Resubmitting a Paper UB Form Claim

Resubmitting a Paper UB Form Claim

  1. Navigate to the Patient Ledger (from the Financial Management module, select the Patient Ledger Sheet Bar optionPatient Ledger Sheet Bar option under the Billing heading on the left side of the screen.) The Patient Ledger screenPatient Ledger screen appears.

     

  2. Click the patient information shown highlighted in blue in upper left of the screen to select a patient record.
  3. All Transactions posted to the selected patient record (account) display in the Transaction ListTransaction List in the middle of the screen.

  4. For each charge to be included on the resubmitted claim, remove the Bill Date, if present:
  5. For each charge to be included on the resubmitted claim, update the Type of Bill by changing the 4th digit from 1 to 7 on the Charge Detail screen. For example, if your current Type of Bill is 0831, change it to 0837.
  6. If the balance due is not currently sitting with the payor you are resubmitting the claim for, you will need to Transfer the balance due to the correct Role:

  7. For each charge to be included in the resubmitted claim, add the Original Reference Number shown on the Remittance Advice for the rejected claim:

  8. Process the paper claim as usual. You should see the Original Reference Number in the Document Control Number in Field 4 a, b, or c of the paper UB-04 form.

 

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