View the UB-04 Representation

The UB-04 Representation is rendered from actual claims data that has been imported from your facility. The data is presented in the field locators as it would appear on an actual UB-04 claim.

By default, Contract Manager displays data in the form it was received. For example, UB-04 claims are displayed in UB-04 format and UB-92 claims are displayed in UB-92 format. However, you can override the way the data displays to either format. For more information about setting UB display preferences, refer to Edit UB Display Preferences.

Note: The UB-04 representation displays in a PDF format.

Procedure

  1. Access the UB-04 Representation page.

    If you know the account number:

    • Select Go To > Account Research > By Account Number. The Account Research by Account Number page opens.
    • Type the account number and click Display Account. The Patient Account Audit page opens.
    • Click the UB04 link in the View column. The UB-04 Representation page opens.

    If you do not know the account number:

    • Select Go To > Account Research > from Worklist. The Account Research from Worklist page opens.
    • From the Task list, select Create Worklist.
    • Specify other selection criteria and click Display Accounts. The Account Worklist page opens. For more information about search criteria, refer to Specify Account Worklist Criteria.

      Note: PEM claims are not included in worklist results.

    • Click the account number you want to review in the Account Number column. The Patient Account Audit page opens.
    • Click the UB04 link in the View column. The UB-04 Representation page opens.
  2. Review the UB-04 representation.

    Values in the Diagnosis, HCPCS / RATE / HPPS CODE, and Principle Procedure Code fields are links to additional information about the diagnosis code.

    • Click the link to view basic information about the code.
    • KnowledgeSource subscribers can log in to KnowledgeSource to view detailed information about the code.
  3. To print the UB-04 form, click the Print icon in the PDF tool bar.
  4. Close the UB-04 Representation page to return to the previous page.