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HIPAA SIMPLIFIED

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Claims / Encounters

The ASC X12N Health Care Claim: Professional (837P), Institutional (837I), and Dental (837D) transactions allow healthcare professional, institutional, and dental providers to submit healthcare claims for a service or encounter.  A healthcare claim includes:

  • Patient Information
  • Related diagnoses
  • Procedures performed or services provided
  • Related charges
  • Claims / Encounters

    • Standards

      Current Standard

      • The current mandated version of the ASC 12N Health Care Claim (837) transactions is 5010.

      The following Technical Report Type 3 can be purchased at the ASC X12 Store:

      • ASC X12N/005010X222A2 Health Care Claim: Professional (837P)
      • ASC X12N/005010X223A3 Health Care Claim: Institutional (837I)
      • ASC X12N/005010X224A3 Health Care Claim: Dental (837D)

      Anticipated Standard

      The next anticipated version of the ASC X12N Health Care Claim (837) transactions is 7030. These TR3s will be available for public review and comment from February 1, 2017 through May 2, 2017.

      Online ASC X12 Public Review Forum

    • Companion Guide

    • Operating Rules

      Regulation

      Although CAQH CORE® has developed operating rules pertaining to the ASC X12N Health Care Claim: Professional, Institutional, and Dental (837) transactions for their voluntary Phase IV certification program, the National Committee on Vital and Health Statistics (NCVHS), advisory body to the Department of Health and Human Services, recommended that the Phase IV Operating Rules not be adopted under regulatory mandate. No federal regulation is anticipated.

      Voluntary Certification

      CAQH CORE offers a voluntary certification program for their Phase IV Operating Rules, which cover the ASC X12N Health Care Claim: Professional, Institutional, and Dental transactions.

      Claims and Encounters / Benefit Enrollment / Premium Payment / Referral and Authorization Operating Rules