At a glance
- Confirm patient/account information, bill type, statement dates, facility/provider identifiers, and payer order.
- Review revenue codes, procedure information when required, dates, units, charges, and totals as a coherent set.
- Check diagnoses, condition codes, occurrence codes/dates, and value codes/amounts that apply to the claim.
Step 1: establish the institutional claim context
- Patient and account identity
- Facility and billing information
- Payer order and coverage data
- Type of Bill and statement period
Step 2: review service lines
Read across each line and compare revenue code, procedure/HCPCS information when required, service date, units, and charge. Make sure copied lines were actually reviewed for the current stay or encounter.
Step 3: review claim-level coding and events
Check diagnoses plus any applicable condition, occurrence, and value codes. Those fields should be supported by the record and consistent with the bill type and dates.
Step 4: review provider roles and identifiers
Verify attending and other applicable provider information, NPIs, and facility identifiers against current records rather than a prior claim.
Step 5: preview the exact output
Inspect alignment, clipping, page scaling, and the bottom fields, then retain the final claim and record the submission destination/date.
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
- Understanding Type of Bill on the UB-04
- What Is the UB-04 (CMS-1450) Form?
- HCPCS and Procedure Codes 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.