What is the standard electronic claim submission format used to submit claims to third-party payers?

What is the standard electronic claim submission format used to submit claims to third-party payers?

• A. 837
• B. 270
• C. 835
• D. 277

Answer: (A)

Submitting health care claims electronically to third-party payers uses the 837 transaction set. This HIPAA-standard format covers both professional and institutional claims and standardizes the data needed for adjudication, such as patient details, provider information, service lines with CPT/HCPCS and ICD codes, dates of service, charges, and payer identifiers. The other numbers relate to different EDI processes: 270/271 is for eligibility verification, 835 carries the remittance advice (payment information), and 277 is used for claim status inquiries. So, the 837 is the format designated for electronic claim submission.

Submitting health care claims electronically to third-party payers uses the 837 transaction set. This HIPAA-standard format covers both professional and institutional claims and standardizes the data needed for adjudication, such as patient details, provider information, service lines with CPT/HCPCS and ICD codes, dates of service, charges, and payer identifiers. The other numbers relate to different EDI processes: 270/271 is for eligibility verification, 835 carries the remittance advice (payment information), and 277 is used for claim status inquiries. So, the 837 is the format designated for electronic claim submission.