Ub 04 to 837i mapping 2025

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35-36. Occurrence Span Enter the span of occurrence dates as indicated in 31 - 35. 38. Responsible Party Name and Address Enter the responsible party name and address.
Enter insurance information, including the patients name exactly as it appears on the insurance card. Use correct diagnosis codes (​ICD-10 or ICD-11) and procedure codes (CPT/HCPCS) using modifiers when required. Use only the physical address for the service facility location field.
Rooms/Beds CodeDescription 37 Ward accommodation at patients request - Not used by PPS Hospitals. 38 Semi-private room is not available. Not used by PPS Hospitals. 39 Private room medically necessary. Not used by PPS Hospitals.1 more row Feb 7, 2025
Electronic Version (837I): The electronic equivalent of the UB-04 is the 837I (Institutional) file, which is used for electronic claims submission and must comply with HIPAA regulations.
The UB-04 form and the 837-I The UB-04 form, also called the CMS-1450 is the paper version of the form, which is used in manual claims submissions. The 837-I is the electronic version, used by medical billers in institutions that file claims electronically.

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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 needed in this context. Ensuring accuracy in these elements is vital for successful billing.
FL4: Type of bill - The first digit of the three-digit number identifies the type of facility, the second digit classifies the type of care being billed and the third digit indicates the sequence of the bill for a specific episode of care.

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