837P and 837I Health Care Claims

837P and 837I Health Care Claims Notes For Beacon Health Options Partnering Parties

837P and 837I Health Care Claims are accepted by Beacon Health Options (Beacon) as mandated by the administrative simplification provisions of HIPAA. 837P and 837I Health Care Claims guidelines provided below areused in conjunction with the X12 implementation guide. The implementation guides for all HIPAA transactions are available from Washington Publishing Company and are available electronically.

837P and 837I Health Care Claims Setup/Certification Process

  1. Providers/trading partners interested in submitting electronic claim transactions must complete one of the following forms supplied by Beacon:
    a) EDI Clearinghouse Setup Form
    b) EDI Direct Submitter Setup Form
  2. These forms can be downloaded from Beacon’s website at www.beaconhealthoptions.com or can be requested by contacting EDI Operations.
  3. The EDI Clearinghouse Setup Form has to be completed by every provider who will be submitting via a clearinghouse.
  4. The EDI Direct Submitter Form has to be completed by the technical resource for the health care provider.
  5. Complete the applicable form and return by fax to 617.747.1200 or email edi.operations@beaconhealthoptions.com.
  6. When Beacon EDI receives the form, it will send you an email acknowledgement letter that indicates your setup has been completed with Beacon EDI Operations.
  7. A submitter ID is assigned to each trading partner. You will utilize the submitter ID to create a login ID and password on the EDI Gateway for file transmission.

837P and 837I Health Care Claims Testing

Beacon requires testing for all direct submitters submitting 837P and 837I transactions. Please follow the appropriate format specifications listed in the specific data requirements and submission directions. Test files must be submitted using the secure protocols and submission methodology selected.

Once a test Submitter ID is set up for a trading partner, the submitter can begin to send claims transactions for testing. In order to test, it is imperative that a technical contact at the provider/submitter organization be established. This contact must be able to monitor, change and submit the 837P and 837I transaction files to Beacon. This contact should be familiar with 837P, 837I, and 997 files. During the testing process, Beacon will examine submitted transactions for required formats and elements and will get responses during the testing process.

This testing stage will continue until testing satisfaction is achieved in both sides. Beacon’s testing procedures will validate the test file in its entirety. The entire file will either pass or fail validation. Beacon does not allow partial file submissions. If the file fails validation, a failure report will be provided explaining the failure messages. Upon the completion of successful testing, you will be notified and assigned a new submitter ID for the production system. The ID number must be used in all files submitted for production claims processing, and must be communicated and coordinated with the provider’s billing office in order to ensure the required billing information is provided to their billing agent/submitter.

During testing of the 837P and 837I transactions, Beacon recommends that test claim files contain a minimum of 25 claims and not exceed 100 claims in any one batch. File contents must simulate claims from normal business. Creating small files for testing provides for easier trouble-shooting and re-creation of the test file. Once your files have passed testing, you may send larger files.

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