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Institutional Claims/Intermediate/32 minutes/Reviewed 2026-07-10

CMS-1450 (UB-04) and 837I Institutional Claims

Understand type of bill, revenue codes, occurrence and value data, diagnosis and procedure reporting, and institutional claim flow.

Quick answer

Institutional providers generally submit 837I transactions. CMS-1450, also called UB-04, is the paper counterpart used only when an applicable exception allows paper submission.

Rules to know

  • Type of bill identifies facility, care classification, and bill sequence.
  • Revenue codes organize charges but do not replace required HCPCS or procedure data.
  • Occurrence, condition, and value codes carry claim-level facts.
  • Discharge status and statement dates affect processing.

Operational workflow

  1. 01Determine bill type and covered statement period.
  2. 02Validate patient status, payer order, and provider identifiers.
  3. 03Map revenue, procedure, diagnosis, occurrence, condition, and value data.
  4. 04Reconcile charges, units, dates, and medical record support.
  5. 05Submit the 837I and resolve acknowledgments before adjudication follow-up.

Common failure modes

  • Incorrect frequency digit on type of bill.
  • Revenue line without required supporting procedure information.
  • Discharge status that conflicts with the actual disposition.

Knowledge check

Which data element identifies facility type, care classification, and bill sequence?

Official sources

Medicare Billing: CMS-1450 and 837IMedicare Learning NetworkReviewed 2026-07-10Electronic Health Care ClaimsCenters for Medicare & Medicaid ServicesReviewed 2026-07-10Medicare Claims Processing Manual (Publication 100-04)Centers for Medicare & Medicaid ServicesReviewed 2026-07-10

Education only. Verify the current code set, payer contract, coverage policy, implementation guide, and claim-specific facts. Do not enter protected health information into this site.