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Required by MVP Health Care beginning 5/23/07. The following example illustrates the changes between the UB-92 claim form and the MVPHealth Care data requirements on the new UB-04 paper claim form. UB-04 form MVP Health Care Data Field Changes on UB-04 Paper Claim Form 8a 29 Accident State (required field when applicable) 39-41 Submit as Value Codes & Amounts Code 54 Newborn Weight in Grams Code 80 Covered Days 56 NPI (National Provider Identifier) 57 Preferred Care Provider ID (a.

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