Name of Manual - Blue Cross and Blue Shield of Minnesota

UB-04 (CMS 1450) Form
Institutional Claim
Submission
Claims Filing
The paper UB-04 (also referred to as the CMS-1450) is accepted
only from out-of-state nonparticipating providers per Minnesota
Statute 62J.536 and the Blue Cross provider contracts.
The electronic transaction 837I is the only accepted claim
submission format for institutional claims.
UB-04 Manual The National Uniform Billing Committee (NUBC) publishes a
manual containing the claim data specifications that are submitted
on the 837I or UB-04 claim format and guidelines on completion
of the UB-04 form.
About the NUBC Established in 1975, the NUBC is the official data content body
responsible for maintaining the data set for institutional health care
providers. Representation includes provider, payer, electronic
standards development organizations, public health data standards
organizations, and others. The NUBC is also one of six Designated
Standard Maintenance Organizations (DSMO) responsible for the
maintenance and development of HIPAA administrative
simplification transaction standards. (Note: Also see
http://www.nubc.org/INFORMATION_ON_UB-04.pdf)
Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (05/10/12) 8-13