The EDI 837 transaction set is an electronic version of a paper Healthcare Claim Payment and Remittance Advice that complies with the ANSI X12 EDI specification. The EDI Health Care Claim Transaction set (EDI 837) is used in HIPAA EDI transactions to submit health care claim billing information, encounter information, or both. This transaction set is sent by a health care provider to an insurance payer such as an insurance company, health care professional (HMO), preferred provider organization (PPO) or a government agency (Medicaid, Medicare etc.). Providers may send 837s either directly or via intermediary billers and claims clearing houses. Information on coordinated benefits and payments are sent back to providers using the EDI 835 transaction set by Health insurers and other payers. After March 31, 2012, the 5010 standards divided the 837 transaction sets into three groups as follows: 837I– for institutions, 837P for professionals and 837 D – for dental practices.
The claim information includes the following data for single care encounter between a provider and a patient:
Other EDI transaction sets related to EDI 837 are: