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Elizabeth M. Whitehorn, Director

Provider Notices issued 03/15/08

Implementation:  UB-04, National Drug Code (NDC) Reporting, and Present on Admission (POA) Indicator

To:​

Participating Hospitals:  Chief Executive Officers, Chief Financial Officers, Patient Accounts Managers, and Health Information Management Directors; Hospice Agencies; Renal Dialysis Facilities; and Ambulatory Surgical Treatment Centers (ASTCs)

​
​Date: ​March 14, 2008
​Re:

Implementation:  UB-04, National Drug Code (NDC) Reporting, and Present on Admission (POA) Indicator​

UB-04

Effective with claims received on or after May 1, 2008, providers who have previously utilized the UB-92 paper claim format must use the UB-04. UB-92 paper claims received on or after May 1, 2008, will be returned to the provider. 

The attached chart identifies specific information that is needed by the Illinois Department of Healthcare and Family Services for adjudication of claims billed on the UB-04. The attached chart, in conjunction with the UB-04 Data Specifications Manual, should be utilized when billing for institutional services.  To become a UB-04 Subscriber, refer to the following Web site at:  <http://www.nubc.org/become.html>.

National Drug Code (NDC) Reporting

Effective with dates of service on and after May 1, 2008, the department encourages hospitals, renal dialysis facilities, and ASTCs to begin reporting the National Drug Code (NDC) for certain drugs administered in the outpatient setting.  These drugs are limited to renal dialysis injectable drugs, including Epogen, and expensive drugs that qualify for an additional add-on payment.    

CMS has granted HFS a six-month extension through June 30, 2008, for mandatory reporting of the NDC for institutional provider claims only.  Informational messages will be returned to the providers through June 30, 2008, for claims that do not contain the applicable coding.  During this interim period, providers will continue to receive the applicable add-on payments for these drugs.

Effective with dates of service on and after July 1, 2008, if a claim contains a drug that would be eligible for an add-on payment, and the claim prices >$0.00, but the claim does not contain the corresponding NDC coding, the claim will be paid without the applicable add-on.  Providers will receive one of the informational messages regarding NDC reporting.  If the provider determines that an incorrect NDC was billed that resulted in non-payment of the add-on, this claim must be voided and rebilled correctly.  A provider notice regarding NDC reporting will be released in the near future. 

Detailed coding information for the UB-04 is contained in FL 43 in the attached table.  Coding information for the 837I is reported in Loop ID 2410 for the electronic transaction.  The renal dialysis drugs that will require NDC reporting can be referenced in an Informational Notice dated February 14, 2006.  Although Epogen is not listed in this notice, its current HCPCS code is Q4081, and NDC reporting will be required.  The expensive drugs that will require NDC reporting can be referenced on the department’s Web site at: 

http://www.illinois.gov/hfs/MedicalProviders/MedicaidReimbursement/Pages/Expensive.aspx

Present On Admission (POA) Indicator

Effective with admissions on and after May 1, 2008, the department will require hospitals to submit a Present On Admission (POA) Indicator for the principal diagnosis code and every secondary diagnosis code on inpatient hospital claims.  At present, state implementation of this requirement is for data collection purposes only.  If the POA is not reported, the claim will not be rejected, but the hospital will receive the informational message I18 – POA Indicator Required on the paper Remittance Advice.  However, the department strongly encourages the reporting of this information.  Please refer to the notice dated March 12, 2008, regarding the POA indicator.

Any questions regarding this notice should be directed to the Bureau of Comprehensive Health Services at 1-877-782-5565.

Theresa A. Eagleson, Administrator

Division of Medical Programs

UB-04 Fields

The department has identified the following form locators that require special attention from providers for accurate processing of claims.

FORM LOCATOR

DESCRIPTION

FL 02

Pay-To Name (Line 1)

Report your one-digit payee code preceding the pay-to name.

Pay-To Address (Lines 2 and 3)

Situational – Required when the address for payment is different than that of the Billing Provider in FL 01. 

FL 04

Type of Bill

4 positions with a leading zero.

Do not include the leading zero on electronic 837I claims.

FL 08

Patient Name (Required)

HFS requires the Patient Name to be equal to the Insured Name (FL 58).

Patient Name ID (Situational)

Report if the number is different from the insured’s ID (FL 60).

FL 09

Patient Address (Required)

The mailing address of the patient is not required for HFS, but is required based on the UB-04 Manual.

FL 39-FL 41

Value Codes

UB-92 FL 07, 08, 09, and 10 have been eliminated on the UB-04 and substituted with new Value Codes.

Value Code 80 – Covered Days

Value Code 81 – Non-Covered Days

Value Code 82 – Coinsurance Days

Value Code 83 – Lifetime Reserve Days

Do not use these Value Codes when billing an 837I.  Use Claim Quantity in Loop 2300, QTY01. 

FL 43

Revenue Description Field – NDC Reporting

  • Report the N4 qualifier in the first two (2) positions, left- justified

  • Followed immediately by the 11-character National Drug Code (NDC), in the 5-4-2 format (no hyphens)

  • Immediately following the last digit of the NDC (no delimiter) the Unit of Measurement Qualifier.  The Unit of Measurement Qualifier codes are as follows:

    • F2 – International Unit

    • GR – Gram

    • ML – Milliliter

    • UN – Unit

  • Immediately following the Unit of Measurement Qualifier, the unit quantity with a floating decimal for fractional units limited to 3 digits (to the right of the decimal).

  • Any spaces unused for the quantity are left blank.

FL 51

Health Plan Identification Number
HFS will require that providers report our legacy 3-digit TPL codes and 2-digit TPL status codes in this field until the HIPAA National Plan Identifier is mandated.  The format will continue to be the 3-digit TPL code, 1 space, then the 2-digit status code (6 bytes total).  There can be up to 3 payer lines, which correspond with FL 50 (Payer Name). 

FL 56

National Provider Identifier – Billing Provider

Providers must register their NPI information with HFS.  HFS is currently operating under a NPI Contingency Plan, which allows providers to submit claims with only their NPI, if the NPI has been registered with HFS.

FL 57

Other (Billing) Provider Identifier

HFS legacy Provider Number

FL 64

Document Control Number (DCN)

HFS will utilize this field for the original DCN that is tied to the Void and Rebill process, at the time HFS implements the Void/Rebill process.  This field will only be populated when submitting a type of Bill Frequency of “7” (Replacement of Prior Claim) or Type of Bill Frequency of “8” (Void/Cancel of Prior Claim).

FL 67

Present On Admission Indicator (POA)

The “POA” indicator is reported in the eighth digit (shaded area) of FL67 for the principal diagnosis and in the eight digit (shaded area) of FL67A-Q for each secondary diagnosis.  If the POA indicator is not placed in the shaded areas noted, it will be captured as part of the diagnosis code.

FL 76 - 79

Attending, Operating, & Other Physician Identifiers

The department will accept the NPI, but will adjudicate claims based on the physician identification number reported in the Secondary Identifier.

Secondary Identifier Qualifiers:

  • 0B – State License Number

  • 1G – Provider UPIN Number

  • G2 – Provider Commercial Number

FL 80

Remarks

HFS will utilize this field to assign their unique Document Control Number (DCN).  Providers should not report any information in this field.

FL 81

Code-Code Field (Situational).

To report additional codes related to a Form Locator (overflow).  HFS Requirement (Needed for Adjudication) Qualifier “B3” – Healthcare Provider Taxonomy code