Which Form Locator is used for Release of Info Certification on the UB-04 form?

• A. Form Locator 50 - Payer Identification
• B. Form Locator 51 - Health Plan Identification Number - Situational
• C. Form Locator 52 - Release of Info Certification - Required
• D. Form Locator 53 - Assignment of Benefit Certification - Required

Answer: (C)

The Release of Information Certification field on the UB-04 is the one used to document the patient’s or their authorized representative’s consent to share medical information for claim processing. This certification is required in many cases to authorize disclosure to the payer and other entities involved in the claims workflow, so recording it correctly ensures compliance and enables proper data flow with the claim. The other fields serve different purposes: one is for identifying the payer, another holds the health plan identification number when applicable, and another is for the assignment of benefits certification. But for the specific act of certifying the release of information, the designated Release of Information Certification field is the correct location.