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- 1040 - document type
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- CMS 1500 - document type
- EU Declaration of Conformity - document type
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UB04 - document type

Document Understanding Modern Projects User Guide
Last updated May 15, 2025
UB04 - document type
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.
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.
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.
Display Name | Field Name | Field Type | Content Type |
---|---|---|---|
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 | number |
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 | number |
Admission Type | type-of-visit | regular | number |
Discharge Hour | discharge-hour | regular | number |
Principal Procedure Date | principal-procedure-date | regular | date |
Condition Codes | condition-code | regular | id-no |
Creation Date | creation-date | regular | date |
Provider Name | 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 |
Remarks | remarks | regular | string |
Authorization and Employer Information - Treatment Authorization Codes | treatment-codes | items | string |
Authorization and Employer Information - Document Control Number | document-control-number | items | string |
Authorization and Employer Information - Employer Name | employer-name | items | string |
Code-Code - Qualifier Codes | qualifier-codes | items | string |
Code-Code - ID 1 | id-1 | items | string |
Code-Code - ID 2 | id-2 | items | string |
Insured Informations - Insured's Name | insured-name | items | string |
Insured Informations - Patient's Relationship | patient-relationship | items | string |
Insured Informations - Insured's Unique ID | insured-unique-id | items | string |
Insured Informations - Group Name | group-name | items | string |
Insured Informations - Insurance Group Number | insurance-group-number | items | string |
Medical Service Details - Revenue Codes | revenue-codes | items | string |
Medical Service Details - Description | description | items | string |
Medical Service Details - HCPCS/Rate/Hipps Code | hcpcs-rate-hipps-code | items | string |
Medical Service Details - Service Date | service-date | items | string |
Medical Service Details - Service Units | service-units | items | string |
Medical Service Details - Total Charges | total-charges | items | string |
Medical Service Details - Non-Covered Charges | non-covered-charges | items | string |
Occurrence - Occurrence Code | occurence-code | items | string |
Occurrence - Occurrence Date | occurrence-date | items | date |
Occurrence Span - Occurrence Span Code | occurrence-span-code | items | string |
Occurrence Span - Occurrence Span From | occurrence-span-from | items | string |
Occurrence Span - Occurrence Span Through | occurrence-span-through | items | string |
Payer Informations - Payer Name | payer-name | items | string |
Payer Informations - Health Plan ID | health-plan-id | items | string |
Payer Informations - Release Of Information | release-of-information | items | string |
Payer Informations - Assignment Of Benefits | assignment-of-benefits | items | string |
Payer Informations - Prior Payments | prior-payments | items | string |
Payer Informations - Estimated Amount Due | estimated-amount-due | items | string |
Physician Information - Physician NPI | physician-npi | items | string |
Physician Information - Physician Qualifier | physician-qualifier | items | string |
Physician Information - Physician ID | physician-id | items | string |
Physician Information - Physician Name | physician-name | items | string |
Value Codes and Amounts - Value Codes | value-codes | items | string |
Value Codes and Amounts - Value Codes Amount | value-codes-amount | items | string |
You can download the a sample filled-in form from here.
You can also preview the sample of a filled-in form: