Which Form Locator corresponds to the Estimated Amount Due and is required?

• A. Form Locator 50 - Payer Identification
• B. Form Locator 55 - Estimated Amount Due - Required
• C. Form Locator 56 - NPI
• D. Form Locator 58 - Insured's Name

Answer: (B)

The thing being tested is recognizing where the claim communicates the patient’s expected financial responsibility. On the UB-04 form, the data field labeled as the Estimated Amount Due is the one used to show how much the patient (or their payer) is expected to owe. This field is required, meaning it must be completed on the claim to provide a clear estimate of the patient liability for the payer and for proper discharge planning and collection.

The other data items referenced—payer identification, a provider identifier, and the insured’s name—serve different purposes (identifying the payer, the provider, and the insured) and do not convey the estimated patient responsibility.