NEW
Font size
S
M
L
XL
WorksheetsUB04
Total questions: 6
Worksheet time: 3mins
Name
Class
Date
1.
UB04 claim forms are used by _____________ providers.
a)
Facility
b)
Professional
c)
Dental
d)
All of these
2.
The physical address of the facility is found in box ____ of the UB04
a)
56
b)
2
c)
5
d)
1
3.
The codes found in box 42 are ______ _____ and tell us the accommodation or ancillary service being billed.
a)
Occurrence codes
b)
Value codes
c)
Revenue Codes
d)
Admission
4.
The dates of service on a facility claim can be found in box ______.
a)
6
b)
5
c)
76
d)
56
5.
The dollar amount in the Total box on a UB04 will be enter in the _________ line of the claim procedure list in Streamline.
a)
last
b)
first
c)
total
6.
What box contains the Facility NPI?
a)
76
b)
66
c)
5
d)
56
Reset
