB-04 claim form. 1
Admission Source (Box 15) Type the default Admission Source code that prints in Box 15 of the UB-04 claim form.   1
Discharge Hour (Box 16) Type the default Discharge Hour value that prints in Box 16 of the UB-04 claim form.   2
Force all Institutional Claims to Paper Select this check box to force every Institutional claim to generate as a paper claim instead of an electronic claim, regardless of the carrier's claim filing format.    
Create Facility Claims Based on Ins Doctor Select this check box if Facility claims should be generated based on the Insurance Doctor on each encounter rather than the Performing Doctor. Facility claims can be categorized as either Institutional or Professional.    

NOTE: If the Insurance Carrier Table, Location Code Table, or Type of Service Table is shared between databases, changes you make to those tables may be copied to the other databases depending on the setup of the Table Sharing Interface. If the UB-04 Integration has not been completed in the databases where only Professional claims are submitted, these changes will not affect claim submission. Contact Customer Service to request that these fields not be shared between databases, if facility billing is needed in more than one database and the setup is unique in each database.

For detailed setup instructions, see the UB-04 Setup Information on the Introduction, System Processes menu.