EDI 837 Mapping Specifications for the Health Care Claim Format


AgencySet IDFGTransaction DescriptionSubcommitteeStandard
ANSI837HCHealth Care Claim InsuranceDownload


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Research and Development:
See the list of EDI 837 mapping specifications in the below data grid. The Jobisez.com site has an online translation tool that converts the EDI 837 (Health Care Claim) document into a CSV file. You can also gain knowledge by researching all EDI document types. Jobisez LLC can also provide assistance if you need additional help.

Solutions:
Are you looking to trade the EDI 837 transaction with one of your trading partners? Do you need an EDI VAN Savings solution to exchange the 837? Or perhaps you would like to use a Cloud-Based application, so you can plug your 837 transaction directly into your ERP and TMS systems. Even small companies have the ability to trade the EDI 837 by using the EDI Mobile Device solution.


All EDI 837 Mapping Specs and Guidelines


Official Definition:
Data 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 rendering, 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 information 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 Uniformed Services (CHAMPUS), etc.) or an entity such as a third party administrator (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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