Winning in a converging world

1
Introducing the UB-04

Your Guide to Training
2
The
UB-04
3
History of the Uniform Bill

• Between 1968 1972, thirteen different form
  designs were developed and later discarded in an
  effort to develop a uniform bill for hospitals
• The 14th version was field tested in Georgia in
  1973, modified again, and introduced for a 2nd
  trial in Wyoming
• HCFA (aka CMS) agreed to participate in a five
  State pilot test of this latest version, known as
  UB-16-78
• A similar form was being used in NY State, known
  as UBF-1
• South Carolina was using a form known as A-92-R
• In May of 1982, The National Uniform Billing
  Committee reviewed the various forms and
  developed/approved the UB-82

4
History of the Uniform Bill(Continued)

• State Uniform Billing Committees were formed, to
  shift the focus from Nationwide to Statewide
• Implementation timelines were developed and plans
  made to disseminate State UB -82 manuals, which
  reflected the National guidelines coupled with
  unique State billing requirements
• The UB-82 had an 8 year moratorium on changes to
  the structure of the data set design. After
  numerous State surveys were sent, the NUBC sought
  to implement improvements, incorporating the best
  of the UB-82, along with other changes that
  further improved on the previous data set designs
• Hence, the UB-92 was formed, and fully
  implemented in 1994

5
History of the Uniform Bill(Continued)

• Following the close of a public comment period
  and careful review by the NUBC, the UB-04 was
  approved as the replacement for the UB-92 at the
  February 2005 meeting
• Health plans and clearing houses need to be ready
  to receive the new UB-04 by March 1, 2007.
  Submitters (Hospitals, Skilled Nursing
  Facilities, Hospices and other Institutional
  claims filers) can begin to use the UB-04 on
  March 1, 2007
• There is a transitional period between March 1,
  2007 and May 22, 2007, where both forms (UB-92 or
  UB-04) can be used
• Starting May 23, 2007, all Institutional paper
  claims must use the UB-04. The UB-92 will no
  longer be available for use after this date.

6
UB-04 Differences

• All Form Locators (FL) will be Nationally
  controlled (the UB-92 presently has both State
  and Local FL Assignments)
• All Code Ranges will be reserved for National
  assignment (The UB-92 presently has National and
  Local Code Ranges)
• The UB-04 Data Specs will be the principle
  content used in the HIPAA Electronic format (837)
• The UB-04 is designed to accept the forthcoming
  ICD-10-CM changes and support both National Payer
  and Provider ID s
• A National UB-04 manual is now available and
  published with hyperlinks developed that tie to
  individual State Uniform Billing Manuals

7
How Do I Prepare For TheUB-04?

• Contact your Patient Accounting System vendor and
  determine their timeline for releases associated
  with the UB-04
• Contact your EMC vendor and determine their
  timeline as well
• Establish a UB-04 task force internally and
  develop a work plan with specific names and
  dates, to assure a smooth transition
• Determine how new information will be captured
  (ie. Accident State Additional Condition
  Occurrence Span Codes Additional DXs, POA
  Indicators, and Code-to-Code Fields)
• Order UB-04 forms and begin hardcopy print
  testing
• Develop a transition plan to convert pre 5/23/07
  UB-92s to UB-04 for future filing to payers

8
FL 01
PROVIDER NAME
FL 01 Provider NameFL 01 Provider AddressFL 01
Provider City, State, ZipFL 01 Provider
Telephone FL 01 Provider FaxFL 01
Country Code Required Field The name and service
location of the provider submitting the
bill Country Codes Required when the address is
outside of the United States and are available
from American National Standards Institute 11
West 42nd St. 13th Floor New York, NY 10036

PROVIDER STREET ADDRESS
ST
ZIP
PROVIDER CITY
PROVIDER TELEPHONE
PROVIDER FAX
CC

9
FL 02
FL 02 Pay-To NameFL 02 Pay-To AddressFL 02
Pay-To City, State, Zip New Field Situational
Field Used when the pay-to name and address
information is different than the Billing
Provider in FL1 Can only identify a 5 digit zip
code Line 4 is not used and reserved for
assignment by NUBC


PAY-TO NAME
PAY-TO STREET ADDRESS
PAY-TO CITY
ST
ZIP
RESERVED FOR ASSIGNMENT BY NUBC

10
FL 03


FL 03a Patient Control Number FL 03bMedical
Record Number Moved / New Field Previously
in FL 23 Both are Required Fields

