Orientation Overview UB-04 Form Locators Summary

The UB-04 billing course for PA PROMISe™ outpatient hospital billing is provided by the Pennsylvania Department of Public Welfare as a supplement to the billing guide included in the Provider Handbook for 837 Institutional/UB-04 Claim Form located on the Department of Public Welfare, Office of Medical Assistance (OMAP) website: http://www.dpw.state.pa.us/omap/

It is our hope that you will gain the knowledge needed to complete the UB-04 claim form processed by the PA PROMISe™ system while minimizing time away from the patients you serve.




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