hipaa claims

HIPAA 837 Institutional Transaction Guides (OCHCA)

The ASC X12N 837 Institutional transaction is the electronic equivalent of the UB-92 paper claim form. All hospitals and institutional facilities must use the 837 Institutional transaction to bill electronically for services covered under the SoonerCare program.

  • The 837 Institutional transaction must be used for inpatient claims.
  • Providers must use their 10-digit NPI number as the billing/pay-to provider ID.
  • Limit each transaction set to 5,000 claims.
  • Limit each claim to a maximum of 50 service lines.
  • For attending, operating and other physicians, please use only the physician’s 10-digit NPI number as the primary identifier in the appropriate NM1 segment.
  • The physician’s taxonomy code is not used for operating physicians or physicians classified as “other.”
  • Do not use revenue code 001 as a total for all service lines included on the claim.
  • Unit rate is required if revenue code is 100-219 (SV02-06).

To learn more about HIPAA EDI and become a certified EDI Professional, please visit our course schedule page.

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