EDI Knowledge Base   UB92

About UB92

UB92 is a guideline for building electronic claims. UB92 supports policy requirements for users and defines processes using procedure statements. The UB92 standard was fully implemented for Medicare in 1993 (the UB83 was implemented in 1983) and continues to be supported.

UB92 was designed to standardize and increase the submission of electronic claims and coordination of benefits exchange. The UB92 standard is used to electronically submit claims for health care received in an institutional setting to payers. It is also used to exchange health Care claims and payment information between payers with different payment responsibility. UB92 users are institutional providers. A variety of payers also use the format to exchange claim and payment information.

Documents

UB92 consists of fixed-length (192 bytes) records. Each record has an unique identifier and logically related data elements.

Record Name Record Type Code
Processor Data 01
Additional Coordination of Benefits (COB) Information 02
Reserved for National Assignment 03-04
Local Use 05-09
Provider Data 10
Reserved for National Assignment 11-14
Local Use 15-19
Patient Data 20
Noninsured Employment Information 21
Unassigned State Form Locators 22
Reserved for National Assignment 23-24
Local Use 25-29
Third Party Payer Data 30-32
Reserved for National Assignment 33
Authorization 34
Local Use 35-39
Claim Data TAN-Occurrence 40
Claim Data Condition-Value 41
Claim Change Reason Code 42
Reserved for National Assignment 43-44
Local Use 45-49
IP Accommodations Data 50
IP - Amount Paid by Primary Payer 51
Reserved for National Assignment 52-54
Local Use 55-59
IP Ancillary Services Data 60
Outpatient Procedures 61
IP Ancillary Services Data - Amount Paid by Primary Payer 62
Outpatient Procedures 63
Ancillary or OP Reason Codes 64
Local Use 65-69
Medical Data 70
Plan of Treatment and Patient Information 71
Specific Services and Treatments 72
Plan of Treatment/Medical Update Narrative 73
Patient Information 74
Medical Documentation for Ambulance Claims 75
ESRD Medical Documentation 76
Plan of Treatment for Outpatient Rehabilitation 77
Reserved for National Assignment 78

Record structure sample

RECORD TYPE 10 - PROVIDER DATA
  • Must follow either RT 01 or 95.
  • Must be followed by RT 20 or RT 74. RT 20 is used when submitting billing record. RT 74 is used only when attachment information is being sent independent of the claim

NOTE: This record must be present for each provider batch combination

FIELD NAME TYPE FROM TO
1 Record type '10' XX 1 2
2 Type of Batch XXX 3 5
3 Batch Number 99 6 7
4 Federal Tax Number or EIN 9(10) 8 17
5 Federal Tax Sub ID X(4) 18 21
6 National Provider Identifier X(13) 22 34
7 Medicaid Provider Number X(13) 35 47
8 CHAMPUS Insurer Provider Number X(13) 48 60
9 Other Insurer Provider Number X(13) 61 73
10 Other Insurer Provider Number X(13) 74 86
11 Provider Telephone Number 9(10) 87 96
12 Provider Name X(25) 97 121
13 Provider Address X(25) 122 146
14 Provider City X(14) 147 160
15 Provider State XX 161 162
16 Provider ZIP Code X(9) 163 171
17 Provider FAX Number 9(10) 172 181
18 Country Code X(4) 182 185
19 Filler (National Use) X(4) 186 189
20 Filler (State Use) X(3) 190 192
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