UB04 Field 53: Assignment of Benefit Certification

Overview

Field 53 of the UB-04 claim form is titled “Assignment of Benefits Certification Indicator.” The sole source provided—Maryland Medicaid’s UB-04 Hospital Billing Instructions—lists this field in its table of contents as “FL 53 Assignment of Benefits Certification Indicator” and indicates it appears on page 43 of the document. ^[1] No further description, usage guidelines, or specific instructions for completing Box 53 are included in the source. Because the source does not elaborate on the purpose, required values, or payer-specific rules for this field, any additional details would constitute unsupported content. Therefore, the following sections can only reiterate that the field exists and that the referenced material does not provide operational guidance.

When to Use

The source material does not specify any conditions under which Box 53 (Assignment of Benefits Certification Indicator) should be used. The table of contents entry merely identifies the field name and its page location in the PDF. ^[1] Without explicit instruction from the source, no claims about inpatient, outpatient, or other use cases can be made. In typical UB-04 billing, this indicator may convey whether the patient has assigned benefits to the provider, but the provided text does not confirm that usage. Consequently, providers are advised to consult the full Maryland Medicaid document or relevant payer manuals for definitive guidance.

Step-by-Step Claim Example

The source provides no example or illustration of how to complete Box 53 on a UB-04 claim. ^[1] Without a worked example or data values described in the source, it is impossible to construct a step-by-step claim scenario. Any attempt to create an example would rely on external knowledge not permitted by the rules. Therefore, this section cannot be completed using the available information alone.

Common Mistakes & Audit Red Flags

The source does not list common mistakes, audit red flags, or editing rules for Field 53. ^[1] No data regarding acceptable values, required indicators, or rejection patterns is present. As a result, no assessment of potential errors can be derived from the provided content. Billing professionals should refer to the full Medicaid provider manual or contact their fiscal intermediary for compliance guidance.

Related Codes/Fields

The source document’s table of contents lists several adjacent fields, but it does not describe any relationships or dependencies with Field 53. The following table reproduces the neighboring fields as shown in the source:

UB-04 Field	Field Name	Source Reference
FL 52	Release of Information Certification Indicator	[1]
FL 53	Assignment of Benefits Certification Indicator	Same as above
FL 54	Prior Payments – Payer	Same as above
FL 55	Estimated Amount Due	Same as above

No explicit linkage between these fields is stated. The source does not indicate whether the assignment of benefits indicator must align with any other field on the claim.

Given the limitations of the source, this article represents the maximum content that can be produced in strict adherence to the rule that every sentence must be traceable to the provided document.

---

References

[1] Maryland Medicaid — FL 53 — https://health.maryland.gov/mmcp/provider/Documents/ffs-billing/UB04-Hospital-Billing-Instructions%20%281%29.pdf