Stream: implementers
Topic: UB-04 Claim Form to Digital format
raj (Mar 24 2020 at 16:23):
Does anyone know if any company/organization has converted UB-04 billing claim form to digital fomat?
If so, what data models from FHIR did you incorporate for digitizing UB-04 form?
Thanks!
Lloyd McKenzie (Mar 24 2020 at 16:34):
@Paul Knapp
Paul Knapp (Mar 24 2020 at 17:24):
@raj I have uploaded a draft UB04 -> FHIR STU3 mapping spreadsheet to the Financial Management Confluence Documents page at https://confluence.hl7.org/display/FM/Documentation
raj (Mar 25 2020 at 13:59):
Thanks @Paul Knapp I will check and documentation and will get back to you for any further queries!
raj (Mar 25 2020 at 16:00):
@Paul Knapp
If I understand correctly, the mapping to UB04 document has been done with the below claim resource of FHIR. right?
http://hl7.org/fhir/stu3/claim.html
If so, I don't see the mapping for some of the fields like Claim.Item (for fields Claim.Item.Service,Claim.Item.Category,Claim.Item.servicedate,etc...)
Is there a full implementation for digitizing UB04 with this FHIR model and if so, would it be possible to view sample Claim Invoice(test data) from a Nursing Home/Health Care agency?
Our company is trying to digitize these Invoices that we receive from Providers/Health care facilities and we are looking if it would be feasible to get the Invoice data in this FHIR Data structure
Thanks for any information you provide!
Paul Knapp (Mar 25 2020 at 16:26):
@raj Note that that mapping is to STU3 and I would strongly recommend using FHIR R4.
The UB-04 is a Claim (payer facing) not an Invoice (patient facing) - I'm picky with the language because it matters in terms of who is the target and the target's responsibility for payment: insurers consider a claim in light of a plan, parties responsible for invoices are responsible for 100% of the outstanding balance. Typically for institutional care statements (which FM is working on developing for R5) are used rather than Invoices for patient billing.
In the mapping I mapped UB-04 field 44 to service/unit - the billing code, which may include NDC or RxNorm codes, goes in Claim.service and the amount in Claim.item[n].unitPrice.
Field 44 is mapped to .item[n].serviceDate.
It would be useful if you could provide more description of your use case, for example are you building an insurer application or a patient supporting applications.
raj (Mar 25 2020 at 19:01):
@Paul Knapp
Thanks for the explanation. I was able to find the mapping details for service and servicedate fields, and will check R4 version as well.
To provide more info, this application would be an insurer application(internal application to our insurance company).
Currently, we receive billing details/forms from Facilities/Care Providers and they are processed manually . We are trying to digitize them and checking if it can be implemented through FHIR DataModel. The payment processing is done at our end.
All of these facilities do send the same data to CMS system via Blue Button API and therefore, we are checking if the UB04 Billing form can be modeled with any FHIR Data Structure, our company could implement a Data Model that mimics it, and all of these facilities would be able to send the billing info via API in this new FHIR format.
Thanks again for your response.
raj (Mar 31 2020 at 13:35):
@Paul Knapp
Wanted to know if you could provide any more details on the above query that I mentioned.
Also,for accessing and building a .NET project that uses this Claim resource and UB04 template, will the following github project work?
https://github.com/FirelyTeam/fhir-net-api
Last updated: Apr 12 2022 at 19:14 UTC
