UB04 Field 2: Pay-To Provider Name and Address

Overview

UB-04 Field 2, also known as Form Locator 2 (FL 2), is the Pay-To Provider Name and Address field. It is located in the upper left-hand corner of the claim form, immediately below Field 1. This field captures the specific name and mailing address of the entity designated to receive payment for the services rendered.

While Field 1 identifies the physical location or the billing provider's primary address, Field 2 is situational. It is only required when the payment destination differs from the billing provider's address in Field 1 CMS Pub. 100-04 Chapter 25. For electronic claims (837I), this information corresponds to the 2010AB Loop. If this field is left blank, payers default to the address provided in Field 1 for check issuance or Electronic Funds Transfer (EFT) routing.

When to Use This Field

Field 2 is used in specific administrative and organizational scenarios where the service location is not the financial recipient.

• Centralized Billing Offices (CBO): Large health systems often perform all billing and collections from a single corporate headquarters. While Field 1 lists the specific hospital or clinic where the patient was treated, Field 2 lists the CBO's address to ensure checks are sent to the accounting department rather than the clinical site NUBC UB-04 Manual.
• Third-Party Billing Services: Facilities that outsource their revenue cycle management may require payments to be sent to a lockbox or the billing company's address.
• Lockbox Payments: Hospitals frequently use bank lockboxes for secure payment processing. In this case, Field 2 must contain the bank's address and the facility's "Pay-To" name to ensure the postal service and the payer route the funds correctly.

Step-by-Step Claim Example

Scenario: A patient receives outpatient surgery at "Northside Community Hospital" (the billing provider). However, the hospital is part of the "Regional Health Network," which processes all payments at a centralized lockbox in a different city.

1. Field 1 (Billing Provider): Enter "Northside Community Hospital" and its physical street address.
2. Field 2 (Pay-To Provider): Enter "Regional Health Network" followed by the lockbox address (e.g., PO Box 9988, Chicago, IL 60601).
3. Field 56 (NPI): Ensure the NPI matches the billing provider (Northside Community Hospital).
4. Payer Response: The payer's adjudication system identifies the presence of Field 2. While the claim is processed under the NPI of the hospital, the Remittance Advice (RA) and payment are routed to the Chicago lockbox address.
5. Outcome: The funds are deposited directly into the hospital's corporate account, avoiding the delay of forwarding mail from the clinical site to the corporate office.

Common Mistakes & Audit Red Flags

Errors in Field 2 often lead to "lost" payments or administrative rejections.

• Mismatched Pay-To Data: If the name and address in Field 2 do not match the W-9 or the EFT enrollment on file with the payer, the claim may be suspended or rejected with Claim Adjustment Reason Code (CARC) 16 (Missing/incomplete/invalid information) Noridian Medicare.
• Redundant Entries: Entering the same information in Field 2 that is already in Field 1 is unnecessary. Medicare instructions state that if Field 2 is submitted with the same data as Field 1, the data will be ignored CMS Pub. 100-04 Chapter 25.
• PO Box Restrictions: While Field 1 generally requires a physical street address for the service location, Field 2 is one of the few areas where a PO Box or Lockbox is explicitly permitted and expected for payment routing.

Related Codes & Fields

• Field 1: Billing Provider Name and Address
• Field 5: Federal Tax Number
• Field 56: National Provider Identifier (NPI)
• Field 57: Other Provider ID

References

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