May 2007 Newsletter

Plan for the New UB-04 Health Plan ID Field

By: EDI Project Leader

With the implementation of the new UB-04 claim form, there are several new fields that have been introduced, many of which have, unfortunately, caused some confusion with regard to their usage. The Health Plan Identification Number field, Block 51 on the UB-04, is described in the NUBC manual as:

“The number used by the health plan to identify itself.”

Eventually, this field will be used to report the National Plan Identifier, once CMS and other groups decide on a coding scheme that can meet every insurance company’s needs to identify themselves. Until the National Plan Identifier for insurance carriers can be decided on, whichever code is currently being used to identify an INURANCE COMPANY should be used in this block. This is NOT, in most cases, the provider’s legacy provider number. This information should be put in Block 57 A/B/C on the UB-04, directly below the Provider’s NPI (Block 56). 

For many commercial payers, the information placed in Block 51 should be the five-character ID assigned by either the payer or entities like Emdeon or THIN. Some examples are:

• AETNA - 60054 (Emdeon’s assigned number)
• Medical Mutual - 29076 (Emdeon’s assigned number)
• Anthem Blue Cross – 00332

The code is generally used by the receiving payer to determine its respective payer lines (primary, secondary, or tertiary) on incoming claims. Quadax has already noticed instructions from a couple of major insurance companies that do not use this field properly. 

As the UB-04 form takes its place as the new vehicle for sending institutional data to payers, it is critical that every field is understood by providers, so that information can be used and translated properly into the ANSI 837 format.

Other new fields on the UB-04 that you should pay special attention to include: