Box 15 - Admission Source

Box Definition

Box 15 on the UB-04 is where the Admission Source is entered.

In AveaOffice

To change the Admission Source on a claim form:

1. Navigate to Patients and click on the patient name from the list.

2. (You can also locate the patient using Search)

3. Within the Profile tab, click on the blue link Intake.

4. Within the Admit/Discharge sub-tab, click Edit.

5. Scroll to the Admit Source field, click on the dropdown arrow

6. Select the Admit Source for patient.

EDI Loop

Loop 2300, Segment CL1