PBS 11: Assignment of Benefits
University of Wisconsin Medical Foundation
Patient Business Services Policies & Procedures
ASSIGNMENT OF BENEFITS (AOB)
__ __ New __X__ Revised
If Revised, Supersedes Policy Dated: 10-25-05
Effective Date: 12-1-05
Policy Number: PBS – 11
Approved By (Name): Connie Kinsella, Vice President, Patient Business Services
An Assignment of Benefits (AOB) form is an authorization from a patient to allow UWMF to
release the medical information necessary to process his/her insurance claims. It also authorizes
his/her insurer to make payment directly to UWMF.
To define the process of capturing Assignment of Benefits (AOB) for patients receiving services
at UWMF-managed and DFM teaching sites.
1. An Assignment of Benefits form (AOB) will be presented to patients for signature on an
annual basis. (Note, this is consistent with Medicare’s policy: extended signature
authorizations for office/outpatient services obtained by physicians are valid until revoked, as
long as they remain on file. However, Medicare advises that providers verify patient
information at regular intervals.)
2. Patients who refuse to sign an AOB, or modify it in such a way to refuse to accept financial
responsibility for balances after insurance payment, may be treated as self-pay patients.
1. At check-in, staff (Hub staff at 1 S. Park, 20 S. Park, East Towne and West Towne,
reception staff at all other sites), shall check the DAR to determine whether an AOB
needs to be captured. If so:
a. Print an AOB from Epic. See attached screen shots (if your site has programmed
Epic to automatically print AOBs at the beginning of each day, skip the section
relating to printing an AOB form).
b. Give the AOB to patient and request that s/he to sign the form. If the patient
requests a copy, make one and give it to the patient.
PBS 11: Assignment of Benefits
c. Enter the AOB information on the Additional Information Tab of the Interactive
Face Sheet. This will require you to access Registration from the Appointment
Desk. In addition to adding the Type of Document (AOB), enter Status [received,
received with exceptions (see #2) or refused (see #3)] and Date. See attached
d. Batch and send the AOB, via inter-D mail, to: PBS, Scanning, Excelsior Drive,
Mail Code 115-BUS.
2. If a patient completes the exceptions section relating to HIV, AODA, and/or behavioral
health, enter a status of Received with Exceptions. This will flag the patient’s record so
that services with diagnosis codes relating to HIV, AODA, and/or behavioral health can
be routed to a work queue and evaluated to ensure proper billing.
3. If a patient refuses to sign the AOB, enter a status of Refused. This information will pull
to the DAR so staff knows not to keep asking the patient to sign an AOB. However, it is
recommended that they periodically try to obtain an AOB from these patients, as it is to
the patient’s advantage to sign one.
4. If the patient asks to modify the AOB, inform the patient s/he may not do so (except if
s/he is doing so in the exceptions box related to HIV, AODA and/or behavioral health
treatment). For example, if a patient wants to modify the AOB language to state that s/he
will only be responsible for usual and customary charges, this is a change we cannot
1. Access Meditrieve via the icon on your desktop (if you do not have this and have a need
to access scanned documents, please submit an open call to the support center). You will
be able to retrieve scanned documents by patient name, patient MRN, document type,
type, or date. See attached screen prints for detailed instructions.
Screen Prints – Printing AOB & Recording Receipt of AOB in Prelude
Screen Prints – Retrieving Document from Meditrieve
Scanning of Financial Documents Policy