Type of Bill (TOB)

Key facts

Maintained by

National Uniform Billing Committee (NUBC)

Claim location

Form locator 4 of the UB-04; also on the 837I

Structure

Facility type, bill classification, frequency

Common examples

11x inpatient hospital, 13x hospital outpatient, 21x SNF inpatient

What is type of bill?

Hospitals, nursing homes, home health agencies and other facilities bill on the institutional claim, the UB-04 paper form or its electronic equivalent, the 837I. The type of bill code tells the payer what kind of claim it is before it reads any line items.

The code is usually shown as three digits, sometimes with a leading zero. Each position has its own meaning, and the codes are maintained by the National Uniform Billing Committee (NUBC).

How the type of bill code is structured

Reading the three digits in order:

• First digit, type of facility: 1 hospital, 2 skilled nursing, 3 home health, 7 clinic, 8 special facility.
• Second digit, bill classification: for example inpatient, outpatient or, for clinics and special facilities, the specific subtype such as rural health clinic, FQHC, hospice or critical access hospital.
• Third digit, frequency: 1 admit through discharge, 7 replacement of a prior claim, 8 void or cancel of a prior claim, with other values for interim bills.

Why type of bill matters

Payers route and price claims by type of bill. A 13x claim is priced under outpatient rules, an 11x claim under inpatient rules, and a 71x or 77x claim under rural health clinic or FQHC rules. A wrong code can send a correct claim to the wrong payment system.

In claims analysis, type of bill is the fastest way to separate inpatient from outpatient facility spending, find replacement and void claims that should not be double counted, and identify which facility types a patient used.