Box 55 a/b/c - Estimated Amount Due

Box Definition

Boxes 55a, 55b, and 55c on the UB-04 are where the estimated amount due is shown in dollars and cents after prior payments are subtracted.

• A - Primary
• B - Secondary
• C - Tertiary

In Kipu RCM

This field is not editable in the RCM and will always display as "0".

EDI Loop/Segment

Loop 2300, Segment AMT, Qualifier F3. For additional information on loops and segments, click here.