UB-04 form will be required in 2007
The National Uniform Billing Committee (NUBC) has released the new UB-04 form and data set specifications that health care providers must use to process health care claims beginning in 2007, when the current UB-92 form and data set will be discontinued.
Providers will be able to transition to the new form between March 1 and March 22, 2007, when both the new and current forms/data sets will be accepted, but must begin using the new form and data set by May 23, 2007.
Health plans, clearinghouses, and other information support vendors must be ready to handle and accept the new form and data set by March 1, 2007. The NUBC, which maintains the standard billing data set for health care providers, revised the form and data set to better align with the Health Insurance Portability and Accountability Act’s transaction standard and other national standards.
For information on obtaining full-color proofs of the form for testing purposes, or a beta release of the corresponding data specifications manual, contact Todd Omundson, associate director of the American Hospital Association’s health data management group, at [email protected].
NPI transition plan announced by CMS
The Centers for Medicare & Medicaid Services (CMS) has announced a plan for transitioning to the National Provider Identifier (NPI) in the Medicare fee-for-service program.
As part of the movement toward administrative simplification, the Health Insurance Portability and Accountability Act (HIPAA), enacted in 1996, mandates the establishment of certain standards for use in electronic transactions such as health claims, health encounter information, and referral certification and authorization. The NPI is one of those mandated standards.
Under the CMS plan, Medicare claims must include the provider’s current or legacy Medicare number through Jan. 2, 2006. From Jan. 3, 2006 to Oct. 1, 2006, Medicare will accept a legacy number of NPI accompanied by a legacy number. From Oct. 2, 2006, to May 22, 2007, Medicare will accept a legacy number and/or an NPI.
Starting May 23, 2007, all HIPAA-covered health care providers must use an NPI. More information and instructions for applying for an NPI are available at the National Plan and Provider Enumeration System web site at https://nppes.cms.hhs.gov
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