HIPAA EDI 835 And 837: The difference between two healthcare transactions
An 835 transaction, also known as Electronic Remittance Advice (ERA), is used by healthcare payers to provide detailed information about payments, adjustments, and denials to healthcare providers. An 837 transaction, also known as Healthcare Claim, is used by healthcare providers to submit claims for reimbursement to healthcare payers, detailing the services provided to patients. Let’s break down the differences between these two healthcare transactions.
835 Transaction
Purpose: The 835 transaction, also known as the Electronic Remittance Advice (ERA), is used for healthcare payment and remittance advice. It provides detailed information about claims payments, adjustments, and denials from healthcare insurers to healthcare providers.
Content: It typically includes information such as the amount paid, reason codes for adjustments or denials, patient information, provider information, and details about the services rendered.
Format: The 835 transaction is typically transmitted in an electronic format following HIPAA standards, such as the ANSI X12 format.
Direction: It flows from the payer (healthcare insurer) to the payee (healthcare provider).
837 Transaction
Purpose: The 837 transaction, also known as the Healthcare Claim, is used for submitting healthcare claims from healthcare providers to healthcare payers (insurers). It serves as the electronic equivalent of a paper claim form.
Content: It includes detailed information about the healthcare services provided, such as diagnoses, procedures, dates of service, patient demographics, and provider information.
Format: Like the 835, the 837 transaction is also typically transmitted in an electronic format following HIPAA standards, such as the ANSI X12 format.
Direction: It flows from the payee (healthcare provider) to the payer (healthcare insurer).
In summary, the 835 transaction deals with payment and remittance advice from payers to providers, while the 837 transaction deals with the submission of healthcare claims from providers to payers. They serve different purposes in the healthcare billing and reimbursement process.
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