Box 1 on the UB-04 claim form displays the Billing Provider Name, Address, and Phone Number.
To update the Billing Provider information on the claim form, let's review the steps below.
- Navigate to Practice Admin > Configuration > Insurance Billing and select Create Scheduled Change Set.
- 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 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.
Loop 2010AA, Segments N3 & N4