The 2020 UB-04 Manual Page 1 of 6 Introduction The uniform bill for institutional providers known as the UB-04 was approved by the National Uniform Billing Committee (NUBC) at its February 2005 meeting. The UB-04 is the replacement for the UB-92 form/data set and represented the culmination of a four-year study that involved numerous public surveys and discussions at various NUBC meetings. The members of the NUBC mutually agreed to the data elements for inclusion to the UB-04 Manual and the layout of the UB-04 form. The data elements referenced in the UB-04 Manual are also used in the electronic claim standard as called upon by the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Consequently, there was additional emphasis placed on aligning the reporting instructions to closely mirror the HIPAA claim standard for institutional providers. Other HIPAA changes included adding national identifier fields for providers and health plans. In addition to aligning the UB-04 to the electronic standard, the NUBC recognized the changing needs for information and its importance with respect to health services research and health policy development. As a result, the NUBC introduced several new data elements to the UB-04 to further improve the understanding of health care services. Most of the UB-04, however, is conceptually similar to earlier versions -- the UB-92 and UB-82. (The numeric suffix (i.e., 82, 92, and 04) references the year in which the NUBC approved the adoption of the data set.) UB-04 Implementation Transition History Receivers (health plans and clearinghouses) were to have been ready to receive the new UB-04 by March 1, 2007. Submitters (health care providers such as hospitals, skilled nursing facilities, hospice, and other institutional claim filers) could use the UB-04 beginning March 1, 2007 however, there was a transitional period between March 1, 2007 and May 22, 2007 where either the UB-04 or the UB-92 could be used. Starting May 23, 2007, all institutional paper claims must use the UB-04 the UB-92 is no longer acceptable. NPI and Legacy ID Reporting on UB-04 The reporting of the NPI on the UB-04 follows the NPI Final Rule which became effective May 23, 2008. FL 51 - Payer ID/Health Plan ID As a result of the publication 45 CFR Part 162 Administrative Simplification: Adoption of a Standard for a Unique Health Plan Identifier Final Rule, ASC X12 developed clarifications for a consistent implementation of this data in the HIPAA TR3s. However in 2018, the Department of Health and Human Services published a proposed rule to rescind the adopted standard unique health plan identifier (HPID) and the implementation specifications and requirements for its use and the other entity identifier (OEID) and implementation specifications for its use. The name and definition of FL 51 was updated in the 2015 UB-04 Manual in accord with the 837 005010X223A3 Errata Document which allows either a Payer Identification Number or Health Plan ID (HPID) to be sent. No change in the title of FL 51 has been made at this time. The UB-04 requirement is to simply report the number used to identify the payer or health plan it does not support dual use, and no differentiating qualifier is employed. National Uniform Billing Committee Official UB-04 Data Specifications Manual 2020 AHA © 2019 Single User License (Expires 6/30/2020) Please do not copy or distribute Version 14.00 July 2019 Page 5 of 292
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