The original Uniform Bill known as the UB-82 was introduced in 1982 by the National Uniform Billing Committee (NUBC) as its first attempt to devise a single hospital billing form that could be used nationally by most providers and payers. In 1992, after ten years of use, the UB-82 was updated and renamed the UB-92. The electronic HIPAA version of the Uniform Bill, known as the 837I, was introduced in 2003. It included the same data as the UB-92 and also several new fields and format changes required under HIPAA. In 2004, to better align the Uniform Bill with its new HIPAA equivalent, the NUBC introduced the UB-04, which officially replaced the UB-92 on March 1, 2007.
The UB-04 is also known as the CMS-1450 claim form. A wide range of facilities use the UB-04 or its electronic HIPAA equivalent. They include acute care facilities; SNFs; psychiatric, drug, and alcohol treatment facilities; stand-alone clinics; ambulatory surgery centers; subacute facilities; home health care agencies; and hospice organizations. The form is primarily designed for submitting claims for Medicare Part A reimbursement of both inpatient and outpatient services to Medicare FIs and MACs. Because of its flexibility, however, the UB-04 has also been adopted by most other payers as well. It is not used to report the charges of physicians, which are billed on the CMS-1500 claim form, also known as the 837P in its electronic HIPAA format.
The UB-04 claim form can be transmitted on paper or electronically. The electronic version is an EDI (electronic data interchange) transaction. In both formats, claims are usually created with a software program. The paper claim is transmitted to the payer on paper, however, and the EDI claim is transmitted from computer to computer. The advantages of EDI transmission include speed, economy, less possibility of data entry error, and faster turnaround. With HIPAA's mandate in 2003 that all but the smallest providers transmit data for Medicare claims electronically using the HIPAA claim, electronic claim transmission has become the predominant form.
When a claim meets all necessary specifications and passes all predetermined data edits, it is known as a clean claim. The patient account specialist aims to achieve clean-claim billing on all UB-04s. A claim that does not meet all the specifications of a clean claim is either denied or rejected by the payer. A provider cannot resubmit a denied claim but can appeal it. The reverse is true of a rejected claim: the provider can correct a rejected claim and resubmit it but cannot appeal it.
The UB-04 has eighty-one data elements contained in eighty-one different fields called form locators (FLs). The form locators on the UB-04 can be sequentially grouped into ten different sections based on similar types of data. The data included in each form locator are determined by Medicare's billing rules. In most cases, other payers have the same or similar rules. Most of the form locators are required fields for Medicare billing, and other payers' requirements may differ somewhat. The billing rules for each form locator specify (a) the type of data that must be entered in the field, (b) the format of the data, and (c) the number of characters-letters, numbers, symbols, or spaces-allowed. Specific formats for each form locator can be numeric, alphabetic, alphanumeric, or text-based.
Eleven form locators on the UB-04 are unlabeled. Seven of these fields (FLs 7, 30, 37, 49, 68, 73, and 75) are reserved for assignment by the NUBC and are not intended for provider use. The remaining four (FLs 1, 2, 38, and 67) are not labeled on the UB-04 but do have names in the documentation and are intended for provider use.
Each of the nine chapters that follow in Part 2 of this text provides a detailed walk-through of a group of form locators on the UB-04. Form locators are described and listed in numeric order, and guidelines, formatting examples, and billing and coding tips are provided. The detailed instructions apply mainly to Medicare claims. The billing entities are primarily acute care facilities, as the main focus of this text is the correct processing of inpatient and outpatient hospital claims.
