The EDI 837 transaction set is the format established to meet HIPAA requirements for the electronic submission of healthcare claim information. The claim information included amounts to the following, for a single care encounter between patient and provider:.

• Ansi 837 Format Electronic Claim

A description of the patient. The patient’s condition for which treatment was provided.

The services provided. The cost of the treatment As of March 31, 2012, healthcare providers must be compliant with version 5010 of the HIPAA EDI standards. The 5010 standards divide the 837 transaction set into three groups, as follows: 837P for professionals, 837I for institutions and 837D for dental practices. The 837 is no longer used by retail pharmacies.This transaction set is sent by the providers to payers, which include insurance companies, health maintenance organizations (HMOs), preferred provider organizations (PPOs), or government agencies such as Medicare, Medicaid, etc. These transactions may be sent either directly or indirectly via clearinghouses. Mechanical engineering reference manual for the pe exam 13th ed pdf.

Ansi 837 Format Electronic Claim

Health insurers and other payers send their payments and coordination of benefits information back to providers via the transaction set.Managing EDI transactions with full HIPAA 5010 compliance is a snap with. You get the extensive features of our advanced with additional support for healthcare-specific transactions. Ready to see for yourself?. This X12 Transaction Set contains the format and establishes the data contents of the Healthcare Claim Transaction Set (837) for use within the context of an Electronic Data Interchange (EDI) environment. This transaction set can be used to submit healthcare claim billing information, encounter information, or both, from providers of healthcare services to payers, either directly or via intermediary billers and claims clearinghouses.