UB04 Release of Info Certification Code Y: Yes, the provider has a signed statement on file permitting the release of data.

Overview

The National Uniform Billing Committee (NUBC) maintains the approved coding for this field, and Medicare Administrative Contractors (A/B MACs) must capture all NUBC‑approved input data described in Chapter 25 of the Medicare Claims Processing Manual for audit‑trail purposes ^[1]. The UB‑04 is a uniform institutional provider bill used for multiple third‑party payers, and each payer may require or omit certain data elements.

When to Use

Code Y must be entered in FL 52 whenever the provider holds a valid signed authorization from the patient (or legal representative) that permits the release of medical data to the specific payer being billed. This authorization is typically obtained at the time of admission or during the patient’s initial encounter and remains in effect until revoked. If the provider does not have such a signed statement, a different code (e.g., N, Q, or blank) would be used; code Y should never be used unless the signed document is physically or electronically available in the provider’s records.

Step‑by‑Step Claim Example

1. Verify authorization: Obtain a signed “Authorization for Release of Information” form from the patient (or legal representative) that explicitly allows the provider to share medical information with the payer—typically the Medicare Administrative Contractor or MassHealth.
2. Enter code Y: On the UB‑04 claim form, locate Form Locator 52. Enter the letter Y in the single‑character field. No additional punctuation or spaces.
3. Complete remaining fields: Fill out all other required form locators as instructed in the CMS Claims Processing Manual and MassHealth Billing Guide. For example, ensure that the billing provider’s name and address (FL 1) and patient demographics (FL 8–11) are correct.
4. Submit claim: Transmit the claim electronically (or on paper if an approved exception applies) to the appropriate payer. MassHealth states that “all claims must be submitted electronically, unless the provider has received an approved electronic claim submission waiver” ^[2].
5. Retain documentation: Keep the signed authorization on file for the duration required by state and federal record‑retention rules (Medicare requires at least 5 years after the claim is paid). This documentation supports the code Y certification.

Common Mistakes & Audit Red Flags

• Using code Y without a signed authorization: This is a compliance violation and can lead to claim denials, recoupment of payments, and potential penalties under HIPAA privacy rules. Always verify that a valid, signed statement exists before using code Y.
• Omitting the field or leaving it blank: Some payers, including MassHealth, require a value in FL 52. A blank or invalid code may cause the claim to be rejected or delayed. The CMS manual stresses that A/B MACs must capture all NUBC‑approved input data for audit‑trail purposes ^[1].
• Using the wrong code for the situation: For example, using code N (no signed statement on file) when a signed statement actually exists is inaccurate. Use code Y only if the signed statement is on file.
• Failing to update authorization when payer changes: If the patient changes insurance plans, a new authorization specific to that new payer may be needed. Code Y certifies that the current statement permits release to the payer listed on the claim.

Related Codes/Fields

Code/Field	Description	Reference
FL 52, code Y	Yes, signed statement on file permitting release of data	[1]; [2]
FL 52, code N	No signed statement on file	NUBC (not detailed in provided excerpts)
FL 52, code Q	Signed statement on file, but release limited by patient request	NUBC
FL 52, blank or other code	Varies by payer; may be invalid for Medicare or MassHealth	Per payer instructions
FL 01 (Billing Provider)	Provider name and address where authorization must be held	[1]
FL 08 (Patient Name/ID)	Identifies the patient whose authorization is referenced	[1]

Note: The above codes are derived from standard NUBC definitions. The provided source excerpts do not explicitly list codes N, Q, or other values for FL 52; the table includes them for context based on common usage. Always refer to your specific payer’s billing instructions.

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References

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

[2] MassHealth UB‑04 Guide — https://www.mass.gov/doc/ub-04-billing-guide-0/download