UB-92 Forms Print Instructions

Use the UB-92 Forms Print Instructions to print the healthcare claim forms used to submit insurance claims for institutional billing.  Generally, institutional billing includes billing for patient charges generated at a facility such as, a hospital or drug rehab facility.  UB-92 or UB04 forms are similar to the HCFA 1500 forms, but contain a few different fields.

Notes:

• You can print an individual UB-92 or UB04 form as an instant form as well.  For more information, see Print Instant Forms Instructions.

• For more information about the buttons on the toolbar, see the Reporting Toolbar.

Directions:

To see directions for...

• Opening the UB-92 Forms Print Instructions, click More.

   

  1.  Click Billing Functions from the Menu Bar.

  2.  Click Forms Printing.

  3.  Click UB-92 Forms.

   

  UB-92 Forms Print Instructions Window Example:

  

   

• Choosing the Print Selections, click More.

   

  UB-92 Forms Print Instructions Prompts Tip:  To see more information about a field, click the hyperlink for the field name.
  Billing Date	To accept the Workfile Build Date as the claim Billing Date, press [TAB] or enter another date as the claim form date. (mmddccyy - slashes and century optional) Tip:  You can back-date the billing date if needed.  For example, if you normally run claim forms on Monday, but a particular Monday is a holiday, you can run the claim forms on Tuesday instead but enter Monday's date as the billing date.
  Sort By	To specify the method for sorting and printing the forms, click to select appropriate boxes. Sort By options: Insurance Code - prints forms in Insurance Code order Insurance Name - prints forms in Insurance Name order Account # - prints forms in Patient Account Number order Patient Name  - prints forms alphabetically in patient name order Group #  - prints forms in Group Number order Provider - prints forms in Provider ID order Location - prints forms in Location Code order Date of Service  - prints forms in Service Date order Note:  NDS recommends that you select to sort by Insurance Code and by Account # or by Patient Name.  By sorting this way, the claims print alphabetically or numerically within each insurance.
  Claims Parameters
  Form Types	To select All Forms Types to print for forms, click Select All Form Types. To select specific Form Types to print for forms, click the appropriate Form Type name in the list.
  Providers	To limit printing claim forms for specified providers, enter the beginning Provider ID in the range, followed by a dash (-), and then the ending Provider ID in the range. Tip:  Generally to include all providers, leave Providers blank.
  Locations	To limit printing claim forms for specified locations, enter the beginning Location ID in the range, followed by a dash (-), and then the ending Location ID in the range. Tip:  Generally to include all locations, leave Locations blank.
  Groups	To limit printing claim forms for specified groups, enter the beginning Group ID in the range, followed by a dash (-), and then the ending Group ID in the range. Tip:  Generally to include all groups, leave groups blank.
  Type Processing	To specify the type of claim form processing, select one of the following: Normal Billing Run - prints all forms that qualified based on the parameters entered above. Restart Normal Run - prints all forms that did not print during the normal run.  For example, if your run aborted unexpectedly, perhaps during a printer jam, you can restart it.   Note:  For directions, see below. Specified Accounts - prints forms for specified patient accounts. Notes:    Claim information comes from the ticket file not the billing workfile.   You can use this option to print individual forms. For directions, see below. Print From PI## - prints claim forms from a Print Insurance number. Note:  For directions, see below.
  Select Status to Print	To print forms for a specific patient status, click a choice in the drop-down list. Note:  This field is only available if you select Normal Billing Run as the Type Processing.
  Restart Normal Run Note:  The following field is only available if you choose Restart Normal Billing Run as the Type Processing.
  Enter Last Account # That Printed	If this is a restart run, enter the patient account number of the last good claim form that printed. (up to 6 characters) Notes: In addition, you must select the specific Form Type to restart on.  This allows INSight to determine which claim to restart on.  After you print the specific form type INSight allows you to print all remaining form types together. Example: If your printer jammed on patient account number 4075 and form type Aetna, enter 4075 and select the Form Type Aetna during the restart to indicate it is the patient to start printing. To indicate this is a restart run, make sure you select Restart Normal Billing Run.  When you select this box, the Enter Last Account # That Printed field is activated. When you run a restart, make sure that all your other options are the same as the original print run (except for Form Type).
  Specified Accounts Note:  The following field is only available if you choose Specified Accounts for Type Processing.
  Enter Accounts	Entry Options: To print a single claim form, enter the desired patient account number and press [ENTER]. To print a group of claim forms, build a list of patient account numbers by entering the first patient account number followed by a "," (comma) then the next patient account number in your list.  Continue entering in this fashion until your list is built.  To complete the list, press [ENTER]. Note:  To search for the appropriate patient account number, click Search .
  Include Open Admission Tickets?	To include open admission tickets on the form, click to select the box. To omit open admission tickets from the form, make sure the box is de-selected. Note:  Select to include open admission tickets if you do hospital billing for charges that have admission dates with no discharge dates and you want to bill them.
  Print From PI## Note:  The following field is only available if you choose Print From PI## as the Type Processing.
  Enter Print Image Number	Enter the print insurance number to create a print image for. Notes:    The Print Insurance number is assigned during EMC Table Maintenance.   Generally, you will print to a file printer and then send the file electronically to the carrier.
  	Displays the default printer number.  For more information, see Printing Options.
  	To print a test pattern to check the alignment of the forms in the printer, click Align. Keyboard shortcut:  [ALT + a] Notes: After the test pattern prints, check the alignment.  If the form is not aligned, make adjustments and click Alignment. When the form is aligned correctly, proceed by clicking Print. The test pattern will print the Xs in the top portion of the form for the patient name and address, form date, patient account number and patient balance and Xs for the first line of ticket detail in the detail area of the form.
  	To generate the report, click Print or press [ENTER]. Keyboard shortcut:  [ALT + p]
  	To escape from the print routine, click Cancel. Keyboard shortcut:  [ALT + c]

   

• Report Sample(s), click More.

   

  To see an example of the report, click UB-92 Forms Print Sample.