Make sense of any
UB-04 Claim
Generate accurate and consistent data from any document, any layout.
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
Viewer
JSON
form_locator_1_provider_name
Memorial General Hospital
form_locator_1_provider_address
1000 Hospital Drive, Chicago, IL 60601
form_locator_2_pay_to_name
Memorial General Hospital
form_locator_3a_patient_control_number
PAT-2024-123456
form_locator_3b_medical_record_number
MRN-2024-789012
form_locator_4_type_of_bill
0111
form_locator_5_federal_tax_number
36-1234567
form_locator_6_statement_period
from: 2024-03-10, through: 2024-03-12
form_locator_8_patient_name
Patricia A. Morgan
form_locator_9_patient_address
456 Oak Street, Chicago, IL 60602
form_locator_10_patient_dob
1955-07-22
form_locator_11_patient_sex
Female
form_locator_12_admission_date
2024-03-10
form_locator_13_admission_hour
14:00
form_locator_14_admission_type
1
form_locator_15_admission_source
7
form_locator_17_patient_status
01
form_locator_18_condition_codes
02, 04
Form_locator_31_occurrence_codes
1 item
code
date
11
2024-03-10
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
2024-03-10
2
2,400
2
0250
Pharmacy
2024-03-10
1
850
3
0300
Laboratory
85025
2024-03-10
1
125
4
0320
Radiology-Diagnostic
71046
2024-03-11
1
350
5
0450
Emergency Room
99284
2024-03-10
1
1,200
form_locator_47_total_charges
4925
form_locator_50_payer_name
Blue Cross Blue Shield of Illinois
form_locator_51_health_plan_id
BCBSIL
form_locator_58_insured_name
Patricia A. Morgan
form_locator_60_insured_certificate_number
XYZ987654321
form_locator_63_treatment_authorization_codes
AUTH-2024-5678
form_locator_66_diagnosis_version
0
form_locator_67_principal_diagnosis
code: I21.3, description: ST elevation myocardial infarction of unspecified site, poa: 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
code: 02703ZZ, description: Dilation of coronary artery, percutaneous approach, date: 2024-03-11
form_locator_76_attending_physician
npi: 1234567890, name: Dr. William Zhang, MD
form_locator_77_operating_physician
npi: 0987654321, name: Dr. Lisa Huang, MD
form_locator_81_code_code
PR-1234567890
ub-04.pdf
Viewer
JSON
form_locator_1_provider_name
Memorial General Hospital
form_locator_1_provider_address
1000 Hospital Drive, Chicago, IL 60601
form_locator_2_pay_to_name
Memorial General Hospital
form_locator_3a_patient_control_number
PAT-2024-123456
form_locator_3b_medical_record_number
MRN-2024-789012
form_locator_4_type_of_bill
0111
form_locator_5_federal_tax_number
36-1234567
form_locator_6_statement_period
from: 2024-03-10, through: 2024-03-12
form_locator_8_patient_name
Patricia A. Morgan
form_locator_9_patient_address
456 Oak Street, Chicago, IL 60602
form_locator_10_patient_dob
1955-07-22
form_locator_11_patient_sex
Female
form_locator_12_admission_date
2024-03-10
form_locator_13_admission_hour
14:00
form_locator_14_admission_type
1
form_locator_15_admission_source
7
form_locator_17_patient_status
01
form_locator_18_condition_codes
02, 04
Form_locator_31_occurrence_codes
1 item
code
date
11
2024-03-10
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
2024-03-10
2
2,400
2
0250
Pharmacy
2024-03-10
1
850
3
0300
Laboratory
85025
2024-03-10
1
125
4
0320
Radiology-Diagnostic
71046
2024-03-11
1
350
5
0450
Emergency Room
99284
2024-03-10
1
1,200
form_locator_47_total_charges
4925
form_locator_50_payer_name
Blue Cross Blue Shield of Illinois
form_locator_51_health_plan_id
BCBSIL
form_locator_58_insured_name
Patricia A. Morgan
form_locator_60_insured_certificate_number
XYZ987654321
form_locator_63_treatment_authorization_codes
AUTH-2024-5678
form_locator_66_diagnosis_version
0
form_locator_67_principal_diagnosis
code: I21.3, description: ST elevation myocardial infarction of unspecified site, poa: 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
code: 02703ZZ, description: Dilation of coronary artery, percutaneous approach, date: 2024-03-11
form_locator_76_attending_physician
npi: 1234567890, name: Dr. William Zhang, MD
form_locator_77_operating_physician
npi: 0987654321, name: Dr. Lisa Huang, MD
form_locator_81_code_code
PR-1234567890
Extraction you control
Define your rules. Extract exactly what you need. Define intelligent document extraction pipelines
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.
Secure and Compliant
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 ISO 27001 certified. This ensures that the highest standards of information security are met. DocuPipe is both GDPR and HIPAA compliant.
On-prem and private cloud
Run DocuPipe inside your own network.
Install the full DocuPipe stack in your own AWS, Azure or Google Cloud account, or on any Kubernetes cluster you run, from OpenShift to bare metal in your own datacenter. Documents, credentials and results stay on infrastructure you own, nothing needs to reach the internet, and DocuPipe has no access to your data. It is the same web app and API as our cloud, so schemas, extraction and webhooks work the same way.
- Runs on
- Your cloud account, or any Kubernetes cluster you run
- Internet at runtime
- Not required
- Our access to your data
- None
- Install check
- A real document, end to end, before it reports success
- Upgrades
- Rerun one command, or change one image reference
Public internet
outside your network
No outbound connection required
Your network
Web app and API
Your team signs in over your own network
OCR and extraction
Run inside the deployment
Database and storage
Your database, your buckets
Model calls
Inside your account, or to an endpoint you host
Your cloud account
AWS, Azure or Google Cloud, installed with one command
Any Kubernetes cluster
OpenShift or other Kubernetes, on any cloud provider, installed with Helm
Your own datacenter
Bare metal, designed for air-gapped networks
Over 1 billion pages processed, and counting
Trusted by customers big and small across every industry
Rated 4.9/5 on G2 verified reviews
Related documents:
Related documents:
Credit Memo
GuV (P&L)
Expense Report
Recu
Devis
Bilanz
Factura
Facture
CMS-1500 Form
Quittung
Rechnung
1099-MISC
Ryoshusho
Seikyusho
Superbill
Tax Return
Mitsumorisho
Schedule K-1
Balance Sheet
Budget Report
Rapport Annuel
Bilan Comptable
Income Statement
Steuererklarung
Declaracion de la Renta
More North America documents
More Healthcare documents