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X12 Studio – PDF Claim Form Generator Feature

Stan Kennedy

Exporting X12 837 claim files into standardized CMS1500 or UB-04 forms is simple with T-Connect X12 Studio Toolbox’s PDF Claim Form Generator. CMS1500 is the standardized form for X12 837P (Professional) EDI files.  The CMS1450, aka UB-04, provides the form for 837I (Institutional).  Both forms are provided by the Centers for Medicare & Medicaid Services (CMS). The PDF claim files can be used to view, archive, or manage EDI claims into a human-readable form.  Our Claim Form Generator feature is a very useful tool for EDI Analysts, overlaying 837 EDI data onto industry-standardized forms.

Steps to Generate the PDF 1500CMS or UB04 Forms

  1. To start, download X12 Studio and install the application:
PDF Claim Form Generator 1

T-Connect X12 Studio Toolbox Landing Page

  1. Launch the application and open an existing 837I or 837P X12 EDI format:
PDF Claim Form Generator 2

T-Connect X12 Toolbox Application

  1. Click on the Generate PDF icon in the top menu:
PDF Claim Form Generator 3

Generate PDF icon

  1. View the Output tab at the bottom of the application. This will show where the PDF CMS1500 / UB04 form is saved to. Simply click on the file location in the Output window and X12 Studio will open the PDF claim file.
PDF Claim Form Generator 4

Output Tab

It’s also worth noting, this Output file location can be configured within the ‘Configure’ menu:

PDF Claim Form Generator 5

‘Configure’ Menu

PDF Claim Form Generator 6

Output Directory

  1. Here is the output for the X12 837I (Institutional) EDI file, generated as a PDF CMS-1450, aka the UB-04:
PDF Claim Form Generator 7

X12 837I EDI Output File

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X12 Studio Toolbox

Tallan’s T-Connect X12 Studio Toolbox provides a set of features helpful for streamlining HIPAA processes, including PDF Claim Form Generator.  Tallan can also add any customized formats to fit your healthcare claim processing needs. Additionally, we can help automate mass generation of claim forms and provide integration solutions for your specific processing scenarios. Feel free to contact us directly via the Contact Us Form.

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