Name of Manual - Blue Cross and Blue Shield of Minnesota

Claims Filing
Institution (837I) /Facility Billing
Claim Format
Regulations
HIPAA Administrative Simplification code and transaction
regulations dictate the standard claim format and codes for
electronically submitted claims. Institutional claims are billed on
the 837I electronic format. The paper equivalent is the UB-04
claim form.
Blue Cross considers the following providers as institutional and
as such, should bill on the institutional claim format (837I).
Category Definition
Home health
agency
HHA is a public agency or private organization
that is primarily engaged in providing skilled
nursing services and other therapeutic services,
such as physical therapy, occupational therapy,
medical social services and home health aide
services. Home health agencies can be
freestanding or hospital attached. Care is rendered
in the home and is in lieu of hospital confinement.
Hospice Hospice programs provide health care for
terminally ill patients. Care may be done in the
patient’s home, at special hospice units, or a
separate hospice care facility.
Hospital An institution that provides medical, diagnostic
and surgical care. Services can be rendered on an
inpatient or outpatient basis.
Nonresidential
treatment
center
This type of institution is the same as a residential
primary treatment center with the exception that
services are rendered on an outpatient basis only.
Nursing home A Skilled Nursing Facility provides skilled
nursing care and related services for patients who
require medical or nursing care; or rehabilitation
services for injured, disabled or sick people.
8-18 Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (05/10/12)