Before you start
- Before entering an NPI, confirm which provider role the field requests.
- Provider names and identifiers should correspond to the practitioner information in the encounter and the facility's billing records.
- A payer may apply enrollment, ordering/referring, taxonomy, or specialty rules beyond the basic form layout.
Provider role first, identifier second
Before entering an NPI, confirm which provider role the field requests. A valid NPI can still be wrong if it identifies a provider in the wrong role.
Match the facility record
Provider names and identifiers should correspond to the practitioner information in the encounter and the facility's billing records.
Payer enrollment can add requirements
A payer may apply enrollment, ordering/referring, taxonomy, or specialty rules beyond the basic form layout. Verify those separately.
Institutional-claim review
- Identify the correct attending-provider role for the institutional claim.
- Verify the provider name/NPI against current facility and payer enrollment records.
- Keep attending-provider information distinct from operating or other provider roles.
Attending provider is a role, not simply the most familiar clinician
Institutional claims can report several provider roles. The attending provider should be selected from the facility’s current record for the encounter and reported according to the applicable instructions; it should not be filled automatically with a default physician from the patient chart. When provider information changes, verify both the name and NPI and confirm that the payer enrollment record supports the role being billed.
Sources and verification
Use the CMS institutional-claim sources below for current CMS-1450/UB-04 guidance, then apply the payer’s rules for the facility claim.
- CMS institutional paper claim form (CMS-1450/UB-04)
- CMS Medicare Claims Processing Manual, Chapter 25
Related guides
- Payer Information on the UB-04
- Saving Facility Information for UB-04 Claims
- Understanding Type of Bill on the UB-04
Try UB-04 software
For offices that prepare institutional paper claims, MedClaimSoftware’s dedicated UB-04 / CMS-1450 program can save and retrieve claims, support printing and alignment, and keep facility claim preparation in a focused Windows workflow. The software is $99/year for up to 2 computers, with a free downloadable trial. View UB-04 software.