document-understanding
latest
false
UiPath logo, featuring letters U and I in white

Document Understanding Modern Projects User Guide

Last updated May 15, 2025

UB04 - document type

Overview

The UB-04, or CMS-1450, is a standardized claim form used by healthcare providers to bill Medicare, Medicaid, and private insurance for institutional services. It includes essential details about the patient, services provided, and costs incurred, streamlining the reimbursement process for healthcare facilities.

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

Particularities

The skill is trained to automatically detect data such as:

  • Billing Name, Billing Address, Billing Tax ID Number;
  • Patient Name, Patient Address, Patient DoB;
  • Admission Date, Admission Hour, Type of Visit;
  • Value Code, Value Amount.

Extracted fields

Note: 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 NameField NameField TypeContent Type
Federal Tax Numberbilling-tax-id-numberregularstring
Patient Namepatient-nameregularstring
Patient Addresspatient-addressregularstring
Birthdatepatient-birthdateregulardate
Patient Genderpatient-genderregularstring
Type of Billbill-notyperegularstring
Total Amounttotal-amountregularnumber
Other Procedure Codesother-procedure-coderegularstring
Other Procedure Datesother-procedure-dateregulardate
Statement Covers Period Fromstatement-period-fromregulardate
Statement Covers Period Throughstatement-period-toregulardate
Admission Dateadmission-dateregulardate
Admission Houradmission-hourregularnumber
Admission Typetype-of-visitregularnumber
Discharge Hourdischarge-hourregularnumber
Principal Procedure Dateprincipal-procedure-dateregulardate
Condition Codescondition-coderegularid-no
Creation Datecreation-dateregulardate
Provider Nameprovider-nameregularstring
Provider Addressprovider-addressregularstring
Payment Namepayment-nameregularstring
Payment Addresspayment-addressregularstring
Patient Control Numberpatient-control-numberregularstring
Medical Record Numbermedical-record-numberregularstring
Patient Identifierpatient-identifierregularstring
Source Of Referralsource-of-referralregularstring
Patient Statuspatient-statusregularstring
Accident Stateaccident-stateregularstring
Billing Namebilling-nameregularstring
Billing Addressbilling-addressregularstring
Page Numberpage-numberregularstring
Number Of Pagesnumber-of-pagesregularstring
Total Amount Non-Covered Chargestotal-non-covered-amountregularstring
National Provider Identifiernpiregularstring
Primary Provider IDprimary-provider-idregularstring
Other Provider IDother-provider-idregularstring
Provider IDtertiary-provider-idregularstring
ICD Version Idicatoricd-version-indicatorregularstring
Principal Diagnosis Codeprincipal-diagnosis-coderegularstring
Other Diagnosis Codes67-other-diagnosis-codesregularstring
Admitting Diagnosis69-admitting-diagnosisregularstring
Patient Reason For Visitpatient-reason-for-visitregularstring
PPS Codepps-coderegularstring
ECI Codeeci-coderegularstring
Principal Procedure Codeprincipal-procedure-coderegularstring
Remarksremarksregularstring
Authorization and Employer Information - Treatment Authorization Codes treatment-codesitemsstring
Authorization and Employer Information - Document Control Number document-control-numberitemsstring
Authorization and Employer Information - Employer Nameemployer-nameitemsstring
Code-Code - Qualifier Codesqualifier-codesitemsstring
Code-Code - ID 1id-1itemsstring
Code-Code - ID 2id-2itemsstring
Insured Informations - Insured's Nameinsured-nameitemsstring
Insured Informations - Patient's Relationshippatient-relationshipitemsstring
Insured Informations - Insured's Unique IDinsured-unique-iditemsstring
Insured Informations - Group Namegroup-nameitemsstring
Insured Informations - Insurance Group Numberinsurance-group-numberitemsstring
Medical Service Details - Revenue Codesrevenue-codesitemsstring
Medical Service Details - Descriptiondescriptionitemsstring
Medical Service Details - HCPCS/Rate/Hipps Codehcpcs-rate-hipps-codeitemsstring
Medical Service Details - Service Dateservice-dateitemsstring
Medical Service Details - Service Unitsservice-unitsitemsstring
Medical Service Details - Total Chargestotal-chargesitemsstring
Medical Service Details - Non-Covered Chargesnon-covered-chargesitemsstring
Occurrence - Occurrence Codeoccurence-codeitemsstring
Occurrence - Occurrence Dateoccurrence-dateitemsdate
Occurrence Span - Occurrence Span Codeoccurrence-span-codeitemsstring
Occurrence Span - Occurrence Span Fromoccurrence-span-fromitemsstring
Occurrence Span - Occurrence Span Throughoccurrence-span-throughitemsstring
Payer Informations - Payer Namepayer-nameitemsstring
Payer Informations - Health Plan IDhealth-plan-iditemsstring
Payer Informations - Release Of Informationrelease-of-informationitemsstring
Payer Informations - Assignment Of Benefitsassignment-of-benefitsitemsstring
Payer Informations - Prior Paymentsprior-paymentsitemsstring
Payer Informations - Estimated Amount Dueestimated-amount-dueitemsstring
Physician Information - Physician NPIphysician-npiitemsstring
Physician Information - Physician Qualifierphysician-qualifieritemsstring
Physician Information - Physician IDphysician-iditemsstring
Physician Information - Physician Namephysician-nameitemsstring
Value Codes and Amounts - Value Codesvalue-codesitemsstring
Value Codes and Amounts - Value Codes Amountvalue-codes-amountitemsstring

Samples

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

You can also preview the sample of a filled-in form:



  • Overview
  • Particularities
  • Extracted fields
  • Samples

Was this page helpful?

Get The Help You Need
Learning RPA - Automation Courses
UiPath Community Forum
Uipath Logo White
Trust and Security
© 2005-2025 UiPath. All rights reserved.