Data Collection Forms
Below is list of forms maintained by the USRDS Coordinating Center with direct links to the forms themselves. Note that some forms are now available solely in electronic format and so are not reproduced here. Copies of the legacy paper forms are maintained for historical purposes.
The United States Renal Data System (USRDS) Standard Analysis Files (SAFs) include Medicare Parts A and B final-action claims and Medicare Part D prescription drug events. These claims are curated and specially formatted for users of USRDS data. Thus, the Researcher’s Guide to the USRDS Database is the primary resource that users should consult.
Nevertheless, many details of the elements in claims data can be best understood from the perspective of claim forms, billing instructions, and Medicare data dictionaries. We offer the following resources for users who focus on claims data.
CMS-1450 (UB04)
This claim form is used by institutional health care providers, including acute care hospitals, skilled nursing facilities, and outpatient dialysis facilities. This form is used to submit claims to Medicare Parts A and B.
| Current |
CMS-1500 (UB92)
This claim form is used by physicians and suppliers, including durable medical equipment vendors. This form is used to submit claims to Medicare Part B.
Other helpful links:
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Centers for Medicare and Medicaid Services End-Stage Renal Disease (ESRD) Center |
USRDS Coordinating Center (CC)
Tel: 1.888.99USRDS
(1.888.998.7737)
Email: usrds@usrds.org