837 Health Care Claim

837 Health Care Claim: Professional Transaction based on ASC X12 Technical Report Type 3 (TR3)

837 Health Care Claim: Professional Transaction may be transmitted any day of the week to IEHP from a customer’s business partner. The transaction provides data on Medicare Advantage / Part D data.

Technical Infrastructure and Procedures

Business partners transmitting 837 Health Care Claim: Professional Transaction to IEHP by connecting to the IEHP Network. They go from the Internet through a Virtual Private Network (VPN) tunnel to the IEHP File Transfer Protocol (SFTP) Server. In standard software-to-hardware VPN connections, VPN client software is installed and configured on each machine at the client site that requires SFTP access. Business partners can contact IEHP for more information on establishing connections through the SFTP Server.

Transaction Standards

An overview of requirements specific to each transaction can be found in the ASC X12 837 Health Care Claim: Institutional Transaction Implementation Guide. Each Guide contains information related to ASC X12 Implementation.
1. Format and content of interchanges and functional groups;
2. Format and content of the header, detailer and trailer segments specific to the transaction;
3. Code sets and values authorized for use in the transaction;
4. Allowed exceptions to specific transaction requirements;
5. Transmission sizes are limited based on two factors; and
6. Number of Segments/Records allowed by HIPAA and ASC X12 standards.vantage / Part D data.

Standards for the maximum file size of each transaction set are specified in the appropriate Implementation Guide or its authorized Addenda. 837 Transactions follow HIPAA updated ASC X12 standards. These standards involve Interchange (ISA/IEA) and Functional Group (GS/GE) Segments or “outer envelopes.” All Transactions are enclosed in transmission level ISA/IEA envelopes. Within the ISA/IEA envelope are at least one functional group level GS/GE envelope(s). Within the GS/GE groups are at least one transaction set ST/SE. ST/SEs contain the detail segments and data.

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