HOSPITAL ONLY FORM locator – UB 04

Form Locators that are not shaded are required for all or most providers. You’ll see a notation in the Form Locator if it is required for only certain providers, such as Hospitals or if that Form Locator refers to information entered elsewhere in the claim.


This is an example of a Form Locator required for all providers:
Required:
FL 15: SEX
Enter the patient’s sex as M or F.
Example:
F

Form Locators that are not required are shaded.


Not Required:
This is an example of a Form Locator that is not required for any provider:
FL 31:
Not required.

Please note, although some Form Locators are not required, they are also not shaded. This is because DHHS recommends that you enter special information in these Form Locators. This optional information, such as the patient’s account number, will help you in your recordkeeping.

Also check the Special Instructions to see if your provider type is not required to complete a Form Locator.

Unless these instructions say that a Form Locator must be left blank, you may use Not Required Form Locators for your own business purposes.