Change Request Guidelines Form

National 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 to the UB-04 Manual or UB-04 Data Set may be submitted at any time. To be considered at the next scheduled meeting, requests for changes must be received by the NUBC Secretary at least 45 days in advance. Approved changes are usually effective as of July 1 or about 90 days after approval, as appropriate.

Name

1. Please indicate whether the request is attributable to any of the following:

a. A regulatory change

b. An insurance plan change

c. Administrative improvements or problem solutions

d. Other

2. If the change is due to regulatory or insurance plan changes: please include appropriate citations.

Step 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.

1. Proposed Name:

2. Proposed Definition

3. Type of Units to be Reported

4. Proposed Reporting Instructions

Step 2

Include a brief, non-technical description of the service or issue.

1. Brief, non-technical description

Step 3:

Provide information regarding the "cause" of the proposed change.

Step 4

Explain what the change is intended to accomplish. 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.

1. What is the purpose of the regulation, insurance plan change, or administrative improvement?

2. How will the proposed change facilitate the desired result?

Step 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.)

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Step 6

Indicate whether the proposal was presented to the SUBC.

1. Dates of the SUBC activities:

2. Summary of the discussions and decisions:

Step 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.

Step 8

Indicate the impact on providers.

1. Number of providers affected by the requested change:

2. Type(s) of providers affected by the requested change:

3. Estimate of the volume of claims affected:

4. How will the change affect payment?

5. How would provider claim submissions change if the requested were approved?

Step 9

Provide any further documentation that reinforces the national need for the proposed change.

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Document Upload

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100 MB limit.
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