HIPAASOC2
Process UB-04 Institutional Claim Extractor — HIPAA Compliant
Healthcare organizations process thousands of documents daily. Manual processing delays patient care and increases compliance risk.
138
Fields Extracted
300s
Max Processing
Common Pain Points
- HIPAA violations cost $50K-$1.5M per incident
- Manual processing delays patient care
- Paper-based workflows increase error rates
- Audit preparation takes weeks without structured data
What This Template Does
AI-powered extraction using gemini-2.5-flash. Part of 113 production-ready templates.
Capabilities
- Healthcare Extraction
- Institutional Claims
- Ub 04 Extraction
- Claims
- Ub 04
Output Schema
{
"$schema": "http://json-schema.org/draft-07/schema#",
"title": "UB-04 Institutional Claim Extraction Schema",
"description": "Schema for extracted institutional/hospital claim data from UB-04 (CMS-1450) forms",
"type": "object",
"required": [
"document_type",
"provider_info",
"patient_info",
"revenue_lines",
"diagnosis_codes"
],
"properties": {
"document_type": {
"type": "string",
"const": "ub_04",
"description": "Document type identifier
...Quick Start
$ pip install doclayer
$ doclayer process document.pdf --agent healthcare.ub-04
See It In Action
Real extraction example showing input document and structured output.
Input Document
===============================================================================
UB-04 (CMS-1450)
INSTITUTIONAL CLAIM FORM
===============================================================================
PAGE 1 OF 1 CREATION DATE: 12/15/2024
===============================================================================
PROVIDER INFORMATION (FL 1-5)
======================================Extracted Data
{
"document_type": "ub_04",
"provider_info": {
"fl_1_provider_name": "Midwest Regional Medical Center",
"fl_1_address": {
"street": "2500 Healthcare Drive",
"city": "Springfield",
"state": "IL",
"zip": "62701"
},
"fl_2_pay_to_name": null,
"fl_2_pay_to_address": null,
"fl_3a_pat_control_number": "MR-2024-885521",
"fl_3b_med_rec_number": "MRN-445566778",
"fl_4_type_of_bill": "0111",
"fl_5_fed_tax_id": "37-XXXXXXX",
"fl_56_npi": "1987654321",
"fl_57_other_provider_id": "IL-HSP-0012345"
},
"type_of_bill_breakdown": {
"first_digit": "1 - Hospital",
"second_digit": "1 - Inpatient (Part A)",
"third_digit": "1 - Admit Through Discharge",
"description": "Hospital Inpatient - Admit Through Discharge"
},
"patient_info": {
"fl_8a_patient_id": "ID-998877665",
"fl_8b_patient_name": "Anderson, James Michael",
"fl_9_patient_address": {
"street": "1847 Maple Street",
"city": "Springfield",
"state": "IL",
"zip": "62704",
"country": "USA"
},
"fl_10_birthdate": "1958-03-25",
"fl_11_sex": "M",
"fl_12_admission_date": "2024-12-08",
"fl_13_admission_hour": "14",
"fl_14_admission_type": "1",
"fl_15_admission_source": "7",
"fl_16_discharge_hour": "11",
"fl_17_discharge_status": "01"
},
"condition_codes": {
"fl_18_28": [
"P7",
"02"
]
},
"occurrence_codes": {
"fl_31_34": [
{
"code": "11",
"date": "2024-12-08"
},
{
"code": "17",
"date": "2024-12-08"
}
]
},
"occurrence_span_codes": {
"fl_35_36": []
},
"value_codes": {
"fl_39_41": [
{
"code": "01",
"amount": "$0.00"
},
{
"code": "06",
"amount": "$2,500.00"
}
]
},
"revenue_lines": [
{
"fl_42_rev_code": "0121",
"fl_43_description": "Room-Board/Semi",
"fl_44_hcpcs_cpt": null,
"fl_44_modifiers": [],
"fl_45_service_date": null,
"fl_46_units": 7,
"fl_47_total_charges": "$14,000.00",
"fl_48_non_covered": "$0.00"
},
{
"fl_42_rev_code": "0250",
"fl_43_description": "Pharmacy",
"fl_44_hcpcs_cpt": null,
"fl_44_modifiers": [],
"fl_45_service_date": null,
"fl_46_units": 1,
"fl_47_total_charges": "$3,847.50",
"fl_48_non_covered": "$0.00"
},
{
"fl_42_rev_code": "0258",
"fl_43_description": "IV Solutions",
"fl_44_hcpcs_cpt": null,
"fl_44_modifiers": [],
"fl_45_service_date": null,
"fl_46_units": 1,
"fl_47_total_charges": "$1,245.00",
"fl_48_non_covered": "$0.00"
},
{
"fl_42_rev_code": "0270",
"fl_43_description": "Med-Sur Supplies",
"fl_44_hcpcs_cpt": null,
"fl_44_modifiers": [],
"fl_45_service_date": null,
"fl_46_units": 1,
"fl_47_total_charges": "$892.75",
"fl_48_non_covered": "$0.00"
},
{
"fl_42_rev_code": "0300",
"fl_43_description": "Laboratory",
"fl_44_hcpcs_cpt": null,
"fl_44_modifiers": [],
"fl_45_service_date": null,
"fl_46_units": 1,
"fl_47_total_charges": "$2,156.00",
"fl_48_non_covered": "$0.00"
},
{
"fl_42_rev_code": "0320",
"fl_43_description": "DX X-Ray",
