I. INTRODUCTION

The purpose of this document is to address the operational protocol of the National Uniform Billing Committee (NUBC).

Background

The NUBC was formally organized in May 1975. The principal goal of the NUBC is to develop, promote, and maintain a uniform standard data set and format(s) which can be used by the institutional health care community to transmit related charge and claim information to all third-party payers.

The NUBC parallels the National Uniform Claim Committee (NUCC), for the non-institutional health care community.

The NUBC brings together key representatives to provide a national perspective to the data content and format standards that are routinely used for the reporting of institutional health care claims. Representation is generally from national provider and payer organizations, standard setting organizations, state associations, and research and public health agencies. NUBC members are committed to achieving the goals of administrative simplification as outlined in the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The NUBC works with other standards development bodies to help define how NUBC approved data content is reported in the electronic transactions.

In order to achieve the NUBC goals, as stated above, the NUBC will define the data content to be used for for billing, remittance, and other related business applications including transactions enumerated within HIPAA. In addition, the NUBC will also approve a set of recommendations and support national format specifications for both paper and electronic data interchange (EDI) applications of these data sets.

A. NUBC Membership

The NUBC is comprised of key organizations whose members (generally companies, institutions and other enterprises as opposed to individuals) are affected by the administrative transactions within the institutional sector of the health care community. Representation on the NUBC includes a balance of national payer and provider organizations. In addition, the NUBC includes representatives from standard setting bodies, the National Uniform Claim Committee and other national groups.

Criteria for membership are: a national scope and representation of a unique constituency directly affected by health care administrative transactions. Each committee member is intended to represent the perspective of the sponsoring organization and the applicable constituency. Each representative is expected to have the ability to quickly obtain needed approvals from his/her organization and constituency, so that the NUBC can achieve an expedited process that meets the needs of the health care community. NUBC representatives are responsible for communicating information among the committee and to the group(s) they represent.

The following organizations serve on the committee as voting members (the primary constituency of each is noted):

• American Hospital Association (AHA) - hospitals and health systems
• State Hospital Association - hospitals and health systems
• State Hospital Association - hospitals and health systems
• State Hospital Association - hospitals and health systems
• American Health Care Association (AHCA) - long term care providers
• Federation of American Health Systems (FAHS) - hospitals and health systems
• Federation of American Health Systems (FAHS) - long term care provider systems
• American Association of Health Plans (AAHP) - managed care organizations
• National Association for Homecare (NAHC) - home health providers
• Blue Cross and Blue Shield Association (BCBSA) - Blue Cross and Blue Shield Plans
• Health Insurance Association of America (HIAA) - commercial health insurance companies
• TRICARE Support Office (formerly known as OCHAMPUS) - civilian health benefits programs for uniformed services families
• Health Care Financing Administration - Medicaid
• Health Care Financing Administration - Medicare
• National Association of State Medicaid Directors (NASMD) - state medicaid agencies
• ANSI ASC X12 Insurance Subcommittee - EDI standards development
• Alliance for Managed Care - large commercial health insurance companies
• National Uniform Claim Committee - professional health care providers/payers
• National Center for Health Statistics - public health and health services research

Center for Healthcare Information Management (CHIM) - vendors in the healthcare information technology industry

The three state hospital associations are selected by the American Hospital Association. The state representative seats are rotating and include three year terms that are subject to reappointment for additional three-year terms by the AHA. The rotation is staggered so that only one new member is on the committee at any point in time.

The addition or termination of a member organization shall be subject to approval by vote of the NUBC after the application has been processed in accordance with procedures outlined below.

A request for membership shall be addressed to the NUBC (or a subcommittee to be formed by the NUBC). The request shall indicate the applicant’s direct and material interest in the committee’s work and qualifications and willingness to participate actively, and, if the applicant is an organization, company, or government agency, shall identify a representative (and an alternate, if desired).

In recommending the appropriate action on applications for membership, the NUBC shall consider the:

1. Need for active participation by each constituency;

2. Maintaining an adequate balance and representation of providers, payers and other appropriate entities;

3. Extent of interest expressed by the applicant and the applicant’s willingness to participate actively;

When appropriate, the NUBC may recommend that the applicant seek representation through an organization that is already a member and represents the same or similar interest.

The NUBC shall review the membership list annually. Members are expected to fulfill obligations of active participation. Where a member is found in habitual default of these obligations, and not compliant with the requirements outlined in this protocol document, the NUBC shall take appropriate action, which may include the request to name a replacement or terminate the organization. Voting members may name a representative to complete the term of the removed individual. All expenses of participating in the NUBC or any subcommittee shall be borne by each representative’s organization.

Alternates may be designated by individual members on a meeting-by-meeting basis. Named representatives who miss more than 50% of meetings (including conference calls) a year will be reviewed by the NUBC. The NUBC may request that the member organization designate a replacement or propose termination of the member.

B. Voting Privileges

Each of the listed member organizations of the NUBC is allocated one vote. Votes are made on any changes - additions, deletions, clarifications and/or recommendations - to the national data set specifications (content) as well as to any format changes that may be required. The NUBC also approves any changes in policy or procedures as determined appropriate. Actions on NUBC membership and changes to the protocol shall require a vote of three-quarters of those members present. Actions on other items will require a simple majority of those members present.

C. Duties of the Chair

The Chair will be staffed by the AHA. The duties of the Chair include, but are not limited to:

1. arrangement and administration of the NUBC meetings;
2. developing agenda for meetings;
3. working with the NUBC secretary in the distribution of meeting notices, agenda material, minutes;
4. retaining a presence on national EDI organizations, committees, government advisory committees, or other work groups, to assure the integrity, security, and uniformity of use of the NUBC’s data sets; and
5. retaining ongoing communication interface with all entities including SUBCs regarding NUBC activities.

The Chair carries the financial responsibility of any meeting and/or conference call expense. The chair is also the focal point of external communication on behalf of the NUBC.

D. Duties of the Secretary

The position of the Secretary will be staffed by AHA as part of general administrative support. The individual who serves as Secretary will be distinct from the person who serves as char. Duties of the secretary include, but are not limited to:

1. maintaining up-to-date mailing lists of NUBC members, SUBC chairs, etc.;
2. writing quarterly NUBC newsletters;
3. preparing agenda material for NUBC meetings;
4. maintaining national NUBC technical data elements definitions and specifications as part of the NUBC manual;
5. corresponding with all NUBC members;
6. acting on administrative matters in the absence of the chair;
7. conducting, analyzing and reporting SUBC survey results to the NUBC; and
8. maintaining a consolidated national log which relates the use of each SUBC’s reserved coding ranges and/or unlabeled field locations.