837 institutional claim

837 Institutional Claim scenario and mapping guidelines 837 Institutional Claim example presented in today’s post shows a standard 837 Institutional claim. As we spoke in our previous post, the 837 Healthcare Claim transaction has three different implementation guides specifically developed for Professional, Institutional and Dental claims. The specifications are geared to meet the individual requirements Read More →

837 professional claim

837 Professional Claim scenario and raw data 837 Professional Claim example mentioned in this post shows a standard 837 Professional claim file. It includes data from the provider of Service indicating the member’s demographic information, diagnosis, services rendered and charges. 837 Professional Claim data will be used by the Insurance Company to determine what benefits Read More →

837 EDI

Health Care Claim: general definition, purposes and benefits coordination Health Care Claim 837 transaction is the EDI function that submits health care claim form to the Insurance Company of the patient whom has received care from a Provider of Service. The Health Care Claim form contains specific data related to the Patient, Provider of Service, Insurance Read More →

HIPAA EDI Privacy

HIPAA EDI Privacy – part of the Anthem’s HIPAA regulations HIPAA EDI Privacy  addresses protecting the privacy of protected health information (PHI). As part of the HIPAA regulations, the government has established some controls. They will limit how, when and where protected health information is shared. Medical information, as well as emographic information, is “Protected Health Information” (PHI). Anthem Read More →

HIPAA EDI 837 Transaction

HIPAA EDI 837 Transaction Terminology HIPAA EDI 837 Transaction  is a key component in electronic health care documents transmission. This process improves efficiency in health care by establishing and constantly improving national standards for clearing houses, providers and health insurance plans. HIPAA EDI 837 Transaction  is one of the most used EDI transactions. If you somehow deal with EDI in health care Read More →

EDI 837

EDI 837 transaction structure – Transaction Set Header (ST) and Transaction Set Trailer (SE) EDI 837  Health Care Claim general envelope structure was described earlier in the blog. Below  find the description of two structural parts of an EDI 837 Health Care Claim element. Transaction Set Header (ST) This is the third segment of all EDI transactions including EDI 837. Read More →

837 health care claim

Envelope Structure of 837 Health Care Claim EDI Transaction 837 Health Care Claim transaction example below will be used to explain EDI enveloping. This particular EDI file contains two 837 claims transmitted on 01/01/2012. 837 Health Care Claim Envelope ISA*00* *00* *12*8586755250 *01*807685339 *120101*0742*^*00501*000001899*0*P*: GS*HC*8586755250*807685339*20120101*0742*685*X*005010X222A1 ST*837*3701*005010X222A1 BHT*0019*00*004545*20120101*135420*CH NM1*41*2*AGILE BILLING SOLUTIONS*****46*1981 PER*IC*ANN GILLIS*TE*8185601000 NM1*40*2*ANTHEM BLUE CROSS*****46*47198 HL*1**20*1 PRV*BI*PXC*207Q00000X Read More →