"fl_44_hcpcs_cpt": "71046",
"fl_44_modifiers": [],
"fl_45_service_date": null,
"fl_46_units": 2,
"fl_47_total_charges": "$845.00",
"fl_48_non_covered": "$0.00"
},
{
"fl_42_rev_code": "0351",
"fl_43_description": "CT Scan-Head",
"fl_44_hcpcs_cpt": "70450",
"fl_44_modifiers": [],
"fl_45_service_date": null,
"fl_46_units": 1,
"fl_47_total_charges": "$2,450.00",
"fl_48_non_covered": "$0.00"
},
{
"fl_42_rev_code": "0730",
"fl_43_description": "EKG/ECG",
"fl_44_hcpcs_cpt": "93000",
"fl_44_modifiers": [],
"fl_45_service_date": null,
"fl_46_units": 1,
"fl_47_total_charges": "$425.00",
"fl_48_non_covered": "$0.00"
},
{
"fl_42_rev_code": "0410",
"fl_43_description": "Respiratory Svc",
"fl_44_hcpcs_cpt": "94640",
"fl_44_modifiers": [],
"fl_45_service_date": null,
"fl_46_units": 8,
"fl_47_total_charges": "$1,680.00",
"fl_48_non_covered": "$0.00"
},
{
"fl_42_rev_code": "0272",
"fl_43_description": "Sterile Supply",
"fl_44_hcpcs_cpt": null,
"fl_44_modifiers": [],
"fl_45_service_date": null,
"fl_46_units": 1,
"fl_47_total_charges": "$567.25",
"fl_48_non_covered": "$0.00"
},
{
"fl_42_rev_code": "0001",
"fl_43_description": "Total Charges",
"fl_44_hcpcs_cpt": null,
"fl_44_modifiers": [],
"fl_45_service_date": null,
"fl_46_units": null,
"fl_47_total_charges": "$28,108.50",
"fl_48_non_covered": "$0.00"
}
],
"payer_info": {
"primary": {
"fl_50_payer_name": "Medicare Part A",
"fl_51_health_plan_id": "00308",
"fl_52_release_info": "Y",
"fl_53_assignment": "Y",
"fl_54_prior_payments": "$0.00",
"fl_55_est_amount_due": "$22,486.80",
"fl_58_insured_name": "Anderson, James M",
"fl_59_relationship": "01",
"fl_60_subscriber_id": "1EG4-TE5-MK72",
"fl_61_group_name": "Medicare",
"fl_62_insurance_group": null,
"fl_63_treatment_auth": null,
"fl_64_document_control": null,
"fl_65_employer_name": "Retired"
},
"secondary": {
"fl_50_payer_name": "AARP Medigap",
"fl_51_health_plan_id": "62308",
"fl_58_insured_name": "Anderson, James M",
"fl_60_subscriber_id": "AARP-8899776655"
},
"tertiary": null
},
"diagnosis_codes": {
"fl_66_icd_version": "0",
"principal_diagnosis": {
"fl_67_code": "J18.9",
"fl_67a_poa": "Y"
},
"other_diagnoses": [
{
"code": "J96.01",
"poa": "N"
},
{
"code": "I10",
"poa": "Y"
},
{
"code": "E11.9",
"poa": "Y"
},
{
"code": "J44.1",
"poa": "Y"
}
],
"fl_69_admitting_diagnosis": "J18.9",
"fl_70_patient_reason": [
"R05.9",
"R06.02",
"R50.9"
],
"fl_71_pps_code": "193",
"fl_72_external_cause": []
},
"procedure_codes": {
"fl_74_principal_procedure": null,
"fl_74_other_procedures": []
},
"attending_provider": {
"fl_76_npi": "1122334455",
"fl_76_qualifier": null,
"fl_76_id": null,
"fl_76_name": "Chen, David L MD"
},
"other_providers": {
"operating": null,
"other_1": {
"fl_78_79_npi": "2233445566",
"fl_78_79_qualifier": "DN",
"fl_78_79_name": "Patel, Meera K MD"
}
},
"remarks": {
"fl_80_remarks": "Patient admitted via ER with community-acquired pneumonia. Responded well to IV antibiotics. Discharged home in stable condition with oral antibiotics and follow-up in 7 days."
},
"totals": {
"fl_47_total_charges": "$28,108.50",
"fl_48_total_non_covered": "$0.00",
"page_of": "1 of 1",
"creation_date": "2024-12-15"
},
"calculated_fields": {
"total_revenue_lines": 10,
"total_covered_charges": "$28,108.50",
"length_of_stay": 7
},
"validation": {
"tob_valid": true,
"required_fields_present": true,
"revenue_codes_valid": true,
"icd_codes_valid": true,
"npi_format_valid": true,
"charges_sum_correctly": true,
"dates_logical": true,
"poa_required_present": true
}
}Example UB-04 hospital claim for inpatient stay with multiple procedures and revenue codes. Demonstrates extraction of institutional billing data, length of stay, and facility charges.
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Frequently Asked Questions
What documents can UB-04 Institutional Claim Extractor process?
The UB-04 Institutional Claim Extractor template processes healthcare documents including various formats and layouts. See the instructions for specific document types supported.
How accurate is the UB-04 Institutional Claim Extractor extraction?
The UB-04 Institutional Claim Extractor template uses Gemini 2.5 Flash for high-accuracy extraction. Results include confidence scores for each field.
Can I customize the UB-04 Institutional Claim Extractor template?
Yes, you can modify the extraction schema, add custom fields, or adjust the instructions to match your specific requirements.
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