UB04 Field 2: Pay-To Provider Name and Address

Overview

Field 2 (Pay-To Provider Name and Address) on the UB-04 form is designated for the name and address of the entity designated to receive payment. However, both major reference sources indicate that this field should not be completed by the billing provider during claim submission. The Maryland Medicaid UB-04 instructions explicitly state: “FL 02 Pay-to Name and Address Leave Blank – Internal Use Only” ^[1]. Similarly, the CMS Chapter 25 manual clarifies: “FL 2 - Billing Provider’s Designated Pay-to Name, address, and Secondary Identification Fields Not Required. If submitted, the data will be ignored.” ^[2]. Therefore, Field 2 is effectively a non-billing field; any information placed there by the provider is either ignored by the payer or reserved for internal use. The field serves no function in claim processing or adjudication under these regulations. Providers should treat it as a reserved space that must remain empty to avoid processing confusion, even though the data will be disregarded if entered. This instruction applies uniformly for both inpatient and outpatient claims, as the sources do not differentiate between the two settings ^{[1] [2]}.

When to Use

Based strictly on the provided sources, Field 2 should never be used by the billing provider in the normal claim submission process. The Maryland Medicaid guide directs providers to leave it blank and states it is for internal use only ^[1]. The CMS manual goes further, saying the field is not required and that any data submitted will be ignored ^[2]. There is no scenario described in these sources where a provider should populate Field 2. The only conceivable “use” is that the field may be reserved for internal payer reference, but no guidance is provided on what that internal use entails. Consequently, from a practical standpoint, the field should be left entirely blank. If a provider erroneously enters pay-to information here, it will not affect payment or remittance address—such details are maintained in the payer’s provider master file, as noted in the Maryland Medicaid instructions for FL 01: “Checks and remittance advice are sent to the provider’s address as it appears in the Program’s provider master file.” ^[1]. Thus, there is no operational reason to complete Field 2.

Step-by-Step Claim Example

Scenario: A hospital is submitting an UB-04 claim for an inpatient admission. The billing provider has already entered their name, address, phone number, and service location in Field 1 (Billing Provider Name, Address, and Telephone Number) as required by Maryland Medicaid ^[1]. When the claim processor reaches Field 2 (Pay-To Provider Name and Address), they must ensure it remains completely empty. According to CMS, the field is not required and any submitted data will be ignored ^[2]. Therefore, the claim preparer leaves Field 2 blank. The next field, Field 3a (Patient Control Number), is required and will be completed with a unique alphanumeric identifier ^[1]. No data entry is needed for Field 2 at any point during claim creation. The claim is then submitted electronically or on paper; the payer’s system will simply ignore the empty field. After submission, the remittance advice and payment are sent to the address on file in the provider master file, not to any address entered in Field 2 [Maryland Medicaid — FL 2](https://health.maryland.gov/mmcp/provider/Documents/ffs-billing/UB04-Hospital-Billing-Instructions%20%281%29.pdf]. This example demonstrates that the correct step for Field 2 is to do nothing.

Common Mistakes & Audit Red Flags

Common mistakes arise when providers inadvertently populate Field 2 with pay-to information. One frequent error is copying the billing provider’s address from Field 1 into Field 2, perhaps assuming it is needed for payment routing. However, both sources make clear that this data will be ignored or is reserved for internal use ^{[1] [2]}. Another mistake is using Field 2 to indicate a different payment address (e.g., a billing service address) without properly updating the payer’s master file. This action creates unnecessary work and confusion, though it will not cause claim denial because the data is ignored per CMS ^[2]. Audit red flags are minimal since the field is not used for adjudication. However, an auditor might flag a completed Field 2 as a sign that the provider is not following payer instructions, potentially leading to a request for corrected claims. The Maryland Medicaid instruction to “leave blank” is a clear directive; any entry could be viewed as non-compliance ^[1]. Moreover, if a provider consistently enters data in Field 2, payers may ignore it, but the provider might wrongly believe payment is being sent to the address in that field, leading to payment delays or lost checks. The safest practice to avoid any audit scrutiny is to ensure Field 2 is always empty. No specific audit red flags are mentioned in the sources beyond the general instruction to leave the field blank.

Related Codes/Fields

The following table lists fields commonly related to Field 2 and their requirements based on the provided sources.

Field	Name	Requirement	Source Notes
FL 01	Billing Provider Name, Address, and Telephone Number	Required	Enter provider name, street address, city/state/ZIP, phone/fax (optional). Checks sent to address in master file [1].
FL 02	Pay-To Provider Name and Address	Leave blank / Not required	Maryland: internal use only, leave blank; CMS: not required, data ignored [1] [2].
FL 03a	Patient Control Number	Required	Unique alphanumeric control number assigned by hospital; up to 20 positions [1].
FL 03b	Medical/Health Record Number	Optional	Medical record number for future inquiries; up to 13 positions [1].
FL 04	Type of Bill	Required	3-digit code (no leading zero); third digit is frequency code [1].

This table reflects only the fields mentioned in the provided sources. No other fields are addressed. The primary relationship is that Field 2 should remain empty while Fields 1 and 3a contain critical claim data.

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References

[1] Maryland Medicaid — FL 2 — https://health.maryland.gov/mmcp/provider/Documents/ffs-billing/UB04-Hospital-Billing-Instructions%20%281%29.pdf

[2] CMS Chapter 25 — FL 2 — https://www.cms.gov/regulations-and-guidance/guidance/manuals/downloads/clm104c25.pdf