Box 1 - Billing Provider, Address, Phone Number

  • Updated

Box Definition

Box 1 on the UB-04 claim form displays the Billing Provider Name, Address, and Phone Number.

In AveaOffice

To update the Billing Provider information on the claim form, let's review the steps below.

  1. Navigate to Practice Admin > Configuration > Insurance Billing and select Create Scheduled Change Set.
  2. In the Create Scheduled Change Set window, select the Effective Date to tell the system which DOS should be affected.
  3. Update any applicable fields before selecting Save; when the Scheduled Change Set has been set, the Insurance Billing 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.

EDI Loop/Segment

Loop 2010AA, Segments N3 & N4

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