How is patient responsibility represented on UB-04?

• A. With patient name and address
• B. In the admission diagnosis fields
• C. Only in the discharge summary
• D. Via value codes/amounts or dedicated patient liability fields showing deductible, coinsurance, and copay

Answer: (D)

Patient responsibility on UB-04 is represented through dedicated patient-liability information. The form provides specific fields to convey what the patient must pay after insurance, including deductible, coinsurance, and copay. This can be shown via value codes with corresponding amounts or through dedicated patient liability fields. This setup makes it clear to both the payer and the provider what portion of the bill is the patient’s responsibility, separate from the insurer’s payment. The patient’s name and address, admission diagnosis fields, or discharge summary do not communicate this financial liability, so those options do not fit.