What is a 837?

An 837 file is an electronic file that contains patient claim information. This file is submitted to an insurance company or to a clearinghouse instead of printing and mailing a paper claim.

What does EDI 837 stand for?

The EDI 837 Healthcare Claim concerns the submission of healthcare claim billing information, encounter information or both. This transaction is usually sent by a provider, such as a primary care physician's office, hospital, or other healthcare facility, to a healthcare insurer.

What is 837 format in medical billing?

The 837P (Professional) is the standard format used by health care professionals and suppliers to transmit health care claims electronically. The Form CMS-1500 is the standard paper claim form to bill Medicare Fee-For-Service (FFS) Contractors when a paper claim is allowed.

What is a HIPAA 837 transaction?

The 837 Header identifies the start of a transaction, the specific transaction set, and the transaction's business purpose. Also, when a transaction set uses a hierarchical data structure, a data element in the header, BHT01 (Hierarchical Structure Code) relates the type of business data expected within each level.

What is the difference between an 835 file and an 837 file?

In short, 837 data is how a claim is sent electronically. An 835 is also known as an Electronic Remittance Advice (ERA). It is the electronic claim payment information and documents the electronic funds transfer (EFT). The 835 data shows how the claim is paid or denied electronically.

EDI BASICS for how to read healthcare 837 claim and 835 remittance files

What is EDI vs 837?

The purpose of EDI is to transmit information to other companies electronically instead of using paper. EDI 837 is specifically used for filing claims and for sending medical and healthcare data records to brokerage houses.

What is 835 file used for?

ERA/835 Files

The Electronic Remittance Advice (ERA), or 835, is the electronic transaction that provides claim payment information. These files are used by practices, facilities, and billing companies to auto-post claim payments into their systems.

Who sends an 837?

The 837 files contain claim information and are sent by healthcare providers (doctors, hospitals, etc) to payors (health insurance companies).

How to create EDI 837 file?

How many diagnosis codes can be submitted on an 837?

Claims submitted for multiple lines of business within one ST-SE (Transaction Set) will cause the transaction to be rejected. You may send up to 12 diagnosis codes per claim as allowed by the implementation guide. If diagnosis codes are submitted, you must point to the primary diagnosis code for each service line.

How do I read an 837 file?

What is medical code X12 837?

The X12 Health Care Claim or Encounter transaction. This transaction can be used for institutional, professional, dental, or drug claims. Version 4010 of this transaction has been included in the HIPAA mandates.

What are 834 transactions?

The EDI 834 transaction set represents a Benefit Enrollment and Maintenance document. It is used by employers, as well as unions, government agencies or insurance agencies, to enroll members in a healthcare benefit plan.

What is HIPAA compliant EDI?

The EDI rule is a set of data transmission specifications that strictly govern the way data is electronically transferred from one computer to another. The rule specifically defines the different types of transactions that are covered under HIPAA and stipulates the exact format for each transaction record.

What is 837 institutional file?

The 837I (Institutional) is the standard format used by institutional providers to transmit health care claims electronically. The Form CMS-1450, also known as the UB-04, is the standard claim form to bill Medicare Administrative Contractors (MACs) when a paper claim is allowed.

Can Excel open EDI files?

Opening an EDI transaction file in Notepad

Notepad is not the ideal application to review EDI transaction files. We recommend using Microsoft Excel to view the transaction.

Can you convert EDI to Excel?

To translate inbound documents from EDI to Excel, you use the CData Arc Excel connector to visualize EDI documents in Excel spreadsheets. The Excel Connector comes pre-configured with a template Excel file that generates stylized and formatted Excel sheets out of EDI XML.

What is an example of an EDI transaction?

1000s of standard business transaction documents can be sent automatically using EDI. Some common examples include: purchase orders, invoices, shipping statuses, customs information, inventory documents and payment confirmations.

What is a 277 EDI file?

The EDI 277 Health Care Claim Status Response transaction set is used by healthcare payers (insurance companies, Medicare, etc.) to report on the status of claims (837 transactions) previously submitted by providers.

Is an 835 the same as an EOB?

The 835/Electronic Remittance Advice is an electronic version of the provider Explanation of Benefits (EOB).

What is the difference between EDI 820 and 835?

The 820 is specifically for plan sponsors – that is, companies providing healthcare benefits to their employees – to transmit information on premium payments to the health plans. The 835 is used by health plans for transmitting information on payments to healthcare providers.

What is 837 transaction submittal?

EDI 837-Q1 Specification

This transaction set can be used to submit health care claim billing information, encounter information, or both, from providers of health care services to payers, either directly or via intermediary billers and claims clearinghouses.

Is EDI same as XML?

EDI is an advanced technology that allows businesses to automate order processing and document exchange between computer applications. XML is emerging as a superior standard that seeks to simplify how businesses conduct internet-based e-commerce transactions between electronic devices.

Is EDI the same as X12?

X12 is the default U.S. EDI standard. Outside of the U.S., EDIFACT is the X12 equivalent. EDI transactions within the United States must conform to the X12 EDI standard and require compliant, quality software for translation.