HIPAA 837 Transaction related documents and indutry guides
HIPAA 837 Transaction has some more directly and indirectly related transactions like the Healthcare Claim Status Request (276) and Response (277) & the Healthcare Claim Remittance Advice (835). The 837 transaction is the submission of the claim. The 276 Claim Status transaction allows the Provider of Service to check status of the submitted claims and the 277 Status Response transaction allows the Insurance Company to provider thus claim status back to the Provider of Service. Lastly, the 835 Remittance Advice transaction provides detail information of how the claim is processed by the Insurance Company and how the payment is reconciled back to the HIPAA 837 Transaction transaction.
HIPAA 837 Transaction transaction has three different implementation guides specifically developed for Professional, Institutional and Dental claims. The specifications are geared to meet the individual requirements of the three different types of claim forms. For instance, the HIPAA 837 Transaction Institutional manual allows for Value Codes, Occurrence Codes and Occurrence Spans. These fields are specific to the UB04 claim form only. The 837 Healthcare Claim Dental manual allows for Dental Coding and Tooth Designations. These are only used on dental claim forms. The SV segment occurs on each of the three 837 transactions but there is a slight variation for each claim. Professional uses an SV1 segment, Institutional uses an SV2 segment and Dental uses an SV3segment. This is a quick way to determine what type of 837 file is being encountered.
Structurally, all three sets of 837 specifications are same. The only differences would be claim specific data that pertains to a single transaction. All three transactions contain ISA, GS and ST segments but some data and qualifying codes are specific to the type of 837. Another way to quickly identify which type of 837 is being encountered is by the codes sent in the GS-08 or in the ST-03. Professionals use a 005010X222, Institutional uses a 005010X223 and Dental uses a 005010X224.