This Uniform Billing Manual is based on the National Uniform
Billing Manual, but is enhanced to include Michigan-specific billing information.
In Michigan, the UB-92 is the accepted claim form for Medicare, Blue Cross,
TRICARE/CHAMPVA, Workers' Compensation, Medicaid inpatient and outpatient hospital
claims; and all commercial insurer and HMO claims. (effective
7/1/00)
MANUAL CONTENTS
The UB-92 has 86 numbered Form Locators where information
is entered. Each Form Locator field has its own requirements where names, codes,
dollars, dates, etc., are indicated. The manual provides a complete description
of the definition, purpose, payer requirements, and instructions for each Form
Locator. To facilitate the use of the manual for third-party payers, payer-specific
instructions are separated when necessary. Explanations of each Form Locator
on the UB-92 are given with concise instructions. The sections of sample claim
forms are from actual claims and should provide accurate examples of how UB-92
claims should be completed.
There are ten sections in the manual. A brief description
of each section is provided below:
Section I - Form Locators
This section of the manual includes the instructions for completing each data
element on the UB-92 claim form. These data elements, commonly referred to
as Form Locators (F.L.) have been defined by the National Uniform Billing
Committee. A form locator payer-specific requirement matrix for providers
to use for claim adjudication is located at the beginning of Section I.
Section II - Revenue Code Requirements
This section is provided as a reference of all the revenue codes and descriptions
assigned by the NUBC and/or SUBC. There are five tables in this section.
First, there is an alphabetic list of the revenue description standard abbreviations.
This list will aid the user in finding the appropriate revenue code. In addition,
there are four separate tables included, two for Medicare, one for Blue Cross,
and one for Medicaid. Each table gives the revenue code, the standard abbreviation,
a code indicating coverage, and the requirements for reporting units and rates.
Section III - Medicare Examples
This section provides examples of a variety of completed Medicare claims.
The examples reference key form locators that are crucial for correct completion
of the illustrated claim (key data elements are printed in red ink).
This section is intended to be supportive of other sections in this manual
and is not meant to be used alone or in place of written descriptions previously
presented.
Section IV - Blue Cross Examples
This section provides examples of a variety of completed Blue Cross and Blue
Care Network claims.
The examples reference key form locators that are crucial for correct completion
of the illustrated claim (key data elements are printed in red ink).
This section is intended to be supportive of other sections in this manual
and is not meant to be used alone or in place of written descriptions previously
presented.
Section V - Medicaid Examples
This section provides examples of a variety of completed Medicaid claims.
The examples reference key form locators that are crucial for correct completion
of the illustrated claim (key data elements are printed in red ink).
This section is intended to be supportive of other sections in this manual
and is not meant to be used alone or in place of written descriptions previously
presented. (Note: The Michigan Medicaid program accepts the UB-92 claim for
hospital inpatient claims and outpatient hospital claims only). Effective
7/1/00
Section VI - Other Examples
This section provides examples of a variety of completed claims, including
TRICARE and Workers’ Compensation examples. The examples reference key form
locators that are crucial for correct completion of the illustrated claim
(key data elements are printed in red ink). This section is intended
to be supportive of other sections in this manual and is not meant to be used
alone or in place of written descriptions previously presented.
Section VII - BC Plan Codes & P.O. Abbreviations
This section provides the Blue Cross plan codes to be used as the Payer Identification
(F.L. 50) for Blue Cross payers. Code G210 is for Michigan Blue Cross claims
sent to Blue Cross of Michigan.
This section also includes a list of standard post
office state abbreviations.
Section VIII - Glossary
This section contains a list of acronyms, explanations, and definitions of
terms found in the UB-92 manual.
Section X - Newsletters
This section allows the subscriber to store the SUBC bi-monthly newsletters
in the manual.
General Form Completion Guidelines
While the form itself is uniform, the requirements for completion of certain fields vary among payers. For instance, a field that Medicare requires may not be required by Blue Cross. Providers have the option of completing non-required fields for any third-party payer. This option should ease the training of personnel and programming of computer systems.
Although the UB-92 manual, the Revenue Codes (F.L. 42)
part of Section I and the Revenue Code Tables in Section II in particular, provide
some billing instructions, this manual does not contain complete payer-specific
billing instructions and should not be used as the sole resource for identification
of billing instructions. Payer-specific publications and documents, which contain
more complete information, should also be utilized. To make completion
of the UB-92 easier, some general guidelines have been provided:
Dollar Amount Fields - Dollar amount fields are
formatted with a dotted line. The dotted line serves as the separator between
the dollar and cent amounts. The dollar amount entry is right justified to
the dotted line. The cent amount entry is left justified. Do not enter
decimal points. (NOTE: HCPCS/Rates (F.L. 44) is an exception to this rule.
