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Advisory 95-02

CLARIFICATION OF USE OF FORMS UB-82/UB-92

The following clarifications are provided by the Commission to health care providers and insurance carriers using UB-82 and UB-92 forms.

1. Since March 1, 1994, the Texas Workers' Compensation Commission has allowed insurance carriers to accept both the UB-82 and UB-92 billing forms for institutional services. As of April 1, 1995, the Commission will no longer allow the UB-82 form and will only allow the UB-92 form to be accepted. This change is required in order to simplify the electronic transmission of hospital billing information. Although the UB-92 is an updated version of the UB-82, the difference in the location of required information may cause incorrect data to be transmitted. Dates of service on or after June 1, 1995, must be completed on a UB-92 using the current TWCC-68a instructions.

2. The current form TWCC-68a, instructions for the UB-92, require the carrier to manually annotate medical bills with specific information. All carriers (insurance companies, certified self-insurers, and governmental entities that individually or collectively self-insure) approved for electronic claims submission may be relieved of manually annotating the bill in accordance with Commission Rule 133.300(e). This does not relieve the carrier of the responsibility to date stamp each health care provider bill upon receipt as required by subsection 133.300(b). The annotation required by subsection 133.300(e) continues to apply to all carriers. The date stamp is required in order to determine the payment time frames and must be included as part of bill processing. Also, to expedite bill processing, the carrier must stamp its Master Business Identification number ("MBI" number is assigned to each insurance carrier by the Records Division of the Commission) on paper copies of all medical bills. This MBI requirement supersedes TWCC Advisory 93-05.

3. Reimbursement for outpatient hospital services is not currently included in any of the Commission adopted fee guide or rules. Carriers must determine a fair and reasonable payment amount for outpatient services pursuant to section 413.011(b) of the Texas Labor Code and Commission Rule 134.1(f). In addition, the health care provider is not required to complete the following items on the UB-92 for outpatient services: types of admission (box 19) and the admitting diagnosis (box 76).

Signed March 14, 1995.

Todd K. Brown, Executive Director



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