Institutional Claims · CMS-1450
UB-04 ↔ 837I Crosswalk
A field-level map from the paper UB-04 (CMS-1450) institutional claim form to the ASC X12N 837I electronic claim (version 005010X223A2). Each form locator is matched to its EDI loop, segment/element, and qualifier, with plain-language descriptions on both sides.
Data statusReference Only
- Status
- Reference Only
- Data year / effective
- UB-04 / X12 (current)
- Last reviewed
- May 2026
- Last updated
- May 2026
- Known exclusions
- Curated post-acute subset of the full NUBC / X12 code sets
- Payer-specific edits vary
- Confirm exact wording in the official NUBC manual
Published reference for the stated period — confirm the current figure and any corrections at the source before billing.
Form Locator → EDI Map
837I v5010A2| FL | Paper Form Block | Paper Description | Loop | Segment / Element | Qualifier | EDI Description |
|---|
How to read this. Notation follows the ASC X12 implementation guide: a loop (e.g.
Scope & sources. Mapping reflects the ASC X12N 837I 005010X223A2 Technical Report and a Medicare MAC's published CMS-1450 crosswalk. UB-04 form locator names and code sets are maintained by the National Uniform Billing Committee (NUBC) and the American Hospital Association (AHA); descriptions here are simplified summaries for reference, not the official NUBC definitions. Some locators are payer-specific or not required by Medicare (e.g. FL38, FL43 description, FL66, FL81), and FL07, 30, 37, 49, 68, 73, and 75 are reserved for future use. Always confirm against your payer's companion guide and the official NUBC UB-04 manual before submitting claims.
2010AA) contains segments (e.g. NM1), each made of elements (e.g. NM103 = the 3rd element of NM1). Composite elements use a dash (e.g. HI01-2 = the 2nd sub-element of the first HI position). A qualifier is a code that tells the receiver what the data means — e.g. HI01-1=BG flags a Condition Code, and NM101=71 identifies the Attending Provider. Where the paper claim repeats a field (condition, occurrence, value, diagnosis, procedure lines) the EDI side repeats the composite positions (HI01, HI02, …).
Scope & sources. Mapping reflects the ASC X12N 837I 005010X223A2 Technical Report and a Medicare MAC's published CMS-1450 crosswalk. UB-04 form locator names and code sets are maintained by the National Uniform Billing Committee (NUBC) and the American Hospital Association (AHA); descriptions here are simplified summaries for reference, not the official NUBC definitions. Some locators are payer-specific or not required by Medicare (e.g. FL38, FL43 description, FL66, FL81), and FL07, 30, 37, 49, 68, 73, and 75 are reserved for future use. Always confirm against your payer's companion guide and the official NUBC UB-04 manual before submitting claims.
Professional Claims · 1500 (02/12)
CMS-1500 ↔ 837P Crosswalk
A field-level map from the paper CMS-1500 (02/12) professional claim form to the ASC X12N 837P electronic claim (version 005010X222A1). Each form item is matched to its EMC loop and segment/data element.
Form Item → EMC Loop & Segment
837P v5010A1| Item # | CMS-1500 Description | 837 Loop | 837 Segment / Element |
|---|
How to read this. Notation follows the ASC X12 implementation guide: a loop (e.g.
Scope & sources. Based on the National Uniform Claim Committee (NUCC) 1500 Claim Form Map to the X12N 837P (5010/5010A1) and the ASC X12 837P Technical Report Type 3 (005010X222A1). The CMS-1500 form and item definitions are maintained by the NUCC; the form's data set and codes are © American Medical Association. Descriptions here are simplified summaries for reference, not the official NUCC definitions. Items 8, 9b, 9c, and 30 are reserved for NUCC use (their former data elements were removed in the 837P). Always confirm against your payer's companion guide and the NUCC 1500 Reference Instruction Manual before submitting claims.
2010AA) holds segments (e.g. NM1), each made of elements (e.g. NM103 = 3rd element of NM1). Composite elements use a dash (e.g. HI01-2, SV101 (2-6)). Several items map to more than one loop depending on the claim — e.g. the patient appears in loop 2010CA only when the patient is not the subscriber, otherwise the subscriber loop 2010BA is used. The shaded portion of line 24 (24I/24J) carries the rendering provider's qualifier, taxonomy, and secondary ID; the unshaded 24J carries the NPI.
Scope & sources. Based on the National Uniform Claim Committee (NUCC) 1500 Claim Form Map to the X12N 837P (5010/5010A1) and the ASC X12 837P Technical Report Type 3 (005010X222A1). The CMS-1500 form and item definitions are maintained by the NUCC; the form's data set and codes are © American Medical Association. Descriptions here are simplified summaries for reference, not the official NUCC definitions. Items 8, 9b, 9c, and 30 are reserved for NUCC use (their former data elements were removed in the 837P). Always confirm against your payer's companion guide and the NUCC 1500 Reference Instruction Manual before submitting claims.