MIR-2006-9AB, September 2006

Uniform Billing (UB-04) Implementation – UB-92 Replacement (MM5072)

Provider Types Affected
All providers who bill Medicare fiscal intermediaries (FIs), including regional home health intermediaries (RHHIs), using the UB-92

Provider Action Needed

Impact to You
The UB-04 is replacing the UB-92. You may begin using it on March 1, 2007, during an initial transitional period. Starting May 23, 2007, all of your paper claims must use the UB-04 since the UB-92 will no longer be acceptable.

What You Need to Know
CR5072 announces the replacement of the UB-92 by the UB-04, effective March 1, 2007. The UB-04, which is only accepted from institutional providers that are excluded from the mandatory electronic claims submission requirements, incorporates the National Provider Identifier (NPI), taxonomy, and additional codes.

What You Need to Do
Make sure that your billing staffs are aware of this new uniform institutional provider bill form for paper claims.

Background
At its February 2005 meeting, the National Uniform Billing Committee (NUBC) approved the UB-04 (CMS-1450) as the replacement for the UB-92. Effective March 1, 2007, institutional claim filers such as hospitals, skilled nursing facilities, hospices, and others can begin using the UB-04, with a transitional period between March 1, 2007 and May 22, 2007, during which time either the UB-92 or the UB-04 may be used.

Starting May 23, 2007, all institutional paper claims must be submitted on the UB-04. The UB-92 will no longer be acceptable, even as an adjustment claim, after May 22, 2007.

UB-04
The UB-04 is the basic form that the Centers for Medicare & Medicaid Services (CMS) prescribes for the Medicare program. It is only accepted from institutional providers that are excluded from the mandatory electronic claims submission requirements set forth in the Administrative Simplification Compliance Act, Public Law 107-105 (ASCA), and the implementing regulation at 42 CFR 424.32.

It incorporates the National Provider Identifier (NPI), taxonomy, and additional codes. (Please refer to the crosswalk file attached to CR5072 to show how data elements crosswalk from the UB-92 to the UB-04.)

Note that while most of the data usage descriptions and allowable data values have not changed on the UB-04, many UB-92 data locations have changed, and in addition, bill type processing will change.

There are a few details that you should be aware of:

• The UB-04 (Form CMS-1450) is a uniform institutional provider bill suitable for billing multiple third-party payers. A particular payer, therefore, may not need some of the data elements.
• When filing, you should retain the copy designated “Institution Copy” and submit the remaining copies to your FI, managed care plan, or other insurer.
• Instructions for completing inpatient and outpatient claims are the same unless otherwise noted.
• If you omit any required data, your FI will either ask you for them or obtain them from other sources and will maintain them on its history record. It will not obtain data that are not needed to process the claim.
• Data elements in the CMS uniform electronic billing specifications are consistent with the Form CMS-1450 (another name for the UB-04) data set to the extent that one processing system can handle both. The definitions are identical, although in some situations, the electronic record contains more characters than the corresponding item on the form because of constraints on the form size not applicable to the electronic record. Further, the revenue coding system is the same for both the Form CMS-1450 and the electronic specifications.
• Also note that CMS is accepting valid NPIs on the UB-04 between March 1, 2007 and May 22, 2007, and the NPI is required as of May 23, 2007.

Additional Information
You can find more information about the UB-04 (Form CMS-1450) by going to CR5072, located at http://www.cms.hhs.gov/Transmittals/downloads/R1018CP.pdf    on the CMS Web site.

Included with this CR are the following:

• A copy of the UB-04 form (front and back) in PDF format (Attachment E)
• The UB-92-to-UB-04 crosswalk (Attachment B)
• UB-04 mapping to the HIPAA institutional 837 (Attachment C)
• The revised portion of the Medicare Claims Processing Manual, Chapter 25 (Completing and Processing the CMS-1450 Data Set), Sections 70 (Uniform Bill - Form CMS-1450 (UB-04)) and 71 (General Instructions for Completion of Form CMS-1450 (UB-04)) (Attachment A). These sections contain very detailed instructions for completing the form.

If you have any questions, please contact your FI/RHHI at their toll-free number, which may be found at http://www.cms.hhs.gov/MLNProducts/downloads/CallCenterTollNumDirectory.zip   on the CMS Web site.

Disclaimer
This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.

Effective Date: March 1, 2007
Implementation Date: March 1, 2007

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