Medical Billing - NSF or UB-92

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It is no longer a question in the medical billing community of what the best method of sending claims is. Electronic billing has numerous advantages over sending paper claims including ease of transmission, lower cost, faster turnaround time and a number of other advantages. But what about the type of electronic format? The main ones today are NSF 3.01 and UB-92. So what's the difference and is one better than another? Which one should you use? Does it make a difference? Will using one format over another give you more headaches in the long run? In this installment, we're going to discuss the basic differences between NSF 3.01 and UB-92, including the pluses and minuses of each.

The first thing that you need to know is that NSF 3.01 has been around a lot longer than UB-92. Back in the early days of electronic billing, it was the only option. Therefore, software manufacturers had to include it with their product if they were going to compete in the marketplace. Because of this and because everybody was creating their own NSF 3.01 package, each software manufacturer had to do the best job they possibly could. Because of this, NSF 3.01 was pretty much perfected. The only differences between the software packages was the interface for transmission. The specifications themselves were pretty solid.

Today, with the two formats available and NSF 3.01 no longer being the only choice, for a medical billing agency to switch over to UB-92, there had to be a good reason. Well, there were several.

For starters, because it was a relatively new format, the software was a lot cheaper than the software to send NSF 3.01 claims. For small medical billing agencies, this was a big plus, especially if they didn't have a large client base. Also, the cost to process these claims was cheaper because the format itself wasn't as popular and agencies were trying to get companies to use it. But there was a downside to all this.

Because UB-92 was new, there weren't as many pieces of software to choose from. Most of them were also untested. The early failure rate of UB-92 transmission was great. The specifications were confusing and finding good programmers to create the code was not an easy task. So finding good software was very hard.

Another problem was that because UB-92 was new, not every carrier accepted claims in this format. In the early days only private carriers accepted claims in this format. Even today, not every carrier accepts UB-92 format as a transmission method. So if you are thinking of going with UB-92, you first better check to make sure that the insurance carrier you want to bill accepts claims in that format.

Today, the differences between NSF 3.01 and UB-92 are not quite as great. Yes, there are still insurance carriers that don't accept UB-92 claims. But more carriers are taking them. The downside is that because UB-92 is becoming more popular, the cost has gone up since the early days. So the difference in cost between NSF 3.01 and UB-92 are not as great.

In the final analysis, it all comes down to what your budget is and who you want to send your bills to. In most cases, either NSF 3.01 or UB-92 will get the job done nicely.