| Free EDI Training Guide |
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X12 Health Care Claim 837Data contents of the Health Care Claim Transaction Set (837) for use within the context of an Electronic Data Interchange (EDI) environment. This transaction set can be used to submit health care claim billing information, encounter information, or both, from providers of health care services to payers, either directly or via intermediary billers and claims clearinghouses. It can also be used to transmit health care claims and billing payment information between payers with different payment responsibilities where coordination of benefits is required or between payers and regulatory agencies to monitor the render-ing, billing, and/or payment of health care services within a specific health care/insurance industry segment. For purposes of this standard, providers of health care products or services may include entities such as physicians, hospitals and other medical facilities or suppliers, dentists, and pharmacies, and entities providing medical infor-mation to meet regulatory requirements. The payer refers to a third party entity that pays claims or administers the insurance product or benefit or both. For example, a payer may be an insurance company, health maintenance organization (HMO), preferred provider organization (PPO), government agency (Medicare, Medicaid, Civilian Health and Medical Program of the Uni-formed Services (CHAMPUS), etc.) or an entity such as a third party adminis-trator (TPA) or third party organization (TPO) that may be contracted by one of those groups. A regulatory agency is an entity responsible, by law or rule, for administering and monitoring a statutory benefits program or a specific health care/insurance industry segment. |
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From our NewsEDI Outsourcing: Outsource EDI Project There are many benefits of EDI, and one of the most conspicuous benefits of EDI is that it is the safest way of transferring data and information to the recipients. Now, the web based EDI service is used comprehensively by the business companies across the world. However, Read more... 11601 Wilshire Blvd. Suite 500 Los Angeles, CA 90025 Sales Inquiries: +1 800-761-4268
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