EDI to CMS 1500 or UB 04 Form Tool

Wouldn’t it be great if you could read an 837P or 837I EDI file and overlay that data on top the standard CMS-1500 or UB-04 form?

Caliber Health’s X12 Studio Toolbox provides an easy to use application that provides an interface to upload claim EDI files and view them on a PDF version of the CMS 1500 or UB 04 forms!

What is the difference between the CMS-1500 and the UB 04 (or CMS-1450)?  The CMS-1500 is used by hospitals and other in-patient facilities.  The CMS-1500 aligns with the EDI 837P file.  On the other hand, the CMS-1450 (or UB 04) form is used by doctor offices, individual nurses, chiropractors, and other out-patient care facilities. The CMS-1500 form is based off the EDI 837I claim files.

Here are some benefits of viewing EDI 837 on top of the CMS-1500 / UB-04 forms:

  • Easy to read for non-EDI staff
  • Archive and store documents for search and recover features
  • Communicate EDI files and translate into easy-to-read PDF versions

Now, let’s try it with X12 Studio Toolbox to convert EDI 837I to UB 04 Form!

Step 1 – Download a free trial of the application here.  Install and run the application.

x12 studio free download toolbox

Step 2 – The second step in EDI to CMS-1500 form conversion is to open an 837P or 837I claim file.

edi validation tool open file

Step 3 – Click the ‘PDF Form Generator’ button at the top of X12 Studio Toolbox.

CMS 1500

Step 4 – Click on the file link address in the Output Window at the bottom of the tool.  This will open the form.

x12 studio claim ub04 output

Step 5 – View the PDF version of the CMS-1500 or UB-04 form in the tool.

837I as a ub 04 form

Thanks for checking out our EDI to CMS-1500 Claim form generator blog!  Form more information on this and other features, feel free to reach out to us today!

We are also launching a Form editor in this format.  Edit the EDI content within the form and save the results to EDI 837.  Or create a new EDI file from scratch by entering the data into the CMS-1500 or UB 04 form and save to the 837I or 837P.

Developers, ask about our API solution to automate this and other EDI utilities!

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