PATIENT CONTROL NUMBER
MEDICAL RECORD NUMBER

11

FL 04 05
FL 04 Type of Bill Required Field Expanded by
1 Digit The first digit is a leading zero The
next 2 digits indicate the type of bill (ie. 011
Hospital Inpatient) The fourth digit defines
the frequency of the bill FL 05 Federal Tax
Number Required Field Upper line is the federal
sub-ID assigned by the Provider Lower line is
entered as NN-NNNNNNN (with hyphen)

TOB

TIN

12
FL 06 07
FL 06 Statement Covers Period
From/Through Required Field The From date
should not be confused with the Admission Date
(FL 12). FL 07Unlabeled Not Used On the
UB-92 FL07 use to be Covered Days FL08 use to
be Non/Cvrd Days FL09 use to be Co-Ins. Days FL10
use to be L/T RSV Days All have been eliminated
from the UB-04 and substituted with new Value
Codes

UNLABELED
FROM THROUGH
13
FL 08
FL 08a Patient Name ID Required Field Report
if number is different from the
subscriber/insureds ID (FL60) FL 08bPatient
NameRequired Field On the paper form, use a
comma or space to separate last and first
names Record hyphenated names with the hyphen as
in Smith-Jones, Rebecca
PATIENT IDENTIFIER
PATIENT NAME
14
FL 09
FL 09 a-e Patient Address - StreetPatient
Address - CityPatient Address - StatePatient
Address - ZipPatient Address -
Country Code Required Field Previously in a
single field Zip code is 9 positions Country
Codes are available from American National
Standards Institute 11 West 42nd St. 13th
Floor New York, NY 10036
PATIENT ADDRESS - Street
PATIENT ADDRESS - City
ST
ZIP
CC
15
FL 10 11
FL 10 Patient Birth Date Required Field If
full birth date is unknown, use zeros for all
eight digits, for paper claims Enter MMDDYYYY
format FL 11Patient SexRequired Field The
sex of the patient as recorded at admission,
outpatient service, or start of care FL 11 on
the UB-92 use to be Unlabeled
PATIENT BIRTHDATE
SEX
16
FL 12 - 17
FL 12 Admission/Start of Care Date FL 13
Admission Hour FL 14Priority (Type) of Visit FL
15Source of Referral for Admission or Visit FL
16- required on IP claims Discharge HourFL
17Patient Discharge Status FL 16 on the UB-92
Patient Marital Status has been eliminated from
the UB-04 All are required fields, except FL 13
and FL 16, which are situational fields
17
FL 18 - 28
FL 18-28 Condition Codes Situational Fields 11
Total Condition Codes Codes are entered in
alphanumeric sequence (numbered codes precede
alphanumeric codes) No specific dates are
associated with this code If all of the
Condition Codes fields are filled, used FL 81
Code-Code Field with the appropriate qualifier
(A1) to indicate that a Condition Code is being
reported FL 23 on the UB-92 used to be Medical
Record Number, which has now been moved to FL3b
on the UB-04
18
FL 29 30
FL 29Accident State New Field Situational
Field Required when the services reported on
this claim are related to an auto accident and
the accident occurred in a country or location
that has a state, province, or sub-country code
named in X12 code source 22 FL 30Unlabeled Not
used reserved for assignment by NUBC
19
FL 31 - 34
FL 31-34Occurrence Codes Situational Fields 8
total Occurrence Codes Codes should be entered in
alphanumeric sequence (numbered codes precede
alpha codes) Enter all dates as month, day and
year MMDDYYYY FL 31 on the UB-92 was an
Unlabeled Field If all Occurrence Codes are
filled, then use FL 81 (Code-Code field) using
the appropriate qualifier (A2) to indicate than
an Occurrence Code is being reported
20
FL 35 - 37
FL 35Occurrence Span Code/From/Through Situation
al Field If all Occurrence Span Codes are
filled, then use FL 81 (Code-Code field) using
the appropriate qualifier (A3) to indicate than
an Occurrence Span Code is being reported FL
36Occurrence Span Code/From/Through Added
Additional Occurrence Span Code FL
37UnlabeledThe ICN/DCN on the UB-92 (FL 37),
has been Relocated to FL 64 on the UB-04
21
FL 38
FL 38Responsible Party Name / Address Situationa
l Field Used to print the name and mailing
address of the party responsible for the bill if
a window envelope is utilized
RESPONSIBLE PARTY NAME / ADDRESS
22
FL 39 - 41
FL 39-41Value Code / Amount Situational
Fields 12 total Value Codes Value Codes are
entered in alphanumeric sequence Fields 39a
through 41a must be completed before b line
fields, etc. Negative numbers are not permitted
except in FL 41 Report values in whole numbers,
right justified to the left of the dollars/cents
delimiter. The decimal is implied. If all of the
Value Code Fields are filled, used FL 81
(Code-Code) with the appropriate qualifier code
(A4) to indicate that a Value Code is being
reported.
23
FL 42 - 45
FL 42 (Lines 1-23) Revenue Code Required FL
43 (Lines 1-22) Revenue Code Description
RequiredFL 43 (Line 23) Page __ of __
Required Previously inside the Charge Body of the
UB-92 FormRequired on all pages FL 44 (Lines
1-22) HCPCS/Rates/HIPPS Rate Codes Situational
Expanded by 5 Digits 1 HCPCS and 4
modifiers FL 44-45 (Line 23) Creation Date
Required New Field FL 45 (Lines 1-22) Service
Date Situational Required on OP Claims
24
FL 46 - 49
FL 46 (Lines 1-22) Service Units Required
Field FL 47 (Lines 1-23)Total Charges Removed
Sign Field Required Field Reduced 1 Digit FL 48
(Lines 1-23)Non-Covered Charges Situational
FieldRemoved Sign Field Reduced 1 Digit Revenue
Code 0001 is used on the final page to indicate
total covered non-covered charges FL 49 (Lines
1-23)Unlabeled Not Used
25
FL 50 - 52
FL 50 a. Payer Name Prime


