Completing The UB-04 Claim Form – Introduction Practice Test

Which data element in the header identifies the facility submitting the claim?

Facility name and address Diagnosis pointers Payer information Occurrence codes

Correct Answer:

Facility name and address

Explanation:

The data element that identifies the facility submitting the claim is the facility name and address. In the UB-04 header, this field records who is filing the claim—the exact hospital or clinic submitting the form—so that the payer and involved providers know the source of the claim. Other header elements serve different purposes: payer information shows who is responsible for payment, not who submits; occurrence codes capture dates of events like admission or discharge; and diagnosis pointers link diagnoses to procedures. So the facility name and address is the piece that directly identifies the submitting institution.

Access more questions from this quiz

Continue to Completing the UB-04 Claim Form – Introduction Practice Test for more practice questions and the full quiz experience.

Access More Questions