Box 2 on the UB-04 claim form displays the Pay-To Name and Address. This information will indicate where payment should be sent in the event if different than the information in Box 1.
Let's review how to update the Pay-To Name and Address on the claim form.
- Navigate to Practice Admin > Configuration > Insurance Pay-To and select the Create Scheduled Change Set to generate the edit window.
In the Create Scheduled Change Set window, select the Effective Date to tell the system which DOS should be affected.
- Update any applicable fields before selecting Save; when the Scheduled Change Set has been set, the Insurance Pay-To section will indicate the changes taking effect based on the Date of Service.
- Note: If a claim has multiple dates of service, any change sets that affects only some dates of service will result in a split claim upon creation or correction.
Loop 2010AB, Segment N3 & N4