b. Payer Name 2ndary
c. Payer Name Tertiary Line A is
required, Lines B C are situational (FL 50 and
FL 51) FL 51 Situational Health Plan ID
(a,b,c) Report the HIPAA national health plan
identifier when it becomes mandatory FL 52
Required


Release of Information
- PrimaryRelease of
Information
-SecondaryRelease of Information
- Tertiary
26
FL 53 - 54
FL 53 Required


Assignment of
Benefits -
PrimaryAssignment of Benefits
-SecondaryAssignment of Benefits
- Tertiary FL 54 Situational



Prior Payments -
PrimaryPrior Payments
-SecondaryPrior Payments
- Tertiary The Patient Prior Payment Field has
been eliminated
27
FL 55 - 57
FL 55 Situational


Estimated Amount
Due - PrimaryEstimated
Amount Due -SecondaryEstimated
Amount Due -
Tertiary Eliminated the Due From Patient Field
from the UB-04 FL 56 Situational National
Provider ID FL 57 Situational



Other Provider ID
- PrimaryOther Provider ID
-SecondaryOther Provider ID
- TertiaryOther Provider identifiers
as assigned by the health plan
28
FL 58 59
FL 58 Required


Insureds Name
- PrimaryInsureds Name
-SecondaryInsureds Name
- Tertiary List last names first and use
a comma or space to separate last and first
names FL 59 Line A is required, Lines B C are
situational


Patients Relationship
-
PrimaryPatients Relationship
-SecondaryPatients Relationship
- Tertiary
29
FL 60
FL 60 Line A is required, Lines B C are
situational


Insureds Unique ID
- PrimaryInsureds Unique ID
-SecondaryInsureds Unique ID
-Tertiary
30
FL 61 62
FL 61 Situational


Insurance Group
Name - PrimaryInsurance
Group Name -SecondaryInsurance
Group Name -Tertiary FL
62 Situational


Insurance Group
Number - PrimaryInsurance
Group Number
-SecondaryInsurance Group Number
-Tertiary
31
FL 63 64
FL 63 Situational


Treatment
Authorization Code - PrimaryTreatment
Authorization Code -SecondaryTreatment
Authorization Code -Tertiary FL 64 Situational



Document Control Number FL 64
Employment Status Code on the UB-92 has been
deleted from the UB-04
32
FL 65
FL 65 Situational


Employer Name
- PrimaryEmployer Name
-SecondaryEmployer Name
-Tertiary
33
FL 66 - 68
FL 66 Required


DX Version
Qualifier Denotes ICD VersionFL 67 - Required
Principal DX Code Present on Admission
Indicator Positions 1 7 are for the DX
code(s) Position 8 (shaded area) are for POA
Indicator's) FL 67 A-Q Required



Other Diagnosis 18 Total Dxs (9 New) Note the
Shadowed Fields FL 68 UnlabeledNot used FL 66
on the UB-92 Employer Location has been deleted
from the UB-04
34
FL 69 - 71
FL 69 Situational


Admitting
Diagnosis Code The ICD Dignosis code describing
the patients diagnosis at the time of
admission Required on IP Claims FL 70
Situational


