In UB-04 billing, which is used to bill patients admitted to a facility to inpatient care, patients are billed a daily rate based on the days spent in a facility receiving care, rather than for specific services.

You must run the UB-04 preprocessing task for each patient admitted to the facility to enable the facility to generate the encounters and fee sheets required for billing.

This topic contains the following sections:

Requirements for Billing UB-04 Claims

To enable the system to generate UB-04 claims, ensure that the following prerequisites are set up in the system: 

  • The patient must be admitted to an inpatient facility. 
  • The bed allocation must be done from the start of billing date.
  • The discharge date and bed release date must be entered in the system, along with the discharge reason when the client is discharged.
  • You cannot run the preprocessing task for a client who is admitted and discharged on the same day.

Admit a Patient into a Facility or Program

You must add each patient as an applicant to receive treatment at a facility or program, and then approve and process the client's application. You then admit the patient to the facility as a new resident. 

Add Patient as an Applicant

You can optionally click the Benefits button to check the benefits that are covered by insurance for a particular service the patient might receive. 

  1. Click the Applicants tab, and then click click Add Applicant in the left-hand navigation bar. The List of Applicants page opens.
  2. Click the Add Applicant button. The Add Applicant page opens.
  3. Click the Initial Screening Call tab, and then enter the client's information. 
  4. Click the Insurance Information tab, and then enter the details for the client's primary and secondary insurance payers, if applicable. 
  5. Click Save.

Approve and Process an Application

  1. Click the Applicants tab, and then click click Approve Applicants in the left-hand navigation bar.
  2. Search for the applicant that you want to approve. You can search for the applicant by typing the first three characters of the applicant's name and clicking Search.
  3. Click the Process Application link in the Action column for the patient.
  4. In the Process Application dialog box, select the application status, and then click Save.

Admit the Applicant as a New Resident 

When an applicant becomes a resident, the following changes occur automatically:

  • Residents are automatically admitted to the facility if a move-in date is present.
  • The Level of Care is set to Independent Living (IL).
  • The Billing Type is set to Independent Living (IL).
  • In Billing Info, the Paper Statement option is set to No.

To add a new resident, complete the following steps:

  1. Click the Applicants tab.
  2. On the left navigation menu, click Add New Resident. The Add New Resident page opens.
    By default, the Show Only Waitlist filter is selected to display only waitlisted applicants. To show all applicants, select Show All. Residents who are accepted into the facility display in green.
  3. Select the check box next to the resident that you want to add, and then click Create Resident.
    You can verify that the resident was added by selecting the Show All filter. The resident should display in the list.
  4. The Resident can be moved back to waiting list status clicking on Rollback Resident hyperlink.

Run the UB-04 Prepocessing Task for Inpatient Clients

After you admit a new inpatient client, run the preprocessing task to enable billing for services rendered by the facility. When the process completes, encounters with the following conditions are created automatically for each patient:

  • Encounters are created for every day for the month selected with a predefined daily charge for services based on the patient's date of admission.
  • Pause Encounters are created if patient care is paused for a selected month.
  • The charges for Pause Encounters and Admit Encounters are totaled and one final billable encounter is created for the last date of the month showing the total charge.

Complete the following steps to run the preprocessing task:

  1. Click the Billing tab.
  2. Click UB04 Pre-process in the left-hand navigation menu, and then select Pre-process.
  3. Enter search criteria to find patients, and then click Search. 
  4. Select the checkbox for each patient you will bill for inpatient treatment, and then click Process. The task might take a significant amount of time to complete due to the amount of data processed.
  5. To view the status of the pre-process task, click UB04 Pre-process in the left-hand navigation menu, and then select Pre-process.


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