1st Quarter 2007

The UB-04 Claim Form Has Arrived

By Qasim Zaidi and John McDermott

Although the current hospital claim form, the UB-92, has been the industry standard for over 14 years, an updated version, the UB-04, will soon replace it, and manufacturers should be prepared to update printed materials that reference it and answer customer questions about it.

The UB-04 is the third revision of hospital claim forms that had their origin over 30 years ago. In 1975, the American Hospital Association (AHA) formed the National Uniform Billing Committee (NUBC) to create a standardized billing form and data set that institutional providers and payers could use nationwide. In 1982, the NUBC endorsed the first standardized billing form, called the UB-82. This form was the standard hospital billing form until 1992, when the NUBC updated the UB-82 to create the UB-92. Currently, the UB-92 is the 'de-facto' billing form used by 98 percent of institutional healthcare providers. ¹

During 2002, the NUBC undertook a review of the UB-92 form primarily to accommodate the Health Insurance Portability and Accountability Act (HIPAA) mandated National Provider Identifier (NPI) number. HIPAA mandates that all health care providers begin billing using their NPI number starting May 23, 2007. In addition, the NUBC was also concerned about the ability to recognize and allow for the eventual implementation of the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) code set.

The finalized version of the UB-04, approved by the NUBC in February 2005, accommodates both of these concerns, in addition to several other updates. Some key changes include the ability to report up to 16 diagnosis codes (the UB-92 only allowed for the reporting of a maximum of nine diagnosis codes); the ability to specify which diagnoses were present at patient admission; and the inclusion of a "Code-Code Field" which allows for the reporting of external (non-NUBC) code sets, often important to the adjudication or review of claims not billed to Medicare.

Below are the key dates for the implementation of the UB-04 form:

• March 1 through May 22, 2007- During this transitional period, institutional providers may begin using the new UB-04 , but may still use the UB-92.
  
• May 23, 2007- Medicare contractors will no longer accept the UB-92 form. Providers must bill all claims using the new UB-04 form.

If you have billing guides or other reimbursement materials that reference the UB-92, please contact Covance for assistance with updating them so that your customers do not experience any claims delays or denials.

1 www.nubc.org/history