UB04 Field 1: Rendering Provider Name and Address

Overview

Field 1: Billing Provider Name, Address, and Telephone Number is a mandatory field located in the upper-left corner of the UB-04 (CMS-1450) claim form. This field identifies the institutional entity—such as a hospital, skilled nursing facility, or home health agency—that is legally and financially responsible for the services rendered. It serves as the primary identifier for the billing entity and must correspond exactly with the provider's enrollment data on file with the payer.

The field captures four specific lines of data:

1. Legal Name of the facility.
2. Street Address (Physical location or mailing address as registered).
3. City, State, and ZIP Code (9-digit ZIP is often required).
4. Telephone Number, including area code.

While Field 1 identifies the billing entity, it is distinct from Field 2 (Pay-to Name and Address), which is only used if the payment should be directed to a different location, such as a centralized billing office CMS Pub. 100-04 Chapter 25.

When to Use This Field

Field 1 is required for every institutional claim submitted, regardless of whether the services are inpatient or outpatient. It establishes the "Who" and "Where" of the billing party for the payer's adjudication system.

Scenario 1: Critical Access Hospital (CAH) Outpatient Services

A Critical Access Hospital (CAH) submits a claim for an emergency department visit. Field 1 must contain the CAH’s legal name and the physical address of the facility. Even if the hospital uses an off-site billing vendor, Field 1 remains the facility's information unless a specific "Pay-to" address is required in Field 2 NUBC UB-04 Manual.

Scenario 2: Skilled Nursing Facility (SNF) Inpatient Stay

A Skilled Nursing Facility (SNF) bills for a 30-day Part A stay. The facility must enter its name and the specific site address where the care was provided. If the SNF is part of a larger corporate chain, the name in Field 1 must match the specific NPI and Tax ID associated with that individual facility location to avoid "Provider Not Found" rejections CMS Pub. 100-04 Chapter 25.

Step-by-Step Claim Example

Patient Scenario

A 68-year-old Medicare beneficiary is admitted to St. Jude’s General Hospital for a scheduled hip replacement. The hospital is the billing provider.

Field Values

• Line 1: St. Jude’s General Hospital
• Line 2: 1234 Medical Center Drive
• Line 3: Springfield, IL 62704-0001
• Line 4: (217) 555-0199

Payer Response

The Medicare Administrative Contractor (MAC) receives the claim and performs an automated "front-end" edit. The system compares the name and 9-digit ZIP code in Field 1 against the Provider Enrollment, Chain, and Ownership System (PECOS).

• Success: If the data matches exactly, the claim moves to the next stage of adjudication.
• Failure: If the hospital recently moved but did not update its address in PECOS, or if the ZIP code is missing the four-digit extension required by the payer, the claim is rejected with a Reason Code indicating "Invalid Billing Provider Information."

Common Mistakes & Audit Red Flags

• Address Mismatch: Using a "Doing Business As" (DBA) name that does not match the legal name registered with the IRS and CMS. Payers often reject claims where the name in Field 1 does not align with the Tax ID provided in Field 5 CMS Pub. 100-04 Chapter 25.
• Missing 9-Digit ZIP Code: Many modern claims processing systems, including Medicare, require the full ZIP+4 format. Submitting only a 5-digit ZIP code is a frequent cause of "Unprocessable" claim returns.
• Handwritten Corrections: For paper claims, any handwriting or "white-out" in Field 1 will trigger an immediate rejection by Optical Character Recognition (OCR) scanners used by major payers NUBC UB-04 Manual.

Related Codes & Fields

• Field 2: Pay-to Name and Address
• Field 5: Federal Tax Number
• Field 56: National Provider Identifier (NPI)
• Field 76: Attending Provider Name and Identifiers
• Field 81: Taxonomy Code

References

1. CMS Pub. 100-04 Chapter 25
2. NUBC UB-04 Manual