HIPAA 5010 837P Professional Claim

For the electronic submission of healthcare claim information, the EDI 837 transaction set format was developed to comply with HIPAA regulations. For a single patient and provider care interaction, the claim information amounts to the following:

• Details about the patient
• condition of the patient that required therapy
• The solutions delivered
• the price of therapy

Healthcare providers must adhere to HIPAA EDI requirements version 5010 as of March 31, 2012. The 837 transaction set is divided into three sections according to the 5010 standards as follows: For professionals, use 837P; for institutions, use 837I; and for dentistry offices, use 837D. Retail pharmacies no longer utilise the 837. The payers, which might be insurance companies, health maintenance organisations (HMOs), preferred provider organisations (PPOs), or governmental organisations like Medicare, Medicaid, etc., get this transaction set from the providers. These transactions may go via clearinghouses directly or indirectly.

ISA*00* *00* *ZZ*1234567 *ZZ*11111 *170508*1141*^*00501*000000101*1*P*:~

GS*HC*XXXXXXX*XXXXX*20170617*1741*101*X*005010X222A1~

ST*837*1239*005010X222A1~

BHT*0019*00*010*20170617*1741*CH~

NM1*41*2*SUBMITTER*****46*ABC123~

PER*IC*BOB SMITH*TE*4805551212~

NM1*40*2*RECEIVER*****46*44556~

HL*1**20*1~

NM1*85*2*BILLING PROVIDER*****XX*1122334455~

N3*1234 SOME ROAD~

N4*CHICAGO*IL*606739999~

REF*EI*999999999~

HL*2*1*22*0~

SBR*P*18*******12~

NM1*IL*1*BLOGGS*JOE****MI*1234567890~

N3*1 SOME BLVD~

N4*CHICAGO*IL*606129998~

DMG*D8*19570111*M~

NM1*PR*2*PAYER*****PI*12345~

N3*1 PAYER WAY~

N4*ST LOUIS*MO*212441850~

REF*2U*W1014~

CLM*1000A*140***19:B:1*Y*A*Y*Y~

HI*ABK:I10~

LX*1~

SV1*HC:99213*140*UN*1***1~

DTP*472*D8*20151124~

HL*3*1*22*0~

SBR*P*18*******12~

NM1*IL*1*BLOGGS*FRED****MI*9876543201~

N3*1 ANOTHER STR~

N4*CHICAGO*IL*606129998~

DMG*D8*19700601*M~

NM1*PR*2*PAYER*****PI*12345~

N3*1 PAYER WAY~

N4*ST LOUIS*MO*212441850~

REF*2U*W1014~

CLM*1001A*140***19:B:1*Y*A*Y*Y~

HI*ABK:I10~

LX*1~

SV1*HC:99213*140*UN*1***1~

DTP*472*D8*20151124~

SE*41*1239~

GE*1*101~

IEA*1*000000101~