Common UB-04 Paper Claim Errors

1. Claim-context errors

Type of Bill, statement dates, patient status, payer, and facility information describe the institutional claim as a whole. When those fields conflict, the problem is broader than a single service line. Start error review at the claim level before inspecting individual charges.

2. Service-line relationship errors

Revenue codes, HCPCS/procedure information when required, service dates, units, and charges work together. A code can be valid by itself but still be wrong for the line or inconsistent with the rest of the claim.

3. Stale event and value data

Condition, occurrence, and value codes often describe specific circumstances. They are particularly risky in copied claims because they can look plausible long after the event or value no longer applies. Require a deliberate review of carried-forward claim-level codes.

4. Provider and payer mismatches

Attending/other provider roles, NPIs, facility data, and payer information should match current enrollment and coverage records. A valid identifier in the wrong role can still cause processing problems.

Institutional-claim review

• Review claim-level context first: patient, payer, bill type, statement dates, and provider information.
• Then review service lines and clinical/event coding for internal consistency.
• Preview the complete paper output and retain a copy of the version actually sent.

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

• UB-04 Paper Claims vs. Electronic Institutional Claims
• Understanding Type of Bill on the UB-04
• What Is the UB-04 (CMS-1450) Form?