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Question 1
Which Form Locator is Attending Name/ID-Qualifier 1G?
Correct Answer:
Form Locator 76
Explanation:
In UB-04 data entry, the Attending Name/ID-Qualifier is tied to a specific Form Locator, and that qualifier 1G is entered in Form Locator 76. This locator is designated for the attending physician’s name and their identifier qualifier, so when you see 1G for Attending Name/ID-Qualifier, you place it in 76. Other form locators in this vicinity are reserved for different provider roles (such as admitting, operating, or other attending types), so they don’t apply to the Attending Name/ID-Qualifier. Understanding this mapping helps ensure the attending provider’s information is recorded accurately for billing and data analytics.
Question 2
Which Form Locator is Other ID?
Correct Answer:
Form Locator 78-79
Explanation:
Other ID is the field used for secondary patient identifiers on the UB-04. It’s placed in two adjacent form locating spaces because an alternate ID may be longer or require two parts. That’s why the correct locator pair is the two consecutive fields, 78 and 79, which together capture the Other ID. The remaining form locators correspond to different data elements on the form and are not used for recording this secondary identifier.
Question 3
Which UB-04 feature reports monetary values such as patient responsibility?
Correct Answer:
Value Codes and Amounts
Explanation:
On UB-04, monetary values such as patient responsibility are reported using value codes and amounts. Each value code identifies a specific type of financial amount (like patient deductible, coinsurance, or copayment), and the corresponding amount field shows the dollar value for that category. This structure lets the payer see exactly how much the patient owes separate from the standard charges and payments. Occurence codes record key dates and events, not money. Attending physician identifies the clinician, not finances. Statement covers period indicates the service timeframe, not monetary details. So the feature that captures monetary values tied to the patient’s responsibility is value codes and amounts.
Question 4
Which Form Locator is designated for Future Use on the UB-04 form?
Correct Answer:
FL 7
Explanation:
Form Locators labeled Future Use are there to accommodate potential changes later without redesigning the form. They’re not used for current data, so the correct practice is to leave that field blank on a claim unless a payer specifically directs otherwise. This keeps claims consistent and avoids processing issues. The other fields on the UB-04 are active data elements (patient information, dates, codes, amounts, etc.) and are populated as applicable.
Question 5
Which Form Locator holds Occurrence Span Dates and Codes and is required, if applicable?
Correct Answer:
Form Locator 35-36
Explanation:
Occurrence data on UB-04 is used to identify events that happen during the stay and, when those events span a range of dates, both the code and the start/end dates must be reported together. The Form Locators designated for reporting an occurrence span—together with its corresponding dates—are the ones you use when there is an event that begins and ends in the hospitalization period. You fill these fields only if such an event exists; if there’s no span to report, these fields are left blank. This placement is specifically for capturing span information in a single place so payers can accurately interpret the duration and nature of the event. Other form locators cover different data elements, so they don’t serve this purpose.
Question 1
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About this Exam

Prepare with the Uniform Billing, version 04 (UB-04) Certification Practice Test practice quiz. This question bank includes 10 questions covering form, ub-04, locator, patient, and name. Use it to review important concepts, identify knowledge gaps, and build confidence for the related exam, course, or assessment.

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Uniform Billing, version 04 (UB-04) Certification Practice Test

This practice set contains 10 questions from the matching question bank and focuses on form, ub-04, locator, patient, and name. Work through each question carefully, review the provided solutions, and revisit topics that need more study before your next attempt.

This is an independent study resource intended for practice and review; it is not an official examination or an endorsement by any organization named in the title.

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