UNIFORM BILLING COMMITTEE DATA ELEMENT
SPECIFICATIONS CHANGE REQUEST GUIDELINES
The National Uniform Billing
Committee (NUBC) holds meetings and conference calls throughout
the year and change requests may be submitted at any time.
However, to be considered at the next scheduled meeting, requests
for changes to the UB-04 Manual or UB-04 Data Set must be received
by the NUBC Secretary at least 45 days in advance. Approved
changes are usually effective as of April 1, October 1, or about
90 days after approval, as appropriate.
In order for the NUBC to properly
and efficiently consider change requests, each request must be
accompanied by the following documentation:
1. Briefly describe what
"action" you are requesting and the proposed
implementation or effective date. For example, the action
requested may be to add a new condition code by "X"
date. As part of the description, include a proposed name and
definition for any new code. If appropriate, also indicate the
type of units to be reported and any other reporting instructions
that should be included in the UB-04 Manual. If you are requesting
a definitional change or clarification, please submit your
2. Include a brief, non-technical
description of the service or issue.
3. Provide information regarding
the "cause" of the proposed change. Indicate whether
the request is attributable to: 1) a regulatory change; 2) an
insurance plan change; 3) administrative improvements or problem
solutions; or 4) other. Include appropriate citations if the
change is due to regulatory or insurance plan changes.
4. Explain what the change is
intended to accomplish. That is, explain the purpose of the
regulation, insurance plan change or administrative improvement.
(It is not adequate to merely indicate that the change is being
requested "because we need the information" - NUBC
members must understand why the change is necessary.) Finally, it
is important to clearly indicate how the proposed change will
facilitate the desired result.
5. Demonstrate that you are
raising a national issue. Provide documentation regarding
other states, plans or fiscal intermediaries that have similar
problems and support your request. (Request submitters should
contact at least a sample of states, plans or FIs. Provide the
name, title, organization and phone number of persons contacted.
Be prepared to answer the question, "Are other plans, FIs or
states having this problem?")
(Note: The NUBC circulates most
requests to State Uniform Billing Committees (SUBCs) for review
and comment. Request submitters are not expected to duplicate this
effort. The purpose of contacting a few other entities is to
confirm that the request is: 1) consistent with the needs of at
least some other FIs, plans or programs; 2) is not a single state
problem; and 3) addresses a problem that apparently does not have
a simple alternative solution using existing codes.)
6. Indicate whether the proposal
was presented to the SUBC. Indicate the dates of the SUBC
activities and provide a summary of the discussions and decisions.
7. Describe why existing UB-04
codes or alternative approaches are insufficient. When
evaluating requests, NUBC members focus on issues such as: 1)
whether existing codes in the UB-04 Manual could be used
(condition codes, occurrence codes, value codes, and revenue
codes); 2) whether the information would be more appropriately
collected using ICD-9-CM, CPT-4 or HCPCS codes; or 3) whether an
approach used by other states, plans, etc. addresses the issue in
a less burdensome fashion.
8. Indicate the impact on
providers. Indicate the number and types of providers affected
by the requested change. Provide an estimate of the volume of
claims affected. Describe how the change will affect payment.
Explain how provider claims submissions would change if the
request was approved.
9. Provide any further
documentation that reinforces the national need for the proposed