Key Points of UB04 Claim Form The National Uniform Billing Committee approved the Uniform Bill (UB-04) paper claim in 2005 as a replacement of UB-92 paper form. According to latest regulations, all medical claims must be submitted using UB04 claim form. However, it only applies to claims that are submitted in paper, prominence of which is gradually decreasing today. The latest version of paper uniform bill by institutional healthcare providers and comprises of core data elements that are important for efficient claims processing in today’s mundane environment. The form is maintained by NUBC and contains a number of major improvements over UB-92, including improved alignment with electronic remittance advice. Comparison: UB-92 and UB-04 UB04 form, initiated by NUBC, includes major enhancements and improvements over and above UB-92. This includes – •Greater number of condition code fields, from 7 to 11 • Expanding the size of diagnosis field for accommodating ICD 10 medical codes, Presen on Admission reporting, and electronic remittance •Expanding procedure field size for accommodating ICD-10-PCS codes •Including three unique fields for E code reporting •Newer fields representing the current version of ICD classification used •Expanding number of fields for diagnosis, from 9 to 18 •Eliminating provider representative signature fields •Including three different fields for patient’s reason to visit •Revising physician fields including separate fields for National Provider Identifier and qualifications, first and last names •Three unique fields for E code reporting • Expanding line 23 under FL43-44, providing space for identifying multiple page claim forms and reporting of date the claim form was created Elements of UB-04 Form UB-04 forms include the following components, which are an enhancement of UB-92:
Patient’s Reason to Visit – In UB04, the reason for patient’s visit has a specific FL and is used for capturing as many as 3 reasons for visit codes for outpatient encounters. According to the manual, FL70a-c is used for outpatient claims for reporting ICD 9 Cm diagnosis codes that describe stated reason for seeking care. This might include patient distress, poisoning, injury, or a condition or reason such as pregnancy in labor or follow-up. Electronic Remittance – UB04 claim forms also include specifications for ERA, mentioning the requirements of submitting and managing claims electronically. ERA electronic remittance advice streamlines the claim reimbursement cycle, improving productivity by allowing healthcare providers to know in advance which claims have been paid and in what amount. It also helps in processing secondary claims much faster and minimizing the time to accounts receivables. POA Indicator It is the data element for UB-04 and has been made mandatory for inpatient payment systems in hospitals. POA indicator helps in identifying whether a medical condition was present during an order for inpatient admission, including different conditions developing during outpatient encounter such as observation, emergency department visit, or outpatient surgery. Cutting-edge UB04 software helps in addressing a wide range of business needs that are currently unmet. This includes indicator on institutional claims for different conditions that were “present on admission” and integrating ICD 10 code sets. It is important for medical billing professionals to be aware of the necessary changes that will dramatically affect claim submission process in paper and electronic environments as a result of UB04.