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UB-04 Claim
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Healthcare Document Intelligence
The world's best UB-04 extraction
Accelerate institutional claim processing with automated UB-04 form extraction. Extract all 81 form locators including patient data, revenue codes, HCPCS/CPT codes, ICD-10 diagnosis and procedure codes, and occurrence codes. Reduce denials and speed up reimbursement.
ub-04.pdf
Memorial General Hospital
1000 Hospital Drive, Chicago, IL 60601
Memorial General Hospital
PAT-2024-123456
MRN-2024-789012
0111
36-1234567
Form locator 6 statement period
2024-03-10
2024-03-12
Patricia A. Morgan
456 Oak Street, Chicago, IL 60602
1955-07-22
Female
14:00
1
7
01
Form locator 18 condition codes
2 items| Value |
|---|
02 |
04 |
Form locator 31 occurrence codes
1 item| Code | Date |
|---|---|
11 | Mar 10, 2024 |
Form locator 39 value codes
1 item| Code | Amount |
|---|---|
01 | 1,500 |
Form locator 42 revenue codes
5 items| Line | Revenue code | Description | Hcpcs | Service date | Units | Total charges |
|---|---|---|---|---|---|---|
1 | 0120 | Room & Board Semi-Private | — | Mar 10, 2024 | 2 | 2,400 |
2 | 0250 | Pharmacy | — | Mar 10, 2024 | 1 | 850 |
3 | 0300 | Laboratory | 85025 | Mar 10, 2024 | 1 | 125 |
4 | 0320 | Radiology-Diagnostic | 71046 | Mar 11, 2024 | 1 | 350 |
5 | 0450 | Emergency Room | 99284 | Mar 10, 2024 | 1 | 1,200 |
4,925
Blue Cross Blue Shield of Illinois
BCBSIL
Patricia A. Morgan
XYZ987654321
AUTH-2024-5678
0
Form locator 67 principal diagnosis
I21.3
ST elevation myocardial infarction of unspecified site
Y
Form locator 67a other diagnoses
3 items| Code | Description | Poa |
|---|---|---|
I10 | Essential hypertension | Y |
E11.9 | Type 2 diabetes mellitus | Y |
E78.5 | Hyperlipidemia | Y |
Form locator 74 principal procedure
02703ZZ
Dilation of coronary artery, percutaneous approach
Form locator 76 attending physician
1234567890
Dr. William Zhang, MD
Form locator 77 operating physician
0987654321
Dr. Lisa Huang, MD
PR-1234567890
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Connect UB-04s across your stack
DocuPipe captures UB-04 forms from hospital billing departments, clearinghouses, or scanned batches. Extract comprehensive claim data including service lines and diagnosis codes, then sync to claims processing systems or payer portals.
Sources
EHR/EMR
Fax/eFax
P
Patient Portal
Document Scanner
Destinations
EHR/EMR
Claims Platform
P
Practice Management
API
Extract fields. Consistently.
Your business has specific documents with your own rules of how you need to understand them and act on them. Define exactly what you need to extract, reliably, for any layout and language.
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Fully secure. Always.
Your documents are your own and never shared for any reason. DocuPipe encrypts all documents in transit and at rest, and has undergone formal certification to become SOC‑2 and ISO 27001 compliant, ensuring that the highest standards of information security are met. DocuPipe is both GDPR and HIPAA compliant.
Better in every way
Experience accuracy, flexibility, and speed with DocuPipe.
| Feature | DocuPipe | Textract | Google OCR | GPT |
|---|---|---|---|---|
| OCR printed text | ||||
| Handle simple tables | ||||
| Handle long documents | ||||
| OCR handwriting | ||||
| Nested tables | ||||
| Complex forms | ||||
| Crossed out text | ||||
| Support for 60+ languages | ||||
| AI document standardization | ||||
| Speed | ||||
| Document type classification | ||||
| Document Splitting | ||||
| Highlight information source on document | ||||
| Visual Review |
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