What information is entered in FL 1 on the UB-04 form?

What information is entered in FL 1 on the UB-04 form?

• A. The patient's name
• B. The facility's tax identification number
• C. The provider's name, address, and telephone number
• D. The claim submission date

Answer: (C)

FL 1 contains the provider's name, address, and telephone number. This top-area information identifies who is submitting the claim and gives the payer a direct contact point for questions or follow-up. It helps ensure the claim is linked to the correct facility or provider and can be routed for processing without delay. Other details, like the patient's name, tax ID, or submission date, appear in different sections of the form, not in FL 1. Placing the provider’s contact information in FL 1 keeps the claim identifiable and contactable right from the start.

FL 1 contains the provider's name, address, and telephone number. This top-area information identifies who is submitting the claim and gives the payer a direct contact point for questions or follow-up. It helps ensure the claim is linked to the correct facility or provider and can be routed for processing without delay. Other details, like the patient's name, tax ID, or submission date, appear in different sections of the form, not in FL 1. Placing the provider’s contact information in FL 1 keeps the claim identifiable and contactable right from the start.