CMS 1450 (UB04) Compatibility

The UB-04 (Universal Billing Form 04) is the replacement for the UB-92.

The UB-04, which is only accepted from institutional providers that are excluded from the mandatory electronic claims submission requirements, incorporates the National Provider Identifier (NPI), taxonomy, and additional codes.

Beginning with KIP Deluxe version 10.3.48, the UB04 form compatibility was established.

The UB-04 is the basic form that the Centers for Medicare & Medicaid Services (CMS) prescribes for the Medicare program. It is only accepted from institutional providers that are excluded from the mandatory electronic claims submission requirements set forth in the Administrative Simplification Compliance Act, Public Law 107-105 (ASCA), and the implementing regulation at 42 CFR 424.32.

It incorporates the National Provider Identifier (NPI), taxonomy, and additional codes. (Please refer to the crosswalk file attached to CR5072 to show how data elements crosswalk from the UB-92 to the UB-04.)

Note that while most of the data usage descriptions and allowable data values have not changed on the UB-04, many UB-92 data locations have changed, and in addition, bill type processing will change.

There are a few details that you should be aware of:

* The UB-04 (Form CMS-1450) is a uniform institutional provider bill suitable for billing multiple third-party payers. A particular payer, therefore, may not need some of the data elements.
* When filing, you should retain the copy designated “Institution Copy” and submit the remaining copies to your FI, managed care plan, or other insurer.
* Instructions for completing inpatient and outpatient claims are the same unless otherwise noted.
* If you omit any required data, your FI will either ask you for them or obtain them from other sources and will maintain them on its history record. It will not obtain data that are not needed to process the claim.
* Data elements in the CMS uniform electronic billing specifications are consistent with the Form CMS-1450 (another name for the UB-04) data set to the extent that one processing system can handle both. The definitions are identical, although in some situations, the electronic record contains more characters than the corresponding item on the form because of constraints on the form size not applicable to the electronic record. Further, the revenue coding system is the same for both the Form CMS-1450 and the electronic specifications.
* Also note that CMS is accepting valid NPIs on the UB-04 between March 1, 2007 and May 22, 2007, and the NPI is required as of May 23, 2007.

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