UB04 – Type de document

Vue d'ensemble (Overview)

Le formulaire UB-04 ou CMS-1450 est un formulaire de demande standardisé utilisé par les prestataires de soins de santé pour facturer les prestations Medicare, Medicaid et d'assurance privée pour les services publics. Il comprend des détails essentiels sur le patient, les services fournis et les coûts encourus, rationalisant ainsi le processus de remboursement pour les structures de soins de santé.

This Document Understanding^TM skill is extracting 26 regular fields and 6 column fields containing key data points of the UB04.

Particularités

La compétence est entraînée pour détecter automatiquement des données telles que :

• Nom de facturation, adresse de facturation, numéro d’identification fiscale de facturation ;
• Nom du patient, adresse du patient, date de naissance du patient ;
• Date d'admission, heure d'admission, type de visite ;
• Code de valeur, montant de la valeur.

Extracted fields

Remarque :

If you are using using public endpoints, such as https://du.uipath.com/ie/invoices, all fields are available. However, if you are using custom-trained extractors, the availability of extracted fields is dependant on the version you are currently using. You can also check the list of fields and types on any endpoint in the /info/model object. To access this, simply add /info/model to any endpoint, like so: https://du.uipath.com/ie/invoices/info/model. For an enhanced reading experience of the fields list, it's recommended to install a JSON viewer extension in your browser.

Table 1. List of extracted fields for UB04

Display Name	Nom du champ	Type de champ	Type de contenu
Federal Tax Number	billing-tax-id-number	regular	string
Patient Name	patient-name	regular	string
Patient Address	patient-address	regular	string
Birthdate	patient-birthdate	regular	Date
Patient Gender	patient-gender	regular	string
Type of Bill	bill-notype	regular	string
Total Amount	total-amount	regular	Numérique
Other Procedure Codes	other-procedure-code	regular	string
Other Procedure Dates	other-procedure-date	regular	Date
Statement Covers Period From	statement-period-from	regular	Date
Statement Covers Period Through	statement-period-to	regular	Date
Admission Date	admission-date	regular	Date
Admission Hour	admission-hour	regular	Numérique
Admission Type	type-of-visit	regular	Numérique
Discharge Hour	discharge-hour	regular	Numérique
Principal Procedure Date	principal-procedure-date	regular	Date
Condition Codes	condition-code	regular	id-no
Date de création	creation-date	regular	Date
Nom du fournisseur	provider-name	regular	string
Provider Address	provider-address	regular	string
Payment Name	payment-name	regular	string
Payment Address	payment-address	regular	string
Patient Control Number	patient-control-number	regular	string
Medical Record Number	medical-record-number	regular	string
Patient Identifier	patient-identifier	regular	string
Source Of Referral	source-of-referral	regular	string
Patient Status	patient-status	regular	string
Accident State	accident-state	regular	string
Billing Name	billing-name	regular	string
Billing Address	billing-address	regular	string
Page Number	page-number	regular	string
Number Of Pages	number-of-pages	regular	string
Total Amount Non-Covered Charges	total-non-covered-amount	regular	string
National Provider Identifier	npi	regular	string
Primary Provider ID	primary-provider-id	regular	string
Other Provider ID	other-provider-id	regular	string
Provider ID	tertiary-provider-id	regular	string
ICD Version Idicator	icd-version-indicator	regular	string
Principal Diagnosis Code	principal-diagnosis-code	regular	string
Other Diagnosis Codes	67-other-diagnosis-codes	regular	string
Admitting Diagnosis	69-admitting-diagnosis	regular	string
Patient Reason For Visit	patient-reason-for-visit	regular	string
PPS Code	pps-code	regular	string
ECI Code	eci-code	regular	string
Principal Procedure Code	principal-procedure-code	regular	string
Remarques	remarks	regular	string
Authorization and Employer Information - Treatment Authorization Codes	treatment-codes	Eléments	string
Authorization and Employer Information - Document Control Number	document-control-number	Eléments	string
Authorization and Employer Information - Employer Name	employer-name	Eléments	string
Code-Code - Qualifier Codes	qualifier-codes	Eléments	string
Code-Code - ID 1	id-1	Eléments	string
Code-Code - ID 2	id-2	Eléments	string
Insured Informations - Insured's Name	insured-name	Eléments	string
Insured Informations - Patient's Relationship	patient-relationship	Eléments	string
Insured Informations - Insured's Unique ID	insured-unique-id	Eléments	string
Insured Informations - Group Name	group-name	Eléments	string
Insured Informations - Insurance Group Number	insurance-group-number	Eléments	string
Medical Service Details - Revenue Codes	revenue-codes	Eléments	string
Medical Service Details - Description	Description	Eléments	string
Medical Service Details - HCPCS/Rate/Hipps Code	hcpcs-rate-hipps-code	Eléments	string
Medical Service Details - Service Date	service-date	Eléments	string
Medical Service Details - Service Units	service-units	Eléments	string
Medical Service Details - Total Charges	total-charges	Eléments	string
Medical Service Details - Non-Covered Charges	non-covered-charges	Eléments	string
Occurrence - Occurrence Code	occurence-code	Eléments	string
Occurrence - Occurrence Date	occurrence-date	Eléments	Date
Occurrence Span - Occurrence Span Code	occurrence-span-code	Eléments	string
Occurrence Span - Occurrence Span From	occurrence-span-from	Eléments	string
Occurrence Span - Occurrence Span Through	occurrence-span-through	Eléments	string
Payer Informations - Payer Name	payer-name	Eléments	string
Payer Informations - Health Plan ID	health-plan-id	Eléments	string
Payer Informations - Release Of Information	release-of-information	Eléments	string
Payer Informations - Assignment Of Benefits	assignment-of-benefits	Eléments	string
Payer Informations - Prior Payments	prior-payments	Eléments	string
Payer Informations - Estimated Amount Due	estimated-amount-due	Eléments	string
Physician Information - Physician NPI	physician-npi	Eléments	string
Physician Information - Physician Qualifier	physician-qualifier	Eléments	string
Physician Information - Physician ID	physician-id	Eléments	string
Physician Information - Physician Name	physician-name	Eléments	string
Value Codes and Amounts - Value Codes	value-codes	Eléments	string
Value Codes and Amounts - Value Codes Amount	value-codes-amount	Eléments	string

Échantillon

You can download a sample filled-in form from here.

Vous pouvez également prévisualiser un exemple de formulaire rempli :