See Section I for specific instructions.)
Hyphens, Slashes and Special Characters - All fields
should be completed without the use of hyphens, slashes or special
characters. For example, a date entry of November 1, 1993 is to appear as
110193 (For Medicare, see special instructions under the form locator).
Recording of Time (Hours) - All fields requiring
the recording of time must use the twenty-four (24) hour clock. For example,
8 p.m. would be recorded as 20.
Medicaid - The Medicaid program in the State of
Michigan accepts the UB-92 for inpatient and outpatient hospital
claims. The Medicaid billing instructions in this
manual also apply to claims for patients who are eligible for Children's
Special Health Care Services (CSHCS). (effective 7/1/00)
NUBC ROLE AND RESPONSIBILITIES
The responsibility for the assignment of criteria for specific UB-92 Form Locators and codes is generally under the control of the National Uniform Billing Committee
(NUBC). Changes are conveyed from the national level to the state level by the NUBC through the State Uniform Billing Committees (SUBC). There are, however, certain Form Locator fields and code structures that have been allocated to individual state control by the NUBC in order to meet the unique needs of the states. The Michigan SUBC has used a number of these fields and codes to meet the requirements of specific payers in Michigan. The Form Locators and codes which are still available for state and national use are indicated throughout the manual.
SUBC ROLE AND RESPONSIBILITIES
The SUBC, staffed by the Michigan Health & Hospital
Association, and supported by Blue Cross Blue Shield of Michigan, Medical Services
Administration, United Government Services, United HealthCare, Health Insurance Association
of America, TRICARE and Workers' Compensation, has representation from health
care providers, major third-party payers, software vendors and others
(see membership list).
The purpose of the SUBC in Michigan is to provide the central
authority which governs the requirements and instructions for completion of
the UB-92 claim form for Michigan providers and payers. The SUBC developed the
Michigan-specific UB-92 Uniform Billing Manual to help meet this goal. In September
1994, the SUBC approved a Position on Acceptance of UB-92
which states its commitments to reduce administrative costs, and advocate the
universal use and acceptance of the UB-92, by all payers.
Changes to the manual will be
communicated through bi-monthly newsletters. Annually, replacement pages, which
incorporate the pen-and-ink changes made and communicated throughout the year,
will be distributed. Billing instruction changes are also communicated, independent
of the SUBC, by payers in their own newsletters and publications. Requests
for changes or corrections to the UB-92 Manual should be submitted to the State
Uniform Billing Committee, 6215 W. St. Joseph Hwy, Lansing, MI 48917, on a
SUBC
request form. An example of a completed form is included in this introduction
(see example). The SUBC will review all changes, and
approve/disapprove changes under its jurisdiction. If a change requires NUBC
approval, and is endorsed by the SUBC, it will be submitted to NUBC for its
approval.
UB-92 MANUAL SUBSCRIPTIONS
Michigan UB-92 Manuals are sold to interested parties on an annual subscription basis which runs from January 1 through December 31. Subscriptions can be purchased, on a pre-paid basis, from the Michigan Health & Hospital Association. Inquiries may be directed to the Michigan Health & Hospital Association, Attention: UB-92 Manual Subscription, 6215 W. St. Joseph Hwy, Lansing, MI 48917. The MHA phone number is (517) 323-3443.
A subscription includes receipt of a current UB-92 manual, bi-monthly Pen
and Ink newsletters (which include pen-and-ink changes to be made to the manual), special communications, and annual replacement pages. The replacement pages incorporate all the pen-and-ink changes made during the subscription period. In order to maintain a current manual, subscribers must renew their subscription on an annual basis. Renewal notices are sent to subscribers in November.
ELECTRONIC SPECIFICATIONS
Electronic submission of the UB-92 format is strongly encouraged. The Electronic Data Interchange (EDI) department at Blue Cross Blue Shield of Michigan (BCBSM) defines requirements, accepts, and forwards electronic files for Medicare, BCBSM, and Medicaid. Payer-specific software applications are also available. For further information, or a copy of the Electronic Media Claims (EMC) specifications manual, call the EDI marketing area at (810) 486-2445. In addition,
UGS defines requirements for Medicare claims when the BCBSM network interface is not used.
