X12 HIPAA 837I Institutional Claim
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:
- 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.
X12 HIPAA 837I Specification
X12 HIPAA 837I specification is available at:
X12 HIPAA 837I Code Example
X12 HIPAA 837I code example is available at:
X12 HIPAA 837I Sample File
ISA*00* *00* *ZZ*1234567 *ZZ*11111 *170508*1141*^*00501*000000101*1*P*:~ GS*HC*XXXXXXX*XXXXX*20170617*1741*101*X*005010X223A2~ ST*837*987654*005010X223A2~ BHT*0019*00*0123*19960918*0932*CH~ NM1*41*2*JONES HOSPITAL*****46*12345~ PER*IC*JANE DOE*TE*9005555555~ NM1*40*2*MEDICARE*****46*00120~ HL*1**20*1~ PRV*BI*PXC*203BA0200N~ NM1*85*2*JONES HOSPITAL*****XX*9876540809~ N3*225 MAIN STREET BARKLEY BUILDING~ N4*CENTERVILLE*PA*17111~ REF*EI*567891234~ PER*IC*CONNIE*TE*3055551234~ HL*2*1*22*0~ SBR*P*18*******MB~ NM1*IL*1*DOE*JOHN*T***MI*030005074A~ N3*125 CITY AVENUE~ N4*CENTERVILLE*PA*17111~ DMG*D8*19261111*M~ NM1*PR*2*MEDICARE B*****PI*00435~ REF*G2*330127~ CLM*756048Q*89.93**14:A:1*A*Y*Y~ DTP*434*RD8*19960911~ CL1*3**01~ HI*BK:3669~ HI*BF:4019*BF:79431~ HI*BH:A1:D8:19261111*BH:A2:D8:19911101*BH:B1:D8:19261111*BH:B2:D8:19870101~ HI*BE:A2:::15.31~ HI*BG:09~ NM1*71*1*JONES*JOHN*J~ REF*1G*B99937~ SBR*S*01*351630*STATE TEACHERS*****CI~ OI***Y***Y~ NM1*IL*1*DOE*JANE*S***MI*222004433~ N3*125 CITY AVENUE~ N4*CENTERVILLE*PA*17111~ NM1*PR*2*STATE TEACHERS*****PI*1135~ LX*1~ SV2*0305*HC:85025*13.39*UN*1~ DTP*472*D8*19960911~ LX*2~ SV2*0730*HC:93005*76.54*UN*3~ DTP*472*D8*19960911~ SE*42*987654~ GE*1*101~ GS*HC*XXXXXXX*XXXXX*20170617*1741*101*X*005010X223A2~ ST*837*987654*005010X223A2~ BHT*0019*00*0123*19960918*0932*CH~ NM1*41*2*JONES HOSPITAL*****46*12345~ PER*IC*JANE DOE*TE*9005555555~ NM1*40*2*MEDICARE*****46*00120~ HL*1**20*1~ PRV*BI*PXC*203BA0200N~ NM1*85*2*JONES HOSPITAL*****XX*9876540809~ N3*225 MAIN STREET BARKLEY BUILDING~ N4*CENTERVILLE*PA*17111~ REF*EI*567891234~ PER*IC*CONNIE*TE*3055551234~ HL*2*1*22*0~ SBR*P*18*******MB~ NM1*IL*1*DOE*JOHN*T***MI*030005074A~ N3*125 CITY AVENUE~ N4*CENTERVILLE*PA*17111~ DMG*D8*19261111*M~ NM1*PR*2*MEDICARE B*****PI*00435~ REF*G2*330127~ CLM*756048Q*89.93**14:A:1*A*Y*Y~ DTP*434*RD8*19960911~ CL1*3**01~ HI*BK:3669~ HI*BF:4019*BF:79431~ HI*BH:A1:D8:19261111*BH:A2:D8:19911101*BH:B1:D8:19261111*BH:B2:D8:19870101~ HI*BE:A2:::15.31~ HI*BG:09~ NM1*71*1*JONES*JOHN*J~ REF*1G*B99937~ SBR*S*01*351630*STATE TEACHERS*****CI~ OI***Y***Y~ NM1*IL*1*DOE*JANE*S***MI*222004433~ N3*125 CITY AVENUE~ N4*CENTERVILLE*PA*17111~ NM1*PR*2*STATE TEACHERS*****PI*1135~ LX*1~ SV2*0305*HC:85025*13.39*UN*1~ DTP*472*D8*19960911~ LX*2~ SV2*0730*HC:93005*76.54*UN*3~ DTP*472*D8*19960911~ SE*42*987654~ GE*1*101~ IEA*1*000000101~
Comments
0 comments
Please sign in to leave a comment.