UB04 Field 2: Pay-To Provider Name and Address

Introduction

UB-04 Field 2 (also referred to as Box 2) is used to designate the Pay-To Provider Name and Address. This field is critical for ensuring that reimbursement is directed to the correct entity, particularly when the billing provider's payment address differs from the physical location listed in Field 1.

Requirements

Requirement Type	Status
Inpatient Requirement	Required
Outpatient Requirement	Required
Data Elements	Provider Name, Street Address, City, State, Zip Code, and Telephone Number

Billing Tips

When completing Box 2, ensure the provider name and address exactly match the information on file with the payer to avoid payment delays. This field should only be used if the 'Pay-To' information is different from the 'Billing Provider' information provided in Field 1. Enter the provider name, address, zip code, and telephone number as specified in the standard billing guidelines.