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Elizabeth M. Whitehorn, Director

Provider Notice issued 11/07/11

National Uniform Billing Committee (NUBC) Changes Effective October 1, 2011

To:​ Participating Hospitals: Chief Executive Officers, Chief Financial Officers, and Patient Accounts Managers​
Date:​ ​November 7, 2011
​Re: National Uniform Billing Committee (NUBC) Changes Effective October 1, 2011​

To comply with the NUBC UB-04 definitions for reporting the Admission Date and Statement Covers Period entries, HFS will be implementing claim editing changes in the near future. The edit logic changes required by the Centers for Medicare and Medicaid Services (CMS) to conform to the definitions are effective with claims submitted on or after October 1, 2011; however, hospitals should not implement these changes for HFS claims until further notice by the department.

The NUBC UB-04 definitions for reporting the Admission Date and Statement Covers Period on claims are as follows:

  • The Admission Date (FL 12) is the date the patient was admitted as an inpatient to the facility.

  • The Statement Covers Period (From and Through Dates in FL 6) identifies the span of service dates included in a particular bill. The From Date is the earliest date of service on the bill.

HFS will be modifying its edits regarding these data elements to match the NUBC UB-04 definitions.

  • The Admission Date and the From Date are not required to match.

  • The number of days in the Statement Covers Period cannot be compared to any other data element, such as total accommodation days reported in the revenue code section.

Important Note: HFS, unlike Medicare and some other payers, does not allow bundling of outpatient charges on an inpatient bill when the outpatient charges occur within a 72-hour window preceding an inpatient admission. The department's billing instructions will not change at this time.

Any questions may be directed to your hospital's medical assistance consultant in the Bureau of Comprehensive Health Services at 1-877-782-5565.

Theresa A. Eagleson, Administrator

Division of Medical Programs