Reporting Healthcare Claims Data to NHSN

About Claims Data

Healthcare claims data are records generated when a patient is admitted to a hospital or receives care or services within a hospital. To obtain reimbursement, insurance providers (Medicare, Medicaid, and other insurance companies) require hospitals to submit bills for the hospitalization, care, and services provided using either the Uniform Billing (UB)-04 claims paper form or the 837I (institutional) electronic form. The UB-04/837I uses standardized codes that are copyright protected and maintained by the National Uniform Billing Committee (NUBC).

THE UB‑04 DATA FILE is copyrighted by American Hospital Association (“AHA”), Chicago, Illinois. The UB‑04 Codes in this report developed by the CDC are included with the permission of the AHA. No portion of OFFICIAL UB‑04 DATA FILE may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without prior express, written consent of AHA.

Why Report Claims Data?

Claims data are widely used for inpatient and outpatient billing and are standardized across the healthcare continuum. When these data are combined with clinical information, they serve as powerful tools that can inform patient safety and care quality strategies. CDC has developed a secure process that enables hospitals to report claims data directly to NHSN. 

Claims data will have a crucial role in calculating NHSN’s FHIR-based digital quality measures (dQMs) by providing data elements necessary to support event determination, event exclusion, and patient‑level risk adjustment. Using claims data with dQMs offers several significant advantages: 

• Provides additional data elements not typically available in EHRs to refine event identification 

• Improves accuracy of patient safety event exclusions by incorporating claims-based details 

• Strengthens patient-level risk adjustment through richer information on comorbidities and care utilization 

• Increases confidence in measurement results by ensuring that data analysis is informed by both clinical and administrative data 

Preparing to Report Claims Data to NHSN

Before submitting claims data to NHSN, facilities should understand reporting requirements, identify key personnel, and complete the necessary preparation activities.  

Facilities gain access to the Claims Data import function after submitting a Claims Data Reporting Plan. To submit claims data to NHSN, facilities must ensure their data comply with NHSN’s requirements outlined in the CDC NHSN Claims Data Reporting Protocol. Facilities should identify personnel who will serve as the champions or liaisons throughout preparation and implementation. These individuals ensure the facility completes the necessary tasks before submitting the CSV.  

Claims data reporting is currently available to hospitals participating in the NHSNCoLab, which is CDC’s collaborative initiative focused on advancing digital quality measures (dQMs) and interoperability. It will soon be available to all healthcare facilities enrolled in the NHSN Patient Safety Component. 

About National Hospital Care Survey (NHCS)

Facilities also have the opportunity to contribute to broader national healthcare data collection efforts through participation in the National Hospital Care Survey (NHCS). 

As part of the Claims Data Reporting Plan, facilities may authorize NHSN to share their claims data with the NHCS.  The NHCS collects high-quality, nationally representative data about hospital use. Leadership at your hospital should review the consent to participate [PDF – 156 KB] in the survey before agreeing to share these data in the NHSN application. 

Hospitals participating in NHCS will receive an easy-to-read summary report with data figures and tables, access to an online Annual Hospital Report, and may be eligible for monetary benefits as well. Hospitals that are current participants in the NHCS will no longer have to submit their data directly to NHCS. To learn more about the survey, visit the NHCS website.   

Key Personnel for Reporting Claims Data to NHSN