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UB-92 (Uniform Billing Code of 1992) - Bill form used to propose hospital insurance claims for payment by third parties. Similar to legacy HCFA 1500, but kept for the inpatient component of health services. An electronic format of the CMS-1450 paper claim form that has been in common use since 1993.

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Unassigned Claim - A claim submitted for a service or deliver by a provider who does not agree to assignment.

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Unbundling- A coding discrepancy that involves unraveling a procedure into parts and charging for each part rather than using a single code. The practice of providers billing for a package of health care procedures on an individual foundation when a single procedure could be used to explain the combined service.

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Uncompensated Care - Service provided by physicians and hospitals for which no payment is conventional from the patient or from third-party payers. Some costs for these services may be enclosed through cost-shifting. Not all uncompensated care results from aid care. It also includes bad debts from persons who are not confidential as charity cases but who are unable or unwilling to pay their bill.

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Underinsured- People with public or private insurance policies that do not wrap all essential health care services, resulting in out-of-pocket expenses that exceed their capability to pay.

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Underwriting- Process that selecting, classifying, analyzing and assuming risk according to insurability. The insurance purpose bearing the risk of adverse price fluctuations throughout a particular period. Analysis of a group that is done to decide rates or to determine whether the group should be offered coverage at all.

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Underwriting Impairments - Factors that to be inclined to increase an individual's risk above that which is normal for his or her age.

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Underwriting Manual - A document that provides background information about a variety of underwriting impairments and suggests the suitable action to take if such impairments exist.

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Underwriting Requirements - Requirements, sometimes concerning to group characteristics or financing measures that MCOs at times impose in order to provide healthcare coverage to a given group and which are intended to balance a health plan's knowledge of a planned group with the ability of the group to voluntarily choose against the plan.

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Universal Access - The right and aptitude to receive a comprehensive, uniform, and affordable set of confidential, appropriate, and effective health services. Universal service is an actuality in countries with national medicine programs or socialized healthcare, such as the UK, Canada, France and most countries in the world.

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Universal Coverage - A kind of government sponsored health plan that would supply healthcare coverage to all citizens. This is an aspect of Clinton's original health plan in the mid 1990s and is a quality of national health insurance plans similar to those obtainable in other countries such as the UK or Canada.

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Update Factor - The year-to-year increase in base payment amounts for PPS and barred hospitals and dialysis facilities. The update factors usually are legislated by the Congress after considering annual recommendations provided by ProPAC and HHS.

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Upcoding- A coding inconsistency that involves using a code for a procedure or analysis that is more complex than the actual process or diagnosis and that results in higher reimbursement to the provider.

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Urgently Needed Care - A CMS term, it refers to care that an enrollee receives for a sudden illness or injury that needs medical care right away, but is not life intimidating. Primary care doctor generally provides immediately needed care if the enrollee is in a Medicare health plan other than the Original Medicare Plan. If the enrollee is out of your plan's service area for a short time and cannot wait until recurring home, the health plan must pay for urgently needed care.

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Urgent Services - Benefits covered in an Evidence of Coverage that is necessary in order to prevent serious decline of an insured's health that results from an unforeseen illness or injury.

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Use - Under HIPAA, this term refers to the sharing of individually particular health information within a covered entity. For Partners' purposes, utilize is the sharing of such information within the Partners affiliated covered entity

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Usual, Customary and Reasonable (UCR) - Referring to charges for medical services, the UCR is the amount a health plan will distinguish for payment for a particular medical procedure. It is classically based on what is considered "reasonable" for that procedure in your service area.

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Utilization- Utilization is frequently examined in terms of patterns or rates of use of a single service or type of service such as hospital care, physician visits, and prescription drugs. Measurement of utilization of all medical services in mixture is usually done in terms of dollar expenditures. Use is uttered in rates per unit of population at risk for a given period such as the number of admissions to the hospital per 1,000 persons over age 65 per year.

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Utilization Management (UM) - The process of evaluating the need, appropriateness and efficiency of health care services against established guidelines and criteria. UM usually includes new actions or decisions based on the overall study of the utilization.

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Utilization Management Committee - The MCO committee that reviews and updates the MCO's utilization management program that establishes utilization review protocols, reviews referral and utilization patterns, and reviews utilization decisions for medical appropriateness.

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Utilization Review (UR) - A formal review of utilization for suitability of health care services delivered to a member on a prospective, concurrent or retrospective basis. In a hospital, this includes review of the appropriateness of admissions, services prepared and provided, length of a stay, and discharge practices, both on a synchronized and retrospective basis.

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