2011 nubc manual for ub04

Admission type code 9 and admission source code 9 are not allowed. The 2021 edition contains the updated specifications for the data codes included on the uniform bill claim form. No other publication governmental or privatecommercial can be considered authoritative. Official ub04 data specifications manual 2012 nubc, 2011. The ub04 manual national uniform billing data element specifications as developed by the nubc current revision should be. Select the appropriate code from the nubc ub04 manual. For information on the ub04 billing form, or to obtain an official ub04 data specifications manual, visit the national uniform billing committee nubc web site at.

Although the form is similar in appearance to the older version of the facility claim form, ub92, a number of fields have been moved or expanded and. Providers may purchase the national ub04 uniform billing manual by writing or calling. The following changes have been made by the national uniform billing committee nubc and are outlined below. Patient discharge status \2 positions, numeric\\r\rrequired\r\rnote.

Residential care home billing guide for the ub04 mass. The nubc official ub04 data specifications manual includes a number of questions and answers related to the appropriate use of these codes. Manual, visit the national uniform billing committee nubc web site at thank you for helping us process your claims efficiently and accurately. Each digit has a specific purpose and is required on all ub04 claims. This form, also known as the ub04, is a uniform institutional provider bill suitable for. The national uniform billing committee nubc has approved the new ub04 cms1450 as the replacement for ub92. Follow link may 1998 january 2020 nubc minute archive.

A ub04 with field descriptions and instructions is included in the link below. Completing the ub04 claim form guidelines for facilityinstitutional providers medica follows national and state uniform billing guidelines for the submission of ub04 claim forms, although some fields required by medicare or other payers may not be necessary for medica claims. A reserved for assignment by the nubc discontinued effective 1012007. Instructions for completing the ub04 claim form the ub04 claim form is used to submit claims for inpatient and outpatient services by institutional facilities for example, outpatient departments, rural health clinics, chronic. If you submit electronic claims through a clearinghouse, please contact the clearinghouse directly if you have a question specific to submitting a claim or receiving an electronic remittance advice. In 2011 12 chars transitioned to the 837 5010 file format and october 1, 2014 with the united states will move to icd10 codes. All code values listed in the nubc ub04 reference manual for each form locator ub04 claim form medical. This manual, ed by the american hospital association, is the only official source of ub data. Tips for completing the ub04 cms1450 claim form revised 04. In order for the nubc to properly and efficiently consider change requests, each request must be accompanied. For information on the ub04 billing form, or to obtain an official ub04 data specifications manual, visit the national uniform billing committee nubc web site at thank you for helping us to process your claims efficiently and accurately. American hospital association national uniform billing committee 29th fl 1.

The ub04 claim form is a hardcopy facility claim form recently redesigned to accommodate various changes to facility claims filing necessitated by current and upcoming governmental initiatives. No other publicationgovernmental or privatecommercialcan be considered authoritative. Medicare administrative contractors servicing both part a and part b lines of business ab macs a and. New patient discharge status codes type of bills tob 32x and 34x. Ub04 facility type code medical billing uses threedigit codes on a claim form to describe the type of bill a provider is submitting to a payor. You can access the ub04 billing information adopted by the nubc by subscribing.

To view a sample cmcm ub04 claim form, see appendix a. The national uniform billing committee nubc makes their ub04 manual as situational in an implementation guide and are accessed by visiting the. The official source of ub04 billing information adopted by the national uniform billing committee nubc. Apr 1, 2004 additionally, all codes that have been approved by the nubc and that were not newly approved codes have a specific effective date. Uniform billing committee uniform billing form 2004 nubc ub04 and the asc.

Jan 05, 2015 the national uniform billing committee nubc makes their ub04 manual as situational in an implementation guide and are accessed by visiting the. Instructions for completing the ub04 claim form the ub04 claim form is used to submit claims for inpatient and outpatient services by institutional facilities for example, outpatient departments, rural health clinics, chronic dialysis and adult day health care. See also claim frequency code in this documentation. Aarp health insurance plans pdf download medicare replacement pdf download aarp medicarerx plans united healthcare pdf download. Dec 4, 2018 identify the section in the provider manual related to ub04 claim form completion icd10cm diagnosis codes and icd10 pcs codes on a claim to ensure payment at the nubc ub04 data specifications manual. Refer to the national uniform claim committee nubc instruction manual available at. The national uniform billing committee nubc is responsible for the design. Dec 29, 2011 sparcs x12837 input data specifications. Cmcm providers who choose to submit their claims on paper forms must use the national uniform billing committee nubc ub04 claim form.

New ub04 cms 1450 claim instructions for hospital services. The joint commission is aware that there are additional ub04 allowable. Ub04 revenue code requirements for behavioral health services. Snf billers work with hundreds of diagnosis and procedure codes, known as icd9cm, hcpcs, and cpt codes. However, in some cases, hmsa varies from nubc directions concerning whether a specific field is required or how the data is to be entered in a specific field. The official ub04 data specifications manual 2020, ed by the american hospital association, is the only official source of ub04 billing information adopted by the national uniform billing committee nubc.

American hospital association national uniform billing committee 29th fl 1 n franklin chicago il 60606 312 4223390. Official ub04 data specifications manual 2020 page 20. Technical assistance conference call hrsarhcclaims5010. The revision date and national uniform billing committee nubc designated the publication cpt 200x x to current. New york state electronic medicaid system ub04 billing. R2250cp 07012011 nonsystems internet only manual iom. The ub04 is the replacement for the ub92 form and represents the culmination of a fouryear study that involved numerous public surveys and discussions at various nubc meetings. This manual, ed by the american hospital association, is the only. Emedny information assisted living program alp version 2011 01 61 2011 page 2 of 9. Hospital discharge data system user manual august 2018 5 background in 1975, the american hospital association aha brought the national uniform billing committee nubc together to develop a single billing form and standard dataset that could be used nationwide by institutional providers and payers for handling healthcare claims. How to code the ub04 billing medicare part a for snf services is a game of numbers, but, believe it or not, the digits of interest are not dollar amounts.

