Change Request Guidelines

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 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 suggested wording.

  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 change.