837P Claim

837P Claim Form CMS-1500: Implementation Guides

837P Claim (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 health care professionals and suppliers use to bill Medicare Administrative Contractors (MACs) when a paper claim is allowed. Centers for Medicare & Medicaid Services (CMS) designates the 1500 Health Insurance Claim Form as the CMS-1500 (02/12) and the form is referred to throughout this fact sheet as the CMS-1500. In addition to billing Medicare, the 837P and Form CMS-1500 may be suitable for billing various government and some private insurers. Data elements in the CMS uniform electronic billing specifications are consistent with the hard copy data set to the extent that one processing system can handle both.

The American National Standards Institute (ANSI) Accredited Standards Committee (ASC) X12N 837P (Professional) Version 5010A1 is the current electronic claim version.

  • ANSI = American National Standards Institute
  • ASC = Accredited Standards Committee
  • X12N = Insurance section of ASC X12 for the health insurance industry’s administrative transactions
  • 837 = Standard format for transmitting health care claims electronically
  • P = Professional version of the 837 electronic format
  • Version 5010A1 = Current version of the Health Insurance Portability and Accountability Act (HIPAA) electronic transaction standards for health care professionals and suppliers.

Health care professionals or suppliers billing electronic claims must comply with the ASC X12N implementation guide. The 837P Health Care Claim: Professional Implementation Guide is available for purchase and provides instructions on the content and format requirements for each of the standards’ requirements. ASC X12N implementation guides are the specific technical instructions for implementing each of the adopted HIPAA standards and provide instructions on the content and format requirements for each of the standards’ requirements. These documents are written for all health benefit payers, not specifically for Medicare. You can purchase Implementation Guides, including Version 5010 Consolidated Guides from the Washington Publishing Company.

To learn more about HIPAA implementation rules, please visit our course schedule.

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