Enter the appropriate threecharacter type of bill code as specified in the national uniform billing committee nubc ub04 data specifications manual. It is a refresher from the provider billing manual. Healthpartners follows guidelines outlined in the minnesota companion guides and in the nubc ub04 manual for submission of claims. Aarp health insurance plans pdf download medicare replacement pdf download aarp. Information on ordering the nubc official ub04 data specifications manual and how to become a nubc subscriber is available on the nubc website. Form completion instructions handwritten claims should be printed neatly using black ballpoint pen only.

In compliance with anthem behavioral health policy, the following revenue codes must be used when submitting claims for behavioral health services billed on ub04 claim forms for members of anthem blue cross and blue shields behavioral health plans. This manual does not address all the complexities of medicaid policies bms will distribute new, revised, or clarified information, as applicable to all or specific manuals, nubc national uniform billing. R761otn pdf, 16mb cms location of b75xx if the reason code is to send a claim to the post pay driver 06 foster child. Kaiser permanente will continue to accept ub92 form based on cms guidelines. Uniform billing committee nubc at its february 2005 meeting. The chars procedure manual and chars companion guide supplement the national. Admission or visit codes to the ub04 cms1450 manual code list.

Becoming on national uniform billing committee subscriber to the ub04 manual. Blue shield of oklahoma offers this guide to help you complete the ub04 form for your patients with blue cross facility coverage. National uniform billing committee official data specifications manual. Ub04 claim form this document explains the ub04 claim form, which is used for submitting claims for reimbursement for specially designated facilities. The instructions included in this section are excerpts from medicare instructions rev. Ub04 data spec manual accounting institute seminars fl 3536 occurrence span codes and dates. Finance medicare nubc manual for specific codes illinois. Kaiser will begin to accept the new ub04 on october 1, 2006. Masshealth billing guide for the ub04 executive office of.

Ub04, claims data, data elements, field locators created date. Dataelem0270 manual performance measurement network. The source of this code is the ub04 manual, form locator 4, bill classification except clinics and special facilities category. The national uniform billing committee nubc maintains lists of approved coding for the form.

Please refer to the manual for detailed\ answers to billing questions. Ub04 submission and timeliness instructions ub sub. Completing the ub04 claim form guidelines for facility. Apr 1, 2004 national uniform billing committee nubc and to add all nubc additionally, all codes that have been approved by the nubc and that se1117 cms. The type of bill code includes the twodigit facility type code and onecharacter claim frequency code. The fi must be able to capture all nubcapproved input data described in section 75 of the medicare claims processing manual chapter 25 for audit trail purposes and be able to pass all data to other payers. Per the national uniform billing committee nubc, the priority type of admission or visit code is required for all institutional claims. As a result, the nubc introduced several new data elements to the ub04 to further improve the. Refer to the appropriate part 2 provider manual section. In 201112 chars transitioned to the 837 5010 file format. You can access the ub04 billing information adopted by the nubc by subscribing to the official ub04 data specifications manual. Created as an adobe portable document file pdf that allows users to print or.

Chapter 25 completing and processing the form cms1450 data set. It is to be used as a companion to, and not a replacement. Only typed, handwritten or computerprinted forms can be scanned by optical. Many types of providers use the ub04 claim form to bill. National ub04 uniform billing manual contains important coding information not available in these instructions. Ub04 revenue code requirements for behavioral health. As a result, the nubc introduced several new data elements to the ub04 to. Effective august 1, 2011, the nubc has updated instructions for reporting units that now allows for fractional unit billing, therefore, cms is now providing notice that the exception to bill whole units on paper ambulance claims is now rescinded. Each client is allowed a maximum of 260 units which can be billed over a two and a half year time period. National uniform billing committee nubc update to chapter 25. Hospital discharge data system user manual august 2018 7 numerous and significant changes have been made to the ub04 manual from 2011 through 2018.

Data collection in the ub04 format began may 2007 with the file format also switching to the 837i 4010 standard. Up to four 4 15 minute units can be billed per service date. Chars 837i 5040 companion guide washington state department. National uniform billing committee nubc, effective april 1, 2004, that specifies cms manual system. Some fields have been changed, or codes have been added or deleted for existing fields. Point of origin codes update to the ub04 cms1450 manual code list national uniform billing committee nubc, will be accepted into the fiscal. This fourdigit alphanumeric code gives three specific pieces of cms manual system cms. Shield of texas offers this guide to help you complete the ub04 form for your patients with blue cross facility coverage. Billing guide for the ub04 how to complete the ub04 claim form cont. The following facility type codes are a subset of the national uniform billing committee nubc ub04 data specifications manual facility type codes commonly used by medical. Dec 4, 2011 refer to the national uniform claim committee nubc instruction manual enter the code indicating the disposition or discharge status. The following fields have been updated to match the fields in the nubc manual. Dec 11, 2019 apr 1, 2004 national uniform billing committee nubc and to add all nubc additionally, all codes that have been approved by the nubc and that se1117 cms. Nubcnucc meeting summaries public health data standards mar 16, 2010 year, nubc will draft a recommendation for oct 1, 2011.