Patients Reason for
Visit Code Required for all unscheduled OP
visits FL 71 Situational Prospective Payment
System Code The PPS code assigned to the claim
to ID the DRG based on the grouper software
called for under contract with the primary payer
35
FL 72 73
FL 72 Situational


External Cause of
Injury Code The ICD Dx codes pertaining to
external cause of injuries, poisoning, or adverse
effects 2 new FLs (total of 3 E-Codes) on the
UB-04 Positions 1 7 are for the DX code
position 8 (shaded area) is for the POA
Indicator FL 73


Reserved for
Assignment by the NUBC Not used
36
FL 74 75
FL 74 Situational. Required for IP Claims (when
a procedure was performed)


Principal
Procedure Code /Date Reporting the decimal
between the 2nd and 3rd digits of the ICD is
unnecessary because it is implied Not used on OP
Claims FL 74a-e Situational


Other
Procedure Code /Date Not used on OP claims FL
75Reserved for Assignment by the NUBC Not used
37
FL 76 - 79
FL 76 All Situational


(1) Attending
NPI/QUAL/ID (2) Last/First Name


FL 77


(1)
Operating NPI/QUAL/ID (2) Last/First Name



FL 78 79


(1) Other ID
NPI/QUAL/ID (2) Last/First Name Provider type
Qualifiers DN Referring Provider ZZ Other
Operating MD 82 Rendering Provider Secondary ID
Qualifiers 0B State License 1G Provider
UPIN G2 Provider Commercial



38
FL 80 81
FL 80 SituationalRemarks Reduced Field
Size FL 81 a-d Situational Code-CodeQUAL/CODE/V
ALUE New Field See Qualifiers on next page FL
79 on the UB-92, Procedural Coding Method Used,
has been eliminated from the UB-04



UB-92 Form Locators 85 Provider Rep Signature
and Form Locator 86 Date Bill Submitted have
been eliminated from the UB-04
39
FL 81 (continued)Code-Code Qualifiers

• A1 NUBC Condition Codes (FL 18 28)
• A2 NUBC Occurrence Codes (FL 31 34)
• A3 NUBC Occurrence Span Codes (FL 35 36)
• A4 NUBC Value Codes (FL 39 41)
• B1 Standards for the Classification of Federal
  Data on Race and Ethnicity (for public health
  data reporting only when required by state or
  federal law or regulations)
• B2 Marital Status (for public health data
  reporting only when required by state or federal
  law or regulations)
• B3 Health Care Provider Taxonomy Code (code
  source ASC X12 External Code Source 682)
  (National Uniform Claim Committee)

40
Deleted, Discrete, DistinctUB-04 FL Changes
41
Eliminated ExpandedUB-04 FL Changes
42
Expanded UB-04 FLs
43
New UB-04 FLs
44
New UB-04 FLs and New Layout (continued)
45
Reduced Filed Size Relocated Removed Sign
UB-04 FL Changes
46
Thank you for your attention!
Questions?
47
For More Information Contact

• Steve Lutfy, FHFMA, MHSA
• Steve Lutfy, FHFMA, MHSA, is a Managing Director
  with PricewaterhouseCoopers, LLP and has greater
  than 25 years of hospital
• patient accounting experience, working in a
  variety of both large hospital systems and small
  community hospitals. Throughout his
• career, Steve has been exposed to all aspects of
  the Revenue Cycle, including areas of
  Pre-Admission, Admission, Financial
• Counseling, Billing (UB-92 and HCFA 1500),
  Follow-up, Customer Service, Collections and
  Compliance Programs.  Prior to
• joining the firm, Steve served as the Director of
  Patient Financial Services for Palmetto Richland
  Memorial Hospital, which is
• part of Palmetto Health Alliance in Columbia,
  S.C. Steve has a B.S. in Business Administration
  from the University of South
• Carolina and a Master of Health Services
  Administration from the Medical University of
  South Carolina. He is also a Fellow with
• the Healthcare Financial Management Association
  (HFMA) with a major in Patient Financial Services
  and serves as Chair for the
• State of South Carolinas Uniform Billing
  Committee (UB-92) through the South Carolina
  Hospital Association. Steve is a past
• President of the South Carolina Chapter of HFMA,
  past Chair of HFMAs National Patient Financial
  Services Forum, and past
• HFMA Chapter Liaison Representative (CLR) for
  Region V.  Steve is the current Chair of the
  State of South Carolinas Uniform
• Billing Committee, and runs PwCs National
  Virtual Business Office located in Columbia, SC.
• Steve can be reached at [phone] or by
  e-mail at stephen.g.lutfy_at_us.pwc.com