What is the difference between 837 and ub04?
Asked by: Prof. Coty Bergnaum | Last update: November 28, 2025Score: 4.9/5 (54 votes)
What is an UB04 form used for?
The CMS-1450 form (aka UB-04 at present) can be used by an institutional provider to bill a Medicare fiscal intermediary (FI) when a provider qualifies for a waiver from the Administrative Simplification Compliance Act (ASCA) requirement for electronic submission of claims.
What is an 837 in healthcare?
• An 837 file is an electronic file that contains patient claim information. This file is submitted to an insurance company or to a clearinghouse instead of printing and mailing a paper claim. • The data in an 837 file is called a Transaction Set.
What is required for the UB-04 837 I?
Final answer: The UB-04/837-I form requires Revenue codes, medical necessity documentation, and correct Part A and B procedural codes to generate payment from Medicare. The CMS 1500 Part B is not necessarily required in this case. Understanding these codes is crucial as errors can lead to payment delays or denials.
What is bill type 837?
The 837P (Professional) is the standard format used by health care professionals and suppliers to transmit health care claims electronically.
4 Major Benefits of 837 Claims in Healthcare
What type of bill is a UB04?
- 1- Hospital.
- 2- Skilled Nursing Facility.
- 3- Home Health.
- 4- Christian Science (Hospital)
- 5- Christian Science (Extended Care)
- 6- Intermediate Care.
- 7- Clinic.
- 8- Special Facility.
What is a transaction type 837?
The EDI 837 transaction set is the format established to meet HIPAA requirements for the electronic submission of healthcare claim information. The claim information included amounts to the following, for a single care encounter between patient and provider: A description of the patient.
What is the difference between 837P CMS 1500 and 837I UB04 forms?
1500 is a medical claim (Professional) and UB04 is hospital claim (Institutional). 837P is a 1500 Medical Claims and 837I is a UB04 Hospital claims. When paper is sent, a 1500 form is used for Medical claims and a UB04 form for Hospital.
What codes are used on a UB04 form?
- FL 14 - Priority (Type) of Admission/Visit.
- FL 15 - Point of Origin for Admission or Visit.
- FL 17 - Patient Status.
- FL 18-28 - Condition Codes.
- FL 31-34 - Occurrence Codes.
- FL 35-36 - Occurrence Span Codes.
- FL 39-41 - Value Codes.
- FL 59 - Patient Relationship to Insured.
How do I get my UB04?
The Centers for Medicare and Medicaid Services (CMS) website has a free fillable UB 04 form PDF that you can access for free at https://www.cms.gov/medicare/coding/outpatientcodeedit/ub04.
What is the EDI 837 standard?
The EDI 837 Health Care Claim Transaction Set is a standardized format for submitting healthcare claim information electronically. Healthcare providers use it to send claims to payers, such as insurance firms and government agencies.
How many diagnosis codes can be submitted on an 837?
You may send up to 12 diagnosis codes per claim as allowed by the implementation guide.
What data is in an 837 claim file?
The 837 file includes insurance claim data. The complication is that 837 files may contain not just one claim but multiple from the hospital to the payer. The 837s will include information that details aspects of patients' treatment, including medical services provided, cost of treatment, and additional adjustments.
Who is the referring provider on UB-04?
REFERRING PROVIDER: If referring provider is an individual, use last name, first name, and middle initial. Middle initial is optional. If referring provider is a facility, provide the facility's full name.
What is the difference between hospital billing and professional billing?
In professional billing, payment is generally received directly from the patient's insurance company or the patient if insurance does not cover the services. In hospital billing, payment may be received from the patient's insurance company, from the patient, or a third-party payer, such as Medicare or Medicaid.
What are the different types of claim forms?
- Claim form type: Institutional. Claim form: 837I. Claim form: UB04.
- Claim form type: Professional. Claim form: 837P. Claim form: CMS1500.
- Claim form type: Dental. Claim form: 837D. Claim form: J400.
What is a UB04?
The UB-04 claim form is used to submit claims for outpatient services by institutional facilities (for example, outpatient departments, Rural Health Clinics and chronic dialysis centers).
What is a UB-04 claim form often used in?
The UB-04 Form is used in more than 98% of Medicare claims and over 80% of all institutional claims. It serves as a comprehensive record of all reimbursable care received by patients, which are subsequently used by the payer to determine the reimbursement amount.
Where is the DRG on a UB04?
BILL DISCHARGE DATE – Enter the discharge date on the claim (the THROUGH date in FL 6 of the UB-04). BILL DRG – Enter the DRG for the claim. The DRG is determined by the Grouper software or may be on the UB-04 claim form in FL 71.
What is a 837 form in medical billing?
837 files play an important role in healthcare transactions. They enable providers to submit claims electronically while maintaining security and privacy standards. This means faster reimbursement, less administrative overhead, and fewer claims processing errors. In addition, staff can submit several claims at once.
What is the difference between 837I and 837P?
837P is the x12 EDI standard for the Clinic/Outpatient/Professional Claims, 837I is the x12 EDI standard for the Hospital/Inpatient/Institutional Claims) and 837D for the Dental Claims. Types of Claims: 837 P – Professional claims.
What are the five sections on a claim?
1) It is the claimant's responsibility to establish the five basic requirements of a claim, which is known as the "burden of proof." 2) There are 5 basic elements of a claim: Time, Civil Employee, Fact of Injury, Performance of Duty, and Causal Relationship. All 5 elements must be met before benefits can be awarded.
What is the primary purpose of the EDI 837?
The EDI 837 file format is designed for transmitting healthcare claim information from healthcare providers to insurance payers. It contains comprehensive details about the services rendered, including patient demographics, diagnosis codes, procedure codes, service dates, and billed amounts.
Is 837 inbound and outbound?
If the Transaction Insight host is a clearinghouse, 837 data that it receives from providers is inbound even though the receiver ID might be an insurance company. The clearinghouse then repackages the 837 and sends it on to an insurance company. This transmission of the 837 is now outbound.
What are the different types of 837 claims?
There are separate transactions for Health Care Claims: Institutional (837I), Professional (837P), and Dental (837D).