Skilled Nursing Facilities (SNFs) rely on accurate billing to ensure smooth operations and steady cash flow. A key part of this process is the use of standardized claim formats, which help maintain consistency across the healthcare industry.

Introduced in 2007 as a replacement for the UB-92 and standardized by the National Uniform Billing Committee (NUBC), the UB-04 form remains the core tool for institutional billing today. Though the UB-04 is a paper-based form that some payers still accept, most insurers now prefer the EDI 837I – the electronic version of the claim. The EDI 837I is faster, more accurate, and designed to minimize errors through built-in edits.

This blog explains the differences between UB-04 vs. EDI 837I and provides a step-by-step process for completing claims.

Difference between UB-04 vs. EDI 837I

Though both the UB-04 form and the EDI 837I serve the same purpose of submitting institutional claims in SNF billing, they differ in format and method. The UB-04, also known as CMS-1450, is a paper claim form that facilities can complete and submit by mail, fax, or scan. It is still accepted by many payers but is slower to process as it requires manual handling and corrections.

On the other hand, the EDI 837I is the electronic version of the claim. It is submitted digitally through a clearinghouse or directly to payers, which makes it faster, more accurate, and more efficient. Unlike paper forms, the electronic format has built-in edits that catch errors before submission and reduce payment delays.

Both formats are valid, but regulatory standards such as HIPAA encourage the use of EDI 837I, and most insurers now prefer or even require it.

Step-by-Step Process of Completing UB-04 and EDI 837I in SNF Billing

Submitting claims correctly is critical for SNFs to ensure timely reimbursement and compliance. Below is a clear step-by-step process to complete these claims with accuracy and confidence:

Step 1: Gather Patient Information

The first step is to collect all the patient’s personal details, such as their full name, date of birth, gender, and address. You also need to gather their insurance details including Medicare, Medicaid or private insurance ID numbers. This information must be correct as even small mistakes can cause delays or denials in payment.

Step 2: Enter Provider and Facility Details

In this step, you have to fill in the details about the facility and the healthcare provider. This includes the National Provider Identifier (NPI), the facility’s Tax ID and the complete address of the hospital or nursing home. You also need to add the attending doctor’s name and identification number so that the payer knows exactly who provided the care.

Step 3: Document Services with Codes

Next, you have to record all the services the patient received. This may include nursing care, therapy sessions, medication, or room and board for Skilled Nursing Facilities. Each service has to be linked to the correct revenue code, and in some cases, you also need to include HCPCS or CPT codes. These codes help insurance companies understand the type of care provided.

Step 4: Assign ICD-10 Diagnosis and Procedure Codes

Now you have to enter the medical diagnosis and procedures. The main diagnosis must be written first, followed by any other conditions that affect the patient’s care. If the patient had procedures, such as wound care or IV therapy, you must include the correct ICD-10 procedure codes. Accurate coding is critical as it explains why the services were necessary.

Step 5: Input Charges and Billing Units

After recording the services, you should enter the charges and billing units. This includes daily room charges, the number of therapy minutes, the cost of medications, and any medical supplies used. In fact, every service must also show the number of units and the total charge so that the insurance company knows how much to reimburse.

Step 6: Payer Information and Authorization Numbers

Now, you have to provide the details of the payer, which may be Medicare, Medicaid, or a private insurance company. If the care requires pre-approval, you also need to include the authorization or certification number. The addition of such information enables the claim to be processed quickly without unnecessary delays.

Step 7: Validate the Claim with Edits and Scrubbing

Before you send the claim, it is crucial to check it for errors. Billing software and clearinghouses have built-in tools that review the claim and highlight missing or incorrect information. This process is called claim scrubbing, which helps to reduce mistakes and increase the chances of the claim being accepted on the first submission.

Step 8: Submit the Claim

The last step is to send the claim to the insurance company. If you are using the paper UB-04 form, it can be mailed or scanned and sent to the payer. If you are using the electronic method, the claim is converted into the EDI 837I format and submitted through a clearinghouse. It is important to remember that submitting electronically is usually faster, more accurate, and more secure than using paper forms.

DOs (Best Practices Beyond the Basics)

• Do maintain an audit trail – Keep copies of submitted claims, acknowledgment reports, and remittance advice for compliance and audits.
• Do coordinate with interdisciplinary teams – Work closely with nursing, therapy, and pharmacy staff to ensure all services are coded and billed accurately.
• Do use data analytics – Monitor denial trends and reimbursement patterns to identify recurring issues and improve claim acceptance rates.
• Do customize claim workflows by payer – Each payer may have unique requirements (e.g., modifiers, occurrence codes), so customize the submissions accordingly.
• Do leverage automation tools – Automate recurring claim fields (like provider info) to save time and reduce clerical errors.
• Do perform pre-billing reconciliation – Compare charges in the billing system with clinical documentation to avoid underbilling or overbilling.

DON’Ts (Common but Less Obvious Mistakes) for UB-04 and EDI 837I

• Don’t ignore secondary payers – Always capture secondary/tertiary coverage to avoid revenue loss from uncollected balances.
• Don’t rely solely on clearinghouse edits – Manual reviews are still needed, as clearinghouses may miss payer-specific nuances.
• Don’t overlook discharge status codes – Incorrect codes can trigger denials, especially for SNFs transitioning patients to hospitals or home health.
• Don’t assume all payers accept electronic claims – Some niche or smaller insurers still require paper UB-04 submissions.
• Don’t skip timely filing monitoring – Track deadlines across payers; missing them results in non-payable claims.
• Don’t underestimate documentation alignment – If therapy minutes, wound care notes, or medication logs don’t align with billing codes, audits and clawbacks can follow.

Role of Outsourcing in UB-04 and EDI 837I

Outsourcing SNF billing and coding service providers in India plays an important role in managing UB-04 and EDI 837I billing. In fact, billing companies like InfoHub Consultancy Services help streamline the entire process by taking care of claim preparation, coding, and submission with accuracy. They use advanced software and experienced staff to reduce errors that often lead to claim denials. Furthermore, these companies make sure that facilities remain compliant and avoid penalties by keeping up with the latest compliance rules and payer requirements.

So what are you waiting for? Offshore SNF billing and coding services in India are the most optimal solution to handle large volumes of claims at lower costs.

FAQs

1. Can UB-04 claims be submitted online?

Some payers allow scanned UB-04 uploads, but most prefer electronic EDI 837I claims.

2. What happens if claim fields are left blank?

Missing fields may trigger rejections, requiring correction and resubmission.

3. What is the link between ICD-10 and UB-04 claims?

ICD-10 codes explain medical necessity and are required for reimbursement approval.

4. How does EDI 837I improve denial management?

It flags errors before submission, reducing rejections and speeding up payments.

Related Blogs

Understanding RUG Levels and Why They Matter in SNF Billing

Skilled Nursing Facilities (SNFs) have undergone significant changes in the way they receive payments over the years. In the past, Read more

Solve Your Staffing Crisis: Accessing a Ready-to-Go, Skilled Billing Team.

Businesses across the United States are grappling with persistent staffing shortages. Finding, training, and retaining qualified personnel has become a Read more

Complete Guide to J-Codes in Medical Billing for Injectable Drugs and Biologics

A patient receives a 10 mg injection of a specialty drug during an outpatient visit. Your team submits the claim Read more